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and inflammation. Patients with painful inflam-
matory conditions of the
BACK and SPINE, such as
OSTEOARTHRITIS or RHEUMATOID ARTHRITIS, may find
ibuprofen especially helpful in easing symptoms
and slowing the deterioration that often comes
with
CHRONIC PAIN and swelling. Ibuprofen also
dulls
ACUTE PAIN, loosens PARASPINAL MUSCLES, eases
BACKACHE, and reduces the joint pain of ARTHRITIS.
Dosage and Potential Side Effects
Available in various strengths, ibuprofen comes
in a variety of generic forms and brand names,
such as Motrin, Nuprin, and Advil. Whether in
a tablet or a liquid, this popular NSAID is often
combined with other ingredients in products used
to ease fevers, coughs, or muscle cramps. How-
ever, ibuprofen should not be combined with
diuretics or blood-thinners, nor should it be taken
with
HERBAL THERAPY containing feverfew, ginger,
garlic, or ginkgo biloba. By itself, side effects may
include mild stomach upset, headache, or drowsi-
ness. Anything more should be reported to a
doctor.
Statistics and Studies
If preferred, patients who take a daily maintenance
dose of 81 mg
ASPIRIN can use ibuprofen later that
day for pain. As a MayoClinic.com article reported,
“Studies indicate that aspirin is still effective if taken
two hours before a single daily dose of ibuprofen.
But taking multiple doses of ibuprofen daily or tak-
ing ibuprofen before aspirin can impair the protec-
tive effect of aspirin.” Also, “a recent study showed
that occasional use of ibuprofen—less than 60 days
a year—doesn’t seem to impair aspirin’s ability to
reduce the risk of heart attack.”
Some people prefer one over the other, but both
ibuprofen and aspirin have anti-clotting effects similar
to a blood thinner. Because of this, doctors often rec-
ommend that patients refrain from using an NSAID
up to a week before scheduled
SURGERY. To find out if
that were necessary though, a group of doctors tested
11 healthy adults not in need of surgery. For one
week, volunteers took 600 mg of ibuprofen, orally,
every eight hours. At the end of that time, research-
ers tested blood platelet formation in each participant
at intervals of 40 minutes, eight hours, and 24 hours.
Less than one hour after the last dose of ibuprofen,
seven of the 11 showed abnormal platelet function.
In 24 hours, none did, as their blood had returned to
normal clotting time. Whether such results will be
replicated with aspirin or other NSAIDs has yet to be
studied.
DrugDigest.com. “Ibuprofen.” Available online. URL: http://
www.drugdigest.org/DD/DVH/Uses/0,3915,335%
7CIbuprofen,00.html. Last updated May 18, 2005.
Goldenberg, N. A., L. Jacobson, and M. J. Manco-Johnson.
“Brief Communication: Duration of Platelet Dysfunc-
tion after a 7-Day Course of Ibuprofen,” Annals of
Internal Medicine 142, no. 7 (April 5, 2005): 506–509.
http://www.annals.org/cgi/content/full/142/7/I-54.
MayoClinic.com. “Ibuprofen: Does It Counteract the
Benefits of Aspirin?” Mayo Foundation for Medical
Education and Research. Available online: http://
www.mayoclinic.com/health/ibuprofen/AN00803.
Last updated October 7, 2005.
MedlinePlus. “Ibuprofen,” U.S. National Library of Medi-
cines and the National Institutes of Health. Available
online. URL: http://www.nlm.nih.gov/medlineplus/
druginfo/medmaster/a682159.html. Last updated
January 10, 2006.
idiopathic juvenile osteoporosis See JUVENILE
OSTEOPOROSIS.
idiopathic scoliosis Lack of a clear cause defines
this type of
SCOLIOSIS that presents side-to-side cur-
vature of the
SPINE and affects POSTURE in INFANTS,
CHILDREN, or ADOLESCENTS. Babies diagnosed before
age three are classified as having early onset or
infantile idiopathic scoliosis, while juvenile idio-
pathic scoliosis may first be detected in children
three to 10. Adolescent idiopathic scoliosis occurs
after the 10th birthday but prior to adulthood.
Symptoms and Diagnostic Path
Spinal curvatures in babies or young children can
usually be seen with the eye, particularly during
bath time or when readying a child for bed. With
fast-growing adolescents though, parents may not
notice a worsening curvature in the
BACK unless
a misshapen shirt provides a clue. Since teenagers
often avoid the medical checkups they once had
126 idiopathic juvenile osteoporosis
regularly as children, a school nurse may be the
first to spot a problem.
