Exercise Helps Manage Hip Arthritis Pain

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(Reuters Health) – Water- or land-based exercise should provide some short-term benefit in pain management for hip osteoarthritis, though there are few well-designed trials testing it, according to a new review.

Americans develop three million new cases of osteoarthritis each year. Most vulnerable are those who are older, obese, have previous joint injuries, overuse, weak muscles or genetic risk factors.

“It is nice to finally have some hip-specific data, as hip and knee osteoarthritis are often grouped together and it is almost certain that there are differences between these groups of patients, as well as differences in those with multiple joint osteoarthritis,” said Dr. Amanda E. Nelson of the Thurston Arthritis Research Center at the University of North Carolina Medical Center in Chapel Hill, who was not part of the new study.

“However, the studies are still small and heterogeneous, and larger, longer-term studies of more specific interventions are certainly needed to provide more specific recommendations,” she said.

The review only considered pain, not joint function, which may also improve with physical activity, Nelson told Reuters Health by email.

The researchers, lead by Kay M. Crossley of La Trobe University in Bundoora, Australia, reviewed 19 studies of water-based or land-based exercise therapy or manual therapy for hip pain, 10 of which were designed specifically for hip osteoarthritis.

Four studies found short-term benefits, up to three months later, with water-based exercise compared to minimal pain management. Six found similar benefit for land-based exercise therapy in the short term, but there was no evidence for benefit in the medium or long term, up to one year after therapy.

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Manual therapy, which includes joint manipulation, active stretching and massage, did not appear to provide additional benefit on its own or in combination with exercise, the researchers reported in the British Journal of Sports Medicine.

That’s not encouraging, said Dr. Kim Bennell of The University of Melbourne in Australia, who was also not part of the review. “However, the number of studies is relatively small and there was a lot of variation in the methods of the studies, so further research is needed in this area to confirm the results.”

Most doctors do not recommend exercise therapy, relying instead on pain-relieving drugs for osteoarthritis, despite agreement across guidelines and organizations that non-drug approaches are worthwhile, Nelson said.

“There are numerous potential barriers to recommendation and treatment including access to care, financial concerns, and the burden of managing multiple medical conditions in a short visit with a provider, among others,” she said. “Therefore, although the guidelines are in agreement, it is likely that the majority of patients are not receiving this recommendation from their providers, and that even fewer actually follow through on the recommendation if given.”

The 19 studies in the review all tested different type, frequency and duration of exercise, so the best sort of exercise, how much and how often to do it, remains to be determined, she said.

It would appear that a 12-week program with exercises generally including strengthening and range of motion three times per week is beneficial, Bennell told Reuters Health by email.

“Based on the overall body of work in physical activity, though, any regular physical activity is likely to be beneficial to most patients,” Nelson said. “It is safe to say that most adults do not get enough physical activity, and that this is even more of an issue among those with osteoarthritis.”

SOURCE: http://bit.ly/1Z1OiCu British Journal of Sports Medicine, online November 26, 2015.

Original Article HERE

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Researchers Find A Simple Daily Practice Can Control Pain Better Than A Placebo

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An article from our friends at A Plus:

A true example of mind over matter.

Meditation has shown that the human mind is a powerful thing. Through focused thought, humans have been able to improve their concentration, promote mental well-being, and encourage various aspects of physical health as well.

Some of these assertions, however, have been dismissed as a placebo effect rather than actually being effective. A new study by researchers at Wake Forest Baptist Medical Center in Winston-Salem, N.C., has put this to the test by pitting mindfulness meditation against a placebo. The results unequivocally showed that meditation came out on top for pain management. The results were published in The Journal of Neuroscience.

The placebo effect is a fascinating — though little-understood — phenomenon in which a person can actually improve their condition as long as they think they’re getting treatment. Pseudomedications that have no active ingredients are given to subjects who believe they’re taking an actual drug. Once they believe that they are supposed to feel better, some actually see an improvement in their symptoms.

“We were completely surprised by the findings,” lead researcher Fadel Zeidan explained in a statement. “While we thought that there would be some overlap in brain regions between meditation and placebo, the findings from this study provide novel and objective evidence that mindfulness meditation reduces pain in a unique fashion.”

Participants in the study were separated into four groups: mindfulness meditation, placebo meditation, placebo topical cream, and the control, which did not receive treatment. Mindfulness meditation is characterized by sitting still and focusing exclusively on one’s breathing. Though it is difficult to only think about breathing at first, it becomes easier with practice. In this study, this meditation was performed four times a day for 20 minutes per session.

Next, each of the participants was subjected to a painful stimulus (in this case, a probe heated to 120 degrees Fahrenheit) and asked to rate their pain. In order to keep the results from being completely subjective, brain scans were done using an MRI.

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Interestingly, those who practiced mindfulness meditation experienced more than double the pain relief compared to those who used the placebo ointment, and the decrease of emotional response to the pain was nearly tripled as well.

“This study is the first to show that mindfulness meditation is mechanistically distinct and produces pain relief above and beyond the analgesic effects seen with either placebo cream or sham meditation,” Zeidan continued.

The results of this study are very interesting and a testament to not only the prowess of the human brain, but also how much we have left to learn about how these processes work.

The researchers acknowledge that one of the limitations on the study is that all of the participants are ordinarily pain-free. Hopefully future studies will explore how meditation compares to placebo for those who suffer from chronic pain.

Original Article HERE

Nine Things To Know About Stem Cell Treatments

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Many clinics offering stem cell treatments make claims that are not supported by a current understanding of science.

Disclaimer: This article was originally published on The International Society for Stem Cell Research’s (ISSCR) Website

Stem cells have tremendous promise to help us understand and treat a range of diseases, injuries and other health-related conditions. Their potential is evident in the use of blood stem cells to treat diseases of the blood, a therapy that has saved the lives of thousands of children with leukemia; and can be seen in the use of stem cells for tissue grafts to treat diseases or injury to the bone, skin and surface of the eye. Important clinical trials involving stem cells are underway for many other conditions and researchers continue to explore new avenues using stem cells in medicine.

