Chiropractic + Wellness

Analgesics are pain-relieving medications, also known as painkillers. These can be over-the-counter and prescription medications. Either could be part of a treatment plan for spine-related pain. Individuals dealing with back or neck conditions, typically take analgesics to reduce symptoms.

• Analgesics are available over-the-counter/OTC and with a prescription
• Prescription analgesics usually include the more powerful form of over-the-counter medications
• Various analgesics are available in topical form
• Analgesics can be specialized with some to relieve pain, with others reducing inflammation/pain

Over-the-counter

Acetaminophen, Non-steroidal anti-inflammatory drugs, and topical analgesics are the most commonly used medications for various pain symptoms. Over-the-counter analgesics are most effective when taken at the first sign/presentation of acute pain. Whiplash, along with muscle sprains and strains are common injuries known to cause short term pain that can be mild to severe. Follow the medication's instructions on dosage recommendations and precautions.

If the medication does not work or helps manage the pain, and/or pain symptoms worsen, contact your healthcare provider. This could be an indicator that a more powerful prescription analgesic is needed to help manage the pain, along with added therapy like physical therapy, and chiropractic to help avoid dependence on the prescription meds.

Acetaminophen

Tylenol is one form of medication taken for different types of pain and is one of the most popular over-the-counter analgesics. Acetaminophen's purpose is exclusively to relieve pain. It does not reduce inflammation.

Non-steroidal anti-inflammatory drugs - NSAIDs

Non-steroidal anti-inflammatory drugs work to reduce inflammation and pain. Types of over-the-counter These include:

• Aspirin
• Ibuprofen
• Naproxen

Topical analgesics

Topical analgesics like capsaicin cream and salicylates are an alternative to analgesics taken by mouth. These creams, balms, gels, and sprays are applied to the painful area. It is a very common application and is widely used for joint, muscle, and back pain. Salicylates are plant-based chemicals that operate to decrease the body's production of prostaglandins. These are lipids that let the body know that there is a problem causing inflammation and pain.

Prescription

A doctor could prescribe an analgesic as part of a treatment plan to help manage short-term and chronic pain. It is extremely important to precisely follow the doctor's instructions on how much and when to take the medication. Remember that any of these medications have the potential for side effects, which includes the risk of negative interactions when taken with other meds. Be sure to talk with a doctor about potential risks, and keep them informed about all medications like blood pressure and diabetes meds and natural herbs/vitamins/supplements taken for other medical conditions.

COX-2 Inhibitors

Cyclo-oxygenase-2 or COX-2 inhibitors are a prescription NSAID medication type that is formulated to target specific enzymes that trigger inflammation. Inflammation is not just a symptom but can also be a cause of pain related to many different spinal disorders. COX-2 inhibitors have a lower risk of causing/contributing to gastrointestinal problems.

There are other potential side effects and risks associated with COX-2 inhibitors. Potential side effects include an increased risk of cardiovascular problems, like a heart attack or blood clots. COX-2 inhibitors reduce the risk of stomach problems than classic NSAIDs but if gastrointestinal conditions exist to talk with a doctor before taking these medications.

Opioids

These are highly potent analgesics and are no longer the first type of pain-relieving medication that a doctor prescribes. They are now to be the last resort for reducing moderate to severe pain symptoms. These medications work by decreasing the perception and reaction to the pain. Opioids are prescribed for short-term use following surgical procedures and trauma. However, there are different situations where use is appropriate. When opioids are recommended, the doctor will begin with the lowest strength/dosage to manage the pain. Types of opioids include:

• Codeine
• Hydrocodone
• Hydromorphone
• Oxycodone
• Meperidine
• Tramadol

Opioids have an increased risk for addiction and abuse. If an opioid-based medication is prescribed the medication is safe and effective as long as it is used exactly as the doctor instructs. Side effects can include:

• Drowsiness
• Constipation
• Nausea
• Euphoria
• Slowed breathing

A Pain Helper

Analgesic medications are commonly used for various types of pain-causing conditions. When they are used properly with a doctor’s supervision they are safe and effective at managing pain and discomfort. If new symptoms present and/or the pain worsens or becomes different contact your doctor on appropriate instructions.

