When a nerve is pinched in the neck’s spinal column, pain can be such a prominent symptom that more subtle, but diagnostic, aspects are overlooked.

By way of background, the spinal cord in the neck is connected to the nerves of the arms through pairs of spinal nerves. These spinal nerves, also known as roots or “radicles,” transmit incoming messages (electrical impulses) from the arms’ nerves concerning sensations of touch, pain, heat and cold on various patches of skin. Additionally, the cervical roots convey outgoing messages (also electrical impulses) through the arms’ nerves to their muscles, causing them to contract.

So when a cervical root is pinched, the pinch can cause not just pain, but–by blocking incoming and outgoing nerve impulses–it can also produce numbness of patches of skin, weakness of muscles, or both. The syndrome caused by the pinch in the neck is called cervical radiculopathy. The suffix “-pathy” means damage or impairment, so radiculopathy means damage or impairment of a radicle (root).

There are four pairs of cervical roots connecting the spinal cord to the arms’ nerves and they are named for the segment of spinal cord to which they are attached–C5, C6, C7 and C8, with the “C” designating cervical. While a pinch of any of these roots typically produces searing, deep pain in the shoulder which preoccupies the unfortunate person who has it, the shoulder pain is the least identifying or diagnostic component of the person’s symptoms.

The pain often shoots into the arm on the affected side, and certain movements of head and neck can worsen or reproduce this pain. While the arm component of the pain is less intense than that felt in the shoulder, its location is often the key to figuring out which root is pinched. Moreover, the pattern of numbness or weakness also varies according to which root is pinched. These patterns are almost identical from person to person and are as follows:

C5 impairment can send pain over the top of the shoulder in the first fourth of the arm which is also where numbness occurs, when present. When there is weakness, it involves the ability to elevate the arm sideways to the level of the shoulder or above. There are no good (rubber-hammer-type) reflexes the doctor can use to test this root.

C6 impairment can send pain as far as the thumb which is also where numbness occurs, when present. When there is weakness, it involves the ability to bend the elbow. The doctor can additionally test for C6 impairment with the biceps-reflex which involves striking a tendon in the crook of the elbow.

C7 impairment can send pain as far as the middle fingers which is also where numbness occurs, when present. When there is weakness, it involves the ability to straighten the elbow. The doctor can additionally test for C7 impairment with the triceps-reflex which involves striking a tendon on the back of the elbow.

C8 impairment can send pain as far as the little finger which is also where numbness occurs, when present. When there is weakness, it involves certain hand-movements, including the ability to join the tips of the thumb and the little finger and also to spread the fingers sideways. There are no good reflexes the doctor can use to test this root.

Having identified the typical syndromes, the next step is to understand what caused the pinch in the first place. It is typically one of two things–a herniated (“slipped”) disk or a bony spur. Younger adults are more likely to have a herniated disk and older adults are more likely to have a bony spur. Disks are soft structures sandwiched between each pair of spinal column bones (vertebral bodies). Their ordinarily tough outer membranes can weaken and allow extrusion of inner disk material–somewhat like toothpaste squeezed out of a tube–into the side-canals through which the spinal roots must pass. This traps and compresses them. Bony spurs, in contrast, are not soft at all. Instead, they are hard ridges of excess bone located on the edges of the back-bones. They are produced by arthritic degeneration. They, too, can trap and compress the spinal roots where they exit the spine.

How is cervical radiculopathy diagnosed? As described, the patient’s history and examination are often very informative and specific. When the pattern of nerve-impairment is ambiguous, tests of nerve and muscle electricity–called nerve conduction studies and electromyography–can help localize the impairment. These electrical tests can also detect impairments in the nerves of the arms which might mimic cervical radiculopathy, but require different medical management.

Until the 1980s myelograms made the best pictures of the pinches occurring in the spine. To perform a myelogram a doctor started with a lumbar puncture (also known as a spinal tap) in the patient’s lower back and injected x-ray dye into the watery space within the membrane covering the spinal cord and its roots. The patient was then tilted so that the dye ran into the corresponding space in the neck. Standard x-ray pictures showed the column of dye together with any indentations of the column caused by a herniated disk or bony spur.

