No gain for pain

Patients with acute low back pain do not appear to benefit from the addition of diclofenac and/or spinal manipulative therapy to recommended first-line care, according to an Australian study. A total of 240 participants with low back pain were allocated at random into four groups receiving combinations of diclofenac 50 mg twice daily, spinal manipulation, and placebo treatments. All patients had seen a general practitioner and had been given paracetamol. The primary outcome was time taken to recover from pain. Physiotherapists administered the spinal manipulation two or three times a week for a maximum of 4 weeks. Secondary outcomes included pain, function, and disability. Neither diclofenac nor spinal manipulative therapy appeared to show a clinically positive effect on the time taken to recovery. Patients taking active diclofenac and/or having active spinal manipulative therapy did not recover more quickly than those on the placebo forms of treatment. The researchers comment that, when appropriate baseline care is given, further treatments may not provide additional benefit.

Lancet 2007; 370: 1638-1643

Obesity and breast cancer

Increasing body mass index (BMI) and waist : hip ratio in women appear to be associated with an increased risk of breast cancer, say United States researchers. In a large study established in 1995, data on weight gain, diet, reproductive and menstrual history, and incidence of breast cancer from almost 100 000 postmenopausal women were analysed. Current BMI and waist : hip ratio were associated with an increased risk of breast cancer, as were the same parameters at 50 and 35 years. The risk was more pronounced in women not using menopausal hormone therapy. Weight gain between 18 years and the current age was also consistently associated with an increased breast cancer risk.

Arch Intern Med 2007; 167: 2091-2102

The spoils of war

Soldiers returning from service in Iraq have shown an alarming incidence of mental health problems on a second screening, according to United States Army re-searchers. On rescreening several months after return from deployment, soldiers reported significantly higher rates of mental health concerns including post-traumatic stress disorder, major depression, and alcohol misuse than when initially surveyed. Concerns about interpersonal conflict, as reported by participants, increased fourfold between the two surveys, which were conducted a median of 6 months apart. The authors advise that soldiers appear more likely to report mental health problems several months after their return from a war zone.

JAMA 2007; 298: 2141-2148

Urinary retention — prognosis poor

Men who suffer acute urinary retention and are admitted to hospital have a high mortality rate in the first year after discharge, a British study reports. All men aged over 45 years admitted with a first episode of acute urinary retention were included in the analysis, which examined comorbidities and mortality rates in the 176 046 participants. In men with both spontaneous and precipitated acute urinary retention, the mortality rate increased with age and was significantly higher than that of the general population. Overall, nearly 15% of men with spontaneous acute urinary retention died within a year. More than a third of men with acute urinary retention also had at least one major comorbid condition, which greatly increased mortality. The authors admit the possible selection bias introduced by using only hospital admissions, but comment that, regardless of that effect, this group of patients is vulnerable and should be carefully managed.

BMJ Online, 8 Nov 2007

Dr Tanya Grassi, MJA

©The Medical Journal of Australia 2005 www.mja.com.au PRINT ISSN: 0025-729X ONLINE ISSN: 1326-5377