Multiple myeloma is cancer that forms in plasma cells. As a type of white blood cell, plasma cells are responsible for creating antibodies that attack germs and fight off infections. Multiple myeloma infiltrates healthy bone marrow to generate cancerous cells, crowd healthy blood cells and cause a number of health problems. This condition can cause bone pain in the spine or chest, nausea, fatigue, frequent infections and mental fogginess.
In its advanced stages, multiple myeloma can thin and break bones, and according to The Myeloma Beacon, at least 70 percent of multiple myeloma patients suffer from bone disease and pain, including vertebral compression fractures. The team at Chronicillness.co Site of United States understands patients with spinal fractures may experience significant back pain, decreased sensation, or poor urinary control, and that the condition can be debilitating.
Vertebroplasty is a bone stabilization procedure that can provide pain relief from spinal fractures, and studies have found multiple myeloma patients have benefited from this minimally invasive spine surgery. In fact, a group of Italian researchers completed a study of 106 myeloma patients who’d undergone vertebroplasty from 2002 to 2009 and found that pain went from a 9 on a scale of 1 to 10, to 1 after surgery.
Researchers also discovered the following results:
Disability decreased significantly after surgery for multiple myeloma patients.
“On a scale of 0 percent (no disability) to 100 percent (bed bound), the median pretreatment disability level was 82 percent. After surgery, the median disability level decreased to 7 percent, with 26 percent of patients reporting no disability.” – The Myeloma Beacon
All of the patients were taking pain-relieving medications prior to surgery, but after the procedure, 51 percent of patients reported no longer needing medications others were able to lower the medication dose.
Before vertebroplasty, 76 percent of patients required an orthopedic brace to assist with back pain. After vertebroplasty, only 14 percent of patients needed the brace.
If you’re living with multiple myeloma, contact the pain management specialists at Chronicillness.co Site of the United States to determine whether or not you’d benefit from vertebroplasty or kyphoplasty.
As you may have noticed, products with CBD are now touted for all sorts of conditions, including pain relief (for fibromyalgia, for example), anxiety, depression, insomnia, Parkinson’s, Alzheimer’s and cancer. But how effective is CBD, what risks are associated with using CBD and why are we suddenly seeing it advertised and sold everywhere? (For example, this flag has appeared outside a small pharmacy across the street from where I live.) Many important questions do not yet have answers.
The proliferation of CBD products is an important women’s health issue for several reasons. First, chronic pain is a concern for many women – it’s the focus of Chronicillness.co first scientific summit, Chronic Pain in Women, on July 17 and 18. Second, as a fat-soluble compound, CBD (like THC), crosses the placenta, and is present in breast milk. And third, it is possible that CBD products could cause a woman to fail a drug test. (If a CBD product contains THC (the chemical in marijuana that causes a “high”) above the 0.3% threshold allowed under the new federal law, or a drug test is sensitive enough to detect low levels of THC, an individual could test positive. Likewise, if an individual has used a lot CBD products containing low levels of THC, or if a test is specifically looking for CBD, a positive drug test is possible.)
CBD is cannabidiol, one of many compounds found in the cannabis family of plants, which includes marijuana and hemp. Products containing CBD can be “pure” (if it is the single compound), or it can be “full spectrum” when they contain all the compounds extracted from the plant material, (i.e., hemp), and some products many indicate “active hemp extract” without mentioning CBD.
The manufacturing and sale of CBD products have exploded since a December 2018 federal law removed CBD from the list of controlled substances and allowed hemp production, as long as the hemp doesn’t contain more than 0.3% THC.
So, what might CBD good for? The FDA has approved a medicine with CBD (Epidoliex®) for two very rare forms of childhood epilepsy. Some of the advertised CBD products tout benefits for neurological conditions, which may be based on research showing CBD interacts with certain types of neuroreceptors, and some limited clinical data. This information was summarized in a 2017 report from the National Academy of Medicine: “The Health Effects of Cannabis and Cannabinoids.” However, CBD (like its psychoactive cousin THC) has not been rigorously studied outside of the clinical trials for the FDA-approved medicine, and most of the claims about CBD are based upon anecdotes or poorly conducted investigations. What this means for women’s health is that there are significant unknowns and many questions still to be researched.
The FDA is moving forward with developing rules about CBD. A hearing was held in late May, but it is unclear how long it will take FDA to develop and implement new regulations. (See the FDA’s Q&A page about CBD, related products and its regulatory activities here.) In this regulatory void, some states have enacted rules about how CBD products can be sold, marketed, or labeled.
