Tag: chronic illness

Raise awareness about chronic illnesses by understanding their impact, symptoms, and the importance of support and education.

  • Do Over-the-Counter Painkillers Alter Emotions, Reasoning?

    Sure, an over-the-counter painkiller like Tylenol or Advil can help ease aches and pains, but could it mess with your thoughts and emotions, too?

    That’s the finding from a new review of recently published studies. The studies focused on how nonprescription painkillers might temporarily alter emotions such as empathy or even a person’s reasoning skills.

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    “In many ways, the reviewed findings are alarming,” said a team led by Kyle Ratner, a psychology and brain science researcher at the University of California, Santa Barbara.

    “Consumers assume that when they take an over-the-counter pain medication, it will relieve their physical symptoms, but they do not anticipate broader psychological effects,” the study group said.

    One clinical psychiatrist who reviewed the findings said they aren’t far-fetched.

    “Intuitively, this makes sense, as physical and emotional senses can overlap in the brain,” said Dr. Alan Manevitz of Lenox Hill Hospital in New York City.

    “While physical pain can be locally ‘felt’ at the site of a physical injury, the main source and registration of physical pain is in the brain,” he explained. “The same is true of hurtful, emotional and painful feelings. We say our ‘heart is breaking,’ but emotions are felt in the brain.”

    The new study reviewed findings from studies focused on common over-the-counter painkillers such as ibuprofen (Advil and Motrin) or acetaminophen (Tylenol).

    The experiments suggest that a regular dose of the pills might affect a person’s sensitivity to painful emotional experiences. For example, in one study, women who took ibuprofen reported less hurt feelings from emotionally painful experiences, such as being excluded by others or writing about being betrayed.

    However, men had the opposite pattern—they became more sensitive to these types of scenarios if they had just taken the painkiller.

    Ratner’s team suggested that these medicines might also reduce a person’s ability to empathize with the pain of others. For example, one experiment found that people who took acetaminophen were less emotionally distressed while reading about a person suffering physical or emotional pain and felt less regard for the person, compared with people who did not take acetaminophen.

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    People also seemed more willing to part with possessions after taking an over-the-counter painkiller in one study: Their asking price for a possession was lower if they had recently taken such a drug.

    Nonprescription painkillers might even impair “information processing,” the researchers said. In one study, people who took acetaminophen made more errors of omission during a task than those who did not take the drug, for example.

    Dr. Michael Ketteringham, a psychiatrist at Staten Island University Hospital in New York City, reviewed the findings. He stressed that—given an ongoing epidemic of opioid abuse—people shouldn’t be too concerned about the new report.

    “Over-the-counter pain medications play an important role as alternative medication to opioids in the treatment of pain,” Ketteringham said.

    But the study team wondered if, sometime in the future, it might be possible that the medicines could be used to help people deal with hurt feelings.

    Still, both Ratner’s team and Manevitz stressed that it’s far too early to turn over-the-counter painkillers into psychological treatments.

    “Clinically, we are a far cry away from the doctor saying, ‘Heartbreak? Take two Tylenol and call me in the morning,’” Manevitz said.

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  • Electrical Pulses May Ease Lower Back Pain

    A new treatment that aims electrical pulses at irritated nerves around the spinal cord appears effective at relieving chronic lower back pain and sciatica, a preliminary study suggests.

    The minimally invasive procedure, called image-guided pulsed radiofrequency, eased lingering pain in 80 percent of 10 patients after a single 10-minute treatment. Ninety percent were able to avoid surgery.

    “Given the very low risk profile of this technique, patients suffering herniated disc and nerve root compression symptoms may undergo a safe and fast recovery, going back to normal activities within days,” said study author Dr. Alessandro Napoli, an interventional radiologist at Sapienza University in Rome, Italy.

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    “In fact,” he added, “one of the dramatic advantages of this technology is that we can perform it in a day-surgery setting, without anesthesia, and [patients] go home the same day.”

    Napoli’s study was scheduled for presentation Wednesday at the Radiological Society of North America’s annual meeting in Chicago. Studies presented at scientific conferences typically haven’t been peer-reviewed or published, and results are considered preliminary.

    About 8 in 10 people suffer from lower back pain at some point in their lives, according to study documents. This pain can be due to a herniated disc in the lower spine. Sciatica is radiating leg pain caused by a pinched nerve in the lower spine, which also may be due to a herniated disc.

    Also called a slipped or ruptured disc, a herniated disc occurs when the spongy material inside a spinal disc squeezes through its tough outer shell because of aging or injury. This material can press on surrounding nerves, causing pain and numbness or tingling in the legs, according to the American Academy of Orthopaedic Surgeons (AAOS).

