Treatment Options to Manage Pain from Compression Fractures

Have you ever bent over to grab something only to be paralyzed by sharp back pain? If you haven’t had a fall or experienced any other trauma and you’re beyond age 60, another possible reason is a compression fracture. It’s more common in postmenopausal women, but it can happen in men too. Another sign of a compression fracture is that your lower back pain gets worse with any type of movement of the back. If you are lying or sitting still, the pain is minimal, but once you begin to move, the pain worsens immediately.

Patients usually describe the pain as feeling like a series of muscle spasms, says Samuel Samuel, MD, Medical Director of Pain Management at Cleveland Clinic’s Marymount Hospital and Marymount South. “The primary cause of compression fractures is osteoporosis, which is especially common in post-menopausal women.” he says. “However, there are several other causes such as multiple myeloma, cancerous tumors or trauma.”

Treating Compression Fractures

A medical procedure known as a kyphoplasty or vertebral augmentation is very effective for patients with a spinal compression fracture, Dr. Samuel says. During this outpatient procedure, the physician injects a cement material into the spine to stabilize the fracture.

“It is usually highly effective immediately at controlling the pain,” he says. “The procedure has some risk to it because we’re working on the spine, but we do it using X-rays so that we make sure we have delivered the cement to the correct place.” Dr. Samuel says the procedure helps preserve the height of your vertebral body so it doesn’t collapse any further.

Patients usually wake up from the procedure with significantly less pain than they had before. However, there may still be some minor pain or discomfort, he says.

Physicians often prescribe a back brace for additional support.

You can purchase a brace at a medical supply store, but it requires a prescription for a proper lumbosacral orthosis device. “Usually the braces that are sold in the pharmacies are not sufficient to treat the compression,” Dr. Samuel says.

Best treatment is prevention

You’ve heard the old adage. But, especially for post-menopausal women, Dr. Samuel recommends helping prevent compression fractures by getting the proper amounts of vitamin D and calcium. For best results:

  • Incorporate salmon and other seafood into your diet.
  • Exercise and stay active.
  • Get routine bone density tests through your primary care physician.
  • Talk to your doctor about whether a class of medications called biphosphonates is right for you. They help prevent the loss of bone mass by strengthening your bones with calcium and vitamin D.

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New Study: Does taking opioids for back pain delay return to work?

Being prescribed an opioid for low back pain may keep workers off the job longer, according to a new study from McMaster University. Researchers analyzed 1,442 claims from the Ontario Workplace Safety and Insurance Board and found that workers receiving disability benefits for low back pain were more likely to stay on claim if they received opioids.

The researchers did not establish causation between opioid prescription and a longer time to resolve claims – workers who received opioids may have been more injured and needed the additional time to recover. “On the other hand, adverse effects of opioids on mental and physical function could be the reason,” Jason Brusse, lead study author and assistant professor of anesthesia at McMaster, said in a university press release. Back pain is a common problem among working adults in North America, with a lifetime prevalence of 63% and a point prevalence of 21%. After the common cold, low back pain (LBP) is the most frequent cause of lost time from work. Globally, LBP is the primary cause of years lived with disability.

Brusse recommended additional research on the correlation. The study, which was published Aug. 26 in the journal BMJ Open, was funded by the Ontario Workplace Safety and Insurance Board Research Advisory Council and the Ontario Chiropractic Association.

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Effectiveness of Therapeutic Facet Joint Interventions in Managing Chronic Spinal Pain

The therapeutic spinal facet joint interventions generally used for the treatment of axial spinal pain of facet joint origin are intraarticular facet joint injections, facet joint nerve blocks, and radiofrequency neurotomy. Despite interventional procedures being common as treatment strategies for facet joint pathology, there is a paucity of literature investigating these therapeutic approaches. Systematic reviews assessing the effectiveness of various therapeutic facet joint interventions have shown there to be variable evidence based on the region and the modality of treatment utilized. Overall, the evidence ranges from limited to moderate.

A total of 21 randomized controlled trials meeting appropriate inclusion criteria were assessed in this evaluation. A total of 5 observational studies were assessed. In the lumbar spine, for long-term effectiveness, there is Level II evidence for radiofrequency neurotomy and lumbar facet joint nerve blocks, whereas the evidence is Level III for lumbosacral intraarticular injections. In the cervical spine, for long-term improvement, there is Level II evidence for cervical radiofrequency neurotomy and cervical facet joint nerve blocks, and Level IV evidence for cervical intraarticular injections. In the thoracic spine there is Level II evidence for thoracic facet joint nerve blocks and Level IV evidence for radiofrequency neurotomy for long-term improvement.

The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake consumption.

Based on the present assessment for the management of spinal facet joint pain, the evidence for long-term improvement is Level II for lumbar and cervical radiofrequency neurotomy, and therapeutic facet joint nerve blocks in the cervical, thoracic, and lumbar spine; Level III for lumbar intraarticular injections; and Level IV for cervical intraarticular injections and thoracic radiofrequency neurotomy.

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How Much Do Spinal Steroid Injections Ease Low Back Pain?

Spinal epidural injections of steroids may relieve low back pain from a ruptured disc, but only briefly, a new study shows and the injections offer no significant relief for pain related to narrowing of the spaces around the spinal cord, the researchers say.

