November 19, 2002 [Volume 3, Issue 23]
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In this issue of To Your Health:
Some Like It Hot
The two most popular nonprescription medications in the U.S. - ibuprofen (i.e., Advil) and acetaminophen (i.e., Tylenol) - have been promoted as "first-line" management of acute low back pain. These analgesics may cause potential kidney, stomach, and liver problems, however. Self-administered topical heat wraps may offer a drug-free alternative treatment for acute back pain.
In
a recent study in the journal Spine, the authors compared eight
hours/day of low-level topical heat therapy with maximal recommended dosages
of ibuprofen and acetaminophen. Pain, muscle stiffness, disability, and
back flexibility were compared in almost 400 people with back pain, ages
18-55, over two days of therapy and two days of follow-up.
Heat-wrap therapy was more effective than either drug. Heat wraps were significantly more effective than ibuprofen and acetaminophen in terms of self-reported pain relief. In the heat-wrap group, back flexibility was greater, and disability and muscle stiffness were lessened to a greater degree.
Based on these findings, continuous low-level heat-wrap therapy may be better than painkillers for acute back pain. Your doctor of chiropractic can tell you more about this noninvasive, drug-free pain treatment, which involves simply wrapping a Velcro belt with a heating element around your torso.
Reference: Nadler SF, Steiner DJ, Erasala GN, et al. Continuous low-level heat wrap therapy provides more efficacy than ibuprofen and acetaminophen for acute low back pain. Spine 2002:27(10), pp. 1012-1017.
Learn more about back pain at https://www.chiroweb.com/find/archives/musculoskeletal/backpain/index.html.
Too Many Tonsillectomies?
Tonsillectomy, or removal of the tonsils, is the most common major surgery performed on children in the U.S. In 1996, nearly 300,000 children under age 15 underwent some form of tonsillectomy to prevent serious or recurring infections. This surgery has been around forever, and is proven effective for children with severe, recurrent throat infections. Yet insufficient evidence supports this procedure in children with only moderate infections.
In a study at the Children's Hospital of Pittsburgh, over 300 children ages 3-15 were utilized based on the determination that they suffered from throat infections to a greater degree than recommended for surgery under current guidelines, but to a lesser degree than children in previous studies on the effectiveness of tonsil removal. Children received either no surgery or one of two forms of tonsillectomy.
Although surgery groups showed lower rates of throat infection than nonsurgery groups over the three years after surgery, rates of moderate-to-severe infection were still considered "low" in nonsurgery groups. Also, despite a slightly lower infection rate, nearly 10% of the children who had surgery developed complications.
Under current guidelines, it appears that too many tonsillectomies are being authorized. The authors of this study in Pediatrics conclude that the relatively insignificant advantage currently gained from tonsillectomies in moderately affected children does not justify the risks, pain, and financial costs involved.
Reference: Paradise JL, Bluestone CD, Colborn DK, et al. Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics 2002:110(1), pp. 7-15.
For more information about pediatric health, check out https://www.chiroweb.com/find/archives/pediatrics.
Caffeine Keeps Going, and Going...
You're not alone drinking that morning cup of coffee. Around 85% of Americans drink caffeine daily in the form of coffee, tea, or soft drinks. People take caffeine because it is a stimulant - our bodies respond to caffeine essentially the same as they do to stress - but its effects may last longer than you might expect, based on a recent study in Psychosomatic Medicine.
Forty-seven healthy, habitual coffee drinkers were followed for three days to monitor blood pressure, heart rate, and hormonal changes based on caffeine consumption. The individuals were monitored through a normal day of drinking coffee; a day when given caffeine pills twice (total equivalent to four cups of coffee); and a day when only given placebo pills containing no caffeine.
Caffeine significantly raised both diastolic and systolic blood pressures and increased levels of epinephrine (a stress hormone) in the body by 32%, which in turn increased feelings of stress. Also, although all caffeine pills were given prior to 1 p.m., their effects lingered until bedtime.
Even eight hours after caffeine consumption, one-quarter of the amount consumed remains in your body. Stress reactions and higher blood pressure caused by caffeine may be dangerous, so try to limit yourself to one cup of coffee or tea each morning, and avoid caffeine altogether in the afternoon and evening.
Reference: Lane JD, Pieper CF, Phillips-Bute BG, et al. Caffeine affects cardiovascular and neuroendocrine activation at work and home. Psychosomatic Medicine 2002:64, pp. 595-603.
Other nutrition studies can be found at https://www.chiroweb.com/find/archives/nutrition.
"Just" Hormones?
Many women take estrogen plus progestin, a form of hormone replacement therapy, to combat the negative side effects associated with menopause. That may not be the case in the near future, however. After health risks were determined to exceed benefits, earlier this year, the safety monitoring board for the Women's Health Initiative (WHI) halted an eight-and-a-half-year study on postmenopausal women taking estrogen plus progestin.
The WHI, which seeks to define risks and prevention strategies for heart disease, cancer, and fractures in postmenopausal women, enrolled women ages 50-79 in a set of studies between 1993 and 1998. One study of nearly 17,000 women compared estrogen plus progestin in one daily tablet to a placebo tablet (i.e., sugar pill).
Just over five years into the study, however, the risk for invasive breast cancer exceeded the "stopping boundary" for the study, and risks from taking the estrogen plus progestin were deemed too high to continue the trial. Compared to women taking placebo, women taking hormones were significantly more likely to suffer a stroke, breast cancer, or heart disease.
Although progestin plus estrogen is intended in part as a primary prevention for heart disease and death, it actually may increase risk for the condition. If the study had continued for several more years, the risks from taking these combined hormones may have been much worse.
Reference: Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial. Journal of the American Medical Association 2002:288(3), pp. 321-333.
For more tips on women's health issues, see https://www.chiroweb.com/find/archives/women.
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