THURSDAY, Aug. 26, 2021 (HealthDay News) — A new approach to spinal cord stimulation may drastically reduce chronic back pain, a small pilot study suggests.
The study, of 20 patients with stubborn low back pain, tested the effects of implanting electrodes near the spinal cord to stimulate it with “ultra-low” frequency electrical pulses.
After two weeks, 90% of the patients were reporting at least an 80% reduction in their pain ratings, the researchers found.
The improvement is striking, experts said. But they cautioned that the study was too small and short-term to draw conclusions.
“That improvement is almost too good to be true,” said Dr. Houman Danesh, who directs the division of integrative pain management at Mount Sinai Hospital in New York City.
Danesh, who was not involved in the study, said the results could be skewed because the patient group was so small. On the other hand, he said, it’s possible the researchers “have really caught onto something.”
Only larger, longer-term studies can answer that question, Danesh said.
It’s not that electrical stimulation, per se, is unproven for back pain: Pain management specialists, including Danesh, already offer the approach to some patients.
It can be done non-invasively, through transcutaneous electrical nerve stimulation (TENS) — where electrodes are placed on the skin over areas of pain, to deliver electrical pulses to the underlying nerves.
Another option is spinal cord stimulation. There, doctors implant electrodes near the spinal cord, along with a pulse generator that is placed under the skin of the buttocks or abdomen. Patients can then use a remote control to send electrical pulses to the spinal cord when they are in pain.
The theory is that the stimulation interrupts the spinal cord’s transmission of pain signals to the brain.
Right now, spinal cord stimulation is reserved for certain tough cases of back pain — for example, when people continue to have pain even after back surgery, Danesh said.
The effectiveness of the approach, though, varies from person to person, and researchers have been looking at ways to refine it.
For the new study, a U.K./U.S. team tested what it’s calling ultra-low frequency spinal cord stimulation.
The researchers started with lab experiments in rats, finding that the electrical pulses blocked most transmissions of pain signals along the spinal cord — in a manner that seems distinct from current spinal cord stimulation techniques.
They then moved on to 20 patients with chronic low back pain, many of whom also had pain running down the leg (commonly known as sciatica). The researchers implanted electrodes in all 20; two patients dropped out due to infection at the surgical site.
Among the 18 patients who finished the two-week study, pain ratings improved by an average of 90%. Nearly all of the patients had improvements of at least 80%.
When the electrodes were removed, patients’ back pain came roaring back, according to findings published Aug. 25 in the journal Science Translational Medicine.
“The pain improvement is dramatic — that’s one of the features of this treatment that we find so impressive,” said senior researcher Stephen McMahon, who directs the London Pain Consortium at King’s College London in the United Kingdom.
“Other successful pain therapies more typically find 30% to 50% clinical improvement,” he added.
That said, McMahon cautioned that the study was small and short-term. Further clinical studies will be needed to define the therapy’s effectiveness and how long it lasts, he said.
One of the strengths of this early study is that it “shows directly a powerful inhibition of pain-related signals,” McMahon noted.
Having identified “such a robust mechanism,” he added, it may be possible to use the technique for a range of conditions other than back pain.
The study was funded by Presidio Medical, Inc., of South San Francisco, which is developing the technology.
Danesh said, “I think this is continuing a trend of a technological jump in the use of spinal cord stimulation.”
However, he stressed, no matter what treatments people use for low back pain, some low-tech fundamentals remain key — namely, addressing bad posture habits and muscle strength imbalances.
Sitting all day, and the resulting weakening of the gluteal muscles (in the buttocks), is a big culprit, Danesh noted.
So strengthening those muscles, along with being generally active, is a must.
“You have to be mobile, when you’re in pain and when you’re not,” Danesh said. “Movement is medicine.”
SOURCES: Stephen McMahon, PhD, FMedSci, professor, physiology, and director, London Pain Consortium, King’s College London, U.K.; Houman Danesh, MD, associate professor, anesthesiology, perioperative and pain medicine, Icahn School of Medicine at Mount Sinai, and director, integrative pain management, Mount Sinai Hospital, New York City; Science Translational Medicine, Aug. 25, 2021, online
There’s much Americans may disagree on, but many share one thing in common: chronic pain.
