This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

Pain Medication without Gastrointestinal or Cardiovascular Side Effects

You are an active tennis player but cannot return to the court since you sprained your ankle. Or perhaps you have battled osteoarthritis in your knees for the past few decades. Maybe rheumatoid arthritis causes crippling joint pain in your mother’s hands. What can you do about the pain?

 

Only 5 years ago doctors, patients, and the pharmaceutical industry thought they had discovered the “magic bullet” – so called COX-2 inhibitors such as Vioxx and Celebrex. This new class of medication held a theoretical advantage over traditional anti-inflammatory medications in that they were less likely to cause damage to the lining of the gastrointestinal tract. This was a major problem of the old pain medications such as ibuprofen, naproxen, and diclofenac. Ingestion of these older drugs in high doses in as little time as one week was shown to cause stomach ulcers and often serious complications such as GI bleeding.

 

So drug companies designed multiple trials to show that COX-2 inhibitors gave adequate pain relief without the dangers of GI side effects. The pharmaceutical industry even started to investigate whether these wonder drugs could prevent such maladies as colon cancer.

 

Unfortunately, what these trials showed was that yes, COX-2 inhibitors decreased the risk of GI bleeding, but at the significant cost of increased incidence of heart attacks and death. This unexpected finding made headline news when announced a few years ago and led to the FDA’s removal of all but one COX-2 inhibitor from the market and left the remaining drug, Celebrex, with a dreaded “black box” warning. Thus, both patients and their doctors were left to figure out how to manage their debilitating pain.

 

Over the past few years, clinical researchers have conducted their own clinical trials to determine the optimal way to provide GI protection while delivering the needed pain relief. While no formal recommendations from the government have been made, several medical societies have put forth their own consensus guidelines.

 

In general, the use of a proton-pump-inhibitor (PPI), a medication that is extremely effective in reducing the strength of acid produced in the stomach, along with a traditional non-steroidal anti-inflammatory agent, is safe for patients at high risk for GI bleeding. COX-2 inhibitors appear to be safe for short-term use in patients with a low risk for heart disease. Most importantly, talk to your doctor about your use of any prescription or over-the-counter anti-inflammatory drugs and your risk of GI and cardiovascular side effects.

 

Before you know it, you will be back on the tennis court, the pain in your knees and ankles will be gone, and your mother’s hands will be pain free!

Pain Medication without Gastrointestinal or Cardiovascular Side Effects

You are an active tennis player but cannot return to the court since you sprained your ankle. Or perhaps you have battled osteoarthritis in your knees for the past few decades. Maybe rheumatoid arthritis causes crippling joint pain in your mother’s hands. What can you do about the pain?

 

Only 5 years ago doctors, patients, and the pharmaceutical industry thought they had discovered the “magic bullet” – so called COX-2 inhibitors such as Vioxx and Celebrex. This new class of medication held a theoretical advantage over traditional anti-inflammatory medications in that they were less likely to cause damage to the lining of the gastrointestinal tract. This was a major problem of the old pain medications such as ibuprofen, naproxen, and diclofenac. Ingestion of these older drugs in high doses in as little time as one week was shown to cause stomach ulcers and often serious complications such as GI bleeding.

 

So drug companies designed multiple trials to show that COX-2 inhibitors gave adequate pain relief without the dangers of GI side effects. The pharmaceutical industry even started to investigate whether these wonder drugs could prevent such maladies as colon cancer.

 

Unfortunately, what these trials showed was that yes, COX-2 inhibitors decreased the risk of GI bleeding, but at the significant cost of increased incidence of heart attacks and death. This unexpected finding made headline news when announced a few years ago and led to the FDA’s removal of all but one COX-2 inhibitor from the market and left the remaining drug, Celebrex, with a dreaded “black box” warning. Thus, both patients and their doctors were left to figure out how to manage their debilitating pain.

 

Over the past few years, clinical researchers have conducted their own clinical trials to determine the optimal way to provide GI protection while delivering the needed pain relief. While no formal recommendations from the government have been made, several medical societies have put forth their own consensus guidelines.

 

In general, the use of a proton-pump-inhibitor (PPI), a medication that is extremely effective in reducing the strength of acid produced in the stomach, along with a traditional non-steroidal anti-inflammatory agent, is safe for patients at high risk for GI bleeding. COX-2 inhibitors appear to be safe for short-term use in patients with a low risk for heart disease. Most importantly, talk to your doctor about your use of any prescription or over-the-counter anti-inflammatory drugs and your risk of GI and cardiovascular side effects.

 

Before you know it, you will be back on the tennis court, the pain in your knees and ankles will be gone, and your mother’s hands will be pain free!

Facial Expressions of Pain Appear Accurate

 

Researchers have found that some people facially express pain more than others do. Facial pain expressions are automatic, just like those of happiness, anger, and sadness. Pain triggers certain muscle groups in the face to make certain expressions.

The research conducted at the University of Montreal demonstrated that facial expressions appear to accurately reflect levels of pain.  People that expressed more pain through facial expressions reported actually feeling more pain than than others, even though they were all exposed to the same painful stimulus in the study.  The investigators suspect that people with greater facial expressions of pain have lower pain tolerances.

