Corticosteroid Injections In Back Pain

 Corticosteroid injections may be ineffective for low back pain

 

 

Low back pain is the leading cause of disability worldwide. In the US, around half of all workers admit to experiencing symptoms of back pain each year, and approximately 80% of us will suffer a back problem at some point in our lives.

Primary treatment for low back pain involves nonsurgical options, such as narcotic pain medication and nonsteroidal anti-inflammatory drugs (NSAIDs). Other nonsurgical treatments include epidural corticosteroid injections, administered directly to the epidural space in the spine.

Epidural corticosteroid injections work by reducing inflammation and, in turn, relieving pain. According to Dr. Chou and colleagues, the injections are commonly used for radiculopathy (inflammation of a spinal nerve) and spinal stenosis (narrowing of the spinal canal) - two conditions that cause radiating low back pain.

Use of epidural corticosteroid injections for these conditions is increasing, despite the fact that numerous studies have questioned their effectiveness for low back pain.

Epidural corticosteroid injections 'perceived as more effective than they actually are'

 For their study, the team reviewed 30 trials assessing the short- and long-term effects of epidural corticosteroid injections for individuals with radiculopathy or spinal stenosis, comparing them with a placebo.

Specifically, the researchers looked at how epidural corticosteroid injections impacted patients' pain, function and risk for surgery.



While the injections provided greater immediate pain relief for radiculopathy than a placebo, the team found that this effect was small and short term. What is more, the treatment did not prevent patients' need for surgery in the long term.

For spinal stenosis, the researchers found epidural corticosteroid injections offered patients no significant pain relief compared with placebo.

These findings remained regardless of what injection techniques and corticosteroids were used, according to the authors.

While severe side effects from corticosteroid injections were rare, some minor side effects were identified, which included bleeding, blood clots and nerve root irritation.

Talking to Reuters, Dr. Chou said epidural corticosteroid injections are being perceived as much more effective for low back pain than they actually are.

"Unfortunately, there are not a lot of great treatments for these conditions besides surgery, so the options for treatment are limited," he added. "I do let patients know that the natural history for both of these conditions is for improvement over time."

However, the results of this study have been met with some criticism. Dr. Zack McCormick, of the Northwestern University Feinberg School of Medicine in Chicago, IL, told Reuters that the trials analyzed in this research were of low quality, so the findings "cannot be applied to the realistic day-to-day practice of spine medicine."

He noted, however, that the aim of epidural corticosteroid injections is to improve short-term symptoms and quality of life for the patient, not to provide a long-term cure. As such, he says the treatment should "not be used as an isolated therapy."

See More : http://www.medicalnewstoday.com/articles/298566.php

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Neck Pain

10 Tips to Prevent Neck Pain

Neck pain is usually caused by injuries and sprains associated with the muscles, tendons, and ligaments around the cervical spine (upper part of the spine, or the neck), but it can also be caused by a cervical herniated disc or cervical stenosis.

Follow these 10 tips to protect your neck from injury:

    1.Sleep with a cervical pillow.

    Cervical pillows, or orthopedic pillows, are contoured to support the spaces under the head and neck with deeper depressions where the head lies and extra support under the neck. They help keep the neck in alignment with the spine.
     
   2. Sleep on your back.

    Sleeping on your back is the best position to let your entire spine rest comfortably. If you prefer to sleep on your side or on your stomach, make sure your pillow is not too high-around 4 to 6 inches thick. This will prevent your head and neck from turning unnaturally to either side.

3.Position your computer screen at eye level.

Sit comfortably in your office chair in front of your computer and close your eyes. When you open them, your gaze should be directly in the middle of your computer screen. If it is not, use books or other items to adjust the screen height.

Do not allow your head to drift forward over your shoulders. And don't forget to take frequent breaks—get up and move around at least every 30 minutes.

4.Use a telephone headset. 

Be careful not to hold your phone between your ear and shoulder. A hands-free device is a great way to talk on the phone without being tempted to hold your phone incorrectly.

5.Exercise your neck muscles. 

Keep your neck muscles strong by doing strengthening and stretching exercises frequently throughout the day. One of the simplest exercises to do often is the chin tuck exercise.

This exercise helps strengthen the muscles that pull the head into alignment over the shoulders. It also stretches the scalene and suboccipital muscles.

6.Stay hydrated. 

The discs between the vertebrae in the spine are made mostly of water.

Sip water throughout the day to stay hydrated, keeping the discs pliable and healthy. Ideally, try to drink 8 large glasses of water a day.

7.Carry weight evenly. 

A common mistake people make is carrying a heavy purse or a brief case on one side of their body. This causes the shoulders to become uneven, straining the muscles and causing pain.

Take only your essentials in your purse or briefcase, and make an effort to keep your shoulders level at all times when you carry it. Consider using a backpack that distributes weight evenly across the shoulders.

8.Maintain proper posture. 

Poor posture can cause neck pain by straining muscles and ligaments that support the neck, resulting in injury over time.

The head-and-shoulders-forward posture is the most common example of poor posture that contributes to neck pain. This occurs when the neck slants forward, placing the head in front of the shoulders.

This posture causes the upper back to slump forward as well, placing a strain on the entire spine.

9.Relieve trigger-point pain. 

Irritation to the facet joints of the lower cervical vertebrae can result in muscle trigger point pains. Trigger points are small knots in the muscle or fascia that can lead to pain. There are certain massages you can do yourself to work these trigger points and lessen the pain. See Trigger Point Exercises for Neck Pain for a description of these exercises.

10.Prevent whiplash. 

