Marion County Medical Center

Health Shorts

August 2004

Ignoring the Pain Sometimes Helps
When you have excruciating pain, it's common sense to avoid any activity that makes the pain worse. For back pain that course of action is not always best. Staying in bed, once recommended for back pain, is now known to be the worst thing you can do and supervised exercise is usually prescribed to re-build strength and reduce stiffness.

A Dutch study involving 134 employees of KLM Royal Dutch Airlines used a graded activity program-hour-long exercise sessions that included tasks that were part of the workers' daily lives, such as lifting suitcases. Tasks were made gradually more difficult, and therapists were trained to ignore complaints of pain and focus on building subjects' confidence in being able to complete the assigned tasks, regardless of pain.

Results: Subjects given the graded activity program went back to work a month sooner than patients on standard treatment with no greater recurrence of back injury.
[SOURCE: Daniel DeNoon, "Lower Back Pain: Hurt Doesn't Mean Harm," WebMD, January 20, 2004; Annals of Internal Medicine, January 20, 2004]

How About Seeing a Chiropractor?
About 15 percent of Americans call on a chiropractor for at least part of their medical care, and studies have found that chiropractic spinal manipulation is about as effective as other non-surgical treatments for back pain.

Chiropractors have expertise in the alignment of bones, joints and cartilage. Some but not all chiropractors, however, make claims that are not supported by medical practice.

There is no scientific evidence that adjustments to bones or vertebrae will correct specific conditions such as asthma, bronchitis, kidney disease or constipation.
Most scientists agree that good spinal health is no substitute for the protection against disease offered by immunization.
Use of spinal manipulation for neck pain carries a small but significant risk of serious adverse effects, including stroke.
Special supplements sold from the doctor's office for "hidden" allergies or imbalances in body chemistry should be regarded with suspicion.

[SOURCE: "What Chiropracters Can-And Can't-Do for You," Tufts University Health & Nutrition Letter, February, 2003; Chiropractic for Back Pain," Family Practice News, September 1, 2003]

When Back Pain May Mean Danger
Almost everyone suffers back pain at one time or another, and the problem usually goes away in a few weeks or days with or without treatment. Back pain is rarely associated with serious illness. Immediate medical attention is called for, however, when back pain is associated with one or more of the following symptoms:

difficulty passing or controlling urine,
numbness in the anal or genital areas,
numbness, tingling or weakness in one or both legs,
unsteadiness on your feet.

[SOURCE: "A Lingering and Uncomfortable Question: Should Patients with Back Pain Avoid Doctors?" The Back Letter, December, 2003]

Exercise, Cognitive Therapy Better Than Surgery for Back Pain
The number of Americans choosing surgery as treatment for back pain is increasing rapidly, but one recent study of back pain patients with evidence of disk degeneration found that a combination of cognitive-behavioral therapy plus exercise was more effective than surgery in relieving pain.

The cognitive therapy was designed to "help patients identify and overcome their pre-existing negative, and often false, beliefs and fears about back pain." Through the exercise component, these subjects experienced significant increases in muscle strength.
[SOURCE: Diana Mahoney, "Nonsurgical Care Relieves Back Pain: Behavioral Intervention, September 15, 2003]

Calcium: Food Better than a Pill
Dairy products are a major source not only of calcium but of phosphorus, vitamin D and protein-all vital to the development of strong bones and teeth. Supplements and foods fortified with calcium rarely contain all of these nutrients.

After calcium, phosphorus is the second most important component of bones and the two are needed in approximately equal amounts. Dairy products may offer the ideal combination of the two.
[SOURCE: "Fortified Foods: Calcium Leads to Phosphorus Shortage," Food Ingredient News, June, 2002]

Ice Cream Diet? It's All about Calcium
If you've heard about the ice cream diet, it may not be as silly as it sounds. It's all about the role of calcium in controlling body fat and weight. Studies are being carried out to confirm indications that calcium, at moderately high levels, encourages fat metabolism, resulting in less fat storage and increased weight loss or maintenance.

