Antibiotics May Relieve Back Pain Symptoms

By Peter Russell
WebMD Health News

May 10,  2013 -- Taking antibiotics could relieve symptoms of chronic lower back pain for up to 40% of people, according to a new study.

Danish researchers say they've found a link between many cases of back pain and infection from bacteria.

Some experts have questioned how many people are likely to benefit from this treatment. Others have cautioned that boosting antibiotic use in the face of growing resistance could be counterproductive and lead to more superbugs.

Back pain is a common condition, affecting about 4 out of 5 people at some point in their lives.

Recommended treatments include painkillers, hot or cold compresses, lifestyle changes, physical therapy, and keeping active. In extreme cases, when other treatments have failed, surgery may be carried out to remove part of a damaged disc.

The latest studies from the University of Southern Denmark build on previous research, which shows that between 7% and 53% of patients with herniated discs have a type of bacteria. In these patients the bacteria entered the disc at the time it was herniated, or "slipped."

In the first study of 61 patients who had spinal surgery for lower back pain, the researchers found bacteria in 46% of the slipped discs.

In a second study, the research team recruited 162 patients who had been living with low back pain for more than 6 months following a slipped disc. Half of the patients were given a 100-day course of antibiotic treatment, while the others received a placebo.

After a 1-year follow-up period, those who'd taken antibiotics were less likely to still have lower back pain and physical disability. They were also less likely to have leg pain and to have taken days off work because of their back.

The researchers estimate that about 35% to 40% of people with long-term back pain have excess fluid in the spinal vertebrae and might benefit from this type of treatment.

The findings are published in the European Spine Journal.

Media reports that antibiotics could be a cure for back pain have alarmed John O'Dowd, a consultant spinal surgeon and president of the British Society for Back Pain Research. 

"Unless you've had a disc herniation ... I don't think you should be getting too excited, and I don't think this is going to be a treatment for you," O’Dowd says. "I think this is another useful building block of evidence, but I don't think it's either a cure or the answer to back pain."

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Stem Cells to Relieve Low Back Pain?

By Brenda Goodman
HealthDay Reporter

FRIDAY, April 12 (HealthDay News) -- Medical researchers are trying a new treatment for low back pain. Their hope is that harvesting and then re-injecting the body's own bone marrow -- which is rich in stem cells -- may repair worn-out discs in the spine.

In a small new study, the approach appeared to be safe -- and none of the patients reported that their pain got worse after the procedure.

But both the doctors who are testing the technique and outside experts say much more research is needed before they can say whether the treatment offers real relief.

"I tell everybody that this is experimental, with a capital E," said Dr. Joseph Meyer Jr., an anesthesiologist and pain medicine specialist at the Columbia Interventional Pain Center, in St. Louis. "We don't know if it works. I do believe that it's safe, but it might not do anything for you."

For the study, Meyer and his colleagues reviewed the case histories of 24 patients who were injected with their own bone marrow aspirate cellular concentrate (BMAC). Bone marrow concentrate contains adult stem cells, which have been called the body's own repair kit because they can change into -- and potentially heal -- different kinds of tissues.

Meyer's patients reported suffering from chronic low back pain for anywhere from three months to 12 years. Imaging tests showed that all the patients had some evidence of degeneration, or damage, to the discs that cushion the bones of the spine. Disc degeneration is common with age, and it is thought to be a major cause of low back pain.

Many times, exercise and weight loss can help people with persistent low back pain. But if conservative approaches fail and the pain becomes debilitating, Meyer said, the next option is invasive spinal fusion surgery.

"Fusion is a big, big step with questionable effectiveness," he said. "Often, you're back in the same boat a year later."

Meyer said he offered patients the bone marrow treatment as something to try before resorting to surgery.

For the procedure, he used a long needle to extract bone marrow from the back of the hip. The bone marrow was spun in a centrifuge to concentrate the cells and then injected into the space around a damaged disc. Meyer said the treatment costs a few thousand dollars and is not covered by insurance.

Of the 24 patients who initially received the bone marrow injections, half went on to have other procedures over the next 30 months, making it impossible to know what might have affected their back pain.

Of the 12 who had no other kinds of treatment, 10 reported that their pain lessened in the two to four months after their injections. After a year, eight patients were still reporting significant pain relief, while three said their back pain had not improved. One patient had not yet reached the 12-month mark. After two years, five said their back pain was better, and three had no improvement. For the other four, it was still too early to tell.

Meyer said none of the 24 patients who tried the technique had complications from their procedures, but injections always carry the risk of infection.

The study was scheduled for Thursday presentation at the annual meeting of the American Academy of Pain Medicine in Fort Lauderdale, Fla. Studies presented at scientific conferences usually haven't been scrutinized by independent experts, and their results are considered preliminary.

An expert who was not involved in the study said people with back pain shouldn't get too excited about these results, particularly since there was no control group used for comparison.