More than half of U.S. adults suffer from pain, with backs and legs the most common sources, according to researchers from the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS).
Overall, the investigators found that nearly 59% of American men and women were saddled with pain.
“Pain is one of the most common presenting complaints to a doctor’s office,” said Dr. Yili Huang, director of the Pain Management Center at Northwell Health’s Phelps Hospital, in Sleepy Hollow, N.Y.
“It is often the body’s warning sign that something may be wrong. Pain is a symptom and not a disease, so when experiencing new pain, it is important to seek medical advice to help diagnose the cause and to ensure that it is not an emergent or urgent medical condition,” said Huang, who was not involved in the research.
Using 2019 data from the National Health Interview Survey, the NCHS researchers found that 39% of adults had back pain, 37% had hip, knee or foot pain, and nearly one-third had hand, arm or shoulder pain in the past three months. About one in 10 suffered from toothaches.
The goal of the survey was not to draw conclusions from the data, but to provide the groundwork for further analyses, the researchers said.
“Given what we know about the short- and long-term effects of pain, timely, up-to-date national estimates of location-specific pain are an important step in understanding the burden of pain on U.S. adults,” said lead author Jacqueline Lucas, a health statistician/epidemiologist at the NCHS in Hyattsville, Md.
The odds of experiencing pain were related to economics and age, according to the report published July 29 in an NCHS Data Brief.
Those 65 and older, women, white adults and those with incomes below the federal poverty level ($25,750 for family of four in 2019) were most likely to have back pain and lower limb pain, as well as hand, arm or shoulder pain, the report noted.
Among those least likely to experience pain were those aged 18 to 29, men, Asian adults and those with an income 200% of the federal poverty level or above.
Huang said chronic pain is often musculoskeletal and associated with degenerative wear-and-tear, often due to a physically demanding job or aging.
“Women, especially those who are postmenopausal, have a higher incidence of musculoskeletal pain, possibly because of hormonal differences, although the association between hormones and lower back pain is not well understood,” Huang said.
Socioeconomic factors and health are inherently linked, he added.
“It is well-established that pain is associated with social-economic status. Part of that is likely because those who have chronic lower back pain often have physically demanding work. Also, studies have shown a strong association with chronic back, leg and arm pain, and patients with the lowest educational levels and blue-collar workers, likely because of the nature of the work,” Huang said.
Most chronic musculoskeletal pain is probably caused by degeneration and age. Also, “being overweight can lead to added stress to joints of the back and extremities as well, which can lead to increased degeneration,” he noted.
Most people will develop chronic degenerative pain sometime in their lives. “The key to treatment is to focus on quality of life and function, not just the pain,” Huang said.
That doesn’t mean just living with it, however.
“Activities that help us adapt to whatever is causing the pain can be helpful. That can be physical therapy, like exercises, or psychological therapy, like biofeedback or meditation, or medications,” Huang said. “It often makes sense to find a medical professional that is able to help diagnose the source of pain and work with you to find safe options to treat it.”
SOURCES: Jacqueline Lucas, MPH, health statistician/epidemiologist, U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, Md.; Yili Huang, DO, director, Pain Management Center, Northwell Health’s Phelps Hospital, Sleepy Hollow, N.Y.; NCHS Data Brief, July 29, 2021
Although tens of millions of Americans turn to muscle relaxants for lower back pain relief, a new Australian review finds little evidence that such drugs actually work.
That’s the conclusion of a deep-dive into 31 prior investigations, which collectively enlisted more than 6,500 lower back pain patients. Enrolled patients had been treating lower back pain with a wide range of 18 different prescription muscle relaxants.
But while the studies suggested that muscle relaxants might ease pain in the short term, “on average, the effect is probably too small to be important,” said study author James McAuley. “And most patients wouldn’t be able to feel any difference in their pain compared to taking a placebo, or sugar pill.”
Another concern: Beyond their ineffectiveness, “there is also an increased risk of side effects,” cautioned McAuley, director of the Centre for Pain IMPACT with the University of New South Wales’ School of Health Sciences in Sydney.
Such side effects can include dizziness, drowsiness, headache and/or nausea, in addition to the risk that patients will develop a lingering addiction.
