My Little Niece’s Surgery: Hospitals Are Stingy With Pain Relief

By Theresa Tamkins

My niece, Zoe, traveled with her mom and dad from Miami to our house last weekend because the 4-year-old was scheduled for craniofacial surgery at a local hospital.

Zoe was born with a couple of problems, including craniosynostosis, a condition in which the sutures of the skull fuse too early and cause the skull to grow abnormally. She needed surgery when she was only 4 days old, again at age 2, and now, at 4. Read More

Pain Relief for Osteoporosis Patients With Fractures

(HealthDay News) -- In osteoporosis patients with spinal fractures, vertebroplasty provides significant pain relief and helps decrease disability, according to a new study.

Vertebroplasty involves injection of medical-grade bone cement into a fractured vertebra to shore up the fracture and provide pain relief. It's used to treat painful vertebral compression fractures that don't respond to conventional medical therapy with analgesics or narcotics.

The study followed 884 patients for five years who were assessed before and after vertebroplasty. Their average pre-treatment pain score on an 11-point scale decreased from 7.9 (+/- 1.5) before treatment to an average of 1.3 (+/- 1.8) after treatment.

The patients' ability to manage everyday tasks such as washing and dressing was measured using the Oswestry Disability Questionnaire. The patients' scores went from an average of 69.3 percent (+/-13.5) a month before treatment to 18.8 percent (+/- 6.9) a month after treatment.

"These data provide good news for physicians and osteoporosis patients. Many osteoporosis patients with compression fractures are in terrible pain and have a greatly diminished ability to perform basic daily activities, such as dressing themselves," Dr. Giovanni C. Anselmetti, an interventional radiologist at the Institute for Cancer Research and Treatment in Turin, Italy, said in a prepared statement.

The study also found that vertebroplasty didn't increase the risk of fracture in nearby vertebra.

"Vertebroplasty is already known to be a safe and effective treatment for osteoporotic vertebral fractures. Osteoporosis patients remain susceptible to new fractures, which often occur in the contiguous vertebra to an existing fracture. Our large-scale study shows that vertebroplasty does not increase the risk of fracture in the level contiguous to previously treated vertebra and that these new fractures occur at the same rate as they would in osteoporosis patients who did not have vertebroplasty," Anselmetti said.

The study was to be presented Tuesday at the annual scientific meeting of the Society of International Radiology.

Osteoporosis affects about 10 million Americans and causes about 1.5 million vertebral fractures each year, according to the U.S. National Institutes of Health. Multiple vertebral fractures can cause chronic pain, disability, loss of independence, stooped posture, and compression of the lungs and stomach.

More information
The American College of Radiology/Radiological Society of North American has more about vertebroplasty.

Sleepless Nights May Encourage Pain

(HealthDay News) -- Poor sleep can raise risks for pain in women, a new study suggests.
"This study finds that fragmented sleep profiles, akin to individuals suffering from middle of the night insomnia, health care workers on call, and parents caring for infants, alter natural systems that regulate and control pain, and can lead to spontaneous painful symptoms," researcher Michael T. Smith, of Johns Hopkins University, said in a prepared statement.
The findings are published in the April 1 issue of the journal Sleep.

The study included 32 healthy women who were studied for seven nights. For the first two nights, the women slept undisturbed for eight hours. For the next few nights, the women were then assigned to one of three groups: a control group that continued to sleep undisturbed; a forced awakening (FA) group awakened once an hour (eight times) through the night; and a restricted sleep opportunity (RSO) group subjected to partial sleep deprivation by delaying their bedtime.

On the sixth night, the women in both the FA and RSO groups underwent 36 hours of total sleep deprivation, followed by an 11-hour recovery sleep.

During the study, researchers tested the women's pain thresholds and pain inhibition. The women in the FA group showed an increase in spontaneous pain, while those in the control and RSO groups showed no changes in spontaneous pain or pain inhibition.

"Our research shows that disrupted sleep, marked by multiple prolonged awakenings, impairs natural pain control mechanisms that are thought to play a key role in the development, maintenance, and exacerbation of chronic pain," Smith said.

