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| News and Notes: New Treatments for Lower Back Pain Overall Message of Hope for Chronic Pain Sufferers March 24, 2003 (Chicago) -- For years, David K. went to specialist after specialist in hopes of finding the cause of his lower back pain. When no cause was found and medication didn't relieve his symptoms, he learned to live with the pain that kept him from some of his favorite activities and made going to work difficult, if not impossible. Unfortunately, this is an all too common tale among the 26 million-plus people with lower back pain. Another common form of pain, osteoarthritis, can be equally debilitating, and like lower back pain, there was little effective treatment for the symptoms of osteoarthritis, but times are slowly changing. For these reasons, Congress decreed this the Decade of Pain Control and Research. Pain experts from across the globe convened this week in Chicago for the annual meeting of the American Pain Society (APS) to discuss the latest and greatest treatments in chronic lower back pain and pain from osteoarthritis symptoms, as well as some of the roadblocks to better care. Here's what they had to say on what's hot and what's not: The Opiod Dilemma. Opiods such as methadone, morphine, and other narcotics are some of the most effective chronic pain medications. However, they are not without their share of problems, namely addiction potential. For this reason, many doctors are reluctant to prescribe them. But new tools such as the Screener for Opiod Addiction Potential (SOAP) may help effectively channel appropriate pain relief to those who need it most. When completed, SOAP aims to help doctors screen patients for addiction potential. Also, in the future doctors may be able to give a lower dose of an opiod with an NMDA (N-methyl-D-aspirate) receptor antagonist drug, says APS president Richard Payne, MD, chief of pain and palliative care service at Memorial Sloan-Kettering Cancer Center in New York. "Activating the NMDA receptors in the spinal cord may stop or minimize opiod tolerance and physical dependence and provide pain relief with a lower dose of an opiod drug," he says. "When it comes to treating pain, multi-modality therapy is the current thinking, which means physical therapy, muscle relaxants, stretching exercises, and biofeedback -- anything to help alleviate pain -- and opiates have a role," says Martin E. Hale, MD, medical director of Goldcoast Research and an orthopedic surgeon in Plantation, Fla. |
Male Smokers Risk Stroke
Quit Smoking, You'll Cut Stroke Risk in Half
March 27, 2003 -- Here's more ammunition to quit smoking: Men who smoke increase their risk of stroke -- especially a hemorrhagic stroke, which involves a burst blood vessel in the brain.
The finding appears in the March issue of Stroke: Journal of the American Heart Association.
The study, which involved more than 22,000 male doctors, tracked the number of strokes for nearly 18 years. The doctors participating in the study also provided information on their smoking habits -- whether they never smoked, had quit smoking, or if they currently smoked -- and how many cigarettes they smoked daily.
About 12% of all strokes are hemorrhagic strokes, and 38% are fatal within 30 days, according to the AHA.
Smoking has already been identified as a risk factor for ischemic stroke -- which occurs when the blood supply to the brain becomes blocked. The researchers wanted to find out if smoking increased the risk of hemorrhagic strokes. Specifically, they look at hemorrhagic strokes that bled inside the brain -- called intracerebral hemorrhage -- instead of between the brain and skull.
Smoking seems to damage artery walls, making arteries more prone to rupture, writes lead researcher Tobias Kurth, MD, a Harvard researcher at Brigham and Women's Hospital in Boston.
In 1982, when the study began, 50% of the study participants said they had never smoked and 39% said they had quit smoking. Almost 4% said they smoked less than a pack a day and 7% said they smoked at least a pack a day.
During the next 18 years, 1,069 strokes were reported -- including 139 hemorrhagic strokes.
Those who quit smoking had about the same risk as men who had never smoked. But current smokers had an increased risk of all types of strokes.
"Moreover, the more one smokes, the worse it gets," says Kurth, in a news release.
For men who smoked less than a pack a day, there was a 60%-65% increase in the risk of intracerebral hemorrhage. But those who smoked more than a pack daily had more than twice the risk of intracerebral hemorrhage compared with men who never smoked.
Men who quit smoking seemed to decrease risk of these strokes, Kurth says.
Despite the numerous attempts at improving the prognosis of stroke patients, hemorrhagic stroke still has high long-term disability and death rates. These results add to the multiple health benefits that can accrue by efforts to quit smoking, write the authors.
More Sex Tied to Higher Prostate Cancer Risk
Inflammation From Gonorrhea May Make Men More Susceptible
May 11, 2004 --Men who have had multiple sexual partners -- and particularly those who get gonorrhea -- are more likely to also get prostate cancer, say researchers.
For some time, research has known that women who have multiple sexual partners and get certain sexually transmitted diseases (STDs) have a higher risk of getting cervical cancer.
