Take 2 aspirin & call me in the morning doesn’t cut it with chronic pain

5 Realities of Living with Chronic Pain
by Stephanie Burke

Living with chronic pain is challenging enough because of the obvious reason—the pain—but there are other factors that go along with this condition that make life even more difficult.

If you live with chronic pain, consider sharing this blog with your loved ones so they can better understand what your daily life is like.

Chronic pain may persist even after a condition, such as spinal stenosis, is addressed through surgery.

  1. Pain is rarely “all in your head.”

People in pain are often treated as if their pain is actually made up or greatly exaggerated. While it is true that pain is subjective (people simply perceive pain differently) and some people may report pain because they have other agendas, for the vast majority the pain is real and present. It is not made up. The problem is that chronic pain is often caused by anatomical problems that are difficult or impossible to diagnose using standard medical tests, and pain cannot be diagnosed like other medical problems (such as a broken bone that can be seen on an X-ray).

Fortunately, most in the medical community are now trying to understand and appreciate that chronic pain is real and needs to be treated and managed differently.

  1. Pain is not the only problem—it breeds other health problems.

Thoughts and emotions related to chronic pain also can both aggravate and alleviate the pain. For example, depression, which is a serious disease, can worsen the pain. Sleep problems, again caused by the pain, can also make the pain worse. And increased pain usually leads to increased sleep problems.

Often all conditions related to the pain need to be treated concurrently in order for the patient to get any relief.


  1. Pain is deeply personal.

Everyone experiences and expresses pain differently. Any two people with the exact same health condition are likely to feel and express their pain in unique ways depending on a number of factors. Newer chronic pain theories now have physiological explanations for how and why people experience pain differently.

When it comes to back pain, this is especially true. Two people can have the same type of herniated disc, but one feels only slight discomfort and the other feels intense burning pain that is unresponsive to conventional treatment. It is also not uncommon that no anatomical cause of the pain can be detected.

Why is this point important? It means that chronic pain often needs to be treated as the primary problem, which is different than the conventional medical approach of identifying and treating the underlying problem causing the pain.

  1. Chronic pain is its own beast.

Unlike acute pain, which functions as a warning signal (e.g. I just stepped on a nail—better move my foot!), chronic pain does not have any useful function. It just is.

Often, chronic pain is caused by nerves that continue to send pain signals to the brain. When dealing with chronic pain, one of the most frustrating things is that there is nothing to “fix.” It just exists in your body.

  1. Chronic pain is LONELY.

After awhile, many people with chronic pain—especially pain that is caused by a condition that cannot be seen—begin to feel isolated. Here the Internet has done a world of good helping people in pain connect with others in similar situations and find a supportive peer group through online communities of people in similar situations.

Having a clearer understanding of how chronic pain works, as well as the central role that the mind plays in the experience of chronic pain, is becoming more mainstream in the medical community. Patients who start to gain more understanding of their own chronic pain may also benefit in terms of gaining increased emotional support, more effective and sustainable pain management, and even possibly harnessing the power of their minds to assist in coping with the pain.



Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Texters Beware!

Take note texters, your spine is suffering

You’re 18, ready to start college, play sports, make it big and prepare for spinal surgery. Wait, what? Spinal surgery? But I don’t have back pain or injury you say. Go ahead and blame that sometimes 60 degree angle of your neck is at while you are texting friends and family. Our bodies aren’t designed to keep that kind of stress on the neck and will eventually lead to degeneration.

“Your spine is at its happiest when your ears fall on the same plane as your shoulders, and your shoulder blades are retracted. Without these adjustments, you put added stress on your spine, Dr. Kenneth K. Hansraj, spinal & orthopaedic surgeon.

