Nurses and Depression: An Essay

Nursing and depression are a strange pair of entities that intersect at various points of the compass. Yet the nursing profession continues to walk an uneasy line between comprending depression as a patient symptom and experiencing depression  as a career side effect. Today nursing stands at a pivotal place in history, with academia, the origins of medicine, and progress pulling the threads of nursing theory every which way.

Nursing is a time-honored institution whose origins claims famous feminist icons such as Clara Barton, Margaret Sanger, Mary Breckenridge, and Florence Nightingale. But the feminist mystique itself has oudistanced the treatment and conventional wisdom surrounding depression as a medical concern. Depression, and the treatment of depression, for many people, can be a difficult concept to grasp. Depression is a psychiatric disorder of the mind and psyche which affects persons undergoing medical treatment, but can also originate as a harbinger of other diseases. Depression has almost become a slang term in the pop culture vocabulary used casually to descrive feeling “down”. Yet as a medical denominator, the presence of depression  is serious business.

Depression can be a symptom as well as a diagnosis. Yet the physical side of the medical and nursing fields can often override the psychological of many wellness crises. Conventional wisdom usually trumps academic progress. Commercial pharmaceutical treatment usually beats out long-term alternatives, and little endorsment is given to nontherapeutic analysis. The medical institution as a whole functions mostly to heal the body, and the psycho-analytic milestones in healing don’t keep pace with the limitation of treatment access options for the afflicted. Dabbling in depression doagnosis is seen as specialist referral stuff. Medical professionals are all too familiar with these “rules of the road”.

Both doctors and nurses are more comfortable in general discussing medical symptoms according to a pathology of pure anatomy and disordered functions of the body. This is their clinical training taking over. This is understandable, as many facets of the psychological applications of depression treatment color between the lines of many disciplines. And ad hoc experimentation in the world of treatment for depression is uually not rewarded from a multiple of perspectives.

Too often, physicians skip over depression as a treatable illness and focus on the more concrete diagnoses of the body. In many cultures, psychological illness still carries a stigma from periods of civilization where too little was known about the causes and origins of depression. The onus of depressive symptoms as ‘”madness” still  remains.

Early man used drugs, societal separation, and medicinal forms of witchcraft to “treat” early forms of depression. Later cultures shipped mad people offf to sea, in groups, on a Ship of Fools”., Relying on God to guide their destiny. Sigmund Freud and Carl Jung introduced a standardized form of psychological vocabulary to the medical world, and contemporary man has distinguished himself by pursuing depression in its various guides as a clinical and scientific study for decades.

Today, studies connect depression and everything to sleep deprivation, opiate addiction, anorexia nervosa, Post-Traumatic Stress Disorder, and more. Prevention of depression and observing symptoms of depression, are now a key element of physician treatment advice. The dynamic of career choice has affected medical workers, doctors, and nurses as the practices began to take on occupational definition since the late 1600’s. Medicine  as a discipline has undergone radical reforms from it’s early days. The “physicking’ of another person began to take shape not just as a career for learned man, but as an occupation for educated men and individuals in search of a paying career. While the first doctors of this type were from the most elite classes of scholar and the most wealthy set of people in every culture, religion as  a passport to medical practice admitted religious elders to the treatment of others in more than one tribal civilization around the globe.

Many early teaching institutions centered around the scholastic training of doctors, priests, and teachers. The estimation of a physician was often ruled by his breadth of knowledge of medical studies and material of a religious nature. The indoctrination of a scholar in religion was thought to cement the ethics required to operate a medical practice and found the personal ethos necessary for treatment of other persons, conscious or unconscious. The access to the metaphysical world that many cultures connect with physical wellness allowed this transmutation of disciplines to coexist for many centuries.

The ethics associated with physicianship caused male scholars in the early 1700’s to pledge their scholastic faith in religion, as a going rates of “dues” cementing Christian ethics to the science of treating the bodies of other people. But as Calvinism, the teaching s of Martin Luther, and other religious doctrines took shape, the emergence of a new class of doctor purely to treat the physical malady emerged. The doctor as pure scientists emerged. Marie Curie and her husband were examples of this kind of doctor, who practiced their science without allowing religious culture to dominate their thinking. Doctors were thought of as esteemed members of the community, the equal of all but the highest echelons of the social order. Doctors are respected in every type and section of population where high level of education, practice of any differentiated culture, and necessary acknowledgement of the body of knowledge required and the commitment necessary confers a certain prestige.

