In mid June I got a call from Joe, I had helped his father and he wondered if I could help him; A 28 year old man with back pain – of course I could, and told him to make an appointment. However, I was not so certain after taking the history. Back pain was not Joe’s main problem. For five years he had been taking Tramadol, 8 a day in the early years. My exact words were “back pain is not your main problem, you have to come off this shit Tramadol, it is as bad as heroin and it beggars belief you have been left on this for so long”. Tramadol claims more lives than any other drug, including heroin. It was prescribed for me after cancer surgery, I have always maintained pain is there for a reason and we should use that information to help our bodies heal so we can return to normal activity. The fact I am alive today and in remission after being told my cancer was incurable suggests it may be good advice.
This case illustrates the ignorance of the medical profession in dealing with mechanical back pain, where there is no pathology present. And the cowardice of the chiropractic profession for not allowing “registered chiropractors to give the advice I gave Joe, for fear of alienating the medical profession so they won’t throw the profession the crumbs off the table of “Failed Back Surgery“. Remember, these are the UK patients who go back to their doctors, and these figures would not include all the thousands of people who went to chiropractors and osteopaths. Joe’s story was so compelling I asked him to put it into his own words:
“I originally started having problems with my back approximately 5 years ago now, when I slipped over in the snow on my walk to work and landed flat on my back. I quickly knew that there was something wrong because I was in tremendous pain at that time and was unable to sit stand or walk without the pain becoming unbearable. At the time I had a relatively healthy lifestyle and was going to the gym, swimming and running around 4/5 times a week.
I went to the doctors I think about 24/48 hours after the initial injury and they prescribed me some pain medication (I cant remember the name now) to reduce the inflammation and make me more comfortable. However, these made me feel ill and I had to go back about 2 days later. I mentioned that the pain was still really bad and they referred me to get an MRI scan on my back, but in the meantime prescribed me tramadol (there may have been another medication before this but I know by the time the next few things happened I was definitely on tramadol). I was told I could take two 50mg capsules four times a day if needed. I was told by the doctor that tramadol can be addictive, but they suggested that it would be the best medication to ease the pain, so I took them. I can’t remember being told any other side effects at the time and, quite honestly, didn’t read the leaflet when I started taking them. My first experience of taking tramadol was a scary one. I took them before I drove to work in Milton Keynes, and by the time I arrived at where I needed to be I was sweating, getting blurred vision, could feel my heart racing and was breathing heavily, overall feeling really sick (I can only imagine it was like being on drugs). But after that I was able to handle the dosage.
After the MRI the doctor diagnosed that I had suffered a prolapsed disc of the L5. (I believe it was the disc just above the pelvis) and referred me to the pain management clinic, all the while still continuing the tramadol medication. At least 4 months went by before I got my appointment for probably about 8 weeks from then (6 months in total). The specialist at the pain clinic suggested that I receive a lumbar injection for the pain, but when I also mentioned that I was on the tramadol they did not tell me to stop taking them or reduce the dosage at all. But at the time I was happy with that as I felt that they were helping. By this time I had not be able to exercise properly for 6 months and noticed that my general well being was not the way it should be. I was feeling depressed and upset about the injury, and the lack of speed from the NHS to fix the problem only seemed to make me angry.
