Medications used for spine-related pain in older adults may cause adverse drug reactions

 Spine-related pain is increasingly common in older adults. While medications play an important role in pain management, their use has limitations in geriatric patients due to reduced liver and kidney function, comorbid medical problems and polypharmacy (the simultaneous use of multiple drugs to treat medical conditions).

 

Now a new review study has found acetaminophen is safe in older adults, but non-steroidal anti-inflammatories (ibuprofen) may be more effective for spine-related pain. Non-steroidal anti-inflammatories should be used short-term in lower dose courses with gastrointestinal precaution while corticosteroids show the least evidence for treating nonspecific back pain.

 

Additionally, nerve pain medications (gabapentin and pregabalin) can be used in older persons, with caution to dose and kidney function. Newer antidepressants (duloxetine) more so than older ones (nortriptyline) can help with spine-related pain, with attention to possible sedation and dizziness. Some muscle relaxants (baclofen and tizanidine) can be used in older persons, again accounting for kidney and liver function. Opioids have limited use in common spine-related pain, but can be used with caution in cases that don’t respond to treatment.

 

“Most older people experience neck or low back pain at some point, bothersome enough to see their doctor. Our findings provide a helpful medication guide for physicians to use for spine pain in an older population that can have a complex medical history,” explained corresponding author Michael D. Perloff, MD, PhD, assistant professor of neurology at Boston University School of Medicine (BUSM) and a neurologist at Boston Medical Center.

 

The researchers performed a literature review to assess the evidence-basis for medications used for spine-related pain in older adults, with a focus on drug metabolism and adverse drug reactions. They then provided their recommendations based on safe and effective dosing.

 

Among their findings:

• Pain medicines gabapentin and pregabalin may cause dizziness or difficulty walking, but may have some benefit for neck and back nerve pain (such as sciatica) in older adults. They should be used in lower doses with smaller dose adjustments.
• Some muscle relaxants (carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, and orphenadrine) are avoided in older adults due to risk for sedation and falls. Others (tizanidine, baclofen, dantrolene) may be helpful for neck and back pain, with the most evidence for tizanidine and baclofen. These should be used in reduced doses, avoiding tizanidine with liver disease and reducing baclofen dosing with kidney disease.
• Older antidepressants are typically avoided in older adults due to their side effects, but nortriptyline and desipramine may be better tolerated for neck and back nerve pain at lower doses. Overall, newer antidepressants (namely duloxetine) have a better safety profile and good efficacy for spine-related nerve pain.
• Tramadol may be tolerated in older adults, but has risk for sedation, upset stomach, and constipation. It may be used in lower doses after alternative medications have failed and works well with co-administered acetaminophen. Opioids are avoided due to their side effects and mortality risk, but low dose opioid therapy may be helpful for severe refractory pain with close monitoring of patients clinically.

 

According to the researchers, complementary medicine, physical therapy, injections and surgery all have a place to help older persons with spine-related pain. “Medications used at the correct dose, for the correct diagnosis, adjusting for preexisting medical problems can result in better use of treatments for spine pain,” added first author Jonathan Fu, a 2022 MD graduate from BUSM.
 

These findings appear online in the journal Drugs & Aging.

American Heart Association adds sleep to cardiovascular health checklist

Sleep duration is now considered an essential component for ideal heart and brain health. Life’s Essential 8™ cardiovascular health score replaces Life’s Simple 7™, according to a new Presidential Advisory, Life’s Essential 8—Updating and Enhancing the American Heart Association’s Construct on Cardiovascular Health, published today in Circulation, the Association’s flagship, peer-reviewed journal.

Other updates to the measures of optimal cardiovascular health, now for anyone ages 2 and older, include a new guide to assess diet; accounting for exposure to secondhand smoke and vaping; using non-HDL cholesterol instead of total cholesterol to measure blood lipids; and expanding the blood sugar measure to include hemoglobin A1c, a key measure to assess Type 2 diabetes risk.

Cardiovascular disease is the number one cause of death in the U.S. and globally. According to the Association’s 2022 Heart Disease and Stroke Statistics Update, approximately 121.5 million people in the U.S. have high blood pressure, 100 million have obesity, more than 28 million people have Type 2 diabetes, and only 1 in 4 adults reported achieving the physical activity and exercise recommended in the U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans, 2nd edition. Various research studies over the past two decades indicate more than 80% of all cardiovascular events may be prevented by healthy lifestyle and management of known cardiovascular risk factors.

