Question
What can I take for inflammation in my column discs. I went to see the Chiropractor and he said 3 of the discs are going to one sede and there is a smaller size in one side and a bigger one on the other side. I took a long therapy but it didn't work at all. What can I do now? I've being doing exercises but I don't feel better. I took 3 pills called Artren and they helped a little. Are they available here in california? Because I got them from Venezuela.

Answer
Hello A.,

First off, thank you for trusting me with your health.  However, as a disclaimer, please do not take any of my advice without at least consulting with your doctor first.  I always suggest printing this letter and taking it to your doctor for him or her to read.  From the information you抳e provided, I cannot completely determine what your problem or condition is.  The information is too general to know exactly what your diagnosis is.  Sometimes doctors will say certain things to patients, but it is not necessarily the clear diagnosis.  Things become much clearer for me to make a better recommendation for you when there is objective data, such as an X-Ray or MRI report.  However, I will try to assist you to the best of my knowledge.  

It sounds like you have some sort of a disc problem.  Typically, whenever the discs are involved in any painful condition of the spine, they have a tendency to bulge backwards in the spine, which is where the neural tissue is located.  Because of this, you experience pain.  However, you also noted inflammation.  Inflammation is bad (though it can be good when under control) because damaged cells in the body release chemicals that make you feel pain.  Secondly, the area of inflammation begins to develop stagnant circulation which only creates more pain from pressure building up.  For example, if you twist your ankle, your ankle will swell up like a balloon.  The pain is not only from the tissues being damaged, but also from the swelling stretching the tissues in a tight area of space.  This is painful.  So just because your back does not swell up like a balloon does not mean there is not fluid in the area of damaged tissues.  You would never put heat on an acutely injured ankle, because that抯 only going to exacerbate the problem.  And just the same, stay away from the hot showers and hot tubs.  For now, take tepid baths/showers and keep the ice on your back for at least a week or two until you start to have symptoms of relief and the injury has had time to heal.  There are studies that even show ice being as effective at reducing pain as popular over-the-counter pain-killers.  And the best part is, it抯 cheap, too!  When you ice, wrap the ice in a thin towel (to protect your skin) and ice for 20 minutes on, 40 minutes off.  I know it might sound like a lot, but try to do it a half-dozen times per day.

And as mentioned, because the discs have a tendency to bulge backwards, the best way to restore the function and proper placement of the discs to a more foreword position is to perform McKenzie extension exercises (I抦 assuming the discs you are referring to are in your low back and not your neck).  Here is a picture of what the exercises look like: http://www.mckenziemdt.org/images/BronzeLady.gif  When you go into this position, take your time, breathe deeply, and hold the position for about 30-60 seconds.  Do a half-dozen each session, three times per day.  When you go into this position, what happens biomechanically is the lumbar segments squeeze together on the back side and open up on the front side.  When this occurs, the disc is supposed to very gently slide back toward the front into its normal position where there is more space for it.  There might be some slight discomfort with this position, but not too much.  If it is painful, discontinue this.  Another big indicator is if pain increases when you are sitting or bending over, then you want to continue doing the McKenzie extension exercises as picture on the above link.  I抦 not sure what you mean when the 搕hree discs are going to one side.? When you say side, it sounds as if you mean the side of the body.  If this is the case, it would likely be the result of a scoliosis.  The other thing is it can抰 always be clearly determined where the discs are exactly without an MRI, thus making my suggestions slightly fuzzy.

However, for the inflammation, there are over-the-counter drugs, called NSAIDs (Non-steroidal anti-inflammatory drugs) that you could take, such as aspirin and ibuprofen.   However, be advised this is not within my scope of practice to recommend allopathic treatments.  Please check with your doctor before taking these medications.  In addition, these medications have side-effects, so it is important to be aware of that.  If you are looking for natural anti-inflammatory drugs, it is not likely they will be more effective at eliminating your pain than allopathic medications will be.  What you have is a structural issue, and if over-the-counter or prescription NSAIDs are not helping your pain, it is unlikely another remedy will.  The purpose of other remedies is to help with pain and reduce inflammation.  But to truly get to the root of the pain, you will be far better off addressing the structural problem.  If you have a disc problem, talk to your chiropractor or physical therapist about a traction protocol.  This will be more effective for you at eliminating pain, as it will attempt to fix your problem, not cover it up.  Traction is a mechanism that simply pulls the vertebra apart in a gentle manner.  Just as a disc bulge is secondary to too much pressure and wear and tear causing the disc to extrude, traction eliminates this pressure on the disc, helping to stretch the ligamentous tissue into its proper position.  However, because of the chronicity of your condition, one of the most important things you should be doing is taking 1000 mg of fish oil daily to help with the inflammation.

Another thing you should consider is talking to your chiropractor or a physical therapist about getting some ultrasound therapy done.  Ultrasound uses sound waves to affect tissue and promote healing.  It can function like heat or it can function like ice, based on its settings.  It is a little more aggressive at flushing out the inflammation than ice because an ultrasound machine has the capabilities to affect and penetrate deeper tissues.

Being that your discs are affected, it would be wise for you to consider taking a glucosamine chondroitin supplement down the road.  It抯 not such a concern immediately since it will not help immediately with the pain.

Unfortunately, the inflammation is only a problem because there are structural problems with the discs.  When the disc bulge is fixed, the inflammation is fixed.  Some people have to have operations to clean up the material of the disc if they抳e exhausted every resource and tried everything.  Other patients might have an epidural steroid injection.  Though these are not as aggressive as surgery, they are still very powerful drugs and should not be considered until all other options have been discussed with your doctor.

There is a lot of research showing the efficacy of acupuncture for the treatment of back pain, but it is unlikely it will fix the disc problem, again leading to inflammation.  However, part of the reason why acupuncture is so effective is it is supposed to be great for reducing inflammation.  So if you抮e trying to figure ways to lower the inflammation, and consequently the pain, then this is a very viable route for you to consider.  You should know if it抯 going to help or not if you start to see some resolution of pain and symptoms after 2-3 sessions.

As a side note, gamma tocopherol (a form of Vitamin E) also has some anti-inflammatory properties.  It won抰 hurt for you to take a low dose of vitamin E with a meal, but it may not be strong enough to provide the cure you are looking for.

Unfortunately, I don抰 believe the Artren is available in the US.  Maybe some rare stores carry it, but I抦 not familiar with the product.  You could try supplementing with Curcumin instead.  It is an Indian food cooking spice and is well-known for being a natural anti-inflammatory.  However, beware, as research has noted both carcinogenic (cancer) and anti-carcinogenic (anti-cancer) effects.

Overall, your best advice is to try the McKenzie extension exercises, keep the ice on the affected area, and seek out a doctor with an ultrasound machine and a good traction machine, such as the DRX-9000 traction device for the low back.  In addition, for maintenance purposes, you should seriously consider the fish oils, as mentioned above.

I also always like to advise patients to get second opinions from the same type of professionals.  You may have one of the best chiropractors in the world working for you, but every chiropractor is different from the next in a lot of aspects.  I would urge you to seek a chiropractor that practices evidence-based protocols and not gimmick or sales pitches with promises to fix your back without hesitation.  Listen to your gut.  If it sounds like a sales pitch, they抮e probably most interested in their business and not your health.  I hope this information can at least provide you with a bit of information to get you going on your way.  Best of luck!!

Dr. J.R. Strecker, D.C.