Integrative therapies Archive

Ask the doctors

Q. Is there anything I can do at home to ease sciatica pain?

A. Sciatica is a condition that causes pain that radiates down the buttock and the leg. It occurs when one of the two sciatic nerves in your body, which run from your back down to your toes, is compressed or irritated. Most often the problem is triggered by a ruptured disc or arthritis in the lower spine. This condition can be quite painful, but there are some strategies you can use at home to ease your discomfort.

Millions of Americans get coughs and colds during the winter, and many head to the drugstore to pick up one of the hundreds of common medicines available without a prescription. But those products often contain multiple active ingredients that are potentially unsafe if combined. Here’s how to safely choose the right over-the-counter medication for your symptoms.

Constant burping can be annoying — and embarrassing! But there are some simple steps that can help you squelch belching. The key is to reduce the amount of air you swallow.

Start by looking at some simple habits. Two of the biggest culprits behind swallowing too much air are chewing gum and smoking. Drop these habits and you'll be gulping less air — and quitting smoking has even more important health benefits! If you wear dentures, make sure they fit snugly. And avoid "high-air" foods and beverages like carbonated beverages and whipped desserts. After eating, consider taking a stroll rather than plunking down in front of the TV. Staying upright and moving helps your stomach empty and relieves bloated feelings. When it's time to go to bed, try sleeping on your stomach or right side to aid in the escape of gas and alleviate fullness.

In the journals

If you are ever hospitalized for a hip fracture, using an anti-osteoporosis medication may protect you from another bone fracture. A study in the September 2020 issue of Bone examined data on almost 78,000 people ages 50 and older hospitalized with hip fractures. About 10,000 were given anti-osteoporosis medication — usually alendronate (Fosamax) — within one year.

People who began treatment 15 to 84 days after their fracture were less likely to be hospitalized for another kind of fracture in the future compared with people who began treatment later. Those who first took medication after 252 days had the highest risk. The researchers were not able to measure the participants' bone density, so it's possible some people had especially strong or weak bones, which may have influenced the outcome.

In the journals

Lowering high blood pressure with medication is good for the brain as well as the heart, suggests a study published online May 19, 2020, by JAMA.

Scientists reviewed 14 trials involving more than 96,000 people who had their high blood pressure monitored without medication vs. those who took one or more blood pressure drugs, such as beta blockers, ACE inhibitors, and angiotensin-receptor blockers. Almost 58% were men, and the average age was 69. The people were tested for dementia or cognitive impairment (trouble learning a new task, concentrating, or making decisions) before taking medication. They were tested again an average of four years later.

Researchers are beginning to better understand if, when, and how to address this condition, which is linked to a newly recognized type of stroke.

In the womb, all fetuses have a foramen ovale (Latin for "oval hole") between the heart's right and left upper chambers (atria). This opening allows blood to take a shortcut within the heart rather than following a longer path through the lungs, which cannot work until they are exposed to air. After birth, when a newborn baby takes his or her first breath, the foramen ovale begins to close. Most of the time, it seals completely within a few months.

But in about a quarter of people, that doesn't happen. This anatomical variation is called a patent foramen ovale (patent means open) or PFO. Most people never know they have it, because a PFO doesn't cause any signs or symptoms. For the most part, the condition is harmless.

Ask the doctors

Q. I have a herniated disc in my back. What does this mean, and will this heal on its own?

A. A herniated disc, also called a slipped or ruptured disc, is a common problem that can happen at any age, but becomes more common in middle age and beyond. It occurs when the jelly-like filling in a spinal disc — one of the pads between your vertebrae, or spinal bones — breaks through the disc's outer shell, called the annulus, and bulges through the tear. When this happens, the material may press on nearby nerves, which can cause a host of symptoms including inflammation, pain, and numbness. Where in your body you experience these symptoms depends on the location of the herniated disc. For example, if the disc is in your neck, you may feel pain down your shoulder and into your arm. If the disc is lower in your back, it may irritate your sciatic nerve, which can cause pain that radiates through your buttock and down your leg. The good news is that in most cases — 90% of the time — pain caused by a herniated disc will go away on its own within six months. Initially, your doctor will likely recommend that you take an over-the-counter pain reliever and limit activities that cause pain or discomfort. But in some cases, if you've been using these strategies and haven't noticed an improvement, your doctor may recommend further evaluation and possibly an additional treatment strategy, such as physical therapy. Surgery is typically not recommended unless the problem does not respond to therapy, if you are having an increasingly hard time moving, or if your doctor believes the spinal cord is being compressed.

Studies of drugs, diets, and devices all come with their own unique set of challenges.

The best way to know if a new medical treatment truly works is with a randomized controlled trial — the "gold standard" of research studies, also known simply as a clinical trial. Volunteers are randomly assigned to receive either the new treatment or the comparison, which may be a placebo (an inactive therapy) or a treatment that's already available.

As the nation's top cause of death, cardiovascular disease has been at the leading edge of evidence generation, says Dr. Robert Yeh, director of the Smith Center for Outcomes Research in Cardiology at Harvard-affiliated Beth Israel Deaconess Medical Center. "We probably have more evidence for cardiovascular treatments than for any other field of medicine," he says. Among the studies with the greatest impact were the clinical trials that heralded new therapies to treat heart attacks. These include clot-dissolving drugs in the 1980s, followed in the 1990s by artery-opening angioplasty procedures, which remain the standard of care today. Stents, the tiny mesh tubes used in these procedures, have also been extensively studied in clinical trials (see "Testing devices: Different dilemmas").

Research we're watching

Frail, older people with health problems may live longer if they take the blood pressure medications their doctors prescribe, according to a study published in the August 2020 issue of the journal Hypertension.

Previous research suggests that in general, older people benefit from blood pressure drugs. But trials usually don't include people with multiple medical conditions, because those health problems make longevity findings challenging to interpret.

Research we're watching

Ticagrelor (Brilinta), a drug that helps prevent blood clots, was approved in 2011 for treating people who had experienced a heart attack or acute coronary syndrome (a sudden loss of blood flow to the heart). Now, the drug can be prescribed to a broader group of people. In June 2020, the FDA expanded ticagrelor's approval to reduce the likelihood of first heart attack or stroke among high-risk people with coronary artery disease.

The expansion is based on results from a multiyear study of more than 19,000 people with coronary artery disease and diabetes at high risk for a heart attack. Participants who took aspirin plus ticagrelor were less likely to experience a heart attack, stroke, or death from heart disease compared with those who took aspirin alone.