Massage Beats Meds for Lower Back Pain, Study Says (HealthDay)

By Maureen Salamon
HealthDay Reporter by Maureen Salamon
healthday Reporter – Tue?Jul?5, 11:50?pm?ET

TUESDAY, July 5 (HealthDay News) -- Massage therapy may be better than medication or exercise for easing low back pain in the short term, a new government-funded study suggests.

Seattle researchers recruited 401 patients, mostly middle-aged, female and white, all of whom had chronic low back pain.

Those who received a series of either relaxation massage or structural massage were better able to work and be active for up to a year than those getting "usual medical care," which included painkillers, anti-inflammatory drugs, muscle relaxants or physical therapy, the researchers found.

Lead study author Daniel Cherkin, director of Group Health Research Institute, said he had expected structural massage, which manipulates specific pain-related back muscles and ligaments, would prove superior to relaxation or so-called Swedish massage, which aims to promote a feeling of body-wide relaxation.

Structural massage, which focuses on soft-tissue abnormalities, requires more training and may be more likely to be paid for by health insurance plans, which may equate it with physical therapy, said Cherkin.

"I thought structural massage would have been at least a little better, and that's not the case," Cherkin said. "If you're having continuing problems with back pain even after trying usual medical care, massage may be a good thing to do. I think the results are pretty strong."

The study, funded by the National Center for Complementary and Alternative Medicine, part of the U.S. National Institutes of Health, is published in the July 5 issue of Annals of Internal Medicine.

Participants were randomly assigned to one of the three groups: structural massage, relaxation massage or usual care. Those in the massage groups were given hour-long massage treatments weekly for 10 weeks.

At 10 weeks, more than one-third of those who received either type of massage said their back pain was much better or gone, compared to only one in 25 patients who received usual care, the study said. Those in the massage groups were also twice as likely in that period to have spent fewer days in bed, used less anti-inflammatory medication and engaged in more activity than the standard care group.

Six months out, both types of massage were still linked to improved function, Cherkin said, but after one year, pain and function was almost equal in all three groups.

Noting that most Americans will experience low back pain during their lifetime, Cherkin said another benefit of massage is its relative safety.

"Maybe one of 10 patients felt pain during or after massage, but most of those thought it was a 'good pain,'" he said. "A good massage therapist will be in tune with the patient and will ask what hurts."

One of the study's weaknesses was that those who were assigned to usual care knew that others were receiving massage therapy and may have been disappointed to be excluded, tainting their reported improvement, said Dr. Robert Duarte, director of the Pain and Headache Treatment Center at North Shore-LIJ Health System in Manhasset, N.Y.

"I think massage therapy can be useful for patients with back pain, but more as a . . . supplemental therapy," Duarte added.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more on low back pain.

Study: Medicaid does make a difference after all (AP)

By RICARDO ALONSO-ZALDIVAR, Associated Press Ricardo Alonso-zaldivar, Associated Press – Thu?Jul?7, 12:20?am?ET

WASHINGTON – Signing up for Medicaid could improve your overall health and financial security, says a surprising new study that offers clues on how President Barack Obama's health care overhaul might affect millions of low-income uninsured Americans.

The findings run counter to a widespread perception that having a Medicaid card is no better than being uninsured, and maybe even worse.

Led by economists at Harvard and MIT, and released Thursday by the National Bureau of Economic Research, the study found that having Medicaid significantly increased the chances people will perceive their health as being good to excellent, while decreasing the likelihood they'll have to borrow money or skip paying other bills because of medical expenses.

Medicaid is a federal-state program for low-income and severely disabled people now covering about 60 million Americans. Starting in 2014, it will also pick up about half the more than 30 million uninsured people gaining coverage under the new health care law. Since it pays doctors far less than Medicare and private insurance, some experts have questioned whether Medicaid coverage will translate into medical care that people need.

The study provides a partial answer, but it's encouraging.

"The bottom line is that Medicaid really matters in people's lives," said MIT economist Amy Finkelstein, lead author of the report. "There is a large concern out there about whether Medicaid actually makes a difference, and now we actually have evidence."

The study looked at 10,000 Oregonians who won a state-sponsored lottery for Medicaid in 2008, and compared them to those who applied but weren't picked and remained uninsured. The random way that the two groups were selected gives the study a high degree of validity, similar to what's required for deciding whether or not to approve a new drug.

The study found that people with Medicaid were 70 percent more likely to have a regular medical office or clinic for their basic care, and 55 percent more likely to have a personal doctor. Medicaid enrollees were also more likely to get preventive care, such as mammograms and cholesterol screening.