In an article for Spine-health, Dr. Peter F. Ullrich
described a typical examination: “Most students are
given the Adam’s forward bend test routinely in
school to determine whether or not they may have
scoliosis. The test involves the student bending for-
ward with arms stretched downward toward the
floor and knees straight, while being observed by
a healthcare professional. This angle most clearly
shows any asymmetry in the spine and/or trunk of
the adolescent’s body.”
Should abnormal spinal development be sus-
pected, a pediatrician or other physician will exam
the child and order X-
RAYS to assess the degree of
curvature. An MRI (
MAGNETIC RESONANCE IMAG-
ING) will not usually be needed unless the child has
other symptoms, such as pain, that might suggest
spinal nerve involvement or an underlying medical
condition.
According to Dr. Ullrich, “curves that are less
than 10 degrees are not considered to even repre-
sent scoliosis but rather spinal asymmetry. These
types of curves are extremely unlikely to progress
and generally do not need any treatment.” If the
curve ranges between 20 and 30 degrees, follow-
up examinations will be needed about every four
months during periods of growth. As Dr. Ullrich
recommended, “If the curve progresses more than
5 degrees, then the curve will need treatment.”
However, “the only curves that tend to continue to
progress after skeletal maturity are those that are
greater than 50 degrees in angulation, so the treat-
ment objective is to try to get the child into adult-
hood with less than a 50 degree curvature.”
Treatment Options and Outlook
To arrest the development of spinal curvature, a
back brace can be molded to fit a growing child.
This type of brace can be taken off as needed but is
usually worn throughout the day. Unfortunately,
other children may notice and comment on the
ORTHOTIC, which can be socially and emotionally
upsetting to young patients. In some instances, this
problem can be resolved with the use of a bend-
ing back brace that works against the curve while
the child sleeps at night. However, neither type of
orthotic device works well for a mature spine.
Although idiopathic scoliosis has no commonly
accepted cause, this is not true for all types of sco-
liosis. An article in GP explained, “In non-structural
curves, the spine is structurally normal but is curved
due to an underlying condition such as differing leg
length, muscle spasms or even appendicitis.” Regard-
ing treatment, “non-structural scoliosis resolves if
the underlying cause is dealt with.” For example,
“a non-structural (postural) scoliosis reduces on
forward bending. It is usually a mild lumbar curve
compensating for a short leg. It is not progressive
and should correct with a heel raise.”
Patients with excessive spinal curvatures may
require spinal fusion to redirect the curve and
avoid a poor outlook during adult years. For exam-
ple, a severe 90-degree curve can compromise the
function of the heart or lungs. However, in lieu of
SURGERY, another treatment option may be forth-
coming. In 2004, a Pediatric Health News Release
announced, “Scientists at Cincinnati Children’s
Hospital Medical Center have developed a ‘spine
staple’ that could eliminate the need for thou-
sands of invasive spine surgeries in children each
year. . . . The spine staple would be implanted in
a minimally invasive procedure in children who
are at high risk of needing surgery in adolescence.
The staple would slow progression of the curva-
ture or actually decrease the curvature as the child
grows.”
Risk Factors and Preventive Measures
Growing children between the ages of 10 and 18
account for about 80 percent of the cases of idio-
pathic scoliosis diagnosed in this country and, there-
fore, encounter the greatest risks of developing this
condition. Nevertheless, a 2005 report from the U.S.
Preventive Services Task Force (USPSTF) stated,
“The USPSTF did not find good evidence that screen-
ing asymptomatic adolescents detects idiopathic
scoliosis at an earlier stage than detection without
screening.” With “variable” results cited from the
forward bending test typically used in schools, “the
USPSTF found fair evidence that treatment of idio-
pathic scoliosis during adolescence leads to health
benefits (decreased pain and disability) in only a
small proportion of persons. Most cases detected
through screening will not progress to a clinically
significant form of scoliosis. . . . Scoliosis needing
idiopathic scoliosis 127
aggressive treatment, such as surgery, is likely to be
detected without screening.”
Other governmental agencies, such as the U.S.
Department of Health and Human Services or the
U.S. Public Health Service, have the option of fol-
lowing the USPSTF recommendation or not. In any
case, parents who keep a watchful eye on a grow-
ing child of any age will be most likely to obtain the
most timely treatment.
Calonge, Ned, M.D., Chair, U.S. Preventative Services
Task Force. “Screening for Idiopathic Scoliosis in Ado-
lescents: Recommendation Statement,” American Fam-
ily Physician 71, no. 10 (May 15, 2005): 1,975–1,976.
