Review confirms that bed rest is not the best treatment for back pain

For much of the 20th century, rest – which generally meant a few days to a week in bed – was the standard prescription for acute low-back pain. More recently, doctors started counselling patients to stay as active as they could.

An updated Cochrane review now confirms what has become conventional wisdom: “Normal daily activity seems to be the best way for patients with low-back pain to get better,” said Kristin Thuve Dahm, a researcher at the Norwegian Centre for the Health Services and lead author of the review. Active patients experience less pain and avoid the side effects of immobility.

“Everyone is fairly convinced there's not much benefit to bed rest,” said Joel Press, M.D., professor in physical medicine and rehabilitation at the Feinberg Northwestern School of Medicine in Chicago. “We're almost always better moving than not moving. Structures in your back get their nutrition from movement; they have no real vascular system and are supplied with blood by motion, soaking it up like little sponges.”

On the other hand, negative changes associated with immobility show up right away, he said. Studies done in the 1950s showed that people lose 2 percent to 5 percent of their strength per day of complete bed rest.

“Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica.” Dahm KT, et al. The Cochrane Database of Systematic Reviews 2010, Issue 6.

Source: Health Behavior News Service

 

 

Common pain relievers are not linked to heart disease in elderly people

Commonly used painkillers like ibuprofen do not increase the risk of heart attack in the elderly population, according to a new study. Researchers found that the use of these drugs – called non-steroidal anti-inflammatory drugs (NSAIDs) – was also associated with a lower risk of death although they are not sure why.

Their findings, which appear in the British Journal of Clinical Pharmacology, were based on a study that looked at a nationwide hospital admission and pharmacy prescription database of 320,000 Australian veterans.

Professor Arduino Mangoni, who recently joined the University of Aberdeen from Flinders University in Adelaide, led the study.

“Unlike previous studies we did not observe an increased risk of heart disease after considering NSAIDs as a whole, their sub-classes, and several individual drugs. In fact our study has demonstrated that the use of NSAIDs has overall a neutral effect on the risk of heart disease in a large elderly population with multiple co-existing medical conditions.

“We also noted that the use of NSAIDs was associated with a reduction in all-cause mortality and there was a clear association with the number of prescriptions supplied in that the higher the number of prescriptions for NSAIDs the lower the risk of death.”

Source: University of Aberdeen (2010, July 11). Painkillers not linked with heart disease in elderly patients and may protect against death, study finds. ScienceDaily. Retrieved July 15, 2010, from http://www.sciencedaily.com­ /releases/2010/07/100707065216.htm

 

 

Massage can relieve chronic tension headache

Researchers at the University of Granada, in collaboration with the Clinical Hospital San Cecilio and the University Rey Juan Carlos, have shown that the psychological and physiological state of patients with tension headache improves within 24 hours after receiving a 30-minute massage.

One of the main causes of this type of headache is the presence of trigger points. Researcher Cristina Toro Velasco, leader of the study, has shown that a 30-minute massage on cervical trigger points improves nervous system regulation in these people. They also had reduced levels of stress and anxiety associated with the headache.

The results of this pioneer study were published in American Journal of Manipulative Physiological and Therapeutics.

Source: University of Granada (2010, July 11). Simple massage relieves chronic tension headache, study finds. ScienceDaily. Retrieved July 15, 2010, from http://www.sciencedaily.com/ releases/2010/07/100708081233.htm

 

Scientists discover a way to regenerate damaged nerve tissue

University of Calgary scientists have discovered a way to enhance nerve regeneration in the peripheral nervous system. Peripheral nerves connect the brain and spinal cord to the body, and without them, there is no movement or sensation. Peripheral nerve damage is common and often irreversible.

Dr. Douglas Zochodne, a neurologist and professor in the Department of Clinical Neurosciences at the university, and his team used a rat model to examine a pathway that helps nerves to grow and survive. Within this pathway is a molecular ‘brake’, called PTEN, that helps to prevent excessive cell growth under normal conditions.

In addition to discovering for the first time that PTEN is found in the peripheral nervous system, Zochodne's team demonstrated that following nerve injury, PTEN prevents peripheral nerves from regenerating. The team was able to block PTEN, an approach that dramatically increased nerve growth.

Lead author on the study Kimberly Christie says, “We were amazed to see such a dramatic effect over such a short time period. No one knew that nerves in the peripheral system could regenerate in this way, nerves that can be damaged if someone has diabetes for example. This finding could eventually help people who have lost feeling or motor skills recover and live with less pain.”

