Pain Management in the 21st Century

View the Podcast here.

Chronic pain affects nearly 90 million Americans. It usually begins with a sports injury, car accident or health condition like migraines, diabetes, arthritis and cancer.  Chronic pain is different from the acute pain of stubbing your toe and often feels like burning, shooting, or shocking sensations.  The good news is that today’s pain specialists have sophisticated new treatments — from medications to advanced technologies — to provide chronic pain relief. 

 

Chronic pain can be classified as nociceptive or neuropathic pain.  In some cases (nociceptive pain) the body’s nervous system is working properly, relaying signals to the brain that there is an injury.  But in neuropathic pain the nervous system is not functioning properly.  There is no obvious source of pain but the body continues to tell the brain that injury is present.  Treatment is guided by the history of the pain, its intensity, duration, aggravating and relieving conditions.  The concept behind most interventional procedures for pain control is that there is a specific structure in the body with nerves of sensation that is generating the pain. Repair or replacement of the damaged structure may be all that is needed to bring relief. For neuropathic pain, specialists have multiple tools at their disposal – painkillers, injections, physical therapy, massage, heat therapy and use an individualized approach to attack symptoms from multiple angles.

 

Treatment		Comments
Heat	Infrared heat	Transmits the heat directly to the body through vibration of the water molecules present. Vasodilation– an increase in the diameter of the blood vessels, results in increased permeability allowing substances (oxygen , etc.) to pass more easily
	Heat sensation	Capsaicin- works by reducing transmission of a pain-relaying chemical called substance P to the brain
	Radiofrequency ablation	Pain relief lasts for a relatively long period, from three to six months.
Massage		Influences the activity of the musculoskeletal, circulatory, lymphatic, and nervous systems.
Exercise/ Physical Therapy		Reduces pain perception, Strong muscles help support and protect,   Stretching exercises lengthen shortened muscles which can pull and cause pain. (amount and form of exercise recommended for each individual will vary depending on area affected, amount of inflammation, how stable the joints are)
Percutaneous Electrical Nerve Stimulation (PENS)		Theorized that electrical stimulation of the nerve fibers close to a segment of the spinal cord blocks the pain signals from reaching the brain or that electrical stimulation reduces inflammation, swelling and relaxes muscle fibers by releasing endorphins in the brain which act like analgesics
Linear polarized near-infrared light		Suggested that PL-irradiation produces almost the same effect on shoulder joint range of motion as light exercise.
Radiofrequency ablation		Electrical current produced by a radio wave is used to heat-and-destroy a small area of nerve tissue
Accupuncture/ Sham acupuncture		evidence supports the claim that opioid peptides are released during acupuncture
Nutritional Modification		Certain foods (aspartame, methanol) contribute to nervous system damage, others modulate inflammation (omega fatty acids)

 

Modern knowledge of chemical pain signals — how the nervous system, including the spinal cord, interacts with the brain to create the sensation of pain– has led to methods for blocking or ‘confusing’ these signals.   

 

The brain can powerfully shape pain and we are just learning how to exploit its power.  Scientists are investigating the use of antidepressants, biofeedback and relaxation techniques. Wake Forest University School of Medicine researchers conducted a study that suggests that decreasing the expectation of pain can reduce both the pain-related brain activity and perception of pain intensity (Koyama).  Patients elsewhere have been taught to control body functions such as muscle tension, breathing, and heart rate — all of which help to reduce anxiety and stress reactions.  They can be taught to unlearn the pain response.

 

There is help available for chronic pain.  Seek treatment early when there is a better chance for success.

 

References

 

Binder, I..  Aktuelle Urol. 2008 May;39(3):205-14. The complexity of chronic pelvic pain exemplified by the condition currently called interstitial cystitis. Part 1: Background and basic principles.

Usha, Clin Drug Investig. 2004;24(6):353-63. Randomised, Double-Blind, Parallel, Placebo-Controlled Study of Oral Glucosamine, Methylsulfonylmethane and their Combination in Osteoarthritis

Muneshige H. J Rehabil Res Dev. 2006 Jul-Aug;43(4):565-72. Antinociceptive effect of linear polarized 0.6 to 1.6 microm irradiation of lumbar sympathetic ganglia in chronic constriction injury rats.

Demura, Shinichi Clinical Journal of Sport Medicine:Volume 16(4)July 2006pp 293-297

Haake M. Arch Intern Med. 2007 Sep 24;167(17):1892-8. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups.

