Tips On How To Treat Chronic Pain Without Medication

For too long western medicine has portrayed medications as the pinnacle remedy in treating diseases and conditions. Medications are more than likely present in every pain management case that we see. Unfortunately, many pain medications have unwanted side effects not to mention the high probability of pain medications being addicting. As pain management physicians, we encourage patients struggling with pain to consider all of their alternatives before resigning themselves to long-term drug use; nonetheless, please consult your doctor first as to what alternatives are best for you.

Diet & Exercise

If you are familiar with any of our past blogs, you will note just how important diet and exercise can be in influencing chronic pain. With that being said, with the support of your physician, we encourage you to take a look at your overall level of activity and the types of food you frequently eat and see what changes can be made to reduce symptoms of chronic pain without having to rely on pain-relief medications. For example, an anti-inflammatory diet involves eating a lot of low-starch vegetables, fish, some fruit, limited amounts of dairy & whole grains, moderate amounts of red meat, and almost no flour or sugar. This sort of diet may seem foreign based of the typical foods you eat; yet small and simple changes over time can offer immense benefits. For more information on this topic, please see our blog post, “Tips On How Your Diet Can Reduce Chronic Inflammation”. Again, making changes to your diet can be a challenge, but it is well worth it. One clinical trial concluded that some patients started to have substantial pain relief and overall feel better in as little as two weeks. Participants also reported lower blood pressure, lipids, cholesterol, and blood sugar levels. Concerning exercise, numerous studies have found that even minimal amounts of physical activity has been shown to reduce pain symptoms. Pick a couple of your favorite activities: walking, cycling, swimming; anything that you feel comfortable doing may have a tremendous benefit on reducing your dependence on medication. Yet before you go signing up for the next yoga, talk to your doctor and get their approval beforehand.

Manipulative Techniques

Research has shown that manipulation therapy and physical therapy may be effective methods in relieving pain throughout the body (back, neck, shoulder, knees, chest, etc.). During a manipulation therapy session, the physician delivers uses their hands to manipulate patients’ bodies into proper alignment as a way to ease the pain. During a physical therapy session, a healthcare provider will guide the patient through various exercises and stretches meant to alleviate pain. Another well-researched alternative to medication for treating pain is acupuncture. Acupuncture is the practice of strategically placing thin needles on the epidermis throughout the body to stimulate nerves and relieve pain. A meta-analysis completed in 2012 found acupuncture to be useful for the treatment of chronic pain. They found significant differences between true and sham acupuncture indicating that acupuncture is more than a placebo. However, we must note that these differences were relatively modest, suggesting that factors in addition to the specific effects of acupuncture may be important contributors to its overall therapeutic effects.

It is possible to overcome disabling pain and resume an active life without medications. If you think you might benefit from these steps, talk to your talk about implementing one of these alternatives to your pain management regimen. Besides the alternatives we mentioned, what alternatives have you found to be effective? Please let us know!

Tags: chronic pain, diet, exercise, medications, meta-analysis, acupuncture

References:

  1. Andresen TCB, Cristian CR. Efficacy of osteopathy and other manual treatment approaches for malocclusion – A systematic review of evidence. Int J Osteopath Med. 2013;16(2):99–113.
  2. Estruch R, Ros E, Salas-Salvadó J, et al.; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013;368:1279–1290
  3. Itoh K, Katsumi Y, Kitakoji H. Trigger point acupuncture treatment of chronic low back pain in elderly patients–a blinded RCT. Acupunct Med. 2004 Dec;22(4):170–177
  4. Mensink RP, Zock PL, Kester ADM, Katan MB. Effects of dietary fatty acids and carbohydrate on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 con- trolled trials. Am J Clin Nutr 2003;77:1146–55.
  5. Ng MM, Leung MC, Poon DM. The effects of electro-acupuncture and transcutaneous electrical nerve stimulation on patients with painful osteoarthritic knees: a randomized controlled trial with follow-up evaluation. J Altern Complement Med. 2003 Oct;9(5):641–649.
  6. Posadzki P, Ernst E. Osteopathy for musculoskeletal pain patients: a systematic review of randomized controlled trials. Clin Rheumatol. 2011;30(2):285–91.

Vickers AJ1, Cronin AM, Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012 Oct 22;172(19).

5 Proven & Effective Tips To Reduce Your Head Pain

Let’s face it; we all get headaches. A headache can be a burden to our daily lives, whether it’s a clinically diagnosed primary headache such as a cluster, tension, or migraine headache, a secondary headache, or innocuous head pain that generally goes away in due time. Fortunately, there are many treatments that can ease head pain without a trip to the doctor or drugstore and we’d like to share five of our favorite tips. Nonetheless, if you believe you are experiencing a headache as a result of a disease/condition (i.e. secondary headache) or feel that you may be having one of the three primary headaches, please consult your doctor as soon as possible. He or she will be able to treat your headache in the most effective way. Also, though these tips are more for non-life threatening headaches, please talk to your doctor before implementing any of these tips.

