Cigarette smoking and chronic low back pain in the adult population
From: Clin Invest Med. 2009 Oct 1;32(5):E360-7
Chronic low back pain is one of the main causes of disability in the community. Although there have been studies suggesting an association between smoking and chronic low back pain, these studies were limited by the small numbers of patients, and they did not control for confounders. The objective of this study was to determine whether cigarette smoking is associated with an increased risk of chronic low back pain among adults.
Using Canadian Community Health Survey (cycle 3.1) data, 73,507 Canadians aged 20 to 59 yr were identified. Self-reported chronic low back pain status, smoking habits, sex, age, height, weight, level of activity and level of education were identified as well. Back pain secondary to fibromyalgia was excluded. Multivariate logistic regression analysis was used to detect effect modification and to adjust for covariates. Design effects associated with complex survey design were taken into consideration.
The prevalence of chronic low back pain was 23.3% in daily smokers and only 15.7% in non smokers. Age and sex were found to be effect modifiers, and the relationship between smoking and chronic low back pain risk was dependent on sex and age. The association between daily smoking and the risk of chronic low back pain was stronger among younger individuals. Occasional smoking slightly increased the odds of having chronic low back pain.
Daily smoking increases the risk of chronic low back pain among young adults, and this effect seems to be dose dependent. Back pain treatment programs may benefit from integrating smoking habit modification. Further research is required to develop effective prevention strategies.
Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life
From: Public Health. 2009 Aug 24
Examination of the prevalence, correlates and prospective impact of musculoskeletal pain on physical and psychological function in a population health survey of elderly Chinese men and women. Four thousand men and women, aged 65 years and over, living in the community in Hong Kong took part in this study. A questionnaire to determine demographics, socio-economic status, medical history, smoking, alcohol intake and level of physical activity was administered by an interviewer. Participants were asked about the presence of pain in the back, neck, hip and knee in the past 12 months. They were re-interviewed after 4 years of follow-up to document physical performance measures, psychological function and occurrence of falls, fractures and mortality.
Overall, back pain was most prevalent (48%), followed by knee (31%), neck (22.5%) and hip (8.9%) pain; the values was nearly twice as high in women compared with men for all sites. The presence of pain was not correlated with age, but was associated with various measures of socio-economic status as well as comorbidities. Baseline prevalence of pain was related to physical performance and quality-of-life measures, and fracture incidence after 4 years of follow-up.
Musculoskeletal pain is prevalent among elderly men and women, being much higher in the latter, giving rise to considerable functional and psychological impairments. Osteoporosis and osteoarthritis are likely to be the main underlying causes. The condition may be considered part of the frailty syndrome, and in this context, prevention and management represent major public health challenges.
Obama health care for all americans: practical implications
From: Pain Physician. 2009 Mar-Apr;12(2):289-304
Rapidly rising health care costs over the decades have prompted the application of business practices to medicine with goals of improving the efficiency, restraining expenses, and increasing quality. Average health insurance premiums and individual contributions for family coverage have increased approximately 120% from 1999 to 2008. Health care spending in the United States is stated to exceed 4 times the national defense, despite the wars in Iraq and Afghanistan. The U.S. health care system has been blamed for inefficiencies, excessive administrative expenses, inflated prices, inappropriate waste, and fraud and abuse. While many people lack health insurance, others who do have health insurance allegedly receive care ranging from superb to inexcusable. In criticism of health care in the United States and the focus on savings, methodologists, policy makers, and the public in general seem to ignore the major disadvantages of other global health care systems and the previous experiences of the United States to reform health care. Health care reform is back with the Obama administration with great expectations. It is also believed that for the first time since 1993, momentum is building for policies that would move the United States towards universal health insurance. President Obama has made health care a central part of his domestic agenda, with spending and investments in Children’s Health Insurance Program (CHIP), American Recovery and Reinvestment Act of 2009, and proposed 2010 budget. It is the consensus now that since we have a fiscal emergency, Washington is willing to deal with the health care crisis. Many of the groups long opposed to reform, appear to be coming together to accept a major health care reform. Reducing costs is always at the center of any health care debate in the United States. These have been focused on waste, fraud, and abuse; administrative costs; improving the quality with health technology information dissemination; and excessive regulations on the health care industry in the United States. Down payment on health care reform, American Recovery and Reinvestment Act, and CHIP include many provisions to reach towards universal health care.
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All Terrain Vehicles and Associated Spinal Injuries
From: Spine. 2008 Aug 15;33(18):1982-5
All terrain vehicles are associated with a higher incidence of axial compression and burst-type fracture morphologies. Although relatively safe and enjoyable when used properly, all terrain vehicles are associated with thousands of spinal injuries each year.
All terrain vehicles are currently experiencing enormous popularity in the United States. It has been estimated that there are currently over 7 million all terrain vehicles being operated at the present time in America. Although many drivers never get injured, All Terrain Vehicles have accounted for approximately 68,000 injuries and 270 deaths per year since 1985. In 2004 alone, injuries associated with all terrain vehicles use and misuse lead to 136,100 emergency room visits and 767 fatalities.
In 1988, an agreement was reached between the federal government and all terrain vehicle manufacturers that limited the production and sale of all terrain vehicles to only the 4-wheel or quad variety. This decree as well as state legislated helmet use has led to a decrease in the mortality rate. However, to date, there are only 21 states which mandate the use of helmets and other safety equipment. It has been shown in 2001, that in states without helmet laws, there is a 2-fold increase in all terrain vehicle related mortalities.
