Shockwave Is Inferior to Physical Therapy for Shoulder Pain

Shoulder pain is the 4^th most common type of muscle/skeletal pain reported to doctors, and it’s one of the most difficult to treat.  Physical therapy, non-steroidal anti-inflammatory drugs, and steroid injections are the most usual approaches; shockwave therapy has become quite popular, but clinical studies have not shown conclusive evidence of effectiveness.  The British Medical Journal contains a report of a comparison of extracorporeal radial shockwave treatment with physical therapy, conducted in Norway.

The shockwave used was low to medium energy impulses directed at the painful tissue.  Patients were adult men and women with pain below the point of the shoulder, who completed a 5-item pain and 8-item disability questionnaire.  Their pain was typical of subacromial impingement syndrome (or rotator cuff tendonitis); subjects were not included y were not included in the study if they had another cause for their pain (e.g. osteoarthritis).

The 104 patients were randomly allocated to have one session of shockwave therapy weekly for 4-6 weeks, or two 45-minute weekly of physical therapy, for up to 12 weeks.  All patients were monitored with the questionnaire at 6, 12, and 18 weeks; they were advised not to take any other treatment except anti-inflammatory drugs.

After 18 weeks, 64% of the physical therapy group had a reduction in shoulder pain and disability scores, compared with 36% in the shockwave treatment group.  Six patients in the supervised exercise group and one in the shockwave group used less drug treatment.  More patients in the physical therapy group had returned to work during follow-up, whereas more shockwave subjects had additional treatment (e.g. steroid injections) after 12 weeks.     

These results are in accord with those from previous trials recommending physical activity treatment for shoulder pain, and they fail to strengthen evidence for the effectiveness of this type of shockwave treatment.

Don’t Forget the HDL Cholesterol Fraction

Most boomers are well aware of the need to keep their ‘cholesterol’ level under control, and many take a medication (e.g. a statin).  They’re happy when their efforts result in adequate control of the major cholesterol fraction, low-density lipoprotein cholesterol (LDL-C), or their total cholesterol.  But the ‘good cholesterol’, or high-density lipoprotein cholesterol (HDL-C) is almost as important.  This has been shown in a study reported in the Archives of Internal Medicine.

The role of HDL-C was studied in 454 patients in the Framingham Offspring Study who were started on various lipid-lowering regimens.  The purpose of the analysis was to see whether increases in HDL-C were independently linked with a reduction in cardiovascular ‘events’ (e.g. heart attack, unstable angina, heart failure, sudden cardiac death, or stroke).  The patients were followed for an average of 8 years.

After adjustment for changes in LDL-C and plasma triglycerides, and for differences in pre-treatment lipid levels, smoking status, body weight, and the use of beta-blocking drugs to treat high blood pressure, there was evidence that an increase in HDL-C level was a strong predictor of a lessened likelihood of a cardiac event.  There was a 21% drop in the risk of such an event for every 5 mg/dL increase in HDL-C.  This benefit was not associated with the use of any particular lipid-lowering drug.

Not surprisingly, some drug manufacturers are seeking new drugs that are targeted at raising HDL-C levels; none has yet been marketed, however.  Cranberry juice has been shown to increase HDL-C levels, as have fish and other foods containing omega-3 fatty acids.  But most of the common lifestyle efforts to lower total cholesterol are likely to raise your HDL-C somewhat, as well;  just don’t forget to monitor it, too.

Are You Really Eating Enough Fruit & Veggies?

The US Centers for Disease Control and Prevention – the CDC – have written a state-by-state report on the average intake of fruits and vegetables.  It’s online at their website.  The report lists the states according to their percentage of people meeting the goals set in the NIH's Healthy People 2010, where “75% of persons aged 2 years and older should consume at least two daily servings of fruit”, and “50% should consume at least three daily servings of vegetables, with at least one-third being dark green or orange vegetables”. That, simplified, is “Five-A-Day”.

