Limited Effectiveness of Painkillers for Low Back Pain Revealed by Research
After almost 60 years of research, evidence of high certainty is still lacking on the efficacy and safety of painkillers, otherwise known as analgesics, commonly used for brief episodes of low back pain. A recent analysis of existing studies found that until better quality studies that compare analgesics with one another are carried out, patients and clinicians are advised to be cautious about using analgesic medications for managing non-specific acute low back pain.
Analgesics, which include codeine, ibuprofen, and paracetamol, are commonly used for treating non-specific acute low back pain, which is defined as pain that lasts less than 6 weeks. However, there is limited evidence for their efficacy. To investigate this further, researchers searched scientific databases for randomized controlled studies that compared analgesic medications with a different analgesic, no treatment, or a placebo in individuals who had reported suffering from non-specific acute low back pain.
The analysis included 98 randomized controlled studies conducted from 1964 to 2021, involving 15,134 individuals 18 years and older and 69 different medications or medication combinations. The studies included opioids, paracetamol, NSAIDs, anti-convulsant medications, corticosteroids, and muscle relaxants. A validated risk tool was used to assess the risk of bias.
The primary measurements of interest were the intensity of low back pain on a 0 to 100 point scale when the treatment ended and also safety which was determined by the number of individuals reporting any adverse event while undergoing treatment. The average pain intensity at the beginning of each study was 65 out of 100.
Evidence of low or very low confidence of around 25 points was noted for reduced pain intensity after having treatment with anti-inflammatory medication aceclofenac, muscle relaxant tolperisone plus the anti-convulsant medication pregabalin, and muscle relaxant tizanidine, in comparison to placebo. Evidence of very low confidence of around 20 points was also observed for pain intensity reductions for 4 medications, which included the anti-inflammatory medication ketoprofen and muscle relaxant thiocolchicoside, moderate reductions of 10 to 20 points for 7 medications, which included anti-inflammatory medications ketorolac, etoricoxib, and aceclofenac, and small reductions of 5 to 10 points for 3 medications which included paracetamol and ibuprofen.
Evidence of low or very low confidence indicated no significant difference between the effects of some of these drugs. Evidence of moderate to very low confidence was noted for an increase in adverse events, which included headache, dizziness, drowsiness, vomiting, and nausea, with paracetamol, tramadol plus sustained-release baclofen, tramadol, as well as tramadol plus paracetamol in comparison to placebo. Evidence of moderate to low confidence also indicated that these drugs may increase the risk of adverse events in comparison to other medications.
Similar evidence of moderate to low confidence was also found for other secondary results, which included serious adverse events and treatment discontinuation, and also a secondary analysis of classes of medication.
This comprehensive review of analgesic medications for non-specific acute low back pain revealed significant uncertainty around safety and efficacy for pain intensity. The researchers therefore advise individuals and clinicians to be cautious about the use of analgesic medications.
In conclusion, while analgesics are commonly used for treating non-specific acute low back pain, there is limited evidence for their efficacy and significant uncertainty around their safety. Until better quality studies that compare analgesics with one another are carried out, patients and clinicians are advised to be cautious about using analgesic medications for managing non-specific acute low back pain.
Rates of infectious sexual diseases on the decline in region – CambridgeToday
Unprotected sex with more than one partner in a six month period is the biggest risk factor behind a recent rise in syphilis cases in Waterloo region, according to a report on infectious disease trends from Region of Waterloo Public Health.
The annual infectious diseases surveillance report gathers and analyzes information on the infectious diseases that physicians, laboratories and hospitals are required to report to the region’s public health unit in line with Ontario Public Health Standards.
Infectious diseases are illnesses caused by microorganisms such as bacteria, viruses, and parasites that have the potential to cause serious illness and outbreaks.
There were 116 reports of infectious syphilis in the region last year, a rate of 17.8 per 100,000 population compared to 23.1 across the province. The number is down from a high of 143 reported cases in 2021, and a rate of 22.2 per 100,000 that was higher than the provincial average of 20.6.
The report says rates of syphilis, while lower than the province, have increased substantially in recent years, especially among females. This trend has also been observed in the province, which suggests a shift in epidemiology and sexual health practices.
The most common sexually transmitted infections in Waterloo Region continue to be chlamydia and gonorrhea.
There were 1,388 cases of chlamydia reported across the region last year, a rate of 192.8 per 100,000 population compared to 255.9 provincially. That’s down slightly from the age-standardized rate of 196.9 per 100,000 reported in 2021.
Gonorrhea case counts continued to spike across the province in 2022, while experiencing a slight decline in the rate of infection in Waterloo region.
