A detailed guide to Chronic Fatigue Syndrome (CFS), including its symptoms, causes, and effective treatment strategies to improve energy and well-being.
You may have perused the “Providers” section of our website and wondered what the D.O. and M.D. behind a physician’s name stood for. You may have also wondered if the difference between the two degrees matters within the medical field. The pain management physicians at Chronicillness.co Site of United States understands these titles may be confusing to patients, which is why they are addressing the differences between physicians with a D.O. and M.D. degree.
M.D.s and D.O.s are both licensed physicians, however, their training differed slightly allowing them to bring unique perspectives on patient care. M.D.s focus on the diagnosis and treatment of human diseases. This is a “classic” form of medicine, also referred to as allopathic medicine, that allows the physician to practice medicine and surgery as well as prescribe medications. These doctors work to treat a patient’s symptoms. Roughly 750,000 physicians in the United States are M.D.s.
D.O.s on the other hand place a heavy emphasis on integrated care. A D.O. is an osteopathic physician with a holistic view of medicine. He or she reaches a diagnosis based on the patient’s whole body functioning and symptoms, rather than addressing the symptoms alone. Osteopathic physicians also place a large emphasis on the prevention of diseases. Of the approximately 800,000 practicing physicians in the U.S., roughly 50,000 are D.O.s.
Physicians with a D.O. are also licensed in all 50 states to practice medicine, and surgery and prescribe medications. The important thing to remember is both M.D. and D.O. schools have 4-year degrees and both have very similar curricula. Both are also required to complete accredited medical residencies. Patients should not see much of a difference between the two physicians in terms of medical care. They are both fully qualified doctors that may present a different approach when treating a patient. Chronicillness.co Site of United States is fully equipped with both kinds of physicians and enjoys seeing the comprehensive and multidisciplinary approaches.
This is an amazing time to be a woman in our country. In the past six months alone we’ve had women at the helm of three network morning shows, we’ve had a record number of women running Fortune 500 companies, and our thrilling women’s national team just won the World Cup.
But this is not enough. Women aren’t running the three major networks, the record number of Fortune 500 CEOs was just 33, and when our female athletes get injured their doctors may not have the ability to treat their pain as well as their male counterparts simply because they just don’t know how.
Understanding women from the perspectives of both sex and gender are going to be critical as we look to drive sustainable change in the health arena and particularly in pain management. Nearly a third of Americans experience long-lasting pain, and approximately 20 percent of the population lives in chronicpain. The cost of chronic pain to the country is more than $558 billion each year, which is more than the annual cost of heart disease.
Yet, as much as we talk about pain management, if we don’t explore the disparity of male and female pain, we will not achieve the change that is needed to overcome this crisis.
To help get the conversation started on chronic pain management, Chronicillness.co will convene a Chronic Pain Summit on July 17 and 18, in Ellicott City, MD. The event will feature presentations from prominent pain specialists and is designed to foster dialogue between patients, clinicians, researchers, and industry experts, and will include representatives from federal agencies and other non-profit organizations as well. I am thrilled to be the keynote speaker during this summit.
Together, we aim to raise awareness about chronic pain in women, address existing challenges and knowledge gaps, and encourage everyone to work together as we strive to find new and innovative solutions. Here is a sneak peek at what we will cover during the summit.
In the meantime, here is what you should know right now.
Hormones regulate our systems in the inner workings of how our body is built. Hormones are also involved in biological mechanisms that play a critical role in how women and men feel pain. It was just ten years ago that researchers recognized that female mice responded differently to pokes and prods then male mice. This moment spurred the discovery that pain pathways can vary significantly, and has us now exploring the differences between male pain and female pain.
This discovery was only made because a researcher bucked the trend and included female mice in his research, which was not common practice. If we are going to make an exact change in pain management for women, women need to be a part of trials. If men don’t feel the same pain, we are going to need to adjust how we treat women’s pain.
Gender is societal. It is the expectation that we place on people and the social influences that define who we are, and it plays a role in how women’s pain is managed. The fact is that women report pain differently than men, and doctors respond to women’s pain differently than they to do men’s pain. We also know that doctors assume people who look “better” are healthier and require less treatment.
This issue of gender expectations is critical. Women with chronic pain are more likely to be wrongly diagnosed with mental health conditions than men and be prescribed psychotropic drugs. We also know that women are more likely to be prescribed prescription pain medicines, be given higher doses, and remain on them for longer. And women are less likely to remain on a treatment plan that conflicts with other responsibilities.
