DG Journal Club
Extended opioid usage occurred in older patients, aged 60 years and up, who undergo fracture surgery, according to a study presented at the 2021 Virtual Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).
Investigators looked at 29,618 patients who were naïve to opioids and underwent hip fracture surgery between 2009 and 2018 at 1 of 35 hospitals in the Kaiser Permanente health maintenance organisation. They followed patients to determine opioid usage, classifying patients according to filling prescriptions in 3 time periods: 0 to 30 days after surgery, 31 to 90 days after surgery, and 91 to 180 days after surgery. Patients had a median age of 82 years and 70.7% were female.
“While prior studies have found prolonged opioid usage and addiction to be risks for young patients who sustain fractures and undergo surgery, most studies of opioids in older patients have focused on short-term risks such as oversedation and delirium,” said Kanu Okike MD, Hawaii Permanente Medical Group, Honolulu, Hawaii. “Our hypothesis was that prolonged opioid usage could be a risk for older patients as well.”
The investigators found that the proportion of opioid usage was 83.7% in the first time period, 69% in the second time period, and 16.7% in the third time period. A total of 3,137 patients died before the second time period.
Risk factors that emerged for persistent opioid usage included being aged 60 to 69 years, being female, having a body mass index of at least 30, current or past smoking, a history of substance abuse, and an American Society of Anesthesiologists physical status classification of at least 3, denoting a patient with severe systemic disease.
Investigators also looked at the impact of surgery type and found ongoing opioid usage was more common in those who underwent fracture fixation (2,794/15,796) and less common in those after total hip arthroplasty (94/717), with both compared to hemiarthroplasty (1,488/9,542).
The findings suggest about 1 of every 6 older patients who had surgery for hip fracture were still taking opioids for pain 3 to 6 months postoperatively.
“Specific guidelines for the duration of opioids after hip fracture do not exist, but some have suggested that four weeks may be a reasonable target for weaning patients off opioid pain medications following fracture surgery,” said Dr. Okike.
He noted the retrospective nature of the study limits the robustness of the findings.
“Our findings should be taken to represent association and not necessarily causation,” said Dr. Okike. “We controlled for a variety of confounders, but there is still the possibility of residual confounding or incomplete controlling.”
DG Journal Club
AIMS To identify the prevalence, clinical and functional factors associated with urinary symptoms (US) in community-dwelling older adults with acute low back pain (LBP).
METHODS This was a cross-sectional study of data’s baseline of Back Complaints in the Elders Consortium. All elders had LPB heightened. We analyzed data on urinary symptoms, intensity of pain (Numerical Rating Scale (NRS), disability (Roland Morris [RM]), depressive symptoms (CES-D), and gait speed (m/s) in the Brazilian older adults. The sample was of 586 consecutive participants of BACE-Study. Ethical approval was obtained. In addition to the prevalence analysis, logistic regression analysis was performed.
RESULTS The prevalence of US was 18.4% and were associated with CES-D (odds ratio [OR] = 2.84; 95% confidence interval [CI]1.66-4.86), slower gait speed (OR = 0.33; 95% CI 0.14-0.78), and LBP-related disability (OR = 1.09; 95% CI 1.04-1.13) after adjusting for radiculophaty and other confounding factors.
CONCLUSIONS In community-dwelling older people with LBP, US were associated with depressive symptoms, gait speed, and disability. Our findings may provide a new framework for US management with respect to clinical and functional capacity. Specific physical examinations should be encouraged to assess the with acute LBP and US. Others factors can be associated with US in elders with LBP.
Young adults who regularly use marijuana are much more likely to have had a myocardial infarction (MI), according to new data published in Canadian Medical Association Journal.
“With recent legalization and decriminalization, cannabis use is increasing in young adults in North America, and we do not fully know its effects on cardiovascular health,” lead author Karim Ladha, MD, a clinician scientist at Unity Health Toronto. “We found an association between recent cannabis use and MI, which persisted across an array of robust sensitivity analyses. Additionally, this association was consistent across different forms of cannabis consumption, including smoking, vaporization, and other methods such as edibles. This suggests that no method of consumption is safer than another in this regard.”
