A Warning to the World : There is a Global Back Pain Epidemic.

There is an increase in the problem of Back Pain worldwide. According to Dr Prem Pillay, a Spine & Nerve Specialist, an important reason for this is our modern 21st Century Lifestyle. We are sitting for long hours at work and sitting for many hours at home. Many modern office workers and executives are now suffering from Back Pain as a result of this. Back Pain can also be associated with leg pain. This is because of nerve pressure in the spine. This can cause the pain to occur in the buttock, back and side of the legs and even the foot.
Back Pain used to be seen mainly in those who worked in physically demanding jobs like builders, bricklayers, plantation workers, heavy industry workers , construction workers and miners. However, nowdays, Dr Prem Pillay has noticed that there are more executives who come to him for back pain. He has identified prolonged sitting, a poor posture, overuse of computers , frequent business travel and a unhealthy executive lifestyle as major reasons for this problem. When you sit too long, he explains, there is increased pressure in the spine discs. The spine is not one bone but about 33 bones with a soft gel like substance called the disc in between. The disc allows flexibility and movement in the spine. Executive work with computer work and a lack of movement can cause the spine discs to break down and come out or slip out. These slipped discs can pressure on the nerves and cause back pain, leg pain, numbness, tingling, and as the problem gets worse even weakness in the legs. The worse case scenario is becoming unable to walk, unable to pass urine or pass motion. This can happen gradually or in some people it can happen suddenly even from a small accident or injury once the pressure on the spine nerves is already present.
People who have back pain often go for massages or manipulation to therapists and chiropractors. If the pain does not get better after three visits to the therapist, or gets worse after the first visit, or comes back after massage therapy, Dr Prem recommends that you see a real spine specialist. He does warn that massage therapy or physical therapy done in the wrong way by unqualified people can make the problem worse. A proper spine and nerve examination followed by an MRI of the spine can reveal and confirm the problem. X-rays alone cannot show the nerves or pressure on the nerves from a slipped disc.
In some older people, the back pain or leg pain is caused by spine stenosis. This is a narrowing in the spine canal which squeezes the spine nerves. A common story that Dr Prem hears is that the person cannot walk far without the legs feeling uncomfortable. He has to stop and rest first before walking further. This is called spinal claudication pain.
Back pain and leg pain can often be treated without surgery. The proper medications and therapy organized by a spine specialist can help the person recover faster and return to his normal lifestyle.
Some people require spine injections to reduce pain. The better type of spine injections treat the root of the problem. This involves a laser like spine injection to the disc to reduce the disc pressure on the nerves. This can be done as a day procedure without any surgery.
In some people the problem has become too serious and requires surgery. Fortunately modern surgery including microsurgery and microneurospine surgery has advanced to a stage that the risks are low and the recovery can be quick. These are minimally invasive spine procedures with a keyhole like approach. Dr Prem gives the example of a patient Mr. M who came to see him because of back pain that was worse on sitting for too long and on walking a short distance. The test showed that he had spinal nerve pressure from slipped discs and spine narrowing. A minimally invasive advanced microsurgery was done without any metal screws but using modern gel implants. He has now recovered well after a short hospital stay and is walking and working with a good quality of life.
In conclusion, more people including home and office workers are suffering from back pain. If this back pain is frequent or spreads to the legs, Dr Prem Pillay recommends that you see a spine and nerve specialist for a proper check up to find out the root of the problem. A healthy lifestyle with less sitting, the right exercises and a good diet can also lessen the chance of frequent back pain and leg pain.

 Further information is available at www.singaporespine.org

Arm Pain and You: Understand its causes and diagnose it early!

