Study Links Diabetes and Back Pain

People with diabetes have a 35 percent higher risk of experiencing low back pain and 24 percent higher risk of having neck pain than those without diabetes, a review by University of Sydney researchers has found.

Their findings, based on meta-analyses of studies that assess the links between diabetes and back or neck pain outcomes, were published in PLOS ONE.

Most adults experience low back pain during their lives and almost half suffer neck pain at some stage. Diabetes is an increasingly prevalent chronic condition; an estimated 382 million people live with type 2 diabetes, the most common form of this metabolic disease.

There was insufficient evidence in the review to establish a causal relationship between diabetes and back or neck pain, the paper’s senior author Associate Professor Manuela Ferreira from the University’s Institute of Bone and Joint Research said. But the findings warrant further investigation of the association.

“Diabetes and low back pain and neck pain seem to be somehow connected. We can’t say how but these findings suggest further research into the link is warranted,” Associate Professor Ferreira said.

“Type 2 diabetes and low back pain both have a strong relationship with obesity and lack of physical activity, so a logical progression of this research might be to examine these factors in more detail. Our analysis adds to the evidence that weight control and physical activity play fundamental roles in health maintenance.”

The paper also found diabetes medication could influence pain, possiby via its effect on blood glucose levels, and this connection should also be investigated. It also recommended health care professionals should consider screening for unknown diabetes in patients seeking care for neck pain or low back pain.

“Neck and back pain, and diabetes, are afflicting more and more people,” said co-author and collaborator Associate Professor Paulo Ferreira from the Faculty of Health Sciences and Charles Perkins Centre. “It’s worth committing more resources to investigate their interrelationship. It may be that altering treatment interventions for diabetes could reduce the incidence of back pain, and vice versa.”

Source: The University of Sydney


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An Expert’s Guide to Avoiding Back Pain

Back pain is a common problem in the United States, but there are ways to protect yourself, an expert says.

“The back is a complex structure with many delicate parts, but with good judgment and healthy lifestyle habits — including proper lifting, good posture and exercise — it’s possible to avoid common back pain caused by strained muscles,” said Dr. Lawrence Lenke. He is director of spinal deformity surgery at the Spine Hospital at New York-Presbyterian in New York City.

For more complicated spinal problems such as scoliosis, stenosis, fractures or injuries, medical intervention is usually necessary, Lenke said.

“But each person with or without spinal problems can benefit from adopting healthier lifestyle habits to keep your spine as strong as possible,” he said.

Lenke offered this advice:

  • Maintain a healthy weight, don’t smoke, do stretching and strengthening exercises that increase back and abdomen flexibility, and get regular cardiovascular exercise. If your job involves a lot of sitting, get up and walk around every 15 to 30 minutes.
  • Maintain good posture even while sitting. Don’t slouch or hold your head too far forward. Be sure your feet are supported, hips are level with or slightly above the knees and your spine is slightly reclined. There should be a small arch in the lower back.
  • When sitting at a computer, your shoulders should be relaxed and away from the ears. Your elbows should be at the sides, bent to about 90 degrees, and your wrists should be neutral — not bent up, down or away from each other. Your head should face ahead without being too far forward.
  • When using a mobile device for non-voice activities, hold it up instead of bending your neck to look down. At just 45 degrees, the work your neck muscles are doing is equal to lifting a 50-pound bag of potatoes.
  • When lifting, make sure objects are properly balanced and packed correctly so weight won’t shift. Keep the weight close to your body. And take your time. Bend at the hips and knees and use your legs to lift. Maintain proper posture with your back straight and head up.

Source : HealthDay

The 3-Step Guide to Beating Back Pain

Hallie Levine wrote . . . . . . . .

Aching lower backs, either acute or chronic, affect nearly half of healthy, active people older than 60, according to a February study in the Journal of the American Geriatrics Society.

“Lower back pain is one of the most common pain problems for older adults and one of the most frustrating because there are no easy fixes,” says Roger Chou, M.D., a professor of medicine at Oregon Health & Science University in Portland.

Traditional treatments such as opioid pain pills, steroid injections, and surgery are not necessarily very effective and can have significant downsides.