Cincinnati Hospital Children’s Medical Center. “August 10,
2004—Cincinnati Children’s Scientists Develop New
Spine Staples,” 2004 Pediatric Health News Release.
Available online. URL: http://www.cincinnatichildrens.
org/about/news/release/2004/8-spine-staples.htm.
Downloaded December 29, 2005.
McAfee, Paul C., M.D. “Bracing Treatment for Idiopathic
Scoliosis,” Spine-health.com. Available online. URL:
http://www.spine-health.com/topics/conserv/brace/
feature/bracescolio.html. Downloaded December 29,
2005.
National Institute of Arthritis and Musculoskeletal and
Skin Diseases. “Questions and Answers about Scoli-
osis in Children and Adolescents,” NIAMS, National
Institutes of Health (NIH), Department of Health
and Human Services. Available online. URL: http://
www.niams.nih.gov/hi/topics/scoliosis/scochild.htm.
Downloaded December 29, 2005.
Staff. “GP Clinical: The Basics—Recognising and Identify-
ing a Scoliosis,” GP (October 28, 2005): 56.
Ullrich, Peter F., M.D. “Understanding Idiopathic Scolio-
sis,” Spine-health.com. Available online. URL: http://
www.spine-health.com/topics/cd/scoliosis/scoliosis01.
html. Last updated March 30, 2004.
image-guided surgery This computer-assisted
SURGERY provides clear imagery and guides a sur-
geon in reconstructing
VERTEBRAE or stabilizing the
SPINE.
Procedure
Prior to image-guided surgery, a
COMPUTED TOMOG-
RAPHY (CT) SCAN or MAGNETIC RESONANCE IMAGING
(MRI) provide preliminary information. Those tests
also reduce the need for X-
RAYS during the actual
procedure, thereby eliminating additional exposure
to radiation.
In describing image-guided surgery in an article
for SpineUniverse, Dr. Mark R. McLaughlin wrote,
“An optical camera is stationed in the operating
room to receive signals from special digitized instru-
ments equipped with light emitting diodes (LEDs).
During surgery the camera receives and sends the
signals to a high-speed computer. The signals are
received from both the instrument (its position)
and the patient (anatomy).” Using a geometric form
of triangulation, the optical camera establishes “the
distance between two points (instrument position
and patient anatomy). The computer integrates the
‘triangulated signals’ onto the patient’s CAT or MRI
scan images. An image is then generated projecting
the instrument’s exact location in relation to the
patient’s anatomy. The surgeon views the image on
a nearby screen (e.g. computer monitor) to see the
exact location of his instrument.”
Risks and Complications
Precise imaging may be difficult to obtain in patients
with spinal abnormalities, such as those caused by
SCOLIOSIS. Too much movement can complicate the
visuals too. If needed,
FLUOROSCOPY can be added to
the procedure.
Outlook and Lifestyle Modifi cations
Based on the Global Positioning System the military
uses to track vehicles by satellite, an image-guided
procedure offers a high-tech form of
MINIMALLY
INVASIVE SURGERY. An article posted by the Uni-
versity of Maryland Medical Center explained,
“Because the image-guided technology is so precise
and accurate, surgeons can decide how best to get
to a targeted area and avoid healthy tissue before
an incision is ever made. . . . All of this precision
shortens operating times and allows for smaller
incisions, which translates into speedier recoveries
and better results for patients. It also means that
patients with conditions considered ‘inoperable’ in
the past now have an option.”
McLaughlin, Mark R., M.D. “Image-Guided Spinal Sur -
gery,” SpineUniverse. Available online. URL: http://
128 image-guided surgery
www.spineuniverse.com/displayarticle.php/article774.
html. Last updated October 22, 2005.
University of Maryland Medical Center. “Image-Guided
Surgery,” UMMC. Available online. URL: http://www.
umm.edu/neurosciences/image_guided.html. Down-
loaded January 12, 2006.
indocid See NONSTEROIDAL ANTI-INFLAMMATORY
DRUG THERAPY.
indomethacin See NONSTEROIDAL ANTI-INFLAMMA-
TORY DRUG THERAPY.
infantile scoliosis See IDIOPATHIC SCOLIOSIS.
infant massage therapy Unlike vigorous types of
MASSAGE THERAPY for adults, infant massage treats
PARASPINAL MUSCLES with light pressure and loving
care. Not only does this form of tender touch pro-
vide comfort and relaxation, the baby also receives
healthy stimulation.