Magnetic resonance imaging (MRI) was developed in the 1980s and created similar pictures but without having to do a spinal tap or dye infusion. Computed tomographic (CT) scans, developed in the 1970s, are generally the least useful of the spinal imaging techniques, except when an immediately preceding myelogram has been performed, in which case they can be strikingly helpful. Each of these these imaging tests has its strengths and weaknesses–none of them is always the best–so testing must be tailored to each case.

And how about treatment of this condition? Well, that’s a story deserving its own essay. Stay tuned.

(C) 2005 by Gary Cordingley

Before a child can be appropriately diagnosed with cerebral palsy, their doctor must first have to look closely at both the child and the mother’s medical background to see if there are any known causes of cerebral palsy present in the case. The doctor will very carefully check the baby’s motor skills and the reflexes, and then will be tested by a physician, also they will try to determine the Childs hand preference often a child with cerebral palsy will use the hand that is not always the most practical to them due to the fact that depending on the brain damage one side of the body will be much stronger than the other side that is affected.

When cerebral palsy has been diagnosed doctors may go on to do x-rays, magnetic resonance imaging, ct scans and MRI, to determine the possible cause or causes of the cp. Here are just some of the signs that may be present in a child with suspected cerebral palsy: Weakness, early hand preference, abnormal postures, irritability, feeding difficulties, delayed or impaired speech, excessive or feeble crying, slow to gain weight, very slow or failure to develop motor skills.

Cerebral Palsy - Treatments and Alternative Approaches

When a child has been diagnosed with cerebral palsy they will generally need different types of treatment. Physical therapy - this will help to build up the strength of the Childs muscles working on their walking and keeping their balance. Speech-language pathology-this is to help the child learn to communicate mainly working on trying to teach the child to talk. Occupational therapy-this is to help the child with skills they need for everyday living to give them some independence like feeding themselves and dressing. There are also some alternative therapies that can help to control and manage the condition.

Conductive education - This is to help the child become more independent. Their day will be planned out with physiotherapists, speech therapists and what is called their conductor who will oversee all the tasks to see day to day how the child is progressing and set new more tasks for them, which when achieved will increase the Childs self-esteem. The conductor will form a very close bond with the child, which is vitally important for how successful this treatment will be. The conductor will look at the child not the special need and help to bring out the Childs personality and use their interests to help them learn and achieve more.

The Bobath concept - This concentrates on helping the child physically using play to increase muscle control, improve the Childs posture and reduce stiffness. The therapist involved in this use key points of the body when handling the child at all times. This can greatly improve the Childs mobility.

Patterning - This works on teaching the undamaged parts of the brain to takeover what the damaged part should be doing. This is quite an intense therapy for the child as rhythmic stimulation is used on the limbs for up to eight hours a day to help the child gain complete balance and control of their movements which may distress the child greatly and is very time consuming for the parents.

Irritable bowel syndrome is a debilitating and distressing condition, which affects 10-20% of the population. IBS is characterized by abdominal pain and altered bowel function such as constipation, diarrhea or alternating diarrhea and constipation. Some people have occasional symptoms, which can be aggravated by stress or food intolerances. Others experience crippling symptoms, and struggle to maintain their quality of life in the absence of any targeted, effective pharmaceutical treatments.

This disorder affects people of all ages and backgrounds, including children, although women are predominantly affected. Severe IBS can dramatically restrict mobility, through loss of control of bowel function and severe abdominal pain. These symptoms contribute to IBS being second only to the common cold as the most frequent cause of absenteeism from work and school.

Despite the significant impact on individuals and the population at large, there is no clear established cause for IBS. Whilst medical investigations are important to eliminate the possibility of an over-lapping pathology such as parasites, candida, inflammatory bowel disease, cealiacs or Crohn’s disease, there is no specific investigation which patients can test positive for in order to confirm a diagnosis of Irritable Bowel Syndrome. A diagnosis of IBS is more often a diagnosis of exclusion ? if its not another gastrointestinal condition, and it fits the symptom picture of IBS, then it is IBS.

