Could CBT break the vicious cycle of chronic neck pain and depression?

CBT for Neck Pain and Depression

Not all patients with neck pain and depression respond to cognitive behavioral therapy, but there have been numerous studies showing benefits for patients with chronic pain disorders. This type of treatment allows patients to break the cycle of negative thought patterns connected to their pain and depression, which may then help them pursue treatment for the pain or even reduce pain as their depression lifts and tension and inflammation subsides. CBT can also help patients communicate their needs to family members, friends, and employers more effectively so that they feel that their pain is legitimate and worthy of assistance and accommodation. CBT may also help patients achieve more restful sleep which can help reduce pain and depressive symptoms in itself. CBT can, therefore, be beneficial both for patients with neck pain caused by depression and for patients whose neck pain has resulted in depression.

Which came first - stress and depression or neck pain?

Latest Research on CBT for Chronic Pain

A paper presented at the 6th World Congress of the World Institute of Pain detailed the findings of a study of CBT for chronic pain management and confirms the benefits of the treatment. A cognitive behavioral therapy program remained beneficial even three years after the patients’ finished treatment according to Magnus Olason, MD, who presented the paper. His team did not treat patients with opioids, analgesics or other medications and instead helped patients to manage relapse control and pain without such drugs. Over a hundred patients took part in the study which gave them a six-week program of pain management for noncancerous, musculoskeletal pain; nearly half the patients had had pain for five years or more, with 40% suffering from lower back pain. The patients had been prescribed pain relievers, NSAIDs, antidepressants, and relaxants but were screened by Olason’s team to see if CBT might help them.

Long-lasting Positive Effects of CBT for Pain

Seventy-nine patients were assigned to receive either CBT or a non-CBT program with the patients randomly assigned (the others were given a pain management program). Non-CBT patients had physical rehabilitation and exercise as the primary therapies and all patients appeared to have statistically significant reductions in pain, as well as anxiety and depression at the end of treatment and after a year. The differences however, between the CBT group and the others was that at three years the former still had a meaningful improvement in symptoms whereas the non-CBT groups had reverted to baseline scores for pain and other measurements such as quality of life. It is thought that CBT may help effect positive changes in the brain where chronic pain has resulted in abnormal thoughts and associations. This has been found in research using MRIs to look at patients’ brain patterns before and after cognitive behavioral therapy. Increased gray matter in the prefrontal cortex after CBT appears to indicate better control of pain in patients, and pain perception is also changed due to alterations in pregenual cingulate and somatosensory cortices according to Magdalena Naylor, MD, PhD, professor of psychiatry and director of the Clinical Neuroscience Research Unit at the University of Vermont’s MindBody Medicine Clinic in Burlington.

Antidepressants for Neck Pain

Many patients with chronic nerve pain are familiar with the drug amitriptyline, an antidepressant that is also an analgesic. In most cases, those with neurological pain in the neck are prescribed a low dose of amitriptyline rather than the higher doses given to patients where the drug is being used as an antidepressant. If depression is suspected in a patient, whether as an isolated condition, a problem causing the neck pain, or as an effect of neck pain, it may be that a physician decides a higher dose of amitriptyline could be beneficial.

Treating Neck Pain and Depression

The key it seems to treating neck pain and depression is to treat neck pain and depression. By addressing both conditions the patient has a better chance of relieving both, especially in cases where it is unclear which condition came first and which may be contributing to the other. Some medications may be helpful for both conditions, such as nervines, anxiolytics, and antidepressants, whilst therapies designed to aid relaxation are also often beneficial for both neck pain and depression. Yoga, CBT, acupuncture, and even massage therapy could help a patient to relax, break the cycle of stress, anxiety, and pain, and increase motivation to achieve a healthy state for both body and mind. Even by reducing pain a little it may appear to be more manageable and allow a person to return to work, social activities and exercise, and active participation in family life, all of which can then further increase happiness and motivation to fully resolve neck pain and depression.

References

Olason, M., CBT and Chronic Pain, an Interdisciplinary Approach, 6th World Congress of the World Institute of Pain: Abstract 260. Presented February 5, 2012.

Katie Piper's 110th operation to reconstruct her face after an assault used pioneering stem cell therapy for blindness.

Pioneering UK Stem Cell Therapy

Piper approached Dr Sheraz Daya at his London office after seeing him on the television talking about a new stem cell procedure for the eye. Her surgery took place in November at the Queen Victoria Hospital in West Sussex and involved the grafting of donor stem cells from the cornea into the former model’s damaged eye after the corneal stem cells were cultured in the laboratory. The results appear positive thus far with surgery having removed the abnormal cells in the eye and the stem cells promoting healthy cell growth and repair.