Low Back and Neck Pain Treatment

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

The IHS defines migraines as having at least two of the following: unilateral location, pulsating quality, moderate or severe intensity, aggravated by routine physical activity. During the headache the person must also experience either nausea &/or vomiting, and photophobia &/or phonophobia (24). In addition, there is no suggestion either by history, physical or neurological examination that the person has a headache listed in groups 5-11 of their classification system (23-25).

A previous study by the author has detailed features of the different classifications of migraine (8). The aura is the distinguishing feature between the old classifications of common (MW) and classic migraine (MA) (24). It has been described by migraine sufferers as an opaque object, or a zigzag line around a cloud, even cases of tactile hallucinations have been recorded (6,7). The most common auras consist of homonymous visual disturbances, unilateral parathesias &/or numbness, unilateral weakness, aphasia or unclassifiable speech difficulty.

The potential mechanisms for the different migraine types are poorly understood. There have been a number of aetiologies proposed in the literature, but none seem to be able to explain all the potential symptoms experienced by migraine sufferers (26). The IHS describe changes in blood composition and platelet function as a triggering role. Processes which occur in the brain act via the trigemino-vascular system and the intra and extracranial vasculature and perivascular spaces (24).

Fibromyalgia symptoms are presumed to occur subsequently from physical or emotional trauma where there’s been considerable psychological stress, after surgery, or as a result of an infection. In several cases, the symptoms can also progressively accumulate over time without a single event to trigger them. The widespread pain that most frequently accompanies fibromyalgia sufferers can be described as a continuous, dull ache which has lasted for a minimum of three months.

Other symptoms for fibromyalgia include fatigue, where the individual awakes feeling tired despite sleeping for long periods of time, restless leg syndrome or sleep apnea as a result of an interrupted sleep, cognitive difficulties, and other complications, such as depression, headaches and pain or cramping in the lower abdomen.

For years, traditional pain relievers such as non-steroidal anti-inflammatory drugs and the opioids like Morphine, have been used as a form of treatment for fibromyalgia but due to the drug’s high probability of dependency as a source for pain and symptom relief, especially over long term use, opioids are not recommended by any current guidelines for the treatment of fibromyalgia symptoms. Fibromyalgia is not a fatal or terminal disease but its symptoms of chronic pain where the pain can recur throughout an individual’s lifetime can often be a common reason for drug abuse and addiction. Despite the absence of recommendations and studies that prove the benefit of opioids in fibromyalgia, currently about 30% of Canadian and American patients with fibromyalgia report to using opioids for pain relief. 

Studies have shown that individuals who use and abuse opioids tend to have more severe pain, a more severe impairment in daily functioning as well as the presence of mood disorders compared to those who did not use opioids. Several alternatives for treating the symptoms of fibromyalgia include physical therapy and chiropractic care to relieve chronic pain naturally. 

Acetaminophen, best known as Tylenol, is one of the most common medications for headaches and general pain. More than likely the most common back, neck, and overall pain medication around. However, it is only a pain reducer, and will not reduce inflammation.

Doctors often recommend this medicine before moving on to prescription medication. A member of the analgesic pain reliever class of medications. These can vary in strength along with side effects, but their purpose is to reduce pain. Acetaminophen can be found in over 600 prescriptions and over-the-counter medicines, including certain opioids. Other acetaminophen brand names include:

• Tylophen
• Tempra
• FeverAll
• Mapap
• Pharbetol
• Panadol

Strength and Weakness

When neck or back pain presents, over-the-counter medicines fall into two categories. These are acetaminophen or non-steroid anti-inflammatory drugs also known as NSAIDs. Acetaminophen and NSAIDs like Advil, aspirin both relieve pain. However, non-steroid anti-inflammatories also help in reducing inflammation. Although non-steroid anti-inflammatories have this added benefit, they can also present potential side effects like stomach and gastrointestinal problems.

A spinal sprain or strain can cause acute back pain. Acetaminophen is typically recommended for acute back or neck pain and for pain that comes and goes quickly. Individuals that experience periodic pain usually take acetaminophen when the pain flares up. Individuals with chronic spinal pain report acetaminophen help to alleviate/reduce the pain. Many with chronic pain use acetaminophen regularly and not only when the pain presents. This helps manage before pain strikes.

