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A randomized, controlled clinical trial on colic in Denmark that compared chiropractic adjustments to daily doses of dimethicone has concluded: “Spinal manipulation has a positive short-term effect on infantile colic.”¹Infantile colic is a curious and mysterious condition.

It is estimated that, on average, 22.5% of all newborns suffer from colic, defined as “uncontrollable crying in babies from 0-3 months old, more than three hours a day, more than three days a week for three weeks or more, usually in the afternoon and evening hours.” But only “47 percent of infantile colic cases have disappeared by the age of three months, a further 41 percent disappeared before six months of age, and the remaining 12 percent of cases persevered until between the ages of 6 and 12 months.”

First described in 1894, colic has no verified cause(s). Countless studies have, however, determined what it is not caused by: air or constrictions in the intestines; gastrointestinal transit time; intestinal hormones; intestinal microflora; method of delivery (vaginal, Cesarean section or vacuum extraction); use of pudendal block; epidural analgesia; general anesthesia; or intravenous oxytocin.

Numerous medical and nonmedical treatments have been studied, including: music and sounds; vibration; dicyclomine hydrochloride; gripe-water; alcohol; atropine; skopyl; phenobarbital; merperidine; homatropine; and merbentyl. These treatments have shown either “no effect when compared to placebo treatment” or “serious side effects.” Treatment with sucrose does seem to have a “generalized analgesic effect in infants and may therefore also help in infantile colic.”

Dimethicone, the drug used in this randomized trial, has been shown to be “no better than placebo treatment” in several good controlled studies.

The first retrospective chiropractic study on treating colic was conducted in 1985, followed by a prospective multicenter study in 1989. “Both studies suggest that there seems to be a positive effect of spinal manipulation for infantile colic,” but since neither study had a control group, it was impossible to assess whether the chiropractic treatments were significantly better than placebo.

The Danish National Health Service recruited 50 infants meeting the criteria for colic. After they were reviewed and monitored, they were randomly assigned to two groups: dimethicone daily for two weeks or spinal manipulation for two weeks by a local chiropractor. The 25 infants under chiropractic care received motion palpation to locate “articulations” mostly found in the upper and mid-thoracic area. The infants in the chiropractic group received an average of 3.8 adjustments.

During the two-week treatments, the parents kept a colic diary and nurses visited the families to administer a weekly “infantile colic behavior profile.” The results were:

The dimethicone group would have fared much worse than these results suggest if not for the dropout rate of the medicated group. All 25 infants in the manipulation group completed the 13 days of treatment, but there were nine dropouts in the dimethicone group: five dropped out before the first week’s diary could be completed, and thus there was no data on the hours of crying for those five subjects. But the study did register the subjective evaluation of four of the five in the dimethicone group that quit in the first week: two described their child’s condition as “worsened” and two others described it as “much worsened.” Had these four infants completed the study, they would have significantly affected the limited positive effect of dimethicone. To quote the authors:

“By excluding data from the dropouts, we are excluding more severe cases from the dimethicone group, and this has the effect of making that group appear better than it actually was.” The authors make another comment that speaks directly to the issue:

“Spinal manipulation is normally used in the treatment of musculoskeletal disorders, and the results of this trial leave open two possible interpretations. Either spinal manipulation is effective in the treatment of the visceral disorder infantile colic or infantile colic is, in fact, a musculoskeletal disorder, and not, as normally assumed, visceral. This study does not address this issue.”

Reference

1. Wiberg JMM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: A randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther 1999;22:517-22.

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People who have survived a first heart attack have a higher risk of dying or having a second heart attack if they are taking non-steroidal anti-inflammatory drugs (NSAIDs), including the newer class called cox-2 inhibitors.The research detailing these findings appears in the June 20 issue of the journal Circulation, and was first presented at the 2005 meeting of the American Heart Association. The results of the two studies are almost the same, although the latest study shows an even higher correlation between NSAID use and a second heart attack.

“The evidence is accumulating, and it seems that patients who have already had a heart attack are at even more risk than we thought before, and we are talking about short-term treatment,” said study lead author Dr. Gunnar H. Gislason, senior resident at Gentofte University Hospital in Copenhagen, Denmark.

Dr. Mark Fendrick, professor of internal medicine at the University of Michigan School of Medicine and professor of health management and policy at the university’s School of Public Health, added, “This is yet another study adding to the mountain of evidence suggesting that we should be very careful about the use of cox-2 drugs, specifically, and possibly all additional NSAIDs for patients at risk for cardiovascular adverse events.”

NSAIDs are pain relievers, including aspirin, ibuprofen and naproxen, that carry a risk of gastrointestinal bleeding. Cox-2 inhibitors are a specific type of NSAID that do not carry that risk.