Take Medication in Moderation

Walk into any pharmacy and you will be bombarded with a number of medications offering pain relief. Picking the right one will vary from person to person and each one has its risks. But to get the most benefit from an over-the-counter (OTC) medication that is right for you with the least risk, follow these guidelines:

  • Avoid OTC’s that contain caffeine or multiple ingredients for these may cause ‘rebound’ headaches.
  • Choose liquid over pills. Your body will be able to absorb the active ingredient much more readily.
  • Be prophylactic and take a painkiller as soon as you feel pain. Start with the recommended, even a smaller, dose and see how you respond.
  • Take an OTC only when you are experiencing pain. Taking a drug for too long or too often may actually make your condition worse, not better.

Make Friends With Darkness

For some people bright, flickering, and ambient light have been shown to exacerbate symptoms of a migraine. If you are someone who is sensitive to light, cover your windows with special blackout curtains during the day. Wear sunglasses both indoors and out. You might also add anti-glare screens to your computer and use daylight-spectrum fluorescent bulbs in your light fixtures. Last but certainly not least, try to limit the amount of time you spend on your phone, especially closer to your bedtime.

Liberate the Tension From Your Head

People who were ponytails can vouch for us when we say a tight ponytail may lead to a headache. If your ponytail is too tight, it could cause a headache. So, if you’re prone to getting “external compression headaches”, avoid wearing items such as tight hats, headbands, glasses, sunglasses, and (you guessed it) hair ties to reduce your chances of getting a headache. In fact, one study found that over 50% of participants who loosened their hair experienced their head pain reduce with some noting their headache disappeared all together.

Spit Out Your Gum

Chewing gum can hurt not just your jaw, but your head as well. The same is true for chewing your fingernails, lips, the inside of your cheeks, or objects such as pens. Do your best to limit crunchy and sticky foods making sure you take small bites. If you suffer from a condition known as bruxism (night grinding), talk to your healthcare provider about getting a mouth guard or participating in therapy. Research has shown than individuals who participate in cognitive behavioral therapy were able to reduce clenching their jaw, leading to a reduction in headaches.

Icy Hot: Not Just A Catchy Name

We’re sorry if our title misled you. We are not talking about the pain cream ICYHOT®, but we are referring to alternating between hot and cold packs to ameliorate symptoms of a headache. If you are having a headache, specifically a migraine, compress a cold pack on your forehead for approximately 15-minutes followed by a 15-minute break. Try to repeat this cycle up to three times. If you experience tension headaches, place a heating pad on your neck or the back of your head. If you have a sinus headache, hold a warm cloth to the area that hurts. Allowing warm water to run down your head and back as in a warm shower may also be effective in reducing the headache. What other tips and tricks have helped you reduce head pain? Lets us know!

Tags: headache, primary headache, secondary headache, over-the-counter, migraine, bruxism, pain management

References:

  1. Bader G, Lavigne GJ. Sleep bruxism; an overview of an oromandibular sleep movement disorder. Sleep Medicine Reviews 2000;4:27-43.
  2. Blau, J. N. (2004), Ponytail Headache: A Pure Extracranial Headache. Headache: The Journal of Head and Face Pain, 44: 411–413. doi:10.1111/j.1526-4610.2004.04092.x
  3. Offenbächer M., Stucki G. Physical therapy in the treatment of fibromyalgia. Scandinavian Journal Of Rheumatology Vol. 29 , Iss. 113,2000
  4. Sheftell, F. Role And Impact Of Over-The-Counter Medications In the Management of Headache. of Neurologic Clinics. W. B. Saunders Company. Elsevier Inc. 1997
  5. Thompson BA, Blount BW, Krumholz TS. Treatment approaches to bruxism. Am Fam Physician 1994;49:1617-22.

‘Tis the Season! How Alcohol Can Interact With Your Pain Medications

Introduction

It’s that time of year again where we spend time with families, coworkers, and friends all throughout this Christmas Season. We will assume that you will be attending at least one Holiday function where more than likely alcohol will be present. So, in light of the Holiday spirits (no pun intended), we would like to discuss why alcohol might not be your best beverage of choice if you are currently taking any medications. Alcohol is a big part of many types of holiday celebrations, but unfortunately, alcohol can interact in less than stellar ways with pain medications. Interactions between alcohol and a medication can occur in a variety of situations that differ based on the timing of alcohol, medication consumption, gender, weight, and age. Many classes of prescription and non-prescription pain medications can interact with alcohol. For example, opioids, muscle relaxants, narcotics, benzodiazepines, over-the-counter (OTC) anti-inflammatory agents, and antidepressants all interact with alcohol in a specific manner than can wreak havoc on your body. Alcohol can cause extended release formulations of pain medications to release all at once, and some short-acting formulations to release more quickly than normal, a phenomenon called “dose dumping.” Dose dumping can lead to rapidly increased levels of the medications in the system, resulting in overdose and possibly death. So let’s jump right into discussing alcohol & pain medication interactions.

Acetaminophen: A Real Life Example of a Drug-Alcohol Interaction

Let’s use drugs containing acetaminophen as an example. Certain opioid pain medications (e.g. codeine, propoxyphene, and oxycodone) are manufactured as combination products containing acetaminophen. These combinations can be particularly harmful when combined with alcohol because they provide “hidden” doses of acetaminophen that can cause drowsiness, sedation, and decreased motor skills. Acetaminophen also increases gastric emptying, leading to faster alcohol absorption in the small intestine; may also inhibit important gastric hormones. Alcohol enhances acetaminophen metabolism into a toxic product, potentially causing liver damage.