Source: University of Calgary (2010, July 12). New method helps nerves grow after trauma or injury. ScienceDaily. Retrieved July 19, 2010, from http://www.sciencedaily.com­ /releases/2010/07/100712102802.htm

 

 

 

 

 

The Pain News – MAY 2010

 

 

New scientific insights into how acupuncture eases pain

In a report recently published online in Nature Neuroscience, a team at the University of Rochester Medical Center found that the molecule adenosine plays a key role in the effects of acupuncture in the body. Adenosine is a natural compound known for its role in regulating sleep, for its effects on the heart, and for its anti-inflammatory properties. It also acts as a natural painkiller, becoming active in the skin after an injury to inhibit nerve signals and ease pain.

In this study, scientists found that the chemical is also very active in deeper tissues affected by acupuncture. They looked at the effects of acupuncture on the peripheral nervous system – the nerves in our body that aren't part of the brain and spinal cord. These new findings add to the scientific foundation underlying acupuncture, said neuroscientist Maiken Nedergaard, M.D., D.M.Sc., who led the research.

"This carefully performed study identifies adenosine as a new player in the process. It's an interesting contribution to our growing understanding of the complex intervention which is acupuncture," added Josephine P. Briggs, M.D., director of the National Center for Complementary and Alternative Medicine at the US National Institutes of Health.

Source: ScienceDaily (May 31, 2010)

Reference: Nanna Goldman, Michael Chen, Takumi Fujita, Qiwu Xu, Weiguo Peng, Wei Liu, Tina K Jensen, Yong Pei, Fushun Wang, Xiaoning Han, Jiang-Fan Chen, Jurgen Schnermann, Takahiro Takano, Lane Bekar, Kim Tieu, Maiken Nedergaard. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neuroscience, 2010; DOI;

10.1038/nn.2562

  

Meditation can reduce the emotional impact of pain

People who meditate regularly find pain less unpleasant because their brains anticipate the pain less, a new study has found.

Scientists from The University of Manchester recruited people for the study who had been meditating for months, years or decades. It was only the more advanced meditators whose experience of pain differed from non-meditators.

The type of meditation practised also varied across individuals, but all included 'mindfulness’ meditation practices.

"Meditation is becoming increasingly popular as a way to treat chronic illness such as the pain caused by arthritis," said Dr Christopher Brown, who conducted the research. "The results of the study confirm how we suspected meditation might affect the brain. Meditation trains the brain to be more present-focused and therefore to spend less time anticipating future negative events. This may be why meditation is effective at reducing the recurrence of depression, which makes chronic pain considerably worse."

10.1016/j.pain.2010.04.017

 

 

Taking ginger every day may ease muscle pain by up to 25%

For centuries, ginger root has been used as a folk remedy for a variety of ailments such as colds and upset stomachs. But now, researchers at the University of Georgia have found that daily ginger consumption also reduces muscle pain caused by exercise.

Patrick O'Connor, a professor in the College of Education's department of kinesiology, directed two studies examining the effects of 11 days of raw and heat-treated ginger supplementation on muscle pain.

Participants in the studies consumed capsules containing two grams of either raw or heat-treated ginger or a placebo for 11 consecutive days. On the eighth day they performed 18 extensions of the elbow with a heavy weight to induce moderate muscle injury to the arm. Arm function, inflammation, pain and a biochemical involved in pain were assessed prior to and for three days after exercise.

The studies showed that daily ginger supplementation reduced the exercise-induced pain by 25 percent, and the effect was not enhanced by heat-treating the ginger.

Exercise-induced muscle pain is a very common type of injury. While severe muscle pain will probably require treatment with pain-relieving medications, it is good news that common or garden ginger root may also provide relief. 

10.1016/j.jpain.2009.12.013

‘His’ and ‘hers’ pain relievers in the medicine cabinet?

In future, pain-killing drugs may be formulated differently for men and women.

A professor of pain studies at Magill University in Canada, Jeffrey Mogil, presented new research at a recent Christchurch conference showing that not only do the sexes tolerate pain differently, they also react to analgesics in different ways.

"Increasingly, research is showing...that there are actually different circuits in the brain that are responsible for processing pain in men and women," Mogil said.

"I really do think we are going to see eventually blue pills and pink pills."

