Connect with us

Health

Doctors prescribing more muscle relaxants for back pain

Published

on

Back pain plagues many Americans, and new research shows that doctors are doling out muscle relaxant prescriptions to treat the pain — often along with an opioid painkiller.

Experts worry that muscle relaxants may not help much and could cause troubling side effects, especially in older patients.

The study found the rate of long-term prescriptions for muscle relaxants to treat back and other muscle pain tripled between 2005 and 2016.

Also concerning, nearly 70 percent of those prescribed muscle relaxants were given a prescription for an opioid pain-relieving medication like oxycodone (OxyContin) at the same time. Taking these medications together increases the potential risk of ill effects, the researchers said.

“We tried to develop a picture of the national [use] of skeletal muscle relaxants under the hypothesis that maybe physicians — concerned about the use of opioids — might be prescribing skeletal muscle relaxants more often,” said study lead author Charles Leonard. He’s an assistant professor of epidemiology at the University of Pennsylvania Perelman School of Medicine.

“We saw about a threefold increase in patients on continued therapy with skeletal muscle relaxants. People get put on these drugs and they stay on these drugs,” Leonard said. But the problem is they haven’t been studied for long-term use.

Skeletal muscle relaxants are approved for short-term treatment of muscle spasms and back pain. Examples of muscle relaxants include baclofen (Lioresal), carisoprodol (Soma), cyclobenzaprine (Fexmid) and tizanidine (Zanaflex).

Recommendations generally limit use of these drugs to a maximum of three weeks, since they have not been shown to work for muscle spasms beyond that time.

Leonard said these medications can be very sedating. Serious side effects associated with their use include dizziness, falls, fractures, car accidents, dependence and overdose.

Muscle relaxants pose a significant risk to people over 65, and the American Geriatrics Society advises against their use in this age group.

Despite this recommendation, nearly a quarter of office visits for muscle relaxants in 2016 were for seniors, the study noted. This group makes up less than 15 percent of the general population.

“Older adults seem to disproportionately get these drugs,” Leonard said, adding that seniors are often taking other medications as well, which can boost the odds of an adverse reaction.

In particular, the U.S. Food and Drug Administration cautions against using muscle relaxants and opioids together, noting the combination can cause difficulty breathing and death, according to background notes.

The study was based on national prescribing data from 2005 to 2016. The researchers looked at the total number of visits a year, what medications were prescribed and if the prescription was new or ongoing.

The most common reason people were taking muscle relaxants was to treat back problems.

Leonard said the research didn’t look specifically at why doctors were prescribing these medications more, but he suspects there are at least a few factors driving the increase. One is that there aren’t really any good alternative drugs, so doctors may not want to take them away. Another is that patients may put some pressure on their doctor to treat their pain.

But skeletal muscle relaxants shouldn’t be considered a first-line treatment for back pain or muscle spasms, Leonard said. He said physical therapy and over-the-counter medications like Advil or Tylenol can help lessen the pain.

“The data shows that while skeletal muscle relaxants are better than a placebo, there’s no evidence that they provide benefit beyond nonsteroidal anti-inflammatory drugs,” Leonard said.

Dr. David Sibell is a professor of anesthesiology and perioperative medicine from the Oregon Health and Science University School of Medicine and Comprehensive Pain Center.

“The one thing that hit me hardest was the steady beat of new patients prescribed skeletal muscle relaxants that don’t come off them,” said Sibell, who wasn’t involved in the study.

“If there is effectiveness for skeletal muscle relaxants, it’s only short-term. There’s no long-term data. And those 65 and older are very vulnerable to all of the adverse effects of these drugs,” he said.

Sibell said there are other treatment options available. In addition to physical therapy and over-the-counter medications, a prescription anti-inflammatory topical gel may help some people. There are also certain procedures a pain management specialist can offer, he said.

“I think people need to have a greater appreciation of the toxicity of this class of medication. They should not be used for more than a few days at a time,” Sibell advised.
The study findings were published June 24 in JAMA Network Open.

More information

Learn more about back pain from the U.S. National Library of Medicine.

Copyright 2020 HealthDay. All rights reserved.



Source link

Health

Low-dose electrical stimulation helps adults with dyslexia read, study finds

Published

on

Sept. 8 (UPI) — Electrical stimulation of the brain improves reading accuracy in adults with dyslexia, according to a study published Tuesday by PLOS Biology.