The study included more than 33,000 adults between the ages of 18 and 44 years old. Seventeen percent reported using marijuana in the past 30 days. Data was extrapolated from the 2017 and 2018 cohorts of the American Behavioral Risk Factor Surveillance System, a survey of U.S. adults.
According to the authors, a history of MI was reported by 1.3% of marijuana users and 0.8% of nonusers.
Also, compared with nonusers, the prevalence of recent marijuana use was higher among males, unmarried respondents, current combustible cigarette users, current e-cigarette users and heavy alcohol drinkers.
“The large sample size, generalizability and detailed data on cannabis consumption of this cross-sectional study provide unique insight into this growing public health concern” David Mazer, MD, a clinician scientist at Unity Health Toronto, said in the same press release. “Further studies and more data are needed to confirm these findings and elucidate the mechanisms contributing to cannabis-associated cardiovascular outcomes.”
An important limitation
One of the study’s key limitations is that researchers lacked information on what, exactly, came first: the marijuana use or the heart attack.
“We were unable to differentiate between participants who began using cannabis before having an MI, and those who began using cannabis after having an MI,” the authors wrote. “However, the plausibility of our association is strengthened by a similar association between recent cannabis use and history of stroke from the same data set. Additionally, MI leading to cannabis use (reverse causation) is unlikely, and the elevated odds observed among more frequent users may provide evidence of a biologic gradient for this association. Regardless, healthcare professionals need to be aware that a relationship between any recent cannabis use and history of MI exists.”
The association between obesity, or elevated body mass index (BMI), and outcomes in patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) has not been well established. Recent studies in patients receiving venovenous ECMO did not detect an association between obesity and increased mortality. The purpose of this retrospective observational study is to evaluate the association between BMI and survival in patients receiving VA-ECMO for cardiogenic shock.
All patients >18 years of age supported on VA-ECMO for refractory cardiogenic shock in a single academic center between 2009 and 2019 were included. ECMO outcomes, including successful ECMO decannulation and 30-day survival, were analyzed after stratification according to BMI. Multivariable and univariate logistic regression were used to assess the association between BMI and VA-ECMO outcomes.
Of the total patients (n = 355) cannulated for VA-ECMO, 61.7% of the patients survived to ECMO recovery/decannulation, 45.5% of the patients survived to 30 days after ECMO decannulation, and 38.9% of the patients survived to hospital discharge with no statistically significant differences among the BMI groups. Multivariable logistic regression did not reveal any associations between obesity as defined by BMI and survival to ECMO decannulation (odds ratio [OR] 1.07 per 5 unit increase in BMI, 95% confidence interval [CI], 0.86–1.33; P = .57), 30-day survival (OR = 0.91, 95% CI, 0.73–1.14; P = .41) or survival to hospital discharge (OR = 0.95, 95% CI, 0.75–1.20; P = .66).
Despite potential challenges to cannulation and maintaining adequate flow during ECMO, this single centered, retrospective observational study did not detect association between BMI and survival to ECMO decannulation, 30-day survival, or survival to hospital discharge for patients requiring VA-ECMO for refractory cardiogenic shock. These data suggest that obesity alone should not exclude candidacy for VA-ECMO.
The primary outcome in this retrospective study was survival of the ECMO therapy (survival to ECMO decannulation), defined as surviving >24 hours after decannulation without a withdrawal of care. Secondary outcomes included survival at 30 days and survival to hospital discharge.
Author: Tony Mira
The Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced $25.5 billion in new funding for health care providers affected by the COVID-19 pandemic. This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic.
The application will open on September 29, 2021. Providers will apply for both programs in a single application and HRSA will use existing Medicaid/CHIP and Medicare claims data in calculating portions of these payments.