Pain in the Arm can be from nerve problems including the Cervical Spine (Neck part of the Spine) and should be recognized early to prevent nerve damage that can result in weakness and disability.   Keywords:  arm pain, cervical spine, neck pain, shoulder pain, wrist pain, brachalgia, radicular pain, radiculopathy, golf injury,tennis injury, carpal tunnel syndrome Arm pain which includes pain in the neck and shoulder region, shoulder pain, elbow region pain, forearm pain and wrist and hand pain is ocurring more frequently in modern life. Dr Prem Pillay a Spine, Nerve and Pain Specialist in Singapore, explains " This is from several factors including our lifestyles and workstyles of the 21st Century. This results in stress and strain to the neck, shoulder, arms and hands. Consequently, pain , numbness, stiffness and even weakness can occur at these locations resulting in difficulty with work and sports activities." The overuse of Computers and Mobile devices including smartphones and iphones is an important factor in causing arm related pain states Dr Prem Pillay.  With computer use and poor posture, stress can accumulate in the neck causing cervical spine/neck disc protrusions that can press on or irritate nerves that run down the arm. Neck and arm pain can result. Sports activities like tennis, badminton, golf, weight training, gymnastics, horse riding, martial arts (judo, karate, TKD, jujitsu, kendo, etc) , rugby, football etc can also result in arm and neck injuries that can cause arm pain. Even activities like yoga and pilates if not done correctly or from incorrect instruction can result in injury. Localized arm pain in the shoulder, elbow or wrist can be from a joint capsule strain or tendon injury. Other causes include a muscle strain or tear. Partial injuries can heal with rest. The principles of acute treatment include RICE: rest, ice, compression and elevation for an acute injury. Repetitive stress injury (RSI) is associated with office work especially with computers and with some types of manual work even in artists and musicians! When injuries are mild and associated with partial tears, anti-inflammatory pain medications, muscle relaxants, and physiotherapy with heat, ultrasound or lasers can assist recovery states Dr Prem Pillay. Many people try traditional message, chiropractors and massage therapists for these pains. If the pain does not improve after three visits or becomes more painful during therapy you should immediately seek help from a proper Medical Specialist. Dr Prem Pillay states that the proper medical examination and tests can usually accurately determine the cause of the arm pain. Pain in the shoulder can be from localized problems such as a frozen shoulder, partial tears of the rotator cuff, joint cartilage injuries, and muscle tears/strains.  In the elbow, a tennis elbow causing pain on the outside or a golfer’s elbow causing pain on the inside are common.Pain can also occur from a trapped nerve in a tunnel at the elbow associated with tingling, numbness and weakness in the little and ring fingers called Cubital Tunnel Syndrome.  In the hand, a condition called De Quervain’s tenosynovitis can cause pain at the base of the thumb and wrist. Another cause of pain in the hand, wrist and fingers can be caused by nerve pressure on the median nerve in the wrist by thickened ligaments. This is called Carpal tunnel Syndrome. Nerve pressure from a slipped disc in the neck can cause pain in the shoulder, elbow and down the arm to the fingers. This can be associated with tingling, numbness and even weakness. Nerve related pain can be quite disturbing and disabling. Dr Prem cautions that it is important to distinguish pain from a pinched nerve from a muscle sprain. A pinched nerve is often more serious and could spread to more muscles causing not only pain but weakness as the nerve pressure increases. Nerve pain that radiates down the arm is called radiculopathy. Brachalgia is a general term for arm and shoulder pain. Radicular pain can be associated with tingling, and numbness in the area of pain going down the arm to the fingers. Medications and physiotherapy can be helpful once the diagnosis has been confirmed states Dr Prem Pillay. However if nerve pressure is found, pain relief alone is often not enough. It is important to reduce nerve pressure so that is does not result in weakness or paralysis. If the nerve is compressed severely or for too long, recovery may not occur or be incomplete despite surgery. If the problem is found early, modern methods include  superior to laser treatments for spine disc problems without surgery- Discoplasty, through special spine injections can reduce nerve pressure. For carpal tunnel syndrome :  endoscopic release or direct microscopic release can be effective. Cervical spine disc problems that are more serious and cannot be relieved by spine injections together with spine physio could require Microsurgery including minimally invasive spine surgery techniques to remove the disc protrusion or herniated disc that is pressing the nerves. A disc replacement is often done at the same time. Modern disc implants can allow freedom of movement without spine fusion. Dr Prem Pillay states that modern spine surgery can be done safely and effectively if the specialist is experienced,  well trained and qualified. Furthur information is available at http://www.singaporespine.org/ and  http://www.spine-neuro.org/ or by contacting clinicsg@yahoo.com

Back Pain Lessons from Outer Space

NASA, and other Space Agencies placing astronauts in Space, and doctors have noted the increased risk of both Lumbar and Cervical Disc Herniations with resulting Back Pain and Neck Pain in Astronauts. "The ongoing research on these astronauts can shed light on the causes and treatments for those suffering from Back Pain back on Earth, " comments Dr Prem Pillay, a Spine Specialist who deals with Back Pain relief in his practice.

