Medical Minutes

New Approach to Lower Back Pain

Lumbar spinal stenosis (LSS) is a common cause of lower back pain in a large number of older adults. Now, a study out of the University of Florida is showing that a minimally invasive procedure, known as mild®, provides pain relief and improved physical function for at least a year in adults suffering from lower back pain.

The study followed 136 men and women between the ages of 16 and 89 who underwent the mild® procedure. It is designed to reduce pressure on the spine by removing part of a thickened ligament. Unlike traditional spinal surgery, mild® doesn't require general anesthesia, large incisions, or extended recovery time, making it a safer option for many older patients.

Patient-reported pain levels dropped dramatically within the first month after the procedure. Although the pain relief lessened over time, the 12-month follow-up still showed marked improvement compared to baseline levels. In addition, more than 65% of patients reported better physical function throughout the study, with no decrease in mobility or quality of life.

These findings could be significant for older adults suffering from lumbar stenosis, as the procedure could provide meaningful relief without the risks associated with traditional surgery. The study showed that the procedure improved pain and function over the long term, improving an individual’s quality of life.

Electrical Nerve Stimulation May Help with Long COVID Pain and Fatigue

Adults who are suffering from Long COVID pain and fatigue may greatly benefit from a wearable TENS system. This simple device appears to offer immediate, on-demand relief. Researchers at UCLA teamed up with colleagues at Baylor College of Medicine  in Texas and investigated whether a wearable Transcutaneous Electrical Nerve Stimulation (TENS) device, which uses low-voltage electrical currents to reduce pain, could prevent fatigue, and mobility issues.

Long COVID is a complex and lingering condition following COVID-19 recovery. It affects approximately 1 in 13 adults in the U.S. Symptoms such as widespread pain, fatigue, and muscle weakness often continue to disrupt daily activities, including walking and basic tasks.

“While this study focused on managing pain and fatigue caused by long COVID, it may also have potential applications for addressing similar symptoms in individuals with other respiratory diseases, those who have experienced extended ICU stays and developed post-hospitalization weaknesses, and conditions involving chronic fatigue and pain, such as fibromyalgia or chemotherapy-related side effects,” Bijan Najafi, MD, who is the research director of the Center for Advanced Surgical & Interventional Technology at UCLA Health in California.

In the study, 25 participants with chronic musculoskeletal pain, fatigue, and gait difficulties were assigned either a high-dose (active) TENS device or a low-dose (placebo) device. Both groups used the TENS device for three to five hours daily over a four-week period. Researchers measured participants’ pain levels, fatigue, and walking performance before and after the study. 

The study revealed that the high-dose TENS group experienced notable improvements in pain relief (26.1% more relief compared to placebo) and walking ability (8% during fast walking). One factor in the study’s success was likely the high rate of daily device usage. The wearable nature of the TENS device allowed participants to use it seamlessly throughout the day, without disrupting their routines. “This wearable TENS system offered immediate, on-demand relief from pain and fatigue, making it easy to integrate into daily activities,” said Dr. Najafi.

This study provides some hope for finding an effective, non-invasive solution for managing lingering COVID-19 symptoms that continue to affect millions. “But our sample size was limited, so further research is needed to confirm these findings,” said Dr. Najafi.

Personalized Medicine for Women with Breast Cancer

Significant advances in the understanding of different types of breast cancer is now significantly improving care in select  breast  cancer patients. In women with human epidermal growth factor receptor 2 (HER2) breast cancer, the molecular classification of their case plays a pivotal role in the formulation of personalized treatment plans aimed at optimizing outcomes. 

Researchers are using liquid biopsy technologies and this new approach is making a difference. Liquid biopsies can measure circulating tumor DNA (ctDNA) and circulating tumor cells (CTC). This type of analysis offers a non-invasive approach for evaluating tumor-associated biomarkers. This type of molecular classification can lead to more targeted therapeutic strategies.

“The integration of advanced diagnostic technologies, including liquid biopsy and RNA bead-based assays, can significantly improve the accuracy and sensitivity of HER2 detection. This distinction is critical for differentiating HER2-low tumors from HER2-zero cases, as such distinctions can profoundly influence treatment pathways and patient outcomes,” said Dr. Antonio Giordano, who is with Temple University in Philadelphia, Pennsylvania.

Liquid biopsy not only allows for sensitive of multiple target genes from biological fluids but also holds transformative potential for cancer care. This approach facilitates early detection of various cancers, monitors therapeutic responses, and aids in tracking minimal residual disease. Currently, early detection methods are not universally accessible, and traditional tissue biopsies often fail to provide comprehensive insights into tumor dynamics. Liquid biopsy addresses these limitations by enabling real-time monitoring and timely adjustments to treatment strategies.

In women age 70 and older, the most common type of breast cancer is invasive ductal carcinoma (IDC), followed by invasive lobular carcinoma (ILC). These cancers arise in different tissues of the breast, but are treated in similar ways. The most invasive cancers in this age group are hormone receptor positive. Hormone-positive breast cancers are considered slow-growing tumors, which can mean a good overall prognosis.

John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at medicalminutes@gmail.com