Whiplash study says no benefits from intensive treatment

Intensive whiplash treatment is no better than standard care, a study suggests.

The study, in the Lancet looked at the treatment of more than 2,700 people with mild to moderate whiplash.

No additional benefits were seen in those who had more intensive care – which included suggesting a rapid return to normal activities.

A Canadian expert said the study showed the lack of benefit from “unnecessary treatments”.

Whiplash injuries cost the UK economy about £3.1bn a year, mainly due to the expense of treating those with chronic symptoms (between 30-50%) and their subsequent need to take time off work.

Long-term problems can include pain from even the smallest movement, difficulty sleeping and even being unable to work.

Let go of outdated paradigms and stop dwelling on Biomechanical tissue-based models when treating Back Pain.

This was the message from CSP fellow Dr Mick Thacker, director of the ‘Pain: Science and Society’ MSc course at King’s College London.

Giving a keynote lecture, Dr Thacker advised delegates to move away from purely mechanical-based therapies for back pain patients, and become more aware of the role of neuro-immnunology in relation to pain.

“Traditional physiotherapy has based its management of back pain on anatomical, tissue-based principles and biomechanics”, said Dr Thacker.

Hip resurfacing prone to failure

An operation used instead of a full hip replacement has a high failure rate and, in most instances, should no longer be offered, warn doctors.

Their advice is based on figures from the largest database on hip surgery.

Hip resurfacing – where the damaged bone is capped rather than replaced – is often recommended for younger, active patients who will need more surgery as the joint continues to wear.

Medical regulators say they will look at the Lancet journal findings.

The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) has already advised annual checks for people with large head metal-on-metal full hip replacements due to safety concerns. It is thought tiny pieces of metal can break off and leak into the blood.

The current study did not look at the safety of the metal resurfacing implants, although the researchers say there could be the same theoretical safety risk as with metal-on-metal hips.

Instead it looked at failure rates with metal-on-metal resurfacing – where the socket and ball of the hip bone has a metal surface applied to it rather than being totally replaced.

About seven in every 100 hip patients go for resurfacing rather than a full hip replacement, although the rate has been decreasing in recent years.

Some 32,000 people in England and Wales had this type of surgery between April 2003 and September 2011.

Gene flaw linked to Low Back Pain

Scientists have identified a gene flaw linked to disc problems that are a common cause of lower back pain.

The UK study, published in the Annals of Rheumatic Diseases, looked at 4,600 people and found the PARK2 gene was linked to age-related disc problems.

A third of middle-aged women have problems with at least one spinal disc – and the condition is known to be inherited in up to 80% of patients.

Experts said finding the gene could lead to new treatments being developed.

Back pain costs the UK about £7bn a year in sickness leave and treatment costs, but the causes of the condition are not fully understood.

In lumbar disc degeneration (LDD), discs become dehydrated and lose height, and the vertebrae next to them develop bony growths called osteophytes, leading to lower back pain.

The King’s College London researchers carried out MRI scans of all those in the study and looked at differences in their genetic make-up.

The Brains Drain System

The brain drain is real. There is a network of previously unrecognised vessels that rid the brain of unwanted extracellular fluids and other substances, including amyloid-beta – a peptide that accumulates in the brain of people with Alzheimer’s. The new discovery looks set to add to our understanding of the disease.

Jeffrey Iliff at the University of Rochester Medical Centre, New York, and his colleagues, were intrigued by the fact that there are no obvious lymphatic vessels in the brain. Among other things, the lymphatic system removes waste interstitial fluids from body tissue.

“It seemed strange that such an important and active organ wouldn’t have a specialised waste-removal system,” says Iliff.

When the researchers added fluorescent and radioactive tracers to the cerebrospinal fluid of live mice, the tracers quickly spread throughout the rodents’ brains. Using two-photon microscopy to visualise the movement in real-time, the team saw cerebrospinal fluid permeating the entire brain through ‘pipes’ surrounding blood vessels, similar to the lymphatic system that services all other organs.

The pipes work on hydraulic principles, though, and so the system breaks upon opening, making it hard to identify it outside living organisms.

Whiplash Injuries & Trigger Points

Persistent muscle pain following whiplash is commonly considered the result of poor psychosocial status, illness behaviour, or failing coping skills. However, there is much evidence that this persistent  pain may be due to neurophysiologic mechanisms involving peripheral and central nerve sensitisation. Myofascial trigger points may play a crucial role in maintaing this sensitisation. Recent research suggests that the chemical environment of myofascial trigger points is an important factor. Several consequences are reviewed when central pain mechanisms and myofascial trigger points are included in the differential diagnosis and in the management of patients with persistent pain following whiplash.

Pain really is “All in the Mind”

Doctors and nurses have known for many years that some people are more sensitive to pain than others. Now brain scans of people experiencing the same painful stimulus have provided the first proof that this is so. But the scans also suggest that how much something hurts really is “all in the mind”.

“We saw a huge variation between responses to the same stimulus,” says project leader Bob Coghill of the Wake Forest University School of Medicine in Winston-Salem, North Carolina. “The message is: trust what patients are telling you.”

Back Pain linked to shrinking Brain

BACK pain has a mysterious link with brain damage. Brain scans have shown that patients with chronic lower back pain have lost grey matter from two brain areas. Scientists are not yet sure whether this is the cause of back pain or the result, but the finding could lead to new drug treatments for backache that target the brain rather than the back or spine.

The discovery was made by Vania Apkarian of Northwestern University in Chicago, when he and his colleagues scanned the brains of 26 patients who had suffered lower back pain for at least a year. Some had damage to their sciatic nerve, which emerges at the base of the spine, while the others had no known injury. The team found that all the patients had lost grey matter in two brain regions known to be important in pain perception.

Bad Posture can “Switch Off” Back Muscles

Slumping in front of the television or computer could deactivate muscles that support and protect your spine, triggering many otherwise inexplicable cases of lower back pain.

A European Space Agency study in Berlin, Germany, in which young men spent eight weeks in bed, showed that an absence of load on spinal support muscles can sometimes be just as debilitating as a physical injury.

Ultrasound studies have shown that in most cases of lower-back pain, either the lumbar multifidus muscles, which keep the vertebrae in place, or the transversus abdominis, which holds the pelvis together, or both, are inactive. Normally the muscles work continuously to support and protect the lower back.

Heavy lifting, whiplash or other injuries can damage and inactivate these support muscles. This increases the risk of long-term back pain, as people are then more likely to suffer sprains, or damage to the discs or other tissue in the back. However, only between 10 and 15 per cent of cases of back pain begin with such an injury. For the rest, the cause is often a mystery.

Alexander Technique helps with Posture

ERGONOMICS… The term “ergonomics” is derived from two Greek words: “ergon,” meaning work, and “nomoi,” meaning natural laws. Ergonomists study human capabilities in relationship to work demands. POSTURE… In recent years, ergonomists have attempted to define postures which minimise unnecessary static work and reduce the forces acting on the body. All of us could significantly reduce our risk of injury if we could adhere to the following ergonomic principles: All work activities should permit the worker to adopt several different, but equally healthy and safe postures. Where muscular force has to be exerted it should be done by the largest appropriate muscle groups available. Work activities should be performed with the joints at about mid-point of their range of movement. This applies particularly to the head, trunk, and upper limbs.