More information
The National Sleep Foundation has more about sleep.

Psychological Interventions Ease Chronic Low Back Pain

(HealthDay News) -- Psychological treatments such as hypnosis, biofeedback, relaxation and counseling can help relieve chronic low back pain, according to a review in the January issue of the journal Health Psychology.

U.S. researchers examined the findings of 22 studies of patients with low back pain conducted between 1982 and 2003 and concluded that psychological treatments not only improve health-related quality of life and lower the risk of depression, they also reduce patients' experience of pain.

"Because this analysis was both more inclusive and more conservative than previous reviews, we have the best evidence to date that these interventions are helpful," review lead author Robert Kerns, of the VA Connecticut Healthcare System, said in a prepared statement.

Kearns said he and his colleagues were somewhat surprised by the finding that psychological treatments can reduce pain. That's because when psychologists first started to develop these kinds of treatments several decades ago, the objective was to help patients cope with their pain, not to actually lower their pain levels.

"However, a growing body of knowledge suggests that these interventions are actually having a primary effect on people's experience of pain," Kearns said.

The review found that of all the psychological interventions, cognitive-behavioral and self-regulatory treatments seemed to provide the greatest benefits to patients with low back pain.
"Psychological interventions are not cures, but they do reduce pain and improve function, and they are important components in the treatment of people with chronic pain," Dennis Turk, professor of anesthesiology and pain research at the University of Washington in Seattle, said in a prepared statement.

More information
The U.S. National Institute of Neurological Disorders and Stroke has more about low back pain.

Aromatherapy: The Scent of Dispute

(HealthDay News) -- Aromatherapy is an affordable, accessible natural path to relief for a variety of health problems, ranging from arthritis pain to nausea to drowsiness, supporters insist.

But skeptics dismiss any claims that the use of essential oils from flowers, herbs and trees can promote health in any way.

And both sides are unlikely to relinquish their positions anytime soon.

Aromatherapy "works for so many different things, it is amazing," said Kelly Holland Azzaro, a registered aromatherapist in Banner Elk, N.C., and vice president of the National Association for Holistic Aromatherapy (NAHA), an industry trade group. "You can experience aromatherapy by inhalation by putting one drop of an essential oil on a tissue and inhaling," she said.

According to the NAHA, aromatherapy is the "art and science of utilizing naturally extracted aromatic essences from plants to balance, harmonize and promote the health of body, mind and spirit." These essences are then distilled into "essential oils" -- highly concentrated aromatic extracts -- that are derived from a "variety of aromatic plant material, including grasses, leaves, flowers, needles and twigs, peels of fruit, wood and roots."

Among the most popular essential oils, which are widely sold at health-food stores and over the Internet, are eucalyptus, geranium, lavender, lemon, peppermint, rosemary, and tea tree, and according to the NAHA.

"Uplifting scents such as citrus can keep you awake at work," Azarro said. "To help increase alertness, use rosemary and lemon." And to combat nausea, try essence of peppermint, ginger and orange, she added.

While research into aromatherapy's benefits is limited, there are some studies that suggest certain treatments can help ease some symptoms.

For instance, in a 2005 study published in the journal Chronobiology International, researchers reported that lavender aromatherapy helped all 31 men and women feel more "vigor" the next morning, compared to the night they breathed in distilled water, an exercise that served as the control setting.

A study in the March-April 2006 issue of the Journal of Midwifery & Women's Health said that aromatherapy, combined with massage, helped new mothers feel less "blue" and anxious, compared to mothers of newborns who didn't get the treatment.

And a review published in Holistic Nurse Practitioner found that patients with postoperative nausea and vomiting can be helped by aromatherapy as well as acupressure and acupuncture.
But critics find little of value with scent therapy -- or even label it as therapy.

"It's not a therapy, it's a set of products with odors," said Dr. Stephen Barrett, board chairman of Quackwatch Inc., an Allentown, Pa.-based organization that says it fights health fraud and quackery.