But some good evidence supports certain nondrug and nonsurgical options. That’s why 2017 guidelines from the American College of Physicians (ACP) recommend them—and suggest drugs or surgery only when other therapies fail.

That advice is backed up by a nationally representative Consumer Reports survey of 3,562 back-pain sufferers.

More than 80 percent who tried yoga or tai chi, massage therapy, or chiropractic said it had helped them, as did more than 60 percent of respondents who tried acupuncture or physical therapy.

But experts agree that a personalized plan is best. “Everyone responds to pain differently,” says Jack Ende, M.D., immediate past president of the ACP. “And what works for one person may fall flat in another.”

So which steps should you take when your back starts aching, and in what order? Here’s what the research and our experts recommend.

When Back Pain First Strikes

Back pain is considered acute when a new episode lasts for less than four weeks. If your back begins to hurt, experts suggest starting with the following:

Heat or ice. For instance, a warm shower, hot-water bottle, or heating pad can reduce pain. Ice may also feel good.

Gentle activity. It’s best to resume normal activity. (If you can’t, walk for a few minutes every few hours, Ende says.) If you’re able, try easy stretches. A 2017 Cochrane Collaboration review found that people with back pain who were told to stay somewhat active reported less discomfort and recovered faster than those advised to stay in bed.

OTC pain relievers if needed. While the ACP emphasizes nondrug measures, Ende says over-the-counter ibuprofen (Advil or generic) or naproxen (Aleve and generic) can be used for a week or two.

If You’re Still in Pain After a Week or Two

If you still have a lot of pain at this point, your doctor may provide a home-based exercise program or refer you to physical therapy for supervised exercise. (Some sessions are usually covered by insurance.)

PT may include massage or low-level laser therapy, but the exercise component is key. People who get PT within 90 days of the onset of pain get fewer imaging tests and questionable treatments, according to a study published in 2015 in the journal BMC Health Services Research.

After a month or two, you may feel well enough to get back to—or start—a normal exercise program.

And that’s important: People who have had lower back pain but are active are about one-third less likely to see it recur, according to a review published in 2017 in the American Journal of Epidemiology.

When Pain Persists for Months

For pain that continues even after a couple of months of home-based exercise or PT, the ACP recommends considering these (some may be covered by insurance):

Yoga and tai chi. They strengthen core muscles, relieving pressure on your back, says Benjamin Kligler, M.D., national director of the Integrative Health Coordinating Center for the Veterans Health Administration.

A 2017 Cochrane review of studies concluded that yoga improved back function. And research used as a basis for the ACP guidelines found that tai chi was useful for chronic back pain. It can also help with shorter-term pain, but it may take several weeks for you to see results, Kligler says.

Your doctor may be able to refer you to a local class for yoga (opt for a gentle form) or tai chi. YMCAs and fitness centers may also offer them.

Or find a list of certified instructors through the American Tai Chi and Qigong Association, the Yoga Alliance, or the International Association of Yoga Therapists.

Cognitive behavioral therapy or mindfulness-based stress reduction. If back pain has you feeling depressed or anxious, CBT—which focuses on circumventing negative thought patterns—may help. MBSR increases awareness and acceptance of pain with practices such as yoga and meditation.

Adults with chronic back pain who did either technique for 2 hours a week for eight weeks reported significant relief, according to a study published in 2016 in the Journal of the American Medical Association. Ask your doctor for the names of cognitive behavioral therapists, or check the website of the Association for Behavioral and Cognitive Therapies.

Spinal manipulation. Used by chiropractors, osteopaths, physical therapists, and some massage therapists, it involves moving the joints of the spine. A review published last year in JAMA found that spinal manipulation significantly improved pain and function for those with acute lower back pain. A Cochrane review concluded that it works as well as exercise, PT, or standard medical care for chronic back pain.

Check your health insurer’s website for licensed chiropractors and doctors of osteopathic medicine (D.O.), then ask your primary care doctor for a referral. (Our survey found that spinal manipulation is more likely than most nondrug treatments to be covered by insurance, at least partly.) Roger Chou at Oregon Health & Science University advises trying it for three to four weeks but moving on if it’s not helping.