In the succeeding centuries, academic studies have dominated the world of organized medicine. Then the business world took over mass medicine, and the world now has become a globalized client of large scale medical insurance companies. The patient is not always the client, as doctors usually are the ones that pharmaceutical companies look to for sponsorship of their treatment of new type of medications. It is the nursing profession, and nurses in particular, who deliver the front line of medical care and therapeutic attention to patients. It is the nurses in the medical world who are the ones that patients interact with the most.

But as the nursing career as a lifetime occupation has developed as a paying gig, the culture of acceptance and respect may not have been as evolved. The participation in medical profit for nurses has not followed along with that enjoyed by physicians working half the amount of time per week.  While nurses do the “heavy lifting” of patient care, their compensation is not commensurate with the time spent and sacrifices required of someone who has embarked on a nursing career. Nurses may work unpaid overtime, stay late, and do extra work, but nursing pay generally doesn’t always reflect this contribution. Ensuing generations of nurses will decide if more reform is in order.

 

 

 

 

 

 

Nursing and the Wound Care Dilemma

Wound Care in recent years has become big business. As a medical specialty group wound care has grown into a competitive market of the larger medical services provider industry. Wound care has also made a name for itself by providing mobile services. For many at-home patients and institutional clients without in-house debridement doctors, this is a winning solution.

But many patients receiving wound care by such onsite providers have to wrestle with a whole new set of problems. Because of the frequency and the proximity of the new surgeon’s provider visits, this brand-new physician now rules over the patient’s care plan. This random new doctor now is the most influential surgeon in the patient’s orbit.
In the medical world, certain conventions of eminence and integrity are assumed. A physician is generally esteemed by the level of education attained, the prestige of their academic credentials and their source, and the work history performed after graduation. The prestige of the places a physician works after graduation and the relative importance of their work experience determines the opportunities in the medical industry. This also predicates their authority in future patient care giving advice.
The occupational issues the physicians will come up against in the medical community will be a reflection of their formal training. But a position in wound care is due to years spent practicing in the field of wound care medicine. This standing
comes after years, sometimes decades working in professional medical care. Patients receiving wound care services almost never choose the doctor or know anything about them, unlike other types of doctors.
Mobile wound care surgeons analyze the condition of the skin. They measure and record the size depth and breadth of wounds and infected areas. The debridement surgeon can advise new courses of treatment. The wound care surgeon can also discontinue applications if treatments he or she finds detrimental or causeless. They may dismiss effective regimens without a second thought.
Soon the orders for the wound care may bear no similarity at all to the most successful and most impactful wound care regimens the patient has known. No other services can be authorized anymore. The patient is cornered. Then in addition to the discomfort and trauma of heavy infections, the wound care patient is twice over a victim. He or she will be left scratching their head, wondering ‘How did I get here?’

Medical provider services are part of an industry that makes money not doing its job. The more disorders, wounds, lesions, and infection that occur, the more money the hospitals, clinics, and services providers make. Of the gargantuan corporate behemoths that run modern medicine, all of them run on a modern theme: Sickness is an income opportunity.

Wound Care is a segment of an industry that nevertheless subscribes to business drivers that try to curry relationships with their business-to-business clients. In this particular, the patron is the long term care facility or Home Health corporation the patient belongs to. This means that a side contract is attached to the agreement between the physician and the patient. In the B2B world, this means that the interests of the facility and their case management prerogatives come before the wishes of the patient. While the patient may be under the impression that they are in partnership trying to improve their wound care ailments, the real boss of the situation is the facility or Home Health provider management.

This is a dilatory arrangement, as the patient will take consideration of other providers’ advice, including that of the PCP, assuming ongoing wound care success. They may discuss and develop the care plan with a projection of straightforward cooperation from the wound care service. But this assumption may be unwarranted. After making communications with other physicians regarding treatment, medication, and new therapies, the patient may find that the care plan is the victim of a hostile takeover.
Now the patient has heard so many different opinions about her case she feels seasick. After years of listening to persuasive opinions about treatments, the pendulum never rests. There is an endless cycle of wound care referral, the provider’s care initiation, the physician’s kindly bedside manner and befriendment. Then comes the sales pitch, the heavy sell, the isolation from other treatment doctors, and then the coup de gras. The wound care physician announces “It’s my way or the highway”, and the patient wonders how they got into this mess.
Now, all the documentation sets up the wound care provider as the decision-maker of the care plan. Nurses would do well to assist patients in coping and dealing with their doctors double-crossing them. Nurses and counselors should update case managers and family members if the observe patients feeling upset and confused by unsuccessful efforts to make their wishes understood. The concept of respecting resident rights is one that nurses should apply very seriously to all their charges.