Koyama T, McHaffie JG, Laurienti PJ, Coghill RC. “The subjective experience of pain: Where expectations become reality.” Proceedings of the National Academy of Sciences, September 6, 2005, Vol.102, pp.12950-12955.

http://www.empireblue.com/wellchoice/medicalpolicies/guidelines/gl_pw_a053534.htm  accessed Mar 9, 2009

Martin Hoffman, MD. Medical College of Wisconsin. Department of Physical Medicine and Rehabilitation.  Exercise: a Natural Reliever for Chronic Low Back Pain  http://www.mcw.edu 

Little, P. Br J Sports Med. 2008 Dec;42(12):965-8. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain.

http://www.blatmanpainclinic.com/blat_articles_12.htm

Haake, M. Archives of Internal Medicine, Sept. 24, 2007; vol 167: pp 1892-1899. Heinz G. Endres, MD, Eric Manheimer, MS, research associate, Center for Integrative Medicine, University of Maryland School of Medicine, College Park.

Relief for Seasonal Allergies

                          Allergic rhinitis (often called hay fever) occurs when your immune system overreacts to particles in the air that you breathe—you are allergic to them. Your immune system attacks the particles, causing symptoms such as sneezing and a runny nose. Chronic sinusitis, which recurs or lasts longer than 12 weeks, can be caused by upper respiratory tract infection, allergies, deviated septum or other anatomical conditions, and fungi.  Symptoms may include trouble breathing through the nose, headache, aching behind the eye area, tenderness in the cheeks, sinus congestion, nasal discharge, or post nasal drip. But you can control these symptoms with medicine and by avoiding the irritants that cause them.  If allergies are left  uncontrolled you may get complications such as sinus infections, plugged ears or ear infections, and sinusitis. Asthma is a long-lasting condition that results in difficulty breathing, wheezing, tightness in the chest, and coughing. When allergens such as pollens, dust mites, animal dander, cockroaches, and mold make your symptoms worse, it is known as allergic asthma.

                          If you are allergic to outdoor allergens, such as pollen and mold, you don’t have to give up an outdoor life. You just need to identify the irritant and learn when/how to take precautions.  If your allergies flare up in the winter and spring, you are probably allergic to tree pollens.  If summer is unbearable, you are probably allergic to grass and weed pollens.  Late summer and fall problems coincide with ragweed or other weed pollens, such as tumbleweed and sage.  Mold may cause allergies that get worse in damp weather.

There are several types of medications used to treat and prevent allergy symptoms. Medications are available in pill and liquid forms, nasal sprays, eyedrops and skin creams.

       Corticosteroids help prevent and treat the inflammation associated with allergic conditions.

       Antihistamines block histamine, an inflammatory chemical released by your immune system during an allergic reaction.

       Decongestants relieve nasal and sinus congestion.

       Leukotriene modifiers block the effects of leukotrienes, inflammatory chemicals released by your immune system during an allergic reaction.

       Cromolyn sodium prevents the release of histamine, an inflammatory chemical released by your immune system during an allergic reaction.

                          Immunotherapy (allergy shots) may be helpful to some.

Breathe easier this allergy season using these solutions

 

1.      Install a HEPA air filter to purify room air

2.      Try flushing the nasal passages with a warm saline solution

3.      leave shoes at the door to avoid trafficking pollen indoors and change clothes immediately upon entering the dwelling

4.      Cover/wash hair at nights. This prevents allergen buildup on your pillow

5.      Consider wood or solid surface flooring rather than wall to wall carpeting.

 

Watch  “Dr. Donna, MedicineWoman” for Part 2:  Addressing allergy symptoms without drowsiness and side effects.  www.DrDonnaDouglas.com

(with references)

 

 

Combating ‘Brainfog’

‘Brainfog’, ‘cognitive dysfunction’, ‘mild cognitive impairment’ are terms used to describe poor mental stamina and concentration, difficulty learning new things,  difficulty reading a book or following a line of argument,  thinking one word, but saying another.  Cognitive dysfunction can be the result of medical/psychiatric conditions or a side effect of medical treatment.  Environmental activators include prescription drugs (which have profound effects on the brain in the elderly and children),  heavy metal poisoning (esp. mercury), hormonal changes, volatile organic compounds (solvents), gas fumes, carbon monoxide (free standing gas stoves, poorly vented stoves)  and sleep disorders. 

 

Some brain damage may be inevitable but all too often, preventive strategies could have been used to postpone these changes.

There are several steps you can take to combat brain degeneration:

1. Correct nutrient imbalances.  One study in Pharmacological Research (1999), found that a diet rich in docosahexaenoic acid (DHA), improves learning while a lack of DHA reduces learning ability. DHA is an omega-3 fatty acid is found in seafood, algae and coldwater fish.   Another study found that as levels of Vitamin D went down, levels of cognitive impairment went up.  Very few foods in nature contain vitamin D.  Small amounts are found in beef liver, cheese, and egg yolks but significant amounts are generated by cutaneous synthesis. 

