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NCCAM Clinical Digest: Chronic Low-Back Pain and Complementary Health Approaches

April 4, 2014 Comments off

NCCAM Clinical Digest: Chronic Low-Back Pain and Complementary Health Approaches
Source: National Center for Complementary and Alternative Medicine

This issue of the digest summarizes current scientific evidence about spinal manipulation, acupuncture, massage, and yoga, the complementary approaches most often used by people for chronic low back pain.

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The relation between total joint arthroplasty and risk for serious cardiovascular events in patients with moderate-severe osteoarthritis: propensity score matched landmark analysis

November 15, 2013 Comments off

The relation between total joint arthroplasty and risk for serious cardiovascular events in patients with moderate-severe osteoarthritis: propensity score matched landmark analysis
Source: British Medical Journal

Objective
To examine whether total joint arthroplasty of the hip and knee reduces the risk for serious cardiovascular events in patients with moderate-severe osteoarthritis.

Design
Propensity score matched landmark analysis.

Setting
Ontario, Canada.

Participants
2200 adults with hip or knee osteoarthritis aged 55 or more at recruitment (1996-98) and followed prospectively until death or 2011.

Main outcome measure
Rates of serious cardiovascular events for those who received a primary total joint arthroplasty compared with those did not within an exposure period of three years after baseline assessment.

Results
The propensity score matched cohort consisted of 153 matched pairs of participants with moderate-severe arthritis. Over a median follow-up period of seven years after the landmark date (start of the study), matched participants who underwent a total joint arthroplasty during the exposure period were significantly less likely than those who did not to experience a cardiovascular event (hazards ratio 0.56, 95% confidence interval 0.43 to 0.74, P<0.001). Within seven years of the exposure period the absolute risk reduction was 12.4% (95% confidence interval 1.7% to 23.1%) and number needed to treat was 8 (95% confidence interval 4 to 57 patients).

Conclusions
Using a propensity matched landmark analysis in a population cohort with advanced hip or knee osteoarthritis, this study found a cardioprotective benefit of primary elective total joint arthroplasty.

Total Body Bone Area, Bone Mineral Content, and Bone Mineral Density for Individuals Aged 8 Years and Over: United States, 1999–2006

August 20, 2013 Comments off

Total Body Bone Area, Bone Mineral Content, and Bone Mineral Density for Individuals Aged 8 Years and Over: United States, 1999–2006 (PDF)
Source: National Center for Health Statistics

Objectives
This report presents bone measurement data from total body dual energy x-ray absorptiometry scans for 28,454 persons aged 8 years and over who participated in the 1999–2006 National Health and Nutrition Examination Survey. The sample consisted of 22,667 respondents with valid data, and 5,787 with missing data that were successfully multiply imputed (i.e., not highly variable). Bone area, bone mineral content, and bone mineral density (BMD) are presented for the total body, the total body minus the head (e.g., subtotal), and 10 subregions of the body.

Methods
Means, standard deviations, and selected percentiles were calculated for the total body, total body minus head (subtotal), and 10 body subregions by sex, race and ethnicity, and age. Smoothed mean total body BMD was plotted by age, sex, and race and ethnicity. Multiple regression was used to evaluate differences in mean total body BMD by age, sex, and race and ethnicity

Results
After adjusting for race and ethnicity, total body BMD among those under age 20 was significantly higher in respondents aged 12–19 than in those aged 8–11 in both sexes.Among adults of both sexes, total body BMD in persons aged 20–49 was significantly higher than in those aged 50–79, and significantly lower in persons aged 80 and over than in those aged 50–79, after adjusting for race and ethnicity.After adjusting for age, total body BMD was significantly higher in non-Hispanic black persons than in non-Hispanic white persons, regardless of age or sex. However, the pattern differed by age when Mexican-American persons were compared with non-Hispanic white persons:Age-adjusted total body BMD was significantly lower among MexicanAmerican males aged 8–19, was similar in Mexican-American females aged 8–19, and was significantly lower in MexicanAmerican men and women aged 20 and over.

Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis

March 22, 2013 Comments off

Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis
Source: New England Journal of Medicine

Symptomatic, radiographically confirmed osteoarthritis of the knee affects more than 9 million people in the United States.1 Meniscal tears are also highly prevalent, with imaging evidence of a meniscal tear observed in 35% of persons older than 50 years of age; two thirds of these tears are asymptomatic.2 Meniscal damage is especially prevalent among persons with osteoarthritis3,4 and is frequently treated surgically with arthroscopic partial meniscectomy. This procedure, in which the surgeon trims the torn meniscus back to a stable rim, is performed for a range of indications in more than 465,000 persons annually in the United States.5

The high prevalence of meniscal tears in patients with osteoarthritis of the knee and the observation that these lesions are often asymptomatic challenge the ability of clinicians to determine whether symptoms are caused by the tear, osteoarthritis, or both. Clinicians who suspect that the tear is symptomatic may refer the patient to a surgeon for arthroscopic partial meniscectomy. The role of arthroscopic surgery in patients with osteoarthritis has been studied in two randomized, controlled trials over the past decade. One trial6 compared arthroscopic débridement and lavage with a sham surgical procedure, and the other7 compared arthroscopic débridement with a nonoperative regimen. Neither trial showed a statistically significant or clinically important difference between the arthroscopic and nonoperative groups with respect to functional improvement or pain relief over a period of 24 months.6,7

These landmark trials established that arthroscopic treatment was not superior to the other interventions in the treatment of knee osteoarthritis, but they did not focus on management of a symptomatic meniscal tear, which is a frequent indication for knee arthroscopy in patients with osteoarthritis of the knee. The efficacy of arthroscopic partial meniscectomy in symptomatic patients with a meniscal tear and osteoarthritis has been evaluated, to our knowledge, in only one randomized, controlled trial, which was a single-center study involving 90 patients.8,9 This study did not show a significant difference in pain relief or functional status between arthroscopic partial meniscectomy plus a physical-therapy regimen and physical therapy alone. Given the frequency and cost of arthroscopic partial meniscectomy and the paucity of data, we designed the Meniscal Tear in Osteoarthritis Research (METEOR) trial to assess the efficacy of arthroscopic partial meniscectomy as compared with a standardized physical-therapy regimen for symptomatic patients with a meniscal tear and concomitant mild-to-moderate osteoarthritis.

Chronic Pain and Complementary Health Practices

August 1, 2012 Comments off

Chronic Pain and Complementary Health Practices
Source: National Center for Complementary and Alternative Medicine

Millions of Americans suffer from pain that is chronic, severe, and not easily managed. Pain from arthritis, back problems, other musculoskeletal conditions, and headache costs U.S. businesses more than $61 billion a year in lost worker productivity.

Pain is the most common health problem for which adults use complementary health practices. Many people with conditions causing chronic pain turn to these practices to supplement other conventional medical treatment, or when their pain is resistant or in an effort to advert side effects of medications. Despite the widespread use of complementary health practices for chronic pain, scientific evidence on efficacy and mechanisms—whether the therapies help the conditions for which they are used and, if so, how—is, for the most part, limited. However, the evidence base is growing, especially for several complementary health practices most commonly used by people to lessen pain.

This issue highlights the research status for several therapies used for common kinds of pain, including arthritis, fibromyalgia, headache, low-back pain, and neck pain.

Spinal Manipulation for Low-Back Pain

July 18, 2012 Comments off

Spinal Manipulation for Low-Back Pain
Source: National Center for Complementary and Alternative Medicine (NCCAM)

Low-back pain (often referred to as “lower back pain”) is a common condition that usually improves with self-care (practices that people can do by themselves, such as remaining active, applying heat, and taking pain-relieving medications). However, it is occasionally difficult to treat. Some health care professionals are trained to use a technique called spinal manipulation to relieve low-back pain and improve physical function (the ability to walk and move). This fact sheet provides basic information about low-back pain, summarizes research on spinal manipulation for low-back pain, and suggests sources for additional information.

Application of “Less Is More” to Low Back Pain

June 16, 2012 Comments off

Application of “Less Is More” to Low Back Pain
Source: Archives of Internal Medicine

An initiative of the National Physicians Alliance, the project titled “Promoting Good Stewardship in Clinical Practice,” developed a list of the top 5 activities in primary care for which changes in practice could lead to higher-quality care and better use of finite clinical resources. One of the top 5 recommendations was “Don’t do imaging for low back pain within the first 6 weeks unless red flags are present.” This article presents data that support this recommendation. We selectively reviewed the literature, including recent reviews, guidelines, and commentaries, on the benefits and risks of routine imaging in low back pain. In particular, we searched PubMed for systematic reviews or meta-analyses published in the past 5 years. We also assessed the cost of spine imaging using data from the National Ambulatory Medical Care Survey. One high-quality systematic review and meta-analysis focused on clinical outcomes in patients with low back pain and found no clinically significant difference in pain or function between those who received immediate lumbar spine imaging vs usual care. Published data also document harms associated with early imaging for low back pain, including patient “labeling,” unneeded follow-up tests for incidental findings, irradiation exposure, unnecessary surgery, and significant cost. Routine imaging should not be pursued in acute low back pain. Not imaging patients with acute low back pain will reduce harms and costs, without affecting clinical outcomes.

