March 26, 2002 [Volume 3, Issue 7]
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In this issue of To Your Health:
Can They Feel Your Pain?
When
you're in pain, people may tell you that they "know how you feel" - but
do they really know? Studies have shown that physicians tend to rate their
patients' pain lower than the patients themselves in cancer and postoperative
cases. Do primary care physicians also misinterpret other patients' pain
levels?
A recent study in the British Journal of General Practice examined the variation between practitioner and patient perceptions of pain intensity. Nearly 30 general practitioners in Finland and more than 700 of their patients seeking pain relief rated the patients' perceived pain levels. A visual pain scale was utilized, with "no pain" at one extreme and the "worst imaginable pain" at the other; a person would make a mark on the scale at the place where they thought their pain level ranked.
There was little similarity between doctor and patient ratings of an individual's pain. Patients rated their pain significantly higher than did their physicians in chronic-pain cases. In other words, people who experienced long-term suffering were in more pain than their doctors realized. In fact, general practitioners rated pain intensity significantly lower than the sufferer in almost 40% of cases, and higher in 30% of cases - usually for acute pain. The most severe pain cases showed the greatest differences between patient and practitioner assessment.
It is critical that you always communicate with your doctor as openly and effectively as possible. By doing so, you can avoid possible misinterpretation of your pain levels and symptoms of serious conditions. If you suffer from chronic pain, ask your doctor of chiropractic about different methods, such as a visual pain scale, for evaluating your pain and recovery.
Reference: Mäntyselkä P, Kumpusalo E, Ahonen R, et al. Patients' versus general practitioners' assessments of pain intensity in primary care patients with non-cancer pain. British Journal of General Practice 2001:51, pp. 995-997.
For more information on general health, go to https://www.chiroweb.com/find/archives/general/other/index.html.
Extra A Not Acceptable
Vitamin A - plentiful in foods like yams, carrots, asparagus, and eggs - has many health benefits as an antioxidant, such as good vision and healthy skin. However, eating too much vitamin A has been shown to have negative side effects. Long-term, regular ingestion of excessive doses of vitamin A may lead to an increased risk for osteoporosis and hip fracture.
From 1980 to 1998, the authors of a recent study in the Journal of the American Medical Association examined over 70,000 women between the ages of 34-77. Hip fractures were recorded, excluding severe trauma cases like car accidents in which fracture was unavoidable; fractures were compared to the women's diets regarding vitamin A intake from foods and supplements over the 18 years.
Women in the group with the highest overall vitamin A intake from foods and supplements combined were almost 50% more likely to suffer hip fractures than women with the lowest intake. Women with the highest intake of retinol (pure vitamin A) from multivitamins/supplements were approximately 90% more likely to experience hip fracture. A full 21% of the women in the study consumed more than the "tolerable upper limit" of vitamin A, nearly all from supplements.
This study offers further evidence that excessive vitamin A consumption, particularly from supplements, may cause osteoporosis in women. The best way to limit your vitamin A intake is to obtain it only from foods, in its beta-carotene form. Besides increasing fracture risk, excessive levels of vitamin A can be toxic and even fatal.
Reference: Feskanich D, Singh V, Willett WC, et al. Vitamin A intake and hip fractures among postmenopausal women. Journal of the American Medical Association 2002:287(1), pp. 47-54.
To find out more about women's health, go to https://www.chiroweb.com/tyh/women.html.
Packing a Wallop
If you have children in elementary or middle school, you are probably used to seeing them trudge to and from school with backpacks stuffed with heavy textbooks. What you may not know is that children who regularly carry backpacks and schoolbags generate a substantial force on their spines, which may lead to low back pain.
A study appearing recently in the journal Spine evaluated whether children's perceptions of backpack weight or actual backpack weights are related to back pain, and uncovered personal, familial, and school factors that determine backpack weight. In the study, involving 11-year-old schoolchildren in Milan, Italy, researchers recorded the backpack weights of nearly 250 students over six days; 115 of these children completed a questionnaire on their feelings about carrying their backpacks.
Backpack-related activities led to low back pain in almost half of the students; four out of five felt their backpacks were heavy; and two-thirds responded that they felt fatigue when carrying their backpack. Surprisingly, low back pain was not linked to backpack weight or proportion of backpack-to-student weight, but was "clearly" associated with fatigue while carrying a backpack. Lifetime prevalence of low back pain was related to the amount of time children carried backpacks on their shoulders.
In this study, the average backpack weighed 20 pounds. The resulting spinal loads on the 11-year-old children proportionally surpassed the legal occupational limits set for adults, according to the authors of this study. To reduce your child's backpack weight, examine the daily contents to assure only necessary items are within, and have your children leave what they can in their lockers at school.
Reference: Negrini S, Carabalona R. Backpacks on! Schoolchildren's perceptions of load, associations with back pain and factors determining the load. Spine 2002:27(2), pp. 187-195.
To learn more about pediatric health, go to https://www.chiroweb.com/find/archives/pediatrics/index.html.
Get Into the Swing of Things
Of the 25 million golfers in America, up to 62% may suffer an injury in the game. Low back pain is the most common injury in professional and amateur golfers. Repetitive swinging motions and excessive backswing are a few possible reasons for back injury. According to a recent study in the Journal of Manipulative and Physiological Therapeutics, modifying your swing might reduce your chances for injury without shortening your drive.
Seven golfers who normally demonstrated an excessive backswing were fitted with a recording device to measure the muscle activity in their lower and middle back, sides, and right side of the chest. The golfers consecutively hit 10 balls as hard as possible using their typical swing, while a device measured club-head speed and accuracy. Next, the individuals were shown how to modify their swing to incorporate a much shorter backswing; they were allowed to practice this swing, and they then hit 10 more golf balls using the modified swing.
A shortened backswing did not significantly decrease club speed or stroke accuracy, and the target spot on the club head also remained the same. However, muscle activity was significantly reduced in the sides and back during various stages of the golf swing. Translation: The golfers were able to hit just as good using the safer swing.
Perhaps you have an exaggerated golf backswing, yet have avoided changing your swing mechanics because of concern it might decrease your game performance. If that is the case, this study should prompt you to minimize your backswing to prevent back injury. It is important to note that this study also showed that a reduced backswing increased shoulder muscle activity; however, shoulder injuries are usually much less debilitating than back injuries.
Reference: Bulbulian R, Ball KA, Seaman DR. The short golf backswing: Effects on performance and spinal health implications. Journal of Manipulative and Physiological Therapeutics 2001:24(9), pp. 569-575.
For more information about sports health, go to https://www.chiroweb.com/tyh/sports.html.
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