Assuming that no fever or infection exists, infant
massage can aid the tiniest newborn, but this was
not always allowed. As an article by Christopher
Vaughan reported, “In the early 1960s, doctors
treating premature babies feared infection above
all else. So they isolated the infants completely in
sterile boxes; no one could touch them directly. . . .
In the late ’60s, psychiatrist Herbert Liederman
became concerned about the effect of isolation
on the parent-child relationship. When parents
finally brought their babies home after weeks of
fretting, they often felt alienated and unsure how
to care for them.” Therefore, clinical settings, such
as Stanford’s Lucile Packard Children’s Hospital,
encouraged parents to wash their hands and han-
dle their babies. “This research sparked the term
‘bonding’ and the idea that physical contact is an
important part of the parent-infant relationship.”
In subsequent studies, “researchers at other uni-
versities later established that holding and caress-
ing premature infants also helps them develop
physically and emotionally.”
Procedure
To develop a procedure for preterm infants, the
Touch Research Institute at the University of Miami
School of Medicine began conducting studies in the
mid 1980s. As Tiffany Field reported, “The massage
sessions were comprised of 3 five-minute phases.
During the first and third phases, tactile stimulation
was given. The newborn was placed in a prone posi-
tion and given moderate pressure stroking of the
head and face region, neck and shoulders, back, legs
and arms for five one-minute segments.” Studies
eventually showed “The massaged infants gained
47 percent more weight, even though the groups
did not differ in calorie intake; The massaged infants
were awake and active a greater percentage of the
observation time (much to our surprise, since we had
expected that the massage would stimulate a sopo-
rific state and greater sleep time, leading to weight
gain via lesser energy expenditure and calories);
The massaged infants showed better performance
on the Brazelton Scale on habituation, orientation,
motor activity and regulation of state behavior; The
massaged infants were hospitalized, on average, six
fewer days than the control infants.”
Once home, parents might begin by lightly coat-
ing their hands with a natural, perfume-free oil to
avoid chafing the baby’s sensitive skin. The mas-
sage then involves gentle strokes with light pres-
sure, but not too light or the infant will perceive
this as unpleasant tickling. In general, the care-
taker should remain aware of each response the
baby gives. If an infant becomes cranky, startled, or
tense, the massage should cease immediately but be
tried another time.
Risks and Complications
Rough treatment and careless handling pres-
ent the most obvious risks. Whether perceived as
pleasant or unpleasant, most babies quickly react
to stimuli, but an abused infant loses that natural
ability and withdraws into fear. To overcome an
acquired revulsion to touch, massage sessions can
initially be confined to a minute or less then gradu-
ally increased over a few weeks, depending on the
readiness of the child.
Outlook and Lifestyle Modifi cations
For all babies, a good massage should provide a
safe time that aids mental, physical, and emotional
infant massage therapy 129
development, not only for the infant, but also for
the parent. As information from the International
Loving Touch Foundation Web site explained,
infant massage “helps the parent to feel more con-
fident and competent in caring for their children.”
For example, massaging a baby “helps parents
understand their infants’ cues and states of aware-
ness” and also “promotes bonding and attachment.”
If an infant has been ill, massage can help parents
to “feel a greater part of the healing process.” If
the mother herself has been ill or depressed, infant
massage will be likely to aid her healing too.
Field, Tiffany. “Infant Massage,” Touch Research Institute,
University of Miami School of Medicine, edited from
the Zero to Three Journal, October/November 1993.
Available online. URL: http://www.zerotothree.org/
massage.html. Downloaded January 13, 2006.
International Loving Touch Foundation. “Benefits for
Parents and Primary Caregivers.” Available online.
URL: http://www.lovingtouch.com/2/mfi-benefitsp.
php. Downloaded January 13, 2006.
Vaughan, Christopher. “Holding On,” Stanford Magazine.
Available online. URL: http://www.stanfordalumni.
org/news/magazine/2002/sepoct/features/neonatal.
html. Downloaded January 13, 2006.
infants, spinal concerns for Concern for the
SPINE of an infant begins before the arrival of a baby
but also before the arrival of a fetus. As explained
by MayoClinic.com, “the fourth week marks the
beginning of the embryonic period, when the
baby’s brain, spinal cord, heart and other organs
begin to form. Your baby is now
1
⁄
25
of an inch
long.” During that embryonic state, “the embryo is
now made of three layers. The top layer—the ecto-
derm—will give rise to a groove along the midline
of your baby’s body. This will become the neural
tube, where your baby’s brain, spinal cord, spinal
nerves and backbone will develop.” By the seventh
week of pregnancy, the baby “weighs less than an
aspirin tablet.” With the umbilical cord now taking
shape, “the cavities and passages needed to circu-
late spinal fluid in your baby’s brain have formed,
but your baby’s skull is still transparent.” By week
nine, “the embryonic tail at the bottom of your
baby’s spinal cord is shrinking, helping him or her
look less like a tadpole and more like a develop-
ing person.” As neurons multiply in week 10, “the
bones of your baby’s skeleton begin to form.” In
week 13, ribs may take shape, and by week 15,
bone marrow develops. About a month later, the
mother may feel the child begin to move. Shortly
thereafter, bone marrow awakens to its job of mak-
ing blood cells. At week 29, fully developed bones
begin to store minerals, such as
IRON and CALCIUM,
yet bones remain pliable to ease into the world
sometime around week 40.