The current accepted criteria for diagnosing IBS is the Rome criteria (adopted in medical texts and by the American Gastroenterological Association). Their definition of IBS consists of:

At least 12 weeks, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has two of three features:

• Relieved with defecation and/or
• Onset associated with a change in frequency of stool and/or
• Onset associated with a change in form (appearance) of stool.

The following symptoms support the diagnosis of IBS:

• Abnormal bowel movement frequency (more than three per day or less than three per week),
• Abnormal stool form (lumpy/hard or loose/water),
• Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation),
• Mucous passed with stools,
• Abdominal bloating or distension.

There are few effective treatments for IBS. Pharmaceutical medications include anti-diarrheal agents and laxatives, some of which can be harmful if used repeatedly. Significant improvements can be made through dietary changes which can therefore reducing some trigger factors for IBS. It is also important to practice some stress reduction techniques such as breathing techniques, and positive psychology, as there is a direct link between stress and an aggravation of IBS symptoms.

The most promising, long-lasting and side-effect free results in the treatment of IBS were based on a large clinical trial conducted at an Australian university, and published in the Journal of the American Medical Association in 1998.

These results demonstrated a 64-76% improvement rate on all measures of IBS such as abdominal pain, distention and bowel habits. These results were achieved in a double-blind, placebo controlled clinical trial conducted by gastroenterologists and doctors. The remarkable positive results were achieved in the treatment group that received Chinese herbal treatments. This same formula can be purchased as pre-made capsules from select retailers, and it offers great hope for those struggling with IBS.

Dr. Maia Dodds is the author of ‘The Irritable Bowel Syndrome Improvement Program’

Hi Rusty. A few days ago, I slightly injured a finger on my hand. Now my hand is swelling with severe joint pain in the fingers. At first I thought this was a possible sprain in that region, but now my other hand is showing the same swelling of the fingers and pain of the joints. Should I go check this out right away? It doesn’t seem to be getting worse today, but the pain and swelling are persistent. Could this be a sudden arthritis attack? I’m 38 years old and in good health (I just had a check-up at the doctor last week and the blood work came back okay).

Your advice is greatly appreciated.

Answer

Ouch, a little sprain is not supposed to do that. Unfortunately some times it does. I am sorry to hear about this. It is not unusual for arthritis to begin in an effected joint. It is not the norm for it to set in so quickly. There are different kinds of arthritis that can effect the hands and feet that can cause swelling. It is possible that arthritis was already beginning but not showing symptoms yet but this triggered a symptomatic response.

I am concerned that the pain is bilateral, effecting both sides. I doubt it is anything extremely serious but it would be good to see your doctor. The sooner the better. If nothing else, your doctor will be able to treat the pain and swelling. But if it is arthritis or one of the other conditions that can cause this type of swelling in the fingers the earlier the diagnosis the better.

I wish you good health.

According to ongoing research about the needs of patients with emotional problems misinformation or shame to speak about the problem with the doctor or psychotherapist is a major limitation to treatment success. However, transparency, good information and participation in the course of the therapy is the most important factor for a lasting positive result. Maybe the following list of the most relevant questions might help you to get good information about your personal somatic or psychological problems, diagnosis and treatment options.

This list, however, might help you to be prepared for the right questions :

1. Is there a name (clinical diagnosis) for my problem?

2. What are typical symptoms (somatic and psychological)?

3. What are the causes of the problem or the disorder?

4. What is the typical experience of other patients with this kind of problem or disorder?

5. What could I do myself to achieve a solution?

6. What kind of further technical diagnosis is necessary to exclude other organic disorders?

7. What is the aim of these diagnosis? Are there any possible risks?

8. What kind of treatment options (drugs, psycho-social help, different psychotherapy-methods, biological treatment options) exist for my problem?