McAuley said his team was surprised by the findings, “as earlier research suggested that muscle relaxants did reduce pain intensity. But when we included all of the most up-to-date research the results became much less certain.”
One problem is that much of the research “wasn’t done very well, which means that we can’t be very certain in the results,” McAuley said.
For example, none of the studies explored long-term muscle relaxant use. That means the Australian team could only assess muscle relaxant effectiveness during two time frames: throughout an initial two-week regimen and between 3 to 13 weeks. In the first instance, they found low evidence of an insignificant pain relief benefit; in the second instance, they found no pain intensity or disability relief benefit whatsoever.
McAuley’s take-away: “There is a clear need to improve how research is done for low back pain, so that we better understand whether medicines can help people or not.
“Low back pain is extremely common. It is experienced by 7% of the global population at any one time. Most people, around 80%, will have at least one episode of low back pain during their life,” McAuley noted.
But because it’s often very difficult to isolate a precise cause, many treatments — including NSAIDs, opioids, exercise therapy and/or counseling — aim to control pain rather than provide a cure. Muscle relaxants — prescribed to 30 million Americans in 2020 — fall into that category, McAuley said.
Given that muscle relaxants provide neither a cure nor pain relief, there’s “a clear need to develop and test new effective and cost-effective treatments for people with low back pain,” he said.
In the meantime, McAuley says a move is underway to “de-medicalize” lower back pain treatment by embracing techniques that focus on alternatives to medicine or surgery.
For example, “we know that people with low back pain should avoid staying in bed,” he noted, “and they should try to be active, and continue with usual activities, including work, as much as they can.
“People with recent onset low back pain should be provided with advice and education about the low back pain,” McAuley added. “[And] they should be reassured that they do not have a serious condition, and that their low back pain is very likely to improve over time, whether or not they take medicines or other treatments.”
He and his colleagues reported their findings in the July 7 issue of BMJ.
“The problem is, back pain has so many causes,” said Dr. Daniel Park, an associate professor in the department of orthopedics with Oakland University’s William Beaumont School of Medicine in Rochester, Mich.
So when it comes to treatment, “there is no one-size-fits-all,” stressed Park, who is also a spine surgeon at Beaumont Hospital-Royal Oak.
Still, Park thinks that when it comes to muscle relaxants, “there probably is a place for short-term benefit to help patients manage severe pain.”
For example, he suggests patients with “muscle strain from overdoing it,” or those with a herniated disc may actually benefit from short-term muscle relaxant use.
But patients with garden-variety back pain from a degenerative disc? Not so much.
Regardless, long-term pain relief is unlikely, regardless of the source of the problem, Park noted.
“Long-term, therapy and core strengthening will be much more beneficial,” Park said, while every effort should be made to identify the specific cause, and to minimize the risk for a chronic condition, permanent damage and enduring discomfort.
SOURCES: James McAuley, PhD., director, Centre for Pain IMPACT, School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia, and senior research scientist, Neuroscience Research, Randwick, Australia; Daniel Park, MD, associate professor, department of orthopedics, Oakland University William Beaumont School of Medicine, and spine surgeon, Beaumont Hospital-Royal Oak, UnaSource Surgery Center, Oakland Regional Hospital, Rochester, Mich.; BMJ, July 7, 2021
(HealthDay News) — Two-thirds of spinal fractures suffered by American children and teens occur in car crashes when they aren’t wearing seat belts, a new study finds.
Researchers analyzed data on more than 34,500 U.S. patients younger than 18 who suffered spinal fractures between 2009 and 2014. Teens aged 15 to 17 accounted for about 63% of the spinal fractures, two-thirds of which occurred in motor vehicle accidents.
These findings show that around the time teens get their drivers’ licenses, young drivers and passengers are at highest risk for spinal fractures in car crashes, according to the authors of the study published online recently in the journal Spine.
The investigators also found a strong link between not buckling up while in the car and increased risk of spinal fractures.
“Nearly two-thirds of pediatric spinal fractures sustained in [motor vehicle accidents] occurred in children who did not use belts,” Dr. Vishal Sarwahi, from Cohen Children’s Medical Center, in New Hyde Park, N.Y., and colleagues wrote in a journal news release.
