Spina bifida (SB) is characterized by many unpleasant symptoms one of which is back pain. Back pain severely disturbs the quality of life of the patients. Therefore, it becomes very important to abolish this continuously disrupting symptom. There are many ways to control pain. Ten ways of taking care of the management of pain in SB are discussed below . Pain can be general or more localized. Perhaps it is in the upper or lower back .
1. Postural modification
In this type of therapy, the patient is educated about postural conditions causing pain. The patient is advised to change their sitting or lying position to alleviate the pain. Change in position causes a remarkable decrease in pain.
The patient is advised to make a habit of the change in position. This simple adjustment helps the patient to have a better quality of life. It is important to avoid the twitching of muscles and muscle spasms. The patient has to rehearse and adopt the changed postures in which he/she feels better. The patient will eventually get used to the advised posture [1,2] as there is a reduction in pain.
2. Psychological Support
Pain is a physical and emotional problem. The patient is provided with psychological support by the family or health care providers. Psychiatric help is also beneficial for the treatment. The psychiatric help should be provided by trained and qualified psychiatrists or psychologists. This therapy helps to relieve the anxiety of the patients. Thus, the patient is more relaxed and his fears are addressed. With familial support the degree of success of this therapy increases several times [1,2].
3. Physiotherapy and Cranio-sacral Therapy
The main purpose of physiotherapy is to help the patient in the development of normal movements and muscle functions. Physiotherapy also helps to relieve muscle cramps. Physiotherapy in combination with cranio-sacral therapy (a form of alternative therapy body touch focusing on the synarthrodial joints of the cranium) may help in relieving tightness in muscles and balancing the hormone levels. Muscle stretching and muscle strengthening along with cranio-sacral therapy may help to normalize the body functions [1,2].
4. Orthopedic Evaluation
The patient should be regularly evaluated by the orthopedic specialists. The main concern is the evaluation of bone and muscle development. If there is any problem it should be addressed immediately. Porous bones cause severe pain and this condition needs urgent diagnoses and treatment. Abnormal development of bone and muscle may be accompanied by spina bifida. If such condition (bone deformity) is diagnosed the probability of success is reduced .
5. Central Nervous System Evaluation
The central nervous system development should be examined and evaluated by the neurosurgeon. In case of any problem it should be dealt with immediately. For instance, in case of hydrocephalus shunting becomes inevitable. It is a surgical procedure in which a shunt is placed in the brain to drain excessive nutritional fluid (cerebrospinal fluid) from the brain. A common symptom of hydrocephalus is headache .
6. Upper Back Pain Management
Two factors causing upper back pain can be posture and tension (in women, weight of breasts as well). These factors determine the degree of pain. However, pain can also be caused by a shunt or rod which is trying to poke through the skin. If the patient has a painful rod or shunt in back, it should be evaluated and fixed properly, so that complications can be avoided. If the causal factor is mechanical it can be relieved by physiotherapy. Pain can also be relieved by simple analgesia in most cases. Sometimes physiotherapy along with analgesia is needed .
7. Lower Back Pain Management
Lower back pain in SB can be associated with factors such as tethered cord which becomes symptomatic and causes pain. There may be difficulty in walking and bladder problems as well. If these kinds of problems are found and diagnosed early, they can be corrected. The mainstay of treatment is to know the cause of pain. If the cause is known, it can be corrected.
A yoga tutorial video created by an instructor as a request from a student with Spina Bifida
The lower back pain in spina bifda can also be due to muscle problems. This kind of pain needs postural modification. Once this sort of situation has developed it can only be treated by changing the sitting or standing posture .
8. Analgesic Agents
Different types of analgesic drugs can be used in the treatment of pain. The analgesic agent is selected depending upon its efficacy, adverse effects and the severity of pain. In case of low to moderate level of pain simple analgesics are used (e.g., NSAIDs). In case of severe pain opioids are used. The analgesic can be used orally or intramuscularly or intravenously. For the most part, in low to moderate pain, the oral route is used. Oral analgesia takes some time to abolish pain. An intravenous route is used for quick relief of pain .
9. Surgical Interventions
The ultimate solution of the SB pain is surgical intervention. The patient may have to go through a lot of surgical procedures. The patient may need surgery for drainage of nutritional fluid (CSF) because of over production. The patient may need surgery for tethered cord or for some other deformity. These surgical procedures are complicated and the success ratio is low [1,4].
10. Sleeping chips
If the patient is having pain and sleep disturbance using sleeping chips (CieAura holographic chips) can be beneficial. These chips help the patient to have a peaceful sleep. These chips are placed upon the body of the patient where it hurts as well as on his/her temple at night. These are coded chips and contain information which vibrates with the body cells. This has an effect similar to the effect music has on the mind .
- Cannone J. Spina bifida back pain [Internet]. [updated 2011 June 30; cited 2013 Sep 10). Available from: http://www.losethebackpain.com/back-pain/spina-bifida-back-pain.html.
- Kessler Institute For Rehabilitation [Internet]. [cited 2013 Sep 10). Available from: http://www.kessler-rehab.com/programs/outpatient-services/pain-management/Default.aspx.
- Quizlet world learns here [Internet]. [cited 2013 Sep 10]. Available from: http://quizlet.com/11246073/drug-list-analgesics-and-anti-inflammatory-drugs-flash-cards/.
- Chapman C. [Internet]. [cited 2013 Sep 10]. Available from: http://ezinearticles.com/?Spina-Bifida—True-Story-on-Release-of-Chronic-Pain&id=3984238.