"If people like the odors and want to pay for them, I would have no objection," Barrett said. However, he added, don't expect much. "There is no evidence that aromatherapy can alter the course of any disease. There is no logical reason to believe that any such evidence will ever be found," he said.

As for potential risks, Barrett said: "Some people find certain odors irritating. People who use aromatherapy with the hope that it will cure what ails them will waste money."
Azzaro said that, currently, aromatherapy is unregulated in the United States. "And that's part of the issue," she said. People don't understand exactly what it is, either. "People think it's potpourri or a smelly candle."

There's also no state licensing for aromatherapists in the United States. Most practitioners incorporate their training with another profession, such as licensed acupuncturist or registered nurse, according to the NAHA.

If you're interested in pursuing aromatherapy, Azzaro said it's best to ask a practitioner about his or her specific training. "And when you purchase oil, such as from a health-food store, hopefully some educational materials are with the product," she said.

Be aware, too, there can be the possibility of allergic reactions to some treatments.

More information
To learn more about aromatherapy, visit the National Association for Holistic Aromatherapy.

Acupressure Eases Low Back Pain

(HealthDay News) -- Acupresssure -- pushing with the fingertips at the same body points used in acupuncture -- gave patients better, long-lasting relief for low back pain than conventional physical therapy, Taiwanese researchers report.

"Acupressure was effective in reducing low back pain in terms of disability, pain scores and functional status," doctors at the National Taiwan University reported in the current issue of the British Medical Journal. "The benefit was sustained for six months."

The researchers recruited 129 people with chronic low back pain from a specialist orthopedic clinic. All of them filled out a standard disability questionnaire before being assigned to one of two different treatment regimens, with 64 people receiving six sessions of acupressure and 65 receiving standard physical therapy.

"Acupressure conferred an 89 percent reduction in physical disability compared with physical therapy," the researchers reported. The people who got acupressure also scored better on measures of pain and had fewer days taken off from work or school, the researchers said.

However, they cautioned that the effectiveness of any manipulative therapy such as acupressure "is highly dependent on the therapist's technique and experience." All the people in this study received treatment from the same therapist, to eliminate any difference in the treatment given.

"We hope that this technique can be imparted to other therapists now that its efficacy has been shown in our study, so that acupressure can be used in other populations," they wrote. "How acupressure can be generalized to patients with low back pain is the subject of ongoing research."

Dr. Marcos Hsu is an acupuncture specialist at the University of Maryland Center for Integrative Medicine who got his training in acupuncture and acupressure at the Maryland Institute of Traditional Chinese Medicine. He called the Taiwan report "quite amazing," because the benefits persisted for so long. But he added that he would like more information on the causes of back pain in the people treated in the study.

Hsu said he routinely uses acupressure supplemented with acupuncture to treat low back pain. "I have seen good responses similar to those in the paper, but some people do not respond to it," he said. The response generally is good for musculoskeletal problems such as sprains, Hsu said, but when the pain is caused by problems with structural bones and tissues, as in arthritis, the treatment "may take longer to take effect."

Hsu's patients usually receive painkillers, as well, because "most people who come to us are on painkillers, so it is not advisable to stop," he said. Patients can have anywhere from five to 15 treatments, with pressure applied "by our thumbs, hands, wrists, knuckles, elbows, every joint we can use," Hsu said.

People seeking acupressure or acupuncture treatment for low back pain should be cautious whenever they seek out help, Hsu recommended. "Check their credentials first," he advised.
The Taiwan study does have some flaws, added Richard E. Harris, a research investigator in the rheumatology division of the University of Michigan Medical School, who has also done work on acupressure.

Harris said he'd like a more detailed account of the treatment given -- which acupressure points were pressed, for example. And he noted that the participants weren't blinded to the treatment they were given. Patients who got acupressure knew they were getting it, which might have influenced their response, Harris said.

Nonetheless, the report that acupressure seems to be better than physical therapy for back pain is significant and deserves follow-up, he said.

More information
For the lowdown on low back pain, head to the U.S. National Library of Medicine.