Now a study from the University of Michigan presented in San Francisco at the annual meeting of the American Urological Association, shows that men involved in the same behaviors may have an increased risk of getting prostate cancer, particularly if they get gonorrhea.
"These preliminary findings, among African American men, show that a history of gonorrhea increases their risk of getting prostate cancer," researcher Aruna V. Sarma, PhD, tells WebMD.
"We don't know why, but the inflammation involved may make them more susceptible. As we study this issue further, we'll also look at other infectious sexually transmitted diseases, such as viruses, to see if they play a role, too," says Sarma who is an epidemiologist and assistant research scientist in epidemiology and urology at the University of Michigan in Ann Arbor, Mich.
She and her team were interested in studying prostate cancer risk factors in black men because they get this cancer more often than white men do, and when they are diagnosed, they tend to have more advanced cancer. Other researchers have speculated that sexual behavior and a history of STDs may be related to prostate cancer risk.
The researchers examined the associations between sexual activity, STDs, and prostate cancer risk. They compared 117 black men with prostate cancer with 719 black men without the disease. The men were aged 40 to 79 years old.
Frequent Sex May Increase Risk
Men who had had more than 20 sexual partners were more than three times more likely to be diagnosed with prostate cancer, compared with men with five or fewer partners, Sarma says. In addition, men who had sex two to three times a month had more than double the prostate cancer risk, compared with men who had not been sexually active in the previous 12 months. Having sex two to three times a week more than tripled prostate cancer risk.
The findings show how important it is for patients to participate actively in their health and give doctors the information they need to screen for prostate cancer risk, Isaac D. Powell, MD, tells WebMD. "I tell patients that they need to take charge of their health." Powell, who was not involved in the current study, is a professor of urology at the Karmanos Cancer Institute of Wayne State University in Detroit.
By the same token, patients need to be willing to share such information with their doctors, even if cultural barriers make such disclosures awkward. "There's growing evidence that prostatitis and inflammation can be risk factors for prostate cancer, and so the reason for the physicians asking such questions is sound," he says.
Cranberry Juice Fights Heart Disease
Berries' Antioxidants Raise "Good" Cholesterol, Lower "Bad"
March 24, 2003 -- Drink up -- cranberry juice, that is. Cranberry juice loads the blood with lots of disease-fighting antioxidants. It also appears to improve some cholesterol components, which are beneficial in fighting heart disease.
The first long-term study of its kind -- looking at cranberry juice's effects on cholesterol -- finds that two glasses a day raises levels of HDL "good" cholesterol and lowers levels of high LDL "bad" cholesterol. The study also shows a significant increase in antioxidants in the blood.
The study was presented at the annual meeting of the American Chemical Society held in New Orleans this week.
Researchers have long suspected that antioxidant-rich cranberry juice may help lower risk of heart disease. However, this is the first study looking at the effects among people drinking the juice.
Besides heart disease benefits, previous studies have shown that cranberries can help prevent urinary tract infections and may reduce the risk of gum disease, stomach ulcers, and cancer.
Studies of dried cranberries have also shown that the fruit contains more antioxidants called phenols than any of 20 commonly consumed fruits, writes lead researcher Joe Vinson, PhD, of the University of Scranton in Pennsylvania. "We have shown that...cranberry ranks behind dates but ahead of raisins, plums, and apricots.
"Cranberry juice is higher in phenol antioxidants than other fruit juices with the exception of grape juice," he adds.
In this current study, Vinson measured cholesterol levels of 19 people with high cholesterol who were not taking cholesterol-lowering drugs. Ten drank cranberry juice with artificial sweetener. The others drank cranberry juice with regular sugar. Both drinks had about 27% pure cranberry juice, like the brands available at the supermarket.
Each drank one eight-ounce glass daily for the first month, then two glasses a day for the next month, then three glasses a day for the third month. Their cholesterol was tested monthly.
Overall cholesterol levels did not change; however, levels of high-density lipoprotein ("good" cholesterol) appeared to increase significantly -- by as much as 121% -- after two or three glasses of juice a day, Vinson reports.
Orange juice is also a good antioxidant-booster -- but not as powerful as cranberry juice, he adds.
The researchers say their findings underscore the government health recommendations that more fruit and vegetables be part of a healthy diet. Two servings per day of cranberry juice significantly improved LDL and HDL cholesterol, two important parameters that may decrease the risks of heart disease.
Hair Loss
Topic Overview
My hair is falling out. Am I going bald?
Everyone experiences some hair loss every day. In fact, it is normal to lose up to 100 hairs a day. However, for many people, hair loss becomes worrisome. Excessive hair loss can be caused by factors such as genetics, disease, injury, or old age, all of which affect the normal growth cycle of hair.
Why am I losing my hair?
