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Musculoskeletal Conditions

STUDY DEFINES MORE CLEARLY HOW ACUPUNCTURE AFFECTS PAIN
In a new study this year, researchers at Massachusetts General Hospital in Boston did a follow-up on a pilot study from three years ago, showing with MRI that acupunture has far-reaching effects.   It was shown to affect centers that relate to pain, memory and also affective centers of the brain.  Since we extensively employ acupuncture in this office, I have had great interest in the progress of this study.  It is a landmark research piece, and I have discussed it at length with one of the authors, who indicated that it will lead to future studies that will tell us more about how health care practitioners can treat pain more effectively.  Interestingly, the pilot study showed that acupuncture had similar effects in the brain, regardless of the anatomic area treated.  Rupali P. et al. (2008). Acupuncture Modulates Resting State Connectivity in Default and Sensorimotor Brain Networks.   Pain. 136(3): 407–418.
 

TO PRE-STRETCH OR NOT?
There are conflicting opinions regarding methods of reducing muscular injury through warm-up and stretching techniques and these authors performed a metanalysis to examine the potential of a warm-up stretching routine in deterring muscular injury during physical activity. Recently, there was more than one study that indicated that those who pre-stretched more often were injured than those who first exercised for a few minutes, then performed stretches, then resumed their primary exercise activity.  The authors state that many of the differences within previous research were due to conflicting definitions and they provide clear definitions of terms. The research included here concludes that, to the contrary of other recent literature, certain techniques and protocols have shown a positive outcome on deterring injuries. As a result, a warm-up and stretching protocol should be implemented prior to physical activity. The routine should allow the stretching protocol to occur within the 15 minutes immediately prior to the activity in order to receive the most benefit. In my view, this is a welcome study to re-define issues that had resulted in confusion for both health care providers as well as consumers.  Woods K, Bishop P, Jones E. (2007). Warm-up and stretching in the prevention of muscular injury. Sports Med. 37(12):1089-99.
 

EXERCISE AND THE USE OF PRESCRIPTION MEDICATIONS
Few studies have investigated the association between physical activity practice and medicine use and these authors evaluated this association in adults aged 20 years or more. This was a population-based cross-sectional study, with physical activity assessed with the International Physical Activity Questionnaire. Out of the 3,182 individuals interviewed, the level of physical activity was inversely associated with the number of medicines used.  This is a study that likely will not surprise many in health care, for multiple reasons, but it is reassuring to finally read a study that addressed this relationship.   Andrea D Bertoldi , Pedro C Hallal  and Aluisio J D Barros (2006).  Physical activity and medicine use: evidence from a population-based study. BMC Public Health.  6:224.
 

TEAMWORK AND OUTCOMES
There are some interesting studies that discuss chiropractors and coordinating care between family physicians, other health care providers and chiropractors.  The first one that I can recall dates to 1992 in a family practice journal and they reiterate the same theme:  that patients benefit and that and costs decline.  These are two of the more recent studies.  The Sarnat study covered 7 years and found that PCPs using a nonsurgical/nonpharmaceutical approach as a first- line plan demonstrated marked reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone. In the Garner study, 12 primary care physicians and two chiropractors worked together in two community medicine clinics operated by the University of Ottawa, showing high levels of satisfaction from all participants.  Richard L. Sarnat, MD, James Winterstein, DC, Jerrilyn A. Cambron, DC, PhD (2007). Clinical Utilization and Cost Outcomes from an Integrative Medicine Independent Physician Association: An Additional 3-year Update   J Manipulative Physiol Ther. 30 (4):    263–269 AND  Aker, P. et al. (2006). Developing Integrative Primary Healthcare Delivery: Adding a Chiropractor to the Team.  EXPLORE: The Journal of Science and Healing Volume 4, Issue 1, 18-24
 

PAIN AND SLEEP
There is a growing body of evidence suggesting that the greater the impact of chronic back pain, the higher the severity of sleep problems. This works both ways.  This new paper in the journal Pain supports the fact that pain and sleep disorders may be intimately related and that next-day pain levels are correlated with previous night's sleep: less than 3 hours of sleep or more than 9 hours of sleep may exacerbate the pain experienced the next day. Edwards R. et al (2008). Duration of sleep contributes to next-day pain report in the general population.  Pain. 137(1):202-7.
 

FIBROMYALGIA SENSITIVITIES
Muscle tenderness is the hallmark of FM, but the findings of this study and others suggest that persons with fibromyalgia display sensitivity to a number of sensory stimuli, including auditory input. 30 subjects were exposed to auditory tones and pressure, and their responses were recorded on a self- report. In addition to pressure sensitivity, these subjects were much more sensitive to auditory stimuli than the control group.   These findings suggest that FM is associated with a global central nervous system augmentation of sensory information. These findings may also help to explain why persons with FM display a number of comorbid physical symptoms other than pain.  Geisser ME, et al. (2008) A Psychophysical Study of Auditory and Pressure Sensitivity in Patients With Fibromyalgia and Healthy Controls. The Journal of Pain. Vol. 9, Iss. 5, pp. 417-422.
 

AN ALTERNATIVE TO CONVENTIONAL NSAIDS
This interesting article from the neurosurgery department at the University of Pittsburgh is from the latest of three studies that I am aware of about the use of omega-3 essential fatty acids (O3EFA) as an anti-inflammatory.  60% of the 125 people in this study reported improvement in their back pain symptoms, with the conclusion that O3EFA is a safer and essentially equivalent alternative to ibuprofen.  The O3EFA dosage ranged between 1200 and 2400mg per day. We have had a number patients report very good results with the use of this for spinal pain.  Maroon JC, Bost JW. (2006) Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain.  Surgical Neurology. 65(4):326-31.