Here are the five best and the five worst states:

Washington DC       20.1%

Vermont                  17.9%

Maine                      17.7%

Hawaii                     17.5%

New York                16.5%

. . . . .

South Dakota          10.1%

Alabama                   9.8%

Oklahoma                 9.3%

South Carolina         9.3%

Mississippi                8.8%

There’s plenty of room for improvement if we are to take the goals seriously.  I’m certainly banging away at the benefits of Five-A-Day, but the economy doesn’t seem to be doing its part.

Higher Folate Intake Can Battle Hearing Loss in Men

A paper presented at the American Academy of Oto-Rhinology – Head and Neck Surgery Foundation meeting confirmed the likely benefit of a high folic acid intake in preventing hearing loss in elderly men.  (An earlier study from the Netherlands had shown this was a possibility, but it was done before that country embarked on folic acid fortification of food, so the baseline blood folate levels were about half those seen in the USA.)

In the new study, 3,550 men with hearing loss were identified within the US Health Professionals Follow-up Study database.  They then evaluated the men’s nutritional information, and found that those over 60 who had maintained a high intake of dietary folate were 20% less likely to have developed hearing loss.  Looking at other possible food factors with an influence on the outcome, they found no benefit form vitamins C or E or beta-carotene.

The researchers believe this is the largest study to show as relationship between dietary intake and hearing loss.  High folate foods include leafy veggies, asparagus, beans and peas, fortified cereals, baker’s yeast, and liver.  Although the findings were obtained in men (in whom elderly deafness is more common than in women), the earlier Dutch study recruited men and women, so there’s no reason for women to feel they needn’t bother with the leafy veggies etc.

Living on a Noisy Road Can Raise Your Blood Pressure

Excess noise is thought to cause stress responses in the body with subsequent acute changes in blood pressure. Long-time exposure to noise could result in lasting cardiovascular changes such as atherosclerosis and increase cardiovascular risk, as well as hypertension.  Swedish researchers have studied the effects of traffic noise, to try to determine which segments of the population are most susceptible to its ill-effects.  They report in the BioMed Central journal Environmental Health.

The data, which covered health information from 24,000-plus adults living in southern Sweden, included the average road noise at the subject’s residential address.  The participants were asked to report if they had been diagnosed with high blood pressure or were taking anti-hypertensive medication.  The analysis of the possible association between road noise and hypertension was adjusted for possible risk factors for the condition - sex, age, body mass index (BMI), physical activity, level of education, alcohol consumption, smoking and socioeconomic status.

The results showed a modest effect of traffic noise on the likelihood of high blood pressure, after adjustment for the above risk factors.   An average day/night noise level of 45 decibels or more increased the risk of hypertension by 10%, a non-significant degree.  But higher levels – 64 decibels, the level of a dishwasher or a typical conversation – increased the risk by 45%. 

Age played a role in the risk assessment.  More marked effects were seen at the higher exposure levels in relatively young adults and the middle-aged, whereas there were no effects measured in the over 60s.  (Of course, it may be that there was a modicum of deafness in the older folk.  Or perhaps the annoyance produced by noise had worn off after some years, so that stress was less.)

Do You Think Garlic Can Treat the Common Cold?

Garlic is widely used in health supplements, often in the belief it can help prevent virus infections like the common cold and flu, arterial disease, and other ills, including cancer.  None of these claims have been substantiated by well-conducted, randomized, controlled clinical trials.  However, there is weak evidence that garlic can prevent the common cold.  The Cochrane Library has reviewed clinical trials published in the medical literature, and found only five that were potentially relevant; only one of these met the criteria set for evaluating effectiveness. 

There were 146 volunteers in the study; they were randomly assigned to take a garlic supplement (with 180 mg allicilin) or a placebo, daily for 12 weeks.  During that period they were to report if they had a cold, the duration of illness, and time away from work.

