Scoliosis Pain

Scoliosis pain is not a usual symptom actually caused by the presence of a mild to moderate side to side spinal curvature. Most diagnosed patients do not experience any pain from their scoliosis conditions.

Many of the patients who do develop pain are actually suffering from mindbody symptoms often brought on by the diagnostic nocebo effect of the curvature, rather than the curvature itself.

Of course, this is not to say that all cases of scoliosis are asymptomatic. Although research data show that most minor cases are nothing to worry about, serious spinal curvatures are another matter altogether.

Severe and extreme scoliotic curvatures can cause terrible pain and a variety of disabling neurological effects through various processes.

The scope of this article will examine the obvious and lesser considered reasons why a patient may experience pain in association with a scoliosis condition.

Physical Scoliosis Pain

Scoliosis is a relatively common condition and the majority of patients have very mild curves that do not require any treatmentwhatsoever. Most minor spinal curves will not cause any pain or even be noticeable to the patient or others.

Moderate to severe scoliosis may be symptomatic, but always needs to be monitored. Some severe cases of scoliosis actually do compromise the integrity of the spine and can cause painful expressions in the spinal structures, back muscles or internal organs. These symptoms can be generated due to nervecompression, organ compression and a plethora of other case-specific reasons.

True structurally-induced pain from advanced scoliosis should be treated medically and possibly surgically. It is unfortunate that medical science does not have many options when it comes to scoliosis correction.

Hopefully in the future, doctors will have a better idea of the geneticcausation of scoliosis and will be able to prevent it, rather than treat it.

Psychosomatic Scoliosis Pain

Out of the minority of scoliosis patients who do have pain, some are actually suffering from a psychosomatic reaction to the nocebo effect of the diagnosis. In plain language, this means that the patient has been frightened by being diagnosed with scoliosis and the mind takes the 

opportunity

 to create painful symptoms based on expectation, rather than biological causation. Although the symptoms will seem completely structurally-motivated, they are actually enacted by the mind.

This type of pain can not typically be treated successfully using drugs orsurgery. The only proven treatment for a psychosomatic reaction of this kind is knowledge therapy. This is the only treatment that treats the actual psychoemotional cause of the symptoms, rather than wasting time treating ascapegoat physical abnormality.

It is crucial to remember that patients may have mindbody contributions to pain instead of just an exclusive cause. This means that even if a significant scoliosis condition exists and generates some symptoms, the pain may be intensified or extended in duration due to psychological overlay.

All chronic pain conditions have an emotional component and it is crucial to keep this in mind if the condition becomes particularly resistant to traditional care practices.

Recommendation on Scoliosis Pain

It is crucial that doctors inform and reassure a patient about the truth of their scoliosis conditions. Diagnosed patients should understand that mild to moderate spinal curvatures are rarely painful and should not cause them anydisability. This is especially important in young patients who are prone to experiencing terrible fear, insecurity and exclusion due to their spinal curves.

Parental and peer support can make the difference between a life filled with satisfaction and a life dominated by pain.

When I was diagnosed with scoliosis at age 16, I thought my life was over. My chiropractor did nothing to reassure me that my condition was stable and not worthy of fear. Instead, I was made to feel as if I was damaged and in need of lifelong treatment in order to maintain health and function.

It is no wonder why I developed such a disposition towards psychological back pain after this diagnosis. Looking back, my entire 18 years of suffering might have been prevented if this doctor had simply told me the truth, rather than trying to secure a new patient for his practice.

Later on, I learned that my curve was so slight that it actually fell into normal parameters and did not even quality as scoliosis at all. Too bad it took several years for this to occur. By this time, I was already deeply entrenched in the battle for my very life against a host of misdiagnosed back pain conditions.

Although I can’t change my past, I can at least create the chance to prevent this same injustice from occurring to another innocent scoliosis patient.

What Is Scoliosis? What Causes Scoliosis?

Scoliosis is a condition in which the spine bends to the side abnormally; either to the right or left. The curvature can bemoderate to severe. Any part of the spine can be bent in scoliosis; but the most common regions are the chest area (thoracic scoliosis) or the lower part of the back (lumbar scoliosis). 