Safety

Acetaminophen is gentle on the stomach, making some individuals preferring it over the non-steroid anti-inflammatories. But just like any other medication acetaminophen has its risks and can cause severe damage if used improperly.

Taking acetaminophen in large doses can cause severe liver damage. The Food and Drug Administration reports that acetaminophen overdoses send over fifty-thousand individuals to the emergency room every year. And over one-hundred Americans die yearly from accidental overdoses.

Using acetaminophen safely means taking no more than 3,000 milligrams a day and no more than 1,000 milligrams at a time. Take extra precautions when taking extra-strength. These can include as much as 650 mg per pill/capsule.

Before taking acetaminophen for back and neck pain, talk to a doctor or pharmacist about the proper dosage. And tell the doctor about all the medications being taken including natural herbs and holistic. Another reason for telling the doctor is that many other medications have acetaminophen included without you knowing it. Part of the discussion should include alcohol consumption. This can elevate the risk of negative reactions.

Resources

If non-pharmacological treatments/therapies done for at least 4 months prove ineffective then an acetaminophen regimen could be a safe and effective part of a back and neck pain treatment plan. While this medicine is one of the most common treatments, it is not without risks and side effects. Talk to a doctor or pharmacist about all the medications and supplements to ensure the regimen supports health for the long-term. To learn more along with safety information go to Acetaminophen Patient Guide.

Reduce Low Back Pain Custom Foot Orthotics

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Chiropractic Alternative to NSAIDs for Back Pain

Arlington, Va.--People suffering from back pain should consider first trying chiropractic services and other non-drug therapies in light of a new research review that found common over-the-counter and prescription pain medications have limited effectiveness for back pain and raise the risk of side-effects, according to the American Chiropractic Association (ACA).

The review, published this month in Annals of the Rheumatic Diseases, examined 35 randomized, placebo-controlled trials, encompassing 6,000 patients, to determine the effectiveness and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for spinal pain. The authors of the report found that NSAIDs provided “clinically unimportant effects” when compared with patients who received only a placebo. Meanwhile, those who used NSAIDs had a 2.5 times greater risk of experiencing gastrointestinal disorders.
“At present, there are no simple analgesics that provide clinically important effects for spinal pain over placebo,” the authors noted.


The news about NSAIDs follows reports last year that prescription opioids also have limited effectiveness for back pain—one of the most common causes of disability worldwide.


“The American Chiropractic Association urges people to try non-drug approaches to back pain relief first, before resorting to over the counter or prescription medications,” said ACA President David Herd, DC. “In addition to spinal manipulation, chiropractors can offer a range of non-drug therapies for back pain and recommend exercises and important lifestyle changes to help prevent future back pain and injury.”

According to a 2016 Gallup survey, more than 35 million people visit a chiropractor annually.

About the American Chiropractic Association
The American Chiropractic Association (ACA) is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients. Visit us at www.acatoday.org to find an ACA chiropractor near you.

NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

Every day, an estimated 30 million people worldwide take a non-steroidal anti-inflammatory medication, or NSAID.

These versatile medications, available in over-the-counter and prescription strength, treat both pain and inflammation. Inflammation is a contributing factor in most back pain conditions, so reducing inflammation is important to alleviate the pain.

See Lower Back Pain Symptoms and Causes and Causes of Upper Back Pain

NSAIDs are used to address acute (short term) as well as chronic back, neck, and muscle pain.

See Pain Management for Chronic Back Pain

Painkillers for Back Pain and More:

Common uses for NSAIDs include treatment for:

• Mild or moderate back pain, tenderness, inflammation, and stiffness
• Activity-related pain or discomfort (e.g. pain that follows sports or activities such as housework, shoveling snow, or other exertion)
• Pain related to muscle strain in the low back and elsewhere
• Neck stiffness related to muscle, ligament, or tendon strains or damage
• Osteoarthritis joint pain
• Rheumatoid arthritis
• Ankylosing spondylitis
• A number of other forms of arthritis pain

This article provides information on how non-steroidal anti-inflammatory medications can be helpful against back, neck, and other pain, as well as several potential risks and complications to be considered.