 

Nerve Stimulation Appears Effective for Treating Chronic Headaches

 

It almost sounds like science fiction.  A revolutionary remote controlled nerve stimulation device implanted in the brain appears effective for treating chronic headaches.  The state-of-the-art device, called a bion, may become a new treatment alternative for people that cannot tolerate the side effects of headache medications.

Up to 35 million people in America experience headache.  Hemicrania is a type of chronic headache in which people have headaches at least 15 days per month.  It is commonly treated with indomethacin.  However, for many people indomethacin causes stomach bleeding.  The bion may be a treatment alternative that does not involve medication.

The bion is about the size of a matchstick.  A minimally invasive surgery is used to implant the bion in the back of the brain near the neck (occipital lobe). The person with the implant uses a wireless remote control to activate the device and to stimulate the occipital nerve.

The bion reduced long-term pain by 80% to 95% in 4 of 6 participants with hemicrania in a small research study.  Similar results were found in past studies of the bion for treatment of cluster headaches.  Researchers continue to study the use of the bion as an alternative treatmentfor people with chronic headaches.  The investigators are hopeful that in the future the bion will help improve the quality of life for many people.

 

New Discovery: Painful Irritable Bowel Syndrome Linked to Chili Pepper Pain Receptor

 

A new study sheds light on the pain associated with irritable bowel syndrome and offers new hope for those living with the condition.  Irritable bowel syndrome is a digestive problem that affects up to 15% of adults.  It can cause chronic pain, bloating, diarrhea, and constipation.  Irritable bowel syndrome can affect all aspects of a person’s life, interrupting social, leisure, and work activities.  Irritable bowel pain has been challenging to treat. However, researchers have discovered a link between painful irritable bowel syndrome and the pain receptor for chili peppers.

It is common for people with irritable bowel syndrome to experience burning pain after eating spicy foods.  Pain relievers do little to resolve these symptoms.  Researchers at the Imperial College in London discovered that people with irritable bowel syndrome have an unusually high number of chili pepper pain receptors in their colon.  The pain receptor called TRPV1 is now the focus of drug companies worldwide.  The pharmaceutical companies hope to create medications to block the pain receptor and relieve chronic pain for millions of people with irritable bowel syndrome.

 

Botox®... For Beauty and Beyond!

 

Botox® injections may be one of the most significant medical advances of the past half century. First introduced in the late 1970’s, Botox® has demonstrated a proven track record of safety and results for patients who choose to utilize its special properties to smooth aging facial lines. Recent studies have proven that even repeated use of Botox® over long periods of time provide sustained positive results. These studies were undertaken by trained and experienced health care professionals who understand that successful treatment involves striking a natural balance between the patient’s aesthetic needs and a strong medical foundation.

 

One of the most exciting aspects of Botox® treatment is that physicians and researchers are discovering new complimentary uses which will enhance the ability to rejuvenate both the body and mind. Botox®, in combination with other fillers and intense pulsed light, can provide years of youth back to your skin. Different types of light can eliminate such blemishes as small blood vessels, discolorations such as birthmarks, or even unwanted hair. These procedures in combination with Botox® have been preformed with great success allowing your doctor to apply an artist’s touch to your face.

 

Even newer uses to help rejuvenate the body are starting to be utilized by physicians. Botox® injections are currently being provided for the treatment of various types of headaches and chronic pain. Recently, patients with a certain type of migraine experienced benefit from a Botox® injection to muscles in the head and neck. In another study, 80% of patients suffering from tension-type headache felt significant improvement from Botox® injections directly to areas of discomfort. There were minimal side effects and in fact it was felt that Botox® had less potential complications than many oral medications commonly used to treat headache pain. It also appeared from these studies that patients did not develop a tolerance to the Botox®. Instead, as long as they continued to receive injections patients reported pain relief.

 

Recently, the Food and Drug Administration approved Botox® for the treatment of severe underarm sweating known as primary axillary hyperhydrosis, which affects millions in their everyday social and public interactions. While this therapy has been available outside of the United States for some time now, it only recently has gained acceptance in the United States. Patients with this uncomfortable dermatologic condition had few pleasant options prior to the availability of Botox®. Usually sufferers found no relief from topical antiperspirants and were offered oral drugs such as anticholinergics and anxiolytics – drugs with many unlikable side effects. As a last resort patients underwent surgery, often mutilating, to remove sweat glands from underneath the skin. Now patients have the option to have Botox® injected under their skin and the results have been dramatic. Often these patients can go for more than a year before a second injection is needed. Side effects in the studies were minimal and patients are among the most grateful for the dramatic change in their condition.

 

Botox® has come a long way in proving to patients that its effects are dramatic, especially in its ability to rejuvenate facial expressions and recapture a youthful presentation. Now, as physicians are expanding the uses of this treatment for other unpleasant conditions, which can affect the body and spirit and experiencing amazing results, patients have even greater options to look and especially feel their best.