Cox-2 inhibitors and NSAIDs have been caught in a prolonged furor since September 2004, when the cox-2 Vioxx was withdrawn from the market due to concerns about cardiovascular safety. Similar concerns were raised about Bextra, another cox-2, then Celebrex, and then naproxen, a traditional NSAID. Bextra was later withdrawn from the market.

A number of studies continue to look at the different risks and benefits of the drugs. This new research is the first to look at patients who took NSAIDs after suffering their first heart attack.

The study authors looked at all patients in Denmark who had survived a first heart attack between 1995 and 2002. Then they cross-referenced this information with all prescription claims for NSAIDs after their hospital discharge. A total of 58,432 patients were included in the study.

Patients who had survived a first heart attack and were taking any NSAID were more likely to die than those who had survived one heart attack and were not taking NSAIDs. Death rates were highest among those taking cox-2 drugs and high doses of traditional NSAIDs.

Compared to patients not taking any of these drugs, the risk of death was two to three times higher for patients taking low-dose (25 milligrams or less a day) of Vioxx (rofecoxib) or 200 milligrams or less a day of Celebrex (celecoxib).

The risk of death was five times higher for patients taking high-dose Vioxx (more than 25 milligrams a day); almost five times as high among those taking more than 200 milligrams of Celebrex; more than four times higher for those on high-dose diclofenac (more than 100 milligrams daily); and more than two times greater for those taking high-dose ibuprofen (more than 1,200 milligrams daily).

Taking NSAIDs for only short periods of time was enough to show a detrimental effect, the study found.

Although aspirin was not evaluated in the study, the authors presumed that more than 90 percent of people being analyzed were probably taking this drug. Aspirin has a proven beneficial effect in preventing heart attacks.

More and more studies, most of them observational, are showing that NSAIDs have this deleterious effect. A large, randomized, controlled trial has yet to be completed, however, although one sponsored by Pfizer and conducted by the Cleveland Clinic will soon be under way.

So what should consumers do?

“Physicians and patients at risk should think thrice, not twice, before using NSAIDs,” Fendrick said. “If someone with a cardiovascular risk absolutely needs NSAIDs, given the available evidence, I would suggest taking naproxen with a proton pump inhibitor” to counteract the gastrointestinal effects.

Gislason added: “Our recommendation is that patients should at least consult their physician if they are taking any of those drugs, and our recommendation would be that if they can’t be without them, they should stick with low doses of the traditional NSAIDs and probably avoid the new cox-2 inhibitors.”

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Each year, about one out of 20 Americans goes to a chiropractor for manipulation, most often as a treatment for back pain. Although the medical profession has long dismissed chiropractic manipulation as quackery, the people have “voted with their feet” and continue–in large numbers–to seek chiropractic care.

Within the last decade, the chiropractic profession has begun to see vindication. In 1987, it won a lawsuit against the American Medical Association and other medical organizations for “systematic long-term wrongdoing and the long-term intent to destroy a licensed profession.”

More recently, the RAND Corporation, the prestigious research agency, was commissioned by two chiropractic organizations to conduct a review of all research exploring the value of manipulative therapy for low back pain. Its report, published last year, produced evidence to support manipulation’s efficacy in treating acute back pain without serious neurological symptoms.

The latest evidence in favor of manipulation is a controlled study conducted in The Netherlands and reported last month in the British Medical Journal (March 7). It involved over 250 people with back and/or neck pain persisting for more than six weeks.

They were randomly assigned to receive either: physiotherapy (exercise, massage, and physical therapy modalities, such as heat, electrotherapy, ultrasound, short-wave diathermy); manipulative therapy; standard treatments from a general practitioner (painkillers and advice about posture, exercise, and bedrest); or placebo, which consisted of an examination and “treatment” with detuned shortwave diathermy and ultra-sound machines.

The study is significant not only because it is randomized (participants can’t choose their treatment) and controlled (includes a placebo group), but also because it is one of the few to follow participants for a long period of time (one year). The investigators wrote: “We conclude that after 12 months’ follow up both manipulative therapy and physiotherapy seem to be more effective than treatment by the general practitioner or placebo treatment. Furthermore, the findings indicate a slightly better result from manipulation therapy compared with physiotherapy.”

Four years ago, another controlled study compared the effects of a single manipulation on 54 people with either long- or short-term pain. It was conducted by Nortin M. Hadler, M.D., and colleagues at the University of North Carolina at Chapel Hill and published in the medical journal Spine. More significant relief was shown for the long-term pain group, that is, those who entered the study with pain that had persisted for two to four weeks. They reported far more rapid improvement from manipulation than their counterparts who had suffered back pain for less than two weeks.

