Self management and low back pain

Self-management interventions are widely recommended for patients with low back pain (LBP), but a systematic review with meta-analysis by Australian researchers suggests that its effects on pain and disability are likely to be small and are supported by only moderate-quality evidence.
The authors conclude, "Although effective when compared to minimal intervention, we are unsure if self-management provides worthwhile effects in the management of LBP. This result challenges the endorsement of self-management in treatment guidelines."

Arthritis Care Res. 2012;64:1739-1748. Abstract

Knee Osteoarthrosis may be linked to Vit D deficiency

Vitamin D deficiency may be a risk factor for increased knee osteoarthritic pain in black Americans, according to a study published online November 7 in Arthritis & Rheumatism.

A study was conducted in which 94 adults completed questionnaires and underwent sensory testing for heat and mechanical pain.  Participants were 75% women, they had an average age of 55.8 years, 45 were black, and 49 were white.

The researchers collected serum vitamin D levels at the beginning of sensory testing. They measured the heat pain threshold as when sensation "first becomes painful," and the pain tolerance as when the pain reaches the level of "no longer feel able to tolerate the pain." The researchers found that 38 of the 45 black participants (84%) had low vitamin D levels. On initial assessment, the researchers identified the most painful knee as the study index knee. Low levels of vitamin D were significantly associated with lower heat pain thresholds on the index knee as well as pressure pain on the index knee

In a news release, first author Glover said, "Our data demonstrate that differences in experimental pain sensitivity between the two races are mediated at least in part by variations in vitamin D levels. However, further studies are needed to fully understand the link between low vitamin D levels and racial disparities in pain. Although rare, vitamin D toxicity is possible and older adults should consult with their primary care provider regarding supplementation. It may be warranted that older black Americans with chronic widespread pain be screened for vitamin D deficiency to reduce disparities in pain."

According to the news release, the authors also plan to pursue research to test whether improving vitamin D status in older black and white patients affects their experience of chronic pain.

This study was supported by the National Institutes of Health/National Institute on Aging and the UF Clinical and Translational Science Institute. Glover is a John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Scholar and a Mayday Fund grantee. The other authors have disclosed no relevant financial relationships.

Arthritis Rheum. Published online November 7, 2012. Abstract

Get 10% fitter with a 60  second blast

One of the journals I read is  Mens Running', a Uk publication described as " for runners with balls"!  I noticed a short piece that  stated  that 60 seconds of of high intensity exercise three times a week can improve your fitness by 10%. The research took two groups that both did a 10K cycle time trial. Then one lot did high intensity interval training, cycling flat out for 6 seconds, resting 1 minute , then repeating the same thing 10 times. The other maintained their nomal regime. After 2 weeks of  this regime 3xper week, both groups retook the 10K cycle time trial and those that had followed the high intensity regime attained a 10% higher speed. The suggested reason was that high intensity regimes  slow lactate build up and that short sprints make it possible for the body to use the lactate more efficiantly.

Does Spinal Manipulation Relieve Low Back Pain?

In patients with chronic nonspecific low back pain, spinal manipulation/mobilization therapy followed by an 8-week program of specific active exercises has been shown to decrease immediate pain and improve functional ability vs sham therapy plus active exercises, according to these findings(Balthazard et al 2012)

This study aimed to assess whether spinal manipulation/mobilization therapy had an analgesic effect.

A total of 37 patients with chronic nonspecific low back pain were monitored through 8 therapeutic sessions delivered for 4 to 8 weeks. A single physiotherapist with 15 years of experience performed the active intervention

By contrast, the sham therapy used a detuned ultrasound device, and the patient was unaware that the ultrasound device was inactivated.

Active exercises were used in both groups and included pelvic tilt and low back lateral flexion exercises that were performed with the patient in the supine position. The participants also engaged in stretching, motor control, and strengthening exercises during the 8 weeks of sessions.

"This study confirmed the immediate analgesic effect of [spinal manipulation/mobilization] over [sham therapy]," the study authors note. "Followed by specific active exercises, [spinal manipulation/mobilization] reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group," they add and it confirms the clinical relevance of spinal manipulation/mobilization as an "appropriate treatment" of chronic nonspecific low back pain.

BMC Musculoskelet Disord. Published online August 28, 2012.