The most common type of hair loss is androgenetic alopecia, also called male-pattern hair loss and female-pattern hair loss. In this case, you inherit the tendency to go bald from either or both of your parents. In both women and men, genes trigger a sensitivity to a class of hormones called androgens, including testosterone, which causes hair follicles to shrink. Shrinking follicles, the sheath that surrounds the root of a hair, produce thinner hair and eventually none at all. In men with androgenetic alopecia, hair loss occurs in a typical pattern on the forehead area and on top of the head. In women with androgenetic alopecia, hair loss occurs throughout the scalp with overall thinning of hair.
Are there other types of hair loss?
Other, less common types of hair loss can cause clumps of hair to fall out or hair thinning and may be caused by an illness. These include the following:
Alopecia areata is an autoimmune disease in which inflammatory cells attack hair follicles, resulting in distinct, round patches on any area of the scalp or body. Severe cases involve extensive bald patches of hair or complete loss of hair on the scalp or body, although in some cases there is hair thinning without distinct patches of baldness.1 Hair that grows back may be white at first and later regain the original color.
Trichotillomania is an impulse control disorder (as are compulsive gambling and compulsive stealing), in which there is an inability to resist urges to pull out one's scalp hair, eyelashes, eyebrows, or other hair. There is usually mounting tension before pulling and a feeling of relief afterward. Trichotillomania often results in noticeable hair loss.
Traction alopecia involves hair loss around the edge of the hairline and is especially noticeable around the face and forehead. It is caused by hairstyles that pull hair too tight; for example, tight braids or tight ponytails can cause hair loss.
Telogen effluvium involves widespread hair thinning over the scalp or other areas of the body. It is caused by changes in the growth cycle of hair. Large numbers of hairs enter the resting phase of hair growth, which causes shedding and thinning. This change in the growth cycle of hair is often caused by mental stress or physical stress, such as poor nutrition, injury, or surgery. This is a noninflammatory condition, so the skin appears normal.
How will my doctor identify what is causing my hair loss?
The most common type of hair loss, androgenetic alopecia, occurs in distinct patterns that can be recognized by your doctor. Tests, such as hair and scalp analysis or general blood tests to identify a disease source, may be done if the diagnosis of your hair loss is unclear.
What can be done about hair loss?
Many people seek treatment for hair loss, and there are several different types of treatment, which vary in effectiveness. Examples of treatment include taking medication to reduce hair loss, wearing a hairpiece, or having hair transplant surgery to cover bald areas. Research on medications that promote hair growth is ongoing, and more effective medications may become available soon.
Hair loss usually does not directly affect your physical health, although it may be a sign of a medical problem and it can be upsetting and influence your self-esteem.
The most common type of hair loss,
androgenetic alopecia, occurs in distinct patterns that is readily recognizable, so testing is usually not needed in these cases.To determine the cause of your hair loss, your doctor may ask you about:
| Characteristics of your hair loss. Is your hair thinning,
with your scalp becoming more visible, but your hair is not noticeably
falling out? Or is your hair shedding, with lots of hair falling out?
| How long your hair loss has been occurring. How long has it
been since you had your normal amount of hair?
| Your family history of hair loss. Does your mother or
father, brother or sister, or any other relative have hair loss? If so, what
pattern of hair loss?
| Your hairstyling habits. Has your hair become fragile from
pulling it too tight or from other hairstyling habits? Have you had any
chemical treatments to your hair, such as perms or bleaching? Do you use a
blow-dryer that may be too hot?
| Any recent illness. Have you had any skin rashes, such as
ringworm, recently?
| Medications you are taking. Are you taking blood thinners
or medications for arthritis, depression, or heart problems? Have you had
any cancer treatment?
| Your diet. Are you getting enough protein in your diet? | |
Your doctor will also do a physical exam to look at the pattern of your hair loss. Male-pattern hair loss or female-pattern hair loss has one of two distinct patterns. Men tend to lose hair from the forehead area and top of the head with normal amounts of hair on other areas of the scalp. Women tend to have uniform thinning of hair throughout the scalp.
If the diagnosis of your hair loss is unclear, tests may be done. Testing includes analysis of the pattern of hair loss, number of hairs, or gently pulling the hair to see how much hair is shedding. Samples of your hair or scalp may be taken for lab analysis (for example, to detect the presence of a fungal infection). Your doctor may want to remove a small sample of scalp tissue so it can be examined under the microscope (scalp biopsy). General blood tests may be done to identify a disease, such as thyroid disease, that may be causing your hair loss.
Hair loss in women is more difficult to diagnose than it is in men because the pattern of hair loss is not as distinct as it is in men and because there are other conditions in women that could cause the same symptoms. However, for a woman with mild to moderate hair thinning who is otherwise healthy (with normal menstrual cycles and fertility history), testing to diagnose hair loss usually is not done.