The RAND report states that 94% of all manipulative care is delivered by chiropractors, with osteopathic physicians delivering 4%, and general practitioners and orthopedic surgeons accounting for the remainder. A renewed interest in manipulation on the part of the medical profession is also noted in the RAND report, along with a reference to its long history. It states: “Spinal manipulation as a treatment for musculoskeletal pain has been practiced for centuries, having been described by Hippocrates, Galen, and other Western physicians, as well as in the writings of comparable historical figures in Eastern medical history.”

In the course of putting together this report, the RAND physicians relied on advice and “constructive critique” from a nine-member panel of orthopedic surgeons, osteopathic physicians, and chiropractors.

While manipulation continues to receive validation, the standard medical therapies have not fared so well. One by one, over the last few years, some of the most popular medical treatments for back pain have been proven ineffective, often worsening the problem. Traction, prolonged bedrest, and transcutaneous electrical nerve stimulation are but a few examples. Last year, another popular medical treatment, steroid injections, was shown in a carefully controlled study to be no better than a placebo injection (with salt water).

One reason why such treatments became so widely accepted before being fully assessed was offered in a 1991 New England Journal of Medicine editorial by Richard A. Deyo, M.D., M.P.H. “Up to 85% of patients with low back pain cannot be given a definitive diagnosis, because of the poor associations among symptoms, pathological findings, and imaging results… there is no gold standard for the diagnosis .”

In 1986, Dr. Deyo co-authored a landmark study showing that people suffering low-back pain who were randomly prescribed two days of bedrest missed 45% fewer days of work than their counterparts who were assigned to seven days of bedrest. No other differences in pain and functioning were observed between the two groups. His work has influenced the current medical trend toward “earlier ambulation” and exercise.

While medical science pursues its quest for the most effective treatment, chiropractic care is likely to continue accounting for about two-thirds of all patient visits for back pain.

And what about the dangers of manipulation therapy? The RAND physician/reviewers found 135 case reports of serious manipulation-related complications, including 18 deaths, most of which occurred in the period from 1950 to 1980. It is estimated that tens of millions of manipulations took place during this 3O-year period.

Several months ago, the TV show 20/20 featured the RAND report. lts principle author, Paul G. Shekelle, M.D. responded to a question about the basis for manipulation’s efficacy in treating low-back pain, by saying “There is more evidence for manipulation than there is for many of the things orthopedic surgeons and neurologists have to offer.”

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The latest literature on whiplash injuries has been focused on the role of facet joint injury as the cause of pain and disability. One piece of information that has led researchers in this direction is the prominent role of proprioceptive dysfunction in whiplash-related dizziness.

(Proprioception is that part of the nervous system responsible for communicating to the brain the body’s movement and position. Proprioceptive receptors in the cervical spine play a key role in the Posture Control System (PCS)—the mechanism by which the body maintains balance and equilibrium.)

A new study has added to our knowledge of this complex relationship by comparing a group of 75 whiplash patients to three other groups of control subjects: 20 patients with vertigo caused by central nervous system disorder, 20 patients with Meniere’s disease (a disorder of the inner ear), and 30 healthy subjects.

The stated objective was to see how these different conditions influenced the results of a relatively new test called the Smooth Pursuit Neck Torsion test (the SPNT)—a test specifically designed to detect and diagnosing cervical-related dizziness. A secondary finding of the study, however, was that there are significant differences in the origins of dizziness between the different groups of patients.

The SPNT works by comparing the movement of the subject’s eyes on a target in a neutral position and one in which the neck is experiencing torsion. A difference in eye movement between the torsion and neutral positions indicate that the Postural Control System is experiencing interference in the cervical spine.

The only subjects that showed indications of cervical proprioceptive interference were the whiplash patients, and these results were highly significant statistically. The authors conclude that this proprioceptive interference may be caused by damage to the facet joints of the cervical spine—just as other researchers have recently concluded.

Also, the SPNT test may be a good objective test to provide evidence of whiplash injury:

“Neck torsion had no effect in subjects with brain stem or vestibular disorders, or an intact balance system, unlike that in patients with WAD [whiplash-associated disorder] with dizziness and, to a lesser extent, in patients with WAD without dizziness. The SPNT test therefore seems to be useful for diagnosing cervical dizziness, at least in patients with WAD having symptoms of dizziness, because it has a high sensitivity and specificity.”

Tjell C, Rosenhall U. Smooth pursuit neck torsion test: a specific test for cervical dizziness. The American Journal of Otology 1998;19:76-81.

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FRIDAY, Oct. 31 (HealthDay News) — With Halloween right around the corner, many parents are wondering how they can help keep their kids safe.According to Meridith Sonnett, director of pediatric emergency services at Morgan Stanley Children’s Hospital of New York-Presbyterian, taking a few precautions can help make Halloween a happy and safe occasion for everyone.