There is still a lot to learn about stem cells, however, and their current applications as treatments are sometimes exaggerated by the media and other parties who do not fully understand the science and current limitations, and also by “clinics” looking to capitalize on the hype by selling treatments to chronically ill or seriously injured patients. The information on this page is intended to help you understand both the potential and the limitations of stem cells at this point in time, and to help you spot some of the misinformation that is widely circulated by clinics offering unproven treatments.

It is important to discuss these Nine Things to Know and any research or information you gather with your primary care physician and other trusted members of your healthcare team in deciding what is right for you.

1. Currently, very few stem cell treatments have been proven safe and effective

The list of diseases for which stem cell treatments have been shown to be beneficial is still very short. The best-defined and most extensively used stem cell treatment is hematopoietic (or blood) stem cell transplantation, for example, bone marrow transplantation, to treat certain blood and immune system disorders or to rebuild the blood system after treatments for some kinds of cancer.

Some bone, skin and corneal (eye) injuries and diseases can be treated by grafting or implanting tissues, and the healing process relies on stem cells within this implanted tissue. These procedures are widely accepted as safe and effective by the medical community. All other applications of stem cells are yet to be proven in clinical trials and should be considered highly experimental.

Beware of stem cell treatments offered without regulatory approval or outside the confines of a legitimate and registered clinical trial.

2. There is something to lose when you try an unproven treatment

When there is no existing or effective treatment for a disease or condition, it is easy to understand why you may feel there is nothing to lose from trying something new, even if it isn’t proven. Unfortunately, most of the unproven stem cell treatments for sale throughout the world carry very little promise of actual benefit and very real risks:

  • Complications may create new short- and long-term health problems, and/or may make your condition or symptoms more difficult to manage
  • Receipt of one unproven or experimental treatment may make you ineligible for future clinical trials or treatment options
  • Out-of-pocket expenses could be enormous. In addition to treatment costs, there may be accommodation charges or other fees. In most cases, insurance companies and government health programs do not cover the cost of experimental treatments
  • If travel is involved, there are additional considerations, including time away from friends and family

Before you decide whether to pursue an unproven or experimental treatment, carefully assess the treatment you are considering. Weigh the risks and potential benefits. Get input from your loved ones and from your healthcare team; they may provide insight you haven’t thought of.

Unproven treatments present serious health, personal and financial considerations. Consider what might be lost and discuss these risks with your family and healthcare providers.

3. Different types of stem cells serve different purposes in the body

Different types of stem cells come from different places in your body and have different functions. Learn more about various types of stem cells here.

Scientists are exploring the different roles tissue-specific stem cells might play in healing, with the understanding that these stem cells have specific and limited capabilities. Without manipulation in the lab, tissue-specific stem cells can only generate the other cell types found in the tissues where they live. For example, the blood-forming (hematopoietic) stem cells found in bone marrow regenerate the cells in blood, while neural stem cells in the brain make brain cells. A hematopoietic stem cell won’t spontaneously make a brain cell and vice versa. Thus, it is unlikely that a single cell type can be used to treat a multitude of unrelated diseases involving different tissues or organs.

Be wary of clinics offering treatments with stem cells originating from a part of your body unrelated to your disease or condition.

4. The same stem cell treatment is unlikely to work for different diseases or conditions

Because stem cells that are specific to certain tissues cannot make cells found in other tissues without careful manipulation in the lab, it is very unlikely that the same stem cell treatment will work for diseases affecting different tissues and organs within the body.

Scientists have learned to make certain specialized cell types through a multi-step processes using pluripotent stem cells, that is embryonic stem cells or induced pluripotent stem (iPS) cells. These cells have the potential to form all the different cell types in the body and offer an exciting opportunity to develop new treatment strategies. Embryonic stem cells and iPS cells, however, are not good candidates to be used directly as treatments, as they require careful instruction to become the specific cells needed to regenerate diseased or damaged tissue. If not properly directed, these stem cells may overgrow and cause tumors when injected into the patient.

View clinics that offer the same cell treatment for a wide variety of conditions or diseases with extreme caution. Be wary of claims that stem cells will somehow just know where to go and what to do to treat a specific condition.

5. The science behind a disease should match the science behind the treatment

The more you know about the causes and effects of your disease, the better armed you are to identify your best treatment options. If you have a certain type of blood cancer, for example, transplantation with blood-forming stem cells makes sense, as the treatment requires those specific cells to do exactly what they are designed to do. If you have diabetes, receiving a blood-forming stem cell treatment doesn’t make sense, because the problem is in the pancreas rather than in the blood itself. Without significant and careful manipulation in the lab, tissue-specific stem cells do not generate cell types found outside of their home tissues.

Your best protection against clinics selling unproven stem cell treatments is an understanding of the science behind your disease, injury or condition.

6. Cells from your own body are not automatically safe when used in treatments

In theory, your immune system would not attack your own cells if they were used in a transplant. The use of a patient’s own cells is called an autologous transplant. However, the processes by which the cells were acquired, grown and then reintroduced into the body would carry risks. Here are just a few known risks of autologous stem cell treatments:

  • Any time cells are removed from your body, there is a risk they may be contaminated with viruses, bacteria or other pathogens that could cause disease when reintroduced
  • Manipulation of cells by a clinic may interfere with their normal function, including those that control cell growth
  • How and where the cells are put back into your body matters, and some clinics inject cells into places where they are not normally present and do not belong

Every medical procedure carries risk; be wary of clinics that gloss over or minimize the risks associated with their treatments.