    Conservative, nonsurgical approaches typically ease symptoms of a herniated disc over time, according to the AAOS. These treatments include rest, gentle exercise, pain relievers, anti-inflammatory drugs, cold or hot compresses, physical therapy and massage therapy.

    Learn More: Self-Care for Lower Back Pain

    However, about 20 percent of those with acute low back pain don’t find relief through these measures. That leads some to decide on surgery to remove disc material pressing on their spinal nerves. For these people, Napoli said, image-guided pulsed radiofrequency treatment may become a viable option if larger studies reinforce his findings.

    Napoli’s research included 80 people who had experienced at least three months of low back pain from a herniated disc that hadn’t responded to conservative treatments.

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    Image-guided pulsed radiofrequency treatment uses computed tomography—a CT scan—to help physicians insert a needle to the location of the herniated disc and surrounding nerves. A probe that’s inserted through the needle tip delivers pulsed radiofrequency energy to the area over a 10-minute period, resolving the herniation without touching the disc, Napoli explained.

    More than 80 percent of the 80 study participants were pain-free a year after a single treatment. Six people required a second treatment session.

    Pulsed radiofrequency has been widely used in pain medicine for other types of chronic pain, Napoli noted.

    He said the treatment works by “eliminating the inflammation process” in nerves surrounding the herniated disc, hindering painful muscle contractions. “The aim was to interrupt this cycle and give the body the chance to restore a natural healing,” he added.

    Dr. Scott Roberts, a physiatrist with Christiana Care Health System in Wilmington, Del., said the new findings showed “an impressive drop in pain and improvement in function.” However, he noted that the research didn’t include a control group for comparison with people not given the treatment.

    “With no control group, we don’t know how much of the improvement we’re seeing would have happened anyway,” Roberts said. “I was very encouraged by [the study] because its results are significant, but it’s far from conclusive without a control group.”

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  • Pain Relief for Achy Joints

    Getting older certainly has its perks, but the reality is that aging can take its toll on many of us, despite our efforts to get out there and stay active—especially as the cold weather sets in.

    No, it wasn’t an exaggeration when your mother/father/grandmother or someone else rubbed their knee/elbow/back, winced and muttered, “I can feel a storm coming on.”

    Yes, there is evidence that shows a link between weather changes and chronic pain, especially joint pain and migraines. A 2007 Tufts University study showed that for every 10-degree drop in temperature, there was an incremental increase in arthritis pain. Low barometric pressure, low temperatures and precipitation can all increase pain. The theory is that these conditions increase swelling in the joint capsule, says the Arthritis Foundation.

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    It all adds up to giving your body an opportunity to heal itself by reducing its creation of pain-driving substances and stimulating mitochondria, the “energy packs” that drive cellular function and repair.

    Here are a few of the more common causes of joint pain and ways to ease your discomfort.

    1. Injury
    You slip and fall. Overdo it at the gym. Get rear-ended in your car. Sleep in the wrong position. Sit cramped on a plane for too many hours. Have poor posture. There are a zillion ways to injure your body, whether quite innocently and unknowingly from an everyday cause or overuse from repetitive motions over time.

    That pain can lead to stiffness, sleep disturbances, a burning sensation in your muscles, achiness or acute pain running from mild to severe.

    What to do to relieve muscle tension and soreness? Well, you can complain, call a doctor, take a pain reliever or rest—but don’t underestimate the power of massage in delivering a significant reduction in pain and soreness.

    2. Osteoarthritis
    This chronic condition of the joints is sometimes referred to as degenerative joint disease or “wear and tear” arthritis. It gets its name from the way it develops: cartilage, the cushion between our joints, breaks down over time and with use. What comes next? Pain, stiffness and swelling.

    If your knees, hips, lower back and neck hurt, you’re in good company with the 27 million other Americans who feel the pain. Also affected could be the small joints in your fingers and the bases of your big toe and thumb.

    Although physical activity might be the furthest thing from your mind when you’re feeling this way, it pays to be active. Studies show that simple exercise, like walking, can help manage or even reduce the pain from osteoarthritis. Weight management, stretching and anti-inflammatory medications can help, too, as can alternative approaches like massage, acupuncture and hydrotherapy.

    3. Bursitis
    We all have bursae—small sacs filled with fluid that cushion the bones, tendons and muscles near and around the joints of the shoulders, elbows and hips. When these become inflamed from repetitive movements, you’ve got bursitis, which can also affect the knees, heels and base of the big toe. Sometimes you can get bursitis from putting pressure on a joint for too long—like kneeling or leaning on your knees or elbows, for instance.