She particularly recommends limiting trick-or-treating to familiar neighborhoods and neighbors.

Here are more tips parents should keep in mind for Halloween:

• Accompany your children when they go trick-or-treating.
• Examine all candy before letting your children eat it.
• Have your children discard any unwrapped foods.
• Make sure your children’s costumes are non-flammable and short enough so that they don’t trip.
• Make sure the eye holes in masks are the right size and in the right place for clear vision.
• If your children are old enough to trick-or-treat without a parent, have them go in groups.
• At night, make sure your children wear costumes that are bright in color, or have them wear reflectors.
• If the streets are dark, have your children take a flashlight.
• Accompany your children in apartment buildings.
• Have your children use proper street-crossing safety.
• Do not allow your children to enter a stranger’s home; have them ask for treats and wait outside the door.

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ScienceDaily (Sep. 30, 2008) — Pain is more than a symptom of osteoarthritis, it is an inherent and damaging part of the disease itself, according to a study just published in journal Arthritis and Rheumatism. More specifically, the study revealed that pain signals originating in arthritic joints, and the biochemical processing of those signals as they reach the spinal cord, worsen and expand arthritis.

In addition, researchers found that nerve pathways carrying pain signals transfer inflammation from arthritic joints to the spine and back again, causing disease at both ends.

Technically, pain is a patient’s conscious realization of discomfort. Before that can happen, however, information must be carried along nerve cell pathways from say an injured knee to the pain processing centers in dorsal horns of the spinal cord, a process called nociception. The current study provides strong evidence that two-way, nociceptive “crosstalk” may first enable joint arthritis to transmit inflammation into the spinal cord and brain, and then to spread through the central nervous system (CNS) from one joint to another.

Furthermore, if joint arthritis can cause neuro-inflammation, it could have a role in conditions like Alzheimer’s disease, dementia and multiple sclerosis. Armed with the results, researchers have identified likely drug targets that could interfere with key inflammatory receptors on sensory nerve cells as a new way to treat osteoarthritis (OA), which destroys joint cartilage in 21 million Americans. The most common form of arthritis, OA eventually brings deformity and severe pain as patients loose the protective cushion between bones in weight-bearing joints like knees and hips.

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Doctors know which prescription and over-the-counter drugs are the most dangerous. The writers of this article asked them the question, “Which medications would you skip?” Here were their answers:Advair

It‘s asthma medicine that can make your asthma deadly. Advair contains the long-acting beta-agonist (LABA) salmeterol. A 2006 analysis found that regular use of LABAs can increase the severity of an asthma attack. Researchers estimate that salmeterol may contribute to as many as 5,000 asthma-related deaths in the United States each year.

Avandia

Diabetes is destructive enough on its own, but if you try to control it with rosiglitazone, better known as Avandia, it could cause a heart attack. A study found that people who took rosiglitazone for at least a year increased their risk of heart failure or a heart attack by 109 percent and 42 percent, respectively.

Celebrex

This painkiller has been linked to increased risks of stomach bleeding, kidney trouble, and liver damage. And according to a 2005 study, people taking 200 mg of Celebrex twice a day more than doubled their risk of dying of cardiovascular disease. Those on 400 mg twice a day more than tripled their risk.

Ketek

This antibiotic, which has traditionally been prescribed for respiratory-tract infections, carries a high risk of severe liver side effects. In February 2007, the FDA limited the usage of Ketek to the treatment of pneumonia.

Prilosec and Nexium

The FDA has investigated a suspected link between cardiac trouble and these acid-reflux remedies, although they did not find a “likely” connection. But whether this is true or not, they can raise your risk of pneumonia, and result in an elevated risk of bone loss. The risk of a bone fracture has been estimated to be over 40 percent higher in patients who use these drugs long-term.

Visine Original

These eye drops “get the red out” by shrinking blood vessels. Overuse of the active ingredient tetrahydrozoline can perpetuate the vessel dilating-and-constricting cycle and may cause even more redness.

Pseudoephedrine

This decongestant, found in many drugs, can raise blood pressure and heart rate, setting the stage for vascular catastrophe. Over the years, pseudoephedrine has been linked to heart attacks and strokes, as well as worsening the symptoms of prostate disease and glaucoma.

Sources:

• MSN Health

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According to researchers, drinking three or more cups of tea a day is as good for you as drinking water. It may even come with extra health benefits.Contrary to the common belief that tea dehydrates, tea not only rehydrates as well as water does, but it can also protect against heart disease and some cancers.

Experts believe that flavonoids are the key ingredient in tea that promote health. These polyphenol antioxidants are found in many foods and plants, including tea leaves, and have been shown to help prevent cell damage.

Sources:

• BBC News August 24, 2008

• European Journal of Clinical Nutrition January 2007; 61(1):3-18

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