2. Encourage good blood flow. High blood pressure can worsen cognitive impairment and cause memory difficulties.  University of North Carolina brain researchers recently found that active adults had more small blood vessels in the brain and improved cerebral blood flow when compared to their less active counterparts.   Exercise also significantly slows down the loss of new nerve cells in animal studies. All normally healthy people should be able to gently jog one mile without distress.

3. Maintain a steady energy supply. Excessive sugar in the diet impairs concentration while complex carbohydrates (fruits, vegetables, grains)  break down into sugar more slowly, providing sustained energy.

4. Be aware of possible allergies. Seasonal and food allergies can present themselves as mental dullness and fatigue.   

5. Avoid overstimulation. Caffeine in the short term is a mental stimulant. This can be helpful if you have to “perform”, so long as you can rest and recover afterwards. If you are having more than 3 cups a day (tea, coffee, coca cola), then it is probably having an overall deleterious effect.

6.  If you are undergoing chemotherapy and experience “chemo brainfog”, research in animals suggests that N-acetylcysteine, a natural antioxidant, can prevent the white matter changes brought about by chemotherapy. 

 

7. Get enough sleep! Parietal lobe activation declines following sleep deprivation and  corresponds to increased performance variability. No supplement or medication will correct sleep deprivation.

 

There is no cure for mild cognitive impairment.  The rate of progression to more severe impairment  has been lower in individuals taking Aricept (donepezil) but the benefit disappears after 3 years.  Other drugs have been found to increase the risk of sudden death from heart attacks and strokes.  Prevention is still the best medicine.

 

References:

 

The Peninsula College of Medicine and Dentistry (2009, January 24). Low Levels Of Vitamin D Link To Cognitive Problems In Older People. ScienceDaily. Retrieved February 12, 2009

 

Konat et al. Cognitive dysfunction induced by chronic administration of common cancer chemotherapeutics in rats. Metabolic Brain Disease, 2008; 23 (3): 325

 

Chuah, et al. The Neural Basis of Interindividual Variability in Inhibitory Efficiency after Sleep Deprivation . The Journal of Neuroscience, July 5, 2006 • 26(27):7156 –7162. 

 

Dan Peterson, LiveScience. posted: 05 January 2009 10:34

 

Wu et al. Exercise enhances the proliferation of neural stem cells and neurite growth and survival of neuronal progenitor cells in dentate gyrus of middle-aged mice. Journal of Applied Physiology, 2008; 105 (5): 1585 DOI: 10.1152/japplphysiol.90775.2008

J. Keith Smith M.D., Elizabeth Bullitt, M.D., Laurence, Katz, M.D., and Bonita Marks, Ph.D.  Radiological Society of North America.  2008, December 2. Exercise Helps Prevent Age-related Brain Changes In Older Adults..

 

 

 

 

Saether, Linda (18 April 2008). “A journey of brain fogs and hot flashes”. Altanta, Georgia: CNN.  

 

Frackelton JP, Christensen, RL. Mercury Poisoning and Its Potential Impact on Hormone Regulation and Aging: Preliminary Clinical Observations Using a New Therapeutic Approach. Journal of Advancement in Medicine , 1998.  11 (1): 9-25.

 

 

 

http://www.drmyhill.co.uk

Move over Lutein. Omega 3’s Shown to Protect Vision

Are you finding that you can’t read those street signs so well anymore or that fine print has gotten smaller?  Well, you’re not alone.  Age-related macular degeneration (AMD) is the leading cause of blindness and vision impairment in mature North Americans.  There is no cure for AMD, and treatment does not usually restore vision but only prevents disease progression to a slight degree.   (In childhood and middle age diabetic retinopathy is the more common disorder affecting over 1.5 million people).  One critical problem common to both diseases is the loss of blood vessels and abnormal re-growth after injury.

 

A study in published in Nature Medicine (June 2007), showed that increasing omega-3 fatty acids by dietary means could reduce the pathological effects of these diseases in an experimental model.  This study supports the clinical trials done in humans that show a connection between improved eye health and dietary micronutrients.

 

We only have one set of eyes.  They’re not one of those body parts that can be functionally replaced.   To help protect your eyesight here is what you need right now…

 

Magnesium

Vascular regulation can be improved systemically with magnesium.

 

Omega-3-fatty acids

Omega-3-fatty acids can improve blood flow regulation in the eye.  Higher intake of omega-3 long chain poly unsaturated fatty acids is associated with decreased likelihood of having AMD and cataract as well as with delaying the progression of intermediate AMD to advanced AMD.  