Conclusion

You might be thinking, “ Well, I do take a medication but this is only for people who drink a lot of alcohol”. Unfortunately, this is not the case. In fact, most of the data on alcohol-medication interactions was done on those who drank moderate levels of alcohol. Thus please be aware that any level of alcohol may interact with your medications. As alternatives to alcohol try virgin cocktails, non-alcoholic beer, sparkling non-alcoholic cider, sparkling water, and eggnog without the alcohol. All are festive, and allow you to blend in with the crowd. Nonetheless, if you do drink, please make sure to have a ride. Alcohol-medication interactions can exacerbate medication’s adverse side effects (drowsiness, dizziness, euphoria, etc.). We hope this in-depth explanation of the effects of alcohol will help you in making the decision about drinking. Have a blast at all your holiday parties this year and try to play it safe if you are taking any sort of medicines. From all of us here at Pain Consultants of Arizona, we wish you and your family a Merry Christmas!

Tags: alcohol, pain management, medications, Christmas, opioids

References:

  1. Berkow R, ed. Drugs and the liver. In: The Merck Manual. 16th ed. Rahway, NJ: Merck & Co., Inc;1992:781.
  2. Emanuele, N.V., al. Consequences of alcohol use in diabetics. Alcohol Health & Research World 22(3):211–219, 1998.
  3. Jarzyna D, Jungquist CR, Pasero C, et al. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Manag Nurs. 2011;12(3):118–145. e10.
  4. Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend. 2012;125(1–2):8–18
  5. Kuffner EK, Dart RC, Bogdan GM, Hill RE, Casper E, Darton L. Effect of maximal daily doses of acetaminophen on the liver of alcoholic patients. A randomized, double-blind, placebo-controlled trial. Arch Intern Med 2001;161:2247-2252.
  6. Levitt, M.D., al. Use of a two- compartment model to assess the pharmacokinetics of human ethanol metabolism. Alcoholism: Clinical and Experimental Research 22:1680– 1688, 1998
  7. Manyike PT, Kharasch ED, Kalhorn TF, et al. Contribution of CYP2E1 and CYP3A to acetaminophen reactive metabolite formation. Clin Pharmacol Ther 2000;67:275-282.
  8. Nemeroff CB, DeVane CL, Pollock BG. Newer antidepressants and the cytochrome P450 system. Am J Psychiatry. 1996;153(3):311–320.
  9. Niemela, O., al. Early alcoholic liver injury: Formation of protein adducts with acetaldehyde and lipid peroxidation products, and expression of CYP2E1 and CYP3A. Alcoholism: Clinical and Experimental Research 22:2118–2124, 1998.

4 Reasons Nutrition Is Vital When Living with Osteoarthritis

Introduction

Did you know a study done in 2005 reported that approximately 26.9 million American adults suffer from osteoarthritis where this conservative number of people suffering from this degenerative arthritic joint disease has only exponentially increased over the years? But why is that? Studies have shown that arthritis is twice as high in obese people as in those with a healthy weight since the extra weight puts pressure on your joints. Thus is it due to the rise in obesity? Maybe partly due to people retiring at a much later age putting more stress on their joints and bones? In this post we will not speculate as to “what” is causing an increase in osteoarthritis, but rather “how” osteoarthritis symptoms can be reduced and in some cases, prevented. If you suffer from osteoarthritis, then you are well aware that it is a disease where a loss of cartilage in the joints can bring severe inflammation and excruciating pain. Thus we would like to provide you with some handy nutrition and exercise tips (and why they are important) to help you manage this condition to live an enjoyable and healthy life. Nutrition is important to osteoarthritis patients for even small nutritional changes may reduce pain associated with osteoarthritis. However, it is in your best interest to consult your healthcare provider first before implementing any of these tips.

Nutrition Can Keep Your Bones & Cartilage Strong

Eating a sensible diet, focused on musculoskeletal rigidity, may aid in keeping your bones and cartilage durable. For example, studies have shown that foods high in antioxidants as well as in glucosamine may help reduce, if not repair, tissue damage caused by osteoarthritis. For adding antioxidants to your diet, try to add fruits and vegetables; for example, blueberries and leafy greens. For glucosamine, try to incorporate shellfish such as crab, lobster, or shrimp.

Nutrition Can Control Inflammation

Controlling your diet can help to control general inflammation in the body. Certain foods such as sugary foods, fried foods, and refined foods have been shown to increase inflammation in the body. Do your best to reduce if not avoid foods of this nature. On the contrary, numerous studies have also documented many foods that have anti-inflammatory effects. Foods high in omega-3 fatty acids (e.g. salmon & tuna), as well as spices such as ginger and turmeric, may help in reducing inflammation. It is important to note that [fat] is not a bad thing to have in your diet. To contrary belief, healthy fats can actually aid in weight loss. Just be sure the foods you choice are of the healthy-type of fat; for example, the fish we just mentioned, avocados, nut butters, almonds, and olive oil to name a few.