Meta-Analysis Finds No CV Benefit of Omega-3 Fatty Acids

September 13, 2012 (Ioannina, Greece) — A new meta-analysis looking at the effects of omega-3 fatty acids in patients at high risk for cardiovascular events has shown that the supplements have no effect on hard clinical outcomes, including all-cause mortality, cardiac death, sudden death, MI, or stroke. There was a trend toward benefit in the prevention of sudden death, but the reduction failed to reach statistical significance, a finding the researchers believe refutes any supposed antiarrhythmic-mediated effect of omega-3 fatty acids.
"The meta-analysis, taking into account the recent and previously published trials, showed that omega-3 fatty acids did not significantly reduce the incidence of cardiovascular events," senior investigator Dr Moses Elisaf (University Hospital of Ioannina, Greece) told heartwire. "However, there was a trend toward benefit in terms of sudden death, about a 13% reduction, and myocardial infarction, about a 10% reduction, but the decrease was not statistically significant. So, we can conclude from this meta-analysis and other recently published trials that the effect of omega-3 fatty-acid supplementation in high-risk patients is rather low. They are without side effects, but without significant efficacy."
The study is published in the September 12, 2012 issue of the Journal of the American Medical Association

Acupuncture Superior to Placebo, Usual Care for Chronic Pain

September 10, 2012 — Acupuncture is superior to both sham acupuncture and standard care for the treatment of different types of chronic pain, suggesting that the effects of acupuncture are more than just placebo effect, a new meta-analysis shows.
The analysis found that about 50% of patients who got acupuncture had improvement in pain compared with 30% who didn't get acupuncture and 42.5% who had sham acupuncture.
"In other words, 20% of patients were feeling better because they had acupuncture; about one third of those would only feel better if the right needles were put in the right points to the right depth, and two thirds of them would feel better getting any kind of acupuncture," lead study author Andrew J. Vickers, DPhil, attending research methodologist, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York, told Medscape Medical News.

Dr. Andrew J. Vickers

So in contrast to other interventions, for which the placebo effect is typically about one third of the effect of the treatment, "in acupuncture, it looks like it's two thirds," said Dr. Vickers. "That's quite a large benefit and that's what the patient will actually experience in real clinical practice," where the decision is not whether to have true or sham acupuncture but whether to get a referral for acupuncture or not.
The analysis is published online September 10 in Archives of Internal Medicine.

UK Paraplegic Woman First to Take Robotic Suit Home

By Chris Wickham

LONDON (Reuters) Sep 04 - A British woman paralyzed from the chest down by a horse riding accident has become the first person to take home a robotic exoskeleton that enables her to walk.
The exoskeleton is activated by the wearer tilting their balance to indicate the desire to take a step. It supports the body's weight and also allows the person to go up or down stairs, as well as sit or stand up independently.Although bionic exoskeletons have been used in hospitals and rehabilitation centers, Claire Lomas is the first to take the ReWalk suit home for everyday use.

Lomas earlier this year used the suit to complete the London Marathon in 17 days, raising about 200,000 pounds ($317,900) for research into spinal damage, and she was recently given the job of lighting the Paralympic cauldron in Trafalgar Square.
But she said more routine activities are equally gratifying.
"One of the best experiences was standing at a bar," she said. "To be stood up in this means everything to me."

It costs 45,000 pounds  and although clinical studies are ongoing that could back a case for health authorities to fund purchases of the device, the developers argue that savings on the treatment of ailments related to inactivity could offset the cost.Paralyzed people are prone to pressure sores and a loss of bone density, as well as problems linked to poor posture. Jasinski said estimates on the cost of treating these range from $500,000 to $3 million over a patient's life.

The company estimates that of the SIX million wheelchair users in the U.S. and Europe, around 250,000 could be suitable for using the ReWalk device.

Research into exoskeletons goes back 50 years but advances in software management systems and sensors have only recently made them practical.Argo, which is backed by Israeli venture capitalists SCP Vitalife and Israeli Healthcare Ventures, is working on a similar device for quadriplegics, as well as a brain interface that could allow more intuitive 'thought control' of the exoskeleton.
Although Jasinski says this is still years away, scientists have recently unveiled devices that can be controlled in real time by thought using advanced brain scanning.

Others are working on materials that can interact with human nerves and tissue that could eventually lead to prosthetics that are fused with the body and controlled directly by the nervous system.
In June, a team at Maastricht University in the Netherlands unveiled a device that uses functional magnetic resonance imaging, which monitors blood flow in the brain, to allow people to spell out words simply by thinking of each letter.

Another experiment reported in July saw fMRI used by a man at Bar-Ilan University in Israel to control the movements of a robot thousands of miles away at Beziers Technology Institute in France.
Lomas said that after her accident, she rejected pleas from doctors to give up on the idea of using her legs, saying that as a young, active woman before her 2007 accident, "I didn't want to have a big stomach and spindly legs."

Since the accident she has got married, had a child, and next year plans a London-to-Paris bicycle ride using a so-called Functional Electrical Stimulation bike that artificially stimulates the paralyzed rider's own muscles to propel it along.