“The new metric of sleep duration reflects the latest research findings: sleep impacts overall health, and people who have healthier sleep patterns manage health factors such as weight, blood pressure or risk for Type 2 diabetes more effectively,” said American Heart Association President Donald M. Lloyd-Jones, M.D., Sc.M., FAHA, who led the advisory writing group and is chair of the department of preventive medicine, the Eileen M. Foell Professor of Heart Research and professor of preventive medicine, medicine and pediatrics at Northwestern University’s Feinberg School of Medicine in Chicago. “In addition, advances in ways to measure sleep, such as with wearable devices, now offer people the ability to reliably and routinely monitor their sleep habits at home.”

The Association first defined the 7 metrics for cardiovascular health in 2010 to identify the specific health behaviors and health factors that drive optimal heart and brain health. Brain health in relation to cardiovascular health was defined in a 2017 American Heart Association Presidential Advisory. It was further acknowledged as an important component of optimal cardiovascular health in the Association’s January 2021 Scientific Statement on the mind-heart-body connection. Findings from both papers are incorporated into Life’s Essential 8™.

After 12 years and more than 2,400 scientific papers on the topic, new discoveries in heart and brain health and in the ways to measure cardiovascular health provided an opportunity to revisit each health component in more detail. Four of the original metrics have been redefined for consistency with newer clinical guidelines or compatibility with new measurement tools. Also, the scoring system can now be applied to anyone ages 2 and older.

The Life’s Essential 8™ components of optimal cardiovascular health are divided into two major areas – health behaviors and health factors. Health behaviors include diet, physical activity, nicotine exposure and sleep. Health factors are body mass index, cholesterol levels, blood sugar and blood pressure. “The idea of optimal cardiovascular health is important because it gives people positive goals to work toward at any stage of life,” said Lloyd-Jones.

“Life’s Simple 7™ has served as a proven, powerful tool for understanding how to achieve healthy aging and ways to improve cardiovascular health while decreasing the risks of developing heart disease and stroke, as well as cancer, dementia and many other chronic diseases,” he said. “Given the evolving research, it was important to address some limitations to the original metrics, particularly in ways they’ve been applied to people from diverse racial and ethnic populations.”

Lloyd-Jones explained that some of the previous metrics, such as diet, were not as sensitive to differences among people, or as responsive to changes over time within a single individual. “We felt it was the right time to conduct a comprehensive review of the latest research to refine the existing metrics and consider any new metrics that add value to assessing cardiovascular health for all people.”

Life’s Essential 8™ includes:

