Osteopathy and Back Pain

Spinal manipulation by osteopaths appears to work about as well as conventional medicine at curing lingering back pain.

About 5 percent of U.S. physicians are osteopaths. Unlike MDs, they frequently use spinal manipulation as part of their treatment, especially for lower back pain.

In today's New England Journal of Medicine, osteopaths and MDs from Rush-Presbyterian-St. Luke's Medical Center in Chicago and the Chicago College of Osteopathic Medicine reported the results of a study intended to see which approach worked better.

Many studies have shown that most backaches go away within a month, no matter what kind of treatment sufferers get. So the new study was conducted on those who had been in pain for at least three weeks but less than six months.

The doctors randomly assigned 83 patients to get osteopathic manipulation and 72 to get conventional treatment, which consisted of painkillers, muscle relaxants and anti-inflammatory drugs. Three months later, there was no difference in how the two groups felt. Pain decreased by half in both.

Angioplasty Cuts Death Risk

Angioplasty, in which doctors open a clogged blood vessel with a tiny inflatable balloon, dramatically lowers the risk of death or heart attack, and costs less than treatment with clot-dissolving drugs, researchers said yesterday.

The team of Dutch researchers said the death rate with angioplasty is 46 percent lower compared to the rate when patients are given the intravenous drug streptokinase.

Writing in today's New England Journal of Medicine, they said the risk of having a subsequent heart attack is 73 percent lower and treatment costs 4 percent less when angioplasty is used.

But the new study, led by Felix Zijlstra of Weezenlander Hospital in the Netherlands, is not expected to be the final word on whether angioplasty or clotting drugs is the best treatment. Other studies have suggested that there is little difference between the two treatments when they are performed under real-world conditions.

Prozac Urged for PMDD

The popular antidepressant Prozac also should be approved as a treatment for a severe form of premenstrual syndrome, advisers to the Food and Drug Administration decided yesterday.

Premenstrual complaints, ranging from breast tenderness and bloating to anxiety and mood swings, affect 3 percent to 5 percent of women of childbearing age. But doctors say there is a more severe problem called premenstrual dysphoric disorder, or PMDD, which causes a smaller number of women such symptoms as poor concentration, depression and anger.

Doctors already routinely prescribe a number of antidepressants, such as Prozac, Zoloft and Celexa, to treat PMDD. The FDA has not specifically approved them as PMDD treatments, but it is legal for doctors to prescribe drugs for any purpose.

However, if the FDA were to approve an antidepressant as a PMDD treatment, then the manufacturer would get the added bonus of being able to advertise the drug directly to consumers.