Most Common Types of NSAIDs:

NSAIDs comprise a large class of drugs that act by hampering body substances called prostaglandins, which trigger feelings of pain, giving NSAIDs fever-reducing, pain-relieving, and anti-inflammatory properties. There are many types of non-prescription (over-the-counter) and prescription NSAIDs. The four NSAIDs most often used to treat many types of back and neck pain are:

• Aspirin (brand names include Bayer, Bufferin, and Ecotrin, St. Joseph)
• Ibuprofen (Advil, Motrin)
• Naproxen (Aleve, Anaprox DS, Naprosyn)
• Celecoxib (Celebrex)

Other Forms of NSAIDs:

In addition to the above, NSAIDs come in forms other than those taken by mouth. For example:

• Ketorolac can be given as an intravenous, intramuscular, or intranasal drug, making it useful after surgery or if the patient cannot eat.
• Diclofenac is available topically as a gel (Voltaren), patch (Flector), or solution (Pennsaid). The medication is applied directly to the area of pain. Topical forms reduce gastrointestinal and other potential side effects of NSAIDs.

NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

Common NSAIDs for Back Pain
Potential Risks and Complications of NSAIDs
Types of NSAIDs
Anti-Inflammatory Medications for Back Pain Relief Video

Effective Use of NSAIDs:

Taking NSAIDs continuously, rather than just at the onset of pain, helps build up the body’s anti-inflammatory blood level, resulting in a better healing environment in the affected area. The efficacy is markedly lower if NSAIDs are taken only when experiencing pain.

See Using Medication to Manage Pain and Reduce Sleep Problems


Other Points To Be Aware Of While Taking NSAIDs:

• Checking with the doctor. Because NSAIDs have risks and complications, it is important to keep the doctor informed. People taking NSAIDs for long periods are advised to see the doctor regularly so any side effects can be monitored. In some cases, a change in medication may be required.
• Using as little as possible. The U.S. Food and Drug Administration advises that the lowest effective dose of NSAIDs be used, and then for only as long as necessary.
• Combining with acetaminophen. NSAIDs and the pain relief medication acetaminophen (e.g. brand name Tylenol) work differently, so sometimes doctors recommend taking both medications. This often offers better pain relief than taking one type of pain medication. Some people find it also helps lessen the pain as one dose wears off, alternating between the two—for example, taking a dose of ibuprofen, then 3 hours later taking a dose of acetaminophen.

Any adverse reactions from taking an NSAID, or any other medication, should be reported to the doctor without delay.

When NSAIDs Are Not Advised

People having a lumbar fusion surgery are typically advised not to take NSAIDs for at least 3 months after surgery due to concerns about the impact NSAIDs may have on bone healing.

Many doctors also tell patients to stop using NSAIDs prior to other types of surgery because the medication poses an increased risk of bleeding.

Low Vitamin D Linked to Increased Headache Risk

News Bite: Vitamin D may be a component factor in headache a new study demonstrates.

More research is adding to the literature of a link between vitamin D deficiency and headaches, at least for men living in colder climates.

Data from 2600 middle-aged men from Finland who participated in the Kuopio Ischemic Heart Disease (KIHD) Risk Factor Study showed that those with the lowest levels of serum 25-hydroxyvitamin D (25[OH]D) were more than twice as likely to report having chronic headaches as those who had the highest vitamin D levels. In addition, reports of chronic headache were significantly more frequent in months other than the summer months (June through September).

The investigators note that although past studies have examined the link between vitamin D and headaches, the results have been “inconclusive” because many included small sample populations. When the KIHD study originally started, men in this part of Finland had the highest prevalence of heart disease in the world, and it was looking at risk factors for cardiovascular disease.

During the baseline examinations, questionnaires asked the participants to report headache status during the previous 12 months. “Frequent headache” was defined as a daily or weekly occurrence — and was reported by 9.6% of the full group.

Also at baseline, fasting venous blood samples were collected during morning hours and 25(OH)D concentrations were measured.

Interestingly, the mean concentration of serum 25(OH)D for the study group was 43.4 nmol/L, which is below the 50-nmol/L threshold generally considered to be a marker of vitamin D deficiency. In fact, 67.9% of the group had levels that were less than 50 nmol/L.