Tag Archives: low back pain

Glucosamine sulfate appears to have no effect on chronic low back pain from degenerative lumbar osteoarthritis

I’ve posting a blog on the effectiveness of glucosamine sulfate for osteoarthritis of the knee. In my practice, it’s never seemed to work well for arthritis or degenerative disc disease of the lower back. Now, there’s new data supporting my observation.

On its website, ABC News reported, “Glucosamine has looked like salvation to many people with joint pain,” and “statistics attest to the supplement’s widespread appeal.”

For example, a “2007 federal survey of Americans’ use of complementary and alternative medicine found that more than 6 million adults in the United States had taken glucosamine in the previous month.”

Meanwhile, a “study from the US Centers for Disease Control and Prevention, published in 2004, found that among women treated at New Mexico hospitals for joint and muscle pain, 25 percent of those with osteoarthritis used glucosamine.”

Nevertheless, there have been mixed study results regarding the effectiveness of the treatment, according to the Los Angeles Times “Booster Shots” blog. “Some studies have shown the supplement to be effective in treating some joint pain, but others show no benefit.” (You can read why in another of my blogs on the topic)

Now, research coming out of Norway reveals “that glucosamine was no different from a placebo in treating lower back pain.”

The study included 250 individuals with “chronic back pain and degenerative lumbar osteoarthritis” who were randomly assigned “1,500 milligrams daily of glucosamine or an inactive placebo,” HealthDay reported .

The “patients’ pain was measured using the Roland Morris Disability Questionnaire at 6 weeks, then again at 3, 6 and 12 months,” according to the paper in the Journal of the American Medical Association. “At the start of the … trial, patients taking glucosamine scored 9.2 on the pain scale while the patients taking placebo scored 9.7.”

Six months later, “the average score in both groups was 5.0,” MedPage Today reported.” At a year, the average score was 4.8 for glucosamine and 5.5 for placebo, but the difference remained nonsignificant.”

What’s more, “between the end of the intervention and the end of follow-up, there was … no significant difference in average disability score, lower back pain at rest and during activity, and quality of life.”

Still, pointed out the author of an accompanying editorial, “no one study settles any question,” WebMD reported.

But the supplement “did no harm,” explained lead author Philip Wilkens. “And some patients who improved while taking the supplement told him they were sure it helped them.”

I still think it’s worth a try. Just be sure to use one of the brands of Glucosamine Sulfate that have been shown to be most helpful. You can find their names here.

Americans spending more on back surgery, but few find relief

The AP reports, “Even though only a fraction of people with back pain are good candidates for surgery, complicated spine operations are on the rise. So is the hunt for any relief.”

According to “one recent estimate, Americans are spending a staggering $86 billion a year in care for aching backs – from MRIs to pain pills to nerve blocks to acupuncture. That research found little evidence that the population got better as the bill soared over the past decade.”

The AP notes, “The reality is that time often is the best antidote. Most people will experience back pain at some point, but up to 90 percent will heal on their own within weeks,” and “for run-of-the-mill cases, doctors aren’t even supposed to do an X-ray or MRI unless the pain lingers for a month to six weeks.”

So, what do I recommend to my back pain patients?

  • Unless there are neurological signs, there’s no reason for X-rays, CTs, or MRIs for six months.
  • Initially try stretching and strengthening exercises, OTC NSAIDs (naproxen or ibuprofen), heat/cold therapy, massage therapy, physical therapy, or chiropractic therapy.
  • If no help, try other meds and/or change therapies.
  • If you’ve still had no help, consider seeing a pain specialist for consideration of one of several types of injection therapies.
  • Keep a visit to the surgeon as the last step. And, if you see someone who recommends surgery, get a second or third opinion.

TENS judged to be ineffective for low-back pain

Lots of us doctors, and many physical therapists, utilize TENS (transcutaneous electric nerve stimulation) for low back pain. Now a Los Angeles Times “Booster Shots” blog reports that, according to new guidelines published online in the journal Neurology, the “popular pain therapy using a portable device called TENS should not be used to treat chronic low-back pain.” Wow, this will be a change for many of us.

After reviewing studies and medical literature, researchers from the Kansas University Medical Center said that “the therapy is ineffective for low-back pain.”

HealthDay reported, “An exception was diabetic nerve pain, also known as diabetic neuropathy, which can cause symmetrical numbness, decreased sensation, and a feeling of burning, usually involving the legs, but sometimes affecting the hands.”

Study lead author Richard M. Dubinsky, MD, MPH, FAAN, “chair of practice improvement for the” American Academy of Neurology (AAN), said “there is good evidence that TENS is effective in this condition, which develops in about 60 percent of people with diabetes.”

WebMD explained that TENS, which “is a pocket-sized, battery-operated device that sends electric currents to the nerves via electrodes with the goal of treating pain,” has been “used for pain relief for four decades.”

But, after reviewing five “TENS studies involving patients with chronic low back pain lasting three months or longer,” AAN investigators found that while some “studies did show a benefit for TENS, the two most rigorously designed and executed trials reviewed by the researchers did not.”

Well, I guess TENS is now out of my tool bag for low-back pain.

Osteopathic care may ease late-pregnancy back pain

Low back pain in pregnancy is extremely common and manipulative therapy has been shown in a number of studies to be very helpful — especially for a condition called sacroiliac subluxation. Now, comes a story from Reuters Health confirming that gentle manipulation from an osteopathic doctor may relieve late-pregnancy back pain that frequently hinders bending, lifting, or walking.

The findings came from a small study hint and was performed by doctors in osteopathic medicine (DOs), who are medical doctors additionally trained in gentle manipulative techniques to help restore function, range of motion, and lessen pain in bones and adjoining muscles supporting the neck, back, chest, shoulders, and hips.

Osteopathic manipulation may particularly benefit pregnant women seeking medication-free back pain relief, note Dr. John C. Licciardone and colleagues at University of Texas Health Science Center in Fort Worth.

The study, in the American Journal of Obstetrics and Gynecology, included 144 otherwise healthy pregnant women, about 24 years old on average, with moderate levels of back pain and related movement difficulties during late pregnancy.

The women were randomly assigned to one of three groups: usual obstetric care only, usual obstetric care plus weekly 30-minute osteopathic manipulation treatments from the 30th week of pregnancy through delivery, or usual obstetric care plus sham ultrasound skin stimulation sessions.

Over the course of the study, women in the osteopathic group reported improved back pain and related symptoms, Licciardone noted in an email to Reuters Health. The sham ultrasound group reported no pain improvement and those in the standard care group reported increased pain. However, none of these differences were statistically significant.

Late pregnancy back-related movement problems generally worsened until delivery, but did so to a lesser degree in the osteopathic manipulation group.

Overall, these results suggest osteopathic manipulation may compliment conventional obstetric care, Licciardone and colleagues conclude. They call for further, larger investigations to assess the benefits and costs of this form of combined care.

So, if you or a good friend are pregnant, and suffering from low back pain, and your healthcare professional is no trained in low-back manipulation, consider asking for a referral to a healthcare professional (DO, MD trained in manipulation, chiropractor, or physical therapist) who can provide you this service.