From: Phyllis.Cohen@p0.f33.n125.z1.fidonet.org (Phyllis Cohen)
Newsgroups: misc.handicap
Subject: Let's Get Started
Date: 6 Oct 92 21:03:57 GMT
Reply-To: Phyllis.Cohen@p0.f33.n125.z1.fidonet.org
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Index Number: 24668

[This is from the Chronic Pain Conference]

 02 Jul 92, Linda Cummings wrote to Arthur Saus:

 LC> But the interesting part of our discussion was that
 LC> we both started having back trouble after we had had an epidural during
 LC> childbirth. Now, that question is: Is there a connection between the
 LC> epidural and the disc problems?

 And Arthur Saus responded on July 5:

 AS>We don't think so.  There is absolutely no evidence to support this.
 AS>There is certainly plenty of evidence that many physiologic changes
 AS>occur due to the process of pregnancy and childbirth however.  Anyone
 AS>who has gone through that realizes there are back pains that occur
 AS>during pregnancy long before an
 AS>epidural is placed to help with the labor pains.

 And, on 02 Jul 92, Cindy Barnes wrote to Arthur Saus:

 CB> Can a pre-disposition to arthritis of the spine weaken the discs, so that
 CB> when an epidural or a spinal tap, or a mylogram are performed that disc
 CB> will develop a weak spot which then can herniate/rupture?

 And Arthur Saus replied on July 5:

 AS>To the best of my knowledge...NO!  Please see my messages to Linda for a
 AS>further discussion of the anatomy of this area as it relates to epidural
 AS>injections or a "spinal tap".

Hi, Linda!  It seems to me that you have a very interesting
hypothesis  which is subject to testing.  We know from Arthur that
the kind of pain  you, Cindy, and Jocelyne are experiencing is
thought to be due to other  factors, not your epidurals or spinal
taps.  However, we do not know if  he had time to do a literature
search on this, or if someone right this  very minute is conducting
a research study to see if such procedures  increase the risks of
developing conditions such as yours.

 Then on 07-08-92, Linda Cummings commented to Arthur Saus:

 LC>Cindy had an epidural during labor, whereas I didn't.  However, we have
 LC>both had spinal taps, and I have had three myelograms, whereas Cindy has
 LC>only had one.
 LC>
 LC>This is pretty fascinating to us, Arthur.  I wonder if any in your
 LC>profession have talked about this?  Is it possible?  It sure seems to be
 LC>the case with
 LC>Cindy and me...especially the Degenerative Disk Disease (arthritis)....

My training is in social science research, and my head is swimming
with what  would be required to really answer your question.  It
would best be studied  over time, and there would be two ways to
go.

The first would be to take all patients administered epidurals,
and/or  spinal taps (or a 'random sample' of the same) and the
follow them for five   or ten years to see what proportion
developed your condition.  There also   would have to be one or
more control groups of 1) patients with similar   conditions who
did not have these procedures, and 2) 'normal' controls, all  of
whom would also be followed for the span of the study.

The second would be to take current cases of serious disc problems
such as  yours (I don't know the technical name, if there is one),
and get a full  history which would then be coded and analyzed for
common factors.  This  would yield statistics as to whether all
folks having such problems also  had spinal procedures just prior
to developing the problems.  The one  problem with this is that
'correlation does not imply causation.'  There  is no way to know
for sure if everyone would have developed the problems  anyhow, for
some other reason.

Now, Linda, all you have to do is go to medical school, or get a
Ph.D.  in Public Health, and then you can apply for a grant and do
the research  yourself! <grin>

Seriously, though, you could do a literature search, and if
nothing  appeared, approach someone at a University teaching
hospital to see if  they were interested in conducting a study.
YOU could make it happen!

Phyllis

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