Waterloo region reported 266 cases last year, a rate of 38.2 per 100,000. That’s compared to 77.5 per 100,000 province-wide.
Across the board, the demographic with the highest number of cases of sexually transmitted infections locally and across the province is the 20 to 29 age group.
Mpox, previously known as monkeypox, was declared a disease of global public health concern and became a newly reportable disease in Ontario in 2022.
There were only four local cases of mpox last year. Public Health says it has been monitoring the situation, working with health care providers to provide up-todate treatment guidance, and providing mpox vaccines to high-risk individuals.
The mpox virus is most commonly spread to people through close, physical contact with an infected person.
Campylobacter enteritis and salmonellosis were the most common enteric diseases in Waterloo Region in 2022. The local rates for enteric diseases were similar to or lower than those of the province.
Risk factors for enteric illnesses such as Campylobacter enteritis and salmonellosis include consuming undercooked meats and unpasteurized dairy products, ingesting contaminated food or water, and contact with infected persons.
Rates of vaccine preventable diseases in Waterloo Region were similar to those of the province. The most common vaccine preventable diseases in Waterloo Region were pneumococcal disease and pertussis (whooping cough).
In 2022, as we returned to normal activities, we saw a return of circulating respiratory viruses including pertussis with rates higher than had been seen during the first two years of the pandemic.
Public Health says immunization is the best way to prevent whooping cough. Pneumococcal vaccine is also recommended for infants, older adults 65 years and older, and those at high risk from the infection.
Region of Waterloo Public Health undertakes a number of activities to prevent or reduce the burden of infectious diseases in the community.
Programs and services include case management, contacts and exposures for diseases of public health significance; inspections, investigations and outbreak management, including community outbreaks and those in institutions; health promotion activities and services for primary care providers, emergency service workers, childcare providers, and other community groups; and clinic-based services for sexual health, immunization, and tuberculosis screening and management.
Region of Waterloo Public Health says it will provide highlights of respiratory disease trends, including influenza, in a report to council this fall.
Canadians diagnosed with IBD expected to reach 470K by 2035 – CTV News
The number of people in Canada with inflammatory bowel disease (IBD) is increasing rapidly and is expected to grow to 470,000 by 2035, according to a new report from Crohn’s and Colitis Canada.
On Thursday, the national health charity unveiled its 2023 report on the impact of IBD in Canada, calling for action to be taken in order to enhance the well-being of individuals affected by the condition.
According to the report, 322,600 people, or 0.8 per cent of Canada’s population, are expected to be diagnosed with IBD this year. The percentage is projected to reach 1.1 per cent by 2035.
“The number of people in Canada living with IBD is growing rapidly. Healthcare needs to evolve to include multidisciplinary care, including access to specialist physicians and nurses, mental health professionals, dietitians and others to improve quality of.” report co-chair Dr. Gilaad Kaplan, a professor of medicine and gastroenterologist at the University of Calgary, said in a news release on Thursday.
The report says in 2023, a new case of IBD will be diagnosed every 48 minutes, totaling 11,000 individuals. By 2035, this number is expected to rise to 14,000, with a new case being identified every 38 minutes.
The report adds that the incidence of IBD among children under the age of six years old is increasing at a particularly rapid rate. However, the group experiencing the fastest growth in diagnosed cases of IBD is older Canadians.
People with low socioeconomic status, residents of rural, remote, and Northern communities as well as Indigenous people encounter additional barriers to care, the report says.
“We see there is a significant impact on mental health – psychiatric disorders are 1.5 to two times more common in people with IBD. Youth with IBD have nearly double the risk of psychiatric diagnosis. This underlines the importance of making mental health services available, especially in children, adolescents, and young adults.” Dr. Eric Benchimol, report co-chair and professor of pediatrics and clinical epidemiology at the University of Toronto said in the news release.
WHAT IS IBD?
Crohn’s and Colitis Canada says IBD describes a group of conditions the two main forms of which are Crohn’s disease and ulcerative colitis. These autoimmune diseases cause inflammation, ulcers, and bleeding in the bowel that can extend to the rest of the body. IBD is a completely different disease from irritable bowel syndrome (IBS), which does not result in visible inflammation or ulcers in the bowel, according to the report.
“The report highlights the need to use our financial and health care resources as effectively as possible. That’s why, since 2016, our PACE network project has brought together leading Canadian hospital centres to develop best practices to help patients. We’re hoping that within the next two years, we start seeing these pilot innovations being rolled out across Canada and leading to better care.” Lori Radke, CEO of Crohn’s and Colitis Canada, said in a news release.
Reporting for this story was paid for through The Afghan Journalists in Residence Project funded by Meta.