Risks and Complications
At any time prior to birth, alcohol consumption,
inadequate
NUTRITION, smoke, or other ENVIRON-
MENTAL INFLUENCES can disrupt skeletal develop-
ment. G
ENETIC FACTORS also contribute to BIRTH
DEFECTS OF THE SPINE, whereas accidents and womb-
crowding complicate the formation of healthy
VER-
TEBRAE. After prenatal development has ceased, the
minimal risk of a
BIRTH INJURY TO THE SPINE arises
during the actual delivery. Afterward, spinal dam-
age most often comes during transportation, for
example, if someone drops a baby or a vehicular
accident occurs.
In addressing car safety, the American Academy
of Orthopaedic Surgeons (AAOS) said, “Most car
crashes happen within 25 miles of home. That’s
why it is important to put your child in a safety seat
every time you drive. Adults often think that hold-
ing a child on their lap is as safe as using a safety
seat. It is not. Experts refer to the ‘on-lap’ position
as the ‘child-crusher’ position. In a crash at 30 miles
per hour, a 10 pound child could be thrown from
the adult’s lap into the dashboard or windshield
with a force of 200 pounds.”
Only a certified, age-appropriate seat should be
purchased for a child, but if the parent does not find
it manageable, even the priciest equipment does no
good. As an article posted by SafetyBeltSafe USA
said, “The ‘best’ seat is the one that fits your child,
fits your car, and fits your family’s needs in terms
of comfort and convenience, so that you’ll use it
on every single ride.” Also, “babies should ride rear
facing as long as possible to protect the spine. They
must ride rear facing until they are at least one year
old to prevent possible death or lifelong disability.
Babies have heavy heads and weak necks with soft
130 infants, spinal concerns for
bones and stretchy ligaments. In a frontal colli-
sion, which is the type most likely to cause death
or severe injury, a forward-facing baby’s neck may
stretch up to two inches, but the spinal cord rup-
tures if it stretches more than one-fourth of an
inch.”
Statistics and Studies
Car safety affects spinal health throughout a per-
son’s life, but in the earliest moments, deformities
of the
BACK or spine cause more fatalities. Among
black families, National Vital Statistics listed pre-
mature birth or low birth weight as the primary
cause of infant death with the second cause being
“congenital malformations, deformations and chro-
mosomal abnormalities.” Among Native American,
Caucasian, Hispanic, and Asian families, spinal
abnormalities presented the first cause of infant
death.
Special Aids and Adaptations
Prospective parents concerned about a family his-
tory of severe spinal problems might seek the aid
of a pediatrician or other physician who special-
izes in orthopedic concerns. Regarding safety in
transportation, the AAOS reported, “Research on
child safety seats has found that they can reduce
fatal injuries by 71 percent for infants who are less
than 1 year old.” Also, anyone who carries a child
should be physically and mentally able to hold that
valuable cargo with care. As one hand cradles a dia-
pered bottom, the other lightly supports the
CERVI-
CAL SPINE and upper THORACIC SPINE until the infant
develops enough neck strength to hold the head
upright. During the crawling and toddling stages,
stair gates and other protective aids provide limits
yet encourage young children to explore the safe
surroundings personally adapted to and for them.
American Academy of Orthopaedic Surgeons. “Car
Seat Safety,” AAOS. Available online. URL: http://
orthoinfo.aaos.org/fact/thr_report.cfm?thread_id=61&
topcategory=Injury%20Prevention. Downloaded Jan-
uary 12, 2006.
MayoClinic.com. “Fetal Development,” Mayo Foundation
for Medical Education and Research. Available online.
URL: http://www.mayoclinic.com/health/ prenatal-care/
PR00112. Last updated October 7, 2005.
National Vital Statistics. “Table 7. Infant Deaths and
Mortality Rates for the Five Leading Causes of Infant
Death by Race and Hispanic Origin of Mother: United
States,” National Vital Statistics Report 50, no. 12 (August
28, 2002): 21.