"Low back pain often gets better over time," said Dr. Richard Deyo, a professor of evidence-based medicine and a back pain expert at Oregon Health and Sciences University, in Portland. "Even patients who have chronic pain, their symptoms tend to wax and wane and fluctuate. They seek care when their symptoms are worst, and very often they drift back to their average level of pain, which looks like improvement."

"People grasp at straws, and they shouldn't. We have a long history of treatments that look promising when they start and turn out to be no more effective than placebo interventions," said Deyo, who also is deputy editor of the journal Spine. "We also have a history of treatments that, in some cases, turned out to be harmful. It's really too early to know if this is going to be effective or safe."

The study's authors agreed. They said they hope this pilot project will encourage more research.

"We hope it will get people thinking and hopefully promote a future controlled study," Meyer said.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Joseph Meyer Jr., M.D., Ph.D., anesthesiologist and pain-medicine specialist, Columbia Interventional Pain Center, St. Louis; Richard Deyo, M.D., M.P.H., Kaiser-Permanente endowed professor of evidence-based medicine, department of family medicine, Oregon Health and Sciences University, Portland, Ore.; April 11, 2013, presentation, American Academy of Pain Medicine annual meeting, Fort Lauderdale, Fla.

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Are there exercises I can do to relieve my knee pain?

Posted June 01, 2013, 2:00 am

I have pain in my kneecap, right in front of my knee. It hurts to walk down the stairs or even sit for too long. What can I do?

It sounds like you have what is called patellofemoral pain. That’s pain where your kneecap (patella) meets your thighbone (femur). It usually results from overdoing exercise. Fortunately, there’s a lot you can do to prevent and relieve this pain.

To understand this condition, here’s a brief anatomy lesson. Sit in a chair, and then lift up your foot (on either leg) and hold your leg straight out. How were you able to do this? A big muscle in the front of your thigh (your quadriceps, or “quads”) is attached to a tough tendon. The tendon is like a cord; it runs over the top of your knee and attaches to the biggest bone in your lower leg, the tibia. When your quadriceps muscle shortens and tugs on the tendon, it lifts up your lower leg and foot.

In the middle of the tendon, right over the knee, is a small bone: the patella, or kneecap. It protects the bones of the knee joint by putting a hard bone in front of them to take the hit if you fall on your knee.

Your patella glides within a groove in the thighbone. Anything that stresses that connection can cause patellofemoral pain.

Patellofemoral pain can occur with one-time overuse (such as several sets of tennis when you haven’t played regularly) or from chronic stress. It’s common in people who run a lot, especially on hills. It’s also common in people who play sports involving jumping, or frequent stops or direction changes. Doctors often see it in people who suddenly start to work out much harder and more often. Certain physical characteristics, such as flat feet, can also contribute.

Pain-free exercise is the cornerstone of treatment. A workout plan to relieve or prevent patellofemoral pain should focus on improving strength and flexibility in the tissues around the knee. (I’ve put a selection of appropriate exercises below.) Work with a physical therapist, who can design an individualized exercise program for you.

Isometric quadriceps exercise (not pictured): Sit on the floor and lean back on your elbows with one knee bent and the affected leg extended. Tighten the quadriceps muscles of the extended leg; hold for five seconds, and relax. Repeat 10 to 20 times, three times a day.Leg raises to strengthen the quadriceps (above): Sit on the floor and lean back on your elbows with the affected leg extended on the floor and the other knee bent. Tighten the quadriceps muscles of the extended leg, and lift the leg a foot off the floor; hold for five seconds, and slowly lower the leg. Do 10 to 20 repetitions, three times a day.Leg raises to strengthen the outer thigh muscle (above): Lie on your side with the affected leg on top, tighten the thigh muscles, and lift the leg straight up to a 45-degree angle; hold it for five seconds, and slowly lower it. Repeat 10 to 20 times, three times a day. As the muscles become stronger, gradually add up to 5 pounds of ankle weights.Leg raises to strengthen the inner thigh muscle (above): Lie on your side with the affected leg on the bottom and the top leg as shown. Tighten the thigh muscles of the bottom leg, lift it straight up, hold for five seconds, and slowly lower it. Repeat 10 to 20 times, three times a day. Gradually add up to 5 pounds of ankle weights.To stretch the iliotibial band and buttock muscles (above): Bend the knee of the leg you want to stretch and cross it over the other leg, as shown. Twist your trunk toward the bent knee, and press the opposite elbow against the outside of the bent knee. Hold for 10 to 20 seconds. Repeat five to 10 times.Hamstring curls to strengthen the hamstrings (above): Stand with your hands on something for balance; bend the affected knee, and slowly lift the foot behind you until the heel is about level with the standing knee; hold for a second and slowly lower the foot. Repeat 10 to 15 times, three times a day. Increase the intensity by adding ankle weights. You can also strengthen the hamstrings by slowly walking backward on a treadmill or by using the lying-down hamstring curl machine at the gym.