Nutrition Can Aid In Weight Loss

Having an appropriate weight for your body may reduce stress on your bones and joints, especially the weight-bearing joints as in your pelvis or knees. Removing excess weight from your body not only removes added stress on these joints but may also reduce pain. To lose weight, you must expend more calories (through exercise or hypo-caloric diet) than you are consuming. Thus for weight loss or weight-maintenance (if you are at an appropriate weight), eating a diet high in nutrient-dense foods will provide the right amount of calories without over consuming. Furthermore, studies have shown that people who continue to eat processed foods, fried foods, sugar and red meat are more likely to develop rheumatoid arthritis over people eating a diet of fresh fruits, vegetables, fish, and white meats.

Nutrition Can Get You Moving

Physical activity may help to maintain joint mobility where nutrition plays a vital role in how active we are. For example, the more fatty and fried foods that we eat, the more sluggish and worn-down we feel. On the contrary, eating nutrient-dense foods provides the minerals and vitamins to not only give us the ability to exercise but may also promote the motivation to exercise. This motivation in itself is significant for research has shown that 40% of women and 56% of men with osteoarthritis exercise less than 10 minutes a week, given the misconception that exercise wears down joints. In fact, physical activity may also reduce the risk of developing osteoarthritis in the first place. Frequently recommended activities are ones that put minimal stress on the body’s joints; for example, swimming and bicycling. Try to avoid intense activities that may injure or strain the joint cartilage. Exercise is beneficial when performed at a level that does not stress the joints.

We must stress how important it is to consult your doctor before implementing any of the above nutritional tips. Your healthcare provider can help you pick and choose which foods will work best for you and reducing the symptoms of osteoarthritis. We hope this quick overview of how nutrition can reverse the effects of osteoarthritis. What nutritional changes have helped reduce your symptoms of osteoarthritis? Let us know!

 Tags: osteoarthritis, nutrition, exercise, activity, inflammation, anti-inflammation, knee pain, pelvic pain, joints, obesity, diet

 References:

  1. Arita M, Bianchini F, Aliberti J, Sher A, Chiang N, Hong S, Yang R, Petasis NA, Serhan CN. Stereochemical assignment, antiinflammatory properties, and receptor for the omega-3 lipid mediator resolvin E1. J Exp Med. 2005;201:713–722. doi: 10.1084/jem.20042031.
  2. German B, Schiffrin EJ, Reniero R, Mollet B, Pfeifer A, Neeser JR. The development of functional foods: lessons from the gut. Trends Biotechnol. 1999;17:492–499. doi: 10.1016/S0167-7799(99)01380-3.
  3. Leeb BF, Schweitzer H, Montag K, Smolen JS. A metaanalysis of chondroitin sulfate in the treatment of osteoarthritis. J Rheumatol. 2000;27:205–211.
  4. McAlindon T, Felson DT. Nutrition: risk factors for osteoarthritis. Ann Rheum Dis. 1997;56:397–400.
  5. McAlindon TE, Jacques P, Zhang Y, Hannan MT, Aliabadi P, Weissman B, Rush D, Levy D, Felson DT. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum. 1996;39:648–656.
  6. Yelin E. The economics of osteoarthritis. In: Brandt KD, Doherty M, Lohmander LS, editor. Osteoarthritis. Oxford: Oxford University Press; 2003. pp. 17–21.

 

8 Ways For Effective Sleep Hygiene When Dealing With Chronic Pain

Introduction

We dare you to find a person that has never had a restless night of sleep. We think you can agree with us that finding such a lucky person would be quite a daunting task. With that being said, we have all had the occasional night where we just can’t fall asleep. A night or two, although annoying, hardly causes us to become alarmed. Nonetheless, for those suffering from a chronic illness, a couple of nights without sleep can wreak havoc on pain symptoms as well as their overall quality of life. Unfortunately, it is simply not just a couple of nights that individuals with chronic pain have to deal with. Not getting a good night’s rest generally leads to exacerbated pain symptoms where hyperalgesia (intensified pain) may keep someone from falling asleep at night. Said another way, pain worsens sleep patterns and sleep disturbances worsen pain. It is worth noting that chronic pain patients are all too familiar with sleep disorders where more than 66% of patients experience problems. Such a rancorous cycle could lead to a chronic inability to fall asleep, which could result in insomnia or other sleep disorders.

What Exactly Is Insomnia?

Insomnia is a general clinical term that refers to the difficulty in initiating or maintaining sleep that occurs for at least three nights a week for up to 3 months in a given year. It may present as an independent problem (primary insomnia) or as part of a coexisting medical or psychiatric condition (secondary insomnia). Insomnia is known to cause clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning; thus it is important to talk to your doctor as soon as possible if you find yourself meeting this criteria. Fortunately, in many cases insomnia can be reversible and can greatly reduce someone’s sleep-deprived pain symptoms. We will not go into too much detail but there are a number of treatments that can truncate symptoms of insomnia. However, it is very important to consult your physician to determine if the actual cause of your inability to sleep is from insomnia or from another sleep disorder that has yet to be ruled out. For example, sleep disorders caused by medication side effects, psychiatric disorder, or sleep apnea should all be considered as to why are not able to sleep.