How the Stem Cell Surgery Works

The stem cell procedure carried out by Dr Daya used corneal tissue from a male donor and cultivated the stem cells from that tissue in the laboratory before transplanting them into Katie Piper’s damaged left eye. This is the first procedure Piper has had on her blind left eye having been told by doctors that her sight would never return following the acid attack in 2008. Despite undergoing 109 other surgeries to rebuild her face the former model never considered that one day her sight might be restored. Whilst not completely blind in her left eye, Piper could only discern light and dark. Following the stem cell transplant she has regained enough vision to detect depth, movement, and even facial features with gradual improvements in her sight over the three months since surgery.

Stem Cell Sight Surgery After-Care

Katie Piper’s procedure was not the first of its kind but her public profile means that it is under close scrutiny. Piper’s eyes were stitched close and bandaged for the first week after surgery and she was prescribed antibiotics and steroids to reduce inflammation, possible tissue rejection, and to stave off infection after surgery. In addition, the model has eye drops made with her own blood to help encourage the new cells to grow. Piper’s condition, known as aniridia, means that she has no iris left in her eye and so a layer of protective tissue developed over the cornea, thus clouding vision, causing pain in the eye, and leading to redness in the eye as abnormal blood vessel growth occurred. Since her surgery the redness has dissipated, Piper now has a visible pupil in her left eye, and her scar tissue has been successfully removed and replaced with healthy tissue.

Offering Hope to the Blind

Dr Daya has performed surgery similar to Piper’s since 1999, treating more than sixty patients with stem cells for vision loss. The stem cell surgery removes the limbal tissue (at the border of the white of the eye and the clear cornea) from the donor, cultures those cells in the laboratory, and then grafts them into the recipient’s damaged eye. Before the transplant takes place however, the patient’s existing scar tissue and abnormal blood vessel growth requires removal from the surface of the eye. The stem cells are then covered with a thin piece of tissue membrane taken from the womb lining as this encourages cell growth and provides scaffolding for the corneal stem cells.

Read on for more information about the stem cell treatment for blindness.

Apply caution when doing yoga with spinal stenosis - not all poses are suitable for everyone!

Yoga Postures to Avoid with Spinal Stenosis

Osteoporosis in the spine can mean patients experience problems when carrying out forward bends in yoga, with positions such as Uttanasana particularly troublesome. Disc herniation is also a consideration with such positions as acute rupture or nerve injury may occur. Similarly, back bends can prove problematic with disc herniation and spinal stenosis, especially in cases of cervical spinal stenosis and sciatica. Headstands and shoulder stands may offer a chance at enlightenment according to yogis but that might come along with acute spinal fracture, disc herniation, and severe neck pain if a patient already has spinal stenosis, arthritis, or other back condition.

Spinal Twists – Safe Yoga Poses for Spinal Stenosis

The location and severity of spinal stenosis will influence the degree of restriction needed during yoga practice but for many the poses involving spinal twisting can prove too much. Whilst good for stretching the back and hips, and improving core strength, spinal twists are inadvisable for those with hip replacements, those with bulging or ruptured discs, and those with spinal slippage that could be exacerbated by the movement. There are a variety of yoga poses likely to be safe for spinal stenosis sufferers however, and these are discussed in a previous post along with the many benefits of yoga for spinal stenosis.

Yoga for Spinal Stenosis

Bikram yoga may help back pain due to muscle tension but it could cause increased inflammation in spinal stenosis.

Find a Good Yoga Instructor

When suffering from spinal stenosis it is important to apply caution in any exercise regime and finding a good yoga instructor is vital to safeguard and improve spinal health. Before signing up to a class ask about the experience of the teacher with spinal issues. Many yoga instructors have carried out advanced training on spinal anatomy and the use of yoga in therapeutic practice. Some may even have participated in clinical trials using yoga for spinal stenosis and other back problems. It is quite common for those with any medical condition to begin yoga practice with private tuition and then transition to a yoga class once they are comfortable with the poses and their own limitations. This also avoids the temptation to simply follow every pose in a group setting and push the body too far at first. A good yoga teacher will likely allow patients to sit in on a class to get a feel for the level of fitness of other class members and observe the tailored approach used during class by the teacher for others with medical issues.

Safe Alternative Spinal Stenosis Treatments

Symptoms of spinal stenosis such as nerve pain, numbness, weakness, and paraesthesia may cause patients to worry about their movement and mobility. Oftentimes this worry can exacerbate symptoms as patients restrict themselves unnecessarily and lose muscle tone and core strength. Safe yoga for spinal stenosis can help correct postural problems, build strength throughout the body, and improve emotional health and aid relaxation. It is essential to find a well-versed practitioner who understands the spine so as to avoid carrying out inappropriate stretches, that way the patient can simply concentrate on the many benefits to be had through safe yoga for spinal stenosis.

Low-intensity water therapy for fibromyalgia can help with pain relief.

Exercise for Fibromyalgia Improves Memory

Using functional magnetic resonance imaging (fMRI) data, the researchers at Georgetown carried out a study of fibromyalgia patients undertaking a fibromyalgia exercise program in place of pain medications. Not only did they note that the patients themselves reported less pain when ceasing medication they also observed functional changes in brain patterns in the group carrying out exercise. These changes included an increase in activity in the task-related parts of the brain and patients also experienced improvements in working memory during the study.