Transcranial alternating current stimulation, a non-invasive procedure that delivers low-dose electricity to the brain over a period of 20 minutes, was found to improve phonological processing — or ability to discern how words sound or are pronounced — and reading accuracy in 15 adults with dyslexia, the researchers said.

The beneficial effect on phonological processing was most pronounced in those individuals who had poor reading skills, while a slightly disruptive effect was observed in very good readers, they said.

Dyslexia, known commonly as a reading disorder, affects up to 10% of the population, and is characterized by lifelong difficulties with written material,” according to the researchers, who are from the University of Geneva in Switzerland.

Although several possible causes have been proposed for dyslexia, the predominant one is a phonological deficit, or a difficulty in processing word sounds, the researchers said.

The phonological deficit in dyslexia is associated with changes in rhythmic or repetitive patterns of electrical activity in the brain, specifically “low-gamma” oscillations, measuring at 30 hertz or volts, in the left auditory cortex, they said.

However, studies have yet to prove that these these oscillations affect a person’s ability to process word sounds and cause dyslexia, the researchers said.

For this study, the researchers applied transcranial alternating current stimulation over the left auditory cortex in 15 adults with dyslexia and 15 fluent readers for 20 minutes.

At a dose of 30 hertz or volts, the approach resulted in significant improvement in reading accuracy in those with dyslexia, the researchers said.

However, the same improvements were not seen following application of a higher, 60-hertz dose, they said.

The results demonstrate for the first time that low-gamma oscillatory activity causes deficits in phonemic processing and may pave the way to non-invasive treatments aimed at normalizing oscillatory function in auditory cortex in people with dyslexia, the researchers said.

They plan “to investigate whether normalizing oscillatory function in very young children could have a long-lasting effect on the organization of the reading system [and] explore even less invasive means of correcting oscillatory activity,” study co-author Silvia Marchesotti, a post-doctural researcher at the University of Geneva, said in a press release.



Source link

Continue Reading

Health

Surgery may help sleep apnea patients who struggle with CPAP

Published

on

Continuous positive airway pressure may be the go-to treatment for sleep apnea, but many people struggle to use it every night. For those who cannot tolerate CPAP, new research finds that a combination of surgical techniques may bring relief.

The “multilevel” treatment includes removing the tonsils, repositioning the palate — roof of the mouth — and using radiofrequency to slightly reduce the size of the tongue. In combination, these procedures open up the airway and reduce breathing obstruction, the researchers said.

The study found that the multilevel surgery technique reduced the number of times people stopped breathing — apnea events — during sleep and improved daytime sleepiness. People also reported better quality of life after the treatment.

“Obstructive sleep apnea is common and many people cannot use the main treatments, like CPAP masks. Surgery is a valid option when an expert surgeon is involved, and it can improve outcomes,” said the study’s lead author, Dr. Stuart MacKay. He’s an honorary clinical professor of otolaryngology, head and neck surgery at University of Wollongong, in Australia.

The researchers said that nearly one billion people worldwide suffer from sleep apnea. The airway becomes blocked during sleep, and as a result people stop breathing for short periods of time, multiple times throughout the night. People with sleep apnea have a higher risk of daytime sleepiness, motor vehicle crashes, and heart disease and stroke.

CPAP does a good job at keeping your airway open as you sleep, but the treatment — including a mask and a long tube — can be hard to get used to. The study authors said only about half of people with sleep apnea try CPAP.

For the new study, the researchers recruited 102 overweight or obese people with sleep apnea from six clinical centers in Australia, who were in their 40s, on average. The goal was to see if surgery could help adults with moderate or severe obstructive sleep apnea who weren’t able to tolerate or adhere to CPAP devices.

Half of the volunteers were randomly assigned to receive the sleep apnea surgery, while the other 51 continued with medical treatment. Medical management consisted of encouraging weight loss, drinking less alcohol, changing sleep posture and medical treatment for nasal obstruction.

MacKay said the multilevel surgical technique is widely available in many parts of the world. For the patients in this study, surgeries were performed by seven experienced surgeons.

Six months after the surgical procedures, volunteers in the surgery group had about a 27% decrease in the number of apnea events at night. Those on medical treatment had just a 10% decrease.

People in the surgical group also had major improvements in levels of snoring and daytime sleepiness, as well as a boost to quality of life.

As with any surgical procedure, there are risks.

