A new study by researchers at The George Institute for International Health has found that back pain is a reoccurring problem for five million Australians.
According to lead author, Professor Chris Maher, Director of Musculoskeletal Research at The George Institute, "After an episode of back pain resolves, one in four people will experience a recurrence within one year. This explains why around 25% of the Australian population suffers from back pain at any one time."
Low back pain is the most prevalent and costly musculoskeletal condition in Australia(1), estimated to cost up to $1billion per annum with indirect costs exceeding $8billion(2). It is also the most common health condition causing older Australians to be absent from the labour force.(3)
According to Professor Maher, patients and clinicians need to shift their focus to prevention. "We tend to treat the pain when it's there, but when you recover, patients rarely take steps to prevent the problem from returning. People understand the message about lifting correctly but heavy lifting is only one of the risk factors for developing back pain. What many people do not understand is that some of the risk factors for back pain are also the risk factors for other chronic diseases like heart disease. My advice is that people should take a similar approach to back health, as they do for heart health – eating right, exercise and a healthy lifestyle is definitely good for your heart, and also your spine," he added.
"Good, previous research has shown participation in an exercise program after the original episode of low back pain is highly effective in preventing recurrence. Those in the exercise group had half the rate of recurrence of the control group. Other studies have indicated that strengthening muscles and developing fitness show some benefit in avoiding recurring back pain. Mental stress also increases the risk of back pain so including stress management in a health promotion approach would be a sensible way to reduce your chances of back pain. Just paying attention to lifting correctly is probably not enough, a holistic approach is really best."
Tuesday, December 16, 2008
Thursday, December 11, 2008
Lug Your Luggage Safely
Seasoned travelers have a saying – “Pack your bags, then take out half.” This refers to the fact that most of us bring much more than we need on our trips. Now, even more travelers are echoing that line, especially, since so many airline providers are charging passengers a fee for checking luggage. However, if you are one of those people who cannot decide which half to leave at home, the American Academy of Orthopaedic Surgeons (AAOS) has recommendations to help you carry your baggage safely.
According to the U.S. Consumer Products Safety Commission:_•In 2007, more than 50,000 people were treated in hospital emergency rooms, doctors’ offices, clinics and other medical settings for injuries related to luggage.
Packing light may prevent injuries such as:_• Strains, pulls and tears _o Any of these can occur while carrying a heavy suitcase for an extended period of time. _o Lifting and holding a bag incorrectly or lifting luggage from baggage claim carousels, overhead or under-seat compartments._• The chances of these injuries are even greater when a person has been sitting still for a long period of time (as when on a plane) or when the luggage is over-packed and especially heavy.
“Using proper lifting techniques can ensure that your trip isn’t cut short by an injury,” says William R. Marshall, MD, a spokesperson for the AAOS and orthopaedic surgeon in Fort Walton Beach, Florida. “Even a relatively minor injury, such as a muscle pull, to the back, neck or shoulders can be quite painful in the short term and end up ruining your vacation.”
The Academy offers the following strategies to prevent injuries when lifting and carrying luggage:_• Pack lightly. When possible, pack items in a few smaller bags instead of one large luggage piece. It is better – and may prevent muscle sprains and strains – to carry a lighter bag in each hand rather than one heavy bag in one hand or over one shoulder.
• As with any heavy lifting, you should bend at the knees and lift luggage with your leg muscles—not your back and waist—and avoid twisting and rotating your spine. Stand alongside your suitcase, bend at your knees, then grasp the handle and straighten up. Also, try to carry luggage as close to your body as possible.
• When placing luggage in an overhead compartment, first lift it onto the top of the seat. Then, with the hands situated on the left and right sides of the suitcase, lift it up. If your luggage has wheels, make sure the wheel-side is set in the compartment first. Once wheels are inside, put one hand atop the luggage and push it to the back of the compartment. To remove the luggage, reverse this process.
• If using a backpack, make sure it has two padded and adjustable shoulder straps. Choose one with several compartments to secure various-sized items, packing the heavier things low and towards the center. Always wear a backpack on both shoulders--slinging it over one shoulder does not allow weight to be distributed evenly, which can cause muscle strain.
• If you need to use a duffel or shoulder bag, do not carry it on one shoulder for any length of time. Be sure to switch sides often, as this may prevent soreness and discomfort to the shoulder area.
Other important tips:_• When purchasing new luggage, look for a sturdy, light pieces with wheels and a handle. Avoid purchasing luggage that is too heavy or bulky while empty.
• Do not rush when lifting or carrying a suitcase. If it is too heavy or an awkward shape, ask someone for help.
• Do not carry heavy pieces of luggage for long periods of time. If it is very heavy, and you must carry it, stop and take a break. If at all possible, check your luggage when traveling rather than carrying it on a plane, train or bus.
• Make sure to carry all rolling luggage up flights of stairs.
According to the U.S. Consumer Products Safety Commission:_•In 2007, more than 50,000 people were treated in hospital emergency rooms, doctors’ offices, clinics and other medical settings for injuries related to luggage.
Packing light may prevent injuries such as:_• Strains, pulls and tears _o Any of these can occur while carrying a heavy suitcase for an extended period of time. _o Lifting and holding a bag incorrectly or lifting luggage from baggage claim carousels, overhead or under-seat compartments._• The chances of these injuries are even greater when a person has been sitting still for a long period of time (as when on a plane) or when the luggage is over-packed and especially heavy.