7. Patient testimonials and other marketing provided by clinics may be misleading

It can be hard to tell the difference between doctors conducting responsible clinical trials and clinics selling unproven treatments. One common differentiator is the way a treatment is marketed. Most specialized doctors receive patient referrals, while clinics selling stem cell treatments tend to market directly to patients, often through persuasive language on the Internet, Facebook and in newspaper advertisements.

Clinics peddling unproven stem cell treatments frequently overstate the benefits of their offerings and use patient testimonials to support their claims. These testimonials can be intentionally or unintentionally misleading. For example, a person may feel better immediately after receiving a treatment, but the perceived or actual improvement may be due to other factors, such as an intense belief that the treatment will work, auxiliary treatments accompanying the main treatment, healthy lifestyle changes adapted in conjunction with the treatment and natural fluctuations in the disease or condition. These factors are complex and difficult to measure objectively outside the boundaries of carefully designed clinical trials. Learn more about why we need to perform clinical trials here.

Beware of clinics that use persuasive language, including patient testimonials, on the Internet, Facebook and newspapers, to market their treatments, instead of science-based evidence.

8. An experimental treatment offered for sale is not the same as a clinical trial

The fact that a procedure is experimental does not automatically mean that it is part of a research study or clinical trial. Responsible clinical trials share several important features:

  • They build upon their own preclinical data, lab-based research on cells, tissues and animals, that indicates the treatment being tested is likely to be safe and effective
  • Oversight by an independent medical ethics committee to protect participants’ rights
  • Conformity to regulatory requirements, including a listing in a recognized clinical trial registry
  • A structure designed to answer specific questions about a new treatment or a new way of using current treatments (results are usually compared with a control group of patients who do not receive the experimental treatment)
  • The cost of the new treatment and monitoring is not covered by the participant

Responsibly-conducted clinical trials are critical to the development of new treatments. Learn more about clinical trials here.

Beware of expensive treatments that have not passed successfully through clinical trials.

9. The process by which science becomes medicine is designed to minimize harm and maximize effectiveness

There is a lengthy, multi-step process involved in responsibly translating science into safe and effective medical treatments. During this process, scientists may discover that an approach that seemed promising in the lab, does not work in animals, or that an approach that worked in animals, does not work in humans. They may discover that a treatment effectively addresses symptoms of a disease or injury in humans, but that it carries unacceptable risks. Scientists carefully review and replicate their work, and invite their peers to do the same. This process by which science becomes medicine is often long, but it is designed to minimize patient harm and to maximize the likelihood of effectiveness. Learn more about how science becomes medicine here.

Beware of clinics that circumvent the accepted process by which science becomes medicine.

‘Like an orchestra’: Pain management moving toward holistic approach

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Logan resident Dawn Carter’s life changed in January 2015 following an accidental fall down a flight of stairs.

Originally diagnosed with just a concussion, complications from the injury now cause Carter to experience chronic nerve pain and migraines, in addition to seizures and memory loss.

“There is really nothing (my doctors) can do about my pain,” Carter said. “It hurts so bad (that) I feel like an electric eel is swimming throughout my body. It mainly starts in my wrist and works up my arms, up to my shoulders and down to my back.”

According to data gathered by the Institute of Medicine of the National Academies, 100 million Americans suffer from chronic pain conditions, affecting more people than coronary heart disease, diabetes and cancer combined.

Fortunately, treatment options for both chronic and acute forms of pain have evolved from the over-simplified, pharmaceutical heavy days of the 1970s, said Dr. Brian Richardson, who specializes in pain management at Logan’s Southwest Spine and Pain Center.

As pain management evolves, so too does the form it takes. The new standard of care in pain management is that of the holistic approach, or the treatment of a patient’s pain with the combined help of general practitioners, physical therapists and psychologists.

“The way I like to describe treatment to my patients is that it’s like an orchestra,” Richardson said. “Say you’re watching “Les Miserables” live onstage, but the only instrument in the score is a trombone. Alone, that might not be very pleasant. But if you’ve got cellos, violins, saxophones and clarinets, it’s going to sound a lot better and be a much more pleasant experience. It’s the same concept with pain management. Now, we’re using multiple tools to help diagnose, address and fix a problem.”

The physical, mental, social approach

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Physical therapist Swen Sandberg, who has been rehabilitating outpatients through Intermountain Healthcare at Logan Regional Hospital since 2013, said pain management has been working towards the “biopsychosocial” model of treatment over the past few years.

Often abbreviated as BPS, the approach gives equal weight to the physical, mental and social aspects of any given disease.

Sandberg said research studies have shown the effectiveness of the BPS style, with patients showing better recovery results when cared for holistically instead of by a single entity. The results are shifting the way pain management is being approached and introducing an increase in collaboration between medical professionals.

Sandberg predicted that within 10 years, insurance companies will start to provide better reimbursement to patients that are exploring the holistic style of care as opposed to consulting with just a single medical professional.

“The research is backing it up,” Sandberg explained. “It’s the model that Intermountain Healthcare is working towards as well. You can see that it’s the direction that health care is going.”

Richardson said although collaboration with other doctors may sometimes be challenging to coordinate because of varying schedules, he echoed that the increase of experience and evidence confirms it as the new medical standard for pain treatments.

“Not only is the approach important, but it’s absolutely critical,” Richardson said of his regular communication with other doctors. “It’s no longer just giving patients a painkiller. When you look at one modality versus someone also using physical therapy and working through coping skills with a psychologist, that type of multi-modal approach has by far and away been proven to be the most successful.”

Restoring function

Richardson said one of the most common misconceptions regarding treatment for pain is the assumption that doctors will simply prescribe pain medication, but medication isn’t the core of treatment. Instead, the focus lies first on diagnosing the problem itself and then exploring ways to restore function in pained areas.

“Communication with the patient about what the goal is for treatment is before we begin,” Richardson said. “From there, we can manage expectations and work together on the same page.”