• Phase 4 General Distribution – $17 billion will be distributed based on providers’ lost revenues and changes in operating expenses from July 1, 2020 to March 31, 2021.
To promote equity and to support providers with the most need, HRSA will:
● Reimburse a higher percentage of lost revenues and expenses for smaller providers as compared to larger providers.
● Provide “bonus” payments based on the amount of services provided to Medicaid, CHIP, and Medicare patients, priced at the generally higher Medicare rates.
American Rescue Plan (ARP) Rural — $8.5 billion based on the amount of services providers furnish to Medicaid/CHIP and Medicare beneficiaries living in Federal Office of Rural Health Policy (FORHP)-defined rural areas.
• Providers can review eligibility information posted on the PRF Future Payments web page Additional detail will be added prior to September 29.Providers can review eligibility information posted on the PRF Future Payments web page Additional detail will be added prior to September 29.
• HHS also released detailed information about the methodology utilized to calculate Phase 3 payments. Providers who believe their Phase 3 payment was not calculated correctly according to this methodology will now have an opportunity to request a reconsideration.
Grace Period for Reporting Period 1
In light of the challenges providers across the country are facing due to recent natural disasters and the Delta variant, HHS is also announcing a final 60-day grace period to help providers come into compliance with the September 30, 2021 deadline for the first PRF Reporting Time Period. While the deadlines to use funds and the Reporting Time Period will not change, HHS will not initiate collection activities or similar enforcement actions for noncompliant providers during this grace period.
Author: Alyssa Peckham
Opioids are drugs that people use to treat pain and certain other complaints. Opioids can derive from natural sources, and people can make them synthetically. There are several types of opioids available, some of which are illegal.
People mainly use opioids as pain relief medications. A person can purchase cough syrup containing codeine, which is an opioid, without a prescription. However, only doctors can prescribe stronger opioids.
Misusing opioids can cause a person to become addicted to or physically dependent on them. The United States government classes many opioids as controlled substances.
Authorities class some illegal drugs, such as heroin, as opioids. Misusing legal or illegal opioids can lead to serious side effects and even death.
This article will explore what opioids are, the different types of opioids, and how to get help for addiction or overdose.
Opioids are drugs that occur naturally in the opium poppy plant. People can also make certain opioids using the opium poppy itself. Manufacturers make synthetic opioids by using the chemical structure of the opium in the poppy.
Most people use opioids to treat pain. People can also use opioids to treat conditions such as coughing.
Opioids can trigger a large release of dopamine within the body. Dopamine is a neurotransmitter, which is a chemical messenger that transmits signals from nerve cells to other cells in the body.
Dopamine plays an important role in a person’s mood and can help a person feel happy.
Various classifications of opioids exist. Some opioids are available over the counter, while some are only available with a prescription. Opioids that the Food and Drug Administration (FDA) has not approved for medical use are illegal to possess or take.
The following sections will look at some different classifications of opioids in more detail.
A doctor may prescribe a person opioids for pain relief.
Prescription opioids can also cause feelings of euphoria and relaxation. It is important that a person follows the doctor’s advice when taking opioids.
The Drug Enforcement Administration (DEA) classes drugs into five different categories, or Schedules. The Schedule classification that a drug falls into depends on its:
- use as a medication
- likelihood to be misused
- likelihood to cause dependency
The lower the Schedule number, the more dangerous the drug is.
There are several types of opioids that the U.S. government classes as Schedule II drugs. Schedule II drugs have a high potential for misuse. Additionally, Schedule II drugs have the potential to cause severe psychological or physical dependence.
Many prescription opioids are classed as Schedule II drugs. If a doctor prescribes a person a Schedule II opioid, it is important that they follow the doctor’s advice when taking it.
A person should never share their prescribed medication with anyone else. Not only is this against the law, but it can also be extremely dangerous.
