It's been 5 years since the then CEO of giant drug-maker Merck, Raymond Gilmartin, testified to the US Senate Finance Committee regarding evidence showing that Vioxx increases the risk of death due to heart attacks, strokes and other cardiovascular events.

In a Summary of Prepared Testimony, Gilmartin stated that prior to the APPROVe trial (a study looking at the protective effects of Vioxx on the risk for colon cancer), the research done by his company 'showed no difference in confirmed cardiovascular event rates between Vioxx and placebo'.

But a new and comprehensive data analysis published in the November 23, 2009 issue of Archives of Internal Medicine, looked at all deaths that should have been reported by Merck from 1999 (when Vioxx entered the market) to September 2004 (when it was pulled from the market, after APPROVe was halted due to health risks to participants). The analysis pooled patient data from every available published and unpublished study and looked at the information in revised ways. Specifically, measurements for death from any cause and the risk for cardiovascular events were calculated. Over 20,000 patients were included. The researchers found that an association between taking Vioxx and increased risk for cardiovascular events was evident 3 ½ years before the drug was pulled from the market.

Some of the data used in this research became available only when litigation against Merck made it public. This means that it was highly likely Merck withheld some or all of its less favorable study results during the time the drug was on the market. (Yes, they could do that legally...) But the study's authors disclose their ties to industry, as well. In their report, they reveal that every member of the team has, either currently in the the past worked as a consultant for the people who took Merck to court (plantiffs) over the Vioxx issue.

(c) Anne Asher 2007 Licensed to About.com

The Archives analysis evaluated the risk of death or the occurrence of a cardiovascular event in those who took Vioxx as it compared to those who took a placebo. Again, it used all studies, whether the results were good or bad for Merck. The analysis found that by the time the drug was off the market in September 2004, the risk was 43% greater for the Vioxx-takers. To be fair to Merck, the way this analysis was done was not standard industry practice.

One reason the study was done was to determine if Merck should have known (and made known the fact that) their drug posed serious risks to health when they first put it on the market. Another reason for the data analysis, according to its authors, was to help improve public health surveillance efforts for drug safety. The researchers believe the information from the analysis can be used to develop more targeted, comprehensive systems in the future.

I was interested in Merck's response to this new study, so I went to their website. Sure enough, a statement had been posted. Read more...

(c) mzacha

Oh, the scourges of aging! In the neck, one of these is cervical spondylosis, aka arthritis of the neck. It is due to the formation of bone spurs, which often irritate nearby spinal nerves. Cervical spondylosis can get really painful in the case of myelopathy, that is, when the spinal cord is involved.

There are a number treatments for cervical spondylosis, and they are generally non-invasive. If you doctor tries to talk you into surgery, beware that going this route will likely take its toll on you, but whether it is the best option for pain relief remains questionable.

(c) Michael J. Summerville

Many people think of chiropractors as merely back doctors. In reality, the chiropractic profession is built on the belief that spinal alignment affects the health of the whole body. Therefore, your chiropractor might treat your spine in order to bring about a variety of health benefits, including back health.

According to the National Center for Complementary and Alternative Medicine, about 18 million adults and 2 million children go to a chiropractor. While it's true that most visits are for common back conditions and injuries, here's an example of the chiropractic view of health in an ongoing research effort:

Researchers at the University of Chicago gave a particular type of chiropractic called NUCCA to patients taking medicine for their high blood pressure. NUCCA chiropractic specializes in adjusting only the top of the neck. They found a significant decrease in the amount of medication the patients needed after the manipulation. More studies on this connection are expected.

Chiropractic is considered to be a CAM therapy and so it takes your whole being into consideration. Is it right for you?

Photo: Kameleon007

The thought of post-Halloween back pain may conjure images of taking the costumes back up to the attic or lugging heavy bags of candy. But let's not forget the extra weight you may be carrying from having eaten those Halloween treats! With the holidays approaching, be forewarned that back pain a very common problem for overweight people. Carrying extra pounds can increase your risk for developing several back disorders.

If you are a spine surgeon or a surgical nurse specializing in spine who likes to write, About.com has an opportunity for you! As an About.com Contributing Writer, you will work with me to cover the sub-topic of spinal procedures and surgeries. You'll be responsible for producing about 15 short articles per month, and you can also write more than the minimum, if you want.

If you are interested in applying or learning more, please email your RESUME and a WRITING SAMPLE -- both IN THE BODY OF AN EMAIL -- to contributingwriters@about.com. Put the "Back and Neck Pain" in the subject line of the email. Good luck!

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Are you pregnant with low back pain? One type of low back pain that's very common during childbearing is sacral pain. Experts think that when low back pain in this area begins during pregnancy, chances are you may be experiencing it long after your baby is born. About 10% of pregnant women with low back pain continue to experience disabling pain two years after delivery.

