"If you aren't seeing a chiropractor, you must be on drugs."

April 05, 2005 [Volume 6, Issue 8]

Bed Rest: Still Unadvisable for LBP

Considerable evidence in the past decade shows that bed rest has not been beneficial to patients suffering from low back pain (LBP). A recent review by the Cochrane Collaboration Back Review Group analyzed all randomized studies up to March 2003, yielding two new trials comparing advice to rest in bed with advice to stay active for patients with LBP. In total, six trials compared bed rest with staying active for the management of LBP.

Results found that advice to rest in bed was clearly less effective than advice to stay active for patients with acute simple LBP. High-quality evidence shows small but consistent differences in favor of staying active for pain and functional status at 3-4 weeks and 12 weeks follow-up, respectively. Additionally, in patients with acute simple LBP, evidence shows that bed rest will increase length of sick leave in the first 12 weeks, compared to advice to stay active. For patients with sciatica, evidence shows that bed rest has little or no effect on pain and functional status, compared to staying active at 3-4 weeks and 12 weeks.

All in all, it appears that LBP sufferers should not count on bedrest to help decrease their recovery time or stave off pain. If you suffer from LBP, talk to your Doctor of Chiropractic about an appropriate treatment plan to include staying active.

Reference: Hagen KB, Jamtvedt G, Hilde G, Winnem MF. The updated Cochrane Review of bed rest for low back pain and sciatica. Spine, March 1, 2005;30(5):542-46.


Caffeine Increases Risk for Chronic Daily Headache

Before your reach for your next "cup-o'-jo," consider the consequences of excessive caffeine consumption. Caffeine has been shown to cause withdrawal headache, which may contribute to the development of chronic daily headache (CDH), or headache occurring at least 15 days per month.

To confirm such a hypothesis, researchers recruited population-cases and control subjects from three U.S. metropolitan areas as part of a study designed to address caffeine’s potential involvement in CDH. Control subjects reported two to 104 headache days annually (average: 30 days), while population-cases reported 180 or more headache days per year (average: 260 days). Current and past caffeine consumption was assessed by way of self-report.

Results: High caffeine exposure, defined as being in the upper quartile of dietary consumption or using a caffeine-containing over-the-counter medication as a headache treatment, was associated with onset of CDH. Approximately one-fourth of case subjects reported taking pain medication of any type daily for headache in the previous three months.

According to the authors, “High medicinal or dietary caffeine consumption at the time of CDH onset (e.g., pre-CDH consumption) was a modest risk factor for CDH onset. Secondary analyses revealed that pre-CDH caffeine consumption might be an initiating factor in a subset of CDH sufferers, with the high-risk groups being women and those younger than age 40."

Still need a "pick-me-up" in the morning, but want to wean off caffeine? Try drinking green tea instead, which contains substantially less caffeine than coffee and has been shown to have a host of health benefits, including antioxidant and anti-cancer properties.

Reference: Scher AI, Stewart WF, Lipton RB. Caffeine as a risk factor for chronic daily headache. A population-based study. Neurology, Dec. 14, 2004;63(11):2022-27.


Study Shows Exercise May Help Reduce Depression

In 1997, a study found that mild to moderate major depressive disorder (MDD) ranked second behind heart disease in terms of years of life lost due to premature death or disability. National estimates indicate that fewer than one-fourth of individuals with MDD seek treatment, and only one in 10 receive adequate treatment. A recent study was designed to test whether exercise is beneficial in treating mild to moderate MDD, and to determine the dose-response relation of exercise and reduction in depressive symptoms.

Eighty adults diagnosed with mild to moderate MDD were randomized to one of four aerobic exercise treatment groups that varied total energy expenditure (7.0 kcal/kg/week or 17.5 kcal/kg/week) and frequency (three days/week or five days/week), or to a placebo control group that participated in flexibility exercises three days a week. Outcome was determined by the score on the 17-item Hamilton Rating Scale for Depression (HRSD).

Results: After 12 weeks, the group expending 17.5 kcal/kg/week (consistent with public health recommendations) had the lowest scores, while the placebo control group had the highest scores. The authors concluded that “Aerobic exercise in the amount recommended by consensus public health recommendations was effective in treating mild to moderate MDD. The amount of exercise that is less than half of these recommendations was not effective."

If you suffer from mild to moderate depression, try engaging in some type of physical activity. You'll experience a wide range of benefits in a short amount of time, including elevated mood, increased stamina and improved health, overall.

Reference: Dunn AL, Trivedi MH, Kampert JB, et al. Exercise treatment for depression. Efficacy and dose response. American Journal of Preventive Medicine 2005;28(1):1-8.