9. What kind of advantage can be achieved with the treatment (and how long does it take)?

10. What is the goal of suggested clinical diagnostic process

11. What kind of different treatment options are available?

12. What will be realistic advantages of a positive therapy outcome?

13. Can the treatment offer me a reduction of my complaints?

14. How long will it take to achieve first positive results?

15. What might be the influence on my feelings or personality?

16. Are there any negative consequences for my sexuality?

17. Are there risks or possible side effects of the treatment?

18. Do you think my problems will reoccur? Is it a chronic disorder?

19. What kind of information is relevant for people, who care for me?

20. Is there anything I could do myself to accelerate my rehabilitation?

21. How do I get additional information?

22. Are there self-help groups for my problem?

This is a rather comprehensive list of questions and you must not expect to get a quick answer within a short time. But it might be a start to get the answers you need. Reading books and using the internet to find reliable information related to your personal problems is a great support for you and your doctor.

Irritable bowel syndrome (IBS) is a very common condition, but in some ways it is still a mystery. There are many different theories about what causes the syndrome, and different doctors will give you different reasons for your illness ? anything from stress to bad bacteria to food intolerance. And once you have been diagnosed, there is no set form of treatment ? instead, sufferers tend to try two or three supplements or therapies to find a combination that works for them.

IBS is clearly a complicated issue, so here is a basic overview of the symptoms, diagnosis and treatment of this disorder.

The symptoms

Although the symptoms of IBS vary from person to person, there are several symptoms which are typical of the illness. The most common symptom is either recurring diarrhea or recurring constipation (although some patients also have alternating diarrhea and constipation).

Additional symptoms can include stomach pain (sometimes relieved by a bowel movement), bloating, nausea and a lot of gas. These symptoms generally go away for a short time before returning again, as IBS can work in cycles. Sufferers may experience a few weeks or even a few months of good health before the symptoms come back.

Sufferers sometimes find that their symptoms begin after a bout of food poisoning or an operation. Others date their symptoms back to a very stressful period in their lives, and some patients can see no clear reason for why their symptoms began.

The diagnosis

There is no set test for IBS, and it is often called a diagnosis of ‘exclusion’. This means that a doctor may rule out other bowel and stomach complaints such as celiac disease or inflammatory bowel disease before giving you a diagnosis of IBS.

Sometimes patients are given a colonoscopy, where a tiny camera is inserted into the intestines to look for abnormalities. In an IBS sufferer the colonoscopy won’t detect any physical signs of disease ? IBS is often called a ‘functional’ disorder, because it seems to be caused by an alteration in the way the body functions rather than an identifiable cause such as inflammation.

However, this does not mean it is any less real than, say, inflammatory bowel disease, it just means that doctors haven’t come up with a proper test for it yet!

It is very important that you receive a diagnosis of IBS from a medical professional rather than self-diagnosing, as bowel symptoms can be present in many other health conditions.

The treatment

The first stage of treatment may involve any medications your doctor has given you to try. This could be an anti-spasmodic, which will relax the muscles in the gut walls, or perhaps a low dose of an anti-depressant, which can help to reduce the pain.

You may also be given one of the new drugs specifically developed for IBS ? Lotronex for diarrhea sufferers and Zelnorm for constipation sufferers.

If the drugs do not help you then you could try using a fiber supplement such as Citrucel to add bulk to your stool ? this can be helpful for both diarrhea and constipation. Also, there are other supplements such as Caltrate Plus which may be useful (Caltrate Plus contains calcium carbonate which can reduce diarrhea).

It may also be worth looking at your diet. A nutritionist can advise on ways to identify any particular food ‘triggers’ which may be setting off your symptoms, and also on whether you might have a food intolerance to something like gluten or lactose.

Finally, there are several alternative therapies which can be effective for IBS. Hypnotherapy has proved very effective, and a special form called gut-directed hypnotherapy has been developed just for digestive problems. Acupuncture may also be worth looking into.

Stop! and imagine for one moment that your body is being savagely and brutally attacked by chronic pain. This pain is so intense that you become less active. As you become less active you start to develop muscles weakness. Just trying to do normal daily activities such as, working, housekeeping, cooking, playing with the kids, shopping, walking the dog and sleeping has become an extreme ordeal. All is not peaceful in the Land of Nod. In fact, you as a fibromyalgia (FM) sufferer are downright restless.

