Mental Status Influences Success of Steroid Treatment for Back Pain

NEW YORK (Reuters Health) Mar 09 09 – In patients with chronic axial low back or cervical pain, psychopathology predicts the outcome of medial branch blocks (MBBs) with corticosteroids, according to researchers.

“Our study,” lead investigator Dr. Ajay D. Wasan told Reuters Health, “suggests that an assessment of psychiatric symptoms is important in deciding to do an MBB. If a patient has psychiatric comorbidity, then a multimodal treatment plan — which may include an MBB — may be a better treatment option than just an MBB alone.”

In a February 16th on-line publication in BMC Musculoskeletal Disorders, Dr. Wasan of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues report on a prospective study of 86 patients who underwent MBB.

Just before and 1 month after the procedure, all completed the Brief Pain Inventory and the Hospital Anxiety and Depression Scale (HADS). The HADS scale was used to classify patients as exhibiting low, moderate or high levels of psychopathology.

Follow-up at 1 month showed that the 37 subjects in the low psychopathology group reported a mean improvement in pain of 23%. However, the 29 patients in the high psychopathology group reported a mean worsening of pain by 5.8%, a highly significant difference. Moreover, 40% of the low psychopathology group had at least a 30% improvement in pain compared to only 10% in the high psychopathology group.

“No baseline demographic, social, or medical variables were significant predictors of pain improvement,” say the investigators, “nor did they mitigate the effect of psychopathology on the outcome.”

“These findings,” they conclude, “illustrate the importance of assessing comorbid psychopathology as part of a spine care evaluation.”

BMC Musculoskelet Disord 2009.

For full medical article, see link above.

NOTE FROM ACTIVE HEALTHCARE: as with all forms of treatment, the influence of mental status on effectiveness strongly suggest a placebo, or psychosomatic effect.  In additional of the side-effects associated with such medications, their usage should be restricted until after all forms of non-invasive treatment (such as massage, acupuncture and chiropractic) have been exhausted.

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Low Maternal Vitamin B12 Concentrations Linked to Neural Tube Defects

NEW YORK (Reuters Health) Mar 06 09 – The results of a study published in the March issue of Pediatrics suggest that low vitamin B12 level is a maternal risk factor for having a pregnancy affected by a neural tube defect.

“Folic acid fortification has reduced neural tube defect prevalence by 50% to 70%,” Dr. Anne M. Molloy, of Trinity College Dublin, Ireland, and colleagues “It is important to identify other modifiable risk factors,” they note. “Vitamin B12 is metabolically related to folate; moreover, previous studies have found low B12 status in mothers of children affected by neural tube defect.”

The researchers quantified the effect of low B12 status on the risk of neural tube defects in a high-prevalence, population of about 56,000 women. Vitamin B12 concentrations were obtained from stored blood samples collected at an average of 15 weeks’ gestation, during a time when vitamin supplementation or food fortification was rare. The samples were taken from three independent nested case-control groups of Irish women within population-based cohorts.

The subjects included women with neural tube defect pregnancy; those who previously had a neural tube defect, but did not currently have one; and pregnant women with had never has a neural tube.

The authors report that vitamin B12 concentrations were significantly lower in mothers of children affected by neural tube defect. Women in the lowest B12 quartiles, compared to those in the highest quartiles, had higher adjusted odds ratios for being the mother of a child affected by neural tube defect. Women with B12 concentrations of <250 ng/L had a 2.5- to 3-fold higher risk of having a neural tube defect-affected child, after adjusting for folate.

“Based on the data, we were able to calculate that blood vitamin B12 concentrations above 300 ng/L (221pmol/L) on entering pregnancy might offer protection for women against their child having a neural tube defect,” Dr. Molloy said in an interview with Reuters Health.

“Vitamin B12 has an important influence on the way folic acid is used in the body and our results suggest that the two vitamins are jointly involved in influencing a woman’s risk,” Dr. Molloy said. “Our study suggests that women can reduce their risk further by ensuring that they have adequate B12 levels before they become pregnant,” she explained.

“The findings are particularly important to women who consume diets that are low in vitamin B12 and women with intestinal conditions that might affect their vitamin B12 status,” the author noted. “Such women might need to have their B12 status checked to ensure that they have sufficient stores.”

“It is not known how vitamin B12 and folate might interact to influence the formation of the neural tube during the early stages of the embryonic development,” Dr. Molloy said. “Dietary and genetic factors may both have important roles and our research seeks to identify such factors.”

“The next step at a public health level might be to determine whether there is sufficient evidence to recommend that women take vitamin B12 supplements as well as folic acid and/or whether to consider fortifying with vitamin B12,” the author explained. She noted that this is a complex issue. “Currently it is not clear what intake of vitamin B12 might ensure an effective level of protection and this needs to be established.*

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