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Thursday, April 25, 2019

Acetaminophen may do little for acute back pain

Marathoners are the thoroughbreds of high-performance runners, but even the draft horses of the running world — slow and steady joggers — improve their health. A study out this week in the Journal of the American College of Cardiology finds that even five to 10 minutes a day of low-intensity running is enough to extend life by several years, compared with not running at all. It shows that the minimal healthy “dose” of exercise is smaller than many people might assume.

But if your favorite activity is a brisk walk in the park or a quick game of tennis, the research has implications for you, too. “There is no question that if you are not exercising and if you make the decision to start — whether it’s walking, jogging, cycling, or an elliptical machine — you are going to be better off,” says cardiologist Dr. Aaron Baggish, the associate director of the Cardiovascular Performance Program at Harvard-affiliated Massachusetts General Hospital and an accomplished runner himself
Take five to stay alive

The new study focused on a group of more than 55,000 men and women ages 18 to 100. About a quarter of them were runners. Over 15 years, those who ran just 50 minutes a week or fewer at a moderate pace were less likely to die from either cardiovascular disease or any cause, compared with those who didn’t run at all.

The study suggests a relatively low entry level for the benefit of jogging, but it is not a prescription. “A little bit is good but a little bit more is probably better,” Dr. Baggish says. A 2013 study in Denmark suggested that the “sweet spot” for maximum longevity is up to 2.5 hours of running a week.

Although running can trim away some of your existing risk of cardiovascular disease, it doesn’t entirely eliminate it. The combined effect of lifestyle, diet, and family history still contribute to your lifetime risk.

“There is no question that the fitter you are and the more exercise you do, the longer you live and the better your quality of life,” Dr. Baggish says. “But it doesn’t confer immunity.”
Feeling better

This study used preventing death to measure the benefit of running, but it’s not the most typical reason for running. “Many dedicated long-term runners do not run because they want to live longer,” Dr. Baggish notes. “They run because it makes them feel better on a daily basis. There is a mood elevating, quality-of-life benefit that comes from being a regular exerciser.”

For regular runners, the cost of feeling good can be strains and sprains, so Dr. Baggish advocates for the value of what he calls “active rest.” His rule of thumb, not supported by any specific research, is that it’s a good idea to spend 25% of exercise time over the course of a year running at a lower level of intensity or doing other activities like swimming or biking.

“The body responds to training, but to preserve that benefit over the long haul there needs to be active periods of recovery,” Dr. Baggish says. “Pulling back allows the body to repair and heal.” The handshake is an important way that many people communicate nonverbally. It’s a standard gesture when we say hello, goodbye, and make an agreement. We’ve been doing it for millennia.

But hands carry germs that can spread infections to others. And some of these infections can be very serious, including those that can’t be killed by standard antibiotics. Is it time to consider changing the tradition of shaking hands?

Two researchers from Aberystwyth University in Wales make the case that handshaking exchanges a lot more germs than a modern alternative, the fist bump.

Their experiment was simple. Both researchers put sterile gloves on their right hands. One dipped the gloved hand into a contained filled with a solution teeming with harmless E. coli bacteria. Then they shook hands and measured the number of bacteria on the glove that had not been dipped in the E. coli solution. They did the same thing for high fives and fist bumps. (You can see an example of the experiment in this video.)

Shaking hands transmitted 2 times more bacteria than high fives, and 10 times more bacteria than bumping fists. Their results are published in the August 2014 issue of the American Journal of Infection Control.
Wash hands, bump fists

Fist bumps went viral in 2008 when then-candidate Barack Obama and his wife, Michelle, gave each other a fist bump after a campaign speech in Minnesota. (Writer Simon Usborne offers an interesting perspective on fist bumping in The Independent.) Last month, authors of an article in The Journal of the American Medical Association raised eyebrows by suggesting that handshaking be banned in hospitals. Despite the daily efforts of hospital infection control teams, hospital workers only get hand cleansing right 40% of the time.