When you are texting, you are actually doing damage to yourself. Okay, once in a while isn’t going to hurt you, unless you’re driving at the same time, but consistent posture like this will do damage. It’s like carrying 60 pounds of extra weight on your spine. That’s a second grader on your back all the time! Nobody wants that. Normal usage would be about 700 – 1,400 hours of pressure and the worst offenders are looking at about 6,000 hours of that intense pressure on their spine per year. Here’s an idea of the pressure you put on yourself when you text and hold that position for a while.

Image Courtesy of

Image Courtesy of

Your resting pressure when you hold your head up straight is about the weight of your head, or 11 pounds. At 15 degrees tilted, it’s about 27 pounds, 30 degrees is about 40 pounds and by the time you hit a 45 degree angle, you are looking at 60 pounds of pressure on the spine.

That is a lot of pressure to be putting on your spine. However, it’s almost impossible to avoid today’s technologies so what do you do to help combat it?

Make an effort to limit the tilt. Okay, that can be easier said than done so here comes the Mom card. Do as your mom always told you and stand up straight. Good posture is so important on so many levels, don’t let it fall aside for a text. Keep your phone, or electronic device, away from waist level when looking at it to ease of off the pressure. “Look down with your eyes, no need to bend your head.” advises Hansraj

Here at Blue Ridge Orthopaedic & Spine Center, we offer complete comprehensive care for the whole family, including Physical Therapy, which is an invaluable resource to getting you back to your daily activities after an injury or surgery and will work with you to reverse the detrimental effects of repetitive daily activities like this.



Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Physical Therapy offers a non-drug alternative to Pain Management

NIH Says Current Treatment of Chronic Pain Has Created ‘Silent Epidemic;’ More Focus Needed on Non-Drug Approaches

News Now Staff – APTA

According to a report recently released by the National Institutes of Health (NIH), it’s time that treatment of chronic pain moves from a 1-pill-fits-all mindset to an evidence-based, individualized, multidisciplinary model that recognizes the value of non-pharmacological approaches, including physical therapy.

The report (.pdf) is the product of an NIH panel that looked at the current state of treatment for chronic pain, which is estimated to affect 100 Americans. In addition to looking into research on the issue, the panel convened a workshop that included more than 20 speakers. The results of the panel’s work were published earlier this week (.pdf), and featured in the online edition of Time magazine.

Much of the report is focused on the use—and possible overuse—of opioids as the “go-to” approach in almost all cases of chronic pain. In addition to contributing to patterns of drug abuse, the reliance on opioids may simply not be helping in all circumstances, according to the panel report.

“Together, the prevalence of chronic pain and the increasing use of opioids have created a ‘silent epidemic’ of distress, disability, and danger to a large percentage of Americans,” authors write. “The overriding question is whether we, as a nation, are currently approaching chronic pain in the best possible manner that maximizes effectiveness and minimizes harm.”

The answer to that question, the panel found, is no. Patients with chronic pain are typically “‘lumped’ into a single category, and treatment approaches have been generalized with little evidence to support this practice,” they write.

Because the manifestations and response to pain can be so varied, the report calls for a variety of treatment options that include physical therapy, which is specifically mentioned in the report. These non-pharmacological treatments can be very effective—the problem, as one speaker at the workshop noted, is that “lack of knowledge or limited availability of these non-pharmacological modalities and the ready availability of pharmacological options and associated reimbursement structure appear to steer clinicians toward the use of … opioids.”

An NIH press release on the report quotes panel chair David B. Reuben, MD, as saying that “clearly there are patients for whom opioids are the best treatment for their chronic pain. However, for others, there are likely to be more effective approaches.” The solution, he believes, is to ensure that “every patient’s individual needs are met by a patient-centered health care system.”

The panel report cites many barriers to the implementation of such a system, including lack of substantive evidence-based research, limited physician access to experts in other disciplines, and some insurance plans’ resistance to integrative treatment approaches. For now, authors write, the chronic pain landscape is one in which “large numbers of Americans are receiving suboptimal care.”