Some earlier studies have reached similar conclusions, but others have shown some benefit. Meanwhile, the use of epidural steroid injections has been increasing in the face of contradictory guidelines for physicians.

To clarify this confusing situation, Dr. Roger Chou from Oregon Health & Science University in Portland and colleagues sorted through the evidence from 63 published reports about the use of epidural steroid injections for treating low back pain from ruptured discs or spinal narrowing.

“I think the important thing is for patients and clinicians to be able to make informed decisions,” Chou told Reuters Health by email. “Epidural corticosteroid injections are perceived as being more effective than they are.”

Spinal steroid injections brought immediate relief of pain and improvement in function in patients with ruptured discs, but not in patients with spinal narrowing, or stenosis, the researchers reported in Annals of Internal Medicine.

The new analysis seems unlikely to settle any controversies, however.

Dr. Zack McCormick, who specializes in physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine in Chicago, told Reuters Health by email that because the studies available for analysis by Chou’s team were of low quality, the conclusions “cannot be applied to the realistic day-to-day practice of spine medicine.”

“The goal of epidural steroid injection is not for long term ‘cure,’ but rather to (improve) symptoms in order to allow restoration of sleep, quality of life, and tolerance of physical therapy,” McCormick said.

“Epidural steroid injections should not be used as an isolated therapy,” he added. “More studies are needed which show outcomes of epidural steroid injections in conjunction with a multi-modal approach that includes physical therapy, oral medications, and other adjunctive treatments, as this represents true clinical practice.”

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Take These Steps Before Considering Knee Surgery

Arthroscopic surgery to trim or remove a torn meniscus — the cartilage that cushions your knees — is the most common orthopedic surgery in the United States. About 700,000 of the procedures are done each year, a 50 percent increase in the past 15 years.

But research shows that it’s often no better than physical therapy at easing symptoms. And in a New England Journal of Medicine study, patients who had sham surgery — in which surgeons made a small incision, then simulated the rest of the procedure — fared just as well as those who had the real deal. Other research shows that arthritis is more likely to develop in people who have the procedure than in those who don’t.

Bottom line: If you’re suffering age-related knee pain and an MRI scan reveals a tear, first try rest, ice, a knee brace, over-the-counter anti-inflammatory drugs and physical therapy.

Growth Estimates for the Global Genetic Testing Market

The Global Genetic Testing Market accounted for $3.2 billion in 2014 and is expected to grow at a CAGR of 9.26% to reach $6.5 billion by 2022. The factors contributing to the market growth include aging population, growing awareness, availability of direct to consumer tests and increasing incidence of genetic disorders. However, factors such as high cost for testing and reimbursement issues are inhibiting the growth of the market.

Genetic testing is the most profitable and rapidly expanding segment of molecular diagnostics. It is the array of techniques used for the analysis of DNA, RNA, and protein. It is used as a medical tool to determine the genetic defects associated with a particular disease. Genetic testing is also used in non-clinical applications such as paternity testing and forensics.

In clinical applications, the primary focus of genetic testing is to identify the genetic reason for the cause of a disease, confirm a suspected diagnosis, prediction of future disease, to identify when an individual may pass his/her hereditary information to kids, and to predict treatment response in a patient. Genetic testing is also used to screen new-born babies, fetuses, or embryos used in-vitro fertilization for genetic defects.

The genetic testing market is categorized based on its applications into pharmacogenomics testing, predictive testing, prenatal and neonatal testing. Genetic testing for cancer is likely to be the fastest growing segment during the forecast period. Increasing incidence of genetic diseases is providing more opportunities for genetic testing along with the rise in personalized medicine. The federal agencies who play a significant role in regulating genetic tests are Food and Drug Administration (FDA), Federal Trade Commission (FTC) and Center for Medicare and Medicaid services (CMS).

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Minimally Invasive vs. Traditional Total Knee Replacement Surgery

If you’ve decided to have a total knee replacement, you might be considering a minimally invasive procedure. This type of surgery uses smaller incisions and less cutting of the tissue surrounding the knee. The advantage of such a surgery is that it allows for faster recovery, a shorter hospital stay and less blood loss.But aside from these potential short-term advantages, there’s good reason to strongly consider a traditional surgery for a total knee replacement.

Be sure to talk it over with your doctor. While the minimally invasive approach is not for everyone, the risk of complications associated with a more complex operation may outweigh its benefits for you.Whatever surgery you choose, evidence suggests that minimally invasive surgery is no more beneficial than traditional total knee replacement in the long term.

The first thing to do is get options from a surgeon who does minimally invasive total knee replacement and one who does only traditional surgery, and weigh the pros and cons of each.

After your decision:

  • Choose a surgeon who is highly experienced and performs a large volume of the type of procedure you want.
  • Work with your doctor to lose weight to reduce the strain placed on your knees.
  • Stay as active as possible. Before your operation, have your physician recommend exercises that strengthen your quadriceps without causing pain. Good examples are riding a stationary bicycle and swimming or water therapy.
  • Exhaust all conservation treatments, such as medications, injections and physical therapy, before considering knee replacement.

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