Postmenopausal osteoporosis management: A review of the evidence to inform the development of quality indicators

May 10, 2012 Comments off

Postmenopausal osteoporosis management: A review of the evidence to inform the development of quality indicatorsSource: RAND Corporation

This report aims to inform the development of quality indicators for postmenopausal osteoporosis management through (a) assessing the evidence for screening and diagnosis of osteoporosis and related risk factors, and for prevention and treatment of osteoporosis and osteoporosis-related fractures; (b) describing current practice for managing postmenopausal osteoporosis in Europe; and (c) highlighting existing gaps in the evidence base and management practices in Europe. Analyses involved a comprehensive review of reviews regarding the screening and diagnosis of osteoporosis and related risk factors and the prevention and treatment of osteoporosis and osteoporosis-related fractures. While this identified a well developed evidence base on the effects of selected treatments on clinical outcomes of postmenopausal osteoporosis and associated fractures, and on the usefulness of selected simple risk factor assessment tools to identify postmenopausal women who would benefit from further diagnostic assessment, uncertainties remain regarding for example the optimal use of pharmacological interventions for preventive purposes and the effectiveness of population-based screening. We also carried out case study reviews of current practices for managing postmenopausal osteoporosis in England, France, Germany and Spain. We identify a need for the establishment of routine monitoring systems to enable better understanding of contemporary patterns and trends and identify care gaps in the management of postmenopausal osteoporosis and associated fractures. Such analyses are crucial to inform targeted strategies and policies to effectively address the burden of osteoporosis and associated fractures, which is sizable and set to increase across Europe. We set out considerations as a starting point for the further development of quality measures for postmenopausal osteoporosis in Europe.

Osteoporosis or Low Bone Mass at the Femur Neck or Lumbar Spine in Older Adults: United States, 2005–2008

May 6, 2012 Comments off

Osteoporosis or Low Bone Mass at the Femur Neck or Lumbar Spine in Older Adults: United States, 2005–2008
Source: National Center for Health Statistics

Key findings

Data from the National Health and Nutrition Examination Survey, 2005–2008

  • Nine percent of adults aged 50 years and over had osteoporosis, as defined by the World Health Organization, at either the femur neck or lumbar spine. About one-half had low bone mass at either site, while 48% had normal bone mass at both sites.
  • Estimates of poor skeletal status at the femur neck or lumbar spine when considered alone were not the same as estimates based on the two skeletal sites together because some individuals had the condition at one site but not the other.
  • The prevalence of osteoporosis or low bone mass at either the femur neck or lumbar spine differed by age, sex, and race and ethnicity. The prevalence was higher in women and increased with age. Differences between racial and ethnic groups varied by sex and skeletal status category.

Many current clinical guidelines recommend that assessment of osteoporosis or low bone mass, as defined by the World Health Organization (WHO) (1), be based on bone mineral density at either the femur neck region of the proximal femur (hip) or the lumbar spine (2,3). This data brief presents the most recent national data on osteoporosis or low bone mass at either the femur neck or lumbar spine among older adults in the United States population based on these WHO categories. Results are presented by age, sex, and race and ethnicity.

Treatment To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: Update of a 2007 Report

April 9, 2012 Comments off

Treatment To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: Update of a 2007 Report
Source: Agency for Healthcare Research and Quality

This topic is an update to the original topic, “Comparative Effectiveness of Treatments To Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis.” Please click on the the title to view the original research review and associated products.

+ Full Document (PDF)

Background Document for Meeting of Advisory Committee for Reproductive Health Drugs and Drug Safety and Risk Management Advisory Committee

September 11, 2011 Comments off

Background Document for Meeting of Advisory Committee for Reproductive Health Drugs and Drug Safety and Risk Management Advisory Committee
Source: U.S. Food and Drug Administration

In January, 2011, as part of a safety labeling change for all of the bisphosphonates approved for the treatment and/or prevention of osteoporosis, the following language was added to the Indications and Usage section of the product labels:

Important Limitations of Use

The safety and effectiveness of [drug] for the treatment of osteoporosis are based on clinical data of [xx] years duration. The optimal duration of use has not been determined. All patients on bisphosphonate therapy should have the need for continued therapy re-evaluated on a periodic basis.