Chronic Pain & Insomnia: A Catch-22

One form of treatment that we would like to discuss is the use of medications. Certain pain medications can in fact improve sleep and generally are prescribed for patients who have both a sleep disorder and a specific pain disorder. On the other hand, opioid pain medications can disrupt sleep and prevent patients from entering deep sleep after as little as one dose. Opioid pain medications can also cause sleep-related breathing disturbances. This is why it is crucial to consult with your doctor as to what the underlying cause is for your inability to sleep where a more precise treatment plan can be created.

Creating A Healthy Sleep Environment

Below are 8 ways that have been found to be effective in creating proper sleep hygiene where the first 6 are relatively easy to implement. We go into further detail about the last two in the hopes of furthering your understanding of these practices. As with any of these tips, please consult your doctor before implementing any of these.

  1. Use your bedroom only for sleeping. Avoid using your bedroom as an office, a place to eat, or a place to socialize.
  2. Only go to bed when you are sleepy.
  3. Watch caffeine and alcohol intake, especially after noon.
  4. Try to do physical activity earlier in the day.
  5. Try to wake up at the same time every day regardless of when you go to sleep the night before.
  6. Avoid naps during the day
  7. Cognitive Behavioral Therapy

As we mentioned above, medications are a very critical vehicle for alleviating symptoms of insomnia and pain. Nonetheless there does exist a therapy treatment that is just as effective as medications in the long-term and does jot have the side effects that may accompany medications. Cognitive behavioral therapy (CBT) is a form of treatment that has been shown to be highly effective in treating insomnia. CBT is comprised of a number of strategies that seeks to improve overall sleep quality as well as changing thought and behavior patterns that are assumed to interfere with sleep. CBT accomplishes this by helping patients control or eliminate negative thoughts and worries that keep them awake. Through CBT work there is an increased awareness of thoughts related to sleep and once controlled, they tend to decrease and it is easier for the patient to fall asleep. Numerous studies have shown that cognitive behavioral interventions are as effective as pharmacological treatments in the short term and more effective in the long term.

  1. Relaxation Therapy

Another strategy is relaxation training, which is used to reduce or eliminate muscle tension and distract one from racing thoughts. Relaxation therapy is useful for both sleep onset and sleep maintenance insomnia. Techniques include progressive muscle relaxation, guided imagery, biofeedback, and autogenic training; to name a few. Regardless of the type of relaxation strategy used, the treatment involves professional guidance and the teaching of these skills over a number of sessions.

Do your best to adopt one or any of these stress-management strategies to reduce the anxiety or other emotional disturbances associated with your lifestyle. Doing so will be your best bet in keeping sleep-deprived pain symptoms at bay. Again, we must stress to please make sure that you receive treatment for any medical, psychiatric, or other conditions that may interfere with your sleep. What tips have helped you create healthy sleep hygiene? Let us know!

Tags: alcohol, caffeine, CBT, chronic pain, insomnia, pain management, sleep, sleep hygiene

References:

  1. Buysse DJ, Germain A, Moul DE, Franzen PL, Brar LK, Fletcher ME, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med. 2011;171:887–95.
  2. Lichstein KL, Durrence HH, Riedel BW, Taylor DJ, Bush AJ. Epidemiology of sleep: Age, gender, and ethnicity. Mahwah, NJ: Erlbaum; 2002.
  3. McCurry SM, Logsdon RG, Teri L, Vitiello MV. Evidence-based psychological treatments for insomnia in older adults. Psychol Aging. 2007;22:18–27.
  4. Mellinger GD, Balter MB, Uhlenhuth EH. Insomnia and its treatment: Prevalence and correlates. Arch Gen Psychiatry. 1985;42:225–32.
  5. Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, et al. Practice Parameters for the Psychological and Behavioral Treatment of Insomnia: An Update.An American Academy of Sleep Medicine Report. Sleep. 2006;29:1415–9.
  6. Morin CM, Azrin NH. Behavioral and cognitive treatments of geriatric insomnia. J Consult Clin Psychol. 1988;56:748–53.
  7. Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004) Sleep. 2006;29:1398–1414.
  8. Morin CM, Kowatch RA, Barry T, Walton E. Cognitive-behavior therapy for late-life insomnia. J Consult Clin Psychol. 1993;61:137–46.
  9. Pigeon WR, Crabtree VM, Scherer MR. The future of behavioral sleep medicine. J Clin Sleep Med. 2007;3:73–9.
  10. Stepanski EJ, Rybarczyk B. Emerging research on the treatment and etiology of secondary or comorbid insomnia. Sleep Med Rev. 2006;10:7–18.

5 Ways To Prevent Golfer’s Elbow

What a great time to be in Arizona! With a high of 80° and sunny weather, it is the perfect time for Phoenicians and snowbirds to partake in the wonderful outdoor activities the Valley of the Sun has to offer; one of the more popular activities being golf. There is not a better place than Arizona in the winter to experience the plethora of picturesque and world-renowned courses. Nonetheless, the great weather or game of golf is not immune from injuries. An injury that we see on a regular basis is golfer’s elbow (i.e. medial epicondylitis). Here we would like to discuss what golfer’s elbow is and provide some stretching tips on how you can reduce the injury and pain associated with golfer’s elbow.

What Is Golfer’s Elbow?