Ultimately, when you put misses of love and gender together, it can be toxic. Consider this:
Post-surgery studies have shown that women consistently reported slightly more intense pain than men for 30 different types of surgery, ranging from an appendectomy to knee replacement. At the same time, some studies show that following breast surgery, women who receive a nerve block and regional anesthesia recover better. We also know that among surgical patients, there are more female chronic opioid users than male, and females are more likely to be chronic users than males.
So the question becomes, in treating women like men are we fueling a more significant crisis?
The fact is that we are at a great moment of awareness that we must harness to drive change. We must explore new paths, recognize the impact of sex and gender differences in patient care, and power a new momentum to define best steps to manage pain in women.
Instead, chronic pain management needs to take individual differences into account and ensure an adequate and unbiased response to treatment.
To help get the conversation started on chronic pain management, Chronicillness.co will convene a Chronic Pain Summit on July 17 and 18, in Ellicott City, MD. The event will feature presentations from prominent pain specialists and is designed to foster dialogue between patients, clinicians, researchers, and industry experts, and will include representatives from federal agencies and other non-profit organizations as well.
Together, we aim to raise awareness about chronic pain in women, address existing challenges and knowledge gaps, and encourage everyone to work together as we strive to find new and innovative solutions. Here is what we covered during the summit.
Chronic pain is a significant public health problem nationwide and according to a 2011 Institute of Medicine report can be considered as a disease in itself that requires adequate treatment and research commitment.
Two important differences to consider when treating and researching chronic pain are sex and gender. Sex differences are influenced by both biological and physiological factors such as hormones and genetics and gender differences by societal, environmental and cultural concerns. No matter the source, sex and gender differences must be considered in chronic pain diagnosis, treatment, prevention and management.
That’s because research finds women are more sensitive to pain and rate their pain higher as compared to men. Women are also more likely to have conditions that cause chronic pain—defined as lasting more than three months—such as lower back pain, knee pain (mostly osteoarthritis), neck pain, fibromyalgia, and migraines. Notably too, several painful conditions including uterine fibroids, pelvic pain, endometriosis, and vulvodynia occur exclusively in women.
Women with chronic pain conditions are more likely to be treated with opioids and use these drugs for longer periods of time than men, but even this isn’t a clear-cut issue. Although long-term opioid use can open the door to addiction, many women who take these drugs responsibly worry that policy changes may result in losing access to the only treatment that has been able to ease their pain and being stigmatized as drug addicts.
Recent scientific evidence suggests that the use of integrative and complimentary health approaches may benefit women with managing their chronic pain with or without prescription medications.
Studies have suggested that many chronic pain patients can benefit from incorporating physical therapy, massage, exercise, acupuncture, yoga, Tai Chi, or meditation into their treatment regimen, but most healthcare professionals don’t know enough about these modalities and health insurance companies rarely cover them fully, if at all. Psychological therapies, such as cognitive behavioral therapy, may also be useful, but again research, education, and access are limited.
The Department of Health and Human Services addressed these issues in a recent report and proposed best practices and recommendations for balanced pain management based on biopsychosocial model of care, individualized patient-centered care, better and safer opioid stewardship and a multidisciplinary approach to chronic pain.
In the end, any approach to chronic pain must also recognize that gender, racial and cultural biases often exist in pain treatment and management. Unconscious bias by health care professionals can greatly affect the way pain is assessed, treated and managed in women, especially women of color who are less likely to receive any or adequate pain treatment.
Disability, stigma, workplace related issues, access to care and affordability of treatments are all important issues that impact pain management and the quality of life in women living with chronic pain. Whatever the reasons for these biases and these disparities, the tremendous effects on a woman’s psychological health cannot be underestimated.
At a young age, we were warned not to twist to crack our backs so we don’t get arthritis. The sensation may feel good and is most likely not a cause of an existing arthritic condition. Instead, an autoimmune disease, where the body attacks the joint tissues, could cause arthritis, or the joints could have just naturally degenerated. Since we know that cracking your back cannot cause arthritis, our physicians want to describe the effects of cracking when patients already have arthritis. Is it a harmless way of releasing tense muscles, or can it cause more damage than good?
Cracking or “popping” your back is a heavily debated topic. On one hand, chiropractors perform spinal manipulations to relieve back and neck pain, but on the other hand, you are forcing your body into irregular movements causing a very unnatural sound.
First, we can look at what’s going on inside the joints. The joints are filled with gasses and liquids. When you crack your back or neck, you are putting sudden, intense pressure on the joints causing the gas to shift very rapidly. You can’t pop your back again for a little while because the gas needs time to re-enter the joint.