Massage Therapy for Advanced Cancer Appears Helpful

 

Pain and depression are common symptoms for people with cancer near the end of life. For those with advanced cancer in hospice care, the focus is on comfort. Although pain medications can provide relief, they can have unwanted side effects. Now, massage therapy is considered an option that not only appears to immediately relieve pain, but improve mood as well.
 
Researchers from the National Institutes of Health that conducted the study think that massage therapy relieves pain by reducing swelling and increasing circulation. The researchers also think that massage therapy provides a relaxing break that promotes the release of “happy” natural brain chemicals (endorphins). The relief provided by massage therapy is not long lasting, but for the short-term appears to be a worthwhile alternative.

 

Don’t spend Halloween in the emergency room! Tips for Carving Pumpkins Safely

 

Carving pumpkins, costume contests, trick-or-treating and bobbing for apples are all fun Halloween traditions for both children and adults. Unfortunately for hand surgeons, Halloween does not always bring fun and games. In fact, each Halloween doctors are usually busy treating hand injuries from knives used to carve pumpkins. 

 

Hand injuries during pumpkin carving occur quickly and a lot easier than you might think. The pumpkin is moist and slippery. Knives may be hard to control and unpredictable to cut with or pull out of a tough pumpkin. An injury received during pumpkin carving can significantly injure muscles, nerves, and blood vessels and quickly put an end to what should be a fun family event.

 

Following these safety tips can help avoid injury:

         •    Adults should use caution when carving pumpkins. Teenagers should be closely supervised in a non-distracting environment. Children should not carve pumpkins, but may contribute by helping to draw the pattern or remove the pulp. Sometimes painting a pumpkin can be a fun alternative to carving for children.

  • Dry your hands and the pumpkin before carving.
  • The small tools in a pumpkin carving kit are safer to use than kitchen knives.
  • Place the pumpkin on a solid surface such as a carving board during carving.
  • Avoid cutting towards the hand that is holding the pumpkin. Make small controlled cuts with short pumpkin carving tools.    If an injury occurs:        •    Apply direct pressure to the wound. 
  • Clean the wound, apply an antibiotic, and bandage.        •     If the wound bleeds profusely or for more than 15 minutes, is deep or long, go to the emergency room for immediate treatment.     
  • Use pumpkin carving precautions and have a safe and Happy Halloween! 

 

Sprains and Strains – Simple Steps to Get You Back to the Things You Love Faster

 

Whether you're an athlete or a couch potato who hasn't seen a gym in a while, soft-tissue injuries such as strains, sprains, and bruises can happen to anybody at any time. A weekend outing gone awry, too much time doing yard work or bent over a computer,  even playing Frisbee on the beach can leave you hurting unexpectedly.

So, really, everyone should know how to properly treat soft-tissue injuries. Doing the right things in the immediate aftermath may help get you back on your feet faster.

Begin RICE immediately. RICE stands for rest, ice, compression, and elevation. Delaying RICE could mean more pain and swelling and a longer recovery period. So start these 4 steps as soon after you've sustained an injury as possible.

1. Rest: Reduce normal daily activities and avoid putting weight on the injured body part. In other words, stay off your feet and do not do anything that aggravates the injury.

2. Ice: Use an ice pack on the injured area for 10 to 20 minutes at a time and do this four to eight times per day. Don't use the ice pack for longer than 20 minutes, and wrap it in a thin towel so you don't irritate your skin.

3. Compression: To help reduce pain and swelling, wrap the injured body part with a bandage or brace that is doctor-recommended. Make sure it is not too snug and ask your doctor how long to wear it and how many times each day.

4. Elevate: Use pillows to raise the injured limb above your heart to help reduce swelling.

Summer Sports Tips: Preventing Golf Injuries

 

Golf is one of the most popular recreational sports in the US today. It is also a leading cause of injury. Most “weekend” golfers develop injury problems from poor swing mechanics and or poor conditioning. Professional golfers and those who play very often can run into problems from overuse. Here are some helpful tips designed to keep you out on the course, instead of in the doctor’s office.    Two tips regarding the swing are to rotate the hips and shoulders together, and to avoid bending or hyperextending the spine. If you are not a professional, it might be a good idea to take a lesson or two to improve your swing. It is also important to choose appropriate equipment for your size and skill level.

 

Several things can be done long before you hit the course to improve conditioning, and proper warming up and stretching will help before each round. Poor fitness and poor flexibility should be worked on to improve endurance and your general health. Strengthening of the core muscles, including the stomach and spine is important in injury prevention. Forearm strengthening is also helpful for the golf game.

 

Proper warm-up before playing should consist of some type of light exercise to loosen the body, such as brisk walking. Proper stretching should then be done and should include the neck, shoulder, trunk and legs. After stretching, swing practice should be done on the range, or if this is not possible, swinging without a ball should be done. Begin with wedges and then work up through your irons and drivers.

 

By staying fit and swinging properly you can enjoy golf for many years, without too many stays on “injured reserve.”     

