Monthly Archives: April 2013

Meditation (& Pain…)

Headache

 

 

 

Meditation, mindfullness og des lige er særligt “in” i disse tider, hvilket sandsynligvis afspejler de flestes behov for at stresse af. Nogle finder at løb, yoga, musik eller at give konen et par klaps bagi i diverse sammenhænge virker fantastisk ift. afstressning, hvilket indikerer det selvsagte; at det er meget individuelt hvad der virker. Hvad der dog gør sig gældende for de fleste (som ikke har stiftet bekendtskab med fænomenet i enten praktisk eller teoretisk forstand), er opfattelsen af at meditation da er noget værre hippie-bras! Hertil får nogle sandsynligvis associationer til bl.a langt fedtet hår, sved-lugt, clairvoyante, håndlæsning, astronomi, mm.

I kontrast til diverse associationer som måtte opstå, lader det til at meditation har en rettidig plads i det moderne liv. Det startede eftersigende som en slags mental træning i Asiatiske-Buddistiske traditioner, og på nuværende tidspunkt findes der en del litteratur inden for området. Som det vil fremgå af nedenstående har forskningen bl.a. beskæftiget sig med effekten af meditation på diverse angst- og depressionstilstande, og i de senere år også ift. smerte.

“Mindfullness based cognitive therapy” (MBCT) og mindfulness based stress reduction (MBSR) er sandsynligvis nogle af de mest undersøgte meditations-fremgangsmåder i litteraturen (bl.a. i flere randomiserede kontrollerede studier), og har begge til formål at lære udøveren at – på en ikke-dømmende manér – at være opmærksom (mindful) på “oplevelsen af nuet”. Begge fremgangsmåder har en standardiseret 8 ugers protokol, som involverer tre meditationsteknikker i form af body scan, siddende meditation og mindful yoga.

Resultaterne er opsummeret således:

 

Based on multiple randomized clinical trials, there is good evidence for the efficacy of these ST-Mindfulness programs for preventing mood disorders in people at high risk of depression (Teasdale et al., 2000a,b;Ma and Teasdale, 2004Segal et al., 2010Fjorback et al., 2011Piet and Hougaard, 2011), improving mood and quality of life in chronic pain conditions such as fibromyalgia (Grossman et al., 2007Sephton et al., 2007Schmidt et al., 2011) and low-back pain (Morone et al., 2008a,b), in chronic functional disorders such as IBS (Gaylord et al., 2011) and in challenging medical illnesses, including multiple sclerosis (Grossman et al., 2010) and cancer (Speca et al., 2000). ST-Mindfulness has also been shown to decrease stress in healthy people undergoing difficult life situations (Cohen-Katz et al., 2005), such as caring for a loved-one with Alzheimer’s disease (Epstein-Lubow et al., 2006). In chronic pain and functional disorders, ST-Mindfulness is reported to reduce patients’ tendency to catastrophize and engage in repetitive negative cognitions such as, the pain is “terrible and I feel it’s never going to get better” (Garland et al., 2012).

 

Som det fremgår af ovennævnte og som er blevet nævnt i litteraturen (Holzel et al., 2011) ses der effekter af meditations-interventioner på en række forskellige tilstande. Forskellige “behavioral and neural mechanisms” er blevet foreslået i forsøg på at forklare disse positive effekter af meditation; heriblandt ændringer i neurale netværk ansvarlige for følelses-regulering (Holzel et al., 2008), da man bl.a. hos angst-patienter har fundet mindre amygdala-respons ifb. “socially threatening stimuli”. “Metakognition” (= indsigt i egen tænkeproces) anses i denne sammenhæng som den overordnede mekanisme.

 

Ift. smerte, er det interessant at 8 ugers meditation kan have en positiv effekt hos individer med kronisk smerte. – især taget i betragtning af det høje antal af forskellige smerte-regi/”behandlinger” som er uden effekt. Ydermere fortæller det hvad vi allerede ved; at kronisk smerte-syndromer oftest er resultatet af ændringer i hjernen (fx øget sensitivitet), og at erfaringer, tanker, følelser mm. kan modulere den subjektive opfattelse af smerte. I denne sammenhæng nævnes det at en nedsat tendens til “catastrophizing” kunne være en bagvedliggende mekanisme til den observerede smertelindring, hvilket er et velkendt fænomen inden for litteraturen. Dette stemmer desuden overens med hvordan viden omkring smerte, kan have en positiv effekt på den subjektive opfattelse af smerte. 

Indtil da: Meditation, med eller uden fedtet hår, er værd at overveje hvis man har problemer med længerevarende smerte.

 

 

 
Kerr CE, Sacchet MD, Lazar SW, Moore CI, Jones SR. Mindfulness starts with the body: somatosensory attention and top-down modulation of cortical alpha rhythms in mindfulness meditation. Front Hum Neurosci. 2013;7:12. doi:
10.3389/fnhum.2013.00012. Epub 2013 Feb 13.