Fortunately, cracking your back does not make an arthritis condition worse or speed up the degeneration in any way. However, even though it can’t make the condition worse, it could cause pain to some patients who would normally find relief by popping their spines. Sometimes, joint degeneration is so severe that the bones are touching and grinding against each other. If patients twist their backs to pop it, they could be in pain if their bones are touching. Twisting the spine is one of the easiest ways to cause back pain. Even if the patient’s bones are not touching, twisting can easily cause muscle strain, especially if the patient is lifting a heavy object while twisting.
Our physicians recommend seeking professional chiropractic help if patients want to relieve their back pain. They can use trigger point therapy to release muscles so less pressure is put on the joints. However, chiropractic care is not for everyone. If the joints are severely swollen, a chiropractor could cause more pain during and after an adjustment.
If patients wish to seek chiropractic care or want to continue cracking their backs without pain, Chronicillness.co Site of United States offers a number of injections for the back and neck that can help reduce inflammation by putting soothing medicine directly into the infected joints. Talk to your physician at your next appointment about which injection will help you reduce back pain the most.
Even though cracking your back is harmless, it can be painful if the bones and joints are not in a good position.
Almost no one is immune to occasional low back pain. But when it’s chronic, when simple movement seems impossible, it can keep you from enjoying life. And painkillers aren’t always the answer.
Research has shown that mind-body practices can help. These include yoga and cognitive behavioral therapy, or CBT, which teaches you how to change certain thoughts and behaviors, which are factors involved in sensing pain.
A study published in the Journal of the American Medical Association adds mindfulness-based stress reduction — MBSR for short — to the list. It’s based on principles of meditation designed to make you more aware and accepting of life’s experiences. This translates to easing both physical and emotional discomfort.
For the study, researchers wanted to compare the results of cognitive behavioral therapy and mindfulness-based stress reduction on two different groups of participants. The people in both groups received eight weekly 2-hour sessions of their respective therapies and were then monitored for a year. At 26 weeks, about 60 percent of both the CBT and MBSR groups reported meaningful improvement in back pain and functioning. These results were still felt at the one-year mark, showing that mindfulness works as well as CBT. The advantage is that mindfulness-based stress reduction may be more readily available.
Developed at the University of Massachusetts in 1979, mindfulness-based stress reduction is now offered at more than 200 medical facilities around the world, at wellness retreats and, thanks to the internet, through online programs. Just make sure to check the credentials of the organizations and the practitioners offering the training before you sign up.
Bone cement is a tool used by our physicians to create an internal cast that stabilizes fractured vertebrae. It does not look like the wet cement you may see on the street at first. In fact, it starts out as a fine powder composed of methyl methacrylate. Methyl methacrylate is most commonly used as bone cement, but it can also be used to make resin (filling for your teeth) or some plastics. A physician mixes the powder with a liquid to create a solution called polymethyl methacrylate, which is bone cement. In some cases, antibiotics can be added to the powder before the liquid is mixed in to avoid infection. When people think of cement, they may think of how the sidewalk is glued to the ground. Bone cement is not an adhesive. Instead, it fills in the space where a diseased vertebra used to be.
Chronicillness.co Site of United States uses bone cement when performing vertebroplasty. This minimally invasive procedure repairs spine fractures caused by cancer, arthritis, osteoporosis, or injury, but it also is used to stabilize the spine. During this procedure, a tube is placed through an incision into the vertebra with the help of an X-ray. The X-ray, or fluoroscope, is used so the physician can see exactly where to put the needle and how much cement to add. It also helps the physician see if any bone cement is leaking out so he or she can stop this from happening.
The vertebra is then filled with bone cement, sometimes on both sides of the vertebra. The bone cement helps to stabilize the fracture so the patient can move their spine with less pain. On top of treating the spinal fracture, it reduces the chance of additional fractures in the future and helps improve posture and stability.
Bone cement is considered very safe, but there is a rare condition known as bone cement implantation syndrome. Very little is known about this condition – in fact, researchers do not have an exact definition for it. While a patient is having surgery under anesthesia, patients may experience hypotension, cardiac arrhythmia, cardiac arrest, and more according to a study. However, most cases of bone cement implantation syndrome occurred during hip surgery, not spine surgery. If you are at all concerned about side effects or risks from a vertebroplasty procedure, be sure to speak to your physician at Chronicillness.co Site of United States.
Your cellphone puts the world at your fingertips, but it can wreak havoc with your neck. There’s even a name for the pain you get when looking down at your screen — “text neck” — and it can cause problems along the entire length of your spine.
