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December 2, 2014

Jonathan Tobin: Defending the Right to a Jewish State

Heather Hale: Compliment your kids without giving them big heads

Megan Shauri: 10 ways you are ruining your own happiness

Carolyn Bigda: 8 Best Dividend Stocks for 2015

Kiplinger's Personal Finance editors: 7 Things You Didn't Know About Paying Off Student Loans

Samantha Olson: The Crucial Mistake 55% Of Parents Are Making At Their Baby's Bedtime

Densie Well, Ph.D., R.D. Open your eyes to yellow vegetables

The Kosher Gourmet by Megan Gordon With its colorful cache of purples and oranges and reds, COLLARD GREEN SLAW is a marvelous mood booster --- not to mention just downright delish
April 18, 2014

Rabbi Yonason Goldson: Clarifying one of the greatest philosophical conundrums in theology

Caroline B. Glick: The disappearance of US will

Megan Wallgren: 10 things I've learned from my teenagers

Lizette Borreli: Green Tea Boosts Brain Power, May Help Treat Dementia

John Ericson: Trying hard to be 'positive' but never succeeding? Blame Your Brain

The Kosher Gourmet by Julie Rothman Almondy, flourless torta del re (Italian king's cake), has royal roots, is simple to make, . . . but devour it because it's simply delicious

April 14, 2014

Rabbi Dr Naftali Brawer: Passover frees us from the tyranny of time

Greg Crosby: Passing Over Religion

Eric Schulzke: First degree: How America really recovered from a murder epidemic

Georgia Lee: When love is not enough: Teaching your kids about the realities of adult relationships

Cameron Huddleston: Freebies for Your Lawn and Garden

Gordon Pape: How you can tell if your financial adviser is setting you up for potential ruin

Dana Dovey: Up to 500,000 people die each year from hepatitis C-related liver disease. New Treatment Has Over 90% Success Rate

Justin Caba: Eating Watermelon Can Help Control High Blood Pressure

The Kosher Gourmet by Joshua E. London and Lou Marmon Don't dare pass over these Pesach picks for Manischewitz!

April 11, 2014

Rabbi Hillel Goldberg: Silence is much more than golden

Caroline B. Glick: Forgetting freedom at Passover

Susan Swann: How to value a child for who he is, not just what he does

Cameron Huddleston: 7 Financial Tasks You Should Tackle Right Now

Sandra Block and Lisa Gerstner: How to Profit From Your Passion

Susan Scutti: A Simple Blood Test Might Soon Diagnose Cancer

Chris Weller: Have A Slow Metabolism? Let Science Speed It Up For You

The Kosher Gourmet by Diane Rossen Worthington Whitefish Terrine: A French take on gefilte fish

April 9, 2014

Jonathan Tobin: Why Did Kerry Lie About Israeli Blame?

Samuel G. Freedman: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Jessica Ivins: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Kim Giles: Asking for help is not weakness

Kathy Kristof and Barbara Hoch Marcus: 7 Great Growth Israeli Stocks

Matthew Mientka: How Beans, Peas, And Chickpeas Cleanse Bad Cholesterol and Lowers Risk of Heart Disease

Sabrina Bachai: 5 At-Home Treatments For Headaches

The Kosher Gourmet by Daniel Neman Have yourself a matzo ball: The secrets bubby never told you and recipes she could have never imagined

April 8, 2014

Lori Nawyn: At Your Wit's End and Back: Finding Peace

Susan B. Garland and Rachel L. Sheedy: Strategies Married Couples Can Use to Boost Benefits

David Muhlbaum: Smart Tax Deductions Non-Itemizers Can Claim

Jill Weisenberger, M.S., R.D.N., C.D.E : Before You Lose Your Mental Edge

Dana Dovey: Coffee Drinkers Rejoice! Your Cup Of Joe Can Prevent Death From Liver Disease

Chris Weller: Electric 'Thinking Cap' Puts Your Brain Power Into High Gear

The Kosher Gourmet by Marlene Parrish A gift of hazelnuts keeps giving --- for a variety of nutty recipes: Entree, side, soup, dessert

April 4, 2014

Rabbi David Gutterman: The Word for Nothing Means Everything

Charles Krauthammer: Kerry's folly, Chapter 3

Amy Peterson: A life of love: How to build lasting relationships with your children

John Ericson: Older Women: Save Your Heart, Prevent Stroke Don't Drink Diet

John Ericson: Why 50 million Americans will still have spring allergies after taking meds

Cameron Huddleston: Best and Worst Buys of April 2014

Stacy Rapacon: Great Mutual Funds for Young Investors

Sarah Boesveld: Teacher keeps promise to mail thousands of former students letters written by their past selves

The Kosher Gourmet by Sharon Thompson Anyone can make a salad, you say. But can they make a great salad? (SECRETS, TESTED TECHNIQUES + 4 RECIPES, INCLUDING DRESSINGS)

April 2, 2014

Paul Greenberg: Death and joy in the spring

Dan Barry: Should South Carolina Jews be forced to maintain this chimney built by Germans serving the Nazis?