The wound care physician now holds the upper hand and if the patient does not obey orders, the doctor can fault the patient for not being compliant. This can discredit the patient with the medical insurer. Documentation like this can risk the patient losing their medical coverage.
All of the assurances and advice that the patients received when other physicians were following the along the case somehow now gets lost. And it is surely a sheer coincidence that the recommendations of the most recent wound care visits dovetail with the least cost scenario for wound care treatment.
Nurses should recognize when patients feel distressed about any treatment they are receiving. But the impetus of hospitals and long term care facilities is to allow the business drivers of any medical care instituion have the last word.
Nurses today must decide whether to honor patient wishes or put the fiscal gains of their employer first.
This is the wound care dilemma for nurses. To step forward, and help, or do nothing, and hinder the situation. Nurses must acknowledge when the transparency and quality of patient care is compromised by the absence of patient consideration. Nurses must also operate with loyalty toward their employer. For nurses experiencing the above referenced type of scenario, serious reflection should ensue. These issues should make nurses everywhere advocate for patients who are getting manipulated by the ‘system.’
And professional nurses will serve their ethics best by obeying traditional standards of nursing handed down by generations. Namely, to put patient health, welfare, and recovery above all other considerations. Monetary and otherwise.

Chronic Pain Treatment Plans

Nursing contains treatment of all kinds of patients. A conscientious nurse can track the development of a chronic pain condition by assessing the Quality of Life scale for successive periods. Weighing the patient’s ability to perform daily activities, get dressed, go out, exercise, socialize, and perform productive activities like volunteer work or light labor, is a way to measure the complete index. A nurse or physical therapist should conduct a survey at quarterly or annual periods throughout the patient’s treatment duration to keep up with the wear and tear of natural aging and any other conditions.

Without an acute onset, chronic pain can gather from multiple sources, like arthritis, cramps, and headaches. The frequency and severity of the pain and the time during which the patient suffers becomes the analysis item. As a pain issue develops, these activities or tendencies in daily life will diminish. How much the ability to operate pain-free is not the issue, the ability to compensate or just give up regular activity over multiple areas of daily life is the measure. Consideration of over-the-counter pain medication is another part of the overall chronic pain evaluation.

Medical intervention for chronic pain can be difficult without a concrete diagnosis. Furthermore,  a surgeon or specialist may be reluctant to take on serious procedures with side effects of a potential to overreach the pain being felt by the patient currently. Some of the approaches to chronic pain onset can be less medical and pure common sense. Dyspepsia, GERD, and ulcers can account for some of the pain felt from natural aging. The severity of the onset should be evaluated and treated. Digestive and urinary conditions will reflect the patient’s lifestyle both past and present.

Nurses will come into contact with more acute situations of pain management. Injuries from car accidents, home mishaps, personal assaults, and sport injuries can be the beginning of a long lasting problem specific to the injured area or muscle system. Nociceptive pain involves muscle ends or actual end-of-system muscle fiber failings. Neuropathic pain is when the combined system failure results in sensation sof pain as symptoms of a larger disorder. Nociceptive pain and neuropathic pain form the basis of a category called somatogenic pain.

Psychogenic pain is a different type of chronic pain. When emotional or psychological issues and incidents form a repetitive or acute syndrome, psychogenic pain results. When a patient presents with pelvic pain of unknown origin, recurring headaches with no previous history of same, unusual facial pain of a typical frequency & duration, and/or low back pain, psychogenic pain should come to mind. Analysis of a patient’s daily schedule or habits will determine what unusual set of pain symptoms are unusual in sum.

Somatoform disorders are more mystifying and belong to the area of the professional psychoanalyst. The chronic pain markers for a somatoform patient are symptoms of pain that don’t match a patient’s current diagnoses or atypical recurrence of symptoms between stable schedule of medical or therapeutic intervention. As a nurse, is it a duty to report potential symptom and cycles of behavior to the case manasger or primary care physician. The worst that will happen is that you are overreaching, the best case scenario is that you have alerted key medical staff to a serious condition.