While you’re recovering, don’t do anything that causes pain. If you run, avoid hills, go for shorter distances or substitute other activities. Avoid high-impact exercises and squatting or kneeling. Don’t wear high heels or sit with your legs bent for too long.

Ice and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, others) or naproxen sodium (Aleve, others) can help ease immediate pain. If you have flat feet, you may need additional arch support.

If you’re still in pain after more than one year, you may have to consider surgery. Even then, surgery is recommended only if there is an obvious anatomical problem.

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Antibiotics May Relieve Back Pain Symptoms

By Peter Russell
WebMD Health News

May 10,  2013 -- Taking antibiotics could relieve symptoms of chronic lower back pain for up to 40% of people, according to a new study.

Danish researchers say they've found a link between many cases of back pain and infection from bacteria.

Some experts have questioned how many people are likely to benefit from this treatment. Others have cautioned that boosting antibiotic use in the face of growing resistance could be counterproductive and lead to more superbugs.

Back pain is a common condition, affecting about 4 out of 5 people at some point in their lives.

Recommended treatments include painkillers, hot or cold compresses, lifestyle changes, physical therapy, and keeping active. In extreme cases, when other treatments have failed, surgery may be carried out to remove part of a damaged disc.

The latest studies from the University of Southern Denmark build on previous research, which shows that between 7% and 53% of patients with herniated discs have a type of bacteria. In these patients the bacteria entered the disc at the time it was herniated, or "slipped."

In the first study of 61 patients who had spinal surgery for lower back pain, the researchers found bacteria in 46% of the slipped discs.

In a second study, the research team recruited 162 patients who had been living with low back pain for more than 6 months following a slipped disc. Half of the patients were given a 100-day course of antibiotic treatment, while the others received a placebo.

After a 1-year follow-up period, those who'd taken antibiotics were less likely to still have lower back pain and physical disability. They were also less likely to have leg pain and to have taken days off work because of their back.

The researchers estimate that about 35% to 40% of people with long-term back pain have excess fluid in the spinal vertebrae and might benefit from this type of treatment.

The findings are published in the European Spine Journal.

Media reports that antibiotics could be a cure for back pain have alarmed John O'Dowd, a consultant spinal surgeon and president of the British Society for Back Pain Research. 

"Unless you've had a disc herniation ... I don't think you should be getting too excited, and I don't think this is going to be a treatment for you," O’Dowd says. "I think this is another useful building block of evidence, but I don't think it's either a cure or the answer to back pain."

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Drugs May Help Relieve Restless Legs Syndrome

By Steven Reinberg

HealthDay Reporter

MONDAY, March 4 (HealthDay News) -- People suffering from restless legs syndrome may find some relief by taking one of several drugs approved to treat the condition, a new review confirms.

The medications, which include Requip (ropinirole), levodopa, Neurontin (gabapentin) and Lyrica (pregabalin), appear to reduce symptoms of the syndrome in more than 60 percent of patients, researchers report. The first two drugs raise dopamine levels in the body, and the last two drugs reduce the amount of calcium reaching brain cells and trigger the production of other chemicals that help reduce pain. Dopamine is a brain chemical that regulates movement and mood.

"Physicians and patients now have better information on the effectiveness and harms of two types of drug treatments for patients with at least moderately severe restless legs symptoms in which to guide treatment choices," said review author Dr. Timothy Wilt, core investigator at the Minneapolis VA Health Care System.

Restless legs syndrome causes a person to feel a powerful urge to move his or her legs. The legs become uncomfortable when lying down or sitting, and the condition can disrupt sleep and take a toll on the quality of life, the researchers said.

One expert, Dr. Martin Niethammer, a neurologist at the Movement Disorders Center of North Shore-LIJ's Cushing Neuroscience Institute in Manhasset, N.Y., said this study is merely a review of the current treatments for restless legs syndrome.

"There is nothing new here at all," he said. "It doesn't add anything to the field."

This is just a compilation of evidence that follows guidelines that have been long established in both Europe and the United States, Niethammer said.

"These are the only treatments approved by the [U.S. Food and Drug Administration]," he added.

The report was published in the March 4 online issue of JAMA Internal Medicine.

For the analysis, Wilt's team reviewed 29 clinical trials. The researchers found that 61 percent of those taking dopamine agonists showed at least a 50 percent improvement in their symptoms, compared with 41 percent of those taking an inactive placebo.

In addition, those taking dopamine agonists slept better and scored higher on measures of quality of life. Dopamine agonists were originally developed to treat Parkinson's disease.

Side effects of dopamine agonists can include euphoria, hallucinations, weight loss, nausea, insomnia, tiredness or weakness, dizziness and drowsiness.

There are generic versions of Requip that cost far less, running between $11 and $22 a month. Insurance covers the treatment in most cases, so actual out-of-pocket costs will vary by insurance plan. The same is true for levodopa, Wilt said.

Neurontin and Lyrica also helped relieve symptoms in 61 percent of patients, compared with 37 percent of those taking a placebo, the researchers found.

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