Spinal fractures in children and teens were associated with a 3% death rate, with many deaths occurring in unrestrained drivers and passengers, the researchers noted.
Another study finding was that the risk of severe or multiple injuries and death was more than twice as high (nearly 71%) when children and teens didn’t wear seat belts than when they did (29%).
Wearing seat belts was associated with lower rates of multiple vertebral fractures, other types of fractures in addition to spinal fracture, head and brain injuries, and a more than 20% lower risk of death in car crashes.
The researchers also found that 58% of the young spinal fracture patients were male, and that spinal fractures were most common in the South (38%), likely because a lack of public transportation results in more vehicles on the road.
The percentage of U.S. drivers wearing seat belts has risen steadily over the years, but teens and young adults remain less likely to use them, the study authors noted.
The findings highlight the need to take steps to increase seat belt use by younger drivers and passengers, such as targeted approaches using technology and media awareness campaigns, the researchers suggested.
“Ensuring our new, young drivers wear protective devices can greatly reduce morbidity/mortality associated with [motor vehicle accidents] and can help save lives, and spines,” the research team concluded.
Chronic lower back pain can make the most routine tasks difficult. But a new study suggests patients can learn new, practical and less painful ways to move through individualized “motor skills training,” or MST.
A two-year study of nearly 150 patients found that MST appears to better relieve disability from lower back pain than a more common but less-tailored exercise regimen broadly focused on improving strength and flexibility.
“Our findings suggest that motor skill training in functional activities is an effective and efficient treatment that results in important short-term and long-term improvement in function in people with chronic low back pain,” said study lead author Linda Van Dillen. She’s a professor of physical therapy at Washington University in St. Louis School of Medicine.
Lower back pain is incredibly common, and the No. 1 cause of disability, according to Van Dillen. It is the most frequent cause of chronic pain among American adults.
Van Dillen notes that at least 60% to 80% of adults will experience lower back pain, and “almost half of them will have had a major episode by age 30.”
Yet there is no accepted standard of care for chronic lower back pain patients, nor a clear sense of what type of exercise intervention might work best, researchers said.
To get a better handle on the issue, Van Dillen’s team focused on a pool of patients diagnosed with what is known as “non-specific” lower back pain. That means they have tension, stiffness and/or soreness in the lower back area for which there is no clear cause.
Before the study began in December 2013, all participants had struggled with lower back pain for at least a year.
Participants, who ranged in age from 18 to 60, were randomly divided into two groups. One group received “strength and flexibility treatment for the trunk and lower limbs” — a common exercise intervention, according to Van Dillen.
The other group took part in MST, which teaches patients new ways to carry out everyday tasks rendered difficult by back pain.
MST aims to zero in on each patient’s personal posture and movements throughout an entire day, and then to tailor pain-free movement strategies to their specific routines.
Both groups received six weeks of training for one hour per week. Half of each group also received three “booster” treatment sessions six months later. Disability questionnaires were completed at the outset, and at six months and one year out.
While both groups’ ability to perform daily functions without pain improved, the MST group achieved “significantly” better gains (meaning lower disability scores) over the study period.
MST patients were more satisfied with their care and less likely to use drugs for back pain. They were also less fearful of addressing work-related needs, and less likely to avoid normal daily activities, the study found.
Six months out, MST patients had fewer acute back pain flare-ups and were more likely to keep up with their exercises. And after a year, when their back pain flared up, it was less severe, researchers said.
Dr. Daniel Park, an associate professor of orthopedic surgery at Oakland University William Beaumont School of Medicine in Rochester, Mich., reviewed the findings.
He said it remains to be seen just how much better MST is compared to more common interventions.
While Park said the findings appear to be statistically significant and support the benefit of therapy on back pain, he stopped short of saying the researchers had shown “meaningful improvement.”
“I think any structured therapy can be beneficial, because you want the muscles moving and working to help with back pain,” Park said. “We used to think rest and relaxation was better. But studies show only short-term rest is beneficial, and actually if you rest too long, you can have worse outcomes.”
As a result, he added, many doctors advise patients to rest for the short term and then to begin exercising to help the muscles.
