Stop Smoking to Reduce Back Pain: Why the Anti-Smoking Crowd Hurts Less
December 14, 2009
by: Sylvia Marten
That cigarette with your cup of morning coffee is relaxing, isn't it? You can just feel the tension release from your body as you light one up and deeply inhale. Smoking is a powerful habit, the anxiety release fully understood only by people who either currently smoke or have smoked in the past.
However, according to Dr. Edit Balan, your brain and your serotonin levels aren't fooling your back and you can reduce your back pain if you stop smoking. Dr. Balan, director of the pain clinic of the GHS in Haifa, Israel, presented a study at a conference on back pain which shows that smokers have twice the risk of experiencing back pain than non-smokers.
The Oxford Journal on Rheumatology hypothesizes the reason for a higher of incidence of back pain amongst smokers is that smoking leads to malnutrition of discs, which in turn become more brittle and vulnerable to stress. Nicotine constricts blood vessels (known as nicotine-induced vasoconstriction), can potentially cause changes to interior arterial walls and changes in blood flow. Perhaps the reason for less back pain in the anti-smoking crowd can be attributed to more efficient blood flow.
A study of 3,222 smokers and non-smokers conducted by the Division of Clinical Epidemiology in Montreal, Canada concluded that smokers have more frequent episodes of back pain than non-smokers, further evidence that quitting smoking is an important consideration for back pain sufferers.
If you're considering a "stop smoking" New Year's resolution, we know it's not easy (but it's healthy!) - so here are some tips, tricks and resources to help you get through the adjustment period. These tips come from the American Cancer Society's suggestions about how to kick the smoking habit for good.
- Make a definitive decision to quit. Don't try to cut back, or "think about" quitting smoking -- decide to do it and stick with your plan. Choose a date that you will stop smoking and pick a smoking cessation plan that will work for you.
- Stay away from places where smokers convene or where you are used to smoking.
- Do something different. Go for a walk instead of a smoking, take a drive to somewhere new, drink water or juice instead of alcohol, or purchase an herbal tea in the morning instead of coffee.
- When you get that craving to smoke, keep your hands busy. You can try woodwork, knitting, pottery or even taking up an instrument. Snack on healthy, crunchy foods like carrot sticks or seeds. You can chew sugar-free gum. If you are having an exceptionally hard time kicking the smoking habit, many people "take the edge off" by starting with nicotine gum and gradually transition to non-nicotine gums.
- Do your deep breathing. Inhaling deeply can help simulate that feeling you had while smoking, but you'll feel better breathing clean air rather than smoke.
- If do break down and feel like you absolutely need a cigarette, force yourself to wait 10 minutes. Often, by the time the 10 minutes are up, the craving has passed and you will be able to skip the cigarette. Distract yourself during that 10 minute span - call a friend, walk into a store, pay a bill, watch TV, etc.
- Save up the money you would have spent each week on cigarettes. Use some of the money to treat yourself to dinner or a movie, book, CD or other reward for quitting smoking!
There are also anti-smoking medications available such as Chantix and Zyban (please see their respective websites for information on effectiveness, research and contraindications).
You can also keep a Stop Smoking Craving Journal to keep track of when your cravings are the worst and make informed decisions about what to do during those times to improve your anti-smoking efforts.
Additional Stop Smoking Resources
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SmokeFree.gov - Information and resources for quitting smoking from the U.S. government
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The Stop Smoking Guide - Anti-smoking product reviews, forums and blog
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QuitSmokingSupport.com - Support and information to help you stop smoking
Back Pain and Holiday Blues: 18 Tips to Reduce Your Holiday Stress
December 7, 2007
by: Sylvia Marten
Ah yes, the holidays are upon us once again, and with them the holiday blues. Not everyone is in festive spirits, especially those of us with chronic pain. Often, chronic back pain leads to depression, and alternately depression can worsen physical pain. The added anxiety and stress of all the holiday planning and expectations can intensify feelings of sadness. Travel blues may factor into the equation too - vacation blues catch us off guard as we're taken away from our normal routines and pain management support like special ergonomic chairs and mattresses. Even if it's just a temporary bout of the holiday blues, that doesn't mean you have to simply accept it. Here are some things you can do to reduce your holiday stress.
- Talk with friends on the phone, or over coffee.
- Talk with other people who suffer from back pain or chronic pain on the Spine-Health.com forums:
- See your family doctor or psychiatrist - you may have a physiological disorder that requires antidepressants.
- Improve your diet and exercise regularly, at least on non-party days. Don't stress about weight gain at the big family gathering or work holiday party. Having food you enjoy and chatting with friends releases endorphines. Live a little! On other days, make sure that you eat in moderation and get at least a half hour of cardiovascular exercise, even if that means nothing more than taking a walk. If you have difficulty with certain types of exercises due to back or neck pain, try these exercise tips for people with back pain.
- Seek sunshine - the real thing is best, but if it's dark and dreary outside, spend a few extra dollars and get yourself some full spectrum lighting.
- Set realistic goals and don't be the ultimate people-pleaser. Decide what's important and don't overextend yourself.
- Plan a small gathering of friends or neighbors such as a dinner or wine party.
- Read these Spine-Health.com articles:
- 4 Tips to Help Cope With Chronic Pain and Depression
- 5 Things You Should Know About Chronic Pain
- Chronic Pain Coping Techniques - Pain Management
- Make sure your plans move you toward your goal, and celebrate even minor achievements.
- Cook, buy yourself some new music and/or new books to have on hand. (no depressing music!)
- Go to a museum or concert.
- Plan a short trip to a place you enjoy, either by yourself or with a good friend, and don't forget to take along these pain-free travel tips.
- Rent movies from your local movie store or an online DVD rental company.
- Hug somebody! This is no joke, hugging has positive and real physical benefits. The BBC even published the results of a study stating that hugs increase oxytocin and reduce blood pressure in women.
- Meditate. According to researchers at James Cook University in North Queensland, Australia, meditation offers similar mood benefits to running or other physical exercise. If your pain restricts you from strenuous exercise, consider meditation. Don't know how? You can learn to meditate.
- Go ergonomic. If you're at home, it makes sense to have ergonomic seating available. If you're going to sit and watch TV, eat dinner or pay bills, do everything you can to reduce your pain by giving your back the proper support. Pain management is a key component in managing depression during the holidays as well as throughout the year.
- Get enough sleep. Yes, you have to get to the store, wrap those gifts, bake that cake, etc...but sleep deprivation is a big contributor to depression. Be disciplined - go to bed and get 6 to 8 hours of sleep! If you have difficulty sleeping due to chronic pain, you might want to check out our articles on the best mattresses for back pain.
- Clean up the house and get organized. A clean space can make you feel better about any other holiday projects you have going on.
BONUS "BEAT THE HOLIDAY BLUES" TIP:
- Honor your own feelings. While nobody wants to feel depressed, recognizing your sadness can mean that something isn't working in your life the way that you would like it to. If it's something you want to change, hey, it's almost time for those New Year's resolutions, right? Pay attention to what your body is telling you, and if necessary, seek the help you need.
How to Prevent Osteoporosis with a Once-a-Year Injection
December 4, 2007
by: Sylvia Marten
The need to take a once-a-day or even once-a-month osteoporosis medication may soon be eliminated. Recent studies indicate that a once-a-year osteoporosis injection of zoledronic acid like Reclast® can prevent spine fractures and hip fractures from Osteoporosis. In a 3-year study conducted by the manufacturer of Reclast®, Novartis, it was determined that there was a 70% reduction of spine fractures and 40% reduction of hip fractures in a group of 7,736 postmenopausal women.
Reclast® - now approved by the FDA - is a bisphosphonate, a class of drugs that is used to treat osteoporosis; a class that also includes medications such as Boniva, Fosamax and Actonel. According to the FDA, more than half of postmenopausal women on daily or weekly biphosphonates will discontinue osteoporosis treatment after one year, leading to a higher risk of fractures. Given as a 15-minute infusion, the Reclast® (zoledronic acid) injection for osteoporosis has the benefit of long-lasting protection.
Reclast® was originally used in the treatment of metastatic bone cancer and was found to have positive impact on bone density, reducing the degenerative effects of osteoporosis.
Osteoporosis is a degenerative bone disease in which one's bone density is reduced over time. It is a silent disease, and most sufferers of osteoporosis do not know that the condition exists until they experience a spinal fracture or hip fracture. Postmenopausal women are at the highest risk for osteoporosis, but osteoporosis can affect anyone, especially individuals over the age of 40 and those who do not have enough calcium in their diets.
Some physicians noted a minor risk of atrial fibrillation, a potentially dangerous cardiac rhythm disorder, when taking zoledronic acid intravenously. However, in the 3-year study, there was not a significant increase in mortality or morbidity. It is always a good idea to discuss any osteoporosis medication risks with your physician prior to treatment.
Source: Novartis Pharmaceuticals, Inc.
Additional Reading:
Osteoporosis: 4 Proven Steps to Prevent Osteoporosis Fractures What You Need to Know About Osteoporosis Kyphoplasty: Osteoporosis Fracture Treatment Vertebroplasty Interactive Video Resources:
New Back Surgery Technologies
November 28, 2007
by: Sylvia Marten
Technological developments in spine are occurring at an ever increasing rate, but what does this mean for patients? To date, most new technologies have involved reducing the postoperative pain and speeding recovery, and lately, technologies to preserve motion in the spine (as opposed to a fusion).
Often, new technology represents more of a marketing tool for physicians than a true advancement in patient outcomes.
None of these technologies, however, change what we as surgeons can treat. Indications for spine surgery for pain are still limited to decompressing a nerve root or stabilizing a painful motion segment. Spinal conditions that include an anatomical defect that causes nerve root pinching or a painful motion segment may be amenable to surgical correction. Patients that have back pain that cannot be attributed to either of these problems still do not have a surgical option.
Surgical success is mostly determined by first having an accurate preoperative diagnosis, not by what technology is used to do the surgery. Even the best technology will not be useful if what is operated on is not what was causing your pain.
Spine surgery is like any other field of medicine in that it is really more of an art than a science. Practicing spine surgery involves trying to improve ones techniques for accurately diagnosing patients’ problems, and then improving ones surgical technique. To some extent, all this focus on new technology can be a distraction. Often, new technology represents more of a marketing tool for physicians than a true advancement in patient outcomes.
This is not to say new technologies are not helping. Patients in particular need to temper their enthusiasm and be realistic about what can and cannot be accomplished. Truly useful technologies often take years to be verified. There are multiple technologies that were once thought to be the next best thing for back pain but are no longer used. Technologies such as chemonucleosis, percutaneous discectomies, laparascopic lumbar fusions, and to some extent, intradiscal electrothermocoagulation (IDET). At one time or another all of these technologies had seemed to hold the promise of a significant advancement in treating low back pain but have now been largely or completely abandoned.
Just as in the rest of life, with back surgery there are no simple answers, and relying on new technologies alone to improve outcomes is probably not going to be all that reliable. The judicial use of newer technologies combined with rigorous scientific study holds the promise of eventually improving overall patient outcomes. In my opinion, an accurate preoperative diagnosis trumps any of the new spine technologies, and always will.
Chronic Pain = Clinical Depression
November 12, 2007
by: Sylvia Marten
When pain becomes chronic and does not respond to pain medication and other treatments, the normal response is a combination of fear, anxiety, irritability, anger, and eventually depression. People suffering from chronic pain are four times more likely to suffer from clinical depression than healthy individuals. And the greater the pain, the more likely it is that the person will develop depression.
How does depression develop in people with chronic pain? The cycle is described by Dr. William Deardorff as follows:
"[The development of depression] can be understood by looking at the host of symptoms often experienced by the person with chronic back pain or other spine-related pain."
- The pain often makes it difficult to sleep, leading to fatigue and irritability during the day.
- Then, during the day, because patients with back pain have difficulty with most movement they often move slowly and carefully, spending most of their time at home away from others. This leads to social isolation and a lack of enjoyable activities.
- Due to the inability to work, there may also be financial difficulties that begin to impact the entire family.
- Beyond the pain itself, there may be gastrointestinal distress caused by anti-inflammatory medication and a general feeling of mental dullness from the pain medications.
- The pain is distracting, leading to memory and concentration difficulties.
- Sexual activity is often the last thing on the person’s mind and this causes more stress in the patient’s relationships.
Understandably, these symptoms accompanying chronic back pain or neck pain may lead to feelings of despair, hopelessness and other symptoms of a major depression or clinical depression.
A recent study by Strunin and Boden (2004) investigated the family consequences of chronic back pain. Patients reported a wide range of limitations on family and social roles including: physical limitation that hampered patients’ ability to do household chores, take care of the children, and engage in leisure activities with their spouses. Spouses and children often took over family responsibilities once carried out by the individual with back pain. These changes in the family often led to depression and anger among the back pain patients and to stress and strain in family relationships." (Source: Chronic Pain and Depression).
Helpful Resources:
Mind Over Matter: Effective Chronic Pain Control Techniques
October 26, 2007
by: Sylvia Marten
Chronic pain is not a simple sensation, but rather chronic pain is strongly influenced by the ways in which the brain processes the pain signals. Importantly, chronic pain can provoke strong emotional reactions, such as fear, anxiety or even terror, depending on what the individual believes about the pain signals.
If there is any good news with chronic pain, it is that to a certain extent the brain can learn how to manage the sensation of pain. Ideally, use of chronic pain management techniques outlined here can help people dealing with chronic pain feel more in control of their situation and less dependent on pain medications.
First, for chronic pain coping techniques to work, you need to relax your body through focus and deep breathing. Learning to relax takes practice (especially when you are in a great deal of pain), but hopefully the payoff is worth it.
Coping techniques for chronic pain begin with controlled deep breathing, as follows:
- Try putting yourself in a relaxed, reclining position in a dark room. Either shut your eyes or focus on a point.
- Then slow down your breathing. Breathe deeply, using your chest.
- After you feel yourself relaxing, you can begin to use imagery techniques.
Several chronic pain control techniques that are effective include:
Altered focus.
Very powerful. This technique involves focusing your attention on any specific non-painful part of the body (hand, foot, etc.) and altering sensation in that part of the body. For example, imagine your hand warming up. This will take the mind away from focusing on the source of your pain.
Mental anesthesia.
Also very powerful. This technique is done by imagining an injection of numbing anesthetic (like the Novocain a dentist uses) into your area of pain. Similarly, you may then wish to imagine a soothing and cooling ice pack being placed onto the area of pain.
Mental analgesia.
Building on the mental anesthesia concept, this technique involves imagining an injection of a strong pain killer, such as morphine, into the painful area. Along the same lines, you can focus on imagining your brain producing massive amounts of endorphins, your body's natural pain relieving hormones, and having them flood into to the painful parts of your body.
Transfer.
Use your mind to produce altered sensations, such as heat, cold, anesthetic, in a non-painful hand, and then place the hand on the painful area. Envision transferring this pleasant, altered sensation into the painful area.
Pain movement.
Mentally move your pain from one area of your body to another, anywhere you think the pain will be easier for you to handle. If you can't take another minute of your leg pain, for example, mentally move the pain up from your leg and into your low back. If you want, then more your pain out of your body and into the air.
Some of these techniques are probably best learned with the help of a professional, and it usually takes practice for these techniques to become effective in helping alleviate chronic pain. It is often advisable to work on pain coping strategies for about 30 minutes 3 times a week. With practice, you will find that your powers over the pain will increase, and it will take less mental energy to achieve more pain relief.
Good luck, and I hope these help.
Based on the Spine-health.com articles by Andrew Block, PhD: Chronic Pain Coping Techniques - Pain Management and 11 Chronic Pain Control Techniques
Also see:
Top 12 Tips for Buying a New Mattress
October 18, 2007
by: Sylvia Marten
Any mattress that helps you sleep comfortably and wake up feeling refreshed, without pain and stiffness, is the best mattress for you. There is no single mattress that works for all people. You should choose the mattress that provides adequate support and meets your standards for comfort and allows you to get a good night's sleep.
That being said, there are a ton of advertising claims being made by mattress companies and it's hard to choose which is right for you. To help you get started, here are some things to keep in mind when buying a new mattress:
- Research online before going shopping. Two helpful resources that provide information (but don't sell mattresses) are the Spine-health.com Sleep Health Center and Better Sleep websites.
- Talk to your doctor. If you have a health condition, talk to your doctor or physical therapist about what he or she recommends. Keep in mind that doctors are not sleep experts, but they know your medical condition and symptoms and will probably have some good advice from that point of view.
- Firm mattresses aren't always better for your back. Think twice before buying a hard or firm mattress. There is a difference between firm support and firm feel. You want firm support with a comfortable feel (comfortable will be defined by your personal preference. Research has shown that the best mattress for low back pain is a medium firm mattress rather than a firm mattress.
- Pillow tops aren't for everyone. Very light-weight people don't need big thick pillow top mattresses because they don't weigh enough to compress the foam to even touch the underlying coils/support system. On the flip side, larger/heavier people do tend to feel more comfortable with a little extra cushion to help buffer thems from the coils.
- Adjustable beds are a great option, especially if you find you are more comfortable sitting in a recliner than lying down. They allow you to elevate your head and knees slightly to relieve pressure on the lower back. You can also create the same effect using pillows rather than an adjustable bed.
- Ask about money-back guarantees. If you think you'll like a memory foam mattress but aren't quite sure, try the Tempurpedic brand as they typically offer a 30-day money-back guarantee. If you don't like it within the first 30 days, you're probably not going to change your mind so send it back.
- Ask about "comfort guarantees" BEFORE you buy. Many states still allow retailers to give what's called a comfort guarantee. Ask for it BEFORE you buy, and be sure you understand the details – if you're required to pay shipping, if it includes a money-back guarantee or exchange, time frames, etc.
- Check the warranty. A good mattress will have a minimum of a 10 year FULL replacement or NON prorated warranty.
- Protect your investment. Always get some kind of water proof mattress protector. Stains will void your warranty.
- Take it for a test drive. When shopping for a mattress, try to lie on the mattress for at least 10 to 15 minutes. Don't feel self conscious or let the sales person hurry you along – it's a big purchase, and if you don't try it for at least 10 minutes you're not going to get a real feel for it. That being, said it's at all uncomfortable you can rule that one out pretty much right away.
- Check out all the options and variations. Give yourself a comfort test if the salesperson doesn't offer you one. Ask to try a firm, a plush, and a pillowtop in the same brand quality and price point of each other. Lay on each one for 10-15 minutes. When you find the most comfortable one ask to see more of that kind.
- Shop at a real mattress store, not a furniture store or department store. The salespeople at a mattress store usually have more training on the whole subject of sleep. Try to find a store that carries several major brands, such as Sealy, Serta, Simmons, and Tempurpedic. Remember it's your mattress, your back, and your money, so it's worth the time to research it and get the best that you can. That being said you don't have to spend a fortune either – mattresses are often on sale, and the price, frames and delivery fees are often negotiable.
Sources:
Posted by: Stephanie
Unusual Office Chair Solutions
October 8, 2007
by: Sylvia Marten
Many people feel very uncomfortable in their office chair. And there are lots of good office chair reviews if you're looking for a new option. But what if the problem is not your specific office chair but the fact that you're sitting on one at all? If this may be true for you, then here are some office chair alternatives to consider.
Stand up desk
For people who really feel uncomfortable sitting at a desk all day, one solution is not to sit – but rather stand up and work. Just get a desk that is a comfortable height for you to work at while standing.
Other guidelines:
- Put your foot up on a footrail or some type of footrest so you can put rest one foot higher than the other and easily shift your body weight from one leg to the other.
- Use some type of seat as well. Using a stool affords you the most options, as you can sit fully or just sit partially by leaning forward while sitting with your weight distributed between your seat and your foot on the floor.
A side benefit that some people find from working standing up is that they feel more energized and are more productive working while standing up. My first boss told me to stand up when making important phone calls because then you sound more positive and motivated. Also, if you're someone who likes to move around a lot (aka you fidget when sitting still), then standing up while working makes it easier to pace while doing certain tasks, such as talking on the phone.
Add a podium
If working full time at a stand up desk isn't for you, consider adding a podium, lectern or stand up desk in your work area and just do certain tasks while standing, like reading or talking on the phone. This way you can move between your regular desk and your standup area and get some variety in your positions during the workday.
Walking desk
We've talked about walking desks/treadmill desks before. The idea is that you walk very slowly on a treadmill while working standing up. Personally I'm not a big fan of this idea – I like to keep the workout and the work separate. But I can see how this idea would make sense in certain situations, and some people say it works for them.
Exercise ball
The main benefit here is that sitting on an exercise ball is active – your body is constantly making minor adjustments to remain balanced on the ball - and this requires your core body muscles, your abs and large lower back muscles, to work to hold the body upright and balanced on the ball. And because there is not back as on an office chair, it's hard to slump or slouch, which encourages good posture.
Until your core muscles get strong enough to support you and sitting on the exercise ball feels comfortable, it is often a good idea to not have the ball fully inflated so that it is more stable, and start out by sitting on it for only a little while at a time (e.g. 10 to 20 minutes) and gradually work up to several hours at a time. You can buy a ball with sand at the bottom of it if you're concerned about it rolling away every time you stand up (a good idea for people who get up a lot at work).
Other factors to note: This is one of the least expensive office chair options, usually around 15 - $30. However, many people find that they also sit in a regular office chair for at least part of the day.