To begin describing this type of injury, let’s begin by briefly going over the anatomy. Golfer’s elbow involves a tendon known as the common flexor tendon that connects the flexor forearm muscles to the inner (medial) side of the elbow bone (epicondyle). Constant repetition of bending the wrist, for example, as when holding and swinging a golf club, can lead to inflammation of the medial epicondyle. This repetitive motion and cumulative stress can cause the tendons at the inner side of the elbow to deteriorate. Generally, patients experience symptoms of pain and tenderness at the inner side of the elbow that increases during wrist flexion or grasping motions. The pain may radiate down the forearm and if not treated immediately, further micro-deterioration of the tendons could lead to severe pain, inability to play golf, and even surgery.

5 Ways To Prevent Golfer’s Elbow

Fortunately, there are a number of stretches and exercises that can treat and even prevent golfer’s elbow. We have compiled 3 exercises and 2 stretches that work to strengthen the forearm muscles in the hopes of preventing golfer’s elbow. Try to incorporate these stretches and exercises during your golf season (especially if pain does arise on the inside part of your elbow) as well as during the off-season.

  1. Wrist Curl

Place your forearm on your quadriceps with your palm facing the sky. Next hold a lightweight dumbbell in your hand. Very slowly extend your wrist as far as you can (your fingers will move towards the ground), followed by slowly curling the dumbbell moving towards your body. Your flexor forearm muscles should be completely flexed at this point. Do about 10 repetitions with one arm, and then repeat with the other arm.

  1. Reverse Wrist Curl

Place your forearm on your quadriceps with your palm facing the ground. Next, hold a lightweight dumbbell in your hand and very slowly drop your wrist as far as you can (your fingers will move towards the ground). Then, bring the dumbbell upwards towards the sky by contracting the muscles on the outside of your forearm. Your extensor forearm muscles should be completely extended at this point. Again, do about 10 repetitions with one arm, and then repeat with the other arm.

  1. Hand Grip & Squeeze

Simply take a tennis ball and alternate between squeezing and releasing the ball. Perform this for about 5 minutes at a time for each arm.

  1. Parallel Ulnar Nerve Floss

The ulnar nerve runs along side the medial epicondyle and can become “trapped” by constant inflammation and build-up of scar tissue. This floss (stretch) works to break-up the scar tissue, which may “entrap” the ulnar nerve and decrease inflammation. Start by curling your forearm to your biceps. Point your fingers towards your head where your palm is facing the sky. Your hand should be parallel with your shoulders. Gently take your other hand and place it on the pinky and ring finger of your bent arm. Gently push down on these two fingers while bending your neck in the opposite direction of the bent arm. Remember not to push too hard; aim for a gentle stretch. Hold the stretch for only 5 seconds, repeat 5 times and aim to stretch at least 3 times a day.

  1. Perpendicular Ulnar Nerve Floss

This floss technique is similar to the one above; only differing in the direction of the stretch. Straighten your arm in front of you with your palm facing outward. Have your arm about shoulder level and perpendicular to your shoulder. Again with the opposite hand, gently grab the pinky and ring finger of the straightened arm. Gently pull the two fingers towards you. Hold the position for 30 seconds and repeat 5 times. Aim to stretch at least 3 times a day.

These simple and yet effective exercises will go a long way in preventing serious problems associated with golfer’s elbow. Again, these techniques are all working to strengthen as well as loosen the muscle of your forearm. Although these are simple exercises that can be performed at your convenience, please consult your doctor before doing so. Only your doctor will be able to determine if medial epicondylitis is the cause of your pain and will recommend the best rehabilitation option for you. What stretches or exercises work best in keeping you on top of your golf game? Let us know!

Tags: golfer’s elbow, medial epicondylitis, stretches, exercises, pain management, chronic pain

References:

  1. Bisset L, Beller E, Jull G, et al; Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006 Sep 29
  2. Buchbinder R, Johnston RV, Barnsley L, et al; Surgery for lateral elbow pain. Cochrane Database Syst Rev. 2011 Mar 16;(3):CD003525. doi: 10.1002/14651858.CD003525.pub2.
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  4. Luk JK, Tsang RC, Leung HB; Lateral epicondylalgia: midlife crisis of a tendon. Hong Kong Med J. 2014 Apr;20(2):145-51. doi: 10.12809/hkmj134110. Epub 2014 Feb 28.
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  6. Olaussen M, Holmedal O, Lindbaek M, et al; Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy: a systematic review. BMJ Open. 2013 Oct 29;3(10):e003564. doi: 10.1136/bmjopen-2013-003564.
  7. Orchard J, Kountouris A; The management of tennis elbow. BMJ. 2011 May 10;342:d2687. doi: 10.1136/bmj.d2687.
  8. Pattanittum P, Turner T, Green S, et al; Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2013 May 31;5:CD003686. doi: 10.1002/14651858.CD003686.pub2.
  9. Petrella RJ, Cogliano A, Decaria J, et al; Management of Tennis Elbow with sodium hyaluronate periarticular injections. Sports Med Arthrosc Rehabil Ther Technol. 2010 Feb 2;2:4. doi:10.1186/1758-2555-2-4.
  10. Shiri R, Viikari-Juntura E; Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol. 2011 Feb;25(1):43-57. doi: 10.1016/j.berh.2011.01.013.
  11. van Rijn RM, Huisstede BM, Koes BW, et al; Associations between work-related factors and specific disorders at the elbow: a systematic literature review. Rheumatology (Oxford). 2009 May;48(5):528-36. doi: 10.1093/rheumatology/kep013. Epub 2009 Feb 17.

