New Recommendations for Low Back Pain

I welcome the new recommendations by the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists (ANZCA), as published on 14 February 2018 by Choosing Wisely Australia. These recommendations address the growing concerns over the prescription of pain medicines and spinal fusion surgery for lower back pain. Recent studies have demonstrated that an overwhelming amount of research reveals most pain medicines had little to no effect compared to placebos in treating lower back pain. GPs are now unlikely to recommend pain medicines in response to changes in major international guidelines for the management of lower back pain. 

The five recommendations by ANZCA are:

1.       Avoid prescribing opioids (particularly long-acting opioids) as first-line or monotherapy for chronic non-cancer pain.

2.       Do not continue opioid prescription for chronic non-cancer pain without ongoing demonstration of functional benefit, periodic attempts at dose reduce and screening for long-term harms.

3.       Avoid prescribing pregabalin and gabapentin for pain which does not fulfil the criteria for neuropathic pain.

4.       Do not prescribe benzodiazepines for low back pain.

5.       Do not refer axial lower lumbar back pain for spinal fusion surgery.

The highly respected American College of Physicians (ACP) low back pain guidelines recommend clinicians and patients should select nonpharmacological approaches for low back pain, several of which are commonly utilised by chiropractors. For example, for acute and subacute low back pain these recommendations include superficial heat, massage and spinal manipulation among other options where pharmacological treatment is not desired. For chronic low back pain, the guidelines recommend a range of nonpharmacological treatments including exercise therapies, rehabilitation and spinal manipulation.

Lay the Foundation for your kids

According to VicHealth our Children’s lifestyles are becoming increasingly sedentary, with 4 out of 5 children (5–17 years) not meeting the recommended 60 minutes of physical activity every day. Globally, today’s children may be the first generation to have a shorter life expectancy than their parents.

By 2025, it is estimated that one in three Australian children will be overweight or obese. It is currently 1 in 4.

Participation in physical activity halves during adolescence as sport participation levels drop suddenly at around age 15.

Physically active children and youth are more socially active, have reduced symptoms of depression and anxiety, and perform better at school.

What can you do to encourage more activity in your children? As an active childhood can lay the foundations for an active life and an active life can mean a healthier, longer life.

Don't outsource your brain!

When I was at school in the 70’s, handheld calculators had just hit the mainstream – clunky and unwieldy, they still dramatically reduced the time it took to do simple calculations that previously I had struggled to squeeze out of a slide rule (who can remember what that was?)

 Now, scientists are recognizing that using convenience devices likes smart phones, tablets and laptops to do our thinking and remembering for us, risks underutilization of our intellectual faculties, which can result in sloshy or inadequate brain function.

 Top dementia researcher Dr. Frank Gunn-Moore of the University of St. Andrews School of Biology in Fife, Scotland feels that reduced mental acuity will be an unwanted side effect of our dependence on search engines and the expediency of web services.  “It’s important to promote good brain health and to do that -  is to use it, but these days we seem to outsource our brain to the Internet,” said Dr. Gunn-Moore. “If we want to know something, we look it up online rather than trying to recall the information from our memory.”

While no current studies propose a direct link between using online services and diminished thought power, a 2016 paper published in “Memory” did demonstrate that online access has altered the way we process – experimental subjects who had access to the Internet were more likely and quicker to default to those resources when asked to respond to simple questions, instead of first trying to think of the answers organically.

 This may be more habituation than laziness, but it has the same outcome – we are training ourselves to think less and Google more, robbing us of vital brain exercise that keeps us sharp and ready.

Are you in top shape for the Christmas festivities?

Are you in top shape for the Christmas festivities?

Father Christmas has been adjusted to get him through the Christmas rush so make sure you are in the best possible condition to really enjoy the next few weeks. 

May you and your family be blessed with good health and your home filled with happiness and joy in this festive season and the year ahead. Assisting in your health and well-being has been a privilege. We look forward to being able to do the same should the need arise in the years ahead.

We will be open with reduced hours over the next 2 weeks with normal hours resuming from Monday Jan 8th.

 

Wed Dec 27th – 4-6 pm

Fri Dec 29th  - 9-11 am

Wed Jan 3rd – 4-6 pm

Fr Jan 5th – 9-12am

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High fibre diet may help kids with asthma

According to the Australian Bureau of Statistics 2015, 12.4% of boys under 15 suffer with asthma and 9.6% of girls.  This number has increased almost 10% since 2008.  A total of 2.5 million Australians suffer with asthma.  

Luckily, according to a new study from University of Newcastle, there is hope in sight.  Professor Lisa Wood and her researchers found that increasing the intake of dietary fibre decreases inflammation of the airways, improving lung function and relieving symptoms.

SBS news reported Prof Wood explaining how: "Soluble fibre doesn't get digested until it reaches the large intestine and then the bacteria that are present in the large intestine break down the fibre to produce metabolites called short-chain fatty acids and they can go back into the bloodstream and they affect immune cells which control inflammation". Now, this may be news to some, but it seems only to confirm what we already now:  That immune function and the inflammatory process have a lot to do with the health of our gut.  

It is often recommended that children be given a quality pro-biotic supplement to help establish a healthy microbiome.  This study emphasizes the importance of the pre-biotics; the food the gut bacteria like to eat.  Soluble fibre is a pre-biotic.  Pre-biotics are basically plant material - which too many children try to avoid at all cost. 

According to ABS 2016, less than 1% of children consume the recommended amount of daily vegetables and legumes!!!!  They do better with fruit: 78% of 2-3 year olds enjoy the recommended 1 piece of fruit per day, 59% of the 4-8 year olds (1.5 servings) and 39% of the older kids (2 servings).  So it is unlikely that these children eat enough fibre to keep their gut flora happy.  The Victorian website Better Health advises that kids ages 4-8 have 18g of fibre per day, girls aged 9 to 13 need 20g and 14 to 18 year olds need 22g. Boys aged 9 to 13, and 14 to 18 years, need 24g and 28g per day respectively.

Getting this amount of fibre is not difficult if you eat your greens:  An apple contains 3g of fibre, an orange 3.5g and a banana 2.5g.  A handful of nuts give you 4.5g of fibre and 100g of broccoli 4g.  And if you are not averse to grains ½ cup of muesli is 6.5g of fibre and a slice of whole meal bread 2g.