“Using proper lifting techniques can ensure that your trip isn’t cut short by an injury,” says William R. Marshall, MD, a spokesperson for the AAOS and orthopaedic surgeon in Fort Walton Beach, Florida. “Even a relatively minor injury, such as a muscle pull, to the back, neck or shoulders can be quite painful in the short term and end up ruining your vacation.”
The Academy offers the following strategies to prevent injuries when lifting and carrying luggage:_• Pack lightly. When possible, pack items in a few smaller bags instead of one large luggage piece. It is better – and may prevent muscle sprains and strains – to carry a lighter bag in each hand rather than one heavy bag in one hand or over one shoulder.
• As with any heavy lifting, you should bend at the knees and lift luggage with your leg muscles—not your back and waist—and avoid twisting and rotating your spine. Stand alongside your suitcase, bend at your knees, then grasp the handle and straighten up. Also, try to carry luggage as close to your body as possible.
• When placing luggage in an overhead compartment, first lift it onto the top of the seat. Then, with the hands situated on the left and right sides of the suitcase, lift it up. If your luggage has wheels, make sure the wheel-side is set in the compartment first. Once wheels are inside, put one hand atop the luggage and push it to the back of the compartment. To remove the luggage, reverse this process.
• If using a backpack, make sure it has two padded and adjustable shoulder straps. Choose one with several compartments to secure various-sized items, packing the heavier things low and towards the center. Always wear a backpack on both shoulders--slinging it over one shoulder does not allow weight to be distributed evenly, which can cause muscle strain.
• If you need to use a duffel or shoulder bag, do not carry it on one shoulder for any length of time. Be sure to switch sides often, as this may prevent soreness and discomfort to the shoulder area.
Other important tips:_• When purchasing new luggage, look for a sturdy, light pieces with wheels and a handle. Avoid purchasing luggage that is too heavy or bulky while empty.
• Do not rush when lifting or carrying a suitcase. If it is too heavy or an awkward shape, ask someone for help.
• Do not carry heavy pieces of luggage for long periods of time. If it is very heavy, and you must carry it, stop and take a break. If at all possible, check your luggage when traveling rather than carrying it on a plane, train or bus.
• Make sure to carry all rolling luggage up flights of stairs.
Preventing Back Pain
One of the best things you can do to prevent and/or eliminate back pain is to exercise. Both an inactive lifestyle and being overweight contribute to back pain. Exercise benefits you in so many ways, such as lowering blood pressure, helping you maintain a healthy weight, lowering your risk for diabetes, and the list goes on!
Orthotics can help you maintain a healthy spine through the use of spinal pelvic stabilizers. Devices that you wear in your shoes, stabilizers align all three arches of your foot to provide a balanced foundation for your spine and body.
It is estimated that 80 percent of people will experience back pain at some time in their life. Since your back is a complicated structure of bones, joints, muscles, and ligaments, there are many different factors that can play a part in your back pain. It is possible to irritate joints, sprain ligaments, or strain muscles in your back -- which can all cause pain. Poor posture, obesity, and psychological stress can also lead to or worsen back pain. One thing you may not know is that along with chiropractic care, exercise can help prevent back pain.
Doctors of chiropractic (DCs) can help reduce, eliminate, and prevent back pain. Using their hands, they manually adjust the joints and tissue in your back to restore joint mobility, relieving pain and muscle tightness. Maintaining a healthy spine will help keep you healthier overall by keeping your spine free of misalignments that could interfere with your nervous system, the center for all your mental activity. DCs can also provide you with dietary, nutritional, and lifestyle counseling.
Orthotics can help you maintain a healthy spine through the use of spinal pelvic stabilizers. Devices that you wear in your shoes, stabilizers align all three arches of your foot to provide a balanced foundation for your spine and body.
It is estimated that 80 percent of people will experience back pain at some time in their life. Since your back is a complicated structure of bones, joints, muscles, and ligaments, there are many different factors that can play a part in your back pain. It is possible to irritate joints, sprain ligaments, or strain muscles in your back -- which can all cause pain. Poor posture, obesity, and psychological stress can also lead to or worsen back pain. One thing you may not know is that along with chiropractic care, exercise can help prevent back pain.
Doctors of chiropractic (DCs) can help reduce, eliminate, and prevent back pain. Using their hands, they manually adjust the joints and tissue in your back to restore joint mobility, relieving pain and muscle tightness. Maintaining a healthy spine will help keep you healthier overall by keeping your spine free of misalignments that could interfere with your nervous system, the center for all your mental activity. DCs can also provide you with dietary, nutritional, and lifestyle counseling.
Take More Breaks to Avoid Back Injury at Work
Take More Breaks to Avoid Back Injury at Work, Study Says
Workers who lift for a living need to take longer or more frequent breaks than they now do to avoid back injury, according to a new study at Ohio State University.
The study also suggests that people who are new on the job need to take breaks even more often than experienced workers, and that the risk of injury is higher at the end of a work shift.
People who participated in the study lifted boxes onto conveyor belts for eight hours, while researchers measured the amount of oxygen that was reaching the muscles in their lower back.
The oxygen level indicated how hard the muscles were working, and whether they were becoming fatigued, explained William Marras, professor of industrial welding and systems engineering at Ohio State. His research and others' has shown that muscle fatigue is linked to back injury.
The study, which appeared in a recent issue of the journal Clinical Biomechanics, is the first to examine what happens to muscle oxygenation over a full workday.
Despite the fact that the study participants were performing the same job at the same pace all day, their back muscles needed more oxygen as the day went on. Taking a half-hour lunch break helped their muscles recover from the morning's exertion, but once they started working again, their oxygen needs rose steeply and kept climbing throughout the afternoon.