4 Reasons Why A High-Protein Diet May Reduce Chronic Pain

Introduction

It’s very simple to believe that a plethora of diseases and illness have their own recommended diets. For example, conditions like diabetes, obesity, atherosclerosis, hyperlipidemia all have their own recommended diets and parameters as to what nutritional changes will truncate symptoms of these conditions. In no way are we saying this is a bad thing; in fact, we support associations that disseminate these diets. However, what we do see as not being so common, are diets on how to truncate symptoms of chronic pain. In recent years the clinical/scientific research community has gathered a considerable amount of data that chronic pain, particularly the debilitating, severe form that requires opioid treatment, needs a “chronic pain” diet. Unfortunately, there has yet to be any official recommendation for a diet that may reduce symptoms of chronic pain. This is exactly what we would like to discuss.

It is well documented that the foundational principles of a diet for those suffering from chronic pain is a high-protein–intake diet with minimal amounts of carbohydrates. The goals of a high ratio of protein-to-carbohydrates are to promote weight loss, mental function, energy, and strength. It is also recommended that a dietary supplement (e.g. glucosamine chondroitin) be taken to assist regeneration of tissue and prevent osteopenia and osteoporosis.

Background

Before we jump into this mechanism, we want to stress that the release and action of hormones is similar to a circular mechanism. For example, say you just ate a meal and you have increased the amount of sugar in your response. This signal will alert the pancreas to secrete a hormone known as insulin. The job of this hormone is to readily uptake glucose (sugar) in the blood and stores it in tissues. Normally, insulin is regulated by a negative feedback loop where once the sugar in the blood has dropped to a certain minimum, the pancreas will stop producing insulin to prevent the cardiovascular system from becoming hypoglycemic (low blood sugar). However, in unstable circumstances, insulin production will continue past the minimum point. Over a long period of insulin secretion, as well as combining with other anabolic effects, the body can be induced into a state of hypoglycemia.

Now that we got that out of the way, let’s be quick in giving some background as to why this high protein-to-carbohydrates ratio diet is physiologically and biochemically important for those suffering from chronic pain. Chronic pain no doubt puts quite a bit of stress on the body as well as inducing mental stress. When the body is in a state of stress, the adrenal glands (which sit on top of the kidneys) release a large amount of stressor hormones known as catecholamine and cortisol. Such excessive production of these hormones takes a toll on the body by causing the blood glucose levels to become unstable; levels may vary from hyper-(high) to hypoglycemia (blood sugar). Overtime, with so much overproduction of these hormones, the adrenal glands can become in a state of exhaustion where the net hormone–nutrition effect of uncontrolled pain is poor mental state, deficient protein intake, muscle wasting, weakness, and food intake consisting almost solely of carbohydrates (sugars and starches). Thus do to the nature of carbohydrates, overconsumption may lead to weight gain with an unstable release of insulin.

Nonetheless, pharmaceutical management (typically opioids) also has a profound effect on the hormone–nutrition system, compounding the necessity of a pain diet. Those individuals taking opioids typically prefer sugary foods (opioids can induce a state of hypoglycemia causing a “sugar desire effect” on the opioid receptors) and who often experience weight gain; there have been cases where some people have actually doubled their weight in only a matter of a few years from being on opioids. Therefore, the combination of stress from severe chronic pain and opioid management can cause unhinged glucose metabolism in patients and a potent desire to ingest primarily sugars and starches, with little protein or fat intake.

Why Is Protein So Critical?

It is worth noting that there have been studies that have shown that patients will experience an increased intensity of pain only after a few hours of eating a meal high in carbohydrates. It has been speculated that the increase in pain is caused by a sharp increase in insulin; along with the other two factors mentioned above can leave them in a state of hypoglycemia. Thus a major element of the diet recommended here is stabilization of blood sugars. So let’s now jump into some reasons as to why a high-protein intake diet may lead to the reduction of chronic pain symptoms!

  1. Protein Decreases Inflammation

Research has shown that foods high in protein (e.g. fish, cruciferous vegetables) contain high levels of anti-inflammatory mediators. Such agents promote a decrease in inflammation by reducing free radicals as well as immunological agents that are responsible for an inflammatory response.

  1. Protein Builds Muscle-Cartilage

All protein is simple a varying chain of 20 different amino acids. One of the main amino acids that makes up collagen is a nonpolar-hydrophobic amino acid known as proline. A high-protein diet can provide the body with a proper amount of proline that can be available for collagen regeneration, which is essential for the development of cartilage and intervertebral discs.

