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- Compiled and coordinated by Edward Arambewala

 

Neck pain - Synopsis by Dr James Tan

Introduction

The neck (or cervical spine) performs a very important function of supporting the head and allowing full motion of the neck; and at the same time, it must also protect the delicate spinal cord.

Know your neck

Your neck bone consists of seven individual bone (vertebra) with a soft cushion (disc) between each of them. Every time your nod or shake your head, these vertebral and disc work together to allow the mobility. Muscles of your upper back, your shoulders are attached to these neck bones.

Causes of Neck Pain

There are many structures in the neck that can result in neck ache and pain. These are the common causes:

1) Wear and tear (Spondylosis) - this refers to the wearing out (degeneration) of the intervertebral disc that acts as cushions between the individual neck bones. When the disc wears out, it can no longer support the neck as well as it used to be. The body tries to repair this by forming extra bone to act as supports and these are known as bone spurs (osteophytes). It is these osteophytes that cause compression on the nerves and spinal cord that result in some of the more severe symptoms.

2) Disc herniation - when the disc wears out, it can also protrude outwards and it is this protrusion that results in the sharp arm pain sometimes experienced by sufferers of acute disc prolapse. This may also cause tingling in the arms and hands. In more severe cases, there is even weakness in the upper limbs.

3) Inflammation - this refers to the conditions like rheumatoid arthritis. This inflammatory process usually affects the fingers as well as other big joints like the knee joint. In the neck, it usually affects the upper cervical spine resulting in instability and pain.

4) Postural causes - this is the most common cause of neck pain. Prolonged postures of the neck in an unnatural position. For example, falling asleep on the sofa or prolonged working on the computer (especially on laptops) with the neck bent forward.

5) Traumatic injuries - this can range from minor sprains to severe injuries as in whiplash injuries in car accidents.

6) Other rare causes like infection, tumours and congenital abnormalities.

When is it serious?

Most of the time, the pain is self limiting - meaning that it will reduce over time with simple medications like paracetamol or NSAIDs with simple stretching exercises. It becomes serious when you have one or more of the following symptoms:

a) Weakness - this means there is actual nerve compression with damage to the nerve fibres. If left untreated, paralysis may occur and be permanent.

b) Numbness or tingling - occasional numbness that goes away after a short period may be a sign of early nerve compression. If the numbness is persistent, it means nerve damage has already taken place and muscle weakness will soon follow.

c) Loss of bladder and bowel control - this is a very serious situation that warrants immediate admission to hospital and surgery. The presence of sudden incontinence means severe spinal cord or roots compression that if left untreated, will result in permanent disability.

d) Persistent pain on neck movement - the pain from neck sprains usual last from several days to one to two weeks. If the pain persists in severity and worsens over time, especially if it is associated with a fall or accident, there may be an undiagnosed neck fracture with instability.

e) Pain that radiates down the arms - this radicular pain is caused by the nerve root being squashed (usually due to herniated disc). Initially, it may just be pain but with time, tingling and weakness will develop.

What are the treatment options?

The main aim of the doctor would be to exclude serious conditions that can cause permanent damage.

He will go through the history and performed an examination including a neurological examination to determine the state of the spinal cord and nerves.

The next step is imaging studies. There are several alternatives available:

i) X-rays - This is simple and cheap but yields limited information. It is most useful to look for presence of fractures and misalignment of the spine.

ii) CT scans - This is a good tool for looking at bony details but does not give sufficient information on the disc and spinal cord. This is usually reserved for those with metallic implants like pacemakers who cannot have MRIs.

iii) MRI - Usually the investigation of choice as it provides a clear view of the state of nerve roots and spinal cord.

Treatment is always conservative first before resorting to surgery. Conservative options include:

- Rest (use of collar for a few days to reduce motion)

- Simple analgesia like paracetamol, NSAIDs or the newer COX2 inhibitors.

- Exercises - stretching and strengthening

- Hot packs

- Modification of lifestyle

- Physiotherapy including traction, mobilisation.

Surgery is sometimes needed when the above methods fail to provide relief or when there is danger of permanent nerve or spinal cord damage.

Surgical options include:

- Fusion - a procedure where the damaged disc is removed and bone is inserted between the vertebras to fuse the level. This relieves the pressure on the nerve and spinal cord but it also increases the stress to the disc above and below the operated level.

- Arthroplasty

(artificial disc replacement) - this is the newer approach where after disc removal, an artificial disc is inserted. This performs the same function as the disc by allowing motion at the operated level and reduces the damage to the adjacent discs.

- Laminectomy/ Laminoplasty - this is a time tested way to reduce pressure on the spinal cord over a large area by removing part of the bone. This surgery is performed from the back of the neck.