"That was alarming to us, because it means that their muscles were becoming fatigued much faster during the afternoon, and we know that fatigue increases the risk of back injury," Marras said.
Two 15-minute breaks, one mid-morning and the other mid-afternoon, helped muscles recover a little, but not as much as the half-hour lunch.
"This tells us two things," Marras said. "First, rest is good -- a half-hour break does a good job of helping muscles recover. But it also tells us that people are especially at risk for back injury at the end of the day, and the only way to counteract that effect is with more breaks as the day goes on."
Workers who lift for a living need to take longer or more frequent breaks than they now do to avoid back injury, according to a new study at Ohio State University.
The study also suggests that people who are new on the job need to take breaks even more often than experienced workers, and that the risk of injury is higher at the end of a work shift.
People who participated in the study lifted boxes onto conveyor belts for eight hours, while researchers measured the amount of oxygen that was reaching the muscles in their lower back.
The oxygen level indicated how hard the muscles were working, and whether they were becoming fatigued, explained William Marras, professor of industrial welding and systems engineering at Ohio State. His research and others' has shown that muscle fatigue is linked to back injury.
The study, which appeared in a recent issue of the journal Clinical Biomechanics, is the first to examine what happens to muscle oxygenation over a full workday.
Despite the fact that the study participants were performing the same job at the same pace all day, their back muscles needed more oxygen as the day went on. Taking a half-hour lunch break helped their muscles recover from the morning's exertion, but once they started working again, their oxygen needs rose steeply and kept climbing throughout the afternoon.
"That was alarming to us, because it means that their muscles were becoming fatigued much faster during the afternoon, and we know that fatigue increases the risk of back injury," Marras said.
Two 15-minute breaks, one mid-morning and the other mid-afternoon, helped muscles recover a little, but not as much as the half-hour lunch.
"This tells us two things," Marras said. "First, rest is good -- a half-hour break does a good job of helping muscles recover. But it also tells us that people are especially at risk for back injury at the end of the day, and the only way to counteract that effect is with more breaks as the day goes on."
Expanded Musculoskeletal Care During Pregnancy
Women Need Expanded Musculoskeletal Care During Pregnancy, Study Finds
Despite the high prevalence of musculoskeletal pain during pregnancy, few women in underserved populations receive treatment for their low back pain. Moreover, researchers found that pain in a previous pregnancy may predict a high risk for musculoskeletal complaints in future pregnancies. 85 percent of women who experienced pain in a previous pregnancy reported pain during their current pregnancy.
According to Clayton Skaggs, DC, the study’s chief author, 85 percent of women surveyed reported that they had not received treatment for their musculoskeletal pain, and of the small percentage who perceived that their back complaints were addressed, less than 10 percent were satisfied with the symptom relief they obtained.
“Based on the findings of this study, doctors of chiropractic and other health care professionals need to expand the musculoskeletal care available during pregnancy, especially in underserved populations,” Dr. Skaggs said. “As a proactive step, health professionals should consider including back pain screening as part of early obstetrical care to help identify musculoskeletal risk factors and allow for early education and/or treatment.”
The study findings suggest that pregnant women with back pain are predisposed to sleep disturbances. In the survey, close to 80 percent of women reporting sleep disturbances had back pain, whereas only 8 percent of women without pain reported problems sleeping. More alarming was the significant relationship between reports of musculoskeletal pain and the use of pain medication.
Despite the high prevalence of musculoskeletal pain during pregnancy, few women in underserved populations receive treatment for their low back pain. Moreover, researchers found that pain in a previous pregnancy may predict a high risk for musculoskeletal complaints in future pregnancies. 85 percent of women who experienced pain in a previous pregnancy reported pain during their current pregnancy.
According to Clayton Skaggs, DC, the study’s chief author, 85 percent of women surveyed reported that they had not received treatment for their musculoskeletal pain, and of the small percentage who perceived that their back complaints were addressed, less than 10 percent were satisfied with the symptom relief they obtained.
“Based on the findings of this study, doctors of chiropractic and other health care professionals need to expand the musculoskeletal care available during pregnancy, especially in underserved populations,” Dr. Skaggs said. “As a proactive step, health professionals should consider including back pain screening as part of early obstetrical care to help identify musculoskeletal risk factors and allow for early education and/or treatment.”
The study findings suggest that pregnant women with back pain are predisposed to sleep disturbances. In the survey, close to 80 percent of women reporting sleep disturbances had back pain, whereas only 8 percent of women without pain reported problems sleeping. More alarming was the significant relationship between reports of musculoskeletal pain and the use of pain medication.
38% adults: complementary and alternative medicine
Government survey shows 38 percent of adults and 12 percent of children use complementary and alternative medicine
Approximately 38 percent of adults in the United States aged 18 years and over and nearly 12 percent of U.S. children aged 17 years and under use some form of complementary and alternative medicine (CAM), according to a new nationwide government survey.* This survey marks the first time questions were included on children's use of CAM, which is a group of diverse medical and health care systems, practices, and products such as herbal supplements, meditation, chiropractic, and acupuncture that are not generally considered to be part of conventional medicine.
The survey, conducted as part of the 2007 National Health Interview Survey (NHIS), an annual study in which tens of thousands of Americans are interviewed about their health- and illness-related experiences, was developed by the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health (NIH) and the National Center for Health Statistics (NCHS), a part of the Centers for Disease Control and Prevention (CDC). The survey included questions on 36 types of CAM therapies commonly used in the United States—10 types of provider-based therapies, such as acupuncture and chiropractic, and 26 other therapies that do not require a provider, such as herbal supplements and meditation.