1. Diet (updated):  A new guide to assess diet quality for adults and children at the individual level (for individual health care and dietary counseling) and at the population level (for research and public health purposes).
   • At the population level, dietary assessment is based on daily intake of elements in the Dietary Approaches to Stop Hypertension (DASH) eating pattern. The DASH-style diet score has eight components: high intake of fruits, vegetables, nuts and legumes, whole grains, low-fat dairy, and low intake of sodium, red and processed meats, and sweetened drinks.
   • For individuals, the Mediterranean Eating Pattern for Americans (MEPA) is used to assess and monitor cardiovascular health. The MEPA is a DASH-style eating pattern that can be measured with 16 yes or no questions about the weekly frequency of eating olive oil, vegetables, berries, meat, fish, dairy, grains, etc. The MEPA screener does not include consumption of sugar-sweetened beverages, so clinicians are encouraged to ask at the time of assessment.
2. Physical activity (no changes): Activity is measured by the total number of minutes of moderate or vigorous physical activity per week, as defined by the U.S. Physical Activity Guidelines for Americans, 2nd edition. The optimal level is 150 minutes of moderate physical activity or more per week or 75 minutes per week of vigorous-intensity physical activity for adults; 420 minutes or more per week for children ages 6 and older; and age-specific modifications for younger children.
3. Nicotine exposure (updated): Use of inhaled nicotine-delivery systems, which includes e-cigarettes or vaping devices, is added since the previous metric only monitored traditional, combustible cigarettes. This reflects use by adults and youth and their implications on long-term health. Life’s Essential 8™ also includes second-hand smoke exposure for children and adults.
4. Sleep duration (new): Sleep duration is associated with cardiovascular health. Measured by average hours of sleep per night, the ideal level is 7-9 hours daily for adults. Ideal daily sleep ranges for children are 10-16 hours per 24 hours for ages 5 and younger; 9-12 hours for ages 6-12 years; and 8-10 hours for ages 13-18 years.
5. Body mass index (no changes): The writing group acknowledges that body mass index (BMI) is an imperfect metric, yet it is easily calculated and widely available; therefore, BMI continues as a reasonable gauge to assess weight categories that may lead to health problems. BMI of 18.5–24.9 is associated with the highest levels of cardiovascular health. The writing group notes that BMI ranges and the subsequent health risks associated with them may differ among people from diverse racial or ethnic backgrounds or ancestry. This aligns with the World Health Organization’s recommendations to adjust BMI ranges for people of Asian or Pacific Islander ancestry because recent evidence indicates their risk of conditions such as  CVD or Type 2 diabetes is higher at a lower BMI.
6. Blood lipids (updated): The metric for blood lipids (cholesterol and triglycerides) is updated to use non-HDL cholesterol as the preferred number to monitor, rather than total cholesterol. HDL is the “good” cholesterol. Other forms of cholesterol, when high, are linked to CVD risk. This shift is made because non-HDL cholesterol can be measured without fasting beforehand (thereby increasing its availability at any time of day and implementation at more appointments) and reliably calculated among all people.
7. Blood glucose (updated): This metric is expanded to include the option of hemoglobin A1c readings or blood glucose levels for people with or without Type 1 or Type 2 diabetes or prediabetes. Hemoglobin A1c can better reflect long-term glycemic control.
8. Blood pressure (no changes): Blood pressure criteria remain unchanged from the Association’s 2017 guidelines that established levels less than 120/80 mm Hg as optimal, and hypertension defined as 130-139 mm Hg systolic pressure (the top number in a reading) or 80-89 mm Hg diastolic pressure (bottom number).

Each component of Life’s Essential 8™, which is assessed by the My Life Check tool, has an updated scoring system ranging from 0 to 100 points. The overall cardiovascular health score from 0 to 100 points is the average of the scores for each of the 8 health measures. Overall scores below 50 indicate “poor” cardiovascular health, and 50-79 is considered “moderate” cardiovascular health. Scores of 80 and above indicate “high” cardiovascular health. The advisory recommends measuring cholesterol, blood sugar, blood pressure, height and weight at least every five years for the most complete and accurate Life’s Essential 8™ score.

The writing group also reviewed data about the impacts of stress, mental health and social determinants of health, such as access to health care, income or education level, and structural racism, which are critical to understanding the foundations of health, particularly among people from diverse racial and ethnic populations.

“We considered social determinants of health carefully in our update and determined more research is needed on these components to establish their measurement and inclusion in the future,” said Lloyd-Jones. “Nonetheless, social and structural determinants, as well as psychological health and well-being, are critical, foundational factors in an individual’s or a community’s opportunity to preserve and improve cardiovascular health. We must consider and address all of these issues for people to have the opportunity for a full, healthy life as measured by Life’s Essential 8™.”

“Life’s Essential 8™ is a major step forward in our ability to identify when cardiovascular health can be preserved and when it is sub-optimal. It should energize efforts to improve cardiovascular health for all people and at every life stage,” Lloyd-Jones concluded.

Additional Resources:

• Video b-roll, infographic, photos and other multimedia are on right column of release link https://newsroom.heart.org/news/american-heart-association-adds-sleep-to-cardiovascular-health-checklist?preview=38423f97be79806e4b7d87f426751638
• Spanish News Release 
• After June 29, 2022, view the manuscript online.
• After June 29, 2020, Life’s Essential 8™ information is at heart.org/lifes8
• AHA infographic: How Sleep Affects Your Health
• AHA News release: Resistance exercise may be superior to aerobic exercise for getting better ZZZs (March 2022)
• AHA News: Irregular sleep could negatively impact heart health (March 2019)
• AHA website: Sleep plays an important role in heart health
• AHA website: How to Sleep Better with a Bedtime Routine
• Follow AHA/ASA news on Twitter @HeartNews
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Higher protein intake while dieting leads to healthier eating

 

Eating a larger proportion of protein while dieting leads to better food choices and helps avoid the loss of lean body mass, according to a Rutgers study.