While short-term pain relief may be a priority depending on the needs of the individual patient, not all patients may need to be prescribed medication depending on their treatment plan. Richardson used the example of an 80-year-old woman slipping in her bathtub and suffering a compression fracture. In this case, a low dose analgesic may be prescribed to help relax the pain, but the patient would receive an MRI and a back brace first, while also meeting with a physical therapist. A procedure may be recommended if the fracture doesn’t heal naturally from there.

However, if pain medication is in the best interests of the patient, Richardson said enough is prescribed to meet the patient’s needs.

Every 30 days, Richardson would meet with the patient to determine how the treatment is progressing before processing a refill on any prescription.

“It’s rare that you have people with legitimate pain problems that don’t stick with the prescribed regimen,” Richardson explained. “It’s much more common to see people that want to get better.”

Sandberg, the physical therapist, said treatment is on a spectrum between restoring function and pain control. Working towards one end may be able to provide for a solution on the other end, however.

“Very rarely does a patient present without some form of pain,” Sandberg explained. “As therapists, what we do is try to address what’s causing the pain. Sometimes, unless you reduce stress on the joint or the structure, it won’t get better no matter how many pills you take. But other times if we can reduce the pain enough, we can work towards ways to restore that function.”

Sandberg said that many of his patients are on some form of pain medication, but the majority of his modalities aren’t related to pain medication. Instead, he may use ultrasounds or electrical stimulation on the affected areas to retrain the nerves to induce a proper pain response, or provide stretching or traction to joints and tendons to invoke chemical responses that help to relieve the pain.

Sometimes, techniques as simple as changing posture can help relieve pain without turning to medication.

Ending the stigma

Both Sandberg and Richardson acknowledge that there is a certain stigma surrounding chronic pain conditions that may cause patients to not enter treatment. For some, it may be a case of affordability, although Sandberg said that many physical therapy patients may be able to seek treatment for low or no cost regardless of their insurance status. For others, it may be a doubt that doctors really believe their claims of pain.

“Anybody would be frustrated if they got the response, ‘There’s nothing wrong with you,’” Sandberg said. “Sometimes there is a stigma that you may be faking it, but for doctors that notion is completely unacceptable. That can’t exist in the medical community. Pain is taken at face value. Just because there isn’t visible damage now doesn’t mean that there wasn’t damage at some point.”

Richardson said advances in pain management clinics over the past 15 years alone are countering the old notions of simply receiving pain pills.

“We’re committed to finding out what is causing pain and why,” Richardson said. “It can sometimes be a challenge, but once they come through the door and realize what we’re trying to accomplish, that perception changes rapidly.”

Acute vs. chronic pain

Pain takes many forms, which means that professionals like Richardson and Sandberg treat patients on an individual basis to best suit their needs.

“Sometimes the pain is an acute pain, which is here and now,” Richardson said. “For example, you may have a patient who has tweaked their spine tossing a bale of hay and now has nerve pain. If we can treat these conditions quickly enough, we may be able to phase out that pain completely. But with chronic conditions, expectations may need to be reevaluated. Sometimes pain just can’t be cured — there may not be one thing to fix that will stop it from coming back.”

For chronic patients, the involvement of a psychologist can be beneficial, helping patients to learn effective coping strategies regarding the control of their pain. In the cases of psychosomatic pain, which is pain that is caused by the brain’s misinterpretations of nervous system responses, psychologists can also help to reduce the pain or eliminate it entirely.

Sandberg said chronic pain is often the result of a previous injury where the problem is a maladaptive nerve response instead of lingering damage, in which the nerves are unable to register pain in the correct fashion.

“These people may still be in pain because their nervous system hasn’t been able to register the pain response appropriately,” he explained. “To help, we retrain the nervous system through modalities like exercise or electrical stimulation.”

Sandberg said his first sessions with chronic pain patients are often educational, defining the difference between acceptable levels of pain and non-acceptable ones.

“For many, pain is associated with discomfort,” he said. “But there can be different levels of pain that can be improved upon through therapy. For chronic pain patients, the pain may never completely improve, but the function can make progress.”

Exploring alternatives

Aside from the patient’s prescribed regimen, some patients may also choose to supplement their care with other forms of therapy. Richardson said it isn’t uncommon for patients to ask about options such as chiropractic care, massage therapy and acupuncture. Richardson said he encourages proactivity in his patients, noting it as a sign of the patient’s desire to reach to the heart of the problem.

“If someone is willing to explore other functions in addition to their treatment, that means they’re obviously interested in getting better,” he said.

Sandberg said these alternative care options should be weighed on a cost-to-benefit ratio.

“Is it worth the cost? Does it help, or do you feel like it helps?” he said. “Things like herbal medicine or foot zoning may not have as much evidence that they’re helpful, but if the patient is feeling better, we never discourage that. The mind is a powerful thing when it comes to pain control. If you believe that it’s helpful, then it’s helpful.”

Sandberg also encourages patients to explore the options as long as it doesn’t conflict with their current treatment.

“I think proactive searching is important,” he said. “It shows good coping skills. Those patients seem to do really well. If I have a patient that comes in and hasn’t tried anything on their own, I might refer them to a psychologist.”

Original Article Here by Clayton Gefre

Pain Awareness Month: More Questions Than Answers?

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An Article From The HuffPost Healthy Living:

According to the American Chronic Pain Association (ACPA), September was anointed Pain Awareness Month in 2001 “to raise awareness in the issue of pain and pain management,” with a goal of creating “greater understanding among health care individuals, individuals and families who are struggling with pain management, the business community, legislators, and the general public that pain is a serious public health issue.” I think it is safe to say that over the last 14 years a lot of success has been achieved in building awareness about chronic pain and the enormous shadow it casts on the lives of patients, their families, and communities. Greater public awareness has come through the hard work of many activists and organizations like the ACPA, but unfortunately, a lot of the publicity surrounding pain over the last few years has come about over concerns surrounding the use, misuse, and abuse of prescription pain killers.