Fibromyalgia Pain Relief with Exercise

Leading the research team, Manish Khatiwada, MS, from Georgetown’s Medical Center proposed that exercise with fibromyalgia could be beneficial in reducing symptoms of pain and mobility as well as cutting through the infamous ‘fibro-fog’ reported by many sufferers of the condition. Georgetown University has a Fibromyalgia Evaluation and Research Center where many patients take part in studies of this kind but the director of the unit made sure to point out that this study does not necessitate a change in current fibromyalgia treatment plans.

Brain Activity in Fibromyalgia

Fibromyalgia trigger points include several in the neck.

Benefits of Exercise for Fibromyalgia

The women initially experienced an increase in pain experienced subjectively before that pain decreases during the exercise intervention. The inverse happened with the brain areas used in the working memory task, with the cessation of pain medication followed by a decrease and then an increase as the exercise program continued. Neck pain associated with fibromyalgia may be treatable then using exercise and physical therapy as an intervention but care should be taken to ensure no other cause of neck pain is present, such as cervical spinal arthritis, or temporomandibular joint syndrome. This latest research does, however, add to a growing body of evidence showing the likely benefits of exercise for fibromyalgia.

Reference

Khatiwada, M., Vanmeter, J., Walitt, B., Effect of aerobic exercise on working memory in fibromyalgia, Neuroscience 2011: Abstract 258.08, Poster BB5. Presented November 13, 2011.

Children may be exposed to dangerously high levels of radiation during lower back pain diagnosis.

The majority of lower back pain in children is thought to get better of its own accord, given sufficient rest and conservative management. In some cases there is a need for radiographic assessment, but researchers at the 2011 National Conference and Exhibition of the AAP discussed the dangers of accumulative radiation exposure in children, particularly in the pelvic area.

Treating Children’s Lower Back Pain

Undiagnosable mechanical lower back pain accounts for 78% of all adolescent cases with spondylolysis and spondylolisthesis the most common pathologic causes. In adults these may demonstrate a degeneration of spinal structures and the likelihood of worsening spinal stenosis symptoms, but in children such findings are not always signs of a progressive problem and can instead be indicative of acute trauma, or a temporary shifting in the spine during a growth spurt. Spondylolysis and spondylolisthesis causing lower back pain in children can, however, be demonstrative of congenital spinal defects which may benefit from back surgery or bracing.

Dangers of Bone Scans for Kids

Despite the understandable worry whenever a child presents with lower back pain, often the need for imaging such as X-Ray, CT, or MRI scans is limited. Children absorb considerably more radiation than adults do and their metabolism of this radiation is also greater than that of adults. Where lower back pain leads to imaging this can mean that the pelvic region, including the ovaries, bladder, and colon is exposed to potentially dangerous doses of radiation.

Children’s Back Pain Undiagnosed

Dr Drummond, the senior presenting author of the paper and MD at the Children’s Hospital of Philadelphia, Pennsylvania, said that of the 2846 children (10-19yrs old) whose records were included in his review most were female (63%) and in 79% the LBP cause remained unknown. With an average age of fourteen, over 90% of the patients had three or fewer visits to the doctor about the problem, but of the 9.6% diagnosed with spondylosis, plain radiography proved sufficient to diagnose in 86% of cases and CT scan in 1.5%. Bone scans, which incur significantly more exposure to radiation than CT and radiography, were used to diagnose spondylosis in 12.5% of cases.

Revolutionizing the Field of Paediatric Diagnostic Imaging

The researchers were surprised by the results when looking at exposure to radiation as they did not expect the bone scans to be the most problematic. The reason that the radiation exposure in children being assessed for lower back pain was higher in the bone scans is because the radioactive dye from the scan sits in the bladder for a day before being excreted, thus having the opportunity to adversely affect cells in the bladder, especially where the tests are repeated.

Conservative Diagnosis and Treatment

The positive effect of this study is in revealing to diagnosing physicians the potential problems of routine use of such diagnostic imaging in children with low back pain. Many responded to Dr Drummond’s paper by stating their intention to give up the use of such bone scans in children. The alternative advice is to do a 2-view x-ray if thought necessary but to otherwise give children access to physical therapy as part of conservative management. Many cases of lower back pain in children are due to over-exertion, poor posture, and even things such as heavy backpacks, poorly fitting shoes, and draughty classrooms or school buses. A 50-60% improvement after six weeks of physical therapy or conservative management is usually sufficient to confirm the benefits of the treatment plan and the advantages of continuing in that vein, otherwise more investigation may be necessary into the causes of lower back pain in children.

References

American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition; Abstract #14782. Presented October 14, 2011.