Illegal opioids include those that are illegal to use in any capacity and those that are illegal without a prescription.
Illegal opioids have no medical indication. People can misuse these, placing them at increased risk of addiction. Misusing illegal opioids can lead to severe side effects, including liver disease, overdose, and death.
Each type of prescription opioid is available under a brand name. Illegal opioids usually have multiple different informal or slang names. Law enforcement officials and others sometimes call these informal names “street names.”
The following sections will look at some of these names in more detail.
Prescription opioids can be opioid-only drugs, or they can contain additional drugs. The addition of other drugs in opioid combination products can help with pain relief or other symptoms.
There are various types of prescription opioids available, including those in the table below.
|Generic name||Brand names||Forms|
|Oxycodone||OxyContin, Roxicodone, Percocet, Oxaydo, Xtampza||Tablet, extended-release tablet, capsule|
|Hydrocodone||Vicodin, Norco, Lortab, Zohydro ER, Hysingla ER||Tablet, extended-release tablet, capsule, syrup, solution, suspension|
|Codeine||Prometh VC||Tablet, syrup, injection|
|Morphine||MS Contin, Kadian, Duramorph||Tablet, extended-release tablet, extended-release capsule, solution, injection, rectal suppository|
|Hydromorphone||Dilaudid||Tablet, extended-release tablet, solution, rectal suppository|
|Fentanyl||Actiq, Fentora, Duragesic, Subsys, Lazanda, Sublimaze||Tablet that dissolves in the mouth, lozenge, mouth spray, nasal spray, patch on the skin, injection|
|Meperidine||Demerol||Tablet, syrup, injection|
|Opium tincture (Rx only)||N/A||Tincture|
|Tramadol||Ultram, Ultracet, Conzip||Tablet, extended-release tablet, capsule|
|Buprenorphine||Buprenex, Butrans, Probuphine, Belbuca, Suboxone, Zubsolv, Bunavail||Tablet or film that dissolves in the mouth, implant, injection, patch on the skin|
Generally, only doctors can administer injections of Schedule II opioids.
People cannot legally make, sell, or distribute illegal opioids. For this reason, illegal opioids do not have brand names.
However, there are some common alternative names for certain illegal opioids, including those in the table below.
|Generic name||Other names||Forms|
|Heroin||Dope, smack, H, junk, snow, skag, horse, China white, brown, beast, hero||Powder, tar-like substance|
|Carfentanil||Drop dead, C 50, serial killer||Powder|
|Opium||Aunti, Aunti Emma, big O, black pill, chandu, Chinese molasses, dopium, dream gun, gee, fi-do-nie, guma, midnight oil, zero||Liquid, powder, solid block|
Carfentanil is a drug that people use to sedate large animals, including bears and elephants. It is illegal for a human to consume carfentanil.
“Opioid” is an umbrella term that covers both synthetic and natural opioid drugs.
On the other hand, “opiate” only to natural drugs derived from the opium poppy. This means that all opiates are a form of opioid, but not all opioids are opiates.
Prescription opioids are generally safe to take for short periods of time. However, due to their effect on pain levels and mood, prolonged use may lead to physical dependence. When a person has a physical dependence on a drug, they cannot function normally without it.
According to 2016 information from the Centers for Disease Control and Prevention (CDC), over 11.5 million people in the U.S. reported misusing prescription opioids in the previous year.
Illegal opioids are prone to misuse, and misuse increases a person’s risk of developing an addiction. According to the 2019 National Survey on Drug Use and Health, around 745,000 people in the U.S. had used heroin during the past year.
A person who uses opioids regularly or who knows someone who does should look out for signs of addiction. Doctors call this opioid use disorder.
The sections below will look at opioid use disorder and overdose in more detail.
Opioid use disorder
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the 11 criteria for diagnosing opioid use disorder are as follows:
- The person often takes opioids in larger doses or over a longer period of time than they may intend.
