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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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