"The 2007 NHIS provides the most current, comprehensive, and reliable source of information on Americans' use of CAM," said Josephine P. Briggs, M.D., director of NCCAM. "These statistics confirm that CAM practices are a frequently used component of Americans' health care regimens, and reinforce the need for rigorous research to study the safety and effectiveness of these therapies. The data also point out the need for patients and health care providers to openly discuss CAM use to ensure safe and coordinated care."
The 2007 survey results, released in a National Health Statistics Report by NCHS, are based on data from more than 23,300 interviews with American adults and more than 9,400 interviews with adults on behalf a child in their household. The 2007 survey is the second conducted by NCCAM and NCHS—the first was done as part of the 2002 NHIS.**
CAM Use Among Adults
Comparison of the data from the 2002 and 2007 surveys suggests that overall use of CAM among adults has remained relatively steady—36 percent in 2002 and 38 percent in 2007. However, there has been substantial variation in the use of some specific CAM therapies, such as deep breathing, meditation, massage therapy, and yoga, which all showed significant increases.
The most commonly used CAM therapies among U.S. adults were
Nonvitamin, nonmineral, natural products (17.7 percent) Most common: fish oil/omega 3/DHA, glucosamine, echinacea, flaxseed oil or pills, and ginseng***
Deep breathing exercises (12.7 percent)
Meditation (9.4 percent)
Chiropractic or osteopathic manipulation (8.6 percent)
Massage (8.3 percent)
Yoga (6.1 percent).
Adults used CAM most often to treat pain including back pain or problems, neck pain or problems, joint pain or stiffness/other joint condition, arthritis, and other musculoskeletal conditions. Adult use of CAM therapies for head or chest colds showed a marked decrease from 2002 to 2007 (9.5 percent in 2002 to 2.0 percent in 2007).
Consistent with results from the 2002 data, in 2007 CAM use among adults was greater among:.
Women (42.8 percent, compared to men 33.5 percent)
Those aged 30-69 (30-39 years: 39.6 percent, 40-49 years: 40.1 percent, 50-59 years: 44.1 percent, 60-69 years: 41.0 percent)
Those with higher levels of education (Masters, doctorate or professional: 55.4 percent)
Those who were not poor (poor: 28.9 percent, near poor: 30.9 percent, not poor: 43.3 percent)
Those living in the West (44.6 percent)
Those who have quit smoking (48.1 percent)
CAM Use Among Children
Overall, CAM use among children is nearly 12 percent, or about 1 in 9 children. Children are five times more likely to use CAM if a parent or other relative uses CAM. Other characteristics of adult and child CAM users are similar—factors such as socioeconomic status, geographic region, the number of health conditions, the number of doctor visits in the last 12 months, and delaying or not receiving conventional care because of cost are all associated with CAM use.
Among children who used CAM in the past 12 months, CAM therapies were used most often for back or neck pain, head or chest colds, anxiety or stress, other musculoskeletal problems, and Attention Deficit/Hyperactivity Disorder (ADD/ADHD).
The most commonly used CAM therapies among children were
Nonvitamin, nonmineral, natural products (3.9 percent) Most common: echinacea, fish oil/omega 3/DHA, combination herb pill, flaxseed oil or pills, and prebiotics or probiotics
Chiropractic or osteopathic manipulation (2.8 percent)
Deep breathing exercises (2.2 percent)
Yoga (2.1 percent).
"The survey results provide information on trends and a rich set of data for investigating who in America is using CAM, the practices they use, and why," said Richard L. Nahin, Ph.D., MPH, acting director of NCCAM's Division of Extramural Research and co-author of the National Health Statistics Report. "Future analyses of these data may help explain some of the observed variation in the use of individual CAM therapies and provide greater insights into CAM use patterns among Americans."
Approximately 38 percent of adults in the United States aged 18 years and over and nearly 12 percent of U.S. children aged 17 years and under use some form of complementary and alternative medicine (CAM), according to a new nationwide government survey.* This survey marks the first time questions were included on children's use of CAM, which is a group of diverse medical and health care systems, practices, and products such as herbal supplements, meditation, chiropractic, and acupuncture that are not generally considered to be part of conventional medicine.
The survey, conducted as part of the 2007 National Health Interview Survey (NHIS), an annual study in which tens of thousands of Americans are interviewed about their health- and illness-related experiences, was developed by the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health (NIH) and the National Center for Health Statistics (NCHS), a part of the Centers for Disease Control and Prevention (CDC). The survey included questions on 36 types of CAM therapies commonly used in the United States—10 types of provider-based therapies, such as acupuncture and chiropractic, and 26 other therapies that do not require a provider, such as herbal supplements and meditation.
"The 2007 NHIS provides the most current, comprehensive, and reliable source of information on Americans' use of CAM," said Josephine P. Briggs, M.D., director of NCCAM. "These statistics confirm that CAM practices are a frequently used component of Americans' health care regimens, and reinforce the need for rigorous research to study the safety and effectiveness of these therapies. The data also point out the need for patients and health care providers to openly discuss CAM use to ensure safe and coordinated care."
The 2007 survey results, released in a National Health Statistics Report by NCHS, are based on data from more than 23,300 interviews with American adults and more than 9,400 interviews with adults on behalf a child in their household. The 2007 survey is the second conducted by NCCAM and NCHS—the first was done as part of the 2002 NHIS.**
CAM Use Among Adults
Comparison of the data from the 2002 and 2007 surveys suggests that overall use of CAM among adults has remained relatively steady—36 percent in 2002 and 38 percent in 2007. However, there has been substantial variation in the use of some specific CAM therapies, such as deep breathing, meditation, massage therapy, and yoga, which all showed significant increases.
