Prevalence of neck pain in subjects with metabolic syndrome – a cross-sectional population-based study.
From: BMC Musculoskelet Disord. 2010 Jul 30;11(1):171.
Metabolic syndrome has become increasingly common worldwide. Metabolic syndrome is a cluster of risk factors defined by high fasting glucose and triglycerides, low HDL cholesterol, high blood pressure, and abdominal obesity that increases the risk for cardiovascular diseases, type 2 diabetes mellitus, and all-cause mortality. The prevalence of metabolic syndrome in the US population is approximately 35%. In Eastern Finland the corresponding prevalence has been found to be 37%. Neck pain is also a common symptom among the middle-aged population. In a large Finnish population-based study, 24% of men and 37% of women aged at least 30 years had suffered from neck pain during the preceding month.
There are few studies in which the prevalence of pain has been assessed in subjects with metabolic syndrome. In one study females with chronic pain from fibromyalgia were at an increased risk of metabolic syndrome. Another study found that subjects with metabolic syndrome were more likely to have problems with pain symptoms. It has been suggested that stress is related to both metabolic syndrome and neck pain. Low physical activity has been found to be associated with metabolic syndrome and musculoskeletal pain. Some studies have found an association between obesity and neck pain. Because visceral obesity is one of the main features of metabolic syndrome, it could be proposed that metabolic syndrome is also related to neck pain. It has been speculated that both metabolic syndrome and persistent chronic pain syndromes are related to hypothalamus-pituitary-adrenal stress axis dysfunction. Therefore, it could be expected that the prevalence of neck pain is elevated in subjects with metabolic syndrome. Thus, if there were common features in the background of these disorders, the authors hypothesized that neck pain is more prevalent among subjects with metabolic syndrome than among those without metabolic syndrome. In this study the authors aimed to analyse the prevalence of neck pain in subjects with metabolic syndrome.
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The prevalence of headache may be related with the latitude: a possible role of Vitamin D insufficiency?
From: J Headache Pain. 2010 May 13. [Epub ahead of print]
According to recent observations, there is worldwide vitamin D insufficiency in various populations. A number of observations suggest a link between low serum levels of vitamin D and higher incidence of chronic pain. A few case reports have shown a beneficial effect of vitamin D therapy in patients with headache disorders. Serum vitamin D level shows a strong correlation with the latitude. Here, we review the literature to delineate a relation of prevalence rate of headaches with the latitude. The authors noted a significant relation between the prevalence of both tension-type headache and migraine with the latitude. There was a tendency for headache prevalence to increase with increasing latitude. The relation was more obvious for the lifetime prevalence for both migraine and tension-type headache. One year prevalence for migraine was also higher at higher latitude.
There were limited studies on the seasonal variation of headache disorders. However, available data indicate increased frequency of headache attacks in autumn-winter and least attacks in summer. This profile of headache matches with the seasonal variations of serum vitamin D levels. The presence of vitamin D receptor, 1alpha-hydroxylase and vitamin D-binding protein in the hypothalamus further suggest a role of vitamin D deficiency in the generation of head pain.
Effect of obesity and low back pain on spinal mobility: a cross sectional study in women
From: J Neuroeng Rehabil. 2010 Jan 18;7(1):3. [Epub ahead of print]
Obesity is nowadays a pandemic condition. Obese subjects are commonly characterized by musculoskeletal disorders and particularly by non-specific chronic low back pain. However, the relationship between obesity and chronic low back pain remains to date unsupported by an objective measurement of the mechanical behavior of the spine and its morphology in obese subjects. Such analysis may provide a deeper understanding of the relationships between function and the onset of clinical symptoms.
Objectively assessment of posture and function of the spine during standing, flexion and lateral bending in obese subjects with and without chronic low back pain and to investigate the role of obesity in chronic low back pain.
Cross-sectional study Patient sample: thirteen obese subjects, thirteen obese subjects with chronic low back pain, and eleven healthy subjects were enrolled in this study. The authors evaluated the outcome in terms of angles at the initial standing position (START) and at maximum forward flexion (MAX). The range of motion (ROM) between START and MAX was also computed. The authors studied forward flexion and lateral bending of the spine using an optoelectronic system and passive retroreflective markers applied on the trunk. A biomechanical model was developed in order to analyse kinematics and define angles of clinical interest.
Obesity was characterized by a generally reduced ROM of the spine, due to a reduced mobility at both pelvic and thoracic level; a static postural adaptation with an increased anterior pelvic tilt. Obesity with chronic low back pain is associated with an increased lumbar lordosis. In lateral bending, obesity with chronic low back pain is associated with a reduced ROM of the lumbar and thoracic spine, whereas obesity on its own appears to affect only the thoracic curve.
Obese individuals with chronic low back pain showed higher degree of spinal impairment when compared to those without chronic low back pain. The observed obesity-related thoracic stiffness may characterize this sub-group of patients, even if prospective studies should be carried out to verify this hypothesis.
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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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Health problems related to working in extreme cold conditions indoors
From: Int J Circumpolar Health. 2008 Jun;67(2-3):279-87
To identify health problems among workers performing cleaning, maintenance and machine operation tasks inside cold storage rooms with temperatures between -43 degrees C and -62 degrees C in a freeze drying coffee company. All 24 workers working inside the cold stores participated in the study. A questionnaire about cold related health problems and the standardized Nordic questionnaire assessing muscle complaints were completed by all exposed workers. A physical examination was performed on each worker.
The most relevant cold related health problem was episodic finger symptoms (50%), followed by respiratory symptoms (21%), peripheral circulation symptoms (20%), and repeated pain in the musculoskeletal system (12%). Two subjects had a previous diagnosis of Raynaud’s phenomenon. The prevalence of musculoskeletal complains in the neck and low back was 21% in each. The prevalence found for various complaints among the freeze drying coffee workers implies that the cold conditions inside cold stores may present a real risk of cold related health problems and, due to lowered concentration level, for injuries, too. Greater efforts should be made to minimize the cold exposure by designing automation processes to prevent continuous exposure to cold during freeze drying process. In addition, improving the cold protective clothing and guaranteeing its appropriate use will reduce health risks.
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.