So, the nurse in charge of a patient or patients with chronic pain disorders should approach each patient with an individuality based on their own activity patterns and socializing habits. The deconditioning that occurs with a chronic pain sufferer is that they become “hermits”, staying alone in their pain cycles. Refusing to go out and refusing to continue with participation in group events and other healthy social exchanges can exacerbate pain. Long-term care facilities (or “nursing homes” ) often maintain a varied calendar of activities just to solve this problem.

A good nurse will challange her patient to set daily, weekly, or monthly goals to become more active, socialize with others, join a  group, and keep up improving exercise habits. A nurse may choose to give diet hints or have the dietary nutritionist meet with the chronic pain patient to underscore the importance of key food “do’s and don’ts.” The chronic pain patient must learn that anything that sets off blood pressure and systemic response triggers chronic pain events. Therefore keeping  a”low profile” in the battlefield of dietary tempations to binge, and fighting the inclination to slouch on the couch are what nurses should motivate their patients about.

It should be mentioned that many patients, especially aging patients of chronic pain, will insist on viewing themselves as a poor reflection of whom they “used” to be. But trying to keep up with the vision in the rear-view mirror is unhealthy and intimidating for the best of us. Some gentle persuasion to positively change the self-image and project and promote a more confident and updated idea of themselves will help patients cope with their current conditions. Aging in our culture has become more of a norm and in some areas has been acknowledged as a socially and economically powerful demographic.

Sufferers of chronic pain should be observed and monitored for unusual changes in behavior and habits. A nurse should become aware if a TV-addict patient suddenly shuns the TV room. Perhaps the patient known for her morning promenade starts sleeping in. A nurse should become concerned if a patient stops taking care of themselves, letting down personal standards of grooming or dressing. A supportive nurse will notice if their long-time patient is irritable and unreasonable over minor issues and becomes snappish with nursing staff the patients are known to prefer.

A chronic pain sufferer may be showing signs of depression due to lack of participation in many formerly “normal” activities. This is similiar to the depression felt by cancer patients. Chronic stress has been linked to fibromyalgia as well. A supportive nurse will observe if their regular patients sense a change in their lives and how they feel that they can’t quite pin down. Patients may verbalize unusual feelings or stressful responses to everyday queries. This can be an result (masquerading as a symptom) when chronic pain remains untreated capably.

The responsible and ethical treatment advice for a nurse who perceives a patient suffering pain is not to provoke an incident or disagreement. The supportive nurse will not try to spar or argue with a patient suffering from nerve endings already being pricked by uncontrolled chemical and electrical charges. A patient will not enjoy being prodded by a younger, more pain-free individual about why they are losing sleep or just how much more or less pain they feel than an hour ago.

It should be noted that not every nurse is a fan of supportive behavior. Access to a patient’s medical records and longtime treatment may make them privy to a lot of psychosocial details other nurses may not be aware of. Abusing this trust is not only unethical, but mean-spirited and should cause a nurse to question his or her own profesional motivations. Nurses who perceive other staff persecuting a patient prone to chronic pain with negative remarks, behaviors, or poor  attitude should be reported and re-oriented at once.

 

 

 

 

 

 

Patient Care and PTSD Cases

Nurses looking to get traction in the occupational workplace should be vigilant protecting the rights, privacy, and quality of care given when a PTSD situation arises. Patient care can include special cases, patients whose fears and experiences have traumatized them. These patients come from domestic situations, armed services experiences, violence and sexual assaults, where PTSD clouds the victim’s thoughts with shame, doubt, and a negative spiral of blame and inertia.

A professional nurse should tread carefully and follow the charted behavioral interventions and therapeutic approaches to the letter. Some patients who have genuine elements of PTSD in their makeup may have yet to be diagnosed. Post Traumatic Stress Disorder is a  condition whereby certain other conditions may be affected, such as ulcers, high blood pressure, depression, and more. Nursing practice for such (PTSD) patients includes maintaining a calm, relaxing environment where pain and anxiety are reduced in every way possible.

