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2.
Weight loss, physical therapy can help back pain
Dec 05 - A team of researchers has identified a catch-22 of lower
back pain. Those with lower back injuries can exacerbate their
pain by avoiding using hurt muscles. Other muscles, including
those in the abdomen or on the sides of the torso, contort to
compensate, leading to greater pressure on the spine and damaging
discs, explain researchers from Ohio State University in Columbus.
"We have often suspected that patients guard their trunk muscles
but this (study) has shown for the first time how this results
in increases in spine loading that can lead to secondary back
injuries. This is important because second back injuries are often
more serious and expensive," Dr. William S. Marras, the study's
lead author, told Reuters Health. In the study, published in the
December 1st issue of Spine, researchers asked 22 adults with
lower back pain and 22 adults without injuries to lift various
objects using identical postures and then to lift objects in whatever
position was comfortable or natural. The investigators then measured
the electrical activity of participants' muscles and compared
pressure on the spine, known as spine loading, and the side-to-side
force on the spine, know as lateral shear. Adults with lower back
injuries used more muscles in the back when lifting, creating
greater pressure on the spine. Injured patients experienced about
26% greater spine compression, a 75% increase in lateral shear,
and used significantly more muscle activity for 10 muscles than
noninjured adults, the report indicates. Additionally, people
with lower back pain weighed more than their uninjured peers,
a factor that significantly increased pressure on the spine. "Excessive
body weight, or a protruding stomach, is like always holding a
box in front of you," Marras said in an interview. "One must counterbalance
the weight with more activity in the back muscles that aren't
as far from the spine. It is like a see-saw where the back muscles
are not as far from the fulcrum as the weight of the belly." The
results of the study underscore the need for people with lower
back pain to trim down, and suggest that physical therapy for
certain types of back injuries aim to teach patients how to use
their back muscles appropriately, the authors note. Typically,
physical therapy focuses on strengthening the trunk muscles. Additionally,
workplaces can make simple changes that would help reduce lower
back pain among employees with lifting jobs. For instance, Marras
suggested that lifting be done from waist level instead of from
below the knee. "This would significantly reduce the loads on
the spine even though the weight of the object has not changed,"
he explained. SOURCE: Spine 2001;26:2566-2574.
3.
General practitioners underestimate intensity of patients' severe
pain
2002-01-07 -- Primary care physicians tend to rate their patients'
pain intensity significantly lower than do the patients themselves,
especially when the pain is chronic or severe, Finnish investigators
report. Twenty-eight primary care physicians from 25 health centres
evaluated patients' pain intensity using a 100-mm visual analog
scale (VAS). Data were collected for 1 week during each of the
four seasons in 1996. Dr. Pekka Mantyselka and colleagues of the
University of Kuopio also requested the 738 patients, whose ages
ranged from 16 to 75, to rate their pain intensity on a similar
VAS as soon as possible after their office visit. The investigators
divided the scales into five 20-mm units for the purpose of comparison.
As reported in the British Journal of General Practice for December,
the physicians graded pain intensity at least one unit lower than
did patients in 36.7% of visits, and at least two units lower
in 20.5% of visits. The nonconcordance between patients' and physicians'
assessments increased with pain severity, so that at the highest
grade perceived by patients, physicians rated pain lower in 82.2%
of the visits. The disparity was also greater when the reason
for the visit was chronic as opposed to acute pain. Dr. Mantyselka's
team recommends that general practitioners ask patients to rate
their pain intensity and that that evaluation should be "accepted
as a standard in assessing pain intensity, particularly in monitoring
the response to treatment," they write. In clarifying the findings,
the Finnish investigators maintain that nonconcordance between
the two assessments could indicate "complex problems behind the
pain." Br J Gen Pract 2001;51:995-997.
4.
Botox: Bad for Stomach but Good for Bad Back?
May
21 (Medscape Health) Don't try eating it, but a bacteria that
causes food poisoning appears to relieve chronic back pain for
several months, according to a new study. In a purified form,
Botox (botulinum toxin A) has been found to help treat certain
sorts of muscle spasms. Many researchers have tinkered with the
toxin to see if it could be useful in treating everything from
headaches to wrinkles. So far, the FDA has only licensed Botox
for a couple of eye-muscle disorders, and last year, the agency
added cervical dystonia (involuntary contractions of the neck
and shoulder muscles) to the list of approved uses. But Bahman
Jabbari, MD, of the Walter Reed Army Medical Center, says there
is plenty of reason to think that Botox can safely stamp out chronic
pain. "This has been around for almost 10 years now," says Jabbari.
"A lot of patients have used it for other conditions, like neck
pain or muscle spasticity." In a study published on May 21, 2001,
in the journal Neurology, Jabbari's team reports that a total
of 31 patients with a modest amount back pain were either injected
with botulinum toxin A or with a saline solution that served as
the placebo control (a "dummy" treatment). They were told to stick
to their regular pain medications as well. After 3 weeks, the
researchers asked the patients how they felt. The patients were
polled them again 2 months later. By the third week nearly three-fourths
of those who had had a shot of Botox said their pain had been
cut in half. Only one-quarter of the placebo group reported the
same amount of relief. Those who had pain in a specific area of
their back seemed to do the best. "If there was a predominance
of pain to one side, we injected there, which helped," explains
Jabbari. The pain, however, eventually returns. About 60% felt
as good from the Botox shot 2 months later compared to roughly
12% who reported the same amount of relief from the saline solution.
"The effects last for about 3 or 4 months," he says. Any relief
is better than none. But Jabbari admits that a handful of happy
patients does not prove that Botox is useful for back pain suffers.
"It's a small study," he says. "We need more research." Botox
helps relax muscles, but experts still have no clear idea why
it seems to combat chronic pain. Though side effects are rare,
a careless doctor might give too high a dose, which could prove
dangerous, Jabbari warns. Even so, many pain clinics already offer
the popular toxin to those with aching backs, including Jabbari's
own center. But some experts say more research is still needed
on Botox treatments for back pain and urge their patients to use
caution before trying them. "There's not enough scientific literature
to support it," says John Kostuik, MD, who heads the Spine Division
at Johns Hopkins Hospital. "I wouldn't recommend it."
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