A new study, published in Spine found that a corticosteroid injection to the lowest part of the pelvis (called the ischial spine) relieved pain for 4 weeks in 36 women who had chronic pain that had begun while they were pregnant. The women made pain drawings and filled in visual analog scales to rate the intensity, frequency and location of their pain, and the researchers measured the differences in their marks before and after the injections. The women also had a clinical exam by both a physical therapist and a doctor.

_{Source:
Torstensson, T., MSc, RPT, Lingren, A., RPT, Kristiansson, P, MD, PhD. Corticosteroid Injection Treatment to the Ischiadic Spine Reduced Pain in Women with Long-Lasting Sacral Low Back Pain with Onset During Pregnancy. Spine. 2009.}

| Sacrum | Back Pain | Visual Analog Scale - VAS |

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A new data study shows that the rate of cervical spine fusions in elderly Medicare patients rose a whopping 206% between 1992 and 2005. Over 156,000 hospital records were reviewed for demographic information.

A cervical spine fusion is a surgery that unites two adjacent spinal bones by taking out the disc material. Sometimes a bone graft is used (as well as instrumentation) in order to accomplish what doctors call a "union" between the vertebrae in question.

Interestingly, the rate of increase for the neck operations was not the same across the nation. In Idaho, there were lots of surgeries: 14% to be exact. Contrast that with Washington, DC, where the rate was .004%. The researchers also found that the condition most often warranting the surgery was cervical spondylosis with myelopathy, which is a degenerative condition that affects the spinal cord. Fifty-two percent of those who got the fusion surgery were men, 88% were white and 41% were between the ages 65 and 69.

Another study done by the same researchers found that there was a significant risk of death for elderly people who had the surgery for cervical spondylosis with myleopathy. See a short video on spinal fusion.

| Cervical Spine Fusion | Back Pain | Bone Graft |

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If you subscribe to the Back and Neck Pain newsletter you may be aware of The Daily Spine, a special feature (at the bottom) that considers the routine challenges presented or made more difficult by back pain. The Daily Spine articles provide tips for better living despite the ache in your back or neck. Here are a few samples:

• You Don't Have to Throw Your Back Out!
• Morning Stretches for Your Spine
• Aspirin for Back Pain?

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Recently, a study broke new ground in the body of knowledge around spinal cord injury rehabilitation. Previously scientists had been able to elicit limb movement in spinal cord injured people, but the movement did not involve weight bearing. This new study tested a combination of treatments that enabled paralyzed rats to use the treadmill in a nearly normal way. Study investigators say this discovery will have implications for people with spinal cord injuries.

The rats' treatments consisted of drugs, electrical stimulation and exercise. The rats were able to do a stepping like motion controlled by nerve activity (called circuits) that do not involve the use of the brain. If treatments are developed based on these findings, it could mean that regenerating nerves in the spinal cord is not necessary for patients to regain a lot of lost functionality.

_Sources:

1. Grégoire Courtine, Yury Gerasimenko, Rubia van den Brand, Aileen Yew, Pavel Musienko, Hui Zhong, Bingbing Song, Yan Ao, Ronaldo M Ichiyama, Igor Lavrov, Roland R Roy, Michael V Sofroniew & V Reggie Edgerton. Transformation of nonfunctional spinal circuits into functional states after the loss of brain input. Nature Neuroscience, 2009; DOI: 10.1038/nn.2401

2. University of California - Los Angeles (2009, September 21). Scientists Make Paralyzed Rats Walk Again After Spinal-cord Injury. ScienceDaily. Retrieved September 22, 2009, from http://www.sciencedaily.com­ /releases/2009/09/090920204455.htm

| Complete SCI | Incomplete SCI | Newly Diagnosed SCI-For Friends and Family | Exercising with Spinal Cord Injury |

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While you may see a lot of bickering on the news reports about health care reform, there is some bipartisan work going on that could benefit people living with chronic pain, provided the bill passes. In June the National Pain Care Act of 2009, introduced by Sens. Chris Dodd (D-CT) and Orin Hatch (R-UT), and supported by the American Pain Foundation, was unanimously adopted by the Committee on Health, Education, Labor, and Pensions as one of the amendments to the healthcare reform bill.

What's sad, though, is that while Republicans have spent much time working up about 160 amendments to be included in health care reform for America, according to most news reports at least, more likely than not, none of them are planning on voting for it, no matter what. You may remember Sen. Chuck Grassley (R-IA) from the Finance committee stating flat out that he just would not vote for a health care reform bill - even though he is a key author on the bill they plan to unveil this week. But I digress.

In the House the bill was H.R. 756; in the Senate it's S. 660. I blogged about it when the Pain Care Act was passed by the House, back in March.

Standing up for your rights is tough when you have pain because it's so isolating and draining. But September is Pain Awareness Month and there is strength in numbers, so let's look at a few ways you might be able to advocate for yourself and others while we wait for the Pain Care Act to (hopefully) become law. The American Pain Foundation has ideas:

• Raise Awareness
• Sign a Petition
• Find a Local Event


AND

• Learn More About Chronic Pain at About.com's Pain Site

| House Passes National Pain Care Act 2009 | Back Pain | Pain Management |

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