An analysis of pooled data from multiple weight-loss trials conducted at Rutgers shows that increasing the amount of protein even slightly, from 18 percent of a person’s food intake to 20 percent, has a substantial impact on the quality of the food choices made by the person. The study was published in the medical journal Obesity.

“It’s somewhat remarkable that a self-selected, slightly higher protein intake during dieting is accompanied by higher intake of green vegetables, and reduced intake of refined grains and added sugar,” said Sue Shapses, author of the study and a professor of nutritional sciences at the Rutgers School of Environmental and Biological Sciences (SEBS). “But that’s precisely what we found.”

In addition, the researchers found a moderately higher intake of protein provided another benefit to the dieters: a reduced loss of lean body mass often associated with weight loss.

Weight-loss regimens that employ calorie restrictions can often spur dieters to reduce the intake of healthy foods that contain micronutrients such as iron and zinc. Ingesting higher levels of proteins is often associated with healthier outcomes, but the link between protein intake and diet quality is poorly understood, according to researchers.

“The impact of self-selected dietary protein on diet quality has not been examined before, to our knowledge, like this,” said Anna Ogilvie, co-author of the study and a doctoral student in the Department of Nutritional Sciences at Rutgers SEBS. “Exploring the connection between protein intake and diet quality is important because diet quality is often suboptimal in the U.S., and higher-protein weight loss diets are popular.”

The data was collected from more than 200 men and women participating in clinical trials at Rutgers funded by the National Institutes of Health over the past two decades. The analysis of food records and diet quality for this study was funded by the Institute for the Advancement of Food and Nutrition Sciences in Washington, D.C. Participants were between the ages of 24 and 75 and registered a body mass index that categorized them as either overweight or obese. All participants were encouraged to lose weight by following a 500-calorie-deficit diet and met regularly for nutrition counseling and support over a six-month period.

The participants were given nutrition advice based on the guidelines of the Academy of Nutrition and Dietetics and the American Diabetes Association. They were encouraged to allot 18 percent of their caloric intake to lean protein, such as poultry, unprocessed red meat, fish, legumes and dairy, and to expend the balance of their calories on fruits, vegetables and whole grains. They were discouraged from ingesting saturated fats, refined grains, sugar and salt.

Participants kept detailed food records, which researchers analyzed for diet quality, specific categories of foods consumed and ratios and specific sources of protein.

The participants who self-selected their protein intake were then characterized by researchers into a lower-protein approach with 18 percent of overall calories coming from protein or a higher-protein approach with 20 percent of the overall food intake coming from protein.

The study concludes:

• Both low- and high-protein groups lost the same amount of weight – about five percent of their body weight over six months

• Higher-protein groups individuals chose a mix of healthier foods to eat overall

• Higher-protein group individuals specifically increased intake of green vegetables and cut back on sugar and refined grains

• Higher-protein group individuals were better able to retain their lean muscle mass

Mediterranean diet may reduce chance of frailty

 

A new study published in The American Journal of Clinical Nutrition found that consuming a Mediterranean-style diet may prevent frailty. Defined as a recognizable state of increased vulnerability resulting from a decline in function across multiple physiological systems, frailty affects 10-15% older adults, and leads to other health issues. Although the general benefits of a Mediterranean-style diet are well known, its role in the reduction of frailty in older Americans who do not normally consume such a diet was unclear.

The study titled, “Adherence to the Mediterranean-style diet and high intake of total carotenoids reduces the odds of frailty over 11 years in older adults: Results from the Framingham Offspring Study,” showed that consuming a Mediterranean-style diet, may prevent the development of frailty with aging. The study included 2,384 non-frail adults from the Framingham Offspring Study with Mediterranean-style dietary pattern score and antioxidant intakes [vitamin C, E, and total carotenoids] estimated from a food frequency questionnaire combined with frailty assessments that were conducted over ~11 years. Each unit higher score on the Mediterranean Style Dietary Pattern Score (i.e., higher adherence to a Mediterranean-style diet) reduced the odds of frailty by 3%.