That’s one way health care providers spread harmful germs to their patients. An estimated one in 25 people who are hospitalized develop health-care associated infections. These infections kill 75,000 people each year, according to estimates from the U.S. Centers for Disease Control and Prevention.

It was a bold opinion piece. The handshake is a traditional way doctors and all patient care providers convey warmth and empathy to patients, family members and fellow healthcare workers. Would a fist bump do the same? Hard to tell. Some people would easily make the change; for others it just wouldn’t be a good substitute for the handshake.

No matter how you greet someone, washing your hands often will do more to keep you from spreading germs than giving someone a first bump. It’s especially important if you are in the hospital, or visiting someone in the hospital. (No matter where you are, if you don’t know where someone else’s hands have been, the fist bump may not be a bad option.)

Alcohol-based hand cleansers usually work just as well as washing with soap and water. The important exception is with the species of bacteria known as Clostridium difficile. Infection with it causes diarrhea. Clostridium difficile is not killed by alcohol. Washing your hands with soap and water is a must if you have this infection or visit someone with it. When back pain strikes, all you want is relief—as quickly as possible. Many folks turn to over-the-counter pain relievers to help take the edge off and keep them moving. Acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDs (ibuprofen, naproxen, aspirin), are common and reasonable choices.

Australian researchers set out to see just how helpful acetaminophen is for people with back pain that comes on suddenly (so-called acute back pain). They wanted to know if acetaminophen shortened the time from the start of back pain to complete relief—meaning a pain rating of 0 or 1 (on a scale from 0 to 10, with 10 being the worst) for at least 7 days.

What they found was a bit surprising.

For people who used acetaminophen only when their back pain bothered them, it took about 17 days to get complete relief. For those who took the medication three times a day, it also took about 17 days for full relief. And for those who took a placebo—a sugar pill with no medicine at all—the time to recovery was 16 days. In other words, in this group of volunteers the medication made no difference in how fast back pain went away and stayed away. The researchers also found that all three groups had similar experiences in terms of the severity of their pain, disability, and function. Their findings were published online yesterday in The Lancet.

Does this mean that you shouldn’t bother to use acetaminophen for back pain? Not necessarily. It may work well for some people. And, the alternatives may be worse. Some people should steer clear of NSAIDs. They can irritate the digestive tract and increase bleeding risk among people who take drugs that reduce blood clotting. Muscle relaxants tend to be sedating.

But acetaminophen isn’t without risks and side effects. Taking too much acetaminophen can seriously damage the liver, sometimes leading to liver failure or death. Ideally, the average healthy adult shouldn’t take more than 3,000 milligrams a day. Because combination cold, headache, and sleep products contain acetaminophen, you need to pay careful attention.

Back pain is tricky. Acute back pain may follow something you did at work or at play. It can also be caused by a pinched nerve or a degenerative condition such as arthritis. For one-third of people with acute low back pain, discomfort greatly improves in as little as one week.

Here are some tips for trying to get through the worst of your back pain without medication:

    Use cold compresses or an ice pack, not heat, immediately after an injury. About 48 hours after back pain hits, heat may be more helpful. The warmth soothes and relaxes aching muscles.
    Try to keep moving. A limited amount of activity is better than lying in bed. In fact, ask your doctor about appropriate exercises to start sooner rather than later. Exercise therapy can help heal acute back pain and help prevent a repeat episode.
    Chiropractic manipulation, acupuncture, massage, or yoga provide relief for some people with acute back pain. Several studies support using these alternative/complementary therapies.

Most back pain isn’t dangerous, but it is important to know “red flag” situations that require immediate medical attention. “Be sure to see your doctor right away if you have unexplained back pain with fever, weight loss, or neurological symptoms such as numbness, weakness, or incontinence,” says Dr. Robert Shmerling, clinical chief of rheumatology at Beth Israel Deaconess Medical Center and associate professor in medicine at Harvard Medical School.

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