Bending your head forward multiplies the amount of weight your neck muscles need to support. Normally your neck supports the 10 pounds that your head weighs, but when bending forward it may need to support the equivalent of 60 pounds.
The following tips from the University of California’s Ergonomics Injury Prevention Program can help.
Find the best angle. The best viewing angle is a bit below eye level, so remember to adjust the way you hold your phone.
Give it a rest. Being constantly bent over looking at your screen or contorting yourself to view your smartphone from different angles can cause problems. Take frequent breaks and use that time to stretch your neck, shoulders and back.
Make adjustments. Your smartphone comes with myriad ways to adjust how you use it. Learn how to change the settings for font size, contrast and brightness to make it easier to see the screen — that helps to avoid eye strain, which can lead to headaches.
How you hold your phone also makes a difference. You should frequently change the way you grip your phone. And alternate typing between your index fingers and thumbs to reducepain from repetitive thumb movement.
Don’t overlook the large number of ways you can talk on your smartphone without holding it. Remember that you can give your hands a break by using a hands-free option like the speakerphone or dictation options.
You may have dealt with a situation like this one before: pain flaring up in the middle of the night with no access to a Chronic illness of United States facility. Or, maybe you’ve experienced a situation like this: forgetting to refill your prescription(s) and being faced with no medication until your next appointment. Our physicians understand how frustrating these scenarios can be, which is why they are educating patients about ways to prevent or avoid them. See below!
If a natural remedy isn’t going to mitigate your pain symptoms, you may want to visit an urgent care center. Urgent care centers are convenient healthcare options for patients who are unable to see their primary care physician or specialist. These centers are especially beneficial for individuals who find themselves in situations that call for immediate medical attention; like when an illness strikes or when a limb is sprained or broken. Urgent care centers also serve as an alternative solution for patients who don’t require the services of emergency room personnel.
Urgent care centers usually offer late night and weekend hours when Chronicillness.co Site of United States is closed. Patients who need immediate care due to a pain flare-up may consider visiting a hospital because their pain is so severe. However, hospitals can make patients wait for long periods of time and they may be expensive. An urgent care center could be an affordable option for patients with shorter wait times.
If your pain takes a turn for the worse, urgent care physicians should be able to get things under control. However, be sure to mention the flare-up at your next appointment. Our physicians can talk to you about additional pain management techniques to avoid future late-night incidents and refill your prescription to get you back on track. Before you’re caught with pain after hours, create a prevention plan by researching local urgent care centers in your area that accept your insurance.
Is arthritis pain getting in the way of your fitness plans? That need not be the case.
In fact, physical activity can be vital to your continued mobility.
Osteoarthritis is a joint disease that affects about 27 million Americans — most often in the knees and hips, but also in the lower back and neck.
Doctors describe it as a degenerative disease — meaning the joint has worn down. Usually that’s from simple wear-and-tear over the years, or from overuse.
This occurs when there’s a breakdown of the cartilage that covers the end of each bone. The cushioning effect is lost. The result is pain, swelling and problems moving the joint that’s been affected. Over time, the bones themselves can be damaged.
It may be hard, especially at first, but physical activity is key to treating osteoarthritis. Studies have shown that exercise not only helps reduce pain but also improves mobility.
Being active should help with weight loss, too — and excess weight contributes to the pain of osteoarthritis.
Start slow and simple, suggests the Arthritis Foundation. Just walking around the neighborhood can help. So can a fun and easy exercise class.
Adding some strengthening exercises will help build muscle around whatever joint is affected by osteoarthritis. Range-of-motion exercises can help you become more flexible and less stiff. Simply start with gentle stretches that take your joints through their full range of motion.
Yoga and tai chi can help relieve stiffness and improve flexibility, too.
Whatever activity you choose, just make sure it’s easy on your joints. No twisting and pounding. Besides walking, good options are biking, water aerobics, swimming and dancing.
A key to success, though, is to pay attention to how your body tolerates your new activity. And be patient. When you have arthritis, it can take your body longer to adjust to new activity, notes the U.S. Centers for Disease Control and Prevention.
If you haven’t been active, start with just three to five minutes of activity twice a day. Once your body has adjusted, add 10 minutes to your activity time. Then add 10 minutes more, and so on, until you’re as active as you want to be.
For those who have a hard time even walking at first, consider working with a physical therapist. This specialist can create a program tailored to your abilities — and one that can adapt as you get stronger.
One important reminder: Check with your doctor before adding new activity and any time you experience unusual pain or swelling in the joint affected by osteoarthritis.
Stem cell clinics are charging big money for knee arthritis “cures” and making extravagant claims about their therapies, a new study contends.