- The person has a persistent desire to cut down or control opioid use or has experienced unsuccessful efforts to do so.
- The person spends a great deal of time on activities necessary to obtain the opioid, use the opioid, or recover from the opioid’s effects.
- The person has cravings for opioids. A craving is a strong desire to use something.
- The person experiences recurring opioid use that results in not being able to fulfill major role obligations at work, school, or home.
- The person experiences continued opioid use despite having recurrent or persistent interpersonal or social problems that are caused or made worse by the effects of opioids.
- The person reduces or completely gives up important social, occupational, or recreational activities due to their opioid use.
- The person experiences recurring opioid use in situations wherein opioid use poses a physical hazard.
- The person experiences continued use despite knowing that they have a persistent or recurrent physical or psychological problem that opioids have likely caused or made worse.
- The person has developed a tolerance, as defined by either of the following:
- a need for markedly increased amounts of opioids to achieve intoxication or the desired effect
- a markedly diminished effect with continued use of the same amount of an opioid
- The person experiences withdrawal, as manifested by either of the following:
- the characteristic opioid withdrawal syndrome
- taking the same, or a closely related, substance to relieve or avoid withdrawal symptoms
People should watch out for the signs listed above in themselves and others, and they should speak with a doctor if they think that they or someone else may be displaying any signs of opioid use disorder.
Overdosing can be a serious side effect of opioid misuse. According to the CDC, around 70% of drug overdose deaths in 2019 involved an opioid.
Some symptoms of opioid overdose include:
- pinpoint pupils
- unconsciousness or unresponsiveness
- difficulty breathing
A person should seek immediate medical attention for someone with these symptoms. Emergency responders can use naloxone to reverse the effects of an opioid overdose.
Although opioid addiction can be difficult to overcome, help is available. The Substance Abuse and Mental Health Services Administration has a directory of opioid treatment programs by state.
Treatment for opioid addiction can include medication and behavioral therapies. Having support from family and friends can also help.
Opioids are drugs that derive from the opium poppy. Opioids can be natural or human-made. Natural opioids are called opiates.
Although opioids are effective pain relievers, people may become dependent on them or develop an addiction. A person should always follow a doctor’s advice when taking opioids.
There are many different types of opioids available. Certain opioids are legal to use with a prescription, whereas others are illegal to use or sell.
If a person experiences symptoms of opioid addiction, they should speak with a doctor. If a person notices any symptoms of an opioid overdose in another person, they should seek medical help immediately.
By Nancy Melville
Critically-ill patients with coronavirus disease 2019 (COVID-19) and/or acute respiratory distress syndrome (ARDS) who are over-sedated are at an increased risk of delirium, regardless of their age, according to a study presented at the 40th International Symposium on Intensive Care and Emergency Medicine.
“This study shows that, besides age, over-sedation represents an important risk factor for delirium in mechanically-ventilated patients, and that over-sedation and delirium were more common in patients with ARDS compared with patients without ARDS,” said Mattia Marchesi, MD, Universitia degli Studi di Brescia, Brescia, Italy.
Deep sedation for critically ill patients with COVID-19 on mechanical ventilation, particularly among those with ARDS, is often necessary; however a balance is necessary to provide the correct depth of sedation while considering the known complications, which can include a higher incidence of delirium.
To compare the incidence of excessive sedation in patients with COVID-19 and/or ARDS and subsequent delirium, Dr. Marchesi and colleagues evaluated data on 78 critically ill patients (21 with COVID-19) requiring intubation and sedation for mechanical ventilation who were admitted to intensive care units at the Spedali Civili University Hospital of Brescia, and the Addenbrooke’s University Hospital, Cambridge United Kingdom, from July, 2018 to April, 2020.
The main intravenous sedatives used included propofol or midazolam, followed by dexmedetomidine and ketamine. For analgesia, fentanyl and remifentanil were primarily administered. For induced muscle paralysis, the most commonly used neuromuscular blocking agents were rocuronium or cisatracurium through continuous infusion, and depth of sedation was monitored with continuous processed electroencephalogram (EEG).