SafetyBeltSafe USA. “Which Safety Seat Is ‘the Best’
for My Child?” Available online. URL: http://www.
carseat.org/Resources/624_bestseat.pdf. Downloaded
January 12, 2006.
infection of the spine See SPINAL INFECTION.
injection See SPINAL INJECTION.
injury See SPINAL INJURY.
intradiscal electrothermal therapy (IDET) If
the nonsurgical methods of
PAIN MANAGEMENT fail,
intradiscal electrothermal therapy (IDET) may offer
a pain-relieving option. IDET can be used to treat
patients with
SCIATICA, less severe cases of DEGEN-
ERATIVE DISC DISEASE, and other disc-related condi-
tions that affect the
BACK and SPINE.
Procedure
In an article for SpineUniverse, Dr. Steven Richeimer
wrote, “This procedure involves the insertion of a
needle into the affected disc with the guidance of
an x-ray machine. A wire is then threaded down
through the needle and into the disc until it lies
along the inner wall of the annulus,” which is the
ring-like portion of the intervertebral disc body.
“The wire is then heated which destroys the small
nerve fibers that have grown into the cracks and
have invaded the degenerating disc. The heat also
partially melts the annulus, which triggers the body
to generate new reinforcing proteins in the fibers of
the annulus.”
Risks and Complications
IDET takes only about an hour, but discomfort may
actually increase for the first few days after the pro-
cedure. As happens with any type of
SURGERY, IDET
offers no guarantee of pain relief, but pain lessens
intradiscal electrothermal therapy 131
for most patients within a few weeks. Some, how-
ever, may encounter additional
DISC problems in
the future.
According to the American Academy of Ortho-
paedic Surgeons (AAOS), IDET is not recom-
mended for patients with
SPINAL STENOSIS, spinal
instability, or spinal nerve compression. Long-
term results remain unknown. Therefore, the
AAOS cautioned, “Because this is a relatively new
procedure, you should make sure that the practi-
tioner you see is adequately trained in using the
equipment.”
Outlook and Lifestyle Modifi cations
Online information from The Virginia Spine Insti-
tute said, “During the disc healing process, from 8 to
16 weeks following the procedure, it is very impor-
tant to treat your discs with care. Your physician
may prescribe temporary lumbar support as well
as activity and physical rehabilitation guidelines.”
However, “in a small study of 700 patients, nearly
80% enjoyed reduced pain and greater mobility.
Half of those patients taking narcotic pain-killers
ended up drug-free.”
Sensible care during recovery may include life-
style changes to aid disc health. Also, ample drinking
water, well-balanced
NUTRITION, and doctor-approved
EXERCISE will improve the long-term outlook for
almost any disc.
American Academy of Orthopaedic Surgeons. “IDET
(Intradiscal Electrothermal Annuloplasty),” AAOS.
Available online. URL: http://orthoinfo.aaos.org/fact/
thr_report.cfm?Thread_ID=339&topcategory=Spine.
Downloaded January 12, 2006.
Richeimer, Steven, M.D. “New Technologies for Treat-
ing Sciatica and Back Pain,” SpineUniverse. Avail-
able online. URL: http://www.spineuniverse.com/
displayarticle.php/article1485.html. Last updated
November 8, 2005.
Virginia Spine Institute, The. “IntraDiscal ElectroThermal
Therapy.” Available online. URL: http://www.spinemd.
com/idet.htm. Downloaded January 12, 2006.
intrathecal spinal pump If nonsurgical methods
of
PAIN MANAGEMENT no longer help, INTRADISCAL
ELECTROTHERMAL THERAPY (IDET) offers a pain-
relieving option. If various types of
SURGERY fail to
ease
CHRONIC PAIN, an intrathecal spinal pump can
deliver pain relief directly to the site.
Procedure
To explain the reasoning behind this procedure, Dr.
Steven Richeimer wrote, “Medicines taken orally get
diffused throughout the entire body which means
that a great deal of medication must be ingested in
order to get the appropriate quantities to the place it
is needed most to ease pain: the spinal cord.” How-
ever, “by surgically implanting a pump under the
skin of a person’s abdomen, and running a catheter
to the precise location in the spine where the pain
is, we can pump medication directly into the spinal
fluid, allowing for a much more potent effect on
the spinal cord. This drastically cuts down the dose
of medication that is needed, and the medication
often provides even better pain relief with much
fewer side effects.”
Risks and Complications
The use of a spinal pump carries a minimal risk of
infection. Also, strong narcotics, such as morphine,
will be used, which can be costly as well as poten-
tially addictive.