A narrative literature review published in the European Spine Journal has concluded that the increased rate of intervertebral lumbar disc (IVD) herniation is most likely caused by an increase in lumbar disc hydration due to the reduced spinal loads experienced in space. Given the dramatic paucity of even basic biomechanical research into the cervical spine, however, the authors were unable to speculate as to the cause of elevated rates of cervical disc herniation after spaceflight.The National Aeronautics and Space Administration (NASA) have previously observed an increased risk of disc herniation (10% (n=321) vs. 3.5% (n=983), respectively) in US astronauts, compared to the general population. Thirty-two of these herniations took place within the first week, post-flight, while another 32 took place within the first year. Investigating this high rate of disc herniation, the authors propose a mechanical mechanism—that overhydrated discs are swollen, as annular structures are stretched and nucleus pressure increased—to explain the increased rates of lumbar disc herniation. The nucleus of the disc can then herniate more easily in flexion, offering an explanation for the increased risk of disc herniation in the first few days after space flight. Data from bed rest studies were analysed to show that the effects of reduced load in space could take weeks, or even months, to fully return to normal. The authors recognised that, while bed rest may not be a good model for the effects of spaceflight on the cervical spine, it could be an acceptable model for the lumbar spine. The authors argue that IVD hyperhydration in astronauts “can be inferred from increases in spine length and body height during spaceflight”. Lead author, Daniel Belavy, said, “Cervical disc herniations are probably more common in astronauts for the same reason that lumbar herniations are: disc hyperhydration. However, this is not clear. Nonetheless, it would be a big coincidence if there were another reason.” Ergonomic issues, such as the position held by astronauts during spaceflight and on landing, as well as the potential cumulative effects of injury to the spine prior to space flight, may compound the risk of post-flight disc herniation. The authors also considered how research into the effects of spaceflight on the spine could improve understanding of the spine more generally. The role of mechanical loading of the IVD may be better understood given more extensive research into the spines of astronauts. This data, plus that of back pain starting before 12pm, for example, support the notion that the effects of diurnal variation in the spine might influence risk windows for back injury. “Differences in back pain incidence over the course of a day is likely related changes in disc hydration during a normal sleep-wake cycle,” Belavy told Spinal News International. Such research could help evaluate which times of the day are safest for activities such as spine flexion, and shed light on the role of mechanical loading in lumbar disc herniation more generally. Belavy commented, “What we gain from understanding why astronauts are more likely to experience a disc herniation will help us understand and manage spinal disorders in the general population.”
Dr Prem Pillay a Spine Specialist agrees stating "This research on Back Pain in Astronauts from Space, shows that avoiding Lumbar flexion or forward bending of the spine especially in the early morning, on getting up from bed or in tying shoe laces for example, can reduce injury and stress to the lumbar discs. This could prevent or reduce Lumbar disc herniation in conjuction with other measures."

References and further info:

NASA 2015
European Spine Journal, Belavy D, et al, 2016
Spine and Pain Info

Smoking Cigarettes Can Be a Pain in Your Neck

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SMOKING CIGARETTES CAN BE A PAIN IN YOUR NECK

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The cervical spine is located in the neck and is made up of bones called vertebrae. Between these bones are cervical discs that allow flexibility and movement of the neck and absorb shock to the spine. Through the normal aging process or through injury or poor posture and prolonged sitting, these discs  degenerate or deteriorate, which means they can loose height, or protrude into the spine nerve spaces, states Dr Prem Pillay, a Spine Specialist. This may result in a person experiencing chronic neck pain that may be difficult to treat. In some cases, the drying and deterioration of the disc may result in the formation of cracks and tears, through which some of the jelly-like central portion of the disc may spill out and irritate local nerves, which much of the time results in pain in the shoulders, arms, hands and fingers.
It isn't only wear and tear  that can damage these discs. Some unhealthy habits, such as smoking, can add to cervical disc degeneration, according to Mitchel Leavitt, MD; resident physician at Emory University's Department of Physical Medicine and Rehabilitation and the lead investigator of a new study looking at smoking and cervical disc disease. "Smoking is not healthy for a person's intervertebral discs given the risk of developing microvascular disease -- a disease of the small blood vessels -- due to nicotine abuse," Dr. Leavitt explains. "Intervertebral discs receive their nourishment from the microvasculature that line the endplates on either side of each disc; when these blood vessels are damaged, the discs do not receive nourishment and this may speed up the degenerative process."
While smoking has been associated with degeneration in the lumbar spine (toward the base of the spine), no studies have been able to make this association with the cervical spine. To address this, Dr. Leavitt's team evaluated the CT scans of 182 consecutive patients who were scanned for various reasons.
"There are more and more high-quality studies coming out that show an association between healthy lifestyle and improved quality and quantity of life as well as better disease management. Spine health is no different, and this study adds to existing studies that have looked at blood vessel health as it relates to chronic back pain," Dr. Leavitt says.
The patients evaluated by Dr. Leavitt's team were mostly female (57 percent), and 34 percent were smokers. The researchers utilized a radiologist with subspecialty training in neuroradiology and a physiatrist -- a physician who specializes in physical medicine and rehabilitation -- to review the CT scans, and they provided documentation on the severity of cervical degenerative disc disease.
Each disc was rated as normal (no loss of disc height), mild (one to 33 percent loss of disc height), moderate (34 to 66 percent loss of disc height), or severe with (greater than 66 percent loss of disc height or having a condition called vacuum disc where gas has accumulated in the discs). Based on this, scores of zero (normal) to three (severe) were given to each disc, and a cumulative cervical degenerative disc disease score was given for the entire cervical spine with a range of zero to 15.
The researchers considered each patient's smoking status and his or her number of pack years smoked, which is the number of packs of cigarettes the patient smokes each day multiplied by the number of years he or she has smoked. Finally, the researchers collected and considered other health information such as age, body mass index, high blood pressure (called hypertension), high cholesterol and diabetes.