Committee Members will be asked to discuss whether the available data support the long- term use of bisphosphonate medications for the treatment and/or prevention of osteoporosis and whether restricting the duration of use or implementing a drug holiday may be beneficial for patients with osteoporosis who require chronic long-term therapy.

From a safety perspective, the committee will be asked to discuss whether there is sufficient evidence to support an effect of long-term use of bisphosphonates therapy targeted at preventing and/or treating osteoporosis on the risk of developing osteonecrosis of the jaw, atypical fractures or esophageal cancer. Should the committee conclude there is a risk, they will be asked to discuss if there is sufficient evidence of an optimal duration of bisphosphonates use that would minimize these risks.

Committee Members will also be asked to discuss whether the available data support additional labeling changes.

Curcumin Modulates Nuclear Factor B (NF- B)-mediated Inflammation in Human Tenocytes in Vitro: ROLE OF THE PHOSPHATIDYLINOSITOL 3-KINASE/Akt PATHWAY

August 11, 2011 Comments off

Curcumin Modulates Nuclear Factor B (NF- B)-mediated Inflammation in Human Tenocytes in Vitro: ROLE OF THE PHOSPHATIDYLINOSITOL 3-KINASE/Akt PATHWAY
Source: Journal of Biological Chemistry

Inflammatory processes play essential roles in the pathogenesis of tendinitis and tendinopathy. These events are accompanied by catabolic processes initiated by pro-inflammatory cytokines such as interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α). Pharmacological treatments for tendinitis are restricted to the use of non-steroidal anti-inflammatory drugs. Recent studies in various cell models have demonstrated that curcumin targets the NF-κB signaling pathway. However, its potential for the treatment of tendinitis has not been explored. Herein, we used an in vitro model of human tenocytes to study the mechanism of curcumin action on IL-1β-mediated inflammatory signaling. Curcumin at concentrations of 5–20 μM inhibited IL-1β-induced inflammation and apoptosis in cultures of human tenocytes. The anti-inflammatory effects of curcumin included down-regulation of gene products that mediate matrix degradation (matrix metalloproteinase-1, -9, and -13), prostanoid production (cyclooxygenase-2), apoptosis (Bax and activated caspase-3), and stimulation of cell survival (Bcl-2), all known to be regulated by NF-κB. Furthermore, curcumin suppressed IL-1β-induced NF-κB activation via inhibition of phosphorylation and degradation of inhibitor of κBα, inhibition of inhibitor of κB-kinase activity, and inhibition of nuclear translocation of NF-κB. Furthermore, the effects of IL-1β were abrogated by wortmannin, suggesting a role for the phosphatidylinositol 3-kinase (PI-3K) pathway in IL-1β signaling. Curcumin suppressed IL-1β-induced PI-3K p85/Akt activation and its association with IKK. These results demonstrate, for the first time, a potential role for curcumin in treating tendon inflammation through modulation of NF-κB signaling, which involves PI-3K/Akt and the tendon-specific transcription factor scleraxis in tenocytes.

See: Curry Spice Could Offer Treatment Hope for Tendinitis (Science Daily)

A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain

August 5, 2011 Comments off

A Comparison of the Effects of 2 Types of Massage and Usual Care on Chronic Low Back Pain (PDF)
Source: Annals of International Medicine

Massage therapy may be effective for treatment of chronic back pain, with benefits lasting at least 6 months. No clinically meaningful difference between relaxation and structural massage was observed in terms of relieving disability or symptoms.

Are toning shoes unsafe? Reports of injuries raise concern

May 25, 2011 Comments off

Are toning shoes unsafe? Reports of injuries raise concern
Source: Consumer Reports

Ads for Skechers Shape-ups and similar toning shoes suggest they can help give you a firm behind and shapely legs. But our recent analysis of complaints to the Consumer Product Safety Commission’s new product complaint database suggest the shoes could send you to a doctor’s office or even an emergency room.

We looked at complaints reported since the database started, on March 11, 2011. As of May 22, 2011, 36 people reported injuries associated with toning shoes. That’s more than for any other single type of product in the database. Most of the reported injuries were minor, including tendonitis and foot, leg, and hip pain. But 15 of the reports were of broken bones, some requiring surgery.

Why so many reported injuries? Our medical experts explain that these type of toning shoes have rocker-style bottoms that are designed to cause instability, forcing users to engage muscles not normally used while walking. But that instability might also lead to turned ankles, nasty falls, and other injuries if you are not extra careful.

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