Mayra Bitsko: Save me! An alien took over my child's personality

Frank Clayton: Get happy: 20 scientifically proven happiness activities

Susan Scutti: It's Genetic! Obesity and the 'Carb Breakdown' Gene

Lecia Bushak: Why Hand Sanitizer May Actually Harm Your Health

Stacy Rapacon: Great Funds You Can Own for $500 or Less

Cameron Huddleston: 7 Ways to Save on Home Decor

The Kosher Gourmet by Steve Petusevsky Exploring ingredients as edible-stuffed containers (TWO RECIPES + TIPS & TECHINQUES)

Jewish World Review

BEWARE: Docs too often order painful, unnecessary tests, narcotics, and even surgery for back pain

By Daniel DeNoon






What to really do for low back pain


JewishWorldReview.com | What doctors call "routine" back pain can really, really hurt. Surprisingly, the best treatment is usually quite conservative--over-the-counter pain relievers, ice and heat, and gentle exercise. Yet for decades, many doctors have been ordering more and more unnecessary tests, narcotics, and referrals for surgery.

"Most routine back pain will improve on its own with conservative therapy in three months, often shorter than that," says Dr. Bruce E. Landon, professor of health care policy at Harvard Medical School. "Even more importantly, when we do more aggressive things--such as injections, imaging, and surgery--the long-term outcomes don't change at all. These things have very little impact on what is going on, and they have the potential to make things worse."

The trend of overdiagnosis and overtreatment is getting worse, according to a new study by Landon and his colleagues. They analyzed nationally representative data from 1999 through 2010 on nearly 24,000 outpatient visits for acute, new onset or chronic flare-up back pain to see if these people were treated according to established, evidence-based guidelines. Endorsed by both U.S. and international experts, these guidelines:

1. Call for treatment with non-steroidal anti-inflammatory drugs (NSAIDS, such as ibuprofen and naproxen) or acetaminophen (Tylenol and generic).

2. Call for referral to physical therapy when appropriate.

3. Advise against early referral for imaging (such as MRI and CT scans) except in rare cases where "red flags" suggest something other than routine back pain.

4. Advise against prescribing narcotics.

5: Advise against early referral to other physicians for injections or surgery.



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GUIDELINES IGNORED

The study, published in the journal JAMA Internal Medicine, revealed that doctors were increasingly ignoring these guidelines. During the study period:


  • Use of NSAIDS and acetaminophen went down, from 36.9 percent of visits in 1999-2000 to 24.5 percent of visits in 2009-2010.

  • Prescriptions for narcotic pain relievers went up, from 19.3 percent of visits in 1999-2000 to 29.1 percent of visits in 2009-2010.

  • Referrals to physical therapy remained low at 20 percent of visits.

  • Referral to other physicians went up, from 6.8 percent of visits in 1999-2000 to 14 percent of visits in 2009-2010.

  • Referrals for CT or MRI scans increased from 7.2 percent of visits in 1999-2000 to 11.3 percent of visits in 2009-2010.


"It is hard to not do anything aggressive, especially when you are having a lot of pain," Dr. Landon says. "So people ask for these more advanced things and, unfortunately, doctors are often willing to prescribe them because that's the path of least resistance."

This path of least resistance for primary care providers is a treasure trove for surgeons, specialists, and pain clinics. In the United States, health care for back pain adds up to about $86 billion each year. When people with routine back pain are referred for MRI imaging, they're eight times more likely to have surgery.

When people with back pain ask for off-guideline treatments, it takes time to understand their expectations and to explain how conservative treatment is better suited to their situation. Doctors may not feel they have that kind of time, notes Dr. John Mafi, chief medical resident at Harvard-affiliated Beth Israel Deaconess Medical Center, Boston, Mass., and first author of the study.

"It is hard to reason with people when they're in a lot of pain," he says. "I'm in favor of the honesty route. I tell people with first-time back pain that narcotics don't necessarily help and, frankly, they are a risk. Instead of reaching for the narcotics, I suggest that if they start with the acetaminophen or ibuprofen and get rest and use ice, the vast majority of the time this will get better on its own."

Dr. Landon notes that it takes five or 10 minutes to explain things as Dr. Mafi suggests, but it takes only 10 seconds to order a test or write a prescription.

"The way our health care system is set up right now makes it hard to do the right thing," Dr. Landon says. "Orthopedic surgeons, neurosurgeons, and pain medicine doctors get paid for doing things, not for counseling."

WHAT TO DO FOR LOW BACK PAIN

If you have a first-time bout with low back pain, or are in the midst of another go-round with it, here's what Dr. Jeffrey N. Katz, professor of medicine and orthopedic surgery at Harvard Medical School, recommends in "Low Back Pain," a Special Health Report from Harvard Medical School:

Cold and heat. At the beginning of the flare-up, start with ice or cold packs. After 48 hours, switch to gentle heat.

Rest. If you're in severe pain when sitting or standing, bed rest can be helpful. But limit it to a few hours at a time, for no more than a couple days. Exercise. An exercise program can help the healing process during an acute flare-up, prevent repeat episodes of back pain, and improve function if you have chronic low back pain. Work with your doctor or physical therapist to develop a suitable exercise plan.

Medication. Over-the-counter pain relievers, such as acetaminophen or an NSAID like aspirin, ibuprofen, or naproxen, are usually all that's needed to relieve acute low back pain. They work best when taken on a regular schedule, rather than after the pain flares up.

If these strategies don't work, talk with your doctor about more advanced options for treating low back pain.

Daniel DeNoon is Executive Editor of the Harvard Heart Letter.

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