Acupuncture. This involves inserting very fine needles into specific points on the body. “I usually have people with chronic back pain try a course of PT because it’s usually covered by insurance, and if that doesn’t seem to help, recommend they try acupuncture for six to eight sessions,” says Joseph Herrera, D.O., system chair for rehabilitation medicine at the Mount Sinai Health System in New York.

A large review of studies found that acupuncture outperformed sham treatment and no treatment for all kinds of chronic pain, including back pain. But it may cost you $100 or more per session. Make sure any acupuncturist you see is licensed by the state. Find listings on the National Certification Commission for Acupuncture and Oriental Medicine’s website.

What About Meds and Surgery?

If none of the above help or you’re in significant pain while starting a treatment like PT, a week or two of medication is reasonable, Chou says. The ACP recommends over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.

If you can’t take an NSAID or need stronger relief, consider the prescription pain pill tramadol (Ultram and generic) or the antidepressant duloxetine (Cymbalta and generic). Both have only a small effect on back pain, so you’ll need nondrug methods as well.

The nerve-pain drug gabapentin (Neurontin, Gralise, Horizant, and generic) is often prescribed for muscle pain, but research suggests that it’s not very effective and causes side effects such as dizziness.

And groups such as the ACP and the American Academy of Family Physicians strongly advise against the use of opioid painkillers such as oxycodone (Oxycontin and generic).

“These drugs are very problematic in seniors because they increase the risk of falls, as well as other concerns such as addiction and overdose,” Chou says.

Should surgery ever be an option? Only for persistent pain, numbness, and tingling that radiates down a leg from a herniated disk; severe or progressive weakness in a foot or leg; or spinal stenosis that hasn’t responded to therapies such as PT, Ende says. Even then, you can hold off if you’re seeing improvement.

Imaging Tests: When to Consider, When to Skip

You may be tempted to run to your doctor and request an X-ray or MRI for back pain. But that’s rarely helpful.

“One of the biggest misconceptions about these screening tests is that we can easily ID the cause from them,” says Richard Deyo, M.D., M.P.H., a professor of evidence-based medicine at Oregon Health & Science University. “The reality is, older adults usually have something that shows up on an X-ray or MRI, like worn-out or bulging disks. But oftentimes that’s not the cause of the problem.”

Consider imaging if you’ve had pain for six weeks and it’s not getting better, Deyo says. In that case, a pinched nerve may be contributing to the problem.

You should also contact your doctor immediately for an imaging test if you have back pain along with unexplained weight loss, a fever higher than 102° F, loss of bowel or bladder control, loss of strength or numbness in one or both legs, or a history of cancer. These may be signs of nerve damage, infection, or a tumor.

Source: Consumer Reports

5 Causes of Back Pain

Teresa Carr wrote . . . . . .

Most people with short-term back pain recover without ever finding out exactly what went wrong. But especially when pain lingers, discovering the underlying source of the pain can help guide treatment. And understanding what can cause your back to hurt is key to preventing a recurrence.

The following are the most common causes of back pain.

Muscle Injuries

Overstretched or injured muscles, tendons, or ligaments can result in strains, sprains, or spasms. Poor posture, prolonged sitting, strenuous work, and repetitive action such as throwing a ball or weeding a garden can stress so-called soft tissues in your back. In our survey, this was the most common cause of back pain, affecting more than one-third of respondents.

Degenerative Changes

As you age, the gel-like disks cushioning the bones of your spine and the cartilage lining the joints can begin to wear. That allows the bones to rub against one another, causing osteoarthritis. Some degeneration of this kind is harmless and unavoidable. Imaging studies show that almost everyone older than 60 has signs of spinal wear and tear. But most never report significant pain.

Herniated, or Slipped, Disks

Lifting, pulling, bending, or twisting puts pressure on the disks. That pressure can cause them to bulge or slip. When a bulging disk in the lower spine irritates the sciatic nerve, the sharp pain, called sciatica, is often excruciating and can radiate down a leg even when there’s no back pain. Slouching at the waist can worsen symptoms.

Spinal Stenosis

The spine responds to degenerative changes by growing new bone in the joints and thickening the ligaments to provide better support. But over time those bone spurs and thickened ligaments narrow the space around the spinal cord and can irritate nerves. Symptoms include numbness, weakness, or cramping in the back, buttocks, arms, or legs. Walking usually worsens symptoms; rest or leaning forward tends to offer relief.