In 2015, we need a lot more than awareness. What we really need are tangible, measurable, and impactful solutions for millions of Americans who are hurting and suffering. Unfortunately, for health care providers and their patients, when it comes to pain treatment, there are often more questions than answers. If there is one lesson we have learned over the last 14 years, it is that we won’t solve America’s pain crisis by just throwing more drugs at it.

Male Patient Visiting Doctor's Office With Back Ache

Perhaps no health problem in America is in bigger need of an infusion of quality care right now than the treatment of pain. With an estimated annual cost of around $600 billion in treatment and lost productivity, we spend more on pain than we do treating cancer, heart disease, or diabetes, but we don’t seem to be getting a great return on our investments. The burden of chronic pain on our medical and disability systems remains high and unfortunately only seems to be getting worse.

Alarmed by our country’s struggles to effectively treat pain, Congress mandated for a study to take place, and in 2010 the National Institute of Health contracted with the Institute of Medicine to perform a comprehensive assessment with recommendations. The Institute’s 2011 eye opening results brought to light the enormity of the problem as well as the lack of consistently good answers for treatment. The study authors called for a “cultural transformation” in how our country goes about studying, assessing and treating pain.

More recently a follow up report has been released, titled the National Pain Strategy, released by the Interagency Pain Relief Coordinating Committee (IPRCC) at the charge of the Assistant Secretary for Health which falls under the U.S. Department of Health and Human Services (HHS).
While the National Pain Strategy is bold in its scope and may seem overwhelming to those in the trenches who treat pain, it offers promise and hope for an estimated 100 million Americans struggling with pain on a regular basis. The report is lengthy and comprehensive, and it raises many good discussion points for patients, doctors, and insurance companies. The full report can be found here.

Here are a few key take home points worth highlighting:

• The report introduces the concept of high-impact chronic pain. While a large proportion of the population may experience some level of daily pain, a certain subset experiences pain to the degree that they can’t function well at work or at home, and even their ability to interact with others is limited. This high-impact group would be expected to require a considerable amount of assistance and treatment. Being able to better identify this group may help streamline the delivery of effective treatment.
• The importance of a more comprehensive, integrated, and interdisciplinary model of care is made clear throughout the report. The committee recognizes that a major lack of access to such programs along with our concurrent over-dependence on more unimodal therapies like pharmaceuticals and risky invasive treatments is a huge problem that must be addressed. They rightfully point out that a major barrier to providing more comprehensive treatments is a lack of necessary insurance coverage and its dependence on the old fee for service payment system. Physician behavior can’t change without an economic system in place to facilitate providing better care to patients.
• The committee wants to emphasize the need for self-management programs. We know that coming up with ways to help pain patients learn valuable tools to effectively self-manage their pain improves their quality of life, reduces pain, and lightens the load on healthcare and disability systems. Making this an important feature of better pain management across the country is an excellent idea.
• The report also brings up the concept of prevention at a number of different levels. This includes studying ways to prevent injuries or diseases from happening in the first place, as well as designing strategies to curtail acute pain problems from progressing into chronic ones.
• The role of the primary care physician also gets a lot of attention. Many simply don’t have the training and expertise to assess more complex chronic pain problems, nor do they typically have the resources at their disposal to provide effective treatment. Primary care doctors need a lot of help and support to better serve their patients in pain.

Creating wholesale changes in the way thousands of doctors interact with millions of patients is no small feat. But as the National Pain Strategy points out, we have a moral obligation to do this better.

Article by:  Original Post HEREChronic pain specialist, author, radio host

It Might be Time to Review Your Pain Relieving Medication

Many people who suffer from arthritis or other painful chronic conditions make a dose of a pain-relieving medication part of their daily routines.

But the U.S. Food and Drug Administration last month decided to strengthen the warning labels on some common drugs taken for such conditions to warn consumers that the drugs can increase the risk of having a heart attack or stroke.

What does the FDA’s action on nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) mean to you?

First, there is no need to panic, says Dr. Ronald Hedger, assistant dean of clinical skills training at Touro University Nevada College of Osteopathic Medicine.

And, second, this would be a good time to talk with your doctor about your own pain management and drug-taking regimen to make sure you are not taking more of the drugs than you need.

The drugs involved in the FDA’s action include ibuprofen (over-the-counter brand names include Motrin and Advil) and naproxen (over-the-counter brand names include Aleve).

The FDA says the risks of heart attack and stroke associated with taking NSAIDs were first noted for consumers in 2005. More recently, the agency says a review of research prompted it to revise the drugs’ labeling to strengthen the warning that taking the drugs can lead to heart attacks or strokes and to offer consumers more detailed information about those risks.

Studies indicate that “if you stay within a 1,200 (milligram) or less range per day, your risk is relatively low,” Hedger says. “So basically, somebody that takes two over-the-counter ibuprofen or an Aleve once a day for arthritis is well within the safety range, with the asterisk that (stroke or heart attack) still could happen. It still increases your risk. But it tends to be (more for) people taking a higher quantity over a longer period of time.”

Patients and their health care providers “have to look at benefit versus risk,” Hedger says. “In other words, if (patients) can’t function from day to day without using it, they can’t just stop, but they need to be more aware of how they take it and of any symptoms.”

Hedger’s advice: Read the literature and labels that come with your medicine and talk with your physician or health care provider about what you’re taking, how much of it you’re taking and whether other options may exist.

Original Article HERE

PLATELET RICH PLASMA (PRP) INJECTION TREATMENT FOR HIP & KNEE ARTHRITIS

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Overview

This non-surgical procedure relieves the pain of hip arthritis with an injection of the patient’s own blood platelets. The concentrated platelets promote the natural healing of damaged ligaments, cartilage and tendons.