According to the National Health Service (NHS), UK, in 80% of cases there is no known cause - it is idiopathic. 

The majority of children with scoliosis require no treatment, as the condition resolves on its own as the child grows. Those who do require treatment use a back brace, which is usually effective. A very small number of patients with scoliosis may require surgery. If left untreated, the condition can lead to serious spine, chest, pelvis, heart and lung damage.

What are the signs and symptoms of scoliosis?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Scoliosis signs and symptoms in children:

• Shoulders may not be of the same height (one is higher than the other)
• Head is not centered directly above the pelvis
• Ribcage is not symmetrical; ribs may be at different heights
• A shoulder blade is higher and more prominent than the other
• One hip is more prominent than the other
• Clothes do not hang properly
• The individual may lean to one side
• Uneven leg lengths

Scoliosis signs and symptoms in babies:

• A bulge on one side of the chest
• The baby might be consistently lying curved to one side

In more severe cases the heart and lungs may not work properly and the patient may experience shortness of breath and chest pain.

Some types of scoliosis can cause back pain. 

In the vast majority of cases scoliosis is not painful.

Great personalities with scoliosis

"Buffy the Vampire Slayer" star Sarah Michelle Gellar runs on a treadmill and does Pilates to help her scoliosis.

Born: 1977
Birthplace: New York City, New York, United States of America
Profession: Television producer, Actor, Voice acting
Institution: Fiorello H. LaGuardia High School, Professional Children's School 

Height: 5'4" 

Runner Usain Bolt was born with scoliosis.

Name: Usain Bolt
Born: 1986
Birthplace: Sherwood Content, Jamaica
Profession: Track and field athlete
Institution: William Knibb Memorial High School
Height: 6'4"

Rebecca Romijn was diagnosed with scoliosis when she was 13.

Name: Rebecca Romijn
Born: 1972
Birthplace: Berkeley, California, United States of America
Profession: Television producer, Fashion Model, Musician, Film Producer, Actor + 2 more
Institution: Berkeley High School, University of California, Santa Cruz
Height: 5'10"

Actress Elizabeth Taylor was born with scoliosis.

Name: Elizabeth Taylor
Born: 1932
Birthplace: Hampstead Garden Suburb, United Kingdom
Profession: Film Producer, Actor
Institution: University High School
Height: 5'2"
Date Of Death: 2011
Cause Of Death: Heart failure
Place Of Death: Los Angeles, California, United States of America

"Descendants" actress Shailene Woodley wore a back brace for two years to treat her scoliosis.

Name: Shailene Woodley
Born: 1991
Birthplace: Simi Valley, California, United States of America
Profession: Actor
Institution: Simi Valley High School
Height: 5'8"

How is scoliosis diagnosed

If you think you have scoliosis, you can see your doctor for an examination. The doctor will ask questions, including if there is any family history of scoliosis, or if you have had any pain, weakness, or
other medical problems.

The physical examination involves looking at the curve of the spine from the sides, front, and back. The person will be asked to undress from the waist up to better see any abnormal curves. The person will then bend over trying to touch their toes. This position can make the curve more obvious. The doctor will also look at the symmetry of the body to see if the hips and shoulders are at the same height. Any skin changes will also be identified that can suggest scoliosis due to a birth defect. Your doctor may check your range of motion, muscle strength, and reflexes.

The more growth that a person has remaining increases the chances of scoliosis getting worse. As a result, the doctor may measure the person's height and weight for comparison with future visits. Other clues to the amount of growth remaining are signs of puberty such as the presence of breasts or pubic hair and whether menstrual periods have begun in girls.

If the doctor believes you have scoliosis, you could either be asked to return for an additional examination in several months to see if there is any change, or the doctor may obtain X-rays of your back. If X-rays are obtained, the doctor can make measurements from them to determine how large of a curve is present. This can help decide what treatment, if any, is necessary. Measurements from future visits can be compared to see if the curve is getting worse.

It is important that your doctor knows how much further growth you have left. Additional X-rays of the hand and wrist or pelvis can help determine how much more you have to grow. If your doctor finds any changes in the function of your nerves, he or she may order other imaging tests of your spine including an MRI or CT scan to look more closely at the bones and nerves of your spine.