After patients were removed from sedation and reached a Richmond Agitation Sedation Scale (RASS) of -3 or above, delirium was evaluated using the Confusion Assessment Method for the ICU (CAM-ICU), which was applied to all patients every 6 hours during their ICU stay.
With a mean monitoring time of 43 hours in patients with COVID-19 and 50 hours for patients without COVID-19, 38 patients (49%) met the criteria for over-sedation, defined as having a patient state index (PSI) of <30 and a burst suppression ratio (SR) of >2 for more than 10% of the total sedation time.
The results showed that those who had delirium were significantly more likely to have over-sedation (odds ratio [OR] = 11.4; P < .001) and be of older age (OR = 1.04; P = .017). Even after adjusting for age, over-sedation had a significant association with delirium (OR = 8.35; P = .002).
Patients with COVID-19 showed a non-significant higher percentage of delirium versus the group without COVID-19 (92.3% vs 63.4%; P = .076), and, though non-significant, patients with ARDS had a higher incidence of over-sedation (60.5% vs 37.5%; P = .069), and delirium (84% vs 58.6%, P = 0.07) versus patients without ARDS.
Marchesi noted that the high incidence of over-sedation with ARDS could have been because clinicians may have used neuromuscular blocking agents and did not know how deep the sedation level was.
He added that further analysis showed that, in addition to a higher risk of delirium, those who were over-sedated also had a longer length of stay.
“Our study supports the continued use of EEG-derived monitoring systems for the quantification of sedation depth and highlights the necessity for larger, randomised trials to verify if monitoring the depth of sedation can improve outcome,” he said.
Author: Adam Rowden
Multiple sclerosis (MS) is a condition that affects the central nervous system. It disrupts the flow of information between the brain and the rest of the body. In mild cases of MS, people can experience blurred vision, as well as numbness and tingling in the limbs. More severe cases can cause paralysis, vision loss, and mobility problems.
Back pain is another common symptom Trusted Source of MS. There are a number of reasons people with MS may have back pain.
For example, they may experience pain due to damaged nerves. Medical professionals refer to this as neuropathic pain.
An individual may also feel pain as a result of changes in the body due to MS. For instance, MS may cause weakness in a person’s legs, which can affect the way they walk. This in turn may result in back and hip pain.
Other people with MS may have back pain that is not related to MS but to another health problem, such as muscle strains or a herniated disc. People with MS may be less able to compensate for this pain than people without MS, which can worsen the pain over time.
This article will explain the possible causes of and treatment options for back pain in people with MS.
Spasticity is a common symptom of MS. It is the tightness or stiffness of the muscles that also includes a wide range of muscle spasms. It typically occurs in the legs, groin, and buttocks, but it may affect the lower back as well.
There are two main types of spasticity: in flexor spasticity and in extensor spasticity.
In flexor spasticity occurs when the muscles are so tight that they bend the limbs and make it difficult to straighten them.
By contrast, in extensor spasticity develops when the muscles are so tight that the limbs remain straight and become difficult to bend.
A number of factors may aggravate spasticity, including:
- sudden movements
- position changes
- extreme hot and cold temperatures
- tight clothing
Mild spasticity is not painful. However, more severe spasticity can become very painful and make carrying out daily tasks more challenging.
Spasticity can also cause muscle spasms or cramps, which can be severe and cause more discomfort.
Treating and managing spasticity
Spasticity varies from person to person. This means that treatment also tends to differ.
Medical professionals often use the following methods to treat spasticity in people with MS:
- physical therapy
- occupational therapy
Without treatment, spasticity can become more serious and lead to complications, including contractures, which is the name for frozen or immobilized joints, and pressure sores.
If a person has MS and experiences spasticity, they should contact a healthcare professional to discuss treatment options.