    The pain from bursitis can make you feel achy or stiff and can hurt when you move or press on the joint, which might also appear swollen or red.

    While you can’t prevent all types of bursitis, there are some things you can do to reduce the likelihood you’ll get it. If you do a lot of things that require kneeling, take stress off your knees by using a kneeling pad; warm up and stretch prior to strenuous activity; maintain a healthy weight to take stress off your joints and strengthen the muscles around them; use your knees, rather than your back, to lift heavy loads.

    Bursitis usually improves on its own, but you can help it along by resting, icing and taking a pain reliever. More aggressive treatment, if necessary, might include physical therapy, prescription medications and steroid injections.

    4. Gout
    This inflammatory form of arthritis affects about 4 percent of American adults.

    Many people think of gout as a “rich man’s disease,” a result of a lavish and expensive diet. That’s only a very small part of the picture. Most of the uric acid—actually about two-thirds of it—is produced naturally by your body. The rest comes from diet, in the form of purines, found in animal and plant foods. In fact, one of the great myths of gout is that it is caused by or can be controlled by diet. The reality of it is that gout is mainly a metabolic disease with genetic origins.

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    Gout occurs when there’s too much uric acid in your body and your kidneys can’t flush it out. It builds in the bloodstream and forms needle-like crystals in a joint. Those crystals, in turn, bring on sudden and severe attacks of pain, tenderness, redness and swelling. It commonly affects the big toe but can also occur in your feet, ankles, knees, hands and wrists. It can make the joint feel like it’s on fire. The pain can get so severe that even the weight of a sheet can be impossible to tolerate.

    Don’t think that you don’t have control over gout. You might not be able to change your genetics, but you can change factors like being overweight, which contributes to things like high blood pressure, high cholesterol and high blood sugar—all linked to gout.

    Experts say that although eating a low-purine diet won’t cure gout, it’s important to eat well and maintain a healthy weight. And, it’s wise to limit foods that increase uric acid levels, such as red meat, shellfish like shrimp and lobster, beer, liquor and high-fructose corn syrup.

    To help ease the pain from acute attacks and prevent future ones, gout is usually treated with medication like nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, naproxen and others), colchicine (a pain reliever used for gout pain) and corticosteroids (like prednisone).

    5. Lyme Disease
    Achy knees and Lyme disease often go together, and that’s because the bacteria transmitted by the tick bite can spread to your joints. This stiffness could also develop in your neck, hands and feet. Aside from joint pain, Lyme’s usual symptoms are fever, headache, fatigue and a skin rash characterized by a bulls-eye red circle that usually appears about seven days following the bite.

    Left untreated, Lyme can also spread to the heart and nervous system.

    Each year, approximately 30,000 people get bitten by a tick and develop Lyme disease. The first way to prevent it is to reduce your exposure by avoiding wooded and brush areas with high grass and leaf litter. Also, use insect and tick repellent, and inspect your body thoroughly for ticks after you’ve been outdoors. Putting your clothing in a hot dryer for 10 minutes can kill off any ticks that hitched a ride.

    Caught early, Lyme can be successfully treated with a variety of oral, and sometimes, intravenous antibiotics or penicillin.

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  • New Chronic Pain Treatments Help the Whole Person

    New Chronic Pain Treatments Help the Whole Person

    Women who live with chronic pain seek relief through all kinds of treatments, from acupuncture to physical therapy, medication to psychology.

    But in recent years, researchers have proven a multidisciplinary approach to chronic pain management can offer substantial and sustained pain relief.

    Even if you have explored multiple treatment modalities, you likely haven’t experienced a true multidisciplinary pain management program. That’s because they are few and far between. These complex team-driven programs require resources typically found only at large medical institutions. Some patients travel from far away to receive care because the potential life-changing effects are worth it.

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    What is a multidisciplinary pain management program?

    In a multidisciplinary approach, a team of clinicians collaborates to create custom treatment programs for each patient, using a variety of modalities. Patients often spend many days a week, sometimes for multiple weeks, in a program.

    “It’s more of a patient-centered, goal-oriented, holistic approach,” said Tim J. Lamer, MD, pain management specialist at Mayo Clinic and president of the American Academy of Pain Medicine. Lamer explained that multidisciplinary pain management is like a puzzle where every piece matters—and they all fit together.

    Institutions like the Shirley Ryan AbilityLab Pain Management Center in Chicago provide a model for multidisciplinary care, according to attending physician Shana Margolis, MD. There, most patients have previously tried one discipline at a time but not an approach that combines them all. The Shirley Ryan AbilityLab uses a biopsychosocial approach, meaning its team treats biological, psychological, and social drivers of pain, both as individual forces and as forces that intersect with one another.