                                                                                                                                                                          

What is the treatment of symptoms and signs of scoliosis

 Treatment of scoliosis 

is based on the severity of the curve and the chances of the curve getting worse. Certain types of scoliosis have a greater chance of getting worse, so the type of scoliosis also helps to determine the proper treatment. There are three main categories of treatment: observation, bracing, and surgery.Functional scoliosis is caused by an abnormality elsewhere in the body.

This type of scoliosis is treated by treating that abnormality, such as a difference in leg length. A small wedge can be placed in the shoe to help even out the leg length and prevent the spine from curving. There is no direct treatment of the spine because the spine is normal in these people.

Neuromuscular scoliosis is caused by an abnormal development of the bones of the spine. These types of scoliosis have the greatest chance for getting worse. Observation and bracing do not normally work well for these people. The majority of these people will eventually need surgery to stop the curve from getting worse.

Treatment of idiopathic scoliosis is based on the age when it develops.

In many cases, infantile idiopathic scoliosis will improve without any treatment. X-rays can be obtained and measurements compared on future visits to determine if the curve is getting worse. Bracing is not normally effective in these people.

Juvenile idiopathic scoliosis has the highest risk for getting worse of all of the idiopathic types of scoliosis. Bracing can be tried early if the curve is not very severe. The goal is to prevent the curve from getting worse until the person stops growing. Since the curve starts early in these people, and they have a lot of time left to grow, there is a higher chance for needing more aggressive treatment or surgery.

Adolescent idiopathic scoliosis is the most common form of scoliosis. If the curve is small when first diagnosed, it can be observed and followed with routine X-rays and measurements. If the curve stays below 25 degrees, no other treatment is needed. You may return to see the doctor every three to four months to check for any worsening of the curve. Additional X-rays may be repeated each year to obtain new measurements and check for progression of the curve. If the curve is between 25-40 degrees and you are still growing, a brace may be recommended. Bracing is not recommended for people who have finished growing. If the curve is greater than 40 degrees, then surgery may be recommended.

As explained above, scoliosis is not typically associated with back pain. In cases with back pain, the symptoms can be lessened with physical therapy, massage, and exercises, including yoga. These can help to strengthen the muscles of the back. They are not, however, a cure for scoliosis and will not be able to correct the abnormal curve.

There are several different types of braces available for scoliosis. Some need to be worn nearly 24 hours a day and are removed only for showering. Others can be worn only at night. The ability of a brace to work depends on the person following the instructions from the doctor and wearing the brace as directed. Braces are not designed to correct the curve. They are used to help slow or stop the curve from getting worse.

If the curve stays below 40 degrees until the person is finished growing, it is not likely to get worse later in life. However, if the curve is greater than 40 degrees, it is likely to continue to get worse by 1-2 degrees each year for the rest of the person's life. If this is not prevented, the person could eventually be at risk for heart or lung problems. The goals of surgery for scoliosis are correcting and stabilizing the curve, reducing pain, and restoring a more normal curve and appearance to the spinal column.

Surgery involves correcting the curve back to as close to normal as possible and performing a spinal fusion to hold it in place. This is done with a combination of screws, hooks, and rods that are attached to the bones of the spine to hold them in place. The surgeon places bone graft around the bones to be fused to get them to grow together and become solid. This prevents any further curvature in that portion of the spine. In most cases, the screws and rods will remain in your spine and not need to be removed. There are many different ways for your surgeon to perform the fusion surgery. It may be all performed from a single incision on the back of your spine or combined with another incision along your front or side. This decision is based on the location and severity of the curve.

Surgery recovery varies some from person to person. Your doctor will usemedications to control your pain initially after surgery. You will likely be up out of bed to a chair the first day after surgery. You will work with a physical 

therapist

 who will assist you in walking after the surgery. As you continue to recover, it is important to improve your muscle strength. The physical therapist can help you with exercises for your muscles that will also help with the pain.

