Booster Shots

Oddities, musings and news from the health world

Category: pain

Knee pain? Try wearing flip-flops, study suggests

March 24, 2010 | 11:11 am

Flipflop Poor flip-flops. Popular though they are, they've been targets for criticisms of many types -- for their lack of arch support, for their potential tripping hazard, for their inability to protect foot skin from the sun and thus their theoretical elevation of foot-skin cancer risk (seriously). And who was to say the criticism was wrong? The shoes are cheap -- they have to be bad, right?

Not so.

Researchers at Rush University in Chicago analyzed the gaits of 31 people with osteoarthritis of the knee while the participants were walking barefoot and while they were wearing clogs, stability shoes, flat walking shoes and the much maligned (and generally inexpensive) flip-flops.

If the goal is to not increase pressure on the knee -- and people with knee osteoarthritis would wholeheartedly say that it is -- then walking barefoot, wearing flat walking shoes or simply slipping on thongs would appear to be the best choice. The same could not be said for clogs and stability shoes.

The researchers note that sole flexibility, like heel height, would seem to be important when choosing footwear.

Now if someone could only do something about that annoying flapping sound.

Here's the abstract as it appears in the journal Arthritis Care & Research and the release as it appears on ScienceBlog -- plus an earlier abstract from a similar study (also out of Rush). It found that a specialized shoe known as a mobility shoe tended to be kinder to the knees than a typical "walking" shoe.

And here's more about knee osteoarthritis from the American Academy of Orthopaedic Surgeons.

— Tami Dennis

Photo: Fun and not-so-bad for you. Credit: Goh Seng Chong / Bloomberg


Drug for menstrual cramps in the works

March 23, 2010 |  3:00 pm

Women Well, it's about time. If men had menstrual cramps, I think we'd have more treatment options than Midol by now. OK, enough complaining. A British company is attempting to develop a medication designed to target the specific cause of menstrual cramps. The researchers presented data from a Phase 2 clinical trial Tuesday at the annual meeting of the American Chemical Society in San Francisco.

Menstrual cramps are caused by contractions of the uterus and an increase in the hormone vasopressin. The goal of the experimental medication, called VA111913, is to block this hormone. The other remedies women use for relief -- painkillers and birth control pills -- only address the symptoms of menstrual cramps, not the cause.

"This is a different approach," said Andy Crockett, vice president of business development for Vantia Ltd., the company developing the drug. "Right now, the current therapies for menstrual cramps are poorly tailored."

While half of all women experience some menstrual cramps, about 10% to 20% have a severe condition, called dysmenorrhea. "It's one of the leading causes of work and school absenteeism in the United States," Crockett said. "We certainly believe this drug has the potential to be a breakthrough."

It's still too soon to know if the drug will work, however. It has passed initial safety tests and is now being tested on 100 women in the United Kingdom and three U.S. sites (Peoria, Ariz.; Austin, Texas; and Salt Lake City). The findings from the Phase 2 trial are expected later this year, but it will be several more years until the medication, if proven safe and effective, makes it to the marketplace.

Until then, ladies, you'll just have to suffer.

-- Shari Roan

Photo credit: Roxana Villa  /  For The Times


Rodent of the Week: An anesthetic that stops only pain

February 5, 2010 |  1:00 pm

Rodent_of_the_week The trouble with nerve block anesthesia is that it blocks pain and motor function. But researchers this week reported progress on an anesthetic that only blunts pain.

Scientists from Children's Hospital Boston were studying substances called surfactants, which are used to help drugs spread more easily through tissue. While testing various surfactants along with the anesthetics QX-314 and QX-222 (types of lidocaine) they found the mixtures halted pain in the sciatic nerves of rats for up to seven hours but didn't impair the animals' movements. In one experiment, the rats were able to tolerate having their paws on a hot plate for long periods of time yet could still stand and maintain balance. The study was published online this week in the Proceedings of the National Academy of Sciences.

The researchers don't know how the surfactants cause this unique response. It could be that surfactants are able to penetrate sensory nerves but not motor nerves.

Surfactants can be toxic in high doses. So further studies will be needed in larger animals, and the research team will look for different types of substances that enhance the movement of drugs into tissues.

As for the question of why anesthetics that preserve motor function are even needed, the best example is childbirth. Such a nerve block would allow a woman to effectively use her muscles to push without feeling the pain.

-- Shari Roan

Photo credit: Advanced Cell Technology Inc.


For menstrual cramps, go with the ibuprofen over acetaminophen

January 20, 2010 | 12:32 pm

Most women likely have figured this out on their own, if the reaction to this study in a recent meeting was any indication, but we like data, so here you go...

Researchers at the Cochrane Library have analyzed studies (because that's what they do -- and they do it well) on pain relief for dysmenorrhoea, known by most people as menstrual cramps. They concluded that non-steroidal anti-inflammatory drugs seem to be more effective at controlling such pain than paracetamol, known my most North Americans as acetaminophen.