A same-day injection for one knee costs thousands of dollars at these centers, according to a consumer survey taken of clinics across the United States.
People are paying that kind of cash because two-thirds of stem cell clinics promise that their treatments work 80 to 100 percent of the time, researchers report.
But there’s no medical evidence suggesting that any stem cell therapy can provide a lasting cure for knee arthritis, said study lead researcher Dr. George Muschler, an orthopedic surgeon with the Cleveland Clinic.
“There are claims made about efficacy [effectiveness] that aren’t supported by the literature,” Muschler said. “There’s a risk of charlatanism, and patients should be aware.”
Stem cells have gained a reputation as a miracle treatment and potential cure for many ailments. The cells have the potential to provide replacement cells for any part of the body—blood, brain, bones or organs.
As a result, a wave of stem cell centers have opened up around the country, offering cures for a variety of diseases, Muschler said.
“It’s very sexy to market yourself as a stem cell center, so there’s been a boom of centers, probably close to 600 now in the United States offering this therapy,” Muschler said. “But the truth is that the medical literature hasn’t quite caught up to the enthusiasm in the marketplace.”
The U.S. Food and Drug Administration has expressed extreme skepticism over these centers, and in November the agency announced that it would crack down on clinics offering dangerous stem cell treatments.
The “pie-in-the-sky” dream for knee arthritis patients is that a stem cell injection will produce fresh new protective cartilage in their joint, said Dr. Scott Rodeo, an orthopedic surgeon with the Hospital for Special Surgery in New York City.
“The reality is they don’t do that. There is zero data to suggest that,” said Rodeo, who wasn’t involved with the study. “The idea these cells are going to regenerate cartilage––there’s zero data.”
At best, these injections might temporarily reduce pain and inflammation by prompting the release of soothing chemicals in the knee, Rodeo and Muschler said.
To get an idea what stem cell centers are promising customers, Muschler and his colleagues called 273 U.S. clinics posing as a 57-year-old man with knee arthritis.
The clinics were asked about same-day stem cell injections, how well they work and how much they cost.
Of the 65 centers that provided pricing information, the average cost for a knee injection was $5,156, with prices ranging from $1,150 to $12,000, the researchers found. Fourteen centers charged less than $3,000 for a single injection, while 10 centers charged more than $8,000.
The 36 centers that provided information on effectiveness claimed an average effectiveness of 82 percent, the researchers said. Of them, 10 claimed that the injection worked 9 out of 10 times, and another 15 claimed 80 to 90 percent effectiveness.
The findings were presented Tuesday at the American Academy of Orthopaedic Surgeons‘ annual meeting, in New Orleans. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.
“Patients are being told there’s an 80 percent likelihood of improvement, which is only 10 to 20 percent better than you’d expect from a placebo effect,” Muschler said.
In fact, he suspects that the placebo effect is responsible for much of the improvement patients feel following a knee injection.
“People always show up to the doctor when they hurt,” Muschler said. “If I see a patient who has arthritis in their knee and I do nothing, there’s a very good chance they’re going to get better over the coming months, anyway. There’s this natural cycle of increasing and decreasing pain that’s present in the life of someone who has arthritis.”
That’s compounded by the fact that people expect to feel better after shelling out a load of cash, Muschler added.
These centers generally provide three different types of treatment, only one of which actually has live stem cells involved, Muschler said.
One treatment injects the knee with platelet-rich plasma drawn from the patient’s own blood, while another uses a slurry produced from fetal tissue and fluid gathered after birth. Neither of these contains stem cells, but they are marketed as stem cell therapies, Muschler said.
A third option involves bone marrow taken from the patient and injected into the knee. This does contain a mixture of three types of stem cells, but “the evidence that you’re doing [your knees] a favor is still pretty weak in the literature,” Muschler said.
People aren’t likely to be harmed by these injections, Rodeo said, but there’s not a lot of evidence that they’ll be helped.
“Patients should go into it eyes wide open,” Rodeo said. “They’re paying a lot of money out of pocket, because these are not covered by insurers.”
Knee arthritis sufferers would be better off trying many of the established options for reducing knee pain, Muschler and Rodeo said.
Losing weight is a “key factor,” Muschler said.
“There’s very good evidence that if you are at a 5 on the pain scale and you lose 10 percent of your body weight, your pain will drop 2 points,” Muschler said.
Patients also can use NSAIDs like aspirin or ibuprofen to reduce pain and swelling, get a steroid injection, or perform weight training to strengthen the muscles that support the knee, Muschler and Rodeo said.