Collecting the Platelets

The PRP process begins when a sample of blood is taken from the patient and placed into a centrifuge, where it is spun rapidly. The spinning process separates it into its components: plasma, platelets and white blood cells, and red blood cells. The red blood cells are drained away, and then the patient’s concentrated platelets, along with a portion of the plasma, are drawn into a syringe.

Preparing the Hip or Knee

The area is cleansed and sterilized. A local anesthetic may be applied to reduce pain at the injection site.

Administering the Injection

The needle containing the platelet rich plasma is directed into the hip and precisely guided to the target area with the help of fluoroscopic x-ray visualization or ultrasound. The platelet rich plasma is injected into and around the damaged tissues. Additional injections to other injured structures of the hip may be needed to ensure complete tissue healing and maximize joint stability.

The Body Reacts

The concentrated platelets release many growth factors that promote a natural immune response, mobilizing stem cells to the injured tissues. Macrophages – specialized white blood cells – rush in to remove damaged cells and prepare the tissue for healing.

The Healing Begins

Stem cells and other cells multiply, repair and rebuild the damaged tissue. This accelerated healing response reduces pain, promotes increased strength, and improves joint function.

Follow-up

The entire PRP treatment process takes about an hour – the patient will be able to go home the same day. Full recovery from the injection usually occurs within one week of the procedure. Many patients require three to four treatments before the injured tissues are completely healed and they return to a normal active lifestyle.

View Video HERE Source: HERE

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Men begin losing testosterone at the rate of 1-3% per year beginning at age 30. Current medical research now defines a male equivalent to menopause as Andropause. Because the testosterone used is totally natural, it is ideal for men wanting the benefits of a bio-identical hormone, without the drawbacks of a synthetic.

Symptoms of testosterone deficiency in men include fatigue, lack of mental acuity, loss of libido, and difficulty achieving, or sustaining erection.

Why Bio-identical Hormone pellet therapy for men? Hormonal needs for men have received national attention, but with marginal treatment options available. Hormonal treatments for mencan be expensive, require daily consumption, and in many cases, need to be carefully timed with their partner’s needs for normal sexual activities and pleasure.

Bio-identical hormone pellet therapy is the only method of testosterone therapy that givessustained and consistent testosterone levels throughout the day, for 4 to 6 months, without any “roller coaster” blood levels of testosterone, which can result in mood and energy fluctuations for the patient.

BioTE Medical has had excellent results treating men with Bio-identical Hormone therapy. There have been only a few reported side effects.

Men find themselves lacking in sexual desire, gaining weight, losing muscle mass and feeling sluggish, depressed and irritable. Yet, they believe they must endure these body and hormonal changes as part of aging, but that is no longer the case thanks to BioTe!

Original Article HERE

Living With Arthritis Pain? 15 Ways You Can Get Relief

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If you’re living with pain from your arthritis, there’s no reason to just suck it up anymore. There are a variety of options to help you relieve at least some of the pain.

Depending on the type and location of arthritis, certain tips will help more than others, but a few experts and people who have suffered from arthritis have pulled together several suggestions for pain management.

Kat Elton, an occupational therapist and author of “A Resilient Life: Learning to Thrive, Not Just Survive with Rheumatoid Arthritis,” has lived with juvenile rheumatoid arthritis since she was two years old.

Here are nine of her general suggestions for arthritic pain relief:

1) Move your body every day. Pay attention to your pain and move within your limits, but know when you can push it (if your inflammation and swelling isn’t very high).

2) Use heat/cold — heat for muscle relaxation, cold for swelling.

3) Vibration massagers work on the gate control theory of pain. Basically you are distracting the nerve endings that transmit pain).

4) Topical analgesics can bring relief.

5) Braces help. Elton has used all kinds for many joints.

6) Compression — both stockings and gloves — works.

7) Get enough rest. Very important — sleep and rest are vital for repair and regeneration, especially when living with pain.

8) Delegate tasks that wear you down — you can even trade hard tasks for ones that are easier on your body.

9) Massage/far infrared saunas are great for pain if you have the funds.

Carol Michaels, founder and creator of Recovery Fitness, said that it’s important to realize that arthritis not only has a physical toll, but also an emotional toll. Recovery Fitness is an exercise program that aims to help cancer patients recover from treatments and surgery,

According to a report from the Centers for Disease Control and Prevention in 2012, one-third of adults in the United States living with arthritis, who are 45 years or older, also suffer from either anxiety or depression.

Michaels suggests the following tips in order to help both mental and physical health:

1) Breathing exercises can help reduce stress and anxiety. They can help you tolerate pain, along with proper stretching. When feeling stressed, we usually take shallow breaths. Perform breathing exercises that use full lung capacity and breathe slowly and deeply.

2) Be aware of your breathing, as it has a calming effect. Inhale for five seconds and fill your torso up with air, then exhale from the lower abdomen for five seconds, pressing the navel in toward the spine. Imagine all of your tension and pain leaving your body with each exhalation.

3) Aerobic exercise is essential for good health and can help to decrease the pain from arthritis. This includes any movement that elevates your heart rate.

4) Walking can boost your energy, giving you the motivation to increase physical activity leading to pain relief. Every day, try to walk farther until you are able to walk for 30 to 45 minutes. If this is not possible because of your health issues, aim for 15 minutes, one to three times a day.

Dr. Jonathan Oheb, an orthopedic surgeon, suggested some additional treatment options besides taking medication such as nonsteroidal anti-inflammatory drugs, called NSAIDs, as well as cortisone injections.

1) Physical therapy should focus on low impact exercises. High impact exercise is bad for joints as it can lead to further inflammation and pain and an acceleration of joint destruction.

2) Weight loss can also help relieve arthritis pain. Some fitness options that are useful for patients include swimming, bicycling, yoga, aerobic exercises and elliptical machines.