    Multidisciplinary pain management programs may include:

    • Pain psychology: Teaching patients how mood affects pain and how pain affects mood, often using cognitive behavioral therapy. “When you’re in pain, it can make you more irritable, anxious, and depressed, which then can make it harder to manage your pain, and you can get stuck in a vicious cycle,” said Margolis.
    • Biofeedback therapy: Providing a variety of relaxation techniques that employ monitoring technology that gives patients instant feedback on their efforts.
    • Physical therapy: Including time spent on strengthening, range of motion, biomechanics, and pacing.
    • Occupational therapy: Focusing on ergonomics and improving a patient’s ability to perform everyday tasks with less pain.
    • Vocational therapy: Helping patients learn to reclaim their working life through a variety of strategies.
    • Art therapy: Using creativity to cope with pain, express emotions, and even reduce symptoms.
    • Interventional therapies: Employing techniques like nerve blocks, injections, or electrical stimulator devices to treat the neurological aspect of pain.
    • Physician and nurse monitoring: Ensuring patients are using medications properly, that comorbid conditions are also well-managed, and more.

    Margolis said a key aspect of a multidisciplinary approach is that the patient is at the center of the program, playing an active role in their own care, as opposed to simply receiving treatment. “We’re trying to give patients tools in their toolbox so they can learn to self-manage their pain,” she said.

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    Research shows results

    Lamer said most patients in a multidisciplinary approach experience improved function, mental health and management of pain in their busy lives. And there’s research to prove it, he said, including at least one study that followed patients for as long as 13 years who experienced long-term benefits.

    More research by Shirley Ryan Ability Lab Pain Management Center and the Department of Physical Medicine & Rehabilitation at the Northwestern University Feinberg School of Medicine in Chicago showed patients experienced improvement in pain, pain-related anxiety, ability to cope, and depression, among others.

    Margolis said that while many people can benefit from a multidisciplinary pain management approach, patients with widespread pain conditions like complex regional pain syndrome and fibromyalgia are likely to experience the greatest benefit. “Any kind of chronic pain condition that’s really affecting the patient’s lifestyle is where we excel,” she said. Emphasis on the mind-body connection and mindfulness plays a significant role in a patient’s success.

    Ready to take action?

    If you’re looking for a multidisciplinary pain management program, ask at your nearest large medical center. If there isn’t one in your immediate area, reach out to reputable programs and ask if they can recommend a provider in your area.

    The American Chronic Pain Association offers an extensive overview of pain management programs.

    The Alliance for Balanced Pain Management offers resources for patients seeking to understand their treatment options.

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  • Why I’m Talking About My Chronic Pain and Why You Should Too

    As a physical therapist, my job is to assist my patients to move better, get stronger, and most often to reduce their pain. This is an important, gratifying, and yet often challenging profession. This is in part due to my own daily chronic pain that is primarily in my low back and tailbone. I have been in some level of pain constantly for the past ten years.

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    While there are times that I share my experience with my patients, I usually smile, persevere and act as if everything is fine. I think many others with chronic pain can relate to this alternate persona—the brave mask so many chronic pain warriors put on daily.

    This is one of the tricky things about living with chronic pain. Most of the time I just want to feel normal. I want to go about my day-to-day tasks as if everything was not a monumental challenge and a huge energy expense. I want to pretend that my chronic pain has not affected my job satisfaction, my relationships and my feelings of self-worth.

    There are other times when I want to scream. I want to wear a sign across my chest that says, “Please be gentle with me, I have chronic pain.” I want everyone around me know what I’m going through, why I am the way I am. I want my struggles heard, to know that it’s not easy. It is not pity I seek, but rather compassionate recognition of the daily challenges of living with chronic pain.

    I’m often afraid to talk about my struggles with chronic pain. This would mean ripping up the mask––that brave face that I have worked so hard to maintain. My hope is that if I am true and open about my experiences more, a few people might feel less alone. A few people may push aside the fear of stigmatization and feel comfortable to be open and honest about what they are going through.

    Early in my clinical training, a patient taught me an important lesson. She told me to never tell someone, “I know how you feel.” Her statement took me aback, but her explanation has really stuck with me. It is true. I could never really know what someone is feeling. It is impossible to know just from their explanations, my own examination and my pre-conceived beliefs and education.

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    I cannot innately tell how past experiences have affected someone. I cannot exactly grasp the psychological impacts that their illness or pain has had on them. I do not know all other aspects of their life that this has affected. I can’t ever fully understand what someone else is going through, but I can listen. I can respect someone’s experience and I can do my best to validate their concerns. I can call on my past experiences of others discrediting my own feelings and I can work hard to not allow this to happen to another person—at least when they are working with me.