As of this writing, fibromyalgia is the most misdiagnosed and misunderstood syndrome of the 21 century. Because it mimics other diseases and conditions, many people with FM initially have often been diagnosed as having multiple sclerosis, scleraderma, rheumatoid arthritis or lupus. Fibromyalgia has also been closely associated with chronic fatigue syndrome, it shares many of the same qualities.

Since so many fibromyalgia sufferers have been misdiagnosed, experts have categorized fibromyalgia as a syndrome rather than a disease. A syndrome is defined as “an aggregated of signs and symptoms associated with any morbid process.”

Although it does occur in men, women in their late 40’s and older are at least four times more likely to develop the disorder.

Pain, it is the most common symptom and complaint of the FM sufferer. Some people experience pain, fatigue, muscle stiffness and swelling in their joints, especially in the morning. This stiffness can be quite distinct and be accompanied by pain in key areas of the body, usually in the neck, shoulder, lower back and buttoch.

Irritable bowel syndrome has been reported in approximately 40-70 percent of these patients. It is not unusual for those afflicted to have diarrhea, constipation or a frequent need to empty their bladder. Fatigue and restlessness in FM patients can cause poor concentration, memory loss, non-restorative sleep and secondary endocrine malfunction involving the hypothalamic pituitary and adrenal glands.

Approximately 50 percent of FM sufferers experience some sort of increase sensitivity to stimuli, such as, flashing lights (photophobia), increase sounds (phonophobia), and varies odors.# Some patients often present with a chronic runny nose, congested head cold, and a throat clearing cough. Another common complaint is restless leg syndrome. When a FM sufferer presents to their doctor their are two things they want more than anything in this whole wide world. They want their pain alleviated and one of the greatest pleasures known to all creatures, the ability to get a good night of rest and sleep.

Fibromyalgia and Sleep

Sleep is vital to our very existence, it is during sleep that our temperature decreases conserving energy, sugars are stored for future use, our immune system is blasted into action and growth hormones are released fostering the repair of cells and tissues.# That important journey into sleep is a beautiful time for our bodies and brains to heal themselves from the vigorous wear and tear of daily living. But, numerous studies have been conducted which reveal that persons with fibromyalgia have a sleep disturbance that prevents them from receiving these healing powers. Many physicians are unaware of the importance of getting a sleep study done on their FM patients.

Here’s what we know, a landmark study published in 1975 discovered that 70 percent of patients with FM had NREM (non-rapid eye movement) stages of sleep “contaminated” by an abnormal EEG pattern called alpha-delta sleep, in which incurrent alpha waves (seen when you are awake) are riding on large, slow delta waves. This constant alpha-delta intrusion robs the body of deep sleep (stage 3 and 4 sleep).# It is during this stage of sleep that our body is being repaired. There is also some evidence indicating that fibromyalgia syndrome and sleep disorders are intimately related, but know one is certain which causes the other. Many FM sufferers exhibit bruxism (tooth-grinding), periodic limb movement (PLM), and obstructive sleep apnea (OSA). The absence of stage 3 and 4 sleep in FM can also cause chronic sleep deprivation and may contribute to the rapid physical decline many doctors see in their patients.

Diagnosing FM is not an easy task. To actually receive a diagnosis of fibromyalgia, the American College of Rheumatology, identified 18 separate points on the body called “tender points,” by applying pressure with the index, third and fourth fingers of the examiner’s hand at nine key bilateral surface sites. These include the side of the hip joint, and buttock and the inside of the knee.

In addition, the patient must complain of widespread pain lasting at a duration of 3 months or more. the pain must be radiating on both sides of the body, and be above and below the waist.

Fibromyalgia and the Polygragh

There is no cure for fibromyalgia. The only relief FM sufferers can hope for is the treatment of their symptoms. Majority of FM patients complain that no matter how long they sleep, it is never restful. Their sleep may be interrupted by frequent awakenings, or they wake up gasping for air, or in pain. Even more common most patients complain of waking up day after day feeling exhausted.

Many of the symptoms that FM patients experience are shared by those with other sleep disorders. As sleep care professionals, we do know the symptoms. Now we must raise awareness to patient and doctors treating FM, that their lack of sleep can be caused by so many factors. Such as, pain, sleep apnea, PLM and bruxism.