Outlook and Lifestyle Modifi cations
As Dr. Ralph F. Rashbaum explained in a Spine-
health article, “medication in the pump is added
periodically (e.g. monthly) by injecting medica-
tion through the skin into the pump reservoir.”
Presumably, this means regular follow-ups with a
physician.
To find out whether an intrathecal spinal pump
will work well, a trial phase allows the patient to
try the treatment on a short-term basis. If needed
though, the actual implant can also be removed.
Rashbaum, Ralph F., M.D. “Spinal Cord Stimulators and Pain
Pumps—Implantable Systems for Neuropathy,” Spine-
health. Available online. URL:http://www.spine-health.
com/topics/conserv/neuropaintr/neuropaintr04.html.
Downloaded January 13, 2006.
Richeimer, Steven, M.D. “Spinal Pumps and Stimulators,”
SpineUniverse. Available online. URL: http://www.
spineuniverse.com/displayarticle.php/article1612.
html. Last updated October 22, 2005.
132 intrathecal spinal pump
iron In healthy red-blooded people, this mineral
aids red cell production. Those cells then carry oxy-
genated blood throughout the body, enabling a
person to perform daily
ACTIVITY or EXERCISE with
vitality. Such vigorous efforts aid
BONE BUILDING
and strengthen
PARASPINAL MUSCLES too.
All iron, however, is not created equal. Accord-
ing to the National Institutes of Health (NIH) Office
of Dietary Supplements, “there are two forms of
dietary iron: heme and nonheme. Heme iron is
derived from hemoglobin, the protein in red blood
cells that delivers oxygen to cells. Heme iron is
found in animal foods that originally contained
hemoglobin, such as red meats, fish, and poul-
try. Iron in plant foods such as lentils and beans is
arranged in a chemical structure called nonheme
iron. This is the form of iron added to iron-enriched
and iron-fortified foods. . . . Heme iron is absorbed
better than nonheme iron, but most dietary iron is
nonheme iron.”
Dosage and Potential Side Effects
The Weightlossforall.com Web site from England
listed “Foods Rich With Iron,” which included 20
mg of heme iron found in a traditional British dish
known as blood pudding. As another blood source
from which most high-heme springs, liver offers
9 mg of iron, but even a can of shrimp contains
5 mg of heme iron, while lean beef has about 2.5
mg. To avoid blood sources and cholesterol, non-
heme iron can be found in many culinary herbs,
with the understanding, of course, that the heap-
ing amounts required to meet the Recommended
Daily Allowance (RDA) would ruin a meal. Nev-
ertheless, dietary sources of nonheme iron include
thyme, curry, cinnamon, rosemary, and paprika but
with more substantial amounts found in cashews,
almonds, and other nuts. Despite the numerous
natural sources for iron-rich
NUTRITION, people
with dietary restrictions may not get enough. Since
each age group has unique requirements for iron,
supplements should be taken according to the RDA
shown on a product label or as recommended by a
doctor.
Statistics and Studies
At almost any age or place, signs of iron deficiency
can be seen. As the NIH reported, “The World
Health Organization considers iron deficiency the
number one nutritional disorder in the world.
As many as 80% of the world’s population may
be iron deficient, while 30% may have iron defi-
ciency anemia.” Besides blood loss and low dietary
intake, iron deficiency commonly occurs because of
adverse interactions with medications or interfer-
ence from other foods.
The NIH Office of Dietary Supplements further
advised, “Some researchers have raised concerns
about interactions between iron, zinc, and cal-
cium. When iron and zinc supplements are given
together in a water solution and without food,
greater doses of iron may decrease zinc absorption.
However, the effect of supplemental iron on zinc
absorption does not appear to be significant when
supplements are consumed with food. There is evi-
dence that calcium from supplements and dairy
foods may inhibit iron absorption, but it has been
very difficult to distinguish between the effects of
calcium on iron absorption versus other inhibitory
factors such as phytate.” According to other studies
cited by the NIH, “tannins (found in tea), calcium,
polyphenols, and phytates (found in legumes and
whole grains) can decrease absorption of nonheme
iron. Some proteins found in soybeans also inhibit
nonheme iron absorption.”
While
CALCIUM hinders iron absorption, and vice
versa,
VITAMIN A and VITAMIN C help the body bet-
ter absorb iron, similar to the way
VITAMIN D boosts
calcium uptake. Too much boosting, however, is
seriously inadvisable. As the NIH warned, “In chil-
dren, death has occurred from ingesting 200 mg of
iron.”