    I learned that opening up about my pain did lead to judgment from a few—one family member told someone that I write about my chronic pain, as a way to complain and vent. Many more have provided support and encouragement. I also learned that ignoring your pain and suffering in silence does not make it go away. I have found that by acknowledging my pain it encourages me to seek more treatment and work harder toward finding relief.

    Most importantly, talking about my pain has allowed me to maintain the healthy human connection that we all crave and need so badly in this life. It is so much easier to genuinely connect with the people in your life when you are raw and honest. It is never easy, but eventually you will have to take the mask off and let the person see the real you.

    I hope that you will find that by talking about your experiences with chronic pain and acknowledging its presence will lessen the power it has over your life. By ignoring my pain, I felt helpless. I let my chronic pain determine what kind of day I was going to have, how long a relationship could last, and how many hours I could stand to work in a week.

    While the process is ongoing, I am happy to be taking steps to regain control and be honest about my experiences. I am in far less discomfort than I used to be and now I have something even more important—the hope that one day I might actually be pain-free.

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  • Smart Steps for Healthy Feet

    Are your feet something you think about only when they hurt? Simple steps can protect them from common problems, some of which are hard to get rid of.

    READ: The Ways to Treat Your Feet Right

    The first step is to wear shoes, such as water slip-ons, in moist environments like indoor swimming pools and communal showers at the gym. Damp areas allow bacteria and viruses to thrive, and walking barefoot makes you more susceptible to common infections like nail fungus, athlete’s foot and warts.

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    You don’t have to give up style, but skip shoes that don’t feel comfortable from the moment you try them on. Calluses, corns, blisters and irritations can all result from or get worse from shoes that pinch and don’t fit well. It’s a mistake to expect that the shoes will “give” and feel better over time.

    Choose hosiery with care. That means buying socks and tights made from breathable fabrics. It’s not always possible to wear cotton, so if your feet get sweaty when you wear hosiery made of synthetics like nylon, take these steps: Carefully wash and dry feet when you get home, hand-wash the hosiery every night and let shoes dry out before you wear them again — you may need to wait 48 hours.

    A pedicure might be a great treat for your feet, but beware of harmful practices, both at salons and at home. It’s OK to gently slough off dead skin cells with a pumice stone after soaking your feet, but tools with razor blades are dangerous.

    Cutting cuticles is also unsafe. Gently push them back with an orange wood stick. To prevent ingrown toenails, clip straight across, not in a curve. The edges should be just a few millimeters shy of the toe tips. Use an emery board to smooth any ragged spots straight across.

    If you’re concerned about any changes in your feet, promptly contact your doctor or a podiatrist for an evaluation.

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  • Nerve Block Technique Might Help Chronic Back Pain

    A procedure that uses radio waves to treat chronic low back pain provided long-lasting relief to a small group of patients, researchers report.

    Called intradiscal biacuplasty (IDB), the procedure uses two water-cooled needles to blast radiofrequency energy at the nerve fibers within and around a spinal disc that’s begun to degenerate but has not ruptured, explained lead researcher Dr. Michael Gofeld.

    “Basically you’re destroying the nerve fibers, which will lead to the elimination of pain,” he said. Gofeld is a chronic pain management specialist at St. Michael’s Hospital and Women’s College Hospital in Toronto.

    A year out from treatment, half of the patients who received IDB in the study said they still were experiencing significant pain reduction, Gofeld and his colleagues reported.

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    The treatment is specifically to help people with discogenic back pain, Gofeld said — pain related to discs that are deteriorating but have not ruptured.

    Prior studies have found that discogenic back pain accounts for 39 percent of cases of chronic lower back pain, he said.

    The idea of using radio waves to treat back pain has been around for a quarter-century, Gofeld said. But recent breakthroughs using water-cooled needles have made the technology potentially more effective.

    “If the needle gets too hot, the energy will not spread efficiently enough,” Gofeld said.

    The procedure takes about a half hour, followed by six weeks of physical therapy, he said. Ideal patients have lower back pain that doesn’t shoot down the legs and limited disc degeneration, with no significant tears or ruptures.

    Dr. John Mafi, an internist and assistant professor at UCLA’s David Geffen School of Medicine, in Los Angeles, pointed out that the U.S. Food and Drug Administration approved IDB for use in 2007. But the technology has not been widely adopted in the United States, he said.

    “It’s not widely used,” Mafi said. “Insurance doesn’t seem to cover it yet, and that may be because they want to see more evidence.”