But how, (you ask) would a doctor know for sure in a patient complaining of sleep deprivation that their lack of sleep is because of pure fibromyalgia verses fibromyalgia overlap with another sleep disorder?

Here’s your answer, “Polysomnography.” The polygraph can be used as one of the tools to help doctors battle the problem. In order for you to better understand how fibromyalgia works in sleep. I invite you to come along with me and peek in on the inner workings of the fibromyalgic brain.

I had been working in sleep medicine as a polysomnography technician for only six months when I saw my first client with fibromyalgia. LT was a forty-eight years old female, mildly over-weight and in poor overall health. Her chief complaint was, (Yep you guess it), pain and lack of sleep.

I meticulously place each EEG electrode on her scalp making sure I properly prep and measure each site. I attached two effort belts, one on her chest, the other on her abdomen. Leads where placed near her eyes and chin. Leads where places on her legs, and EKG leads where placed on her chest. A thermistor airfow was placed at her nares and a pulse oximeter probe on her finger. The setup procedure took about an hour, to pass the time away she and I “chatted” about our families and recent news events

Once in bed the client was hooked up to the EEG machine and monitor. She was allowed to watch a little television around 10:30 PM she started getting sleepy. She lets out one big yawn and shuffled between the covers. On the computer screen I notice LT is drifting in and out of sleep (microsleep). She’s not totally asleep yet, but her body is relaxing and preparing itself for sleep. It is during this time that her body temperature drops, and her pineal gland at the base of her skull is slowly releasing melatonin in her bloodstream, signaling to her brain that it’s time to make that wonderful transition into sleep.

Now this is where the fun for me as a sleep technologist begins. On a computer screen I get to observe all the wonderful electrical activities of the brain. When she was awake I observed those fast, low-voltage type of brain waves called beta waves. But as she closed her eyes, the waves change to a slow-high voltage brain rhythm called alpha waves. Alpha waves danced across the screen for several more minutes, then suddenly right before my eyes the alpha waves were quickly replaced by a new wave pattern called theta. Her mind is no longer thinking about her day, LT has now drifted from a state of conscious wakefulness to that wonderful abyss called stage 1 sleep.

Stage 1 sleep is the lightest stage of sleep. Considered transitional sleep, stage 1 will move LT into a deeper and rewarding sleep state. Her eyes began to roll slightly from side to side, she no longer hear the sounds of cars and trucks passing her window. Or the mild humming noise coming from the fan. But yet if I where to enter her room and lightly touch her arm, she would be easily aroused and not have a sense that she had been sleeping at all.

After 5-7 minutes in stage 1 sleep, LT slowly enters stage 2, during this stage of sleep two identifiable sleep-specific wave forms pop on the screen. Sleep spindles and K-complexes, these are two beautiful wave forms floating across the polygragh. I love vintage cars so every time I look at a sleep spindle, I am reminded of old spoke tires on a ford Model T. K-complexes are quite different then a sleep spindle, it is a super large wave form that appears seconds before a sleep spindle, and looks like the QRS complex on a EKG tracing, with a well delineated negative upward spike which is immediately followed by a positive downward spike. Both of these wave forms appear and disappear across the screen in seconds. LT’s legs begins to twitched several times. She now is definitely showing signs of PLM.

15 minutes later she falls into stage 3 sleep or deep sleep. In stage 3 sleep she is not easily aroused. In this stage of sleep between 20-50 percent of the waves are transformed into delta waves. Over size slow tee-pee shape waves ripple across the EEG computer and appear again and again. When all of a sudden (out of the blue) delta waves are constantly being bombarded by alpha waves. Until finally for every delta wave seen an alpha wave intrudes on its territory. LT is no longer asleep, the alpha-delta intrusion causes her eyes to pop open. After twenty minutes staring at the ceiling, she then takes her first bathroom break, why not, her restful sleep has been interrupted.

