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SALT LAKE CITY — It often starts small but can grow to the point of being a real pain in the back, keeping a person from normal function and enjoying everyday activity.

But back pain can be treated.

“Back and neck pain affects nearly everyone at some point in their lives,” said Dr. Scott Swasey, a specialist with Intermountain Medical Center’s Physical Medicine and Rehabilitation Clinic.

Swasey said prompt and appropriate treatment may be key to avoiding chronic, long-term and debilitating pain.

“Once pain becomes chronic, it is difficult to diagnose,” he said, adding that he recommends people see a physician as soon as the pain “keeps a person from doing what they do every day.”

Swasey, along with Brad Dalton, a physical therapist with Intermountain WorkMed, will take questions from the general public about back pain and available treatment options during Saturday’s Deseret News/Intermountain Healthcare Hotline. From 10 a.m. until noon, anyone can call 800-925-8177 or post questions on the Deseret News’ Facebook page.

At Intermountain’s Physical Medicine and Rehabilitation Clinic, treatment is offered in a multidisciplinary approach, involving at times a physical therapist, pain psychologist, neurosurgeon and/or a spine surgeon, among others.

Swasey said oftentimes there is no singular solution to pain management.

Back pain, the most common cause of disability in people under age 45, can be spurred by problems with the joints in the spine or pelvis that become displaced or stiff, or discs in the spine that do the same, or even by nerve issues. It can remain localized in the back or can be felt in other areas of the body, specifically the limbs or extremities.

There are multiple treatment options, including steroidal injections that provide temporary relief or even surgical procedures that diminish pain long term, Swasey said. But in a 40-minute initial evaluation and examination, he asks patients about their sleep habits first.

He said sleep disorders, as well as depression and anxiety issues, can lead to back pain — or at least be major contributing factors that need attention before pain can be treated effectively.

“It’s all about prevention,” Swasey said, and avoiding the potential for chronic pain.

Maintaining a health diet and regular exercise can help keep back pain at bay, as well as avoiding prolonged inactivity or a sedentary lifestyle, according to the American Pain Society.

Posture, comfortable shoes, mattress firmness and the tendency to stretch or warm up muscles and joints before activity are also factors that can stave off injury or pain.

Smoking and pregnancy are also contributing factors to back pain.

As an Army physician, Swasey said he would see soldiers soon after their injuries and because of what he believes was a quick application of treatment, 90 percent of them were back working, pain-free, within a week.

While he is open to using medication to treat pain in patients, Swasey said he is careful, not only to avoid addiction, but a bigger problem of unwanted side effects, sometimes leading to impairment of normal breathing patterns and even death.

Sleep issues are important to him as a doctor, as he believes they can lead to back pain without an inciting event, such as throwing it out during various physical activity.

Research is only just starting to link the two, but Swasey said it is apparent in what he sees in his office on a regular basis.

“If your pain is bad enough that it’s impairing what you need to do in life, you need to be seen,” he said. “It used to be that we would let it get better on its own, but in my experience, the sooner you get the appropriate treatment the better.”

The solution might be simple, but seeking medical attention, he said, could also help prevent the recurrence of back pain, which is common in people who’ve had it before.

Saturday: Living with back pain

Newswise — Critically ill patients who recover from a potentially deadly syndrome known as acute lung injury frequently emerge with new, apparently long-lasting depressive symptoms and new physical impairments that make them unable to perform many daily tasks, Johns Hopkins research suggests.

Results of the new study, published in the American Journal of Respiratory and Critical Care Medicine, also suggest that the depressive symptoms frequently precede the new physical impairments, not the other way around. The research team also said the findings may be applicable to patients with other types of disease or injury who spend time in hospital intensive care units hooked up to ventilators that breathe for them.

“When people are discharged from the ICU, we tend, understandably, to focus on their physical health, but our data tell us we need to focus on their mental health, too,” says study leader O. Joseph Bienvenu, M.D., Ph.D., an associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “Depression can make recovery much more difficult. Identifying depressive symptoms early — and treating them — could make a real difference in how patients fare physically in the long term.”

Bienvenu and his colleagues assessed 186 survivors of acute lung injury from four Baltimore hospitals at three, six, 12 and 24 months after they became ill, and surveyed their levels of depression as well as their ability to independently perform important tasks of daily life, such as using the telephone, shopping and preparing food.