 

Radiation Technique Appears Effective for Controlling Spine Cancer Pain

 

Many different types of cancer spread or metastasize to the bone, and the spine is the most frequent area of bone involved.  Spine pain from metastasized cancer can be extreme and challenging for pain specialists to treat. In fact, after receiving conventional radiation therapy, few options exist for patients. Fortunately, a new radiation therapy technique, stereotactic radiosurgery (SRS), appears to control pain from cancer that has spread to the spine.

 

In contrast to traditional radiation therapy, SRS delivers a large dose of radiation precisely to a targeted area.  Researchers at the University of Pittsburgh School of Medicine studied more than two hundred patients with cancer metastasis to the spine, some of which had received radiation therapy in the past.  One group of patients received a single treatment of SRS, while the other group received three treatments. The patients that received a single treatment experienced pain relief faster, and the group that received three treatments had longer lasting pain relief. More studies are needed on larger groups of participants, but SRS appears to be a safe and effective treatment for cancer-related spine pain, even for those who received conventional radiation therapy in the past.

Easy strides: enjoy the convenience and health benefits of walking

 

Lace up your shoes and get ready to hit the street for one of the easiest, simplest forms of exercise you can do—walking.  Walking is affordable, and doesn’t require any special tools to help you get healthy and enjoy lasting benefits that go far beyond looking good. As with any exercise program, you’ll be more likely to succeed if you have a walking buddy or accountability partner to help you stay motivated and keep you on track; stick with it and you’ll reap rewards shown to impact not just your waistline, but also your mental and emotional well-being.

Health experts recommend a goal of 10,000 steps per day, many of which can be achieved with a two mile (or about 40 minute) walk and everyday activities will make up the rest of your required steps.

Walking benefits your body in a variety of ways:        •    Improving your risk for Type 2 diabetes. Studies show people with insulin resistance who engaged in brisk walking several times per week improved their body’s ability to absorb and use insulin properly—keeping blood sugar levels in check and reducing the development of Type 2 diabetes.

  • Stress reduction:  Moderate exercise such as walking triggers the release of stress-busting chemicals called endorphins.  These happy hormones can leave you feeling energized and more focused after a workout.
  • Heart health: Heart disease is a leading killer in the United States. Walking at a rate that gets your heart beating more quickly and your blood pumping helps improve heart health, build stamina and keep blood pressure under control.
  • Fight breast cancer: Active women who exercised after a breast cancer diagnosis were 45% more likely to survive compared to women who were inactive. Researchers also found that women who were active up to a year before their diagnosis were 30% more likely to survive.     Moderate walking means taking about 100 steps per minute, 1,000 steps in 10 minutes and 3,000 steps in 30 minutes. Until you get familiar with your pace, try using a pedometer to keep track of your progress.

 

Flip-flop fear: how these flimsy shoes can impact your step

 

Sure, they’re cute and comfy, but the dollar flip-flops you live in could be doing more harm than good. Take a close look at this summer (and sometimes year-round) footwear and you’ll see something very clearly: your shoes aren’t made of much and they could be injuring your body.

The soles are often made from unsupportive, flat foam and offer no support for your foot—a fact that could affect your feet, ankles, knees and back over time.  Because many people are forced to walk differently just to keep the shoes in place, problems like plantar fasciitis, arch pain, nerve problems and toe injuries increase. Some doctors worry that flip-flops make your feet more susceptible to germs, cuts, and infection.

Even with all the reasons not to wear flip-flops, there may still be hope if you approach your style with a bit of responsibility.     Don’t wear your flip flops all day.  Try to limit their use and do your best to choose a flip- flop made of leather to reduce blisters and irritation that cheap plastic can cause 

When purchasing your next pair, hold them up and give them a bend.  A good pair should bend at the ball of the foot (the area at the front of your foot). If the shoes bend completely in half, look for another pair. 

Ensure a good fit. Make sure that your toes and heel fit well and aren’t hanging off the edges. 

Don’t re-wear the same flip-flops year after year. Limit them to one season and then give them a toss. 

Never do yard work or play sports in flip-flops. The open design could mean broken toes or cuts and scratches from outdoor activities.
 

 

Prevent knee pain and injury with some simple steps

 

Knee injuries are extremely common. With a variety of causes,  including sudden injury from sports or a fall, or conditions that develop over time (like arthritis), pain in your knees means exercise, walking or just getting out of a chair can be a challenge.  While not every cause of knee pain can be prevented, there are a few steps you can take to help your knees stay strong and support you for many years to come. 

Control your weight. Your knees are a weight-bearing joint. This means they work to support everything pressing down on them from above, and if you are heavy, that can put a big strain on theknee, increasing your chance of developing arthritis. 

Wear good shoes that fit well. Did you know that your feet play a role in the health of your knees? Properly fitted shoes help align the foot, ankle and knee for proper movement, and can help prevent injury. 

Warm up before you exercise.  Warming up the muscles of the legs helps prevent stress on the knees as the body begins to move. Warming up should include stretching of the muscles at the front and back of your thigh, and make sure to start your exercise routine slowly at first and increase your intensity over a few minutes. 