    For example, the U.S. Centers for Medicare and Medicaid Services (CMS) ruled in September 2008 that the government insurance plans would not cover any radiofrequency treatments for low back pain. The CMS decision memo concluded that there wasn’t enough evidence to prove that the procedures would improve health outcomes.

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    Gofeld’s study, which was funded by device manufacturer Kimberly-Clark Corp., focused on 22 patients who received IDB treatment alongside typical medical care for back pain.

    These patients originally showed less pain at six months following treatment, and now a one-year follow-up found that their pain reduction and improved function had continued, Gofeld said.

    The one-year report also included 25 members of the initial control group for the study, who at first only received typical medical care that included physical therapy and exercises.

    These patients were allowed to “cross over” after six months and receive IDB. They also experienced some pain relief and improved function, the Canadian researchers reported.

    However, their pain reduction was not as strong as that experienced by the original treatment group, Gofeld said.

    “We can infer from this result that the sooner we do the procedure and get the patient into rehabilitation treatment, the better will be the result,” he said.

    Researchers also found no significant side effects associated with IDB.

    The findings were presented Feb. 19 at the American Academy of Pain Medicine’s annual meeting in Palm Springs, Calif. Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

    Mafi said the small number of patients involved makes this more of a “pilot study.”

    “I wouldn’t jump to any changes in policy based on this study,” Mafi said. “This is a promising start, but now it’s time to do a rigorous clinical trial from this pilot data.”

    Dr. Nathaniel Tindel, an orthopedic spine surgeon at Lenox Hill Hospital in New York City, also sounded a cautious note, based on both the small number of participants and the fact that numerous prior radiofrequency treatments have failed to help people with low back pain.

    “Whenever there are a plethora of procedures offered to treat a condition which is known to heal best when left alone, those procedures are either all very effective or equally ineffective,” Tindel said. “Unfortunately, medical research has already shown us that intradiscal therapy falls into the latter category, and to date has not been shown to have long-term effect on back pain and disc disease.”

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  • 9 Questions to Ask About Postsurgical Pain Management

    One of the best ways to ease anxiety about a major event, like surgery, is to plan ahead. Conversations about postsurgical pain management need to happen before your procedure, so you can focus on your recovery after surgery is complete.

    Here are 9 questions you should ask your attending health care professional before having surgery.

    What should I do before my surgery?

    Make sure you understand your health care provider’s instructions about eating and drinking. Anesthesia administered during surgery may require you to have an empty stomach.

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    What can I expect on the day of my surgery?

    Preemptive or preventive pain relievers may be given, in addition to general anesthesia or other sedatives before surgery. Local anesthetics may be used during surgery to numb the area and help control pain. These may be placed directly into the surgical site, into or around a nerve (“nerve block“) or close to the spinal cord (“epidural”). Ask your health care provider to walk you through the pain management plan so there are no surprises.

    How much discomfort is usually associated with this procedure?

    This will depend on the type of procedure you’re having and the pain medications used before, during and after your surgery. Be sure and talk with your health care provider so you will know what to expect and be familiar with all of your options for pain management.

    How will my pain be managed after surgery?

    Depending on the type of procedure you’re having, a combination of medications may be used before, during and after surgery to block the various sources and pathways of pain. Essentially, these drugs may work in different areas or in different ways to better address your specific needs. Ask your health care provider about the risks and benefits of each medication being used along the way.

    How will we measure my pain?

    One of the best signs of proper pain management is being able to start moving and resume normal activities. You may also be periodically asked to measure your pain on a scale from 1 to 10 (with 10 being the worst pain and anything above 7 being severe). If you’re taking pain medication, it’s important to stay ahead of your pain and not let your pain levels get out of control.

    What do you need to know about me to individualize my treatment plan?

    Sharing information about yourself and your medical history will help your surgeon better understand your treatment needs and tailor a pain management plan that’s right for you. Let your health care provider know if you are:

    • Allergic to certain medications
    • Pregnant or breastfeeding, or planning for either
    • Taking other pain medications
    • Nervous about taking narcotic medications, or if you’ve had a previous negative experience
    • Sleep apneic
    • Asthmatic, or have COPD or other breathing problems
    • Suffering from a stomach ulcer or other gastrointestinal problems
    • Currently taking blood thinners or medications for other conditions
    • Or have ever been diagnosed with heart, liver, or kidney disease

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    How can I minimize exposure to narcotics? What options do I have?

    There are a variety of products your surgeon may give you before and during surgery to minimize your need for narcotics after surgery, including local anesthetics. Local anesthetics are numbing medications that can be used to numb the area where you had surgery from anywhere between a few hours to a few days. These may be placed directly into the surgical site, into or around a nerve (“nerve block”) or close to the spinal cord (epidural). If long-lasting local anesthetics are used during your procedure to numb the surgical site, you may require less narcotic pain medication afterwards.