Whiplash occurs when people are rear-ended in their vehicles. The best way to protect yourself from a whiplash injury is to drive a car with a highly rated head restraint. Adjust the head restraint by following the owner’s manual.

Always practice defensive driving: When stopped in traffic, check your rear-view mirror to make sure no one is speeding up behind you. Have an escape route planned (usually the shoulder of the road) so you know where you will go if you do notice someone speeding up behind you.

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Arthritis - 10 Things You Should ?

Rheumatoid arthritis is a chronic, potentially disabling type of arthritis. If you have been diagnosed with the disease or you have signs and symptoms pointing to rheumatoid arthritis, you should know these 10 basic facts.

1 - Rheumatoid arthritis is an autoimmune inflammatory type of arthritis.

Rheumatoid arthritis is triggered by a malfunctioning immune system (i.e. autoimmune disease). The joints are primarily affected by rheumatoid arthritis, but organs may also be involved (i.e., systemic disease).

2 - Rheumatoid arthritis patients are classified as seropositive or seronegative.

Rheumatoid factor is an immunoglobulin (antibody) which can bind to other antibodies (normal proteins found in the blood which function within the immune system). A blood test is used to detect the presence of rheumatoid factor. About 80% of adults who have rheumatoid arthritis are positive for rheumatoid factor (i.e., seropositive rheumatoid arthritis). Approximately 20% of rheumatoid arthritis patients are negative for rheumatoid factor (i.e., seronegative rheumatoid arthritis).

What Is Rheumatoid Factor?
What Is the Significance of a Positive Rheumatoid Factor?
3 - There are physical symptoms which are common to rheumatoid arthritis.

A physical examination by a rheumatologist (arthritis specialist) can detect certain signs and symptoms consistent with rheumatoid arthritis:

Early symptoms of warmth, swelling, and pain often begin in small joints of the fingers, wrists, and feet.
Affected joints are usually symmetrical (same joint on both sides of the body).
Morning stiffness lasting at least an hour or more.
Rheumatoid nodules (subcutaneous lumps) may be present.
Joint deformities caused by cartilage, tendon, and ligament damage.
Fatigue, loss of appetite, and low grade fever.
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4 - Imaging studies and blood tests, along with the physical examination, are used in combination to diagnose rheumatoid arthritis.

No two cases of rheumatoid arthritis are exactly alike and the disease course is unpredictable. Some patients experience a lot of pain, even if their x-rays don't reveal evidence of severe joint damage. Some patients have evidence of severe joint damage on x-ray but do not experience a lot of pain. Differences between patients make it necessary for rheumatologists to observe the entire clinical picture (medical history, physical exam, imaging, and blood tests) in order to formulate an accurate diagnosis.

What Is Anti-CCP?
Blood Tests to Diagnose and Monitor Rheumatoid Arthritis
Is MRI Valuable for Diagnosing Rheumatoid Arthritis?
5 - With rheumatoid arthritis, joint damage can occur early after disease onset.

Often, joint damage occurs within the first two years following the onset of rheumatoid arthritis. The possibility of early joint damage makes early diagnosis and treatment essential. It's also important for rheumatoid arthritis patients and their doctors to consider an aggressive approach to treatment rather than a conservative approach.

Is Early Diagnosis of Arthritis Important?
Is Early, Aggressive Treatment Recommended for Rheumatoid Arthritis Patients?
6 - There are 1.5 million adults in the United States with rheumatoid arthritis.

Rheumatoid arthritis is the most common form of inflammatory arthritis, but osteoarthritis, which affects 27 million Americans, is the most common type of arthritis overall. Rheumatoid arthritis usually develops between 30 and 50 years of age, but it can develop in anyone at any age.

Arthritis Prevalence Statistics Released by CDC
7 - People with rheumatoid arthritis have an increased risk of mortality or death rate compared to the general population.

Older medical literature suggests that people with rheumatoid arthritis may live 10-15 years less than their healthy counterparts. Life expectancy is influenced by many factors though, including family history, overall health, and lifestyle choices. The newest class of arthritis drugs, referred to as biologics, hopefully will offer a better prognosis.

Rheumatoid Arthritis Shortens Life Expectancy
The Correlation of Life Expectancy and Arthritis
The Effect of Rheumatoid Arthritis on Mortality
8 - There is a high risk of disability for rheumatoid arthritis patients.

According to the Centers for Disease Control and Prevention (CDC), arthritis and other rheumatic conditions are the leading cause of disability in the U.S. More than 30% of adults with doctor-diagnosed arthritis (all types) report a work limitation due to arthritis. According to Johns Hopkins, disability is higher among patients with rheumatoid arthritis, with 60% being unable to work 10 years after disease onset.

Can I Continue to Work?
Social Security Disability Income - Do You Qualify?
9 - Rheumatoid arthritis is three times more common in women than men.

The prevalence of rheumatoid arthritis in women suggests that genetics and hormones may play some role in the cause of rheumatoid arthritis. Some types of arthritis are more prevalent among men, including gout and ankylosing spondylitis, but many types of arthritis are more prevalent among women. According to the CDC, 28.3 million women and 18.2 million men report doctor-diagnosed arthritis (all types).

More About Rheumatoid Arthritis
10 - Even with physical limitations, rheumatoid arthritis patients can have a good quality of life.

Physical limitations may become disabling. The disease may challenge your emotions. Finances may be stretched by an inability to keep working. With a positive attitude, you can take action and find solutions.
source: http://arthritis.about.com/od/rheumatoidarthritis/a/rheumatoid_fact.htm

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