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If you think you should keep your expletives to your self when you get a crick in your neck or your injure your back, think again.

A small study out of Keele University in England found that participants who repeated swear words while holding their hands under icy cold water were able to hold them longer than their virtuous counterparts. While exposure to very cold water is fairly removed from back pain, the study does shed some light on how the nervous system processes unpleasant sensations such as pain.

Stating in press materials that swearing "taps into the emotional brain center", the researchers suggested that the activity triggers our natural fight or flight mechanism, which may help us tolerate the pain. My personal belief is that it helps take the mind off the pain. (Maybe the two are related.) Regardless, the study will be published in the Aug 5 issue of NeuroReport.

| Emotions and Chronic Pain | Back Pain | Nerve Pain |

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Bone morphogenic protein (BMP) – that’s a mouthful to say – is a bone graft material that is used in about ¼ of all spinal fusions. It’s use is growing rapidly (by almost 25% between the years of 2002 and 2006), but not all the questions have been answered. The purpose of BMP is to encourage bone to grow, so that the fusion of the adjacent vertebrae can take place.

A new report published in the Journal of the American Medical Association shows an association between the use of BMP and complications related to the surgery, although in the past, smaller studies have suggested fewer complications. The report also says that fusions with BMP end up costing more.

BMP was approved by the FDA in 2002 for lumbar spinal fusion surgery. To date, there have been no studies yielding national level data about how much or the way in which BMP is used, nor have there been national studies about complication rates. The JAMA study seems to be the first one to look for that information. The researcher reviewed the hospital records of 328,468 spinal fusion patients from the years 2002-2006. He found that neck fusions done with BMP had higher complication rates, and that the use of this material is growing especially rapidly in surgeries done on women. Medicare and non-white patients receive BMP surgeries less often than others.

| What is a Bone Graft? | About Spinal Fusion | Back Pain | Spinal Fusion for Chronic Low Back Pain? |

_Sources:

Benglis, D., et al. A comprehensive review of the safety profile of bone morphogenetic protein in spine surgery. Neurosurgery 62. 5(Supp 2) (2008), (accessed July 6, 2009).

American Medical Association Press Release. Agent Used in Spinal Surgery Linked to Higher Complications Rate, Greater Inpatient Charges. June 30, 2009.

Sandhu, HS. Bone morphogenetic proteins and spinal surgery. Spine 28. 5(Suppl) (2003). (accessed July 6, 2009).

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Just because over-the-counter pain medications are sold without a doctor’s prescription, this does not mean they are always safe to take. I’m talking specifically about acetaminophen, aka Tylenol, which is the leading cause of liver failure in this country.

When a medication has acetaminophen in it, it's a good idea to be aware of the distinction between the amount (dose) that is safe to take and the amount that can cause serious liver problems. (Liver problems can be fatal, by the way.) The best way to do this is to read the label and follow your doctor’s and/or pharmacist’s instructions. Never exceed the dose that’s listed on the package, even if your pain is not going away.

There are hundreds of products on the market that contain acetaminophen, so you need to be very alert to the potential for overdose when you mix them. Risk factors have a tendency to add up, which can increase your likelihood of liver failure. So if you already have liver disease, or if you drink, you should be aware of how much acetaminophen you are getting. Again, read the label; ask your doctor, nurse and/or pharmacist if you are at all unsure.

In the hopes of reducing the incidence of acetaminophen toxicity nationwide, an advisory panel at the FDA has voted to recommend that the FDA take Vicodin and Percocet off the market. Vicodin and Percocet mix narcotics with acetaminophen, and this is particularly dangerous. The panel also voted to reduce the dosage of a single acetaminophen (Tylenol) pill from 500mg to 325mg, and to reduce daily maximum dosage to under 4000mg. The FDA is not required to implement the panel’s recommendations, but it usually does.

Here is some information from the FDA about giving Tylenol to your children.

| Tylenol for Back Pain? | How Much Do You Really Know About Tylenol? Take the Quiz | Over-the-Counter Pain Medications | Choosing Effective Pain Medications |

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_Sources:

FDA Patient News Show #87. Help Patients Use Acetaminophen Safely. FDA website. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/transcript.cfm?show=87#9

Harris, G. Panel Recommends Ban on 2 Popular Painkillers. NYT. June 30, 2009. http://www.nytimes.com/2009/07/01/health/01fda.html?_r=1&hp

If you have tense, taut bands in your muscles and pain in distant areas from those muscles, you may have trigger points. Trigger points and myofascial pain syndrome are related to postural alignment, and can be treated by properly trained massage therapists. There are also injections that can be given into trigger points. There are several types of trigger points such as active, latent, central and key. The trigger points related to myofascial pain syndrome are not the same as the tender points of fibromyalgia. (Fibromyalgia and myofascial pain syndrome share similarities, but in reality are very different conditions.)

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