 

Antioxidants

A formulation composed of vitamins C, E, beta-carotene and zinc used in the Age-Related Eye Disease Study (AREDS) was shown to prevent the development of advanced age-related macular degeneration by 25%. 

Additionally,  lutein and zeaxanthin

 

Sodium

Reduce your sodium intake.  A high-salt diet may increase the risk of posterior cataract.

 

Look on the bright side.  A healthy diet and supplementation where necessary can improve your eyesight.  That’s good news for your eyes.

 

To find these and other reviewed health supplements, visit my informative website, www.DrDonnaDouglas.com/shop/html

 

 

 

 

 

Arch Ophthalmol. 2007 May;125(5):671-9.

Am J Ophthalmol. 2007 Jun;143(6):932-939.

Curr Opin Ophthalmol. 2003 Jun;14(3):159-62

Curr Opin Ophthalmol. 2007 May;18(3):220-3

Expert Opin Emerg Drugs. 2007 May;12(2):195-8

Nature Medicine 13, 868 – 873 (2007)

Are You Prepared for an Accidental Poisoning?

More than 90% of poisonings occur in the home through ingestion of simple household cleaners. Children under 6 are the most frequent victims though adults taking the wrong medication or taking it at the wrong time can also be harmed.  Poisoning can occur when a toxin is inhaled, spilled on the skin, or splashed in the eyes. Generally, any product that gives off fumes or is an aerosol that can be inhaled should be considered a possible poison.

Symptoms of a suspected poisoning may vary depending on the person’s age, the type and amount of poison and how much time has elapsed since exposure. Signs to watch out for include:

                          Nausea, vomiting, Drooling.

                          Headache, abdominal Cramping.

                          Throat pain, Difficulty breathing.

                          Sudden sleepiness or confusion,

                          Anxiousness, irritability, Seizures  or tremors.

                          Substance residue or burn around the mouth, teeth, eyes, or on the skin.

What should you do if you suspect poisoning?   It’s a good idea to keep some common antidotes nearby.  Antidotes either prevent the poison from working or reverse the effects of the poison.

Activated charcoal powder acts as a “super” absorber of many poisons. Once the poison is stuck to the charcoal in the intestine, the poison cannot get absorbed into the bloodstream. It has no taste, but does have a gritty texture. To be effective, activated charcoal powder suspended in a few ounces of water must be given as soon as possible after the poisoning. It does not work with alcohol, caustics, lithium, or petroleum products

Another common antidote is N-acetylcysteine (Mucomyst), which is used to neutralize Tylenol overdoses.

Should you suspect poisoning, immediately contact the National Poison Control Hotline at 1-800-222-1222.   Always believe a child witness to a possible poisoning and err on the side of caution.

Dosing:

Adults and teenagers—Dose is usually 25 to 100 grams mixed with water.

Children 1 through 12 years of age—Dose is usually 25 to 50 grams mixed with water, or the dose may be based on body weight. It may be 0.5 to 1 gram per kilogram (kg) (0.23 to 0.45 gram per pound) of body weight mixed with water.

Children up to 1 year of age—Dose is usually 10 to 25 grams mixed with water, or the dose may be based on body weight. It may be 0.5 to 1 gram per kg (0.23 to 0.45 gram per pound) of body weight mixed with water^4. One tablespoon of charcoal equals about ten grams. Fourteen capsules equal about a tablespoon of powder.

1. Spiller, Henry A, MS, DABAT, Rodgers, George C Jr, MD, PhD, Evaluation of Administration of Activated Charcoal in the Home, Pediatrics, Vol. 108 No. 6 December, 2001 

2. Bond GR. The poisoned child. Evolving concepts in care, Emergency Medical Clinician, N. Am., 13:343-345, 1995 

3. Chyka PA, Seger D. Position statement: single-dose activated charcoa1, American Academy of Clinical Toxicology; European Association of Poison Centres and Clinical Toxicologists, Toxicology Clinical Toxicology, 35:721-736, 1997 

4.  MayoClinic website. Accessed 02032009

Alternative vs. Integrative Medicine

Once upon a time individuals facing cancer felt they had to choose between one of two options- surgery and chemotherapy or alternative treatment.  But a new breed of medicine is emerging, one that bridges the gap between the two worlds and offers the best of each.  It’s called integrative medicine and world renowned medical centers such as Harvard and Stanford are pioneering training programs for the physician of the future.   