Once in bed, her sleep debt built up from her arousal causes her to fall quickly back into stage 1 sleep again. Throughout the night she will repeatedly travel up and down the stages of sleep, never reaching stage 4 or REM sleep because of alpha-delta intrusion and PLM. This constant interruption in her sleep can hamper the proper release of serotonin, (which is necessary for the activation of an important immune system cell called “natural killer cells”)# and growth hormones that aide in rebuilding damage cells. LT’s sleep test ends at 6:00 AM, she had several complaints from being tired, to increase pain, to being unhappy. these are all typical complaints of a FM sufferer.

A trained and experienced polysomnographic technologist then analyzed and scored LT’s sleep data. The report indicated she had frequent leg movements in stage 1 and 2 sleep, consistent with the disorder premature leg movement (PLM), along with frequent arousals and alpha-delta intrusion.

A month later, a follow-up phone call was conducted by the sleep center. Therapy for LT included low dose anti-depressant, physical fitness training and benzodiazepines such as clonazepam which help in promoting better sleep, by relaxing skeletal muscles and reducing her premature leg movements. Every fibromyalgia patient is different and may require a different individualized treatment, (some patients may suffer from sleep apnea or bruxism.) But, for LT these combination of treatment seemed to help and she was happy with the outcome.

Conclusion

I hope this small glimpse into fibromyalgia will help explain why patients need and will benefit from a sleep center. Precise diagnosis is essential to establish the existence of fibromyalgia and distinguish this disease from other sleep disorders. Once the diagnosis is made, a multifaceted approach is then required to ensure healing and restful sleep.

The consequences of fibromyalgia can be significant for those affected as well as bed partners and family members. Although many patients try to self-manage their lack of sleep, most will eventually seek treatment if symptoms are progressive and/or unrelenting. I extend this one challenge to every doctor and that is to ask their fibromyalgia patient one question, “How are you sleeping?”

“If you’re one the nine out of ten adults in the United States who suffers from low back pain, I have good news for you!” states Dr. Nathan Wei, a board-certified rheumatologist and Clinical Director of the Arthritis and Osteoporosis Center of Maryland.

“Low back pain is the most expensive work-related injury as well as the third most common reason for a surgical procedure,” Dr. Wei adds.

The spine is a complex collection…
It consists of bones, called vertebrae, and the joints that allow them to interact; discs that separate the vertebrae from each other; the spinal cord and nerves; the soft tissues such as muscles and ligaments that help hold the spine together. Your spine has 3 major functions including protecting the spinal cord, supporting the body in an upright position, and allowing the body to move freely.

The four major categories of low back pain are:

? Mechanical- arising from either trauma or repetitive motion

? Degenerative- usually from arthritic causes

? Systemic- arising from medical illnesses

? Stress-induced

Mechanical causes are responsible for more than 90% of back pain and the most common cause of back pain is probably muscle injury due to strain or sprain. Other common causes include disc herniation, spondylolisthesis (a condition where the vertebra slips on the one below it), spinal stenoiss (narrowing of the canal that carries the spinal cord), scoliosis (curvature of the spine), osteoporosis (a disease where the bones become fragile and break), and arthritis. Bone tumors are another potential cause.

“Treatment is entirely dependent on diagnosis!”
Dr. Wei says, “There are simple ways to help your back. For instance use the log roll technique to get into and out of bed. Think of your body as a log, and make sure you move it as a unit… rolling into and out of bed.”… He says, “use the same idea when getting into and out of your car. Don’t twist or stick one leg one way and the other leg a different way. Move your body as a unit…”

Check your work area
Make sure your computer, chair, and other parts of your work environment are “friendly” to your back. Good support for your low back as well as your legs is important.

Exercise regularly
Dr. Wei reminds us, “…Stretching is important for your spine?Since rotation is a key movement and the upright position is part of our daily routine, we need to incorporate exercises that stretch and strengthen those muscles that are important for twisting and for posture.”

Space Age Treatment
“A new addition to our low back pain tool kit is a procedure device called intervertebral disc decompression or IDD. It helps decompress the vertebrae non-surgically, and non-invasively. Studies to date have shown a response rate of up to 86%,” adds Dr. Wei

Dr. Wei concludes, “Surgical procedures are a last ditch effort…and should be reserved for patients who have pain unresponsive to conservative treatment or who have a progressive neurologic problem.”

Dr. Wei (pronounced “way”) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians.