Restoration of disk height through non-surgical spinal decompression is associated with decreased discogenic low back pain: a retrospective cohort study.

BACKGROUND: Because previous studies have suggested that motorized non-surgical spinal decompression can reduce chronic low back pain (LBP) due to disc degeneration (discogenic low back pain) and disc herniation, it has accordingly been hypothesized that the reduction of pressure on affected discs will facilitate their regeneration. The goal of this study was to determine if changes in LBP, as measured on a verbal rating scale, before and after a 6-week treatment period with non-surgical spinal decompression, correlate with changes in lumbar disc height, as measured on computed tomography (CT) scans. METHODS: A retrospective cohort study of adults with chronic LBP attributed to disc herniation and/or discogenic LBP who underwent a 6-week treatment protocol of motorized non-surgical spinal decompression via the DRX9000 with CT scans before and after treatment. The main outcomes were changes in pain as measured on a verbal rating scale from 0 to 10 during a flexion-extension range of motion evaluation and changes in disc height as measured on CT scans. Paired t-test or linear regression was used as appropriate with p < 0.05 considered to be statistically significant. RESULTS: We identified 30 patients with lumbar disc herniation with an average age of 65 years, body mass index of 29 kg/m2, 21 females and 9 males, and an average duration of LBP of 12.5 weeks. During treatment, low back pain decreased from 6.2 (SD 2.2) to 1.6 (2.3, p < 0.001) and disc height increased from 7.5 (1.7) mm to 8.8 (1.7) mm (p < 0.001). Increase in disc height and reduction in pain were significantly correlated (r = 0.36, p = 0.044). CONCLUSIONS: Non-surgical spinal decompression was associated with a reduction in pain and an increase in disc height. The correlation of these variables suggests that pain reduction may be mediated, at least in part, through a restoration of disc height. A randomized controlled trial is needed to confirm these promising results. CLINICAL TRIAL REGISTRATION NUMBER: NCT00828880.

The role of urine drug testing for patients on opioid therapy.

Opioid analgesics must be prescribed with discernment and their appropriate use should be periodically assessed. Urine drug testing, although not designed specifically for this role, is a widely available and familiar method for monitoring opioid use in chronic pain patients. Urine drug testing can help track patient compliance and expose possible drug misuse and abuse. We sought to evaluate current attitudes and practices regarding the use of urine drug testing among chronic pain patients taking opioids. To the best of our knowledge, this is one of the first such attempts in the literature to examine and document the practice patterns of urine drug testing in this context. A total of 99 attendees at the American Congress of Pain Medicine were surveyed in 2008 about their urine testing practices for patients on opioid therapy. Surprisingly, more urine testing was motivated by a desire to detect undisclosed substances than to evaluate appropriate opioid use. Some respondents never urine-tested their opioid patients, and about two-thirds of respondents had no formal training in urine testing of patients on opioid therapy. The literature does not thoroughly address the role of urine drug testing in this patient population. Most respondents did random rather than scheduled testing; few had any urine testing protocol. The study found motivations for urine testing and testing practices varied widely, and urine testing, despite its clinical utility, is not used consistently.

Treatment of 94 outpatients with chronic discogenic low back pain with the DRX9000: a retrospective chart review.

BACKGROUND: This study's goal was a retrospective chart audit of 100 outpatients with discogenic low back pain (LBP) lasting more than 12 weeks treated with a 2-month course of motorized spinal decompression via the DRX9000 (Axiom Worldwide, Tampa, FL, U.S.A.). METHODS: Patients at a convenience sample of four clinics received 30-minute DRX9000 sessions daily for the first 2 weeks tapering to 1 session/week. Treatment protocol included lumbar stretching, myofascial release, or heat prior to treatment, with ice and/or muscle stimulation afterwards. Primary outcome was verbal numerical pain intensity rating (NRS) 0 to 10 before and after the 8-week treatment. RESULTS: Of the 100 initial subjects, three withdrew their protected health information, and three were excluded because their LBP duration was less than 12 weeks. The remaining 94 subjects (63% female, 95% white, age = 55 (SD 16) year, 52% employed, 41% retired, LBP median duration of 260 weeks) had diagnoses of herniated disc (73% of patients), degenerative disc disease (68%), or both (27%). Mean NRS equaled 6.05 (SD 2.3) at presentation and decreased significantly to 0.89 (SD 1.15) at end of 8-week treatment (P < 0.0001). Analgesic use also appeared to decrease (charts with data = 20) and Activities of Daily Living improved (charts with data = 38). Follow-up (mean 31 weeks) on 29/94 patients reported mean 83% LBP improvement, NRS of 1.7 (SD 1.15), and satisfaction of 8.55/10 (median 9). CONCLUSIONS: This retrospective chart audit provides preliminary data that chronic LBP may improve with DRX9000 spinal decompression. Randomized double-blind trials are needed to measure the efficacy of such systems.

The role of arginine vasopressin in thermoregulation during fever.

Fever is common in postoperative neurosurgical patients. When fever is present, thermoregulatory responses regulate body temperature within a range that appears to have an upper limit. Endogenous substances, such as arginine vasopressin (AVP), modulate the thermoregulatory response during fever and are referred to as endogenous antipyretics. Endogenous antipyretics attenuate fever by influencing the thermoregulatory neurons in the preoptic region and anterior hypothalamus and in adjacent septal areas. Well known for its antidiuretic and vasopressive properties, AVP plays an important role in antipyresis via the ventral septal area of the limbic system. Evidence suggests that there may be a synergistic relationship between AVP receptors and cyclo-oxygenase enzyme during antipyresis, and the presence of AVP may enhance the efficacy of nonsteroidal antipyretic drugs. On the other hand, there is evidence that increased levels of AVP released during fever may play a role in febrile seizures. Although the antipyretic effect of AVP release during fever is beneficial, excessively high levels of AVP may be detrimental.

Restricting fluid intake during a single meal did not affect food intake in older adults.

Restricting fluid intake has been shown to decrease ad libitum food intake in animals and young adult humans. The purpose of this study was to determine if restricting fluid intake during a meal affects food intake in older adults. In a crossover counterbalanced design, 24 subjects (11 m, 13 f), 61-95 years, received lunch at a congregate meal site. Identical meals were accompanied by a volume of water equal to either 40% (restricted) or 100% (control) of each subject's usual lunch fluid intake. Pre-meal urine osmolality and specific gravity were used as indicators of hydration status. Weighed food intake was not different between the restricted and control conditions (400 g/2875 kJ and 408 g/2971 kJ, respectively). No significant correlations were found between urine osmolality or specific gravity and food intake, either in response to fluid restriction or per kg body weight. These results suggest that the appetite of healthy free-living older adults is not affected by fluid restriction during a single eating episode.