The study also determined whether specific antioxidants (carotenoids, vitamins E, and C) found in a Mediterranean-style diet are related with frailty. Higher intake of carotenoids (an antioxidant commonly found in brightly colored fruits and vegetables) had the strongest association with reduced likelihood of frailty development in middle-aged and older men and women from the Framingham Heart Study, reporting that each 10-mg higher total carotenoid intake reduced the odds of frailty by 16%. Vitamin E and C were not meaningfully associated with frailty prevention.  

Inability to stand on one leg for 10 seconds in mid to later life linked to near doubling in risk of death

 

The inability to stand on one leg for 10 seconds in mid to later life is linked to a near doubling in the risk of death from any cause within the next 10 years, finds research published online in the British Journal of Sports Medicine.

This simple and safe balance test could be included in routine health checks for older adults, say the researchers.

Unlike aerobic fitness and muscle strength and flexibility, balance tends to be reasonably well preserved until the sixth decade of life, when it starts to wane relatively rapidly, note the researchers.

Yet balance assessment isn’t routinely included in health checks of middle-aged and older men and women, possibly because there isn’t any standardised test for it, and there are few hard data linking it to clinical outcomes other than falls, they add.

The researchers therefore wanted to find out whether a balance test might be a reliable indicator of a person’s risk of death from any cause within the next decade, and, as such, might therefore merit inclusion in routine health checks in later life.

The researchers drew on participants in the CLINIMEX Exercise cohort study. This was set up in 1994 to assess associations between various measures of physical fitness, exercise- related variables, and conventional cardiovascular risk factors, with ill health and death. 

The current analysis included 1702 participants aged 51–75 (average of 61) at their first check up, between February 2009 and December 2020. Around two thirds (68%) were men.

Weight and several measures of skinfold thickness plus waist size were taken. Details of  medical history were also provided. Only those with stable gait were included.  

As part of the check up, participants were asked to stand on one leg for 10 seconds without any additional support. 

To improve standardisation of the test, participants were asked to place the front of the free foot on the back of the opposite lower leg, while keeping their arms by their sides and their gaze fixed straight ahead. Up to three attempts on either foot were permitted.

In all, around 1 in 5 (20.5%; 348) participants failed to pass the test. The inability to do so rose in tandem with age, more or less doubling at subsequent 5 year intervals from the age of 51–55 onwards. 

The proportions of those unable to stand on one leg for 10 seconds were: nearly 5% among 51–55 year olds; 8% among 56–60 year olds; just under 18% among 61–65 year olds; and just under 37% among 66–70 year olds. 

More than half (around 54%) of those aged 71–75 were unable to complete the test. In other words, people in this age group were more than 11 times as likely to fail the test as those just 20 years younger.

During an average monitoring period of 7 years, 123 (7%) people died: cancer (32%); cardiovascular disease (30%); respiratory disease (9%); and COVID-19 complications (7%).

There were no clear temporal trends in the deaths, or differences in the causes, between those able to complete the test and those who weren’t able to do so. 

But the proportion of deaths among those who failed the test was significantly higher: 17.5% vs 4.5%, reflecting an absolute difference of just under 13%.

In general, those who failed the test had poorer health: a higher proportion were obese, and/or had heart disease, high blood pressure, and unhealthy blood fat profiles. And type 2 diabetes was 3 times as common in this group: 38% vs around 13%. 

After accounting for age, sex, and underlying conditions, an inability to stand unsupported on one leg for 10 seconds was associated with an 84% heightened risk of death from any cause within the next decade.

This is an observational study, and as such, can’t establish cause. As participants were all white Brazilians, the findings might not be more widely applicable to other ethnicities and nations, caution the researchers.

And information on potentially influential factors, including recent history of falls, physical activity levels, diet, smoking and the use of drugs that may interfere with balance, wasn’t available.

Nevertheless, the researchers conclude that the 10 second balance test “provides rapid and objective feedback for the patient and health professionals regarding static balance,” and that the test “adds useful information regarding mortality risk in middle-aged and older men and women.”