 

 

 

 

Casual assessment of factors (potentially) contributing to lower back pain

 

Som resultat af de forrige indlæg bør det fremgå tydeligt at (længerevarende) smerte er et fænomen af mange (individuelle) facetter, og at den ene form for (smertefri) fysisk aktivitet sandsynligvis virker lige så godt som den anden. Det ville være fedt hvis én trænings/behandlingsform virkede hver gang og for alle individer, men – på trods af at flere gerne vil overbevise dig om det modsatte – er dette ikke tilfældet.

Dette betyder dog ikke at man undlader at undersøge faktorer som potentielt kan bidrage til smerte; i dette tilfælde smerter i lænderyggen (LBP), da det er en af de hyppigste. Her følger en række konklusioner fra et systematisk review af litteraturen inden for arbejds-relaterede faktorer af potentiel betydning for udviklingen af lænde-smerte.

 

1. Occupational bending and twisting. Beskrivelsen dækker givetvis over en bredere job-kategori.

A summary of existing studies was not able to find high-quality studies that satisfied more than three of the Bradford-Hill criteria for causation for either occupational bending or twisting and LBP. Conflicting evidence in multiple criteria was identified. This suggests that specific subcategories could contribute to LBP. However, the evidence suggests that occupational bending or twisting in general is unlikely to be independently causative of LBP.

 

2. Akward postures.

There was strong evidence from six high-quality studies that there was no association between awkward postures and LBP. Similarly, there was strong evidence from three high-quality studies that there was no temporal relationship. Moreover, subgroup analyses identified only a handful of studies that demonstrated only weak associations and no evidence for other aspects of causality in certain specific subcategories. It is therefore unlikely that awkward occupational postures are independently causative of LBP in the populations of workers studied.

 

3. Occupational sitting

This review failed to uncover high-quality studies to support any of the Bradford-Hill criteria to establish causality between occupational sitting and LBP. Strong and consistent evidence did not support criteria for association, temporality, and dose response. Based on these results, it is unlikely that occupational sitting is independently causative of LBP in the populations of workers studied.

 

4. Manual handling or assisting patients.

The studies reviewed did not support a causal association between workplace manual handling or assisting patients and LBP in a Bradford-Hill framework. Conflicting evidence in specific subcategories of assisting patients was identified, suggesting that tasks such as assisting patients with ambulation may possibly contribute to LBP. It appears unlikely that workplace manual handling or assisting patients is independently causative of LBP in the populations of workers studied.

 

5. Pushing or pulling.

A qualitative summary of existing studies was not able to find any high-quality studies that fully satisfied any of the Bradford-Hill causation criteria for occupational pushing or pulling and LBP. Based on the evidence reviewed, it is unlikely that occupational pushing or pulling is independently causative of LBP in the populations of workers studied.

 

6. Occupational lifting.

This review uncovered several high-quality studies examining a relationship between occupational lifting and LBP, but these studies did not consistently support any of the Bradford-Hill criteria for causality. There was moderate evidence of an association for specific types of lifting and LBP. Based on these results, it is unlikely that occupational lifting is independently causative of LBP in the populations of workers studied. Further research in specific subcategories of lifting would further clarify the presence or absence of a causal relationship.

 

7. Occupational carrying.

This review failed to identify high-quality studies that supported any of the Bradford-Hill criteria to establish causality between occupational carrying and LBP. Based on these results, it is unlikely that occupational carrying is independently causative of LBP in the populations of workers studied.

 

8. Occupational standing and walking.

A summary of existing studies was not able to find any high-quality studies that satisfied more than two of the Bradford-Hill causation criteria for occupational standing or walking and LBP. Based on the evidence reviewed, it is unlikely that occupational standing or walking is independently causative of LBP in the populations of workers studied.

 

 

Som det fremgår er det svært at identificere enkeltstående faktorer som har en stærk korrelation med udviklingen af smerte i lænderyggen. Om nogle, lader det ud fra ovenstående review til at foroverbøjning (med/uden rotation) og diverse løft kan have relevans. Samlet betyder dette at man skal undgå at løfte tungt med en rygsøjle i fleksion (og rotation), hvilket de fleste med lidt løfte-erfaring kan nikke genkendende til.

Herudover siger det også noget om at andre faktorer ift. udviklingen af LBP er relevante, og at arbejdsstillinger/opgaver/forhold langt fra kan forklare den store udbredning af LBP som ses inden for bl.a. SOSU- og sygeplejepersonalet. Det kunne tænkes at denne individgruppe har mindre tendens til at indgå i fornuftige kost- og træningsvaner. Endvidere fortæller ovennævnte hvad vi allerede ved; at det er svært at pege på én eller to enkeltstående faktorer når vi gerne vil forsøge at forklare Bente hvorfor hun stadig har ondt i ryggen. Bevægelse lader dog til at være et godt sted at starte forebyggelsen/rehabilitationen.

 

 

 

Andersen JH, Haahr JP, Frost P. Details on the association between heavy lifting and low back pain. Spine J. 2011 Jul;11(7):690-1.