Sources:

Elton, Kat. Email interview. June 3, 2015.
http://www.katelton.com

Freudenrich, Craig. Howstuffworks.com. How Pain Works. Gate Control Theory of Pain. Web. June 17, 2015.
http://science.howstuffworks.com/life/inside-the-mind/human-brain/pain4.htm

Centers for Disease Control and Prevention. Spotlight.

One-Third of U.S. Adults with Arthritis have Anxiety or Depression. The physical and emotional consequences of arthritis are high. Web. June 17, 2015.
http://www.cdc.gov/arthritis/resources/spotlights/physical-emotional.htm

Michaels, Carol. Email interview. June 2, 2015.
http://www.carolmichaelsfitness.com/#!about/c1enr

Oheb, Jonathan. Email interview. June 2, 2015.
http://www.jonathanohebmd.com

5 Questions About Treatment Options for Chronic Pain

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1. What general options do I have to treat my pain?

There are a variety of options for the treatment of chronic pain. Under the general category of medications, there are both oral and topical therapies for the treatment of chronic pain. Oral medications include those that can be taken by mouth, such as nonsteroidal anti-inflammatory drugs, acetaminophen, and opioids. Also available are medications that can be applied to the skin, whether as an ointment or cream or by a patch that is applied to the skin. Some of these patches work by being placed directly on top of the painful area where the active drug, such as lidocaine, is released. Others, such as fentanyl patches, may be placed at a location far from the painful area. Some medications are available over the-counter (OTC) while others may require a prescription.

There are many things that may help with your pain which do not involve medications. These things may help relieve some pain and reduce the medications required to control your pain. Examples include exercises, best performed under the direction of a physical therapist. There are also alternative modalities, such as acupuncture. Transcutaneous Electro-Nerve Stimulator (TENS) units use pads that are placed on your skin to provide stimulation around the area of pain and may help to reduce some types of pain symptoms.

Finally, there are interventional techniques that involve injections into or around various levels of the spinal region. These can involve relatively superficial injections into the painful muscles, called trigger point injections, or may involve more invasive procedures. There are multiple procedures that range from epidural injections for pain involving the neck and arm or the back and leg, facet injections into the joints that allow movement of the neck and back to injections for burning pain of the arms or legs due to a syndrome called Complex Regional Pain Syndrome or Reflex Sympathetic Dystrophy (CRPS).

2. What are some of the typical medications used for the treatment of chronic pain? What are some of the common side effects associated with these medications?

There are several categories of medications that are used for the treatment of chronic pain. In general, your primary physician, patient management specialist, or pharmacist may be to answer any questions about the dosage and side effects from these medications. The most commonly used medications can be divided into the following broad categories:

  1. Nonsteroidal Anti-inflammatory Drugs and Acetaminophen: There are many different types of nonsteroidal anti-inflammatory medications (NSAIDs), some of them (such as ibuprofen) may be obtained over-the-counter. NSAIDs can be very effective for acute muscular and bone pain as well as some types of chronic pain syndromes. When taken for an extended period of time or in large quantities, they may have negative effects on the kidneys, clotting of blood, and gastrointestinal system. Bleeding ulcers is a risk of these medications. Long-term use of cyclooxygenase II (COX II) inhibitors may be associated with an increase in cardiovascular (heart) risks. Acetaminophen is easily obtained over-the-counter, however, care should be taken not to take more than 4000 mg in 24 hours; otherwise, several liver failure may occur. There are some opioid medications that combine acetaminophen within the medication. You should be aware that many over-the-counter medications have acetaminophen as one of their ingredients and when taken in combination with prescribed medication, this may result in an overdose of acetaminophen.
  2. Antidepresssants: Some of the older categories of antidepressants may be very helpful in controlling pain; specifically the tricyclic antidepressants. The pain relieving properties of these medications are such that they can relieve pain in doses that are lower than the doses needed to treat depression. These medications are not meant to be taken on an “as needed” basis but must be taken every day whether or not you have pain. Your physician may attempt to lessen some of the side effects, particularly sedation, by having you take these medications at night. There are some other side effects like dry mouth that can be treated with drinking water or fluids. These medications may not be given to patients with certain types of glaucoma. In addition, these medications should never be taken in larger doses than are prescribed.
  3. Anticonvulsants (Anti-seizure) Medications: These medications can be very helpful for some kinds of nerve type pain (such as burning, shooting pain). These medications also are not meant to be taken on an “as needed” basis. They should be taken every day whether or not you feel pain. Some of them may have the side effect of drowsiness which often improves with time. Some have the side effect of weight gain. If you have kidney stones or glaucoma, be sure to tell your doctor as there are some anticonvulsants that are not recommended to be given under those conditions. The newer anticonvulsants do not need liver monitoring but required caution if given to patients with kidney disease.
  4. Muscle Relaxants: These medications are most often used in the acute setting of muscle spasm. The most common side effect seen with these medications is drowsiness.
  5. Opioids: When used appropriately, opioids may be very effective in controlling certain types of chronic pain. They tend to be less effective or require higher doses in nerve type pain. For pain is present all day and night, a long acting opioid is usually recommended. One of the most frequent side effects is constipation, which if mild may be treated by drinking lots of liquids, but may need to be treated with medications. Drowsiness is another side effect which often gets better over time as you get used to the medication. Excessive drowsiness should be discussed with your physician. Nausea is another side effect which may be difficult to treat and may require changing to another opioid.