The findings were published Dec. 28 online in JAMA Neurology.
SOURCES: Linda Van Dillen, PT, PhD, professor, physical therapy and orthopedic surgery, Washington University School of Medicine in St. Louis, Mo.; Daniel Park, MD, associate professor, orthopedic spine surgery, Oakland University William Beaumont School of Medicine, Rochester, Mich., director, minimally invasive orthopedic spine surgery, William Beaumont Hospital-Royal Oak, Rochester, Mich.; JAMA Neurology, Dec. 28, 2020, online
THURSDAY, July 9, 2020 (HealthDay News) — If you have a bad hip and lower back pain, a new study suggests that hip replacement surgery may solve both issues at once.
Researchers at the Hospital for Special Surgery in New York City focused on 500 patients who underwent hip replacement surgery and followed up with them one year after the operation.
Over 40% reported pain in their lower back prior to hip surgery. Of that group, 82% saw their back pain vanish after surgery.
It was “completely gone,” said study author Dr. Jonathan Vigdorchik, a hip and knee surgeon at the hospital.
He said that experts in his field have studied the connection between the hip and back for years.
A hip replacement is a surgical procedure to replace a worn-out or damaged hip joint with an artificial one. On average, it is a highly successful operation, with 95% of patients experiencing pain relief, according to the Hospital for Special Surgery.
“It’s an outstanding procedure,” said Dr. Craig Della Valle, a professor of orthopedic surgery at Rush University Medical Center in Chicago. “There are very few things in medicine that are close to hip replacement in terms of how good of a medical procedure it is.” He wasn’t part of the study.
But Vigdorchik added that patients who have undergone some types of spinal surgery before a hip replacement face five times the rate of complications compared to the general population — for which the complication rate is less than 1%.
This knowledge prompted him to dive deeper into the hip-back interplay.
“We noticed that there are certain conditions where a hip condition can actually put undue stress on the back,” Vigdorchik explained.
He and his fellow researchers wanted to find out how effective a hip replacement can be in eliminating low back pain, and determine which patients are more likely to benefit.
The patients whose low back pain resolved after the surgery were those with “flexible spines,” according to Vigdorchik. When a person’s spine is flexible, a stiff or poorly functioning hip can drive the spine to move more than usual, causing pain.
Those with normal flexibility in their spine were also highly likely to have their pain resolved.
“Those are the patients whose back pain went away completely after their hip replacement, because their back pain was probably caused by their hip not functioning properly to begin with,” said Vigdorchik.
But the back pain in patients with stiff spines did not go away. Patients with stiff spines already have serious arthritis of the spine, and replacing the hip is unlikely to relieve their pain.
But how can you know if your back pain could be resolved with a hip replacement?
It’s not easy to figure that out on your own, according to Vigdorchik. “It really relies on a good physical exam, and then good X-rays,” he said.
Before a patient undergoes a hip replacement, surgeons will typically take an X-ray of the patient lying down.
In this study, researchers took X-rays of their patients standing up and sitting down, both before and after the surgery.
These X-rays allowed them to see how the hip and spine moved in relation to each other, and assessed the flexibility of their spine, as the patient switched from a standing position to a seated position.
Vigdorchik encouraged other surgeons to utilize these X-rays to identify patients whose ailing backs may be relieved by a hip replacement.
He also advised surgeons in the field to “look beyond just the hip.”
“Anytime they’re looking at the hip, they should also look at the back, and anytime they’re looking at the knee, they should also look at the hip,” Vigdorchik said.
The existence of an interplay between the hip and back is well known to experts, but Della Valle said that this study showed how consistent it is.
He said the study gives surgeons in the field “some tools to try to predict which patients you can tell, ‘Yeah, your back pain will get better,’ and others, well, maybe it won’t.”
The study was published online recently during a virtual meeting of the American Academy of Orthopaedic Surgeons.
SOURCES: Jonathan Vigdorchik, M.D., orthopedic surgeon, hip and knee replacement, Hospital for Special Surgery, New York City; Craig Della Valle, M.D., professor, orthopedic surgery, Rush University Medical Center, Chicago; AAOS 2020 Virtual Education Experience, March 26, 2020, online