A new study carried out by researchers at Northwestern Health Sciences University has found spinal manipulation therapy better for neck pain relief than medication. Publishing their results in the Annals of Internal Medicine’s January 2012 edition, the researchers have stressed the findings are not applicable to all patients and that individual treatment protocols are always warranted. The big surprise from the study was that home exercises for neck pain were also more effective than neck pain medication, meaning that many patients could treat themselves without the side-effects of popular drugs.

Neck Pain Home Exercises Successful

The paper, which may influence treatment decisions by physicians for patients with chronic neck pain, notes that the history of neck pain, the patients’ preferences for treatment, and their previous experience of such therapy will also factor into any treatment choices. Dr. Bronfort, the lead author of the study, along with fellow researchers devised a programme for patients where they learnt how to avoid certain triggers for neck pain including specific sleeping and working postures. The patients were also given a two hour instruction class in self care which included home-based neck exercises. Of the 272 patients taking part in the study, a third were treated with neck pain medication, a third with spinal manipulation therapy, and a third with home exercise and advice. Unfortunately the nature of the study meant that there was no control group receiving no intervention against which to compare all groups. The treatments lasted for twelve weeks and the spinal manipulation was administered by five experienced chiropractors.

Neck Pain Medications

The neck pain medications used in this particular trial were largely prescription drugs including non-steroidal anti-inflammatory medications, acetaminophen, or a combination of the two. Some patients received opioid medications if the NSAIDs and acetaminophen were insufficient for relieving pain. Muscle relaxants were also administered to some patients and patients were given usual advice on modifying activities as needed to help their condition.

Measuring Success at Relieving Neck Pain

Patients in the trial were assessed for pain levels at 2, 4, 8, 12, 26, and 52 weeks. The group receiving spinal manipulation therapy had a significant reduction in neck pain in comparison to the medicated group at the 8, 12, 26, and 52 week marks. Home exercises for neck pain proved more effective than medication at 26 weeks but no clear differences were noticed between the effectiveness of spinal manipulation therapy (SMT) and home neck exercises at any point in the study.

The patients receiving either SMT or conducting neck exercises at home reported benefits in terms of reduced use of medications, improved general health and activity levels, and fewer adverse events. Interestingly, those patients receiving SMT were more satisfied than those carrying out the exercises alone at home. Almost half (46%) of the home exercise group and 40% of the SMT group reported adverse events however, the most common of which was musculoskeletal pain, followed by paraesthesia, headaches, stiffness, and crepitus (joint cracking and associated noise). The medicated group had a 60% incidence of reporting adverse events, usually gastrointestinal symptoms, drowsiness, dry mouth, cognitive effects, rashes, and insomnia.

Limits to the Study

The study is useful in that it fills a research gap looking at spinal manipulation therapy in contrast to neck pain medications and home exercise. However, the patients could not be blinded to the care they received and the benefits of the SMT may in part have come from more frequent interaction with the chiropractors. The authors did suggest that the treatment may be helpful not only in the short term but also in reducing the risks of chronic conditions developing although more research needs conducting to establish such a theory. Other concerns expressed about the study, aside from the lack of placebo control, include the risk of vertebral artery stroke associated with SMT, and the lack of a cost-benefit analysis to accompany the study. This type of research may prompt further study into alternatives to neck pain medications including home neck exercises and spinal manipulation therapy for neck pain.

References

Bronfort, G., Evans, R., Anderson, A.V., Svendsen, K.H., Bracha, Y, Grimm, R.H., (2012),.Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain, A Randomized Trial, Ann Intern Med. 2012;156:1-10, 52-53.

Spinal stenosis can result from illness, injury, and general wear and tear but every year people suffering car accidents develop spinal stenosis symptoms without even realizing that the health of their spine was already compromised. Smoking, dehydration, other inflammatory conditions, nutrient deficiencies, and even repetitive microtrauma can all cause the cervical spine to suffer more extensive damage upon acute injury demonstrating the importance of keeping your spine healthy at all times. Slippy black ice due to the current wintery weather can have you spinning out of control in your car leading to an accident, whiplash, and cervical spinal damage causing spinal stenosis and neck pain. Find out more about spinal stenosis and car accidents and what could help reduce your risks.

Whiplash Symptoms

Those suffering a car accident may not immediately experience whiplash symptoms as these can take a day or so to fully materialize. Neck pain, shoulder pain, headaches, and pain or abnormal sensations in the hands and arms, or even the chest and head, can suggest cervical spinal damage and spinal stenosis after whiplash. Some people find that their motor skills are affected and they feel clumsy or uncoordinated. In such cases there may be acute myelopathy and it is important to seek immediate care to relieve compression of the spinal cord itself. Both cervical spinal stenosis and lumbar spinal stenosis are possible from a car accident although neck symptoms and damage are the more common effects of whiplash.

