We've tackled many pain topics on our live chats since December. Some have resonated more than others, so we decided to have an open forum on Oct. 19 at noon EST. Readers asked Dr. Paul Christo of Johns Hopkins about any pain condition, including back pain, neck pain, headaches, carpal tunnel syndrome, neuropathy and more

Christo is director of the Multidisciplinary Pain Fellowship Training Program at Johns Hopkins University School of Medicine. He also has a radio talk show Saturday nights on WBAL.

Comments made here are for informational purposes only and do not represent or substitute as medical advice. Patients are advised to consult their own physician or pharmacist for advice, diagnosis and treatment.

 Health chat: Open forum on all pain topics(10/19/2011) 
11:45
Baltimore Sun Health: 
Hi, Dr. Christo will be joining us at noon, but feel free to submit your questions now on any pain topic you wish (back, neck, knee, etc.)
Wednesday October 19, 2011 11:45 Baltimore Sun Health
12:01
Baltimore Sun Health: 
Welcome to our live chat on pain. It's an open forum this time on any pain topic you'd like to ask about. Submit your questions, and be as specific you can about the condition and yourself, and we'll get to as many as we can within the hour.
Wednesday October 19, 2011 12:01 Baltimore Sun Health
12:01
dr christo: 
Hello, I'm happy to take your questions about any pain condition today.
Wednesday October 19, 2011 12:01 dr christo
12:01
Baltimore Sun Health: 

OK let's get started.
Wednesday October 19, 2011 12:01 Baltimore Sun Health
12:02
[Comment From GuestGuest: ] 
I had a bad back injury at l-5 about 18 months ago. It was treated with advil and an extensive exercise regimae and I have a 95% recovery on my back issue. The neck also suffered from the back injury or at least I have always associated the Two as well connected. My MRI does show some arthritis and I am 64 years of age. Because I am very active and athletic I have suffered a Lumbar nerve com
Wednesday October 19, 2011 12:02 Guest
12:05
Baltimore Sun Health: 
For those new to our live chats on pain, feel free to read the transcripts of previous chats here. http://www.baltimoresun.com/health/bal-health-chats,0,3625121.storygallery
Wednesday October 19, 2011 12:05 Baltimore Sun Health
12:07
dr christo: 
Hi,
I'm unsure of your question, but low back pain, in general is best treated with exercise as you've mentioned, medications like nortriptyline, and something called cognitive behavioral therapy (changing beliefs or evaluations of your painful condition in a way that reduces the degree of emotional and physical disability associated with the pain). I'm glad that you're doing so well. MRI's can be helpful, but don't explain the cause of pain in many instances.
Wednesday October 19, 2011 12:07 dr christo
12:07
[Comment From GuestGuest: ] 
i have degenerate disc disease(DDD) 3 bad discs in my i have had cortizone shots, physical therapy and cant afford to have the surgery nor take off work that long. What other options are there
Wednesday October 19, 2011 12:07 Guest
12:18
dr christo: 
Hi,
Although spine surgery can be useful and needed in certain spinal conditions, be careful about spine surgery for low back pain alone. If you have pain that shoots from your back down your leg, then the evidence for spinal surgery is stronger for relief of those shooting symptoms than it is for treating the low back pain. More useful strategies include exercise, the cognitive behavioral therapy just mentioned to the other guest, and certain medicines. These medicines are the tricyclic antidepressants (nortriptyline), or even a medicine called, duloxetine (cymbalta). Cymbalta is approved for musculoskeletal pain now. Acupuncture has shown some benefit for low back pain as well. A newer, less invasive therapy called biaculoplasty treats discogenic pain from DDD that uses radiofrequency energy. It may help you, but may not be covered by insurance.
Wednesday October 19, 2011 12:18 dr christo
12:22
Baltimore Sun Health: 
The Baltimore Running Festival was last weekend. Is plantar fasciitis common among runners? How is it treated?
Wednesday October 19, 2011 12:22 Baltimore Sun Health
12:23
Baltimore Sun Health: 
Readers, don't be shy. We want to see your questions and concerns.
Wednesday October 19, 2011 12:23 Baltimore Sun Health
12:30
dr christo: 
Plantar fasciitis is inflammation of the fascia (connective tissue) of the bottom of the foot. It extends from the heel to the base of the toes. It's more associated with obesity, middle age, and things like a tight Achilles tendon, although long distance runners are at risk due to repetitive stress placed on the fascia. The pain is usually worse in the morning or after a period of rest and is felt around the heel pad. The condition usually resolves with conservative treatments. Stretching exercises are helpful, and anti-inflammatory medicines by mouth or steroid injections are used with varying degrees of success.
Wednesday October 19, 2011 12:30 dr christo
12:32
Baltimore Sun Health: 
Are there any new, cutting-edge developments in the works for back and disc pain?
Wednesday October 19, 2011 12:32 Baltimore Sun Health
12:41
dr christo: 
Prosthetic disc replacements are offered for low back pain and degenerative disks today. Interestingly, a recent study comparing disc replacement to rehabilitation found that at 2 years, there was a small benefit in the surgical group but that difference didn't reach clinical importance. Some have advocated that the non-surgical approach is less expensive, safer, and less disruptive than surgery. However, if patient's have herniated discs or spinal narrowing that compress nerves or the spinal cord, surgical intervention may indeed be helpful.
Wednesday October 19, 2011 12:41 dr christo
12:42
[Comment From JustineJustine: ] 
I have a question about aspirin for pain treatment. If you're taking it regularly for your heart, does that affect what kind of medication you should take for headaches and occasional minor pain?
Wednesday October 19, 2011 12:42 Justine
12:50
dr christo: 
Justine,
Medical guidelines recommend that patients using aspirin and taking an NSAID (anti-inflammatory like motrin, naproxyn) should take the aspirin 2 hours before the NSAID. This will help prevent the NSAID from countering the cardioprotective effects of the aspirin. Note that this recommendation does not apply to an NSAID called celebrex. If patients are taking motrin consistently while on aspirin, then the recommendation is to stop the motrin. The use of tylenol or other pain medicines shouldn't be affected by the aspirin. Talk to your doctor to get specific recommendations for your condition.
Wednesday October 19, 2011 12:50 dr christo
12:53
Baltimore Sun Health: 
How does does pain affect brain anatomy?
Wednesday October 19, 2011 12:53 Baltimore Sun Health
12:55
dr christo: 
Studies using functional MRI have shown that people with chronic low back pain show reduced brain gray matter and impaired pain processing. The good news: when pain is reduced, researchers have found a reversal of these brain changes.
Wednesday October 19, 2011 12:55 dr christo
12:56
dr christo: 
Thank you for your questions. I hope this was helpful.
Wednesday October 19, 2011 12:56 dr christo
12:56
Baltimore Sun Health: 
Well, that's all the time we have for today. Thanks for joining us.
Wednesday October 19, 2011 12:56 Baltimore Sun Health
12:56