---

JOURNAL

British Journal of Sports Medicine

DOI

10.1136/bjsports-2021-105360 

Light during sleep in older adults linked to obesity, diabetes, high blood pressu

Light during sleep in older adults linked to obesity, diabetes, high blood pressure
Night lights, TV left on, smart phones linked to significantly higher disease rates

·  Turn off lights during sleep, say sleep specialists
·  Half of participants were exposed to light during nighttime sleep
·  Older adults already at higher risk for diabetes and cardiovascular disease

CHICAGO --- In a sample of older men and women ages 63 to 84, those who were exposed to any amount of light while sleeping at night were significantly more likely to be obese, and have high blood pressure and diabetes compared to adults who were not exposed to any light during the night, reports a new Northwestern Medicine study. 

Light exposure was measured with a wrist-worn device and tracked over seven days.  

This is a real world (not experimental) study demonstrating the prevalence of any light exposure at night being linked to a higher obesity, high blood pressure (known as hypertension) and diabetes among older adults. It will be published June 22 in the journal SLEEP. 

“Whether it be from one’s smartphone, leaving a TV on overnight or light pollution in a big city, we live among an abundant number amount of artificial sources of light that are available 24 hours of a day,” said study corresponding author Dr. Minjee Kim, assistant professor of neurology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “Older adults already are at higher risk for diabetes and cardiovascular disease, so we wanted to see if there was a difference in frequencies of these diseases related to light exposure at night.”    

Study investigators were surprised to find that less than half of the 552 study participants consistently had a five-hour period of complete darkness per day. The rest of participants were exposed to some light even during their darkest five-hour periods of the day, which were usually in the middle of their sleep at night. 

Because this was a cross-sectional study, investigators don’t know if obesity, diabetes and hypertension cause people to sleep with a light on, or if the light contributed to the development of these conditions. Individuals with these conditions may be more likely to use the bathroom in the middle of the night (with the light on) or may have another reason to keep the light on. Someone with foot numbness because of diabetes may want to keep a night light on to reduce the risk of falls. 

“It’s important for people to avoid or minimize the amount of light exposure during sleep,” said senior study co-author Dr. Phyllis Zee, chief of sleep medicine at Feinberg and a Northwestern Medicine physician. 

Zee and colleagues are considering an intervention study to test whether a restoration of the natural light-dark cycle improves health outcomes such as cognition.  

Zee offered tips to reduce light during sleep:

1. Don’t turn lights on. If you need to have a light on (which older adults may want for safety), make it a dim light that is closer to the floor.
2. Color is important. Amber or a red/orange light is less stimulating for the brain. Don’t use white or blue light and keep it far away from the sleeping person.
3. Blackout shades or eye masks are good if you can’t control the outdoor light. Move your bed so the outdoor light isn’t shining on your face.

Who are the study participants?

The study participants were originally enrolled in the Chicago Heart Association Detection Project in Industry (CHA), a public health program and epidemiologic study conducted in 1967-1973 to identify high-risk adults for heart diseases in workplaces throughout the Chicago area. The study included a detailed examination of known risk factors for heart disease.   

Almost 40 years later (2007-2010), Zee and Dr. Martha Daviglus, now adjunct professor of preventive medicine at Feinberg, conducted a separate study (“Chicago Healthy Aging Study (CHAS)”) with 1,395 survivors of the original CHA study who agreed to participate. They underwent another detailed examination of blood pressure, weight, height, cholesterol, glucose and other known risk factors for heart disease. In addition, they wore the actigraphy device on their non-dominant wrists for seven days and filled out a daily sleep diary. Slightly more than half of the actigraphy devices used had the capacity to measure light, which constitute the basis of this new study.   

Can acupuncture reduce headaches?

 

Acupuncture may reduce headaches for people who have chronic tension-type headaches, according to a study published in the June 22, 2022, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Tension-type headaches most often involve a pressing or tightening feeling on both sides of the head with mild to moderate intensity. These headaches are not worsened by physical activity, and do not include nausea. Tension-type headaches are considered chronic when they occur at least 15 days per month.

“Tension-type headaches are one of the most common types of headaches and people who have a lot of these headaches may be looking for alternatives to medication,” said study author Ying Li, MD, PhD, of Chengdu University of Traditional Chinese Medicine in Chengdu, China. “Our study found that acupuncture reduces the average number of headache days per month for those struggling with these painful and disruptive headache attacks.”