Balance stool
A balance stool the same general idea as an exercise ball – forcing you to sit with good posture (as you're not able to slump or slouch) and many versions, such as the Swopper, encourage active sitting as they bounce up and down and side to side, making your core muscles work in order to stay balanced on it. Compared to the exercise ball, a balance stool looks slightly less unconventional and stays in one place.
Most balance stools are in the price range of $200 - $700. Ikea offers a similar option that is similar but less expensive at around $50.
Kneeling chair
A kneeling chair is actually a bit of a misnomer, because you're not really kneeling while on the chair, just sitting while angled forward with some of your bodyweight supported by your shins. Your shins provide stability, but the body is still sitting, not kneeling. The design of the chair is intended to:
- Reduce some of the strain placed on the lower back when sitting in conventional, right angle office chairs – the idea is that sitting while tilted forward slightly places the spine in a more neutral position.
- Encourage good posture by sliding the hips forward so that your weight is distributed between your pelvis and knees/shins, which reduces spinal compression, and therefore reduces the stress and tension in the lower back and leg muscles.
The result is an office chair that makes sitting in the proper position feel comfortable and effortless. As with all chairs, be sure to get one that allows you to adjust the height and angle. Some versions are on casters, if you need to move around, and some have a bit of lumbar back support for when you want to lean back a little.
Recliner
Many people with back pain feel much more comfortable sitting in a reclining position than sitting upright. In a survey on Spine-health.com, we found that 72% of people with back pain felt less pain when lying down or reclining (N = 1368). If you are one of these people and have the option, then working while sitting in a recliner, with feet propped up on an ottoman or attached footrest, then using some type of laptop stand with your recliner may be a good option.
For the inexpensive route, you can use a lap desk – a wood or other type of solid top and beanbag cushion on the bottom – and work on it with your laptop and a wireless mouse.
If you're working for longer periods, then I would recommend using a laptop stand that lets you use a separate keyboard and ergonomically positioned wireless mouse. There is a huge variety of recliners and laptop stands – some very elaborate ones, and there's bound to be a setup that will suit your needs.
Personally, I think sitting in a recliner would be way too comfortable and relaxing – I'm pretty sure I'd be dozing within minutes. Standing or active sitting are definitely better options for me.
Final thoughts
No matter what you choose, there is nothing better than getting up regularly during the day to stretch and walk around. If price is an issue, remember that all the above options are available for much less via Craigslist and EBay, as a lot of people seem to buy these new but end up reselling them without using them much.
Of course this is not a comprehensive list, just a few ideas to get you thinking about alternatives. Have you found something that works well for you? Please let us know. (No sales pitches please.)
More reading:Is Your Pain Medication Prescribed Off-Label?
October 1, 2007
by: Sylvia Marten
Experts estimate that 21% of prescriptions for common drugs are written for off-label uses. According to a study on Off-Label Prescribing published in the Archives of Internal Medicine, three-fourths of those prescriptions were for off-label uses that lacked scientific support. What's going on?
First, let's talk about what we mean by on "label" drugs. In the U. S. , the FDA requires that drug makers submit, test and get approval from the FDA for specific uses of their product before the product can ever be marketed. To obtain approval, pharmaceutical manufacturers must submit extensive study data demonstrating safety and effectiveness, a process which usually takes several years and millions of dollars. When a product is approved by the FDA, a specific "label" for that product is approved too. The label must include the product's approved indications, dosage and method of administration, and use in specific populations.
So, what is "off-label"? After the FDA approves a drug for its specific use, physicians can prescribe the product for uses not covered by the approved label. This is "off-label" use. Off-label uses include:a drug prescribed to patients with conditions not listed on the approved label; departure from the approved drug dosage, method of administration, or patient population; and unapproved product combinations, such as using two different drugs to treat a single condition. This practice is perfectly legal but it lacks any kind of oversight.
"Off-label" drugs for back pain. Among the types of drugs commonly prescribed off-label, most common were heart drugs and anti-convulsants (indicated for seizures). For example, gabapentin, brand name Neurontin, had one of the highest proportions of off-label use among specific medications, namely for neuropathic pain (it is only indicated for use in controlling epileptic seizures and in pain from post-herpetic neuralgia). Neurontin also happens to be a quite commonly prescribed drug for people diagnosed with chronic back pain or chronic low back pain. This of course means the drug is being prescribed off-label in the back pain patient population.