    After surgery, there are several non-narcotic options that may be appropriate for you, including common over-the-counter (OTC) pain relievers like acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen. These may be prescribed in higher doses than the OTC dosages. All can help control mild to moderate pain. Aspirin may also help prevent blood clots, while NSAIDs may help reduce swelling and inflammation. Once you’re in the recovery room, your pain medication may be given orally (by mouth) or through an IV (a tube feeding into a vein).

    Here is more information about postsurgical pain management options.

    What side effects can I expect?

    The kinds of side effects you may experience will depend on the type of medications used before, during and after your surgery. For example, narcotics may cause constipation, nausea and vomiting, while nerve blocks can cause muscle weakness. Ask your health care provider about the side effects that can be expected with all the pain medications you will receive.

    How will I manage pain at home?

    Before you leave the hospital, make sure you feel 100 percent comfortable about how your pain will be managed at home. In most cases, you will be given a prescription for pain medication before or after surgery. You may be able to fill the prescription at the hospital pharmacy or it may be sent in to your local pharmacy for pickup on your way home. Making sure you have your pain medication in hand when you reach home, will help you stay ahead of your pain and not let it get out of control. Before you take your medication, be sure to read the enclosed instructions about how often to take the medication and what side effects to look for. If you have any questions about your pain medication, ask your local pharmacist or your health care professional.

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  • 46 Million Americans Suffer From Arthritis

    Arthritic disease is the most common cause of disability in the United States and now affects 46 million Americans, or more than 21 percent of the adult population, a major new report finds.

    That number is expected to rise even higher as baby boomers age, so that by 2030, 40 percent of American adults will suffer from some form of arthritic disease, the researchers said.

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    Today, almost two-thirds of people with arthritis are under 65, and more than 60 percent are women. The disease hits whites and blacks equally, but the rate is lower among Hispanics, according to the report.

    “Arthritis remains a large and growing problem,” said lead researcher Dr. Charles G. Helmick, an epidemiologist with the U.S. Centers for Disease Control and Prevention. “Cases of osteoarthritis has risen, while rheumatoid arthritis has gone down since our last estimate,” he added.

    Rheumatoid arthritis is a painful autoimmune disorder of uncertain origin leading to chronic inflammation at the joints. Osteoarthritis is a more common illness caused by a gradual breakdown of cartilage in the joints.

    The reasons why there are now fewer cases of rheumatoid arthritis is unclear, Helmick said. One reason may be that experts have changed the way they estimate the number of cases. Today, they use a more specific and restrictive definition of the condition, he said. But there has been a real decreases in cases of rheumatoid arthritis worldwide, and no one is sure why, Helmick added.

    The main reason that osteoarthritis is increasing is an aging population, Helmick said. “As more people age, there will be more people with osteoarthritis. That’s what’s driving the numbers upward,” he said.

    Also, the obesity epidemic in the Unites States is taking its toll, Helmick noted. “Obesity is a risk factor for knee osteoarthritis, one of the most common types of arthritis,” Helmick said. “We don’t have any cures, we treat the symptoms and, when it gets bad enough, we do knee replacements, which are very expensive,” he said.

    As more people suffer from arthritis, the costs associated with the disease will also keep going up. Currently, the costs to the country from arthritis top more than $128 billion a year in lost earnings and medical care, Helmick said.

    The researchers, from the National Arthritis Data Workgroup, used data from the U.S. Census Bureau, national surveys, and findings from community-based studies across the United States to determine the prevalence of arthritis in 2005 and beyond. The results were published in two papers in the January issue of Arthritis & Rheumatism.

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    Key findings in the report include:

    • By 2030, almost 67 million people will have arthritis — an increase of 40 percent. Osteoarthritis, the most common type of arthritis, affects almost 27 million Americans. That’s a big increase from 1990, when 21 million suffered from the condition.
    • The prevalence of rheumatoid arthritis has declined to 1.3 million Americans, from 2.1 million in 1990.
    • The prevalence of gout, a form of inflammatory arthritis, has risen in 2005 to about 3 million up, from 2.1 million in 1990.
    • Currently, juvenile arthritis affects some 294,000 children between infancy and age 17.
    • An estimated 59 million Americans have suffered an episode of low back pain over the past three months, the researchers said, while 30 million have suffered neck pain over the same time period.

    In addition, the report includes estimates for related conditions such as fibromyalgia, spondylarthritides, systemic lupus erythematosus (lupus), systemic sclerosis, Sjögren’s syndrome, carpal tunnel syndrome, polymyalgia, and rheumatic/giant cell arteritis.