The study involved 218 people who were diagnosed with chronic tension-type headaches. They had chronic tension-type headaches for an average of 11 years and had 22 days per month with headaches on average. Participants were randomly assigned to receive either true acupuncture or superficial acupuncture. True acupuncture treatments involved achieving a deqi sensation, which involves placing and moving a needle in the body to reach a tingling, numbness, or heaviness feeling. The superficial treatments had a lesser depth in the body to avoid achieving the deqi sensation. Both groups received two or three sessions per week, for a total of 20 sessions, for two months and were followed for an additional six months.

The main result measured in the study was a reduction of at least 50% in the number of days with headaches. All participants had clinic visits every four weeks. They also used headache diaries to record their symptoms and use of acute medications.

At the end of the study, 68% of the people receiving true acupuncture reported at least a 50% reduction in the monthly number of headache days compared to 50% of the people who received superficial acupuncture.

Researchers found the number of monthly headache days gradually decreased after treatment, in both those who received true acupuncture treatments and superficial acupuncture treatments. For those who received true acupuncture, headache days decreased from 20 days per month at the beginning of the study to seven days per month by the end of the study.  For those who received superficial acupuncture, headache days decreased from 23 days per month at the beginning of the study to 12 days per month at the end of the study.

The only side effects from the treatment were mild and did not require treatment.

“While this study showed that acupuncture can reduce headaches, more research is needed to determine the longer-term effectiveness of acupuncture and how it compares to other treatment options,” said Li. “In comparing treatment options, cost-effectiveness is another important factor to evaluate.”

A limitation of the study was that the research was conducted in one hospital, so the results may not apply to all populations.

The study was supported by the Department of Science and Technology of Sichuan Province and the National Natural Science Foundation of China.

Learn more about headaches at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 38,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

Vitamins, supplements are a ‘waste of money’ for most Americans

• New guidelines say ‘insufficient’ evidence to support use of multivitamins or dietary supplements to prevent cardiovascular disease or cancer in healthy, non-pregnant adults
• Pregnant people, those becoming pregnant still need essential vitamins (iron, folic acid)
• More than half of U.S. adults take dietary supplements, a multi-billion-dollar industry

CHICAGO --- Drawn to the allure of multivitamins and dietary supplements filling nutritional gaps in their diet, people in the U.S. in 2021 spent close to $50 billion on vitamins and dietary supplements. 

But Northwestern Medicine scientists say for non-pregnant, otherwise healthy Americans, vitamins are a waste of money because there isn’t enough evidence they help prevent cardiovascular disease or cancer.

“Patients ask all the time, ‘What supplements should I be taking?’ They’re wasting money and focus thinking there has to be a magic set of pills that will keep them healthy when we should all be following the evidence-based practices of eating healthy and exercising,” said Dr. Jeffrey Linder, chief of general internal medicine in the department of medicine at Northwestern University Feinberg School of Medicine.

Linder and fellow Northwestern Medicine scientists wrote an editorial that will be published June 21 in JAMA that supports new recommendations from the United States Preventive Services Task Force (USPSTF), an independent panel of national experts that frequently makes evidence-based recommendations about clinical preventive services. 

Based on a systematic review of 84 studies, the USPSTF’s new guidelines state there was “insufficient evidence” that taking multivitamins, paired supplements or single supplements can help prevent cardiovascular disease and cancer in otherwise healthy, non-pregnant adults. 

“The task force is not saying ‘don’t take multivitamins,’ but there’s this idea that if these were really good for you, we’d know by now,” Linder said. 

The task force is specifically recommending against taking beta-carotene supplements because of a possible increased risk of lung cancer, and is recommending against taking vitamin E supplements because it has no net benefit in reducing mortality, cardiovascular disease or cancer.

“The harm is that talking with patients about supplements during the very limited time we get to see them, we’re missing out on counseling about how to really reduce cardiovascular risks, like through exercise or smoking cessation,” Linder said.

More than half of Americans take vitamins. Why?

More than half of U.S. adults take dietary supplements, and use of supplements is projected to increase, Linder and his colleagues wrote in the JAMA editorial. 