The Hopkins team found that 40 percent of the patients developed depressive symptoms in the first two years after discharge even though they had not previously experienced them, and that 66 percent experienced new physical impairments. The average age of patients in the study was 49 years — people who should be in the prime of their lives but became disabled and unable to return to work, the researchers say. The researchers are continuing to follow these patients to see if the problems persist for an even longer period of time.

“Patients are burdened for a very long time after their hospital stays,” says principal investigator Dale M. Needham, M.D., Ph.D., an associate professor of pulmonary and critical care medicine and physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. “We need to figure out what we can do to help these previously productive people get back their lives.”

Needham says it is unclear whether it is the acute lung injury syndrome itself causing the new problems or whether the cause is to be found in how patients are routinely cared for in ICUs. Standard ICU care for patients with acute lung injury often includes deep sedation and bed rest. Long stretches of inactivity are known to cause physical impairment, and the use of high-dose benzodiazepines to sedate ICU patients has been associated with depressive symptoms. Needham suspects that both critical illnesses themselves and typical ICU practices contribute to negative outcomes.

Patients’ lungs typically recover relatively quickly from acute lung injury, a syndrome often caused by pneumonia, but also by other infections or trauma. In acute lung injury, the body’s inflammatory response is revved up and gets out of control, causing fluid to flood into the breathing spaces of the lungs and respiratory failure. An estimated 190,000 Americans suffer from acute lung injury each year and more than 74,000, almost 40 percent, will die while in hospital.

Needham says it is important that intensivists like himself, and psychiatrists like Bienvenu work together to ensure the best outcomes for patients, a collaboration that is frequently missing in the care of ICU patients.

Bienvenu says he was surprised by the finding that depressive symptoms frequently precede new physical impairments, since the conventional wisdom is that the inability after an ICU stay to do things like grocery shopping, driving and walking long distances causes patients to feel demoralized about the loss of these functions. But the reverse appears to be true, he says. Depressed patients, he suggests, are harder to motivate to do the physical activities necessary for recovery and maintenance of function.

Bienvenu says acute lung injury is considered an archetypal critical illness and that its consequences may be present to one degree or another in patients who have suffered other critical illnesses. “All doctors should look out for these symptoms in their patients who have been in the ICU,” he says.

PR Web

Cambridge, MA (PRWEB) December 07, 2011

The early impact of the 2007 New York workers’ compensation reforms is identified by the Workers Compensation Research Institute (WCRI) in a new study, Early Impact of the 2007 Reforms in New York, designed to evaluate whether the regulatory changes met stated objectives.

The key regulatory changes increased maximum statutory benefits, limited the number of weeks of permanent partial disability (PPD) and developed a fee schedule for pharmaceuticals. This report is the fourth in a series monitoring the performance of the New York workers’ compensation system benefit delivery system.

“This report is a significant tool for assessing the performance of the New York workers’ compensation system following the implementation of major reforms,” said Ramona Tanabe, WCRI’s Deputy Director and Counsel. “It will help public policymakers, employers, insurers and other stakeholders determine whether the changes were successful in meeting their goals and identify any unintended consequences.”

The increase in the maximum weekly benefit resulted in the increase of the average temporary total disability benefit by 19 percent after the implementation of the second of three increases in the benefit rate.

As planned, these increases in maximum weekly benefits have brought New York closer to national rates and reduced the percentage of workers whose benefits were limited by the maximums. For example, the percentage of injured workers whose benefits were limited by the maximum benefit fell from 48 percent prior to the first increase to 29 percent after the second increase. WCRI estimates that the third increase in the maximum will reduce this percentage to 24 percent.

The study found a shift for PPD/lump sum cases at an average of 12 months experience – a 10 percentage point decrease in claims that received PPD payments only (no lump sum) and an 11 point increase in claims with a lump sum settlement only (no PPD payments).

WCRI observed that although the limitation on the weeks of PPD wage replacement benefits is expected to result in significant savings, it will likely be several years before the effect is reflected in the data.

The study also reported that the implementation and subsequent change of the pharmacy fee schedule had the effect of decreasing the average price per pill by 10 to 20 percent.