Until the FDA acts, CBD products (with the exception of Epidoliex®) are not being regulated as prescription drugs, over-the-counter medicines, vitamins or as foods, (including dietary supplements). Therefore, adding CBD to any of those products is in violation of federal rules. Because of potential risks to consumers, the FDA has sent warning letters to some companies selling CBD products, particularly when claims are made about the CBD product as if it were a medicine, such as a treatment for cancer or other medical conditions.
Using CBD products rather than FDA-approved or physician-prescribed treatments is another risk associated with the proliferation of CBD products. As the FDA Commissioner wrote about CBD products in April 2019, “We also don’t want patients to forgo appropriate medical treatment by substituting unapproved products for approved medicines used to prevent, treat, mitigate or cure a particular disease or condition.”
The major safety and quality concerns about CBD products can be divided into a few categories:
The good news is that there doesn’t seem to be many direct side-effects of CBD for most people – although the clinical trials for Epidoliex® found some patients developed liver problems. However, outside of the studies on children with rare forms of epilepsy, large well conducted trials are limited, which especially raises concerns about health effects from long-term use. For women with chronic conditions and taking prescription medicines (including birth control pills), the unknown side effects and drug-drug interactions could be particularly important.
Quality, dosing and contamination issues are also serious concerns. How CBD is manufactured or purified is important because different extraction and purification methods produce different mixtures of compounds. Also, extraction from cannabis plant material has traditionally been done using butane or propane, which can leave petroleum residues in the final product. There are potentially other quality and safety problems that can arise in manufacturing – particularly when there is so little oversight or regulations. Specifically, researchers have found CBD products can contain THC, pesticides, lead or other heavy metals. The lack of data also means there is great uncertainty about what appropriate dosage levels might be for particular people or for different uses. And, of course, accurate dosing is a problem when quality control is inconsistent, i.e., how do you know how much CBD you are receiving, if the manufacturer may not be certain about the concentration of CBD in their products.
And why is CBD being added to foods (both for humans and pets) despite this violating FDA regulations because CBD is an active ingredient in an approved medicine? Maybe it is trendy and sounds like a great new thing? Or maybe it is a revenue-driven marketing strategy that is leveraging off state laws allowing the legalization (and taxation) of medical and recreational marijuana – despite marijuana still being illegal under Federal law.
The bottom line is that you likely can get CBD oil, capsules or foods where you live, but are there possible harms? Yes. But what these harms may be is still largely unknown. Therefore, until there are clear rules about the types of CBD products that can be sold and quality manufacturing requirements, including the information that manufacturers and sellers must make available (perhaps similar to the labels on foods or for OTC medicines), what is appropriate dosing, and of course, what CBD might actually be good for, it is “buyer beware.”
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.
If sit-ups are a part of your regular workout routine, you may want to reconsider. The Navy and the U.S. Marine Corps are already doing so after a study found that 56% of fitness–related injuries came from sit-ups. The article goes on to say that while the armed forces are reviewing their fitness standards, the Canadian Armed Forces have already done away with sit-ups.
So why are sit-ups so bad? Studies show that the lumbar spine undergoes a lot of pressure against the ground when a person completes a sit-up. While this is normally not a harmful action, repeated pressure can injure the spine. In a worst-case scenario, the spine can push into a nerve, which could cause a chronic neuropathic condition.
Chronicillness.co Site of United States has been seeing a record number of patients who have severe back pain. In fact, back pain in the United States is on the rise, affecting millions of Americans annually and especially in the lumbar spine.
Instead of doing a traditional sit-up, our physicians have a few suggestions for abdominal exercises that shouldn’t injure the back. In general, it’s recommended to practice planks and side planks. In this exercise, patients hold a push-up position, but instead of their hands, they are on their elbows and forearms. This strengthens the abdominal muscles because it activates the core to keep the spine completely flat.
While planks are a great way to prevent spine injury, sit-ups and other workout–related injuries could have already taken a toll on the back. If you or a loved one are experiencing low back pain, consider coming to Chronicillness.co Site of United States for treatment. We can help manage pain that is due to conditions of the spine including a herniated disc, injuries to the facet joints, and conditions relating to nerve damage due to an injury. Our physicians highly encourage people to seek treatment as soon as they notice that their back pain is just not going away on its own. Treating acute back pain is much easier than treating a chronic condition, so patients should see a physician as soon as possible. We may even be able to help you form a workout routine that’s safe to do while seeking back pain treatment!
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.
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.