Genetic research has also shown red-heads are more responsive to painkillers, and

red-headed women are more sensitive to such drugs than other people.

The human body produces a substance similar to capsaicin – which makes chilli peppers hot – at pain sites, and blocking production of this substance can ease pain, a new study shows.

In work with mice, researchers at the University of Texas Health Science Center in San Antonio found that a family of fatty acids called oxidized linoleic acid metabolites (OLAMs) play an important role in the biology of pain.

"This is a major breakthrough in understanding the mechanisms of pain and how to more effectively treat it," senior investigator Kenneth Hargreaves, chair of the Department of Endodontics in the Dental School at the UT Health Sciences Center, said in a news release.

"Nearly everyone will experience persistent pain at some point in their lifetime," Dr. Hargreaves said. "Our findings are truly exciting because they will offer physicians, dentists and patients more options in prescription pain medications. In addition, they may help circumvent the problem of addiction and dependency to pain medications, and will have the potential to benefit millions of people who suffer from chronic pain every day."

Source: Journal of Clinical Investigation, April 26, 2010

 

 

The Pain News – APRIL 2010

 

‘Vertebroplasty’ may provide effective pain relief for patients with osteoporosis

The results of three recent studies demonstrate that a procedure called vertebroplasty, used to treat vertebral compression fractures (VCFs), may provide significant and sustained pain relief.

Two large studies demonstrating the effectiveness of vertebroplasty were presented at the Society of Interventional Radiology 35th Annual Scientific Meeting, March 13-18, 2010, and published as abstracts in the Journal of Vascular and Interventional Radiology. The third was presented at the American Society of Spine Radiology's 2010 Annual Symposium in February.

 

Vertebroplasty is minimally invasive – it is performed under local anaesthesia and involves injecting bone cement into one or more collapsed pieces of vertebrae that are causing back pain. Pain relief after the procedure was shown to be immediate, was sustained for a year or more, and other outcomes were significantly better than with conservative medical therapies.

 

References:
Anselmetti G, Manca A, Chiara G, et al. Abstract No. 16: Percutaneous vertebroplasty (PV) in the osteoporotic patients: Optimal indications and patient selection to improve clinical outcome. Personal experience in 1542 patients over 7 years experience. JVIR. 2010;21(2):S8-S9.
Klazen CA, Lohle PN, deVries J, et al. Abstract No. 11: Percutaneous vertebroplasty versus conservative therapy in patients with an acute osteoporotic vertebral compression fracture. Vertos II: A randomized controlled trial. JVIR. 2010;21(2):S6-S7
PRNewswire. Multi-Center Data in a Large Series of Patients Show Vertebroplasty Provides Dramatic and Lasting Pain Relief for Vertebral Compression Fractures. Online news release, 2010(Feb 17). From a presentation at the American Society of Spine Radiology's 2010 Annual Symposium, February 2010.

 

 

 

 

Can foot pain be avoided by running barefoot?

According to a story by Christopher McDougall published in Parade magazine, there is an increasing body of evidence that athletic shoes may cause rather than prevent running injuries.

 

“Daniel Lieberman, a professor of human evolutionary biology at Harvard University, and Dennis Bramble, a biology professor at the University of Utah, argue that for the last 2 million years, humans have engaged in long-distance running. And, for almost all of that time, humans have been running barefoot, coming down on the forefeet with toes spread and bending the ankles and knees to absorb the shock. Lieberman believes that today's sneakers – with their fat heels, squishy soles, and stiff arch supports – may be causing us instead to land hard on our bony heels with our legs straight.”

 

A leading American sports podiatrist, Stephen Pribut, says:

 

“We've gone too far with cushioning and arbitrary shoe designs,” and he agrees that no study has ever shown that barefoot runners are hurt more often than runners in shoes. In a 2009 review article for the British Journal of Sports Medicine, researchers searched 30 years of studies and were unable to find one demonstrating that running shoes make people less prone to injury.

 

Source: www.parade.com

 

 

Back pain in group therapy

Cognitive behaviour therapy appears to reduce pain in the lower back. In a study of 701 people with lower back pain, British researchers found that those who had up to six sessions of group cognitive behaviour therapy – which included advice on staying active and using painkillers when necessary – had significantly less pain than those who had no extra treatment. The improvements continued a year afterwards. Writing in the Lancet, the researchers say the therapy was much cheaper than other treatments for back pain, such as acupuncture.

 

Source: www.thelancet.com published online 26 Feb 2010