Don’t stop moving.  Whenever possible, try to keep moving. Even if you aren’t able to run, take a walk around the block or just try moving your knees while watching television. Lack of use can cause a big decline in the function of your knee, which may be difficult to regain.      

 

Clues to Why Meditation Relieves Pain

 

By Neil Wagner

A new study shows just how strong a pain reliever meditation can be. It also found clues to why meditation can be so effective.

The researchers found that meditation was able to relieve pain better than morphine generally does.

The significance of this study may lie in the fact that so little training was needed to give such strong pain relief.

Pain in this case was based on people's responses to brief heating of a portion of their right leg to 120 degrees Fahrenheit. Meditation caused a 40% lowering of pain intensity and a 57% lowering of pain unpleasantness. Typically, morphine or other pain relieving drugs only lower these symptoms by about 25%.

Fifteen healthy volunteers who had never meditated before were taught a form of meditation known as focused attention. In focused attention, people are taught to concentrate on their breathing and to let go of distracting thoughts and emotions. The volunteers learned this technique by attending four 20-minute classes. Afterwards, when their skin was heated, every volunteer experienced less pain while meditating. Individual values dropped anywhere from 11-93%, compared to the pain experienced in a non-meditating state.

One of the reasons that meditation was so successful in blocking pain may have been that it altered activity in four different regions of the brain. Using a brain scan called arterial spin labeling magnetic resonance (ASL MRI), the researchers measured activity in various regions of the brain while the volunteers' skin was heated.

They found that meditation lowered activity in the primary somatosensory cortex, an area known to be involved in identifying where pain is felt and how intense it is. Before meditation training, activity in this area was very high. After training, when participants were meditating, no activity was detected.

The scans also showed increased activity while meditating in three other brain regions: the anterior cingulate cortex, anterior insula and orbito-frontal cortex. The more these areas were activated, the more pain reduction there was in the volunteers.

The researchers, from Wake Forest Baptist Medical Center, used ASL MRI because it's better at showing longer term brain processes than a conventional MRI scan is.

The significance of this study may lie in the fact that so little training was needed to give such strong pain relief. Less than an hour and a half of training was required. And there are plenty of people who could benefit from a drug-free way to lower pain.

The study appears in the April 6, 2011 issue of the journal Neuroscience.

April 21, 2011

 

New Routes to Easing Chronic Pain

 

By Michael Gertner

None of us is a stranger to pain. And though we all suffer from life’s occasional aches and pains, these are usually temporary and go away in a matter of hours or days.

Others are not so lucky. They experience chronic pain, a debilitating condition with no cure in which pain is a constant companion.

It is believed that in people with chronic pain signals from the brain, affecting how the body perceives pain, have somehow gone awry. Once turned on, they don't turn off.

The discoveries of two different groups of researchers provide new details on the ways the brain handles chronic pain. This research not only sheds light on how people can best manage chronic pain, it will potentially lead to new pain relief treatments.

New details on the ways the brain handles chronic pain

In one study, published in the Journal of Neuroscience, researchers at the University of Bristol identified a biological basis for chronic spontaneous pain, which normally feels like a slow, burning sensation. The scientists discovered a particular protein channel, called TREK2, present in the sensory nerve fibers that detect spontaneous pain.

TREK2 typically acts as a “brake” in these nerve cells, limiting their activity and therefore limiting spontaneous pain. In people with chronic pain, the TREK2 channel isn’t synthesized as much, causing the nerve cells to fire all the time and contribute to the spontaneous burning pain.

The scientists also discovered that TREK2 synthesis is decreased after skin inflammation, a condition associated with nerve and organ damage that results in a specific type of chronic pain called neuropathic pain.

In another study, researchers at the Johns Hopkins University School of Medicine and the University of Maryland identified two molecules that appear to perpetuate chronic pain. These molecules also cause uninjured areas of the body to be more sensitive to pain when a nearby area has been hurt.

Using genetically engineered mice, the scientists induced pain on a system of pain-sensing nerves in the face called the trigeminal nerve. When one branch of the nerve was pinched for a long amount of time, the other branches were extra sensitive to additional pain.

In another part of the study, researchers bathed skin patches in the ear of mice with capsaicin, the active ingredient in hot peppers. Capsaicin usually activates a protein channel known as TRPV1, which is responsible for the sensation of pain in many nerve endings.

Not only were levels of TRPV1 elevated on branches of the nerve that were pinched, but also on uninjured branches that extended well beyond the pain site.

Next, the researchers performed a rescue experiment where they blocked production of serotonin, a neurochemical released by the brain during chronic pain. They discovered that blocking serotonin production reduced the elevation of TRPV1 channels on nerve endings.

This finding, published in Neuron, is promising for the future of pain therapeutics, since certain drugs that impact serotonin and TRPV1 have already been shown to be safe and effective in humans. Now they can be used to target chronic pain.

“With the identification of these molecules, we have some additional targets that we can try to block to decrease chronic pain,” an author of the study, Xinzhong Dong of Johns Hopkins, said in a statement.