MS damages the nerves. This can cause people with MS to feel pain due to a “short-circuiting” of these nerves as they carry signals from the brain to the body.
Medical professionals refer to this pain as neuropathic pain. It is one of the most common symptomsTrusted Source of MS that can dramatically reduce a person’s quality of life.
This type of pain can occur all over the body. If a person has neuropathic pain in their back, it can manifest as a sharp, stabbing, or shooting sensation. A person may also experience a burning sensation in the lower back. This pain can feel as if it moves from the lower back into the leg.
A number of factors may increase a person’s likelihood of experiencing neuropathic pain, including:
- being overheated
Treating neuropathic pain
Anti-seizure medications and certain antidepressants are common Trusted Source treatments for neuropathic pain. Medical professionals use these medications to calm overactive nerves, which can reduce pain.
However, according to the National Multiple Sclerosis Society,the Food and Drug Administration (FDA) has not approved these drugs for use to treat pain that MS causes.
Other methods for treating neuropathic pain include:
- mindfulness and meditation
- cognitive behavioral therapy (CBT)
A 2015 study Trusted Source notes that around 1 in 3 people with MS experience Lhermitte’s sign.
Typically, Lhermitte’s sign means that MS has caused damage to the nerves in the neck. Hyperexcitability, which is an increased firing of nerve fibers in the brain, is another possible cause.
There are some other factors that can increase a person’s risk of experiencing the pain. They include Trusted Source:
- extreme heat
Treating Lhermitte’s sign
Lhermitte’s sign pain is sharp, resembling an electric shock, and does not last long. Usually, the pain resolves on its own over time. That is why healthcare professionals often do not treat the pain itself.
Some evidence Trusted Source suggests that drugs such as carbamazepine, oxcarbazepine, and gabapentin may be useful for some people.
However, for many individuals, education about the triggers of Lhermitte’s sign can help them manage the discomfort.
A medical professional may wish to manage the causes of stress to lower a person’s likelihood of experiencing Lhermitte’s sign.
In some instances, a person may wish Trusted Source to wear a soft neck brace to avoid the neck movements that may trigger the condition.
A person may also wish to wear an electrical stimulating device. These can use a mild electric current to reduce pain signals and relax the neck muscles.
Many people with MS may have muscle and mobility problems that can affect a person’s gait and posture.
Poor posture can cause Trusted Source back pain to develop over time.
MS can also cause pain or a numbing sensation in the legs or feet. A person with MS may then adjust the way they walk, distributing their weight unevenly, in order to compensate for this. By walking in this manner, they may put their back under additional strain, which can cause back pain to develop.
If a person with MS has mobility problems, they can use a cane or other assistive device to walk. However, if they use them incorrectly, this can also put additional strain on the back, potentially causing back pain.
Treating muscle and mobility issues
A person may undergo a variety of treatments to address muscle and mobility problems. Common treatment options include Trusted Source:
- physical therapy
- heat therapy
- training on how to use a specific assistive device
People with MS may have back pain that is unrelated to their MS. However, some causes are more prevalent in people with the condition.
Causes that may particularly affect people with MS
The following possible causes of back pain may affect people with MS.
A herniated disk
Disks in the spine cushion the vertebrae. If a disk ruptures or tears, which medical professionals refer to as a herniated disk, then a person may experience back pain. This is because the nucleus inside the disk pushes outward and can put pressure on nearby nerves.
Healthcare professionals sometimes call herniated disks slipped or ruptured disks. A herniated disk can also cause numbness or weakness in the limbs.
If a person’s sciatic nerve becomes irritated, it may cause pain. Medical professionals call this condition sciatica.
If a person has sciatica, they may experience shooting pain in the lower back and buttocks. They may also experience numbness in the legs and a tingling sensation in their feet and toes.
Arthritis is the general term for joint inflammation. It can affect a person’s joints, the tissues that surround them, and other connective tissue, potentially causing back pain.