Pre-existing Stenosis and Pain

Where a patient has pre-existing narrowing of the spinal column the effects are likely to manifest in that area rather than in another region of the spine where there is more room to accommodate short-term inflammation and trauma. Those with little or no spinal stenosis may also suffer from a car accident but the symptoms are more likely to dissipate as inflammation subsides. Considerable stenosis of the spine can be present and remain asymptomatic, only being discovered following an event such as a blow to the back or neck, or a car accident causing whiplash and associated symptoms.

Diagnosing Spinal Stenosis

A variety of tests to assess the degree of stenosis will be carried out by the physician, such as extension, rotation, and flexion exercises that can help to identify the likely source of the pain in the anterior or posterior spine. Some problems may take longer to develop, such as muscle loss, coordination and balance issues, or bladder/bowel incontinence, all of which are connected to progressive myelopathy rather than radiculopathy. Such symptoms, which may be labelled as ‘central cord syndrome’, require immediate attention and may indicate the presence of more extensive damage and spinal stenosis from a car accident than was at first thought.

Treating Spinal Stenosis After a Car Accident

Treating symptoms of spinal stenosis following a car accident may involve an increase in medications already taken, such as NSAIDs, acetaminophen, or even corticosteroids, as well as epidural steroid injections for relief of acute pain and inflammation. Patients may find physical therapy and relaxation techniques work well to relieve pain, especially if the incident was particularly stressful and traumatic. Exploring these options with the doctor is important to establish effective back pain treatment following a car accident, especially as certain exercises could exacerbate the damage.

Where inflammation is present it is unwise to apply heat to an area, but ice packs could help to relieve pain and other symptoms. Massage is also problematic in some cases as this can increase compression of the nerves or irritate inflamed joints and muscles. Most chiropractors and osteopaths will be reluctant to treat a patient following an acute injury to the spine without first acquiring diagnostic imagery of the spine and conducting other assessments to ensure they do not unwittingly worsen the problem. Caution is advised over anyone applying spinal stenosis treatments without taking a thorough history and assessment.

Spinal Stenosis Surgery

Back surgery for spinal stenosis may be required for some patients suffering a car accident. This is usually where pre-existing spinal stenosis has been made worse by the accident and there is considerable compression on the nerves and/or spinal cord by mechanical means rather than through inflammation alone. Where a spinal fracture, disc herniation, or spinal slippage has occurred it is often necessary to operate to remove offending material and stabilize the spine to prevent further nerve or spinal cord damage. Anterior cervical discectomy, decompression, and fusion is one type of surgery that may occur to relieve spinal stenosis after a car accident.

Other surgeries include foraminotomy, laminectomy or laminotomy, and even cervical arthroplasty where an artificial disc is used to restore the intervertebral height whilst maintaining some flexibility. The best way to avoid the need for such surgery is take good care of your spine, including staying hydrated, stopping smoking, remaining active and well-nourished, and performing strengthening and stretching exercises for the spine. That way, if you are unlucky enough to have a car accident, spinal stenosis may not occur and any symptoms you suffer should, hopefully, disappear long before any court case is settled.

A new study presented at a conference last month revealed data supporting the use of glucosamine and chondroitin for joint pain and stiffness connected to osteoarthritis and aromatase inhibitors. Osteoarthritis in the neck can lead to pinched nerves, subluxation, and even spinal cord compression, causing neck pain and stiffness, as well as headaches, and even paraesthesia, numbness, and weakness in the limbs. Aromatase inhibitors may contribute to neck pain via this mechanism, but the drugs are increasingly used to improve survival times in breast cancer patients. Discussing their findings at the 8th International Conference of the Society for Integrative Oncology, researchers from Columbia University talked about the adverse effects on joint health in breast cancer patients taking aromatase inhibitors to manage their cancer. Joint pain and stiffness experienced by these women appeared to be relieved by the concomitant use of glucosamine and chondroitin, although the symptoms remained largely unresponsive to conventional pain medication.

Joint Pain from Aromatase Inhibitors

The incidence of joint problems and musculoskeletal issues in those women prescribed aromatase inhibitors is often blamed for the low adherence to such therapy. Findings ways to minimise joint pain in those taking aromatase inhibitors could help more women attain the survival benefits conferred by the drugs. Unfortunately, other studies have not found the supplements effect in the general population for treating osteoarthritis symptoms, with a 2006 meta-analysis looking at the use of glucosamine and chondroitin over a six-month period. A previous meta-analysis, in 2002, suggested that the supplements might effectively relieve disability and pain in osteoarthritis. The benefits are usually described in the knee joints, ankles, and wrists, rather than in the spine however, and there are those who consider it unlikely that neck pain or back pain could be relieved by using glucosamine and chondroitin simply because the low levels of blood circulating to the spine would preclude significant movement of the substances to the region.