There was no real difference between the two groups in emergency room use, but people with Medicaid were significantly more likely to use inpatient and outpatient services, as well as prescription drugs.

"It gives important evidence that expanding Medicaid improves access to care and use of preventive services," said study co-author Katherine Baicker, an economist at the Harvard School of Public Health. "It makes a huge positive difference in the lives of the people who gain access to the program."

The study used seven distinct measures to try to distinguish differences in health between those on Medicaid and those who remained uninsured. These ranged from screening for depression to asking whether overall health is the same, better or worse over the past six months. People with Medicaid did significantly better on all seven measures.

One reason they might feel better: fewer medical bills sent to a collection agency.

There are some caveats, however.

Adding 10,000 people to the Medicaid rolls in one state involves much less strain on the health care system than bringing in 15 million to 17 million people nationwide in 2014, as the health care law envisions. If there aren't enough doctors at that time, patients who just gained coverage could have a hard time finding a provider, or face long waits for an appointment.

"One always has to be careful about extrapolating," said Finkelstein. "But I think it's the best evidence we have to date."

Medicaid Coverage 'Substantially' Improves Access to Care: Study (HealthDay)

THURSDAY, July 7 (HealthDay News) -- Expanding Medicaid coverage among low-income adults increases health care use, improves health and well-being and reduces the financial strain for people with the publicly funded health coverage, according to new research.

"This study shows that Medicaid substantially expands access to and use of care for low-income adults relative to being uninsured," co-principal investigator Katherine Baicker, professor of health economics at Harvard School of Public Health, said in a Harvard news release.

She and her colleagues looked at 10,000 low-income, uninsured adults in Oregon who were randomly selected in a 2008 state lottery to accept additional people into its Medicaid program. The health outcomes of these people were compared to the 80,000 applicants who weren't selected in the lottery.

The first year of the ongoing study showed that Medicaid coverage increases the likelihood of outpatient care by 35 percent, the use of prescription drugs by 15 percent, and of hospital admission by 30 percent. This leads to about a 25 percent increase in annual health care spending.

Medicaid coverage also increases the use of recommended preventive care such as mammograms by 60 percent and cholesterol monitoring by 20 percent. It also increases access to care. For example, people with Medicaid were 70 percent more likely than those without insurance to have a regular doctor's office or clinic for primary care, and were 55 percent more likely to have a particular doctor that they usually see.

Compared to uninsured people, those with Medicaid coverage were 40 percent less likely to have to borrow money or skip paying other bills to pay for health care, and 25 percent less likely to have an unpaid medical bill sent to a collection agency.

The researchers also found that the adults with Medicaid coverage were 25 percent more likely to report they were in good to excellent health, and 10 percent less likely to report being depressed.

The findings are published July 7 as a working paper (number 17190) on the website of the National Bureau of Economic Research. Support for the study was provided by the U.S. National Institute on Aging, the Centers for Medicare & Medicaid Services, the California Healthcare Foundation, and other foundations and government agencies.

"Some people wonder whether Medicaid coverage has any effect. The study findings make clear that it does. People reported that their physical and mental health were substantially better after a year of insurance coverage, and they were much less likely to have to borrow money or go into debt to pay for their care," co-principal investigator Amy Finkelstein, a professor of economics at MIT, said in the news release.

The researchers will follow the lottery participants for another year and directly measure health outcomes such as obesity, blood pressure, cholesterol and blood sugar control.

Under the Obama administration's Affordable Care Act, Medicaid coverage will be expanded to cover additional low-income adults in all states in 2014.

More information

The U.S. Centers for Medicare and Medicaid Services has more about Medicaid.

New study links heart risks to anti-smoking drug Chantix (AFP)

WASHINGTON (AFP) – A study found Monday that Pfizer's anti-smoking drug Chantix poses significant cardiovascular risks, a claim the pharmaceutical giant immediately denied while defending the drug's benefits.

According to the study published in the Canadian Medical Association Journal, the drug varenicline (brand name Chantix) is linked to a 72 percent greater risk of hospitalization due to a serious adverse cardiovascular event like a heart attack or arrhythmia.

"We have known for many years that Chantix is one of the most harmful prescription drugs on the US market, based on the number of serious adverse effects reported to the FDA" (US Food and Drug Administration), said study lead investigator Curt Furberg of Wake Forest Baptist Medical Center.

"It causes loss of consciousness, visual disturbances, suicides, violence, depression and worsening of diabetes," he said in a statement. "To this list we now can add serious cardiovascular events."

Pfizer promptly responded to the accusations and critiqued the study's methodology, noting that "the difference of 72 percent reported in the Singh analysis also needs to be put into appropriate context."