    One expert advised staying active and keeping your weight under control to help prevent or treat arthritis.

    “We know that cases of osteoarthritis are likely to grow, because it’s age-related,” said Dr. Patience White, chief public health officer at the Arthritis Foundation. “In addition, weight plays a big role in risk, as well as lack of physical activity, in keeping your muscles strong,” she said.

    Losing weight and keeping physically active can help to reduce pain and keep the disease at bay, White said. “If you lose as little as 10 pounds, you can decrease pain in the knees and hips by 50 percent,” she said. “With exercise, you can decrease progression.”

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  • Pain: Another Gender Gap

    Like many other things in life, pain discriminates by gender. Women, studies show, feel pain more intensely than men, suffer disproportionately from conditions like chronic pain and migraines, and are more likely to be undertreated for pain than men.

    More pain, no gain

    More than 70 percent of people who report suffering chronic pain are women, according to a 2003 report in the journal Obstetrics and Gynecology Clinics of North America. Compared with men, women are more prone to a wide range of painful conditions, including migraines, irritable bowel syndrome, temporomandibular joint disorder, and fibromyalgia.

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    Women also appear to feel pain more intensely than men. Lab studies show that if you expose women and men to the same painful situation, such as being exposed to gradually increasing heat, women are usually the first to say ouch. On the plus side, other studies show that women handle pain better than men do. This might be because women have more experience coping with the predictable pains of menstruation and childbirth, and know how to prepare for painful episodes.

    Ironically, the half of the population that feels the most pain is also the half that is least likely to get the treatment they need. The National Women’s Health Resource Center reports that women with chronic pain often have trouble convincing doctors of the severity of their pain. As a result, they’re also more likely than men to have their pain undertreated.

    Some may be tempted to write off these differences as attributable to cultural influences. After all, there’s no doubt that boys and girls grow up with different outlooks on pain. Girls often feel free to cry over small injuries, while boys feel extra pressure to hold in tears. But the gender gap in pain goes far deeper than culture or upbringing. As recently reported by the American Pain Society, researchers are finding fundamental biological differences in the ways male and female bodies sense and respond to pain. Learning more about these differences can help shed light on the basic nature of pain and may lead to improved treatments for all patients.

    Hormonal differences

    Not surprisingly, hormones explain many gender differences in pain. The monthly ebb and flow of female hormones such as estrogen can clearly help fuel migraine headaches, a potentially disabling condition that is three times as common in women as in men. Women are especially vulnerable to migraines during their menstrual periods, when estrogen levels are low. Studies suggest that drops in estrogen can also interfere with the body’s ability to control pain. During menstruation, women produce only meager amounts of endorphins, the body’s natural pain relievers. When estrogen levels are high — near the time of ovulation — women can produce about as many endorphins as men, as reported at the annual meeting of the American Association for the Advancement of Science.

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    The brain also plays a role in the gender gap. In a small study of patients with irritable bowel syndrome, researchers at the University of California in Los Angeles have found that men and women use different parts of their brain to respond to pain. Scan results showed that women tend to turn on their limbic system, the emotional center of the brain. Men, in contrast, respond to pain with the cognitive or analytical part of their brain. Researchers speculate that these brain differences may reflect ancient gender roles. In the old days, women in pain often needed to protect and comfort their young, a highly emotional job. Meanwhile, injured men were more likely to attack the source of the trouble — with a spear, if necessary.

    Unfortunately for women, an emotional response can make an already painful situation even worse. As reported by the American Pain Society, women are more likely than men to develop anxiety or depression along with their pain. Both anxiety and depression can sharpen feelings of pain while raising the risk of disability.

    Men avoid pain treatment

    Of course, the cool, calm approach often taken by men has its drawbacks, too. Men are less likely than women to take their pain seriously, according to the National Institutes of Health. Instead of getting treatment, men often just hope their pain will go away — at least for a while.

    A study conducted over 36 months analyzing emergency room visits by more than 32,000 Baltimore men found that there was an increase in male visits immediately following televised sports events. The study, presented in October 2006 at the American College of Emergency Physicians conference, suggests that many men who visited the Baltimore VA Medical Center’s emergency room for various illnesses, including chest pain, abdominal pain, shortness of breath, and headaches chose to ignore their pain until they’d finished watching their football, baseball or basketball game.

    As doctors learn more about gender differences in pain, both men and women should get more of the relief they need. There’s certainly room for improvement. Until attitudes change, women may have to be especially aggressive in getting the right treatment for their pain. Men and women may be wired differently, but in the end, relief should be gender-blind.

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