February 7, 2014

Exercise Works to Decrease Migraine Headaches

 

By Esther Entin, MD

Migraine headaches are a source of pain, loss of work, and decreased quality of life for a significant number of people. Medication options include drugs that are taken at the onset of symptoms or drugs that are taken daily to prevent attacks from occurring or lessen the pain when they do. Non-medication options that have been shown to be helpful are behavioral therapies such as relaxation, biofeedback and stress management. A recent study compared a regular exercise program to two preventative strategies, medication and relaxation.

Ninety-one patients were enrolled in this study. All the participants had had migraines for at least a year, were between ages 18 and 65 years. All experienced headaches 2-8 times per week. The study's subjects were divided into three groups. All three groups kept a journal of headache frequency and severity for one month before starting on their specific intervention.

One group received a standard drug for migraine, topiramate. One group received training and supervision in specific relaxation techniques, and a third received training and supervision in an exercise program.

The members of the relaxation group practiced breathing, stress management and relaxation techniques for six sessions at the clinic and performed their routines at home with a CD. The topiramate group had their medication adjusted regularly to their maximally-tolerated dose.

The exercise group learned a program indoor cycling with a 15-minute warm-up, 20-minute exercise and 5-minute cool-down. They were required to exercise at least three times per week at home and /or at the clinic. All participants were free to use acute migraine medication if needed.

The study showed that regular exercise, performed at least three times a week for 40 minutes was as effective as topiramate and behavioral management for decreasing the weekly episodes of migraines. There were no adverse side effects in the exercise or behavioral therapy group and none that were considered to be serious in the medication group.

The researchers did not speculate as to the physiologic mechanism by which the exercise program was helpful. They concluded that regular exercise is an effective preventative strategy for migraine sufferers and may be especially helpful for those patients who do not wish to take daily medication.

The study was published online ahead of print in the journal Cephalagia.

October 28, 2011

 

A Closer Look at Over-the-Counter Painkillers

 

By Alice G. Walton

Talking a low daily dose of aspirin has been a long time recommendation for heart health, and many of us pop a Tylenol or an Advil to knock out a headache, muscle ache, arthritis pain, or menstrual cramps. Because of the accessibility of over-the-counter (OTC) medications like aspirin, acetaminophen, and ibuprofen, many may think nothing of grabbing a pill to ease what ails us, or, in the case of aspirin, to actually improve our long term health and reduce our risk for disease.

Newer research is demonstrating a downside of OTC painkillers. Some studies suggest that taking these medications over the long run – even in low doses – may be associated with more health risks than benefits. And some can be serious. Here we’ll outline the new studies that have suggested that, while the risks may be rare, OTC medications are not as gentle and safe as we may be tempted to think.

Weighing Aspirin’s Bleeding Risks Against Its Heart Benefits

Organizations like the American Heart Association recommend aspirin for people who are at higher risk of cardiac issues such as heart attack or stroke. But since it is a blood thinner, aspirin is known to elevate risk of bleeding, which can be serious and could potentially outweigh its benefits.

Doctors agree that not everyone should take aspirin as a preventative measure to reduce heart risk, according to the authors of a new study, but there is little consensus about the point at which the benefits outweigh the risks, even for those at higher likelihood of having a cardiovascular event. (1) A team of researchers looked at whether low dose aspirin taken over the long term reduced the risk of cardiac events in women above and beyond the risks it posed.

The study set out to determine this balance point, by tracking the heart health over a decade of almost 28,000 women who had taken part in the Women’s Health Study. Half of the participants took an average of 100 mg of aspirin every other day; the other half took a “dummy pill” (placebo).

Overall, the risk of having a stroke, heart attack, or dying of a cardiac issue was reduced from 2.4 to 2.2% in the women who took aspirin, compared to the control group. This reduction is not huge. And some of the participants in the aspirin group suffered from bleeding problems, like gastrointestinal bleeding, peptic ulcers, or easy bruising.

Acetaminophen: Slow and Steady Doesn’t Always Win

It’s not only aspirin that’s under the magnifying glass. Many of us think that acetaminophen, such as Tylenol, is far safer than aspirin. But a recent study found that even low dose acetaminophen over the long term can be even more damaging to the body than a high single dose. (2)

When researchers analyzed the records of 663 patients who had been treated for liver toxicity at a Scotland hospital, they found that 161 of them had taken a “staggered overdose,” a low, chronic amount, usually to deal with recurrent aches and pains like muscle aches, headache, and toothache. The continual use had damaged their livers, as their bodies struggled to remove the chemical day in and day out.

Staggered overdose patients were also more likely to suffer brain and kidney as well as liver problems compared to patients who had taken a large single dose of acetaminophen. They were also at higher risk of having to be on a breathing machine – and, surprisingly, they had a greater risk of dying. (2)

Appropriately, earlier this year the FDA urged all makers of acetaminophen to reduce capsule strength to 325 mg of the drug, and to display a Boxed Warning on the packaging, outlining the risk of liver damage. Considering the number of people who use acetaminophen for common aches and pains such as arthritis, rethinking the dosing and marketing of the drug is likely a wise move.