I received the lumbar injection quite quickly after that (no more than 4 to 6 weeks later) and it helped, but I was still continuing to take the tramadol with no doctor or specialist suggesting that it be a good idea to reduce the dosage. But I began to feel myself again as I was able to exercise, I started losing the weight I had put on and feeling like a normal 22/23 year old. It only lasted 3 months though and I was told that I wouldn’t be given another one as they could only give me 3 injections over a period of time, so I continued to take the tramadol and waited for the acupuncturist appointment (which was the next course of action). I think I went to the appointments for the acupuncture and realised straight away that they were not working so I went back to the specialist who then referred me to a physio. By this time over a year had past since the initial injury and nothing was helping except the tramadol. I found myself living from dosage to dosage and could feel the effects of not taking the medication. If I ever missed a dosage or went too long between each dosage I woke up feeling like I had been beaten up and felt at least ten years older than I was physically, not to mention the feeling of restlessness and panic. It took another 6 moths before I got to see a physio (18 months in total) and I remember the physio basically saying to me that it had been so long since the injury occurred that there was not an awful lot she could do other than stretch me and try to help me to manage where I was at now (basically “you’re like this now, deal with it!”). That got me so upset, I never went back and resigned myself to the life I was left with. I tried numerous things myself like osteopathy, working through the pain and losing weight through exercise, swimming but eventually everything went to wayside and a gave up in myself! I knew the tramadol was not helping me emotionally or physically but they were offering the only relief to any pain (other than the lumbar injection). I managed to reduce the dosage I took down to 2 50mg capsules in the morning and evening and then about 3 years ago I reduced it further to only taking two capsules ( one in the morning and evening)
Over time I had felt that the injury felt better but knew in the back of my mind that I needed to get off of the medication because whenever I missed a dosage I was feeling a withdraw that I had never felt before in my life. The most notable one was about 12/18 months back when my fiancée and I had decided to take a weekend away and I realised on the first evening as I was about take my nightly pill that I had left them at home. That night I did not sleep at all, I was pacing the room, I walked the grounds of the hotel, I couldn’t stop shaking my leg through nervous tension I think and generally wasn’t myself, we had to drive back the next day just to get my medication.
More recently this year, I felt that the pain was returning and getting slowly worse through the year up until May when I decided to go back to the doctors to finally get myself some help to get off of the tramadol and a better resolution sorted for the pain. This was not the case, the doctor instead blamed the pain on my being over weight ( which I hadn’t been 5 years ago), that I was depressed (which I hadn’t been 5 years ago) and just sent me to get a second MRI (which came back with minor degenerative disc wear, but no prolapse) so he was reluctant to do anything more for me other than tell me to go and get some exercise (which I know would help but didn’t help at the time). I had to literally push to get referred to the pain management clinic again.
In the meantime, I came to see you and in the short amount of time I have been treated by you, I have managed to get totally off of the tramadol medication and have generally feel in less pain than I have in the last 5 years (although I still do take 1 lyrica capsule a day and do generally have numbness and tingling from my right hip down to my knee, but this now comes and goes and is not as constant as before).”
After my initial examination of Joe I concluded his symptoms were not caused by a disc prolapse, but rather a subluxation in the L5/ S1 spinal Joint and the sacra Iliac joint dysfunction
The only thing different about Joe’s treatment was that it took longer than usual to get him out of pain, because the pain and muscle spasm had become chronic. Normally it takes about two weeks to get people out of pain, then you start the patient doing strengthening exercises to support the spinal joints that have been adjusted. The most helpful thing people can do to prevent and manage back pain is by leading an active lifestyle, this is difficult when people are in pain or taking strong pain medication because they are unable to break the vicious cycle of joint dysfunction, nerve interference, muscle spasm, pain and more joint dysfunction. When patients ask for recommendations for a “good chair” I will often advise the least comfortable one because you are less likely to sit on it for hours.
Most people who attend Spinal Joint for the first time have aches and pain which may be debilitating or just preventing them from performing normal activity. Sitting for long periods changes spinal posture resulting in stiffness and reduced range of movement of the joints of the back and neck. Restoring joint motion, with “manipulation”, will inhibit pain transmission, relax tight muscles and improve co-ordination and posture. Movement reduces pain after the acute stage of injury, which is why it’s often worse first thing in the morning, after a night in a bed.
For people in pain, returning to physical activity as soon as possible is vital for a good outcome. Early intervention is key to restoring normal function and breaking the self perpetuating cycle of pain, inflammation and muscle spasm developing. When a joint is painful use a cold pack to reduce the inflammation; pain medication should only be used as a last resort because it just masks the underlying cause of the problem. Continued use of pain medication increases the likelihood of chronicity and osteoarthritis later in life. A structured exercise program to strengthen “core” muscles, improve posture and maintain normal joint motion is essential to maintain the benefits of any treatment plan.