 

A Brief History

 

“Alternative medicine” was probably the first ‘other medicine’ term to gain popularity in the US and refers to treatments not taught in Western medical schools. This includes the use of vitamins, herbs and mind-body techniques. Essential to the alternative approach is a belief in the body’s ability to heal itself and that health is more than simply the absence of disease.  Increasing consumer use of alternative medicine in the early 1990’s led to the creation of the Office of Alternative medicine as part of the government’s National Institutes of Health.  This growing ‘new’ medicine gained popular media attention in the 1993 New England Journal of Medicine article by Harvard alumni David Eisenberg, MD.  The article estimated that in 1993, unconventional medicine users spent approximately $13.7 billion out of pocket on herbal remedies that are not covered by health insurance companies.    By 1997 out-of-pocket alternative medicine consumer spending had increased to $27 billion.  Eisenberg’s study also showed that most Americans used both conventional and alternative medicine, not one or the other.  The attempt to complement perceived weaknesses in each system was a revelation to the medical establishment and in 1998 the Office of Alternative Medicine was renamed the National Center for Complementary and Alternative Medicine (NCCAM).  The era of complementary medicine was born. 

 

By early 2000, larger medical centers began offering complementary medicine programs.  Patients receive the same type of care as before but have the opportunity to receive services such as acupuncture, yoga classes, art and music therapy programs under the guidance of the medical center.  But the evolution was not at an end.  Americans wondered whether these complementary approaches could benefit them not just as an add-on to the standard medical care, but as an integral part of their care.

 

There was a ‘great divide’ between the two medical systems due to the difference in approach and methodology.  Western trained physicians are not required to study botanical pharmacology or mind-body influences and Western medical schools do not offer alternative medicine certification.  For those practicing in either camp, the possibility that either medical practice has the ability to influence the effects of the other within the body, and the fact that practitioners are often unaware of each other was disturbing.  There was a need to better understand the interplay but more importantly, understand if/how it can benefit the patient.

 

Enter the Naturopath.  Naturopathic physicians are trained in one of four accredited medical colleges in the United States and practice integrative medicine using standard diagnostic techniques, pharmaceuticals and surgery when necessary.  The American Association of Naturopathic Physicians operates a searchable database making it quick to find licensed care. 

 

From a global point of view, integrative medicine is not new. Other developed nations such as France, Germany and Japan have practiced integrative medicine for decades.  The novelty is in the terms as defined by different cultures.  In Asia, traditional treatments (which would be considered alternative in the West) are still revered and passed down from mentor to student over thousands of years while conventional medicine (that taught by Western medical schools) is a comparatively new practice. 

 

What to expect in a complementary treatment program.

Current complementary medicine programs at institutional treatment centers provide complementary approaches as an option.  Surgery, radiation and chemotherapy are the standard of care for cancer.  Optional treatments may include nutritional support, naturopathic medicine, mind-body medicine, physical therapy, pain management and others.  Clinical trials investigating new treatments may be available (http://nccam.nih.gov/clinicaltrials/alltrials.htm) but the nature of clinical studies does not accommodate customization.

 

What to expect from an integrative medicine program.

In the integrative setting, practitioners collaborate in patient care- the entire team is fully aware of all treatment protocols.  Nutritional therapy, botanical preparations, mind-body medicine and physical therapies are coordinated into a single treatment plan. Examples of current integrative treatments include MRI-guided hyperthermia (heat treatment) in conjunction with radiation therapy of breast cancer,  and botanical adjuvants in standard chemotherapy.   

 

For future and current physicians, the University of Arizona has initiated training in integrative medicine, including a fellowship and distance learning program.  The reality is that any new therapy is an ‘alternative’ therapy until it is sufficiently proven by science to recommend its use. We are still in the process of testing the ‘new medicine’ but there is much to gain from what we already know.

 

Note: Advanced cancer presents special medical challenges.  Therefore, it should be addressed in a facility that has the capacity to diagnose and address complications that may arise. This is essential when considering a treatment center.

 

 

Resources:

 

National Center for Complementary and Alternative Medicine.  http://nccam.nih.gov/

 

Clinical Trials involving Complementary Medicine. 

http://nccam.nih.gov/clinicaltrials/alltrials.htm

 

Video Clips: Physicians and Scientists from Harvard Medical School, University of California Medical School, University of Maryland and others discuss integrative medicine.  http://thenewmedicine.org/professionals_and_educators

 

University of Maryland Searchable Database of Complementary and Alternative Medicine.    http://www.umm.edu/altmed/

 

American Association of Naturopathic Physicians. Physician locator. 

http://www.natruopathic.org

                                                        

Directory of Integrative Cancer Treatment Centers. 

http://www.DrDonnaDouglas.com/consultation.html