Acetaminophen for Kids: Dosing Problems

The use of acetaminophen in children has also been under scrutiny in recent months. Confusion about proper dosing for children has prompted the FDA to revamp dosing instructions on children’s acetaminophen. Labels will now include directions for dosing in children as young as 6 months and up (previously it had been two years and older). And labels will only indicate that acetaminophen should be used for fever reduction, not for pain, since according to the FDA there is just not enough evidence to warrant its use for pain in kids.

The Consumer Healthcare Products Association has also moved to make changes to the way children’s medications are mixed, so that the concentration of infants' and children’s acetaminophen will be the same.

Because the use of acetaminophen in children is still an ongoing debate, and because it may interfere with vaccinations' effectiveness, it’s important to talk to your child’s doctor to discuss the pros and cons of acetaminophen. Doctors’ recommendations for proper use may also be different from the bottle’s label, since they can depend on the specific situation, which is another good reason to check with your pediatrician before giving your child medication.

Ibuprofen: A Better Bet or Just as Risky?

Other recent research has looked into the safety of other go-to pain medications, like non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen. Unfortunately, while it is generally safe, this common OTC painkiller also has its downside.

One study found that certain NSAIDs can pose significant risks to the heart: regular use of OTC ibuprofen was linked to greater risk of stroke – up to 29%, for both fatal and nonfatal forms. (3) Other, newer research has found that use of OTC ibuprofen at very low doses may double the risk of miscarriage in the first trimester of pregnancy. (4) The NIH warns that even ibuprofen and naproxen (Aleve) can cause bleeding, ulcers, heart attack, stroke, and sudden death. Aspirin and ibuprofen can also interfere with the action of antidepressants. The adverse events associated with NSAIDs are uncommon, but they do exist and can be unpredictable.

The Best Dose: Small and Infrequent

No medication is perfectly safe over the long term. As helpful as they truly are, even our beloved OTCs pose risks when taken over long periods of time, and the risks are not negligible. Easy accessibility and marketing make aspirin, acetaminophen, and NSAIDs appear mild and harmless, but this is an oversimplification.

In the same way that we tend to think of “natural” products as being less risky than prescriptions, OTC medications might appear, at first glance, to be a gentler way of treating what ails us. But as these studies point out, they are all made of chemicals that affect various bodily systems for better and worse and can be difficult for the body to process and clear safely.

As important as it is to know that OTC medications carry risks, it would be foolish, however, to overlook their benefits. Most recently, a study presented at the American Stroke Association meeting in early February found that aspirin compared favorably with the blood thinner, Warfarin, in terms of its ability to protect against stroke. So, while it's clear this common OTC medication carries some genuine risks, it also brings benefits that should not be overlooked.

The best advice is likely to take small doses as infrequently as possible. And to the best of your ability, do the real things that improve heart health, rather than simply relying on a pill. Avoid saturated fat and exercise as long as your doctor doesn't warn against it. Talk to your doctor if you are concerned about dosage and the effects of intake over the long term.

February 15, 2012

(1) Dorresteijn, JAN, et al., “Aspirin for prevention of vascular events in women: Individualized prediction of treatment effects,” Eur Heart J, 2011.

(2) Craig, DGN, et al., “Staggered overdose pattern and delay to hospital presentation are associated with adverse outcomes following paracetamol-induced hepatotoxicity,” British J Clin Pharm, 2011.

(3) Fosbol, EL, et al., “Cause-specific cardiovascular risk associated with non-steroidal anti-inflammatory drugs among healthy individuals,”Circ: Cardiovascular Quality Outcomes, 2011.

(4) Nakhai-Pour, HR, et al., “Use of nonaspirin, nonsteroidal, anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion,” Canadian Med Assoc J, 2011.

Chronic Pain Reveals Its Secrets

 

By Neil Wagner

Researchers at Northwestern University may finally have found the cause of chronic pain, pain that simply will not go away after an injury has healed or long-lasting pain of unknown origin. The cause appears to be excessive signaling between two regions of the brain, the frontal cortex and the nucleus accumbens.

How confident are the researchers in their findings? They were able to predict with 85% accuracy which people with a back injury would ultimately go on to experience episodes of chronic pain and which would not, based on a single brain scan at the study's start.

According to a 2011 report by the Institute of Medicine, there are 100 million chronic pain sufferers in the U.S.

Possibly because chronic pain has proven so difficult to treat, there can be an attitude in the medical community that chronic pain sufferers are malingerers, people who are simply unable to keep a stiff upper lip, cope with the pain and get on with their lives like most people do. Hopefully this study will put an end to that attitude.

Because there has usually been no known source for a patient's chronic pain, most treatments have focused on simply trying to relieve the pain that does occur. Now researchers have a starting point for developing effective therapies that will treat the pain at its source by blocking the brain signals that cause it.

The study followed 40 people who had experienced an episode of back pain for the first time in their lives. Brain scans were conducted on the subjects at the study's start and three more times over the course of a year. Along with increased communication between the frontal cortex and nucleus accumbens, the subjects who ultimately experienced chronic pain also showed a loss in gray matter density.