- Facet Blocks and radiofrequency neurotomy - this is a minimally invasive technique to reduce neck pain, A fine needle is inserted from the side of the neck and local anaesthetic and a very small dose of steroid is injected to give relief to neck pain.

- Disc nucleoplasty - this is one of the latest minimally invasive methods to treat mild prolapsed disc and neck pain caused by disc degeneration. It involves using coblation technology to remove disc material.

Conclusions

It is important to take good care of the neck by proper posture in the way we sit, work and play. Once degeneration starts, it is not reversible. The good news is if we start taking proper care, the degeneration can be slowed down and it may be years before any intervention may be needed.


Re-birth revelations:

Whether to accept or not left to you - Dr. Jayasinghe

Sri Lanka’s leading clinical Hypno-therapist Dr. H. B. Jayasinghe who has trained over 50 doctors in this therapy to treat several medical conditions like getting


Dr. H. B. Jayasinghe

over addictions to alcohol, drugs etc and stammering, told a fair gathering of professionals and others in Colombo last week that “re-birth revelations made by patients under hypnotic treatment, is left for the public to believe or not”.

Dr. Jayasinghe was giving a lecture on ‘Re-birth revelations through hypnotism,’ and was responding to a question asked by a member in the audience whether the doctor believed in the re-birth revelations made by the patients given under the hypnotic state.

He said in several countries there is research going on, or this subject, and a final conclusion has not yet been made, as it takes a lot of time checking and re-checking on these revelations and in some cases it appears to be correct.

However until these research findings are finalised and concluded as a medical professional he (Dr. Jayasinghe) could not say scientifically whether he believed in these revelations yet.

Dr. Jayasinghe in the course of this lecture which was sponsored by the Sri Lanka Medical Association (SLMA) in association with Healthwatch, and was held at the SLMA Lional Memorial auditorium on May 31st.

Detailed story next week


Reuters Health News Summary

Following is a summary of current health news briefs.

Anti-clot drug combinations boost bleeding risks

Heart patients are often given two or three different drugs to prevent life-threatening blood clots but these combinations can double, triple or even quadruple the risk of stomach or intestinal bleeding, U.S. researchers said on Tuesday. Clot-preventing drugs such as aspirin, warfarin or Coumadin and clopidogrel or Plavix sold by Bristol-Myers Squibb and Sanofi-Aventis are increasingly being given to heart patients in combinations.

“Extreme” drinking puts college students at risk

Extreme binge-drinking may be putting college students at significant risk of accidents and injuries, a new study suggests. Researchers found that among more than 2,000 college students with drinking problems, those who admitted to “extreme” drinking — eight or more drinks in day for men, five or more for women — were more likely than their peers to have suffered a recent alcohol-related injury.

Stool test shows promise in detecting many cancers

Using just a stool sample, doctors may now be able to detect colon and many other cancers of the digestive tract including stomach, pancreatic, bile duct and esophageal cancer, U.S. researchers said on Tuesday.

They said a new test, which detects genetic material shed from the surface of cancer cells, found nearly 70 percent of assorted digestive tract cancers.

More eyeglasses could help global economy: WHO

Giving away free glasses is a cheap way of boosting the global economy with billions of dollars lost every year due to visual impairments, the World Health Organization (WHO) said on Tuesday.

An estimated 153 million people worldwide have impaired vision due to untreated eye conditions such as near or farsightedness that can cause blurred vision, researchers from around the world reported in the WHO Bulletin journal.

Heart drug may block breast cancer gene

A gene that is highly active in up to 20 percent of breast cancer cases might be blocked by a generically available blood pressure drug, U.S. researchers reported on Tuesday. The gene, called AGTR1, caused normal breast cells to behave like cancer cells but the blood pressure drug losartan stopped them, the team at the University of Michigan found.

Coffee seen OK for diabetic men

Drinking even fairly high amounts of coffee does not raise the risk of developing heart diseases in diabetic men or increase their risk of dying early, according to a brief report in the medical journal Diabetes Care.

Although research involving people in the general population has suggested no harmful effects on the heart from drinking coffee, there’s been little information about any effect in people with diabetes, Dr. Rob M. van Dam and colleagues point out. Recently, however, there has been evidence suggesting that coffee consumption may impair diabetics’ ability to process glucose.


‘Space headaches’ come out of the blue

Astronauts who have no history of bad headaches can be prone to disabling attacks while in space, a phenomenon that suggests “space headaches” deserve a medical category all of their own, neurologists said on Tuesday.

Contrary to prevailing theories, headaches in space are not caused by motion sickness, they said.

Instead, the problem could lie in an increase in blood flow to the head, causing painful pressure on the brain.

A team led by Alla Vein at the Leiden University Medical Centre in the Netherlands asked one female and 16 male astronauts aged from 28-58 who had stayed aboard the International Space Station (ISS).