The state-based workers’ compensation system has evolved and survived for 100 years but it could face tough challenges in the coming years as the country struggles to dig itself out of the deep recession.

The recession has caused an “unprecedented disruption of the labor market” that will have widespread and long-term effects, according to a leading workers’ compensation researcher and economist.

Richard Victor, executive director of the not-for-profit Workers’ Compensation Research Institute (WCRI), is warning that one economic fact alone could trigger a re-examination of workers’ compensation and other job-related programs. It is that there are 25 million Americans vying for just 3.5 million available jobs. That’s seven people for every opening.

Victor dubbed this employment crisis the “elephant in the room” during his organization’s annual research conference in Boston.

The 25 million includes the unemployed and underemployed. In a normal economy, there might be half that many looking for work, he said.

Victor believes the issues raised by today’s unemployment crisis are structural. He said that there is a mismatch between the Americans looking for employment and many of the jobs available. In relation to workers’ compensation, Victor said many of the available jobs are “not matched to the skills, interests and location of injured workers.”

The point has been underscored by the president of the Federal Reserve Bank of Minneapolis. Narayana Kocherlakota sees mismatch by geography, skills and other factors as a major issue and estimates this adds about 2.5 point to the unemployment rate.

The issues are not just temporary, in Victor’s view.

Just to fill the jobs gap left by the recession, the country needs to create about 6 million jobs; then it needs another 7 million jobs to keep pace with those newly entering the job market, Victor said.

According to the Wall Street Journal, the labor market lost almost 8.8 million jobs from a peak in January 2008 (138 million payroll jobs, when the unemployment rate was 5 percent) to the bottom in February 2010 (129.2 million).

The labor market needs to be producing far more jobs, as many as 300,000 a month to get back to normal levels of unemployment within five years.

Job creation will depend upon how fast the gross domestic product grows. Many economists expect GDP to grow less than 2.5 percent for the rest of this year and for all of next. At that rate, the economy will add just 125,000 jobs a month, barely keeping up with population growth.

Even at an optimistic GDP growth of 3.1 percent a year, it could take a decade or more for the country to get back to any “normal” employment situation, Victor said.

“So this [high unemployment] is going to be with us a long time,” said Victor.

The WCRI economist suggested that as society grapples with this chronic unemployment, job-related programs could come under pressure and state workers’ compensation systems could be drawn into a bigger debate over how to help pay for extended unemployment.

“How will the system cope?” he asked his WCRI audience of about 250.

He painted a potential scenario where employers, injured workers and public policymakers begin asking questions about workers’ compensation, questions that have been settled by state workers’ compensation systems in the past, but ones that may be re-opened because “it’s a different environment.”

Injured workers may ask if they will ever be rehired or if they should try to hold onto their workers’ comp benefits longer since no jobs are available.

There are 200,000 workers injured every month in the U.S. and the probability of re-employment goes down the longer someone is out of work, he said.

Employers may face more litigation as more workers turn to attorneys to help them fight for benefits. Business owners may start asking if benefit formulas should be reworked or standards for terminating benefits be revisited.

Also, some may question anew the feasibility of return-to-work, rehabilitation or retraining programs since few jobs are available.

Also in Victor’s scenario, state workers’ compensation boards will face bigger workloads. There could be more delays and longer durations for payments. The system, and its costs, may become less predictable. Some state systems may be more vulnerable than others.

Victor said he is particularly worried about those who will be entering the labor market over the next five to seven years and face limited opportunities. “This can have profound, long term effects,” he said.

To open the day and one-half WCRI research conference in Boston, Peter Barth, professor of economics (emeritus) at the University of Connecticut and long-time researcher and consultant on workers’ compensation issues, reviewed the 100-year history of workers’ compensation over which the system has evolved but stayed fundamentally the same.

“Have there been improvements? Yes,” Barth said. “Is there still room for improvement? Yes.”

WCRI attendees also heard advice on how to measure and manage workers’ compensation medical costs, how to improve patient care involving narcotics, and recommendations of alternative approaches to managing chronic pain.

Then Victor closed the conference with his much-anticipated “elephant” talk.

“The elephant’s coming. Be prepared,” he told his WCRI audience.

WCRI is an independent, not-for-profit research organization based in Cambridge, Mass.