There were 24 common colds among the garlic takers, and 65 among the placebo group.  This was a statistically-significant difference.  The duration of illness was similar in both groups – 4.63 days vs. 5.63 days, a not-significant difference.  The only adverse effects of garlic reported were rash and odor.

On average, children have 6-8 colds a year, and adults have 2 to 4.  (As someone in their late 70s, I get fewer than one common cold a year – a bonus for getting old!)  The ‘frequencies’ of colds in these groups of 73 persons each was 1.3 a year for the garlic-takers and 3.5 a year for the placebo.  It looks as if they used a ‘young adult’ population.

Garlic has many useful properties – especially in the kitchen.  It may be that generous intake can help you prevent a cold, even if it won’t shorten the illness of make you feel better while you’re sick.  But that’s what chicken soup is for.

Boomers and Beyond, Get on the Net!

Researchers at the Phoenix Center for Advanced Legal & Economic Public Policy Studies have conducted a study that resulted in a policy paper titled Internet Use and Depression among the Elderly.   It shows clearly that people over 55 who go online regularly have a lower rate of depression than those who don’t.   

A recent survey of US households show that, while 79% of the general population reports using the Internet, only 42% of those 65 and older do so.  There are conflicting views about the impact of Internet use on mental health.  For instance, one view is that Internet use facilitates interpersonal communication, and therefore should improve mental well-being, by reducing loneliness.  On the other hand, some people believe that Internet use leads to social exclusion, thereby reducing well-being and depression.  Which of these hypotheses is more relevant for older people?  This was the background to the present study.

The data for analysis came from the Health and Retirement Study run by the University of Michigan, which obtains 2-yearly information from over 22,000 over the age of 50.  After applying some restrictions (e.g. must be age 55 or above, fully retired [i.e. not working], not a nursing home resident), there were 7,000 subjects with data for analysis.  Internet use was defined by a yes/no answer to a question, e.g. “do you use the Internet regularly for e-mail or other purposes?”  Depression was measured using the eight-item depression scale developed by the Center for Epidemiologic Studies (CES-D).      

Thirteen different statistical analysis methods were used to evaluate the association between Internet use and depression.  The range of a reduced risk of depression for Internet users was 17% to 26%, with 20% as the average, compared with non-users.      

A 20% reduced risk is considerable, and should be a basis for further analyses or studies.  My top question – just how was the Internet used by those in the “user’ group?  A difference between those who relied on e-mail to maintain interpersonal relationships would probably have a very different result from those who spent most of their time “surfing the net”;  these two examples represent the opposing views used as examples in the second paragraph above.

Saturday Quack – Magnetic or Copper Bracelets for Arthritis

Copper bracelets for arthritis pain relief have been used for years, without any proof of effectiveness.  It’s not even sure that copper is absorbed through the skin.  More recently, magnetic bracelets have been touted for the same purpose – relieving pain.  Apparently the market for therapeutic magnetic items is around 4 billion US dollars.

A UK study from the University of York, published in the journal Contemporary Therapies in Medicine, has examined the effectiveness of copper and magnetic bracelets in patients with osteoarthritis.  Forty-five patients with osteoarthritis were recruited from family practices in Yorkshire;  they were all over 50 years of age, and had been diagnosed with the condition earlier.  They were to wear, in randomized 4-week rotations, four types of wrist strap:  a commercially available magnetized strap, a weak magnetic strap, a copper bracelet, and a demagnetized strap (placebo).   The subjects were regularly assessed using the self-scoring WOMAC Osteoarthritis Index, the McGill Pain Questionnaire, and the Pain Rating Index; their use of medications was also recorded.

Results of these tests showed that there were no meaningful differences between the four devices worn on the wrist with respect to their effect on pain, stiffness, and physical function.  This is not the first report of disappointing effectiveness of these bracelets, but it represents the first placebo-controlled randomized study.  “It seems likely that any perceived benefit obtained from wearing a magnetic or copper bracelet can be attributed to psychological placebo effects”, to quote the principal investigator of  the study.