As with any surgery, there are risks of surgery for scoliosis. The amount of risk depends partially on your age, the degree of curve, the cause of the curve, and the amount of correction attempted. In most cases the surgeon will use a technique called neuromonitoring during surgery. This allows the surgeon to monitor the function of the spinal cord and nerves during surgery. If they are being placed at increased risk of damage, the surgeon is alerted and can adjust the procedure to reduce those risks. There is a small risk of infection with any surgery. This risk is decreased with the use of antibiotics, but it can still occur in some cases. Other potential risks include injury to nerve or blood vessels, bleeding, continued curve progression after surgery, broken rods or screws, and the need for further surgery. Each of these is rare.If a tumor such as osteoid osteoma is the cause of the scoliosis, surgery to remove the tumor is generally able to correct the curve.

People with degenerative scoliosis will often have more complaints of back and leg pain. This is related to the arthritis in the back and possible compression of the nerve roots that lead to the legs. Nonoperative treatment including physical therapy, exercises, and gentle chiropractic can help relieve these symptoms in some cases. People who fail to improve with these treatments may benefit from surgery. X-rays and possible MRIs will be obtained to plan for surgery. The surgery could include only a decompression or removal of bone spurs that are compressing the nerves. In some cases, a fusion will be necessary to stabilize the spine and possibly correct the abnormal curve.

Scoliosis Surgery: Potential Risks and Postoperative Care

Scoliosis surgery is extensive surgery and is only recommended when scoliosis curves are progressing rapidly enough to potentially cause severe deformity. It is important for patients to understand the risks of surgery and the post-surgery experience.

Surgery Risks

1. Paraplegia
The most concerning risk with scoliosis surgery is paraplegia. It is very rare (about 1 in 1,000 to 1 in 10,000 chance) but is a devastating complication. To help manage this risk, the spinal cord can be monitored during surgery through one of two methods:

• Somatosensory Evoked Potentials (SSEPs). This test involves small electrical impulses that are given in the legs and then read in the brain. If there is the development of slowing of the signals during surgery this can indicate compromise to the spinal cord or its blood supply. Another way to monitor the cord is with Motor Evoked Potentials (MEPs), and often both are used throughout a surgery.
• Read more with Somatosensory Evoked Potentials (SSEP).
• Stagnara wake up test. This test involves waking the patient during the surgery and asking them to move their feet. The patient does not feel any pain during this procedure and will not remember it afterwards.
•  If either of these tests indicates spinal cord compromise, the rods can be cut out and the surgery abandoned. Fortunately, this situation is extremely uncommon, and many procedures can be rescheduled if the patient is found to be neurologically intact after the surgery.
  2. Excessive Blood Loss
  Another risk with scoliosis surgery is excessive blood loss. There is a lot of muscle stripping and exposed area during the surgery. With proper technique the blood loss can usually be kept to a reasonable amount and blood transfusions are rarely needed. As a precaution, many surgeons will ask the patient to donate his or her own blood prior to surgery (autologous blood donation), which can then be given back to the patient after the surgery. Also, during scoliosis surgery the patient's blood can be collected and transfused back to the patient.
  3. Other Potential Risks and Complications
  
• The rods breaking or the hooks or screws dislodging (although with modern instrumentation systems, this type of hardware failure is quite uncommon)
• Infection (less than 1%)
• Cerebrospinal fluid leak (rare)
• Failure of the spine to fuse (about 1%-5%)
• Continued progression of the curve after surgery

Postoperative Care

Following scoliosis surgery, patients usually can start to move around about 2 to 3 days after the procedure. The total hospital stay is usually about 4 to 7 days. Patients can return to school about 2 to 4 weeks after surgery, but activity needs to be limited while the bone is fusing.
It is important to note that the more immobile the spine is kept the better it will fuse. Bending, lifting, and twisting are all discouraged for the first three months after surgery. For this reason, some surgeons will prescribe wearing a back brace for a period following the surgery which helps to restrict movement. Any physical contact or jarring type activities are restricted for about 6 to 12 months after surgery.
Generally the patient will be monitored with intermittent examinations and X-rays for 1 to 2 years after the surgery. Once the bone is solidly fused no further treatment is required.
For the most part, patients can resume normal activity levels after a thoracic fusion since fusing the thoracic and upper lumbar spine does not change the biomechanics of the spine all that much. Female patients who have had a scoliosis fusion can still become pregnant and deliver babies vaginally.