Patients should always consider carefully all medications that are prescribed to them. It is fair for patients to ask their doctors whether a prescription is on or off-label, and this can be easily and more thoroughly researched on reliable health information websites that address medications, such as MedlinePlus, the FDA, or condition-specific sites. If off-label, it is important to know whether there is sufficient data to support its use or if the practitioner's decision is based on anecdotal evidence. The patient should weigh off-label recommendations against the alternatives with his/her practitioner, and ultimately decide if he/she is comfortable with an off-label drug for the specific health issue being addressed. It is important for patients to keep in mind that a drug prescribed off-label to them is a drug that has not been approved by the FDA for some element of their specific health situation.
Is "off-label" drug prescribing good or bad? There isn't a clear cut answer. Anecdotally, many of my colleagues and personal circle of friends have experienced off-label drug use with positive results. For example, our children have been prescribed albuterol for various severe pulmonary episodes (not asthma, for which it's indicated) with much success. The Spine-health.com message boards are full of stories of people taking medications off-label for back pain or leg pain as prescribed by their doctors, with many experiencing much needed pain relief not possible with approved drugs. So, off-label use can be positive in that it expands access to important health benefits that may not be possible with alternatives. On the flip side, concerns and warning bells should go off with respect to safety and the long-term impact of a drug use that has not been extensively studied.
The study authors cited several reasons as to why the high percentage of off-label prescribing is occurring, with some reasons being legitimate and others not. The practice itself raises issues that require addressing, including a better/faster process for getting legitimate additional uses for a drug indicated, but also for ensuring patient safety for patients dutifully following an off-label treatment protocol as prescribed by physicians they trust.
Posted by: Sylvia
Additional reading:
The Health Care Crisis
September 27, 2007
by: Peter
The uninsured population of the United States has perplexed our country and our leaders for several decades now. Many have termed this our national health care crisis, but it is not nearly as much a health care crisis as a health insurance crises. As medicine has gotten more technical and expensive, the affordability and availability of insurance has gone down. Health insurance affects our society in many different ways including cost shifting, job decisions, and actual availability of health care.
How we got to where we are is complicated and there are no easy answers as to how we can correct our problems. Opinions are very polarized as to whether or not national health insurance will correct all our problems, but the question is really not that easy. At the same time that many countries with national health insurance are trying to privatize large sections of the healthcare, we are trying to experiment with a whole new tax and guaranteed health care system.
As we taxpayers, patients, and citizens ponder this problem, we need to consider several different realities. Right now we pay 17% of our gross national product for healthcare. Everyone agrees that this is a substantial sum, but there is no agreement as to how to lower this amount while continuing to expand healthcare that is available today. Technology continues to increase not only the quality of care but the cost.
There are only two ways to ration healthcare or any other commodities; either the marketplace determines what is efficient, worthwhile and affordable, or the government creates an agency that artificially determines appropriate care and the appropriate reimbursement.
Neither method is perfect or a magic solution. Market based solutions can be inequitable, and government solutions can be very inefficient and even more cumbersome than the current disjointed private health insurance system.
I propose that we need to expand our thought process beyond just whether or not national health insurance is the problem. As a lifetime Republican voter I am personally very distrustful that a whole new government agency can be more efficient than a private health care system. After all, our military, post office and other governmental agencies are not exactly paragons of efficiency.
Two problems need to be addressed
- Most of what has gotten us into the current state of affairs is the tax system. Fixing our tax system is more important than creating national health insurance. Right now most of us obtain our health insurance through our employer. If we leave our employer we no longer have health insurance. Any new system will have to make insurance owned by the employee and not the employer.
- The next problem to solve is the fact that most patients who are not insured are so because they do not use much health care, whereas as we age we have a higher need for insurance and healthcare but can no longer afford the insurance. Insurance is designed to spread risk among many people and with 46-47 million uninsured people, the risk is spread right now only among a certain segment of the population. Any system that is designed needs to be all inclusive and compulsory for everyone.
If we could solve the two above problems we would be much closer to being able to provide for an equitable system that provides ownership in the health care system, and still allows patients flexibility in employment options. If congress cannot provide for a more reasonable tax system and more reasonable insurance options, then they will have to nationalize healthcare. However, if the politicians in this country cannot provide for reasonable playing field for a market based healthcare solution, I would be very dubious that they will have any really constructive or practical solutions as a government run agency.
Posted by: Peter Ullrich, MD