Glucosamine and Chondroitin Study Details

The researchers presenting their data at this conference were almost stopped in their tracks by the negative results of the 2006 meta-analysis. Looking at a subgroup suffering from moderate to severe pain at the start of the studies revealed that there were some patients who did appear to benefit from the supplement regime however, and so Dr Greenlee and colleagues persisted with their own research, sponsored by AstraZeneca. Their study is a Phase II single-group trial of postmenopausal women with breast cancer stage I to III. All the patients had been taking aromatase inhibitors for three months or more prior to the study’s commencement and all reported joint pain higher than 4 on a 10 point visual analog scale. Those with pre-existing osteoarthritis were included if their pain had worsened after initiating treatment with aromatase inhibitors.

Problems with the Study

This study only looked at a small number of patients, with just 37 completing the trial over twelve weeks. However, the study group was quite diverse, with 40% of patients white, and 40% Hispanic, and with a median age of 61, possibly making the results more likely to be applicable to a larger number of women. Most of the women were overweight however, which is a known factor for joint pain as excess stress is put on the musculoskeletal system to support the extra weight.

How Much Glucosamine to Take for Joint Pain

The doses used in this study were 1500mg/day of glucosamine and 1200mg/day of chondroitin, and the researchers evaluated the patients every six weeks in the clinic. The main assessment method used was the Outcome Measure in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARS) criteria, although the researchers themselves have questioned the appropriateness of such a measurement following the trial’s conclusion. Other evaluations were completed, including the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH), and Brief Pain/Stiffness Inventory-Short Form (BPI-SF). The primary end-point assessment method was chosen so as to allow the researchers to compare their results with the 2006 meta-analysis using the same experimental assessment.

Functional Improvements with Glucosamine and Chondroitin

Although the patients reported reductions in pain and stiffness in the hips and knees at 12 and 24 weeks, along with improved function, other joints were also positively affected during the study, including the wrists and hands. Grip strength improved during the trial, and between 35% and 50% of the patients reported pain and stiffness reduction overall. Commonly reported adverse effects included headache, dyspepsia, and nausea, although no severe adverse effects of taking glucosamine and chondroitin were noted. The researchers thus concluded that the regime was safe for women with breast cancer, and may be beneficial in those experiencing aromatase-inhibitor-induced joint pain. The low negative effect of the supplement regime makes the drugs appear more favorable when accounting for their lower effect compared to other interventions that have higher risks of adverse reactions. In cases where aromatase inhibitors are thought to be causing or exacerbating osteoarthritis and neck pain, glucosamine and chondroitin could offer relief it seems.

References

8th International Conference of the Society for Integrative Oncology: Abstract 4. Presented November 10, 2011.

Wondering what to have for dinner tonight? How about a stem cell hamburger? Recent newspaper headlines have proclaimed that the first ‘test-tube’ burger is only a year or so away, but it could set you back several thousand pounds and could you really stomach meat that had been grown in the laboratory? Laboratory-grown meat could be allergen-free, low cholesterol, and even infused with certain nutrients or possibly used as a drug-delivery mechanism. Stem cell therapy burgers – coming soon to a diner near you.

Solving World Hunger with Stem Cell Meat

Population crises and world-food shortages have a number of scientists hailing stem cell meat as the answer to malnutrition around the world but aside from the dubious environmental and ethical arguments spinning around such research, is it even feasible to grow such a product? Dutch scientists are currently developing a burger grown from 10,000 stem cells taken from cattle and then cultured in the laboratory to produce muscle tissue. The problem with such stem cell meat is that it bears little resemblance to the actual flesh of an animal, which hardly has McDonalds banging at the scientists’ door ready to place an order.

In-Vitro Meat Development

In-vitro meat, as it has been dubbed by some, is the focus of work by Mark Post, professor of physiology at Maastricht University in the Netherlands. Using stem cells extracted from a health cow, the researchers then prompt the cells to divide and grow until there are billions of them ready for transplantation to a scaffold. The purpose of the scaffold is to bulk up the young muscle cells through the application of tension, in a similar fashion to how muscle is created in a living, sentient cow. These muscle fibers are then minced to form burger meat.

Problems with Lab-Grown Meat

As yet, it appears that no one has volunteered to try the faux meat, and Post looks like he might have to take on that unusual stem cell research project himself. Fellow researchers at the same university did have previous success in 2009 in growing strips of pork (pig flesh) in the laboratory. The result was far from appetising however, with a greyish color and a slimy squid-like texture. Scientists in New York have also been experimenting with the creation of stem cell animal foods, having grown fish fillets from goldfish muscle cells.

In a fairly damning indictment of the state of our current relationship to food, Professor Post’s colleague was quoted as saying ‘When we are eating a hamburger we don’t think, “I’m eating a dead cow”. And when people are already far from what they eat, it’s not too hard to see them accepting cultured meat.’ The use of such in-vitro meat may first arise in animal feeds, then in heavily processed foods, and even in fast foods before improvements in the taste and texture are achieved, thus allowing stem cell meat to be considered a feature of a meal.