Eating fruits and vegetables is associated with decreased cardiovascular disease and cancer risk, they said, so it is reasonable to think key vitamins and minerals could be extracted from fruits and vegetables, packaged into a pill, and save people the trouble and expense of maintaining a balanced diet. But, they explain, whole fruits and vegetables contain a mixture of vitamins, phytochemicals, fiber and other nutrients that probably act synergistically to deliver health benefits. Micronutrients in isolation may act differently in the body than when naturally packaged with a host of other dietary components.

Linder noted individuals who have a vitamin deficiency can still benefit from taking dietary supplements, such as calcium and vitamin D, which have been shown to prevent fractures and maybe falls in older adults. 

New guidelines do not apply to pregnant people

The new USPSTF guidelines do not apply to people who are pregnant or trying to get pregnant, said JAMA editorial co-author Dr. Natalie Cameron, an instructor of general internal medicine at Feinberg. 

“Pregnant individuals should keep in mind that these guidelines don’t apply to them,” said Cameron, who also is a Northwestern Medicine physician. “Certain vitamins, such as folic acid, are essential for pregnant women to support healthy fetal development. The most common way to meet these needs is to take a prenatal vitamin. More data is needed to understand how specific vitamin supplementation may modify risk of adverse pregnancy outcomes and cardiovascular complications during pregnancy.” 

Additionally, recent research from Northwestern has found most women in the U.S. have poor heart health prior to becoming pregnant. Cameron said that, in addition to discussing vitamin supplementation, working with patients to optimize cardiovascular health prior to pregnancy is an important component of prenatal care. 

Eating healthy, exercising is ‘easier said than done’ 

Dr. Jenny Jia, a co-author of the JAMA editorial who studies the prevention of chronic diseases in low-income families through lifestyle interventions, said healthy eating can be a challenge when the U.S. industrialized food system does not prioritize health. 

“To adopt a healthy diet and exercise more, that’s easier said than done, especially among lower-income Americans,” said Jia, an instructor of general internal medicine at Feinberg and a Northwestern Medicine physician. “Healthy food is expensive, and people don’t always have the means to find environments to exercise—maybe it’s unsafe outdoors or they can’t afford a facility. So, what can we do to try to make it easier and help support healthier decisions?”

Over the past few years, Jia has been working with charitable food pantries and banks that supply free groceries to people who are in need to try to help clients pick healthier choices from the food pantries as well as educate those who donate to provide healthier options or money. 

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Latest Health News

 Health News Report

3 days ago

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Health News Report2 weeks ago

About 3 grams a day of omega-3 fatty acids may lower blood pressure, more research needed

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Health News Report2 weeks ago

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Health News Report2 weeks ago

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Health News Report2 weeks ago

Too much self-confidence can endanger health

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Health News Report2 weeks ago

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Health News Report2 weeks ago

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Health News Report3 weeks ago

Breastfeeding duration associated with cognition

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Health News Report3 weeks ago

Longer duration of exclusive breastfeeding has protective effect on childhood asthma

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Health News Report3 weeks ago

Seven healthy habits linked to lower risk of dementia

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Health News Report3 weeks ago

Eating eggs can boost heart health

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Health News Report3 weeks ago

Low glycemic index diet helps heart patients lose weight

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Health News Report3 weeks ago

Lifestyle changes, metformin effective to prevent or delay Type 2 diabetes

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Health News Report4 weeks ago

Cranberries could improve memory and ward off dementia

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Health News Report4 weeks ago

Wearing a compression garment during or after training does not facilitate muscle recovery

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Health News Report4 weeks ago

Physical activity and healthy diet during menopause help to protect from the health risks associated with increased adiposity

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Health News Report4 weeks ago

New weight-loss intervention targets instinctive desire to eat

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Health News Report4 weeks ago

5 mg dose of melatonin had a significant increase in total sleep time and sleep efficiency

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Health News Report5 weeks ago

Vegetables that thwart pollutants

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Health News Report5 weeks ago

Taking ownership of your health

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Health News Report5 weeks ago

Latest Health News - Diet

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Health News Report5 weeks ago

Regular blueberry consumption may reduce risk of dementia

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Health News Report5 weeks ago

Latest Health Research - Aging, Exercise, General Health

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