Disorders like PTSD come from traumatic incidents in the patient’s past, and may be unknowingly triggered without sincere and through querying of the patient’s social profile. A nurse can request a referral from the primary care physician for a psych referral. Any nurse should be careful not to disclose any specific medical information to observers or passersby. This is a HIPPA violation. Nurses should re-orient the PTSD patient (when acting out or presenting symptoms) back to their room and make the assessment in a private setting.

Document carefully any interactions with the patient that cause you concern. Make sure that you follow the best nursing practices when a PTSD incident occurs. When dealing with a patient who is confused, lost, or suddenly bewildered by where they are, or if they forget what they are doing, be prepared. If the PTSD patient shows exaggerated reaction to noise, other patient’s conversation, amplified reaction to nearby distractions, and has poor tolerance to exterior sounds, check with the charge nurse for further instructions. .

The physician’s instructions for treatment should include necessary approaches for environmental comfort. Refer to the patient’s medical chart and care plan for instructions and advice. Patients’ response to their intake survey should indicate what likes and dislikes they will respond to and against. PTSD patients must avoid trigger incidents or scenarios to avoid recurring attacks of anxiety and panic attack crisis.

These behavioral afflictions are defensive disorders the human psyche concocts to shield a person from environmental/mental pain or abuse. This patient will be wary, vigilant, and acutely (and sometimes aggressively) combative against unknown situations. Often sufferers of PTSD are extremely vocal. Nurses can utilize this feature of the patient profile to engage them out of a negative spiral. Redirect the mental focus of the PTSD patient onto a pleasant matter or other topic, such as movies or books, poetry or sports. Avoid discussions of politics or crime.

PTSD is a misunderstood disease which many old-school nurses may scoff at or otherwise fail to evaluate a patient for. Nurses should tread carefully with diagnosed PTSD sufferers and use exceptional patient courtesies to make sure such patients feel insulated from their triggering episodes. PTSD should never be made to feel threatened or stressed. This constitutes patient abuse. Nursing or facility staff who persist in creating tense or uncomfortable incidents, or provoke the patient should be reported both directly to management and reported anonymously to the State Nursing Board or the LVN/Psychiatric Nursing Association.

Incidents which recur in the PTSD patient’s life are the situations with sounds, odors, or persons who spark the Post Traumatic Stress Disorder are responsible for triggering painful situations and outsize scenes within the patient’s room, ward, or floor. Nurses and nursing aides of such patients should make sure all patient needs are addressed during each shift. Lab technicians or phlebotomists new to the patient should be escorted by familiar staff. In this way, proper nursing patient care makes certain that the accidental triggers of a particular trauma do not become re-created and take the patient by surprise.

   PTSD patients rely on skilled nursing staff for optimum recovery outcomes. And more educated consumers will know the difference between incompetent nurses and those who just choose to disregard noted interventions.

Nurse Treatment of Back Pain

The nurse with a patient complaining of back pain should screen the individual or treatment and therapeutic approach. Back pain, especially in the elderly or the very young, can be a red flag for more extreme disorders or more involved and complicated medical problems. Nurses studying the symptoms of back pain disorders and related conditions should review the list of symptoms and therapies. There is a tendency to medicate back pain, which can shield the patient from being diagnosed with more complex attention to the patient’s more overall health. Smoking and depression, for example, have been linked with diagnosis of back pain.

A nurse’s advice is the first line of defense when back pain strikes or rears up. A nurse should be fiercely protective of any patient complaining of unusual amounts of back pain, especially when they seem to have no basis in normal causes. Backaches after pregnancy and fibromyalgia, for example, would be considered expected. But a nurse will be able to single out over time that a patient has experienced serve back pain during some phases of their condition, and less or none in other stages of their admission. Nurses should be careful to fit the bed positioning to suit the best rest position for that particular patient‘s size and height.

A patient will rely (consciously or unconsciously) on the nurse’s ability to relate this occurrence of symptoms with the physician or other nurses. The nursing staff can plot from the chart when and under what stress the patient reports the most pain. The nurse can review notes from other nurses concerning the most serious incidents of back pain in a patient and analyze the cause. Does the pain result from exercise or inaction? Too much bed rest or not enough in the right position? Too many hours straining over a hot laptop, and not enough restful sleep in a bed meant for the purpose?

A change in bathing habits or a change in the weather could activate arthritis nerves, escalating back pain for a patient who previously only generally complained of it. Turning a mattress or finding a different sort of pillow may be ease the neck tension that cause the surprise of back pain for a patient. The patient may be so used to their particular daily habits in sitting or standing, sleeping and resting, that they have not noticed that these may have damaged best posture or their sleep rhythm. Even temporary daily adjustment to a poorly formed car seat could cause problems over time.