Here's the abstract of the study (go to the bottom of the page for the "plain language summary").

As for which NSAID was more effective or safer, the researchers couldn't say. Other over-the-counter NSAIDs include  naproxen (Aleve) and aspirin.

Here's more on menstrual cramps and pain relief from MedicineNet. It explains why aspirin might not be the best choice either. The old standby has less effect on chemicals called prostaglandins.

-- Tami Dennis


Ow! Enough of these running shoes. Anyone have some high heels?

January 4, 2010 |  3:42 pm

MarathonThose hallmarks of physical fitness die-hards and comfort addicts alike -- running shoes -- apparently aren't all they're cracked up to be.

In a study of healthy young runners published in PM&R: The Journal of Injury, Function and Rehabilitation, researchers found that running in the shoes can put more stress on the knee, hip and ankle joints than running barefoot.

It was even harder on the knees than walking in high heels, they noted. Here's the full study.

Such findings won't surprise many shoeless runners. Roy Wallack recently wrote of running guru Barefoot Ken's decision, some years ago, to ditch his feet's uniform:

"That experiment changed his life, ultimately establishing barefooting as a potential cure for some running injuries, implicating modern cushioned shoes in those injuries, and becoming the impetus for what may be the most counter-intuitive product in the history of sport: the barefoot running shoe." Here's that story. And a review of those barefoot running shoes.

And the findings may have special meaning to many wearers of high heels. Some of the shoes are fairly comfortable (comfortable-ish? tolerable? not downright painful?), but others ...

The researchers point out that there was nothing especially unique about the shoe they used in the study, saying that it was representative of today's generation of running shoes. But they weren't about to say "toss off those high-priced shackles and run free" either.

They wrote: "The use of athletic footwear in running as a means to protect the foot from acute injury and the potentially debilitating effect of switching to barefoot running on foot health excludes such an alternative. The development of new footwear designs that encourage or mimic the natural compliance that normal foot function provides while minimizing knee and hip joint torques is warranted."

You can count on some shoes -- some time fairly soon -- that are marketed to do just that.
 
-- Tami Dennis

Photo: This photo may appear to be of the start of last year's Los Angeles Marathon. It's actually a small fraction of the market for running shoes.

Credit: Los Angeles Times  


TENS doesn't help low-back pain

December 30, 2009 |  1:00 pm

Backpain A popular pain therapy using a portable device called TENS -- transcutaneous electric nerve stimulation -- should not be used to treat chronic low-back pain, according to guidelines published online today in the journal Neurology, the medical journal of the American Academy of Neurology. The therapy is ineffective for low-back pain, according to the paper's authors, although there is limited evidence that TENS is useful for treating diabetic nerve pain.

TENS is a pocket-sized device that delivers a mild electrical current to nerves through electrodes. The treatment has been used for a variety of types of pain, although there is little scientific data to demonstrate how it works. One theory is that the electrical stimulation confuses the brain and blocks the pain signal.

Studies on the value of TENS have produced conflicting results. The authors of the new guidelines analyzed all data on TENS in studies lasting three months or longer. The lead author of the paper, Dr. Richard M. Dubinsky of Kansas University Medical Center, said people currently using TENS for chronic low-back pain should discuss the guidelines with their doctor.

But TENS may still be useful for some patients, especially those with nerve pain, said the authors of an editorial accompanying the study. TENS is safe and easy to use and may still be a good alternative to pain medication. "... It is not unreasonable to take a practical position that, in spite of the relatively weak scientific and clinical evidence, TENS still represents a valuable therapeutic alternative in neurological pain disorders," they wrote.

-- Shari Roan

Photo credit: Jay Clendenin / Los Angeles Times


Overweight kids may be at higher risk for back pain

December 1, 2009 | 11:04 am

Obese and overweight children are at higher risk for conditions such as diabetes and high cholesterol, studies have shown, but they may also be more susceptible to back pain and spinal problems.

J1ltn3nc In a study presented this week at the annual meeting of the American Radiological Society in Chicago, researchers found a link between having a higher body mass index and disc abnormalities. They examined MRIs of 188 children ages 12 to 20 who had complained of back pain. The MRIs revealed that 56% of the children had some lumbar spine abnormalities.

Age-adjusted BMI was calculated for 106 patients; 54 had a BMI greater than the 75th percentile for their age, and 37 (68.5%) of those children had abnormal findings on their MRIs. The 34 children who were at or below a healthy weight had normal spine MRIs.

"These results demonstrate a strong relationship between increased BMI in the pediatric population and the incidence of lumbar disc disease," said Dr. Judah Burns, the study's lead author, in a news release. Burns, a fellow in neuroradiology at the Children's Hospital at Montefiore in New York City, added, "Back pain causes significant morbidity in adults, affecting quality of life and the ability to be productive."