The firm said the actual difference in cardiovascular complaints between patients using Chantix and those using a placebo reported in the study analysis was less than a quarter of one percent.

The FDA has asked Pfizer to conduct several clinical studies that cross-prescribe Chantix and placebo groups to different patient groups.

As of the beginning of the year, more than 1,200 complaints had been filed in US courts about the side effects of Chantix.

The drug is sold in nearly 90 countries and used by seven million Americans.

The European Medicines Agency and national agencies issued a warning as early as December 2007 over the risks of depression, suicidal ideas or suicide attempts in people who use the drug, known as Champix in France, to quit smoking.

Massage Beats Meds for Lower Back Pain, Study Says (HealthDay)

TUESDAY, July 5 (HealthDay News) -- Massage therapy may be better than medication or exercise for easing low back pain in the short term, a new government-funded study suggests.

Seattle researchers recruited 401 patients, mostly middle-aged, female and white, all of whom had chronic low back pain.

Those who received a series of either relaxation massage or structural massage were better able to work and be active for up to a year than those getting "usual medical care," which included painkillers, anti-inflammatory drugs, muscle relaxants or physical therapy, the researchers found.

Lead study author Daniel Cherkin, director of Group Health Research Institute, said he had expected structural massage, which manipulates specific pain-related back muscles and ligaments, would prove superior to relaxation or so-called Swedish massage, which aims to promote a feeling of body-wide relaxation.

Structural massage, which focuses on soft-tissue abnormalities, requires more training and may be more likely to be paid for by health insurance plans, which may equate it with physical therapy, said Cherkin.

"I thought structural massage would have been at least a little better, and that's not the case," Cherkin said. "If you're having continuing problems with back pain even after trying usual medical care, massage may be a good thing to do. I think the results are pretty strong."

The study, funded by the National Center for Complementary and Alternative Medicine, part of the U.S. National Institutes of Health, is published in the July 5 issue of Annals of Internal Medicine.

Participants were randomly assigned to one of the three groups: structural massage, relaxation massage or usual care. Those in the massage groups were given hour-long massage treatments weekly for 10 weeks.

At 10 weeks, more than one-third of those who received either type of massage said their back pain was much better or gone, compared to only one in 25 patients who received usual care, the study said. Those in the massage groups were also twice as likely in that period to have spent fewer days in bed, used less anti-inflammatory medication and engaged in more activity than the standard care group.

Six months out, both types of massage were still linked to improved function, Cherkin said, but after one year, pain and function was almost equal in all three groups.

Noting that most Americans will experience low back pain during their lifetime, Cherkin said another benefit of massage is its relative safety.

"Maybe one of 10 patients felt pain during or after massage, but most of those thought it was a 'good pain,'" he said. "A good massage therapist will be in tune with the patient and will ask what hurts."

One of the study's weaknesses was that those who were assigned to usual care knew that others were receiving massage therapy and may have been disappointed to be excluded, tainting their reported improvement, said Dr. Robert Duarte, director of the Pain and Headache Treatment Center at North Shore-LIJ Health System in Manhasset, N.Y.

"I think massage therapy can be useful for patients with back pain, but more as a . . . supplemental therapy," Duarte added.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more on low back pain.

Botox rival shows crow's feet advantage in study (Reuters)

NEW YORK (Reuters) – Medicis Pharmaceutical Corp's newer anti-wrinkle drug Dysport proved significantly better than Botox at improving crow's feet in a small clinical study, a finding that could give frown lines to market leader Allergan Inc.

Allergan's Botox (onabutulinumtoxin A) was approved by U.S. regulators in 2002 to treat wrinkles between the eyebrows, while Dysport (abobutulinumtoxin A) won approval for the same indication in 2009. The drugs are similar forms of botulinum toxin, a chemical that can block nerve impulses.

Neither drug is specifically approved to treat crow's feet, the lines that radiate from the corners of the eye and are most obvious when you squint or smile. But both of the injectable drugs are commonly used by doctors to make the branching wrinkles less apparent.

Results of the 90-patient trial -- conducted by Kartik Nettar of the Maas Clinic, San Francisco, and by the University of California, San Francisco -- were described on Monday in the online edition of the Archives of Facial Plastic Surgery.

All participants received injections of one drug in the target area on the right side of the face and the other treatment on the left side, to assess potential benefit.

Researchers then assessed the site's appearance using a five-point scale and patients were also asked their own opinions.

The difference in crow's feet was deemed by researchers to be significantly favorable to Dysport, when subjects contracted the muscles as much as possible. Moreover, about two thirds of participants said they favored the side of their faces that was treated with Dysport, according to the study.