The usual amounts of back pain every adult processes can be due to stress, weight gain in the abdomen, rare syndromes, and poor sitting postures. But unusual pain experienced when the patient is sitting down or lying down can be cause for concern. The spinal cord and related nerves, and the pelvic bones and the sternum area, all come into play. Neck tension and postural neck pain can become the cause of tensed nerve in the lower back, often related to motion in the bed during sleep hours. Nurses should survey the patient upon waking about how their neck and back feels.

Patients with back pain should embrace alternate technologies as well as a consult with e specialty physician. Some habits can be cured, such as reading in bed and poor posture. Homeopathic alternatives for pain treatment have enjoyed a resurgence lately. Such patients should be monitored and the intervention be written for nursing prompts for better posture or “lights out” for less reading in bed, for example. Movement and grooming should be evaluated for best posture and less strain on lower back positioning for long periods of time. Nurses should be particularly attentive to fall/injury risks for back pain sufferers, such as dressing, transitioning from bed to standing without support, and in-bed movement without a rail.

Reflexology, meditation, and acupuncture can give significant relief for back pain sufferers, and many HMOs and insurance types cover these regimens. And massage can often do wonder for back pain victims. Thoracic exercise, lumbar spine exercise, Pilates, and Yoga can contribute to better overall back health. But the conventional medical approach still matters. Surgery and injections may be necessary, depending on the level of the condition. A hybrid approach can work well.

A general physician or custodial doctor may refer the back pain patient for an X-ray, MRI or CT scan. A bone scan or discography may be necessary to evaluate the cause of the back pain. The general physician may refer the patient to a specialty physician. Several physicians may need to be seen before the right one grasps the needs of a specific patient. The pain doctor or chiropractor may direct the patient to multiple modalities, such as stress management, physical therapy, holistic directions, as well as improved posture while sleeping, a better mattress and better neck rest from incorrect arrangement of pillows. And an evaluation of the patient’s coverage can allow for further options.

A nurse should be concerned with an over-reliance on medications to solve these pain problems. Chronic pain can be a condition too often medicated for, and not analyzed enough. Too often, many patients are impressed with commercialized depictions of pain-free lives in pharmaceutical advertisements. A nurse may have to parse these ideals down to simple English for a patient eager to accept the pill path of pain treatment. The dispute over NSAID therapy, more widely advertised drugs, and clinical trial results marches on.

Persons with back pain should be encouraged to try non-pharmaceutical approaches like yoga for strengthening the back, stretching, environment, or focused breathing. The level of attachment a patient has to their back pain can affect their willingness to employ various methods to lessen it or get rid of it entirely. Lifting the tent flap of back pain can reveal unpleasant truths a patient may be unwilling or unable to deal with. Bridging the gap between current pain symptoms and a pattern of anti-pain practices should be the care plan goal of many patient dealing with such issues.

Back pain is also a symptom of tense nerves, chronic stress, and harmful relationships. A watchful nurse can plot a record of just when the patient complains of back pain symptoms and analyze what occurred that might have prompted spasms or a cramped lower back. During times of medical issues and their tendency to create unrelated crises, the relatives and friends of a patient can create havoc with their emotions and concerns “dumped” on the patient. A nurse should observe when a certain phone caller or visitor makes the patient distraught.

Of course, energy vampires suck the energy from an empathic patient who does not have a filter to stop the onslaught of verbal disputes and arguments that occur when medical planning and family conflicts persist. Too often, a nurse will see the patient giving attention to a person who will deflate the and overload them with complaints and problems.

A person suffering from back pain must have a strategy to eliminate harmful inputs that worsen their symptoms. The intervention in the care plan will indicate to a nurse what steps they are authorized to take, such as moving abusive family members on and providing hints for coping.

Student nurses should know that duodenum ulcers, kidney problems, osteoporosis, and inappropriate headrests can cause back pain. Lifestyle choices such as a heavy shoulder bag or handbag, heavy lifting or stooping, or overstuffed pillows can disturb delicate rhythms in spinal function and rest. The causes of back pain and the conditions resulting in untreated back pain should be a regular course of study and a basis for materials review.