The most commonly used CAM therapies among U.S. adults were
Nonvitamin, nonmineral, natural products (17.7 percent) Most common: fish oil/omega 3/DHA, glucosamine, echinacea, flaxseed oil or pills, and ginseng***
Deep breathing exercises (12.7 percent)
Meditation (9.4 percent)
Chiropractic or osteopathic manipulation (8.6 percent)
Massage (8.3 percent)
Yoga (6.1 percent).
Adults used CAM most often to treat pain including back pain or problems, neck pain or problems, joint pain or stiffness/other joint condition, arthritis, and other musculoskeletal conditions. Adult use of CAM therapies for head or chest colds showed a marked decrease from 2002 to 2007 (9.5 percent in 2002 to 2.0 percent in 2007).
Consistent with results from the 2002 data, in 2007 CAM use among adults was greater among:.
Women (42.8 percent, compared to men 33.5 percent)
Those aged 30-69 (30-39 years: 39.6 percent, 40-49 years: 40.1 percent, 50-59 years: 44.1 percent, 60-69 years: 41.0 percent)
Those with higher levels of education (Masters, doctorate or professional: 55.4 percent)
Those who were not poor (poor: 28.9 percent, near poor: 30.9 percent, not poor: 43.3 percent)
Those living in the West (44.6 percent)
Those who have quit smoking (48.1 percent)
CAM Use Among Children
Overall, CAM use among children is nearly 12 percent, or about 1 in 9 children. Children are five times more likely to use CAM if a parent or other relative uses CAM. Other characteristics of adult and child CAM users are similar—factors such as socioeconomic status, geographic region, the number of health conditions, the number of doctor visits in the last 12 months, and delaying or not receiving conventional care because of cost are all associated with CAM use.
Among children who used CAM in the past 12 months, CAM therapies were used most often for back or neck pain, head or chest colds, anxiety or stress, other musculoskeletal problems, and Attention Deficit/Hyperactivity Disorder (ADD/ADHD).
The most commonly used CAM therapies among children were
Nonvitamin, nonmineral, natural products (3.9 percent) Most common: echinacea, fish oil/omega 3/DHA, combination herb pill, flaxseed oil or pills, and prebiotics or probiotics
Chiropractic or osteopathic manipulation (2.8 percent)
Deep breathing exercises (2.2 percent)
Yoga (2.1 percent).
"The survey results provide information on trends and a rich set of data for investigating who in America is using CAM, the practices they use, and why," said Richard L. Nahin, Ph.D., MPH, acting director of NCCAM's Division of Extramural Research and co-author of the National Health Statistics Report. "Future analyses of these data may help explain some of the observed variation in the use of individual CAM therapies and provide greater insights into CAM use patterns among Americans."
Tuesday, July 8, 2008
Low back pain recovery slow
Low back pain recovery slow; and worse for those on compensation
Contrary to current guidelines and common belief, new research published in The British Medical Journal has shown that recovery from low back pain is much slower than previously thought and even slower again for those with a compensable injury.
Australian researchers at The George Institute for International Health proved that prognosis from acute (or recent) lower back pain is not as favourable as claimed in clinical practice guidelines and challenges the common belief that 90% of patients recover within four to six weeks, with our without treatment.
"These are extremely important results because they confirm that low back pain is a significant health problem and that there is substantial room for improvement in its management," said Professor Maher. "We found that recovery from low back pain was typically much slower than previously reported - nearly one third of patients did not recover from the original episode within a year."
Professor Chris Maher, The George Institute, Australia and colleagues studied 973 patients with acute low back pain for one year. Each was managed by their preferred clinician; a doctor, physiotherapist or chiropractor, who followed treatment guidelines established by Australia's National Health and Medical Research Council (NHMRC).
These new findings show that even with treatment, after two months only 50% had fully recovered from the original episode of pain. At one year about 40% reported that their back was still causing them pain.
"These results challenge the accepted view that recovery is rapid following an episode of acute low back pain. For many people back pain becomes a long-term problem that severely impacts their life. This is despite receiving what we think is the best possible care. We clearly need to rethink our approach," Professor Maher added.
The strongest predictor of delayed recovery was if the episode of low back pain was compensable: compensation halved the chances of recovery.
"The results also highlight that we should review our compensation system because people within this system do much worse than those outside of it."
In 2005 the additional health care expenditure due to spine problems was estimated to be US$86 billion or 9% of USA health expenditure .
Contrary to current guidelines and common belief, new research published in The British Medical Journal has shown that recovery from low back pain is much slower than previously thought and even slower again for those with a compensable injury.
Australian researchers at The George Institute for International Health proved that prognosis from acute (or recent) lower back pain is not as favourable as claimed in clinical practice guidelines and challenges the common belief that 90% of patients recover within four to six weeks, with our without treatment.
"These are extremely important results because they confirm that low back pain is a significant health problem and that there is substantial room for improvement in its management," said Professor Maher. "We found that recovery from low back pain was typically much slower than previously reported - nearly one third of patients did not recover from the original episode within a year."
Professor Chris Maher, The George Institute, Australia and colleagues studied 973 patients with acute low back pain for one year. Each was managed by their preferred clinician; a doctor, physiotherapist or chiropractor, who followed treatment guidelines established by Australia's National Health and Medical Research Council (NHMRC).