An article on the study was published online in Nature Neuroscience.

August 3, 2012

Meditation May Help Relieve Anxiety, Depression, and Pain

 

By Charlotte LoBuono

“Serenity now! Serenity now!” Many Seinfeld fans, and likely a few others, have invoked that mantra when dealing with a flat tire, computer crash, misbehaving kid or other stressful life event.

These chanters may be on to something, according to a new study from Johns Hopkins School of Medicine.

Meditation is not generally considered a mainstream medical treatment. However, the study found that meditation can relieve moderate symptoms of anxiety and depression depression about as well as antidepressants. And there is no risk of side effects.

“A lot of people have this idea that meditation means sitting down and doing nothing,” lead author on the study, Madhav Goyal says. “But that's not true. Meditation is an active training of the mind to increase awareness, and different meditation programs approach this in different ways.”

The researchers reviewed the findings on 3500+ people across 47 clinical trials who had either a psychiatric or physical condition such as depression, anxiety, stress, insomnia, substance use, diabetes, heart disease, cancer and chronic pain and who also underwent what was typically an eight-week training program in mindfulness meditation.

When people spent about 30 minutes per day on mindfulness meditation, which emphasizes non-judgmental self-awareness of the mind and body, it moderately reduced their levels of anxiety, depression, and pain.

“I think people should be aware that the average person going through a meditation program can expect small to moderate reductions of multiple negative dimensions of psychological stress, as well as for chronic pain,” Goyal told The Doctor.

Doctors should be prepared to talk with their patients about the value of meditation programs in addressing psychological stress, particularly when symptoms are mild, Goyal believes.

Various mindfulness practices focus on different aspects of self-awareness, such as awareness of the breath, thoughts, and bodily sensations, Goyal adds. Online and even in small towns you can now find programs such as mindfulness-based stress reduction (MBSR).

Although the research team noted that mindfulness programs provide some pain relief, they don't yet know what kinds of pain it might be most helpful for, and whether different amounts of mindfulness training may have different effects.

The group is planning to continue its work by studying the effects of mindful meditation on headache pain to better answer these questions.

The study is published in JAMA Internal Medicine.

January 13, 2014

Massage Beats Conventional Treatments for Lower Back Pain

 

By Neil Wagner

Massage is currently seen as a complementary or alternative treatment for back pain. It's not used as a standard treatment. A recent one-year study suggests that maybe it should be.

Ten weeks into the study, participants who had received massage were experiencing considerably less back pain than the other participants were.

The study was of 401 Seattle patients with chronic lower back pain. It set out to compare the effectiveness of two different types of back massage to that of usual care for chronic lower back pain. Usual care can include some combination of painkillers, anti-inflammatory drugs, muscle relaxants and physical therapy, or it may include very little or no treatment at all. Treatment of lower back pain is not standardized and usual care varies greatly from patient to patient.

Participants were divided into three groups. One group received usual care. The second group received 10 weeks of structural massage. The third group received 10 weeks of relaxation (Swedish) massage. Massage was given once a week. The first massage session was 75-90 minutes and all others were 50-60 minutes.

Ten weeks into the study, nearly 40% of the participants who received massage reported that their back pain was much better or gone. Only 4% of the usual care group reported this. Those who received massage were twice as likely to have spent fewer days in bed, used less anti-inflammatory medication and were also more active than the usual care group.

Massage treatment ended 10 weeks into the study. Six months after the start of the study, those who had received massage still had milder pain symptoms than the usual care group, though the difference was smaller than it had been at 10 weeks. One year after the study's start, there was essentially no difference in symptoms between the two groups.

This suggests that 10 weeks of massage gives benefits that can last at least six months.

The two types of massage were equally effective, a finding that surprised the researchers, who expected to see more benefit from structural massage. Structural massage manipulates specific back muscles and ligaments and is more complex and difficult to learn than Swedish massage is. Almost all massage therapists in the U.S. are trained in Swedish massage. The only advantage the researchers found to structural massage is that it may be more likely to be paid for by insurance plans.

Participants rated both the bothersomeness of their pain and how disabling it was, with lower scores being better. Results ten weeks into the study showed that, on a 10-point bothersomeness scale, symptoms were 1.4-1.7 points lower in the massage groups than in the usual care group. On a 23-point disability scale, scores were 2.5-2.9 points lower in the massage groups. On both scales, the higher differences were for relaxation massage, the lower differences for structural massage. The differences between the two types of massage were not statistically significant.

The study has some limitations. Participants were mostly middle-aged women recruited from a health plan that serves a white, employed population, so the results may not be generalizable to a wider population. And participants were not blinded — they knew whether or not they were receiving massage, though not what type of massage they were receiving. This may have caused some resentment in the group not receiving massage and caused them to under-report their improvement. But the study does suggest that massage improves lower back pain and makes it easier to live with.

An article on the study appears in the July 5, 2011 issue of Annals of Internal Medicine.

August 1, 2011