Q: I've suffered from persistent low back pain for years. I recently had a repeat MRI, which does not show any abnormality to explain my pain. I hate taking medications. Does nerve stimulation work?

A: Back pain is remarkably common. It affects most people during a lifetime and is the most common reason for job-related disability. While most back pain gets better quickly, chronic back pain (lasting at least 3 months) is also common. Yet, the cause of chronic back pain is often uncertain. Even worse, treatment is often ineffective.

That's why so many people turn to transcutaneous electrical nerve stimulation (TENS). With this technique, an electrical current is delivered by tiny wires plugged into a pocket-sized, battery-powered device. It's used for a variety of painful conditions, such as neuropathy (nerve disease) and back pain. The reason it works isn't clear. One possibility is that it interrupts painful nerve signals.

For many conditions, including chronic back pain, it's not clear how effective it is. That's why a group of experts from the American Academy of Neurology reviewed studies that reported on the success of TENS for chronic back pain. They excluded cases of back pain due to a clearly identifiable cause, such as a slipped (herniated) disc or scoliosis (curvature of the spine). They also excluded patients with obesity.

The conclusion of this expert panel was that TENS does not work for chronic back pain. As a result, new guidelines from the American Academy of Neurology will discourage use of TENS for chronic back pain.

But TENS is not useless. This same panel concluded that TENS is effective for diabetic neuropathy, a painful nerve disease that commonly complicates diabetes.

Here are steps you can take that might decrease your discomfort:

--Avoid gaining weight and try to shed a few pounds if needed.

--Exercise regularly. Choose exercises that are easy on the back. Good choices include cycling and swimming.

--Lift properly. Start in a squatting position. Use your legs and hips, rather than bending over to lift.

--Wear shoes that are well-cushioned, low-heeled and soft-soled.

--If you carry a briefcase or backpack, keep it light.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center, Boston, Mass., and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center.

 

 

Supporting Survivors of Suicide Loss: Therapy Can Ease Grief, Guilt
Harvard Health

More than 30,000 Americans, and roughly one million people worldwide, die by suicide each year. The aftermath of grief and bereavement extends much further, with a conservative estimate of six survivors left behind for every suicide death.

Treating Low Back Pain Remains a Challenge
Harvard Health

Back pain is remarkably common. It affects most people during a lifetime. While most back pain gets better quickly, chronic back pain is also common. Yet, the cause of chronic back pain is often uncertain. Even worse, treatment is often ineffective. That's why so many people turn to transcutaneous electrical nerve stimulation (TENS)

Hypoglycemia: Breaking the Vicious Cycle
Katrina Bertol

Do you ever find yourself feeling faint and irritable when you've skipped a meal? Do you feel fatigued, depressed or worried when you don't have enough food or gone too long between meals? Do you crave sugars and carbohydrates and feel immediate relief after eating them? You may be suffering from hypoglycemia, a common result of poor dietary choices and in some cases, genetics.

Prostatitis Often Challenging to Diagnose
Lance Mynderse, M.D.

A lot of men are familiar with certain prostate-related problems, such as the risk of prostate enlargement and prostate cancer. But prostatitis is a painful syndrome that men seldom hear about.

Depression Sometimes Expressed at a Young Age
Stephen Whiteside

Certainly kids can suffer from depression. If you're concerned about your child, a good first step would be to visit the doctor to discuss and evaluate the situation. Sometimes, symptoms that appear to be depression may be caused by an underlying medical condition. If the problem is depression, effective treatments for children are available.

(c) 2010 Harvard Health Watch