In one study from the late 1980s involving obese men with hypertension, those eating two cups of yogurt a day lost about 11 pounds over a year without making other changes in their diet. A more recent study found that subjects following a reduced calorie diet but with 1200 to 1300 milligrams a day of calcium from low-fat dairy products lost more weight than those eating the same diet but with only 400 to 500 milligrams of calcium. Any benefits of ice cream, of course, are associated with low-fat products consumed in moderation.
[SOURCE: "Calcium-An Emerging Element in Weight Management," Journal of the American Dietetic Association, March, 2004; National Institutes of Health, "Calcium," updated July 19, 2004]

Not All Sun Exposure Is Bad
Vitamin D is the sunshine vitamin, and individuals who spend a lot of time outside manufacture all they need. With concern about skin cancer, however, many Americans avoid the sun whenever possible or use sunscreen when they go outdoors. Housebound elderly persons also need to look for dietary sources of vitamin D.

In addition to many other benefits, vitamin D aids in the absorption of calcium and helps maintain normal blood levels of phosphorus. All three are necessary building blocks of bone density and strength.

Vitamin D is obtained from oily fish (salmon, swordfish, bluefish, mackerel and sardines) and, to a lesser degree, from eggs. Milk and cereals are often fortified with vitamin D.
[SOURCE: "Vitamin D's New Day in the Sun," Harvard Women's Health Watch, February, 2004]

Black Teens Need More Calcium
African American girls drink less than one glass of milk a day on average. Black adolescents, both male and female, get less than half the calcium and vitamin D they need for good health and bone growth, according to the U.S. Department of Agriculture.
[SOURCE: "Black Youths Not Getting Enough Calcium," USA Today (Magazine), February, 2002]

Teen Drivers: A Risky Combination
Adolescent drivers are more likely to take risks, to overestimate their skills and to underestimate their vulnerability to serious injury. And they are over-represented in automobile accidents.

In a recent study, 16- and 17-year-old drivers represented less than five percent of the study population but accounted for 19 percent of all crashes. Accidents involving teen drivers were more often attributed to driver error, and the severity of crashes was greater when other teenage passengers were in the vehicle. Night crashes were most likely to be fatal for teen drivers or their passengers.
[SOURCE: Natalie Z. Cvijanovich, Lawrence J. Cook, N. Clay Mann and J. Michael Dean, "A Population-Based Study of Crashes Involving 16- and 17-Year-Old Drivers; The Potential Benefit of Graduated Driver Licensing Restrictions," Pediatrics, April, 2001]

When the Driver Buckles Up...
When the driver-whether an adult or an adolescent-uses a seatbelt, teenage passengers are more likely to buckle up as well, according to a recent study. About 65 to 70 percent of passengers were belted when the driver was, compared to only 10 percent when the driver was not wearing a seatbelt.
[SOURCE: A.F. Williams, A.T. McCartt and L. Geary, "Seatbelt Use by High School Students," Injury Prevention, March, 2003]

Seat Belt Use Could Save Young Lives
Young drivers, who have the highest risk of being involved in an automobile crash, have the lowest rate of seatbelt use. An estimated 75 percent of all drivers but only 69 percent of young drivers (ages 16 to 24) use seatbelts regularly.

Increased use of seat belts would significantly reduce the number of persons killed or severely injured in highway crashes.
[SOURCE: "Buckle Up America Week: Focus on Teens and Young Adults, May 19-26, 2003," Morbidity and Mortality Weekly Report, May 16, 2003]

A Solution for Childhood Obesity
A school-based intervention in the United Kingdom has apparently found a simple, effective approach to curbing childhood obesity-stop drinking soda pop.

Among 644 children, ages 7 to 11, those given four one-hour classroom sessions discouraging consumption of both sweetened and unsweetened carbonated beverages did better than other subjects. They decreased their consumption of soft drinks while those in control groups were increasing theirs. In the intervention group, the percentage of overweight and obese children decreased by 0.2 percent compared to a 7.5 percent increase for the control groups.
[SOURCE: J. James, et al, "Preventing Childhood Obesity by Reducing Consumption of Carbonated Drinks: Cluster Randomised Controlled Trial," British Medical Journal, May 22, 2004; Journal Watch, July 15, 2004]

Treating Fever in Children
If your child has fever and pain, you probably know that you should avoid aspirin. But what over-the-counter remedy should you choose: acetaminophen or ibuprofen? A recent study found that 38 percent more children experienced fever reduction from ibuprofen than from acetaminophen at four hours after treatment. For pain relief, the two drugs had similar results, and no differences in safety were detected.
[SOURCE: D.A. Perrott, et al, "Efficacy and Safety of Acetaminophen vs Ibuprofen for Treating Children's Pain or Fever: A Meta-Analysis," Archives of Pediatric and Adolescent Medicine, June, 2004]