Consider topical analgesics

Better known by brand names such as Bengay or Asperchreme, these product are essentially aspirin (in the form of Methyl-salicylate) in a cream, plus other additives that cause sensations of heat and cold (in that order).

As I have discussed elsewhere, long term oral NSAID use (ibuprofen, naproxen, etc) has some significant potential downsides, (heart burn, and eventually, ulcers) which is not true for topical creams. It is certainly worth giving then a try, though they are probably better for mild pain - I don't find them sufficient for severe pain.

There are lots of varieties, but they all pretty much contain the same three chemicals, though in slightly different ratios. Interestingly, some products will only list 1-2 of the chemicals as active ingredients, but often the other 1-2 will then show up as inactive ingredients. I guess they are  trying to differentiate themselves, but it seems pretty dishonest to me. Also, they don't have to list how much of the 'inactive' ingredients they include, making less clear what you are actually getting.

The three chemicals are:
(1) Methyl-salicylate(sometimes another salicylate bonding is used, such as Trolamine) is just a way to deliver aspirin. It is the most important ingredient in these kinds of creams. This means if you have habituated to aspirin already these products probably won't do much good. For this reason I advise avoiding aspirin in pill form. Better to save its effectiveness for topical use, where the chance of stomach complications are much lower.

(2) Camphor - another topical analgesic, which produces a cooling feeling.

(3) Menthol - another cooling agent, which has the side effect of making the skin more permeable, allowing the salicylate to penetrate deeper. Menthol is also responsible for the strong smell of these products. For once, the 'fragrance' actually has something to do with the effectiveness of the product and isn't just added to improve marketability.

In addition to pain relief, there are a couple of other notable aspects of applying these creams. First, they all smell (of wintergreen (menthol), usually, though sometimes other fragrances are added as well). You'll get used to it. More notably, they burn a bit when applied. This actual contributes to the pain relief a bit, and becomes less bothersome as you get used to the creams.

You can limit the burning sensation to the area of application by wearing gloves. Unfortunately I've found that nitril gloves don't block absorption completely. Another cheaper option which actual seems to offer better protection is to use a sandwich bag to cover your hand. It is a bit more awkward at first, but much easier to put on and take off than a regular glove, and a heck of a lot cheaper. Once you are done with the bag, you can leave it in-between your skin and your cloths to prevent the cream from rubbing off.


Other pain creams

There are a few other options that are not aspirin based. You can now buy ibuprofen in a topical cream. This is a recent development, so hopefully the price will come down as more places carry it.  There are also some prescription NSAID creams, but these can be quite expensive and I have not tried them.
For something entirely different consider one of the hot-pepper rubs. These burn like crazy, but do seem to reduce pain after the burning subsides (which can take a while, perhaps as long as an hour). While a small tube will set you back $10, you only need a small dab, so it's relatively affordable. If you give this a try be sure to use as little as possible the first time, as the burning can take 30 minutes to develop and you really don't want to overdo it.  I find it makes my skin pretty sensitive so try to use it at a time when you don't have to wear clothing over the affected area.

Review: My Place laptop desk in bed (with dimensions)

The My Place laptop desk is intended to raise your laptop out of your lap, while simultaneously providing an incline for the keyboard, which makes typing more comfortable, especially when reclining. It's perhaps the most affordable laptop bed desk; just $35 at amazon, and at the moment, $30 at Bed Bath and Beyond ($20 + tax, after the ubiquitous $10 off coupon).

I bought it with the hope of using it while laying in bed, as in the Laptop Laidback and other similar products you can only buy online for ~ $100. It's not well suited to that purpose however. The underside of the desk is quite close to the ground (both front and back), so you have to lay absolutely flat (you can't put more than a small pillow under your knees). Conversely, the surface where the laptop rests is relatively high, making it difficult to find a comfortable angle for typing, esp. if you want to lay flat instead of propping your back and head up with a couple pillows. Indeed, if you do set the angle sufficiently high (~45deg.), the entire platform becomes unstable because it's too front/top-heavy. Even worse, if you have a ThinkPad, or any other laptop with a curved front underside, the lip of the desk isn't really tall enough to keep the laptop from sliding off. To be fair, the desk wasn't really designed with lying flat in mind. But at least for me, that's the only in-bed position in which I'm pain-free, and therefor the only position I'm interested in using it in.

If you are willing to sit partially up while using the desk, it might be worth considering, however. If so, here are a quick set of pros and cons to consider.

Pros:

1. Folds into a very compact package, for easy transport.
   
2. Though it's made of plastic, it's relatively stiff plastic, and relatively light. I wouldn't want to go hiking with it, but it's certainly easy to carry around the house, etc.
3. The incline for the desk is adjustable across ~10 increments.
4. The desk height can be doubled by unfolding the legs.

Cons:

1. The desk comes in two heights: too low (because of the poor clearance on the underside), and too high.
2. The desk isn't very stable because the legs are not very far spread apart, front to back. I wouldn't use it on a soft surface, especially when the legs are unfolded for double-height.
3. The distance between the lower clearance and the bottom edge of the laptop is 2.5" (see picture), trapping you under the laptop (indeed, on a hard surface, the "desk" actually puts pressure on my lap), while making the laptop itself too high up for ergonomic use (in my opinion).
   
4. The mousepad can also be raised on an incline, but after a few degrees it starts to slide down, making that feature not so useful. And because 25% of the desk is taken up by the mousepad, the laptop necessarily must be offset to the left, which isn't very ergonomic for typing.

This post is part of a series summarizing the various laptop stands that can be used in bed.