“The main risks of pain and bleeding are confined to the two weeks after surgery. Bleeding occurs in about one in every 25 patients. Long-term risks related to taste disturbance, feeling of sticking in the throat, swallow dysfunction are very rare, although they do occur transiently in some,” MacKay said.

Dr. Steven Feinsilver is director of the Center for Sleep Medicine at Lenox Hill Hospital in New York City. He said, “Sleep apnea is a very common disease, about as common as diabetes, and similar to diabetes is associated with increased risk for cardiovascular events, such as stroke and heart disease.”

He added that “CPAP works, but is a difficult treatment.”

Feinsilver said that surgery that could provide a permanent cure has long been the goal for treatment.

“This study shows that relatively minor surgery, performed in a standardized fashion by skilled surgeons, can significantly improve sleep apnea compared to ‘medical treatment’ (essentially no treatment),” he said.

But he noted that even though people reported improvement, their nighttime breathing wasn’t back in the normal range.

“This is certainly a major improvement, but it remains unclear whether outcomes (such as cardiovascular risk) will be significantly impacted,” Feinsilver said. Also, he suggested that this multilevel surgery may only be an option for a select group of patients.

The report was published online Sept. 4 in the Journal of the American Medical Association.

More information

Learn more about sleep apnea treatments from the U.S. National Heart, Lung, and Blood Institute.

Copyright 2020 HealthDay. All rights reserved.



Source link

Continue Reading

Health

COVID-19-related heart, lung issues ease over time in survivors, study shows

Published

on

Long-term heart and lung damage can occur in COVID-19 patients, but it may ease with time, according to a new study.

A second study found that COVID-19 patients recover faster if they begin rehabilitation as soon as possible after getting off a respirator or leaving intensive care.

“The bad news is that people show lung impairment from COVID-19 weeks after discharge the good news is that the impairment tends to ameliorate over time, which suggests the lungs have a mechanism for repairing themselves,” said researcher Sabina Sahanic, a clinical Ph.D. student at University Clinic in Innsbruck, Austria.

“The findings from this study show the importance of implementing structured follow-up care for patients with severe COVID-19 infection. Importantly, CT unveiled lung damage in this patient group that was not identified by lung function tests,” she said.

Both studies were presented at a virtual meeting of the European Respiratory Society.

Sahanic’s research included 86 hospitalized COVID-19 patients in Austria who were enrolled between April 29 and June 9.

The patients, average age 61, were evaluated six, 12 and 24 weeks after leaving the hospital. At their first visit, more than half had at least one persistent symptom — mainly breathlessness and coughing. CT scans showed that 88% still had lung damage.

By their second visit at 12 weeks, patients’ symptoms had improved and 56% had signs of lung damage. Findings from the evaluations at 24 weeks weren’t available yet.

“Knowing how patients have been affected long-term by the coronavirus might enable symptoms and lung damage to be treated much earlier and might have a significant impact on further medical recommendations and advice,” Sahanic said in a meeting news release.

The other study included 19 patients with severe COVID-19. They spent an average of three weeks in intensive care and two weeks in a pulmonary ward before being transferred to a clinic for about three weeks of pulmonary rehabilitation.

A walking test evaluated their weekly progress. At the start of rehab, they could walk only an average of 16% of the distance they should manage to walk if healthy.

That average increased to 43% after three weeks of rehab. While a significant improvement, it’s still far below normal, the researchers noted.

“The most important finding was that patients who were admitted to pulmonary rehabilitation shortly after leaving intensive care progressed faster than those who spent a longer period in the pulmonary ward where they remained inactive,” said study author Yara Al Chikhanie. She’s a Ph.D. student at the Dieulefit Santé clinic for pulmonary rehabilitation and the Hp2 Lab at Grenoble Alps University in France.

“The sooner rehabilitation started and the longer it lasted, the faster and better was the improvement in patients’ walking and breathing capacities and muscle gain,” Al Chikhanie said in the release.

Patients who started rehabilitation in the week after coming off their ventilators progressed faster than those who were admitted after two weeks, she added. But how soon they can start rehab depends on when their doctors deem them medically stable.

“Despite the significant improvement, the average period of three weeks in rehabilitation wasn’t enough for them to recover completely,” Al Chikhanie said.

Data and conclusions presented at meetings are usually considered preliminary until peer-reviewed for publication in a medical journal.

More information

The U.S. Centers for Disease Control and Prevention has more on COVID-19.

Copyright 2020 HealthDay. All rights reserved.



Source link

Continue Reading

Trending