Johns Hopkins Pediatric Orthopaedics Patient Guide to Scoliosis Surgery

	Scoliosis Surgery Scoliosis is a rotation of the vertebrae (building blocks) of the spine that causes it to twist like a spiral staircase. The cause of this rotation is not known in most cases. Surgery is usually done to prevent one or more of the following problems that can occur with more severe scoliosis: � Decreased lung function � Back Pain � Poor Appearance Surgery is generally done when it is safest: before these problems develop. Surgery, therefore, is recommended for those patients that the surgeon feels could later develop the problems listed above. The surgery itself has two parts: � Straightening the spine with rigid rods. � Adding bone graft to the curved area of the spine to fuse it in the correct position previously obtained by the rods. "Graft" refers to pieces of bone taken from other areas of the patient's body (i.e. usually from the pelvis) or the bone bank. The fusion prevents the spine from curving more. After surgery, the patient is noticeably straighter, but not completely. Likewise, the x-ray usually looks better, but is not perfect. The curve that does remain, however, is not normally a problem.
	Risks associated with surgery: There are certain risks of scoliosis surgery that patients and their parents should know about. It is important to keep in mind that your surgeon has recommended the operation because he or she feels that the benefits of the procedure outweigh the risks. 1. Rod displacement: In a small group of patients (5% of those having surgery), one or more of the hooks used to straighten the spine may move from its proper position. This usually is not uncomfortable to the patient. In some cases, this displacement does not require any treatment. In other cases, however, it is best to correct it by additional surgery. 2. Infection: A small group of patients get an infection (1 to 2 % of those having surgery, with an increased incidence in children with Cerebral Palsy). This occurs within the first several weeks of surgery. This generally requires washing out the infection and using antibiotics. 3. "Pseudoarthrosis:" This is a failure of the bones to fuse at any given level and occurs in 1 to 5% of patients who undergo surgery. This can lead to discomfort or partial loss of the correction. The condition, which takes several years to show up, is best treated by placing more graft in the area that has failed to fuse. 4. Nerve damage: This rare complication (occurring in 1 to 2 per 1,000 patients having surgery) happens due to force placed on the spine during curve correction. A patient with this complication experiences partial or complete weakness and/or numbness in one or both legs. He or she may also have bowel or bladder weakness. The nerves are constantly monitored by a special team of neurologists during surgery to prevent nerve damage. 5. Rod discomfort: Patients may experience minor discomfort anywhere from 1 to 5 years after surgery. This occurs in less than 10% of patients and is due to the rod rubbing on sensitive parts of the body. The rods are usually left in place because they are partially covered by the fused bone which provides the strength of the correction. 6. Additional risks: Other uncommon risks include illness from a blood transfusion, urinary infection, and allergy to a medication. Many steps are taken to prevent these from happening.
	General Guidelines: Prior to surgery: The blood bank should be contacted at least six weeks before surgery if the patients wishes to pre-donate his or her own blood. He or she should take a signed note from the doctor on the actual day of donation. Blood from parents and relatives is not recommended. The day of surgery: the video on scoliosis surgery will give patients and their parents a great idea of what to expect, including everything from the pre-operative evaluation to recovery. After-care: the stomach is usually not working for the first two to three days after surgery, but then improves rapidly. Each pediatric orthopaedic surgeon has specific instructions for his/her patient’s home care. Please see the “discharge instructions” from your physician for scoliosis surgery. Discharge from the hospital: usually five to seven days after surgery. Return to school or work: the patient may resume school or activity when energy permits. For most patients, this means 2 to 4 weeks after surgery. The patient may drive when energy permits as well.
	Restrictions: � No lifting greater than 5 pounds � No bending above the waist. It is important to bend from the hips and keep the back straight. � No bicycling for 1 month after surgery. � The patient may shower seven days after surgery. � No sports, running, or jumping for 3 months after surgery. � There are no permanent restrictions after 6 months of the date of surgery. Medications given upon discharge: � Iron tablets: 1 tablet three times per day for 1 month. � Vitamins: if you use them normally. � Pain: Tylenol, 1 to 2 adult tablets every four weeks as needed to control pain. Take medication prescribed to you by the doctors as instructed for the first week at home. Remember that it is important to follow up in clinic six weeks after the date of discharge from the hospital.