These new findings show that even with treatment, after two months only 50% had fully recovered from the original episode of pain. At one year about 40% reported that their back was still causing them pain.
"These results challenge the accepted view that recovery is rapid following an episode of acute low back pain. For many people back pain becomes a long-term problem that severely impacts their life. This is despite receiving what we think is the best possible care. We clearly need to rethink our approach," Professor Maher added.
The strongest predictor of delayed recovery was if the episode of low back pain was compensable: compensation halved the chances of recovery.
"The results also highlight that we should review our compensation system because people within this system do much worse than those outside of it."
In 2005 the additional health care expenditure due to spine problems was estimated to be US$86 billion or 9% of USA health expenditure .
Thursday, May 8, 2008
New Low Back Pain Guideline
For low-back pain patients and their doctors, the American Pain Society, www.ampainsoc.org, said today it is expanding its evidence-based, clinical practice guideline on diagnosis and treatment of chronic low back pain to include recommendations on surgery and other interventional treatments. The expanded guideline was previewed today in a symposium at the APS Annual Scientific Meeting.
The second part of the APS guideline is based on a multidisciplinary panel’s review and analysis of volumes of evidence related to diagnosis and treatment of low-back pain with a number of interventional procedures and surgeries, according to Roger Chou, MD, director of the American Pain Society’s Clinical Practice Guideline Program and associate professor of internal medicine, Oregon Health & Science University.
Chou noted that in addition to the multidisciplinary panel that formulated the guideline for evaluation and management of low back pain in primary care settings, additional experts with expertise on interventional therapies and surgeries for low back pain were recruited to review the evidence and formulate the expanded recommendations.
"Prior to finalizing the guideline, APS conducts extensive peer review, and has sent the guideline to more than 20 experts in surgery, interventional pain medicine, primary care, and other disciplines for comments and feedback," Chou said.
Low-back pain is the fifth most common reason for doctor’s office visits and one in four adults report having it last a least a day. Annually, low-back pain is estimated to account for more than $26 billion in direct health care costs in the U.S.
“The evidence is much better than even five or 10 years ago and both the primary care and interventional recommendations will help physicians be more confident when evaluating possible therapies for low back pain,” said Chou. “As always, physicians and patients should discuss possible options proven by the evidence and choose the ones that make sense for their situation," he added.
During the symposium, Chou and two panel co-chairs, Richard Rosenquist, MD, assistant professor of anesthesiology, University of Iowa, and John Loeser, MD, professor, Department of Neurological Surgery, University of Washington, reported that for many interventional procedures the evidence from randomized controlled trials is mixed, sparse, not available or showed no benefits. Accordingly, the expanded, evidence-based APS guideline will report:
* Invasive diagnostics, such as provocative discography, facet joint block and sacroliliac joint block tests, have not been proven to be accurate for diagnosing various spinal conditions, and their ability to effectively guide therapeutic choices and improve ultimate patient outcomes is uncertain.
* Epidural stenois injections are an option for short-term pain relief for persistent radiculopathy (radiating low back pain caused by a herniated disc). Other interventional therapies, such as local injections, prolotherapy, botulinum toxin (botox) injection, facet joint injection, sacroliliac joint injection, radiofrequency denervation and intradiscal electrothermal therapy are not supported by convincing, consistent evidence of benefits from randomized trials.
* Surgery to treat radiculopathy and spinal stenosis is effective, though the benefits diminish over time.
* Effectiveness of surgery for non-radicular low back pain is less certain, with some studies showing no benefits compared to intensive interdisciplinary rehabilitation. In addition, a significant proportion of patients experience suboptimal outcomes including persistent pain or functional deficits following surgery.
The expert panel reaffirms its previous recommendation that all low-back pain patients stay active and talk honestly with their physicians about self care and other interventions. “In general, non-invasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery,” said Chou.
Recommendations from the first APS Clinical Practice Guideline on Low Back Pain were intended for primary care physicians and appeared in the Oct, 2, 2007 issue of the Annals of Internal Medicine. For diagnosis, the first APS low-back pain guideline advises clinicians to minimize routine use of x-rays or other diagnostic tests except for patients known or believed to have underlying neurological or spinal disorders.
In addressing treatment options, it recommended that medications used should be appropriate for the severity of baseline pain and functional impairment, and clinicians should weigh carefully potential benefits and risks of any drug and explain them. Also for various non-pharmacological treatments supported by the evidence, from spinal manipulation to massage therapy, the first guideline panel recommended they be considered for patients who do not improve with self-care options and prefer not to take pain medications.
About the American Pain Society
Based in Glenview, Ill., the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering.
The second part of the APS guideline is based on a multidisciplinary panel’s review and analysis of volumes of evidence related to diagnosis and treatment of low-back pain with a number of interventional procedures and surgeries, according to Roger Chou, MD, director of the American Pain Society’s Clinical Practice Guideline Program and associate professor of internal medicine, Oregon Health & Science University.
Chou noted that in addition to the multidisciplinary panel that formulated the guideline for evaluation and management of low back pain in primary care settings, additional experts with expertise on interventional therapies and surgeries for low back pain were recruited to review the evidence and formulate the expanded recommendations.
"Prior to finalizing the guideline, APS conducts extensive peer review, and has sent the guideline to more than 20 experts in surgery, interventional pain medicine, primary care, and other disciplines for comments and feedback," Chou said.
Low-back pain is the fifth most common reason for doctor’s office visits and one in four adults report having it last a least a day. Annually, low-back pain is estimated to account for more than $26 billion in direct health care costs in the U.S.