Dutch Invest in Stem Cell Meat

Necessity certainly breeds invention and, for many, the idea that meat is essential to life remains. Meat consumption is expected to double by 2050, despite many environmental groups promoting plant-based diets for the majority of people to cut down on pollution, methane production, and the destruction of land for animal agriculture. It seems likely that the Dutch will win the race to produce viable stem cell meat first, especially given a £1.5million investment from the government into the project. Calculations by Utrecht University Researchers have revealed that just ten stem cells could produce 50,000 tons of meat in two months, with 35-60% less energy consumed in the process, 98% less land used, and 80-95% less greenhouse gases emitted. These calculations may not however account for the fact that many animals are still raised on land with little other possible use.

NASA, PETA, and Stem Cell Meat

With the stem cell burger currently coming in at a cost of $345,000 it is unlikely that it will featured any time soon as the latest enticement into fast-food chains. NASA have expressed interest over the years in using such meat to feed astronauts on missions, and food scientists also looked at the idea with enthusiasm after the Second World War when food shortages were commonplace. PETA have offered a reward for anyone who succeeds at making the venture a commercial success, with the hope that this would help reduce factory and livestock farming.

Texture and Taste in Stem Cell Meat

Problems facing the stem cell researchers at Maastricht are similarly to those faced by stem cell scientists looking at growing organs for transplantation to cure medical ailments and conditions. The issue of ‘texture and taste’ in the stem cell-grown meat translates to problems of cell types and culture, along with structure essential to functioning organisms. Every advance in stem cell medicine leaves people thinking that growing a slab of meat must be fairly straightforward for scientists who can destroy and rebuild the immune system, grow a new trachea for transplantation, or reconstruct a damaged face using home-grown bones. The reality is very different however as the features of meat that most consumers enjoy, including the taste and texture, are products of the activity of the animal, the life it leads, and the diet it enjoys (or not) whilst alive.

Blood and Nutrients in Lab-Meat

Animal flesh is not just one type of cell collected into discrete units, there are muscle cells, blood vessels, fat cells, bone, cartilage, tendons, and the accumulated chemicals from the diet and metabolic processes of all of those cells. There is also blood in those blood vessels, a factor which has so far caused innumerable problems for the scientists wanting to grow the perfect steak. The laboratory meat would simply be a rather runny sludge of cells of a grayish-white color, lacking any real taste, never having had blood pumping through it and never having felt the stresses and strains of normal muscle cells. The scaffolding that the Dutch researchers are using aims to take care of the texture issue using collagen mesh or edible microbeads onto which the myoblasts are applied. The whole thing is then bathed in nutrients in a bioreactor to promote the growth and replication of the cells into myotubes and then the myofibers making up muscle tissue.

The Cost of Stem Cell Meat

Another technique exists using extremely thin sheets of muscle tissue taken from living animals with these sheets being placed into the bioreactor with a nutrient solution and muscle stem cells. This ‘self-organizing’ technique produces meat that is more recognizable as such in terms of cell variety and most likely taste and texture but the sheets of cells must be extremely thin for the process to work. Where the muscle sheets are too large, more than just a few cells deep, the waste products of the cells end up accumulating and lead to cell suffocation and death. In the animal themselves these waste products would simply be removed by circulating blood but that is not yet possible in lab-grown meat. Professor Post’s latest experiments produced extremely thin sheets of around an inch wide, thus making it necessary to grow some 3,000 of these to make an actual burger of a reasonable size. The result looks unappetizing, is likely pretty lacklustre in terms of taste and would, due to the intense labor-costs and strict laboratory conditions, set you back $345,000.

Muscle Stem Cell Activity

Improvements to the techniques for growing laboratory meat from stem cells include the rather crude system of attaching velcro bands to the meat in order to stretch it periodically. This conjures up the image of conveyor belts full of pulsating slabs of muscle and may be how stem cell meat is ‘farmed’ in the future. Other issues that still need to be more satisfactorily addressed include the ability of the cells to reproduce. In theory it is possible for a single cell to just keep producing more and more meat but there is still no clear idea of how long the process can go on producing more muscle cells in practice.

Developing a Taste for Stem Cell Meat

Delivering nutrients and oxygen and removing waste products is also an issue that needs to be overcome if researchers are to produce anything that actually resembles real meat. Either blood vessels need to be grown using stem cell technology in the growing muscle sheets, or an edible nanotube system will need devising to artificially resolve the problem. Designer meat would also most likely need to differ between chickens, pigs, cows, and all the other creatures consumed by man. All of these animals have similar basic biological processes and yet their flesh looks, tastes, and behaves differently when looked at in a culinary light. The input of nutrients is largely what affects the taste of flesh and it is blood which provides this in the animal. Food technologies employed to make the faux meat products such as soy protein and other textured vegetable proteins could be applied to the production of faux meat using animal stem cells but for the most part the lab-grown stem cell meat would have to do this structural work itself.