The release of the report comes at a time when the issue is receiving wider attention, thanks in part to Cake, and a new film starring Jennifer Aniston as a woman with chronic pain. Recently, the Washington Post addressed the issue in an article that called for a “blended approach” to chronic pain, including the use of physical therapy. That story followed up on a January 12 Washington Post article titled “8 ways to deal with chronic pain.” The article’s first recommendation: “embrace physical therapy.”

“The more you move, the better you feel,” reporter Rachel Noble Benner writes in the article. “Strategically strengthening and stretching the body, especially parts that are affected by chronic pain, can increase mobility, decrease pain, and improve overall mood. Find a physical therapist who is experienced in working with people who have chronic pain.”

The Physical Therapists at Blue Ridge Orthopaedic & Spine works exclusively in the treatments of Orthopaedic conditions and have experience working with patients who have chronic pain. In conjunction with your doctor and using evidence-based treatments, we create treatment plans to treat the patient as a whole, not just the injury, and to restore full functionality.

BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center is Northern Virginia’s premier facility for diagnosing and treating back pain and spinal disorders. In addition to our regionally renowned Spine Center, our practice features Joint Replacement, Sports Medicine, Pain Management, Physical Therapy, Trauma Center, Shoulder Care, a Hand Center and a Foot and Ankle Center.

We are committed to treating not just injuries and physical ailments, but rather the whole person, by offering a wide range of specialty programs designed to support treatment. Specialty programs include Massage Therapy, Medical Nutrition and Aquatic Physical Therapy.

APTA has been at the forefront in helping the public understand how physical therapy can be a transformative agent in the treatment of chronic pain. The subject was featured in a Move Forward radio podcast, and the association offers a physical therapist’s guide to chronic pain syndromes. Additionally, the APTA Orthopaedic Section sponsors a special interest group in pain management, and the PT’s role in chronic pain management was featured in the September issue of Motion magazine.

What is Bone?

Anatomy of the Bone

What is bone?

Our bones create a strong framework for which we are built. It protects organs, creates our unique shape, and is a living part of us. Bone also serves as a storage site for minerals and provides the medium–marrow–for the development and storage of blood cells. They are as fragile as they are strong. We must take care of our bones as well as we take care of our whole bodies.

Bone is living tissue that makes up the body’s skeleton. There are three types of bone tissue, including the following:

Front view of a leg bone with cut section showing bone marrow.

  • Compact tissue. The harder, outer tissue of bones.
  • Cancellous tissue. The sponge-like tissue inside bones.
  • Subchondral tissue. The smooth tissue at the ends of bones, which is covered with another type of tissue called cartilage. Cartilage is the specialized, gristly connective tissue that is present in adults, and the tissue from which most bones develop in children.

The tough, thin outer membrane covering the bones is called the periosteum. Beneath the hard outer shell of the periosteum there are tunnels and canals through which blood and lymphatic vessels run to carry nourishment for the bone. Muscles, ligaments, and tendons may attach to the periosteum.

Bones are classified by their shape–as long, short, flat, and irregular. Primarily, they are referred to as long or short.

There are 206 bones in the human skeleton, not including teeth and sesamoid bones (small bones found within cartilage):

  • 80 axial bones. This includes the head, facial, hyoid, auditory, trunk, ribs, and sternum.
  • 126 appendicular bones. This includes arms, shoulders, wrists, hands, legs, hips, ankles, and feet.

What are the different types of bone cells?

The different types of bone cells include the following:

  • Osteoblast. Found within the bone, its function is to form new bone tissue.
  • Osteoclast. A very large cell formed in bone marrow, its function is to absorb and remove unwanted tissue.
  • Osteocyte. Found within the bone, its function is to help maintain bone as living tissue.
  • Hematopoietic. Found in bone marrow, its function is to produce red blood cells, white blood cells, and platelets.