“The evidence is much better than even five or 10 years ago and both the primary care and interventional recommendations will help physicians be more confident when evaluating possible therapies for low back pain,” said Chou. “As always, physicians and patients should discuss possible options proven by the evidence and choose the ones that make sense for their situation," he added.
During the symposium, Chou and two panel co-chairs, Richard Rosenquist, MD, assistant professor of anesthesiology, University of Iowa, and John Loeser, MD, professor, Department of Neurological Surgery, University of Washington, reported that for many interventional procedures the evidence from randomized controlled trials is mixed, sparse, not available or showed no benefits. Accordingly, the expanded, evidence-based APS guideline will report:
* Invasive diagnostics, such as provocative discography, facet joint block and sacroliliac joint block tests, have not been proven to be accurate for diagnosing various spinal conditions, and their ability to effectively guide therapeutic choices and improve ultimate patient outcomes is uncertain.
* Epidural stenois injections are an option for short-term pain relief for persistent radiculopathy (radiating low back pain caused by a herniated disc). Other interventional therapies, such as local injections, prolotherapy, botulinum toxin (botox) injection, facet joint injection, sacroliliac joint injection, radiofrequency denervation and intradiscal electrothermal therapy are not supported by convincing, consistent evidence of benefits from randomized trials.
* Surgery to treat radiculopathy and spinal stenosis is effective, though the benefits diminish over time.
* Effectiveness of surgery for non-radicular low back pain is less certain, with some studies showing no benefits compared to intensive interdisciplinary rehabilitation. In addition, a significant proportion of patients experience suboptimal outcomes including persistent pain or functional deficits following surgery.
The expert panel reaffirms its previous recommendation that all low-back pain patients stay active and talk honestly with their physicians about self care and other interventions. “In general, non-invasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery,” said Chou.
Recommendations from the first APS Clinical Practice Guideline on Low Back Pain were intended for primary care physicians and appeared in the Oct, 2, 2007 issue of the Annals of Internal Medicine. For diagnosis, the first APS low-back pain guideline advises clinicians to minimize routine use of x-rays or other diagnostic tests except for patients known or believed to have underlying neurological or spinal disorders.
In addressing treatment options, it recommended that medications used should be appropriate for the severity of baseline pain and functional impairment, and clinicians should weigh carefully potential benefits and risks of any drug and explain them. Also for various non-pharmacological treatments supported by the evidence, from spinal manipulation to massage therapy, the first guideline panel recommended they be considered for patients who do not improve with self-care options and prefer not to take pain medications.
About the American Pain Society
Based in Glenview, Ill., the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering.
Friday, February 15, 2008
Neck pain study sheds light on best care
A seven-year, international study published today finds that some alternative therapies such as acupuncture, neck manipulation and massage are better choices for managing most common neck pain than many current practices. Also included in the short-list of best options for relief are exercises, education, neck mobilization, low level laser therapy and pain relievers.
Therapies such as neck collars and ultrasound are not recommended. The study found that corticosteroid injections and surgery should only be considered if there is associated pain, weakness or numbness in the arm, fracture or serious disease.
The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders 236 page review of the current research on neck pain is published in the journal Spine. The multi-national and inter-disciplinary study team included Canadian, American, South American, Australasian and European researchers. The Task Force was created to help neck pain sufferers and health professionals use the best research evidence to prevent, diagnose and manage neck pain.
"Neck pain is not a trivial condition for many people," says Task Force president Dr. Scott Haldeman, clinical professor, department of neurology at the University of California, Irvine; and adjunct professor, department of epidemiology University of California Los Angeles. "It can be associated with headaches, arm and upper back pain and depression. Whether it arises from sports injuries, car collisions, workplace issues or stress, it can be incapacitating. Understanding the best way to diagnose and manage this problem is of high importance for those who are suffering and for those who manage and pay for its care."
The study found that neck pain is a widespread experience that is a persistent and recurrent condition for the majority of sufferers. It is disabling for approximately two out of every 20 people who experience neck pain and affects their ability to carry on with daily activities says the Task Force.
A key recommendation of the Task Force is that neck pain, including whiplash-related pain, be classified and treated in a common system of 4 grades:
Grade 1: neck pain with little or no interference with daily activities
Grade 2: neck pain that limits daily activities
Grade 3: neck pain accompanied by radiculopathy ("pinched nerve" -- pain weakness and/or numbness in the arm)
Grade 4: neck pain with serious pathology, such as tumor, fracture, infection, or systemic disease.
"The majority of neck pain falls into Grades 1 or 2," says Task Force member, Dr. Linda Carroll, Associate Professor, School of Public Health at the University of Alberta, and Associated Scientist, Alberta Centre for Injury Control and Research (ACICR). "Many sufferers manage to carry on with their daily activities. Others find their pain interferes with their ability to carry out daily chores, participate in favorite activities or be effective at work. For these people, the evidence shows there are a relatively small number of therapies that provide some relief for a while, but there is no one best option for everyone."
In addition to its comprehensive review of the existing body of research on neck pain, the Task Force also initiated a new study into the association between chiropractic care of the neck and stroke. This innovative piece of research found that patients who visit a chiropractor are no more likely to experience a stroke than are patients who visit their family physician. The study concludes that this type of stroke commonly begins with neck pain and/or headache which causes the patient to seek care from their chiropractor or family physician before the stroke fully develops.
