Dr. Sakai’s thoughts:

This study examined a very specific patient population of young and healthy football players, but it certainly lends support to the use of epidural steroid injections for the treatment of pain due to herniated discs.  The ultimate goal of the injections, beyond relief of pain, is improved quality of life and function, whether it is returning to playing football or being able to do self-care and household activities.  While physical therapy is generally recommended to work on core stabilization and strengthening, it may be difficult to tolerate when the pain is severe.  In these cases, epidural steroid injections may help to decrease pain before initiating physical therapy.  While complications may occur with any injection procedure, they are very rare.  Epidural steroid injections may help to prevent the need for surgery which is associated with greater risks. They are generally considered to be very safe and are used routinely as a first-line treatment for pain from herniated discs.

Dr. Sakai’s thoughts:

“If you have significant spine pain that requires treatment, it is important to know what the options are to be able to make the best informed decision. There are certainly cases when surgery is necessary, such as in cancer, trauma, or infection. Otherwise, back pain can be managed without surgery 85% of the time. While surgical techniques have improved greatly, it is costly and involves great risk. There is the potential for complications and permanent damage that can result in more pain. Even most surgeons generally recommend that you maximize non-surgical treatment options before you decide to proceed with surgery. By doing so, if the decision is made to ultimately proceed with surgery, you can have greater peace of mind in knowing that surgery may be the best option for you at that point. Until then, non-surgical options to consider include, but are not limited to, massage, acupuncture, physical therapy, chiropractic, medications, and injection therapy.”

“” 70% of Americans suffer from low back pain at some point in their lives. However, most people would think that when back pain occurs it is best to rest or lay down. This article supports what has been well documented in scientific literature that activity can actually help the pain go away. This includes both aerobic exercise and certain “back specific” exercises. In addition to exercise programs, reducing extra weight can help too!  Before starting exercises for back pain it is important to consult with your physician first.”

“There’s a huge amount of abuse of these medications, all over the country, and it starts with someone, somewhere writing a prescription,” he said. “Our kids are growing up and are at risk, so we just want to make sure all doctors are trained in prescribing them. It’s not too much to ask.”

Stojanovic will address Congress as a member of the American Society of Interventional Pain Physicians.

Dr. Stojanovic’s Thoughts

At a first glimpse, it seems that there is no known cause for fibromyalgia. That does not mean that the disease is caused by psychological factors, although due to the debilitating disease, people suffering from fibromyalgia tend to become depressed.  Indeed, recent discoveries point that patients with fibromyalgia may process pain differently. Recent study suggests that there is elevated cerebrospinal fluid levels of substance p, a pain transmiter, in patients with the fibromyalgia syndrome. Fibromyalgia is considered a neurosensory disorder characterized in part by abnormalities in central nervous system (CNS) pain processing and can be classified as a central sensitivity syndrome (CSS). This is further supported by brain imaging study utilizing functional magnetic resonance imaging (fMRI) showing that brains in patients with fibromyalgia process pain differently than control subjects. Hopefully these findings will lead to discovery of new treatments that can alleviate the pain in those who suffer from fibromyalgia.

This seems to be only a beginning of our understanding of this complex and difficult to treat disease.

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Dr. Stojanovic’s thoughts:

“The White House drug czar wants doctors, states and law enforcement working harder to stop America’s deadliest drug-abuse problem: highly addictive prescription painkillers. They are killing more people than heroin and cocaine combined as they foster a slew of illegal “pill mill” clinics centered in Florida.”

In truth, there are many other, very successful ways to treat chronic pain than narcotic medications. This applies in particular to spine related problems such as low back pain and “sciatica”. In addition to addiction, narcotics can many times make the pain worse, recently discovered state called “hyperalgesia” or hypersensitivity to pain.