-- Jeannine Stein

Photo credit: Lawrence K. Ho / Los Angeles Times


Chronic pain may mean more falls for older people

November 24, 2009 |  5:21 pm

Falls can be devastating for the elderly, leading to joint replacements, pain and sometimes death. A new study finds that having chronic pain may lead to more falls in older people.

Participants in the study included 749 men and women age 70 and older who were part of the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly study in Boston. They were given a health assessment by a nurse and were asked to record any falls they had during an 18-month period.

At the beginning of the study, 40% of the men and women said they had chronic pain in more than one joint, and 24% said they had chronic pain in one joint. During the study period, 1,029 falls were logged, and more than half the participants reported they fell at least once.

However, researchers found that those who said they had pain in more than one joint had a 50% greater chance of falling than those who had no pain.

They also discovered a link between pain severity and the risk of falls in the short-term. Those who rated their pain as severe or very severe for a month had a 77% increased chance of falling in the following month, compared with those who had no pain.

In the study, the authors wrote, "The findings provide evidence suggesting that the common complaint of the aches and pains of old age is related to a greater hazard than previously thought. Daily discomfort may accompany not only difficulties in performing daily activities but equally as important may be a risk for falls and possibly fall-related injuries in the older population."

The study appears in this week's issue of the Journal of the American Medical Assn.

-- Jeannine Stein


In pain? Just say 'om'

November 10, 2009 | 12:06 pm

FluSHOT Women undergoing natural childbirth have long endorsed the concept that you can think your way past the pain. Using meditation or guided imagery, it's possible to transcend pain, at least to some degree.

Two new studies provide more evidence that something as simple as thinking about a pretty image can help with mild pain. In one study, researchers at the University of Montreal gave 13 study participants mildly painful electric shocks which caused a knee-jerk reaction that could be measured by magnetic resonance imaging. During the shocks, participants were shown a series of images that were pleasant (such as water-skiing in summer), vicious (a bear) or neutral (a book). They found that the pain of the shocks was perceived as being worse when people were looking at unpleasant pictures. The study was published today in the Proceedings of the National Academy of Sciences.

"Emotions -- or mood -- can alter how we react to pain since they're interlinked," the lead author of the study, Mathieu Roy, said in a news release. "Non-pharmaceutical interventions -- mood enhancers such as photography or music -- could be used in healthcare to help alleviate pain. These interventions would be inexpensive and adaptable to several fields."

In another study published this week, in the Journal of Pain, researches found that relatively short and simple mindfulness meditation training can help with pain management. Other studies have shown that people who meditate regularly deal better with pain. But the new study showed that a three-day, one-hour-a-day program can produce similar effects.

The authors of the study, from the University of North Carolina, Charlotte, suggest that mindfulness training reduces the awareness of pain and sensitivity to it because it trains the brain to pay attention to the sensations at the current moment rather than anticipating future pain or dwelling on past pain. This approach also reduces anxiety.

"With the meditation training they would acknowledge the pain, they realize what it is, but just let it go," the lead author of the study, Fadel Zeidan, said in a news release. "They learn to bring their attention back to the present."

-- Shari Roan

Photo: A nurse administers a flu shot in Provo, Utah. Credit: George Frey / Bloomberg


The healing power of yoga for low back pain

November 5, 2009 |  2:01 pm

In some neighborhoods you can throw a rock and hit a yoga studio. In others, however, yoga classes are practically nonexistent, even though the practice has been shown in studies to have beneficial health effects.

K2s4zonc Researchers took yoga to racially diverse neighborhoods in Boston to see whether three months of steady practice would have any consequence on chronic low back pain. Although the condition is common, minorities may not always have adequate access to treatments such as pain relievers, physical therapy and surgery.

For this pilot study, 30 people, average age 44, were recruited from community health centers in Boston in low-income areas that were racially diverse. They were randomly split into two groups -- one did hatha yoga for 12 weeks, taking classes that included poses and breathing techniques. They were also encouraged to practice at home and were given a yoga CD and handbook, plus a mat, strap and block, and were told to continue their regular medical routine. Participants in the other group continued their usual treatment that included seeing their doctor and taking medication.

After the 12 weeks, those in the yoga group had far lower pain scores than the control -- their pain decreased by a third, compared with 5% in the control group. The yoga group also decreased their use of pain medication by 80%, while the control group's medication didn't change. At the end of the study, 73% of the yoga group said they had overall improvement in back pain, compared with 27% of the control group.

"Our pilot study showed that yoga is well-received in these communities and may be effective for reducing pain and pain medication use," said Dr. Robert Saper in a news release. Saper, the lead author of the study, is also an assistant professor of family medicine at the Boston University School of Medicine and director of integrative medicine at Boston Medical Center. The study appears in the November issue of the journal Alternative Therapies in Health and Medicine.

-- Jeannine Stein

Photo credit: Kate Brooks / For The Times



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