A 2016 study Trusted Source reports that people with MS have an increased risk of developing arthritis.
Osteoporosis causes a person’s bones to become weaker and break more easily. This can affect the bones in a person’s spine, which can lead to back pain.
Authors of a 2014 study Trusted Source state there is mounting evidence that people with MS are at a higher risk of developing osteoporosis.
Other causes of back pain
Other causes of back pain include:
- muscle strains
- poor posture
- muscle tension
- muscle spasms
- muscle injury
- kidney problems
Below are a number of ways a medical professional may use to treat back pain in people with MS:
- over-the-counter anti-inflammatory medications, such as ibuprofen and naproxen
- physical therapy
- occupational therapy
- heat therapy
A person may also wish to try certain methods themselves in order to prevent or treat back pain. These include:
- getting regular exercise
- practicing mindfulness and meditation
- avoiding triggers
- improving posture
- correctly using canes or other assistive devices
MS is a condition that disrupts the flow of information between the brain and the rest of the body. This can cause a number of symptoms, including back pain.
There are many possible causes of back pain in people with MS, such as spasticity, muscle tightness, nerve damage, Lhermitte’s sign, muscle issues, and mobility problems.
There are numerous ways a person can treat their back pain, including pain medication, physical therapy, CBT, occupational therapy, and massage.
With the right treatment, a person can manage back pain effectively. A person with MS should discuss back pain and possible treatment options with a doctor.
Cardiotoxicity can be induced by the commonly used amide local anesthetic, bupivacaine. Bupivacaine can inhibit protein kinase B (AKT) phosphorylation and activated adenosine monophosphate–activated protein kinase alpha (AMPKα). It can decouple mitochondrial oxidative phosphorylation and enhance reactive oxygen species (ROS) production. Apelin enhances the phosphatidylinositol 3-kinase (PI3K)/AKT and AMPK/acetyl-CoA carboxylase (ACC) pathways, promotes the complete fatty acid oxidation in the heart, and reduces the release of ROS. In this study, we examined whether exogenous (Pyr1) apelin-13 could reverse bupivacaine-induced cardiotoxicity.
We used the bupivacaine-induced inhibition model in adult male Sprague Dawley (SD) rats (n = 48) and H9c2 cardiomyocyte cell cultures to explore the role of apelin-13 in the reversal of bupivacaine cardiotoxicity, and its possible mechanism of action. AMPKα, ACC, carnitine palmitoyl transferase (CPT), PI3K, AKT, superoxide dismutase 1 (SOD1), and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (p47-phox) were quantified. Changes in mitochondrial ultrastructure were examined, and mitochondrial DNA, cell viability, ROS release, oxygen consumption rate (OCR) were determined.
Apelin-13 reduced bupivacaine-induced mitochondrial DNA lesions in SD rats (P < .001), while increasing the expression of AMPKα (P = .007) and PI3K (P = .002). Furthermore, apelin-13 blocked bupivacaine-induced depolarization of the mitochondrial membrane potential (P = .019) and the bupivacaine-induced increases in ROS (P = .001). Also, the AMPK pathway was activated by bupivacaine as well as apelin-13 (P = .002) in H9c2 cardiomyocytes. Additionally, the reduction in the PI3K expression by bupivacaine was mitigated by apelin-13 in H9c2 cardiomyocytes (P = .001). While the aforementioned changes induced by bupivacaine were not abated by apelin-13 after pretreatment with AMPK inhibitor compound C; the bupivacaine-induced changes were still mitigated by apelin-13, even when pretreated with PI3K inhibitor-LY294002.
Apelin-13 treatment reduced bupivacaine-induced oxidative stress, attenuated mitochondrial morphological changes and mitochondrial DNA damage, enhanced mitochondrial energy metabolism, and ultimately reversed bupivacaine-induced cardiotoxicity. Our results suggest a role for the AMPK in apelin-13 reversal of bupivacaine-induced cardiotoxicity.