Fat cells are also found within the bone marrow.

bone make up

Bone development and growth

Osteogenesis (bone tissue formation) occurs by two processes:

  • Intramembranous ossification involves the replacement of connective tissue membrane sheets with bone tissue and results in the formation of flat bones (e.g. skull, clavicle, mandible).
  • Endochondral ossification involves the replacement of a hyaline cartilage model with bone tissue (e.g. femur, tibia, humerus, radius).

Long bones continue to grow in length and width throughout childhood and adolescence. Increase in length is due to continued endochondral bone formation at each end of the long bones. Increase in circumference of the bone shaft is achieved by formation of new bone on the outer surface of the cortical bone.

Bone Modeling

Modeling is when bone resorption and bone formation occur on separate surfaces (i.e. formation and resorption are not coupled). An example of this process is during long bone increases in length and diameter. Bone modeling occurs during birth to adulthood and is responsible for gain in skeletal mass and changes in skeletal form.

Bone Remodeling

Remodeling is the replacement of old tissue by new bone tissue. This mainly occurs in the adult skeleton to maintain bone mass. This process involves the coupling of bone formation and bone resorption and consists of five phases:

  1. Activation: preosteoclasts are stimulated and differentiate under the influence of cytokines and growth factors into mature active osteoclasts
    2. Resorption: osteoclasts digest mineral matrix (old bone)
    3. Reversal: end of resorption
    4. Formation: osteoblasts synthesize new bone matrix
    5. Quiescence: osteoblasts become resting bone lining cells on the newly formed bone surface

We often overlook our bones when we talk about staying healthy and strong, but we can’t dismiss them and must work to keep them in great shape. The doctors and PA’s here at Blue Ridge Orthopaedic & Spine Center are at the top of their field when it comes to treating you and your orthopaedic concerns.

We have on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. For your convenience, both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

References: and The StayWell Company.

Cold Weather and Joint Pain – Is it related?

The winter weather seems to have blown in quickly this year and ready or not, it’s time to bring out those cold weather clothes. Do you seem to feel more pain in the cold? Here are some reasons why that could be.

Does Cooler Weather Affect Your Joints?

Article written by: Carrie DeVries

As we say goodbye to warm weather and look ahead to fall and winter, many people look forward to breaking out their sweaters, scarves, and boots. But if you have rheumatoid arthritis (RA), you may dread the colder weather, as cool days make joints stiff and achy.

Here are a few tips for those with RA—or any arthritis affected by temperature change—to cope with the cold.

Weather is a factor

Researchers have done multiple studies to uncover the link between weather and arthritis pain. Their findings have failed to turn up clinical proof of a connection. But patient experiences tell a different story.

A majority of those with rheumatoid arthritis report feeling differences in pain based on changes in temperature, humidity, or barometric pressure. According to one study, levels of pain for study subjects with RA were highest on cold, overcast days.1

Other types of arthritis can be affected too. Patients with osteoarthritis will report that swelling and warmth in their joints gets worse during weather changes.

Heat therapy helps joints

If the cold weather makes your pain worse, try adding heat therapy into your daily routine. This can decrease stiffness and promote healing through better circulation.

Here are four ways you can generate a little heat:

  1. Hold a hot pack, warm towel, or heating pad on the painful joint.Doing this for 20 minutes at a time can warm up the joint and provide temporary pain relief.
  1. Try using over-the-counter heat wraps or patches. These items are available in most pharmacies and can provide warmth for up to 8 hours.
  2. Take a dip. You may experience pain relief by swimming or doing water therapy in a heated pool a few times per week, or by soaking a whirlpool or hot bath.
  1. Get moving. It can be tempting to hibernate during cooler weather, but inactivity can actually increase your pain. Regular physical activity will keep joints warm and lubricated. If you prefer to stay inside, consider purchasing a treadmill so you can walk while you watch TV. Check with your physician before you start a new exercise routine.

Read more…


  1. 1.      “Rheumatoid arthritis patients show weather sensitivity in daily life, but the relationship is not clinically significant.” Pain.1999 May;81(1-2):173-7


BRO-Logo-colorBlue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.