Since iron deficiency anemia seldom occurs in
men or in postmenopausal women, they, too, must
take care not to overload. As the NIH said, “As far
back as the 1980s, some researchers suggested that
the regular menstrual loss of iron, rather than a
protective effect from estrogen, could better explain
the lower incidence of heart disease seen in pre-
menopausal women. After menopause, a woman’s
risk of developing coronary heart disease increases
along with her iron stores.” Whether the culprit is
too much iron or too much cholesterol, vigorous
exercise makes use of both. Conversely, the NIH
warned, “the need for iron may be 30% greater in
those who engage in regular intense exercise.”
iron 133
Office of Dietary Supplements. “Dietary Supplement Fact
Sheet: Iron,” National Institutes of Health. Available
online. URL: http://ods.od.nih.gov/factsheets/iron.asp.
Downloaded January 12, 2006.
Weightlossforall.com. “Foods Rich in Iron.” Avail-
able online. URL: http://www.weightlossforall.com/
iron-rich-food.htm. Downloaded January 13, 2006.
134 iron
135
juvenile arthritis
“Arthro” refers to joints and
“itis” to the inflammation that characterizes this
rheumatic condition. Unfortunately, juvenile
arthritis (JA) often goes undetected. People usu-
ally think of
ARTHRITIS as occurring in the ELDERLY,
but JA begins sometime during childhood, usually
before age 15.
According to the article “Arthritis in Children”
posted by the Arthritis Foundation (AF), “about
285,000 children in the United States have a form
of juvenile arthritis. The most common form of
arthritis in children is juvenile rheumatoid arthri-
tis (JRA.)” Besides
JUVENILE RHEUMATOID ARTHRITIS,
“Children also are affected by arthritis as a feature
of more than 100 other diseases including diseases
that affect the spine, connective tissue diseases,
and non-inflammatory disorders such as fibromy-
algia.” However, “the cause of most forms of juve-
nile arthritis remains unknown. Juvenile arthritis
is not contagious and there is no evidence that
foods, toxins, allergies or vitamin deficiencies play
a role. Current research indicates that there may
be a genetic predisposition to juvenile arthritis.
Most of the symptoms are due to inflammation as
a result of the immune system. Nonetheless, there
are many effective treatments available to help you
and your child manage juvenile arthritis.”
Symptoms and Diagnostic Path
Joint pain,
BACK pain, fatigue, and stiffness in
the
SPINE sometimes occur during normal growth
spurts in
CHILDREN and ADOLESCENTS, but those
growing pains can also be symptoms of JA. In gen-
eral,
CHRONIC PAIN indicates the presence of some
type of disorder. To investigate the possibilities, a
rheumatologist may request a blood test. Although
this test may not identify JA, it may rule out simi-
lar conditions, such as
JUVENILE SPONDYLOARTHRI-
TIS or ANKYLOSING SPONDYLITIS. A medical history,
physical examination, and an eye examination can
also assist the diagnosis. If joint inflammation has
affected
RANGE OF MOTION, a rheumatologist, pedia-
trician, or other doctor may use X-
RAYS to evaluate
the condition of those joints.
Although the AF mentioned a lack of evidence
implicating
ENVIRONMENTAL INFLUENCES, such factors
might be considered on an individual basis, with
diagnostic clues often found at home. For instance,
if symptoms begin in more than one person after a
family has moved into an old house, the lead on a
painted surface or in the well-water might be the
cause. More often, JA symptoms arise because of
undetected food allergies. To begin that detective
work, meals and snacks must be restricted to bland
food for about 10 days. Then one potential aller-
gen, such as wheat, tomatoes, shellfish, or choco-
late, can be returned to the diet each week. If a skin
rash or stomach upset occurs, the food should be
removed to see if this eliminates the symptoms. If
so, at least one food allergen has been identified,
which may indicate the presence of others. If no
problem arises, that food can be returned to the
regular diet and the next potential allergen tested.
Treatment Options and Outlook
Traditionally,
PAIN MANAGEMENT of JA includes
NONSTEROIDAL ANTI-INFLAMMATORY DRUG (NSAID)
THERAPY or prescription medication. Depending on
the presence of other symptoms, such as inflam-
mation around the eyes or a skin rash on the body,
regular eye examinations and visits to a dermatolo-
gist may be needed.
Various types of
COMPLEMENTARY AND ALTERNA-
TIVE MEDICINE, such as HOMEOPATHIC MEDICINE or
HERBAL THERAPY, may help some JA patients. In
general, appropriate
EXERCISE, adequate liquids,
J
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