Current smokers were found to have more cervical degenerative disc disease by one point, on average. Additionally, the researchers found that increased age was associated with worsening cervical degenerative disc disease, but co-existing diseases -- such as diabetes, hypertension, high cholesterol and high BMI -- were not associated with the disease.
"This is another example of the detrimental effects of smoking. Tobacco abuse is associated with a variety of diseases and death, and there are lifestyle factors associated with chronic neck pain," explains Dr. Leavitt of the study's findings. "Pain and spine clinics are filled with patients who suffer chronic neck and back pain, and this study provides the physician with more ammunition to use when educating them about their need to quit smoking."
Dr Prem Pillay Medical Director and Spine Specialist at the Neuro Spine and Pain Center Singapore agrees stating '' Holistic treatment of Spine Disc disease and injury includes asking patients to reduce or stop smoking especially before and after spine surgery or procedures to improve healing; together with physiotherapy and workstyle adjustments to reduce disease progression.''

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 References;
The above post is reprinted from materials provided by Association of Academic Physiatrists (AAP). Note: Materials may be edited for content and length.

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Association of Academic Physiatrists (AAP). "Smoking Cigarettes Can Be a Chronic Pain in Your Neck." ScienceDaily. ScienceDaily, 18 February 2016.

More information on the Spine at SingaporeSpine

ADVANCED MINIMALLY INVASIVE SPINE SURGERY-MISS AND AMISS

There are many people who need back and neck surgery but are afraid of it. Many have heard horror stories of severe pain, long recovery periods and even those who have become paralysed. There is however technology currently available that addresses these concerns. It is true however that these methods are available from some neurosurgeons/spine surgeons worldwide; those who have listened to  patients and understood their needs have been working hard to find solutions that are minimally painful, allow quick recovery and are effective treatments.

These solutions include but are not limited to several of the following:

1.Percutaneous Plasma Energy Discoplasty
2.Percutaneous Endoscopic Laser Disectomy-PELD
3.MicroDisectomy
4.Endoscopic Disectomy
5.Microsurgical Discetomy with Dynamic Implants
6.MicroEndoscopic Discectomy-MED
7.Microsurgical Spinal Decompression
8MicroEndoscopic Spine Microsurgery- MESM
9.Percutaneous Disc Regeneration Technology
10.Endoscopic Disc Replacement
11.Microsurgical Disectomy and disc replacement
12.Minimally Invasive Spine Fusion and Instrumentation

Some of these options allow the patient to arrive at a day surgery center, have the procedure under iv sedation and local anesthesia (no general anesthesia) and leave within a few hours of a fairly short procedure. Most patients walk out of the center themselves and can return to work in a few days.

Unlike taking pain medications or pain injections; these procedures do address the root of the problem. They allow reduction in nerve pressure and therefore can prevent ongoing or future nerve damage. Spinal nerves especially the spinal cord, cannot be effectively replaced at this point in time. Stem cell treatment is still experimental and not consistently successful. Taking away spine nerve pressure to reduce the risk of spine nerve injury is still the best strategy.

