July 2005 [Volume 4, Issue 7]

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In this issue of To Your Health:

• Back Surgery May Be Worse Than No Surgery
• Medication Discrepancies Found During Hospital Admissions
• Answers to Your Massage Questions: Highlights From This Month's "Ask a Massage Therapist" Online Forum

Are you considering surgery for your back pain? Before you do, consider this: Research shows that many patients who undergo surgery for lower back pain often have subsequent surgeries for the same condition due to the failure of the initial procedure, which can contribute to further patient disability.

Researchers sought to examine whether LBP surgery patients had poorer general health than those with no history of spine surgery. The study examined more than 18,000 patients with back pain enrolled at first visit in the National Spine Network (NSN) database from January 1998 – April 2000. Of those patients, 3,632 had a history of low back surgery. Data were derived from a first-visit questionnaire and the Short Form Health Survey (SF-36), both of which were completed by all patients when first evaluated for back pain.

Results showed that patients with a history of lumbar spine surgery fared significantly worse on areas such as physical functioning, general health and mental health compared to those patients with no prior history of spine surgery. “Previous back surgery is associated with significantly worse general health status than those without surgery among patients with low back pain..." the researchers wrote, further noting that "active rehabilitation intervention strategies designed to improve physical and mental well-being should be promoted, as they could have an impact on enhancing positive health outcomes."

If you suffer from low back pain -- or any kind of pain, for that matter -- think twice before considering surgery. Instead, consider less invasive means for managing your pain, such as massage therapy and bodywork. Previous studies have shown that massage therapy is extremely effective at reducing back pain. For more information on the benefits of massage therapy, visit www.massagetoday.com.

Hee HT, Whitecloud III TS, Myers L. The effect of previous low back surgery on general health status. Spine, Sept. 1, 2004;29(17):1931-7.

An accurate medication use history is a key element of the patient assessment process on admission to a hospital; however, prior studies have shown that medication discrepancies at the time of hospital admission are common and that such errors have the potential to cause harm to patients.

To study these types of discrepancies, researchers examined 151 patients (average age: 77 years) over a three-month period who were admitted to a teaching hospital. A discrepancy was defined as "any difference between the medication use history and the admission medication orders" and included omissions or additions of medications; medication substitutions within the same pharmacologic class; and changes in dose, frequency or administration as part of the criteria. Patients were included in the study if they reported using a minimum of four prescription drugs prior to admission.

Results: Researchers found that 53.6 percent of study participants had at least one unintended discrepancy, the most common being the omission of a regularly used medication (46.4 percent). It was determined that 38.6 percent of the discrepancies "had the potential to cause moderate to severe discomfort or clinical deterioration."

The researchers noted study limitations that included "the absence of a gold standard for the identification of home medication use. We relied on the report of the patient or caregiver in conjunction with collateral information from medication vials or pharmacy contacts whenever possible. Previous research suggests that our study assessments provided the best available measure of patients’ actual home medication use." Nonetheless, they concluded, "Medication errors at the time of hospital admission are common, and some have the potential to cause harm. Better methods of ensuring an accurate medication history at the time of hospital admission are needed."

Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Archives of Internal Medicine 2005;165:424-429.

Question: What is the best treatment for whiplash?

Answer: Treatment can vary depending on the direction of impact. For example, sternocleidal mastoid muscle (SCM) and scalenes will need to be addressed in the case of a rear impact. In the early stages of healing you can use cold hydrotherapy combined with lymphatic drainage techniques to help reduce inflammation. CranioSacral therapy is useful when neck muscles are too painful to work on. In later stages, you could try origin and insertion techniques, GTO release, muscle stripping, and fingertip kneading to treat trigger points and adhesions. Mobilizations and joint-play techniques to the whole shoulder girdle and spine help work out restricted joints. Just be careful not to mobilize any hypermobile vertebrae. A thorough back massage will address other compensating areas. A good self-care plan with remedial exercises and hydrotherapy for clients to continue at home really speeds up recovery.

Question: My 14-year-old daughter plays soccer and runs track. She likes my husband to "crack" her back on a daily basis to relieve her back pain. Is this harmful?

Answer: Many us "crack" our backs as a quick fix. This often becomes habit forming, witnessed by increased frequency, which is recognized as a musculoskeletal imbalance. If your daughter finds relief through body adjustments you might have her visit a chiropractor. A chiropractor can treat her with the proper adjustments to restore correct alignment. Additionally, introducing massage and bodywork with chiropractic treatments may also help reduce your daughter's athletic injuries and keep her from "cracking" her own back.

Note: Information provided in this Q&A section is drawn from the "Ask a Massage Therapist" online forum, in which massage therapists field questions relative to the massage profession. Readers are encouraged to post their questions at www.massagetoday.com/ask/. Answers should not be misconstrued as a diagnosis, prognosis or treatment recommendation and do not in any way constitute the practice of massage therapy or any other health care profession. Readers should consult their own health care providers for medical advice.

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