Canadian researchers find brain inflammation in patients with long COVID – Winnipeg Free Press – Winnipeg Free Press
Leslie Ann Coles knew “almost immediately” something was wrong after her COVID-19 infection in January 2021.
The filmmaker from Woodbridge, Ont., had never had writer’s block in her life — but she couldn’t find the words to make revisions to a screenplay she’d been working on.
“It was really, really frightening,” Coles said.
Her emotional state changed too.
“I’ve never in my life suffered from depression,” Coles said. “My friends refer to me as the eternal optimist.”
But her usual passion for life and work had waned, leaving her feeling “apathetic, for lack of a better word,” she said.
Researchers have been trying to understand what causes the many symptoms of long COVID, including neurological issues suffered by an estimated hundreds of thousands of Canadians like Coles.
Now, a team led by the Centre for Addiction and Mental Health (CAMH) has found physiological evidence of brain inflammation in people with cognitive and depressive symptoms months after their COVID-19 infections.
Autopsies of people who died in the midst of severe COVID-19 infection have previously shown they had brain inflammation, said Dr. Jeffrey Meyer, head of the neuroimaging program in mood and anxiety at CAMH and senior author of the study published Thursday in JAMA Psychiatry.
The current study shows brain inflammation inpeople who have recovered from acute COVID-19 but go on to have lasting neurological problems — even though their initial infection wasn’t severe, he said.
“These are people who’ve got long COVID and have actually not been hospitalized. They have mild to moderate severity acute COVID, but then have considerable symptoms thereafter,” Meyer said.
“Our study shows that there’s inflammation months to over a year later in people who’ve got long COVID.”
The researchers did positron emission tomography (PET) scans on the brains of 20 participantswho had started suffering from depression within three months of testing positive for COVID-19.
Most of them had additional cognitive issues associated with long COVID, including problems with memory and concentration, also known as “brain fog.”
The researchers compared those scans to 20 brain scans from “healthy” people that had been done prior to the pandemic.
They found that people who had long COVID had higher levels of translocator protein, or TPSO, in their brains. TSPO appears on glial cells, which increase with inflammation.
The most pronounced increase in inflammation was in two areas of the brain — the ventral striatum and dorsal putamen, the study said.
Those are parts of the brain associated with the ability to experience enjoyment, energy and motivation levels, cognitive processing and speed of movement.
“We know that when there’s injury to these brain regions you get some of the symptoms that we’re seeing in the people with long COVID,” Meyer said.
Long COVID sufferers have been eagerly awaiting these findings “for validation that brain fog is real and caused by functional changes from COVID-19,” said Susie Goulding, founder of the COVID Long-Haulers Canada online support group, which helped recruit study participants.
“This concrete evidence will hopefully bring understanding and guidance” to family doctors who encounter patients describing neurological symptoms after COVID infection, Goulding said in a text message to The Canadian Press.
Dr. Angela Cheung, co-lead of a national long COVID research network and senior physician-scientist at the University Health Network in Toronto, said the study confirms what long COVID researchers have suspected for some time.
“We have always thought that inflammation plays a part,” said Cheung, who was not involved in the CAMH study.
“It’s been difficult to measure inflammation in patients.” she said. “This study shows that in people with persistent depressive and cognitive issues, that there is neural inflammation in the brain.”
But Dr. Lakshmi Yatham, a psychiatrist at the University of British Columbia who researches mental health issues related to COVID-19, said that although the study is valuable, there are important limitations to consider.
“It’s a good first attempt to look at the inflammation. But you cannot at this stage attribute that the inflammation is what’s responsible for depressive symptoms,” Yatham said.
One limitation, he said, is that some of the participants had previous experiences with depression.
However, Meyer said those people made up fewer than half of the participants, and any past depressive symptoms had resolved before they got COVID-19.
Yatham said further study is needed using a control group of people who have recovered from COVID-19 and didn’t have long COVID to compare the levels of brain inflammation. That wasn’t possible in the CAMH study because the brain scans of the control group had been done prior to the pandemic.
One of the next steps for the CAMH team is to “test out whether some kinds of anti-inflammatory or inflammatory-altering medications might be helpful for long COVID,” said Meyer.
Cheung said other researchers are also planning anti-inflammatory medication studies.
Leslie Ann Coles has learned tactics to work around memory problems that persist to this day, including constantly writing things down and taking photos on her phone.
For her, like so many other long COVID sufferers, the next steps in research can’t come soon enough.
“I hope they find ways in which this study helps people with long COVID recover,” she said.
This report by The Canadian Press was first published June 1, 2023.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
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