Sulindac & TNF-A mediated pain: a bad combination?

Sulindac is a generic NSAID. TNF-A is regulatory chemical in the body that has been implicated in many inflammatory diseases (rheumatoid arthritis, ankylosing spondylitis) - more TNF-A causes greater inflammation. Interestingly, taking Sulindac can actually increase TNF-A, at least in special circumstances. According to a 2009 study in rats (Sulindac metabolism and synergy with tumor necrosis factor-alpha in a drug-inflammation interaction model of idiosyncratic liver injury), sulindac, when administered with a another inflammatory agent, can significantly increase the amount of TNF-A in the blood as compared to the inflammatory agent alone.

This reduction may be specific to the inflammatory agent (lipopolysaccharide), but it may also occur for any cause of inflammation (ie rheumatoid arthritis, or ankylosing spondylitis, though these are chronic, and the lipopolysaccharide injection was not). It's important to note that the same study found no TNF-A increase when the rats were only injected with sulindac. Something has to cause the TNF-A to be present before sulindac can make it worse.

Other interactions between sulindac and TNF-A have been documented. One paper found that sulindac made TNF-A more effective at killing cancerous cells. Great, but if TNF-A is instead causing needless inflammation then perhaps here too sulindac is increasing it's efficacy. Another paper also suggests that Sulidac can make TNF-A a more effective cancer cell killer.

While it's too early to conclude anything, there are lots of NSAIDs on the market, so it might be prudent to take something else if Sulindac has no special appeal for you. Which is to say, it's not going to cause extra damage, but it might not be as effective.

Two papers have compared sulindac to other common NSAID treatments for AS. A 1979 double-blind cross-over study found that patients preferred taking Indomethacin to Sulindac, though the effect was small, and there was no clinically assessable difference (I prefer indomethacin, myself)in pain. Another study compared diclofenac and sulindac, and found mild evidence that diclofenac was slightly more effective (I also prefer diclofenac).

Laptop bed stand: Acrobat stand/E-Table/etc ($45)

Several companies have been putting their name on this laptop stand, which allows you to use your laptop while laying on your back in bed.

The angle of the laptop can be adjusted over a wide range, but the height of the laptop can only be adjusted over a short (2 inch?) range. At least one owner has also labeled it as being a bit fragile. The upside is it's quite cheap, and portable. Find it for about $45 on amazon (shipping included). Some specs. A demo video.

Without having tried it, I should reserve judgement, but this doesn't look like a great solution to me.

This post is part of a series summarizing the various laptop stands that can be used in bed.

Laptop bed stand: LapDawg ($121)/Wizard($99)

This stand allows you to use your laptop while laying on your back in bed. It appears to be quite adjustable (see diagram).

There are a lot of different companies selling this product (or at least what appears to be exactly the same product).

Lapdawg has it at $121, which was the highest price I saw, but it comes with a 30 day refund of $89 (ie they don't refund the shipping charge).

Another copy sells this item under the name Wizard, for $99 (free shipping).

You can also find what appears to be the same item on ebay, usually under the name 'folding laptop stand'. The price goes as low as $86 with shipping.

The product looks great in pictures (see esp. those on lapdawg's site, which has a bunch of product photos that highlight all the possible positions you might want to use it in). It also seems to be the most adjustable stand around.

Unfortunately, people who have actually used it hands on report that it is pretty flimsy and tends to break within months. That's pretty bad for a ~$100 item. If you buy the Wizard version, it sounds like it's pretty easy to get replacement parts, often for free, but even so it's quite disappointing. User reviews 1, 2, 3, 4 (older version). I'm giving this an "avoid" rating overall, which is a shame because, at least in concept, it seems like the best stand out there.

This post is part of a series summarizing the various laptop stands that can be used in bed.

Computing from bed: laptop stands

Modern life includes a lot of computer use, which for most people means sitting down. Back pain can make sitting prohibitively painful. Laying down is often more comfortable. One option is to lay on your stomach, propped up on your elbows, with your computer in front of you. This is a cheap and easy way to save your back. For some people (myself included) however, this kind of constant extension quickly becomes painful. Even if it doesn't hurt now, given the extensive stress this can cause to your spine it would be wise to get up and move at least once an hour if you use this pose.

The other option is to lay on your back, with your legs propped up and your laptop balanced against your thighs. While putting little stress on your back, this can be hard on your wrists and your neck. To make this more ergonomic you need some kind of laptop stand to raise up the keyboard to a more ergonomic angle and move the screen up as well, so you don't have to bend your neck as far forward to see it.

If you don't need the laptop to be raised very much (ie your neck is still very flexible) then a fairly effective stand can be fashioned from a sheet of cardboard. I'll put up a post later showing how to make one. In the mean time, I'll be considering commercial options which give you a lot more control, one per post (click here for a list).

When McKenzie doesn't work: Alkylosing Spondilitis

If you've tried the McKenzie extensions with little to no benefit (I did, for several years) maybe you don't have a slipped disk. There's at least one condition that doesn't respond to back extensions at all: Alkylosing Spondilitis. It's kind of like rheumatoid arthritis, but it targets your SI joints (and often other joints as well). One of the other diagnostic features is that your pain will sometimes switch sides, for no apparent reason. About 10% of back pain cases are due to Alkylosing Spondilitis. A more offical diagnosis depends on checking your blood for HLA-B27, though this is not conclusive. An MRI or, x-rays can also help make the diagnosis, though X-rays usually only show disease progression after 4 or more years after pain onset.

AS treatments include NSAIDS and Tumor necrosis factor-alpha supressors.