"This type of stroke is extremely rare and has been known to occur spontaneously or after ordinary neck movements such as looking up at the sky or shoulder-checking when backing up a car," noted the study's lead author, Dr. David Cassidy, professor of epidemiology at the University of Toronto and senior scientist at the University Health Network at Toronto Western Hospital.
For the minority of neck pain sufferers who experience Grade 3 neck pain -- that is neck pain accompanied by pain, weakness and/or numbness in the arm, also referred to as a "pinched nerve", corticosteroid injections may provide temporary relief says the study. Surgery is a last resort according to the findings and should only be considered if accompanying arm pain is persistent or if the person is experiencing Grade 4 pain due to serious injury or systemic disease.
Top findings for neck pain suffers:
Stay as active as you can, exercise and reduce mental stress.
Don't expect to find a single "cause" for your neck pain.
Be cautious of treatments that make "big" claims for relief of neck pain.
Trying a variety of therapies or combinations of therapies may be needed to find relief -- see the therapies for which the Task Force found evidence of benefits.
Once you have experienced neck pain, it may come back or remain persistent.
Lengthy treatment is not associated with greater improvements; you should see improvement after 2-4 weeks, if the treatment is the right one for you.
There is relatively little research on what does or does not prevent neck pain; ergonomics, cervical pillows, postural improvements etc. may or may not help.
"This is an important body of research that will help to improve the quality of patient care by incorporating the best evidence into practice and patient education," says Dr. Carroll. "Neck pain can be a stubborn problem -- we hope this comprehensive analysis of the evidence will help both sufferers and health care providers better manage this widespread complaint."
Therapies such as neck collars and ultrasound are not recommended. The study found that corticosteroid injections and surgery should only be considered if there is associated pain, weakness or numbness in the arm, fracture or serious disease.
The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders 236 page review of the current research on neck pain is published in the journal Spine. The multi-national and inter-disciplinary study team included Canadian, American, South American, Australasian and European researchers. The Task Force was created to help neck pain sufferers and health professionals use the best research evidence to prevent, diagnose and manage neck pain.
"Neck pain is not a trivial condition for many people," says Task Force president Dr. Scott Haldeman, clinical professor, department of neurology at the University of California, Irvine; and adjunct professor, department of epidemiology University of California Los Angeles. "It can be associated with headaches, arm and upper back pain and depression. Whether it arises from sports injuries, car collisions, workplace issues or stress, it can be incapacitating. Understanding the best way to diagnose and manage this problem is of high importance for those who are suffering and for those who manage and pay for its care."
The study found that neck pain is a widespread experience that is a persistent and recurrent condition for the majority of sufferers. It is disabling for approximately two out of every 20 people who experience neck pain and affects their ability to carry on with daily activities says the Task Force.
A key recommendation of the Task Force is that neck pain, including whiplash-related pain, be classified and treated in a common system of 4 grades:
Grade 1: neck pain with little or no interference with daily activities
Grade 2: neck pain that limits daily activities
Grade 3: neck pain accompanied by radiculopathy ("pinched nerve" -- pain weakness and/or numbness in the arm)
Grade 4: neck pain with serious pathology, such as tumor, fracture, infection, or systemic disease.
"The majority of neck pain falls into Grades 1 or 2," says Task Force member, Dr. Linda Carroll, Associate Professor, School of Public Health at the University of Alberta, and Associated Scientist, Alberta Centre for Injury Control and Research (ACICR). "Many sufferers manage to carry on with their daily activities. Others find their pain interferes with their ability to carry out daily chores, participate in favorite activities or be effective at work. For these people, the evidence shows there are a relatively small number of therapies that provide some relief for a while, but there is no one best option for everyone."
In addition to its comprehensive review of the existing body of research on neck pain, the Task Force also initiated a new study into the association between chiropractic care of the neck and stroke. This innovative piece of research found that patients who visit a chiropractor are no more likely to experience a stroke than are patients who visit their family physician. The study concludes that this type of stroke commonly begins with neck pain and/or headache which causes the patient to seek care from their chiropractor or family physician before the stroke fully develops.
"This type of stroke is extremely rare and has been known to occur spontaneously or after ordinary neck movements such as looking up at the sky or shoulder-checking when backing up a car," noted the study's lead author, Dr. David Cassidy, professor of epidemiology at the University of Toronto and senior scientist at the University Health Network at Toronto Western Hospital.
For the minority of neck pain sufferers who experience Grade 3 neck pain -- that is neck pain accompanied by pain, weakness and/or numbness in the arm, also referred to as a "pinched nerve", corticosteroid injections may provide temporary relief says the study. Surgery is a last resort according to the findings and should only be considered if accompanying arm pain is persistent or if the person is experiencing Grade 4 pain due to serious injury or systemic disease.
Top findings for neck pain suffers:
Stay as active as you can, exercise and reduce mental stress.
Don't expect to find a single "cause" for your neck pain.
Be cautious of treatments that make "big" claims for relief of neck pain.
Trying a variety of therapies or combinations of therapies may be needed to find relief -- see the therapies for which the Task Force found evidence of benefits.
Once you have experienced neck pain, it may come back or remain persistent.
Lengthy treatment is not associated with greater improvements; you should see improvement after 2-4 weeks, if the treatment is the right one for you.
There is relatively little research on what does or does not prevent neck pain; ergonomics, cervical pillows, postural improvements etc. may or may not help.
"This is an important body of research that will help to improve the quality of patient care by incorporating the best evidence into practice and patient education," says Dr. Carroll. "Neck pain can be a stubborn problem -- we hope this comprehensive analysis of the evidence will help both sufferers and health care providers better manage this widespread complaint."
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