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Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients
From: Journal of Human Hypertension (2007), 1–6
It is well known that achievement of blood pressure goals in more than 70% of hypertensive individuals requires two or more antihypertensive agents. Based on the most recent NHANES 1999– 2000 data, blood pressure control in the US has not improved significantly. Moreover, many people have searched for alternative methods for lowering arterial pressure.
Since the early 1940s, a small cadre of chiropractic specialists have foregone typical ‘full-spine manipulations’, limiting their practice to precise, delicate manual alignment of a single vertebra, C-1 or Atlas; these practitioners make up the National Upper- Cervical Chiropractic Association (NUCCA). Unlike other vertebrae, which interlock one to the next, the Atlas relies solely upon soft tissue (muscles and ligaments) to maintain alignment; therefore, the Atlas is uniquely vulnerable to displacement. Displacement of C-1 is pain free and thus, remains undiagnosed and untreated, whereas health-related consequences are attributed to other aetiologies.
Minor misalignment of the Atlas vertebra can potentially injure, impair, compress and/or compromise brainstem neural pathways. The relationship between hypertension and presence of circulatory abnormalities in the area around the Atlas vertebra and posterior fossa of the brain has been known for more than 40 years. Studies by Jannetta et al. note arterial compression of the left lateral medulla oblongata by looping arteries of the base of the brain in 51 of 53 hypertensive patients who underwent left retromastoid craniectomy and microvascular decompression for unrelated cranial nerve dysfunctions. Such compression was not present in normotensive patients. Treatment by vascular decompression of the medulla was performed in 42 of the 53 patients and amelioration of hypertension was noted in 76%.6 Moreover, studies to clarify the mechanism by which decompression of the left rostral ventrolateral medulla relieves neurogenic hypertension are summarized in a review. It is clear from these studies that a sub-population of hypertensive patients improved their blood pressure after microvascular decompression.
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Cervical spine causes for referred otalgia
From: Otolaryngology Head and Neck Surgery 2008 Apr;138(4):479-85
Present experience in diagnosis and treatment for referred otalgia secondary to cervical spine degenerative disease.
A study of 123 patients with ear pain. All patients had a normal otologic examination and diagnosed with unspecified otalgia. The causes for referred otalgia were categorized into Group I: otalgia from non-cervical spine disease (n = 72), and Group II: cervical spine disease-referred otalgia (n = 51). Pain relief following cervical spine physical therapy was assessed.
The most common cause for referred otalgia in Group I was Temporomandibular joint (TMJ) dysfunction (46%); most common cervical spine finding in Group II was cervical spine degenerative disease (88%). Cervical spine physical therapy in those documented patients all reported subjective pain relief.
As the population in America ages, cervical spine degenerative disease in the elderly will begin to emerge as a major etiologic source for referred otalgia. With a targeted medical history and physical examination one can use directed studies to diagnose cervical spine degenerative disease-referred otalgia, and this pain can be alleviated with cervical spine physical therapy.
Does Cryotherapy Improve Outcomes With Soft Tissue Injury?
From: Journal of Athletic Training. 2004 Jul–Sep; 39(3): 278–279
Based on the available evidence, cryotherapy seems to be effective in decreasing pain. In comparison with other rehabilitation techniques, the efficacy of cryotherapy has been questioned. The exact effect of cryotherapy on more frequently treated acute injuries (eg, muscle strains and contusions) has not been fully elucidated. Additionally, the low methodologic quality of the available evidence is of concern. Many more high-quality studies are required to create evidence-based guidelines on the use of cryotherapy. These must focus on developing modes, durations, and frequencies of ice application that will optimize outcomes after injury.
We often recommend ice for neck pain relief, usually for whiplash injuries, however, I find many patients do not tolerate cryotherapy on the neck well, especially in colder climates. It would be interesting to see some actual studies comparing cryotherapy to a more traditional martial arts approach using a properly designed liniment with light massage on recovery from soft tissue injuries.
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Prevalence of Chronic Pain in a Representative Sample in the United States
From Pain Medicine Published article online: 11-Mar-2008
Objective. Chronic pain is a common reason for seeking medical care. We estimated the prevalence of chronic regional and widespread pain in the United States population overall, and by age, sex, and race/ethnicity.
Setting. We examined the data from 10,291 respondents who participated in the 1999–2002 NHANES (National Health and Nutrition Examination Survey) and completed a pain questionnaire. Items allowed classification of chronic (≥3 months) pain as regional or widespread. We used regression models to test the association of sex and race/ethnicity with each pain outcome, adjusting for age.
Results. Chronic pain prevalence estimates were 10.1% for back pain, 7.1% for pain in the legs/feet, 4.1% for pain in the arms/hands, and 3.5% for headache. Chronic regional and widespread pain were reported by 11.0% and 3.6% of respondents, respectively. Women had higher odds than men for headache, abdominal pain, and chronic widespread pain. Mexican-Americans had lower odds compared with non-Hispanic whites and blacks for chronic back pain, legs/feet pain, arms/hands pain, and regional and widespread pain.
Conclusion. The population prevalence of chronic pain in the United States was lower than previously reported, with smaller sex-related differences and some variation by race/ethnicity.