Stem Cell Meat as Therapy

Stem cell meat would also need to meet various health and safety requirements, making it at least as nutritious as meat taken from the animal itself. The rise of designer meat for medical purposes has already been discussed by some scientists, with cholesterol-free stem cell meat a possibility, along with meat infused with certain nutrients or even used as a drug-delivery mechanism. Stem cell therapy may not be the shot in the arm or bone marrow transplant we are all becoming used to reading about, it could be in the form of a laboratory-grown stem cell meat burger, with added pharmaceuticals, reduced allergens, and the possibility of curing disease.

A three-year study on pain relief for sciatica has found that adalimumab may help delay surgical discectomy in those treated, despite there being little difference in leg and back pain between the treated group and those receiving placebo medication. The randomized study, which took place in Geneva, Switzerland, looked at sixty-one patients suffering from severe acute sciatica and followed the progress of fifty-six of those for three years after randomization. Of the fifty-six, 41% had back surgery during that time, although the adalimumab group had a 28% rate of surgery compared to 56% of those receiving the placebo drug. There are concerns however that the trial focused on the wrong outcome and is too small to effectively demonstrate the use of adalimumab for sciatica treatment.

Injections for Sciatica

The study used two subcutaneous injections of adalimumab for the patients in the trial, which was sponsored by Abbott. Adalimumab is a drug that acts on the immune system protein tumor necrosis factor in an attempt to reduce joint swelling and subsequent damage. Published in the Annals of Rheumatic Diseases, the study’s authors expressed surprise at the insignificance of the effect of adalimumab on sciatica pain in light of an earlier study which also looked at the effect of the drug on pain. The primary outcome being measured in this latest trial was, instead, the need for patients to undergo discectomy for sciatica with the effect on pain being an incidental measure. Sciatica may be incorrectly attributed to disc bulging or herniation causing spinal stenosis and pinched nerves in some cases when in fact the musculoskeletal condition piriformis syndrome is actually to blame. Neither discectomy nor adalimumab treatment would be likely to address the often excruciating leg pain caused by such a condition, with attention needed instead on the spasm or overuse of the piriformis muscle if the condition is to be resolved.

Reducing the Need for Discectomy in Sciatica

The low numbers of patients involved in the trial, thirty in the treatment group and thirty-one in the placebo group, mean that the conclusions drawn from the study may not be widely applicable. The authors concluded that adalimumab reduced the need for back surgery in sciatica by 61% but commentators on the study have raised doubts about the methodology used to reach such a conclusion. The major complaint appears to be that the majority of the discectomy surgery for sciatica occurred fairly quickly after the study commenced, at an average of 2.3months after the treatment started. Additionally, the reasons for electing to carry out such back surgery to relieve stenosis and sciatica were not reported. The arguably more relevant outcomes of leg and back pain from sciatica and SF-12 scores were not different with adalimumab, making some question the positive spin put on the trial’s outcome instead of focusing on the lack of efficacy on patients’ pain. The discectomies may have been carried out for reasons unrelated to sciatica but the authors of the study still speculated that the drug may have had a delayed effect after six months or up to three years after treatment. Deciding to undergo a discectomy takes considerable time in most cases and many such decisions are likely to have been made before any such effects from adalimumab on sciatica set in.

Sciatica Relief with Adalimumab

How adalimumab and anti-TNF-alpha drugs work.

Adalimumab Side-Effects

The anti-tumor necrosis factor medication adalimumab does carry the risk of some side-effects, particularly in patients taking additional medications that also reduce the strength of the immune system. Patients living in certain areas in the US are also at increased risk of contracting infections that lead to tuberculosis, with the fungal infections coccidioidomycosis and histoplasmosis more widespread in the Ohio and Mississippi River Valleys and the southwestern US. There are also concerns over an increased risk of cancer development, particularly in teenagers taking the drug, along with other side-effects such as rashes, itching and pain at the injection site, heart irregularities, seizures, and cognitive symptoms including mood disruption. Anyone considering taking adalimumab for sciatica should apprise themselves of the risks and benefits of the drug and carefully explore their options for pain relief with their physician to see if there is a more appropriate medication.

Sciatica Treatment Options

Other treatments to reduce pain from sciatica include epidural steroid injections and drugs such as gabapentin, with the researchers noting that a tumor necrosis factor-alpha antagonist provided the strongest protective effect on delaying surgery. Other factors that influenced the progression to surgery in patients included correspondence between symptoms and MRI findings, as well as intensity of leg pain and back pain from sciatica at the start of the trial, and the length of time patients had been off work with their condition. Adalimumab looks likely to be added to the list of possible ways of relieving pain and delaying the need for discectomy surgery in sciatica, but more research clearly needs to be done to support such treatment.

Reference

Gebevay, S., Finckh, A., Zufferey, P., Viatte, S., Balagué, F., Gabay, C., Adalimumab in acute sciatica reduces the long-term need for surgery: a 3-year follow-up of a randomised double-blind placebo-controlled trial, Ann Rheum Dis, doi:10.1136/annrheumdis-2011-200373