These procedures are also evolving and becoming more successful with experience, technology and the passage of time. Many of us who are Minimally Invasive Spine Surgeons believe that more spine doctors need to know and be trained to do these procedures. An informed patient can also help to accelerate these changes worldwide by insisting on the latest and least invasive spine treatments.

References

Dr Prem Pillay, Singapore Spine Specialist and Neurosurgeon

Neuro Spine and Pain Center Singapore

Leg Pain can occur from Back Problems!

Leg Pain can come from Back problems that may start as

back pain and then spread to the legs. This is also called
Sciatica or psuedo claudiation leg pain.

Back Pain used to be seen mainly in those who worked
 in physically demanding jobs like builders, bricklayers,
 plantation workers, heavy industry workers , construction
 workers and miners. However, nowdays Dr Prem Pillay 
 has noticed that there are more executives who come

 to him for back pain. He has identified prolonged sitting,
 a poor posture, overuse of computers , frequent business
 travel and a unhealthy  executive lifestyle as major reasons
 for this problem. When you sit too long, he explains, there
 is increased pressure in the spine discs. The spine is not
 one bone but about 33 bones with a soft gel like substance
 called the disc in between. The disc allows flexibility and

 movement in the spine.  An Executive Lifestyle with 
computer work and  a lack of movement can cause the
 spine discs to break down and come  out or slip out.
 These slipped discs can pressure on the nerves  and cause
 back pain, leg pain, numbness, tingling, and as the problem 

 gets worse even weakness in the legs. The worse case
 scenario is becoming unable to walk, unable to pass urine
 or pass motion. This  can happen gradually or in some people
 it can happen suddenly even  from a small accident or injury 
once the pressure on the spine nerves is already present.

People who have back pain and leg pain often go for 
massages or manupilation  to therapists and chiropractors.
If the pain does not get  better  after three visits to the 
therapist , or gets worse after the first visit, or comes back
after the therapy  , its best that you see a real spine specialist.
Dr Prem Pillay does warn that massage therapy or 
physical therapy done in the wrong way by unqualified people
can  make the problem worse.  A proper spine and nerve 
examination followed  by an MRI of the spine can reveal
and confirm the problem. X rays alone cannot show the
nerves or pressure on the nerves from  a slipped disc.

In some older people, the back pain with leg pain is 
caused by spine stenosis. This is a narrowing in the spine 
canal which squeezes the spine  nerves. A common story
that Dr Prem hears is that the person cannot  walk far
without the legs feeling uncomfortable. He or she has 
to stop  and rest first before walking further. This is called
spinal claudication pain  or psuedo-claudication leg pain.

Back pain and leg pain can often be treated without
 surgery. The proper  medications and  therapy organized
 by a spine specialist can help the  person recover faster 
and return to his normal lifestyle. Some people require
 spine injections including nerve blocks,  Neuroplasty, 
facet injections, Annuloplasty, Biacuplasty, and RF to the 

medial branch nerves to reduce pain. The better and 
more advanced  type of spine injections such as Discoplasty
treat the root of the problem.  This involves a laser like spine
njection to the disc to reduce the disc pressure on the nerves. 
This can be done as a day procedure  without any surgery.

In some people the problem has become too serious
and requires surgery.  Fortunately modern surgery including
microsurgery and keyhole type spine  surgery has advanced
to a stage that the risks are low and the recovery  can be  
quick. These are minimally invasive spine procedures with
a keyhole  like approach.  Dr Prem gives the example of a
 patient who came to see him because of back pain with leg pains 

 that was worse on sitting for  too long and on walking a short distance.

The test showed that he had  spinal nerve pressure from 
slipped discs and spine narrowing. A minimally  invasive 
advanced microsurgery was done without any metal screws
but  using modern gel implants. He has now recovered
well after a short hospital stay and is walking and working
with a good quality of life.

In conclusion, more people including home and  office
 workers are suffering  from back pain. If this back pain 
is frequent or spreads to the legs, Dr Prem Pillay recommends
 that you see a spine and nerve specialist  for a proper check
 up to find out the root of the problem. Once the causes

 for the back and leg p[ains are found and treated at the source;
 a healthy lifestyle with less sitting, the right exercises and a good
 diet can also work together  lessen or solve frequent back pain 
and leg pain. 

Furthur information is available at 

http://www.spine-neuro.org/
 and http://www.singaporespine.org/
or by contacting clinicsg@yahoo.com or calling +6568354325 for assistance.