Spinal Instability

When disks and joints wear, they don’t do as good a job supporting the spine. As a result, vertebrae move more than they should. In some cases a bone slides forward, causing a condition called spondylolisthesis. Symptoms often come and go suddenly, sometimes shifting from one side of the body to the other, and can include a feeling of weakness in the legs with prolonged standing or walking.

Source: Consumer Report

Chiropractors Not Magicians When It Comes to Chronic Back Pain

Amy Norton wrote . . . . . .

Chiropractors can help ease some cases of low back pain, though their treatments may be no better than taking an over-the-counter pain reliever, a new analysis finds.

The review of 26 clinical trials found that manipulating the spine can bring “modest” relief to people with acute low back pain — pain that has lasted no more than six weeks.

Chiropractors perform spinal manipulation, as do some doctors, physical therapists and other health professionals. Most insurers, Medicare and Medicaid pay for some chiropractic services, according to the American Chiropractic Association.

But spinal manipulation is no magic bullet, the researchers behind the new study said. The benefits appear similar to those of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.

It seems that when it comes to low back pain, no one has found a quick fix.

That didn’t stop the American College of Physicians (ACP) from releasing new guidelines earlier this year on managing low back pain.

The guidelines advise non-drug options first — including tactics such as heat wraps, acupuncture, massage, exercise and spinal manipulation.

But while they are recommended, none of those options seems hugely effective. An ACP evidence review found each to have a “small” to “moderate” benefit.

Instead, time may be the best healer, the researchers said.

“Most acute back pain goes away on its own in a few days to weeks,” said review author Dr. Paul Shekelle, chief of general internal medicine at the VA Greater Los Angeles Healthcare System.

“Most treatments — whether they be NSAIDs or muscle relaxants or spinal manipulation therapy — have, on average, small effects,” Shekelle said.

“Some patients have much larger effects,” he pointed out. “But, on average, there is no magic bullet for back pain.”

One thing that does seem important, Shekelle said, is that people remain active when they have acute back pain. That seems to speed the recovery process.

Back pain is one of the most common health complaints among Americans. It affects around 80 percent of the population at some point, according to the U.S. National Institutes of Health. Usually, the lower back is the problem area.

In some cases, people suffer pain caused by compression of a nerve — from a herniated spinal disc, for instance. Sciatica, where pain radiates down the leg, is a common example.

But most often, according to Shekelle, people have what’s called “nonspecific” back pain, where there’s no clear cause.

His team analyzed trials that tested spinal manipulation in patients with acute back pain — not sciatica or chronic pain (longer than 12 weeks).

Out of 26 trials, the researchers found that 15 reported “moderate-quality” evidence that spinal manipulation brought patients modest pain relief over six weeks. In 12 trials, patients saw some improvements in their daily functioning, on average.

The therapy did appear to be relatively safe. Around half of patients said they developed minor side effects such as headaches or a temporary increase in pain or muscle stiffness.

The review was published in the Journal of the American Medical Association.

According to Shekelle, many studies in the review compared spinal manipulation against tactics that were not expected to be effective, such as giving patients an educational booklet.

Another issue, he said, was that spinal manipulation was often combined with another therapy, including exercise. That makes it harder to know how effective the spinal manipulation was on its own.

“And then, of course, there are all the things a patient may be doing for their back pain that aren’t part of the trial,” Shekelle said, “like using heat, or getting home massage, or who knows what else.”

The good news is, most people with acute back pain “will almost certainly improve with time,” said Dr. Richard Deyo, a professor at Oregon Health and Science University in Portland.

“It’s perfectly reasonable for people to self-treat, with things like heat wraps,” said Deyo, who wrote an editorial that was published with the study.

For people with more severe pain, the choice of therapy often comes down to what’s practical and affordable, according to Deyo.

Why does spinal manipulation help some people with low back pain? “We don’t know,” Deyo said, “but there are theories.”

The therapy might, for instance, ease muscle tension, reposition spinal disc material, or stimulate large nerves in a way that disrupts pain signals.

“Or maybe,” Deyo said, “it’s partly the hands-on nature, and ongoing relationship with the provider.”

Source: HealthDay


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