3. If I am taking narcotic (opioid) medication for chronic pain, does that mean I am addicted?

Taking opioids in the way that they have been prescribed by your doctor for the treatment of chronic pain is associated with a very low risk of becoming addicted to those opioids. There are some predisposing factors to opioid addiction. These include having a history or a family history of substance abuse or of certain psychiatric illnesses. The following are definitions for addiction, tolerance, and physical dependence according to the American Pain Society:

  • Addiction has a genetic basis in addition to a psychological aspect to the behavior. Addiction is associated with a craving for the abused substance (such as an opioid), and continued, compulsive use of that substance despite harm to the person using the substance. In addition to having a genetic predisposition, there may be an environmental influence affecting both the development and manifestation of the additive behavior.
  • Tolerance occurs after prolonged exposure to a drug. The effects of that drug results in progressive decrease in its effectiveness.
  • Physical Dependence is usually seen in the form of drug withdrawal after the drug has been abruptly stopped or rapidly reduced. It can also be seen when an opioid antagonist is given to someone who is taking an opioid. It is a state of adaptation. Withdrawal symptoms last from approximately 6 to a peak of 24 to 72 hours after the drug has been withdrawn. Some of the symptoms include nausea, vomiting, sweating, abdominal pain or diarrhea and can occur after taking the opioid for as short a period as 2 weeks. It is not a sign of addiction.

If you are prescribed opioids by your doctor, you are to take the opioids as they have been prescribed. If your pain continues despite taking the opioid, it is inadvisable to take more opioid than prescribed without first seeking the advice of your doctor. Taking a long-acting opioid a few times per day is less likely to give the sensation of euphoria that may be associated with some short acting opioids. Long-acting opioids are not meant to be taken on an “as needed” basis and should be taken whether or not you have pain and should not be taken more frequently than prescribed by your doctor. Constipation is one of the more frequently seen side effects of chronic opioid use, remedies, such as stool softeners and stimulants, are available.

4. What are some of the more common nerve block procedures for the treatment of chronic pain? What are some of the common side effects associated with these nerve blocks?

The vast majority of injections done for the diagnosis or treatment of chronic pain are performed on an outpatient basis. Some are performed on inpatients, who may be already hospitalized for other reasons. All of them may be performed under fluoroscopic (x-ray) guidance but are sometime performed in the office without x-ray. For any nerve block, you need to tell your doctor if you are allergic to contrast dye or if you think you may be pregnant. Below is a brief description of some of the more commonly performed nerve blocks by pain management specialists.

  • Epidural Steroid injection: Epidural steroid injection is an injection performed in the back or neck in an attempt to place some anti-inflammatory steroid with or without a local anesthetic into the epidural space close to the inflamed area that is causing the pain. These injections are generally done for pain involving the back and leg or the neck and arm/hand. They may be done under x-ray guidance. Common side effects include soreness of the back or neck at the point where the needle enters the skin, there may be some temporary numbness in the involved extremity but persistent numbness or weakness (lasting over 8 hours) should be reported to your doctor. Epidural steroid injections may be placed in the lumbar (low back), thoracic (mid back), or cervical (neck) regions.
  • Facet Joint Injection: The facet joints assist with movement of the spine both in the neck and back. Injection into these joints can provide relief of neck and back pain; these injections are always performed under x-ray guidance. Common side effects include soreness in the neck or back when the needle was inserted. You will be on your stomach for this injection if it is done for back pain; however you may either be on your stomach or back if the injection is performed for neck pain, depending on the preference of the physician. A needle is placed in your neck or back and advanced to the level of the joint under x-ray visualization. Contrast dye is used if the needle is put within the joint, and sometimes used if the injection is designed to numb the nerves to the joint. This block is often a diagnostic block and a more long lasting injection may be indicated if you have significant pain relief from this injection.
  • Lumbar Sympathetic Block: A lumbar sympathetic nerve block is performed for pain in the leg that is thought to be caused by complex regional pain syndrome type I (or CRPS I). These injections are often performed under fluoroscopic (x-ray) guidance. Local anesthetic is placed near to the lumbar sympathetic chain in order to relieve the pain. Your leg will likely become warm immediately following the injection: this is an expected effect and not a complication. Back soreness is one of the more common side effects. If you feel any sharp pains down your leg or to your groin during the injection, you should let the physician know immediately. There may be some temporary numbness following the injection but if there is persistent numbness or weakness (> 8 hours) the doctor should be notified. You will be lying on your stomach for this injection. The injection is done from the back, in the lower aspect of the back. A needle is placed, often under x-ray guidance, to a spot just to the side and approaching the front part of the spine where the ganglion is located. If it is done under x-ray, a small amount of dye is injected to make sure the needle is in the right spot. After the doctor is satisfied that the contrast dye is in the right place, they will inject numbing medicine then remove the needle.
  • Celiac Plexus Block: A celiac plexus block is generally performed to relieve pain in patients with cancer of the pancreas or other chronic abdominal pains. A needle is placed via your back that deposits numbing medicine to the area of a group of nerves called the celiac plexus. This injection is often performed as a diagnostic injection to see whether a more permanent injection may help with the pain. If it provides significant pain relief then the more long lasting injection may be done. This injection is usually performed under x-ray guidance. You will be lying on your stomach for this injection. The needle is place via the mid back and placed just in front of the spine. Contrast dye is injected to confirm that the needle is in the right spot; followed by some numbing medicine.
  • Stellate Ganglion Block: A stellate ganglion block is an injection that can be performed for the diagnosis of complex regional pain syndrome of the arm or hand or for treatment of pain to that area. It can also be used to help to improve blood flow to the hand or arm in certain conditions that result in poor circulation of the hand. Side effects may include soreness in the neck where the needle was placed. In some instances the side effects may include droopiness of your eyelid on the side that is injected, along with a temporarily stuffy nose and sometimes temporary difficulty in swallowing. This injection is performed with or without x-ray guidance. You will be lying on your back for this injection with your mouth slightly open. It is very helpful to the doctor if you try not to swallow during the injection. If this injection is performed under x-ray the doctor will first inject a small amount of contrast to confirm the placement of the needle then inject some numbing medicine.

5. Will I receive a bill from the pain management specialist?

Your pain management specialist is a physician specialist like your surgeon or internist, and you probably will receive a bill for your pain management specialist’s professional service as you would from your other physicians. If you have any financial concerns, your pain management specialist or an office staff member will answer your questions.

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