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Opiates Ineffective for Chronic Back or Hip Pain

Opiates Ineffective for Chronic Back or Hip Pain

A new study just published in the Journal of the American Medical Association finds that opioids are not an effective solution for chronic pain.

In this article, researchers from the University of Minnesota studied 240 patients who had chronic back, hip, or knee arthritis pain. Half of the study subjects received opiates; the other half received non-opiate pain medications. Patient progress was evaluated at 3-months, 6-months, 9-months, and one year.

The study found:

  • There was no difference in pain-related function between the two groups.
  • At 12 months, the nonopioid patients had less pain than did those who received opiates.
  • “The opioid group had significantly more medication-related symptoms over 12 months than the nonopioid group”

The study authors write:

“Among patients with chronic back pain or hip or knee osteoarthritis pain, treatment with opioids compared with nonopioid medications did not result in significantly better pain-related function over 12 months. Nonopioid treatment was associated with significantly better pain intensity, but the clinical importance of this finding is unclear.”

Previous research has found that about 20% of patients with musculoskeletal pain are prescribed narcotic pain medications for their symptoms, and another recent study found that 36% of people who overdosed from opiates had their first opioid prescription for back pain.

Another recent study found that chiropractic patients are less likely to use opiates for their pain than are medical patients.

From this research, it seems clear that it’s risky to prescribe opiates for musculoskeletal pain. Chiropractic care is a proven safe and effective approach for both chronic and acute back pain.

Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, Kroenke K, Bair MJ, Noorbaloochi S. Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial. JAMA. 2018 Mar 6;319(9):872-882. doi: 10.1001/jama.2018.0899.

Today’s article was written by Michael Melton and is shared from the following website:

What is “Referred Pain”?

What is “Referred Pain”?

Billings Chiropractor“Referred pain” can be a perplexing phenomenon for anyone who experiences it. Referred pain is what happens when you feel pain in an area of your body that is not actually the original source of the pain signals. The most common example of referred pain is when pain is felt in the left arm, neck or jaw of a person suffering a heart attack, while they often have no feelings of pain in the chest area itself.

It’s important to note that referred pain is different from radiating pain, in which the pain felt in one area travels down a nerve, causing pain along the length of the nerve. This is often the case with sciatica, where pain originates in the lower back and radiates down the leg.

Researchers are still not exactly sure what causes referred pain. Some experts believe that it is due to a mix-up in nerve messaging. The central nervous system (CNS) is constantly receiving a barrage of different messages from different parts of the body. These messages may get mixed up somewhere along the path between the place where the irritated nerve is signaling and the spinal cord or brain where pain signals are processed. With an extensive network of interconnected sensory nerves that serve the same region of the body, such as the nerves of the lower back, thighs and hips, it may be more common for signals to get mixed up than you might imagine.

Although referred pain is usually felt as painful, it can also cause feelings of numbness, tingling or the sensation of pins and needles. Another example of referred pain is a tension headache, in which headache pain is due to an irritation of the nerves in the neck.

Referred pain tends not to cross sides of the body. In other words, if the pain signals are originating in the liver or gallbladder (which are on the right side of the body), you may feel pain in your right shoulder. If the signals originate in the pancreas (on the left of the body), you may feel pain in your left shoulder, etc.

Chiropractic adjustments can address the source of the referred pain, leading to long-term pain relief. Nerves in the area of the spinal cord that are irritated due to a spinal misalignment (subluxation) can be a cause of referred pain. When your chiropractor adjusts your spine, he or she removes the source of irritation, thus providing relief. Dr. Oblander is a Billings Chiropractor who is very knowledgeable about which tests can be performed to determine the underlying cause of your pain (whether direct or referred), and can treat it accordingly. If you have questions or want to seek chiropractic treatment, be sure to give us a call at Oblander Chiropractic: 406-652-3553.

What is a “Normal” Pain Tolerance?

What is a “Normal” Pain Tolerance?


Pain is a nearly universal human experience that has several aspects. The first thing we usually think about in relation to pain is its trigger or cause. Perhaps you stub your toe, cut your finger while chopping vegetables, or feel the beginnings of a headache coming on. When this kind of thing happens, your body initiates a physical process driven by your anatomy and physiology. Your senses transmit a message through your nerves to your brain, saying “Something is wrong.” The second aspect of pain, however, is psychological and emotional rather than physical—how do you react to the message that your body is experiencing trouble? Do you ignore the headache and continue with your activities, or do you have to stop what you’re doing and focus on the pain to try to make it go away?

When it comes to our response to pain, two factors are also in operation. These relate to the idea of sensitivity. Pain threshold is the point at which pain first begins to be felt, and pain tolerance is the point at which a person reaches the maximum level of pain they are able to tolerate. When attempting to define what “normal” responses to pain are, both factors must be examined.

“Normal” responses to pain are difficult to determine because they vary so widely.

Some people may react to a bad headache by ignoring it and continuing to work, while others may react to a headache they rate at the same subjective level of pain by becoming completely incapacitated and having to lay down and close their eyes until it goes away. So what factors determine these differences in people’s tolerance of pain, and what can we say about them?

First, there seem to be differences in pain tolerance between men and women, with men exhibiting slightly higher pain tolerance than women. But this generalization can be affected by the oddest things. For example:

  • Studies of dental patients suggest that redheads have lower pain tolerances than people with other hair colors, and actually need higher doses of anesthesia during oral surgery.
  • Athletes have been proven to have higher pain tolerances than people who don’t exercise.
  • People who smoke or are obese are more likely to have low pain tolerances.
  • People who are depressed or anxious are more sensitive to pain and have lower tolerances.

There are also biological factors such as genetics, previous spinal cord damage, and chronic diseases that cause nerve damage that affect how we perceive, interpret, and manage pain. So the problem of defining what constitutes a “normal” level of pain tolerance becomes very difficult. But we recognize intuitively that we’re beginning to approach our own pain tolerance when two things happen—first, the pain begins to interfere with our ability to function in some way and second, it causes us to seek help.

As healthcare professionals, we generally distinguish between acute pain—the pain that usually results from a specific injury or illness, lasts less than 6 months and goes away as the body heals—and chronic pain, which can persist or progress over longer periods of time and may have no clear cause.

Depending on the situation, help may come in the form of common over-the-counter analgesics like aspirin, acetaminophen, and ibuprofen, or from more powerful drugs like opioids. Sometimes it may come in the form of ice, heat or topical treatments. And other times it may come in the form of hands-on therapies like chiropractic and massage.

Whatever your level of pain tolerance happens to be, you can get better at handling pain.

Because of the many factors that can potentially affect pain tolerance, managing one’s pain can be a challenging process of trial and error. You can’t change your genetic pain receptors and how sensitive they are, and dying your hair another color if you’re a redhead isn’t going to make you less susceptible to pain. But there are coping mechanisms that can influence the brain’s perception of pain and help you manage it, effectively increasing your pain tolerance. Relaxation techniques, biofeedback, chiropractic manipulation, massage, and mindfulness meditation have all shown surprising success at enabling people who suffer from chronic pain to manage it more effectively without the ongoing use of drugs.

So if you are one of the 25% to 30% of adults living with musculoskeletal pain, contact our office and ask for help—it IS available, and doesn’t necessarily have to come in a pill bottle!

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