Nine had taken part in short missions of 11 days on average, and eight had taken part in long-duration trips, averaging just under 202 days.

Twelve of the 17 astronauts reported 21 headaches. Nine headaches occurred during launch, nine during their stay at the ISS, one during a sortie outside the station and two during landing.

Two-thirds of the headaches were of moderate intensity, and most of the others were mild. Six percent were severe. One astronaut described feeling so unwell that the only solution was to roll up in a sleeping bag and spend most of the day sleeping.

But none of the astronauts had any history of recurrent headaches on Earth.

All had been tested and found to be in excellent health before their flight.

In addition, none of the headaches appears to have been caused by motion sickness, whose symptoms are typically nausea, vomiting and vertigo. Only two of the headaches, both of them occurring during launch, matched international criteria for migraines. Asked to describe the headache, the astronauts mostly said the symptoms were “exploding” or “heavy feeling.”

This chimes with previous research which shows that blood volume in the upper body is redistributed when a body floats in zero gravity, the doctors believe.

A shift of blood towards the brain could cause a painful increase in pressure within the skull, suggests the paper.

Zero gravity is linked to inadequate oxygenation of the body, and this could also be a “plausible trigger,” it adds.

Astronauts are traditionally reluctant to reveal all the physical complaints they experience in space, partly out of fear that this may prevent them from making future missions on medical grounds. In this case, the respondents were guaranteed anonymity.

AFP


Poor eyesight costs world economy 121bn dollars: study

Failure to address impaired eyesight is costing the world economy an estimated 121.4 billion dollars in productivity losses, according to research published by the World Health Organisation on Tuesday.

An estimated 158 million people suffer from uncorrected or undercorrected eyesight, including 8.7 million who were blind in 2007, according to an independent study by researchers in Australia, South Africa and the United States.

“If each affected person was provided with appropriate eyeglasses, we estimate that there may be a net economic gain, even if up to 1,000 dollars was spent per person to do this,” said one of the authors, Tasanee Smith, of the John Hopkins Bloomberg School of Public Health in the United States.

The study estimated that the global loss in productivity due to impaired vision or blindness reached up to 427.7 billion dollars before being adjusted for employment rates and age.

However, the full cost of remedying eyesight deficiencies through provision of eyeglasses, surgery or other medical interventions was unknown.

AFP


Harvard University study reveals:

Unhealthy lifestyles cause for Diabetes

The results of a Harvard University research study carried over a period of 10 years and published in Archives of Internal Medicine (April 2009, 169.798-807) has shown that the majority of new diabetes cases (9 out of 10) are a result of ‘unhealthy lifestyles’.

Former Senior Advisor WHO, and Consultant Paediatrician Dr. Terence Perera has sent us the following short article on this.

Unhealthy Lifestyles in the Elderly and Diabetes Mellitus

The combined impact of several lifestyle risk factors on the incidence of diabetes mellitus in a general population of older adults in the US has been studied by Harvard University researchers, and the findings of the study published in the Archives of Internal Medicine (April 2009. 169:798-807).

This research study carried out in a sample of nearly 5000 American men and women 65 years and older (mean age 72 years), over a period of ten years has shown that 9 out of 10, of new cases of diabetes mellitus are a result of unhealthy lifestyles.

Lifestyle factors linked to incidence of diabetes include physical activity level, dietary habits, body weight level, alcohol use and smoking habits.

In combination these basic lifestyle risk factors strongly predicted diabetes incidence with approximately 50% lower risk with only physical activity level and dietary habits in the lower risk group and approximately 80% lower risk with physical activity level, dietary habits, smoking habits and alcohol use in lower risk group, and 90% lower risk with all five factors in the low risk group.

Thus, 9 out of ten new cases of diabetes might have been prevented if all older adults were in the low risk group for these lifestyle factors.

These findings, suggest that even later in life, the great majority of cases of diabetes mellitus are related to lifestyles.

To be continued


Laughter the best medicine

After effects

“How did it happen?” the doctor asked the middle-aged farmhand as he set the man’s broken leg.

“Well, doc, 25 years ago ...”

“Never mind the past. Tell me how you broke your leg this morning.”

“Like I was saying...25 years ago, when I first started working on the farm, that night, right after I’d gone to bed, the farmer’s beautiful daughter came into my room. She asked me if there was anything I wanted. I said, “No, everything is fine.”

“Are you sure?” she asked.

“I’m sure,” I said.

“Isn’t there anything I can do for you?” she wanted to know.

“I reckon not,” I replied.

“Excuse me,” said the doctor, “What does this story have to do with your leg?”

“Well, this morning,” the farmhand explained, “when it dawned on me what she meant, I fell off the roof!”

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