But the results were deemed limited in scope since no statistical difference between the two treatments was seen when the muscles were at rest.

More studies are needed to assess why one agent would perform better than the other and to compare the affect of the two drugs on other facial muscles, the researchers said.

Crow's feet are among the first wrinkles to form and can surface in the 30's. Sun exposure, squinting and smoking are among the biggest causes.

Medicis sells Dysport in the United States, Canada and Japan under a licensing agreement with French drugmaker Ipsen SA. Ipsen reported first-quarter sales of $50 million from Dysport, including its own sales of the product for cervical dystonia -- a painful contraction of neck muscles -- and royalties from Medicis for anti-wrinkle uses.

Botox has far bigger annual sales, expected to top $1.5 billion this year, from anti-wrinkle uses and for a variety of medical uses, including migraine headaches, cervical dystonia and stiffness in the elbow, wrist and fingers.

(Reporting by Ransdell Pierson; editing by Andre Grenon)

Kidney improvement sustained by Abbott drug: study (Reuters)

NEW YORK (Reuters) – Diabetics with moderate to severe chronic kidney disease showed significant and sustained improvement in kidney function through 52 weeks of treatment with a novel drug being developed by Abbott Laboratories, according to data from a midstage clinical trial.

The oral drug, bardoxolone methyl, is the first medicine to demonstrate improvement in kidney function in patients with the deadly disease and could delay the need for expensive and inconvenient kidney dialysis, researchers said.

Current treatments, which are primarily blood pressure control medicines, have only been able to slow progression of chronic kidney disease.

"This is totally unique in my 20-plus years of treating patients with chronic kidney disease. There's nothing out there that increases kidney function," Dr. David Warnock, who presented the data at a European kidney meeting in Prague on Friday, said in a telephone interview.

"The important improvement we saw at the primary endpoint of week 24 is persisting and sustained throughout the entire 52 weeks of treatment," Warnock added.

Bardoxolone showed statistically significant kidney improvement compared with placebo at all three doses tested -- 150 milligrams, 75mg and 25mg -- researchers said.

Based on the results of the 227-patient study, Abbott and its partner, privately-held Reata Pharmaceuticals, which discovered the drug, selected the 75mg dose for a recently initiated pivotal Phase III trial.

Bardoxolone is the first drug from a new class called antioxidant inflammatory modulators that work by suppressing inflammation, researchers said.

Patients in the midstage trial had Type 2 diabetes and moderate to severe chronic kidney disease, defined by an estimated glomerular filtration rate (eGFR) of 20 to 45. A person with normally functioning kidneys has an eGFR -- a common measure of kidney function -- of 100.

The Abbott drug raised eGFR by nearly 30 percent compared with placebo at the two higher doses. Those who got the 75 mg dose had an average eGFR improvement of 10.5, while 150mg patients saw a 9.5 eGFR improvement.

About 21 percent of placebo patients suffered a significant loss of kidney function (more than 25 percent) over the course of the 52 weeks, which is typical for the progressive disease, researchers said.

That compared with just 9 percent with significant kidney function loss for bardoxolone patients, meaning 91 percent experienced beneficial effects on kidney function, Warnock explained.

"What we have now today is a very promising data set that would suggest there is a possibility we can actually improve kidney function even in patients who have far advanced severe chronic kidney disease," said Warnock, a professor of medicine in the division of nephrology at the University of Alabama in Birmingham.

"If this is confirmed as being clinically significant in terms of benefit to these patients, the prospects are very, very exciting," he added.

The 1,600-subject Phase III trial will determine whether the new drug can delay progression to dialysis or cardiovascular death among very high risk kidney patients with diabetes.

The most common adverse side effects seen with bardoxolone methyl included muscle spasm, transient elevations in liver enzymes and nausea.

Most of the side effects seen in the first 24 weeks of treatment had moderated or subsided during the latter portion of the study, Warnock said.

"The adverse effect profile was something that we're quite comfortable with, and we feel comfortable moving forward now with the definitive Phase III outcomes study," he said.

An estimated 20 million Americans have chronic kidney disease; about 500,000 are on dialysis or in need of transplants, according to the National Kidney Foundation.

Diabetes is the most common cause of end stage renal disease, which progresses to a need for kidney dialysis and death.

"To keep patients off the dialysis machine will be a huge impact in terms of quality of life," Warnock said.

In addition, end stage renal disease patients consume a huge portion of the Medicare budget compared to their numbers, he said.

"If we can keep people off dialysis, which costs about $75,000 a year, that would be just absolutely huge," he said.

SOURCE: http://bit.ly/kEYznL New England Journal of Medicine, online June 24, 2011.