  1. Protein Balances The Insulin-To-Glucagon Ratio

Just like insulin, glucagon is secreted from specific cells in the pancreas. However, glucagon does the complete opposite job of insulin. After a long period without eating where blood sugar may be low, glucagon is released to mobilize sugar deposits (glycogen & amylopectin) thus increasing blood glucose levels. Also, glucagon is the only hormone that blocks glucose storage as fat. Eating a diet high in protein and low in carbohydrates will balance the ratio of glucagon-to-insulin. Such a diet may prevent a sharp increase in insulin, which prevents a blood sugar rebound by avoiding a sharp decrease in blood glucose (i.e. hypoglycemia that results in carbohydrate cravings and possible pain flares). A high-protein diet may also avoid excess sugar consumption which decreases the amount of excess glucose that might be stored as fat, thus avoiding weight gain.

  1. Endogenous Pain Relievers Are Protein Derivatives

Back to the amino acids! Again all proteins are composed of 20 variations of amino acids. Proteins a chemically digested beginning in the stomach and ending in the duodenum (first section of the small intestines where most absorption takes place). Three main enzymes: pepsin, secreted by the stomach; trypsin and chymotrypsin, secreted by the pancreas are responsible for breaking down proteins into their varying sorts of amino acids. This is important because out of the twenty amino acids that make up proteins, eight of them are known as essential amino acids (these are isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine.) that the body cannot make, thus must be supplied through one’s diet. By eating a diet high in protein will ensure adequate levels of these eight amino acids where they can be absorbed into the blood system via the jejunum and ilium of the small intestines to the liver, exocrine/endocrine glands, and brain; providing the body with the “building blocks” of all compounds crucial for pain relief. Such compounds are known as epinephrine/norepinephrine (endorphins), dopamine, serotonin, and γ-aminobutyric acid (GABA). We must stress that it has yet to be identified as to how much protein someone with chronic pain needs to take in order to provide enough amino acid substrate for the production of these pain-controlling compounds.

So What Does The Diet Look Like?

The diet is actually very simple and can be easy to follow. After discussing with your healthcare provider as to how many calories and number of meals you are going to consume in a day, try to make sure that each meal is at least 50% comprised of protein. Also, ensure at most 30% fat and 20% carbohydrates. Try to avoid consuming sugary drinks. For example, juice, milk, regular sodas, and energy drinks are loaded with sugar. These drinks, as well as other high sugary foods, will cause a sharp increase in insulin and could potentially lead to a rebound effect where hypoglycemia may occur. By avoiding these drinks and foods we hope to reduce overall carbohydrate intake thus preventing hypoglycemia and weight gain. Let’s go back go reason #4 real quick. Although it has yet to be identified as to how much protein someone with chronic pain needs to take in order to provide enough amino acid substrate for the production of these pain-controlling compounds, given the other three reasons, as well as the chemical composition of these compounds, it is safe to say that 1 gram of protein per body weight is sufficient enough to provide adequate levels of amino acids. With that being said, please consult your doctor as to how much protein you should be consuming daily. Also we know that this number may sound high where historically “high protein as been known to cause liver/kidney failure”. But such a claim has been proven to be false or severely exaggerated. Always make sure to drink plenty of water with and between each meal. If you would like to discuss a diet specific for you, please come see us! Please call our office at (480) 222- PAIN (7246) to make an appointment.

Tags: diet, protein, carbohydrates, chronic pain, pain management, inflammation

 

References: 

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  2. Dawson-Hughes B, Harris SS, Rasmussen H et al. Effect of dietary protein supplements on calcium excretion in healthy older men and women. J Clin Endocrinol Metab 2004;89:1169-73.
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  4. Ginty F. Dietary protein and bone health. Proc Nutr Soc 2003;62:867-76.
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  17. Suzuki K, Kato A, Iwai M. Branched-chain amino acid treatment in patients with liver cirrhosis. Hepatol Res. 2004 Dec;30S:25-29.
  18. Walser M. Effects of protein intake on renal function and on the development of renal disease. In: The Role of Protein and Amino Acids in Sustaining and Enhancing Performance. Committee on Military Nutrition Research, Institute of Medicine. Washington, DC: National Academies Press, 1999, pp. 137-154.

Tips On How Your Diet Can Reduce Chronic Inflammation

Introduction

We have all heard the adage “food is medicine,” but there is more evidence to that saying than we give credit to, especially if you suffer from chronic pain symptoms. The caveat is that diet alone is not the most effective way to reduce inflammation. A combination of diet, exercises, and stress control are what make up an effective pain management regimen (we will get more into this in a bit). For now, understand that, unlike fad diets that have their own set of rigid rules and regulations, a diet that reduces inflammation isn’t even really a diet at all. It is more of a lifestyle, or rather an improvement to your overall eating habits. So even though we will use the word diet throughout this article, do your best not to associate it with self-deprecating regimens that fitness gurus preach.

There is strong evidence that diets high in inflammatory foods (e.g. vegan and Mediterranean diets) have been shown to greatly reduce pain symptoms associated with chronic illnesses; for example fibromyalgia, arthritis, and diabetic neuropathy. Thus we would like to give you a quick overview as to what inflammation is as well as provide a few tips that have been shown to reduce a prolonged, or rather abnormal inflammatory response.

What Is Inflammation & How Can A Diet Reduce Inflammation?

Inflammation is a biological response that our body’s produce as a protective measure against pathogens, irritants, or damaged cells. The goal of an inflammatory response is to eliminate the cause of the damage, initiate cell repair, and remove the immune system’s mediators responsible for the initial inflammatory response. Most everyone is familiar with the symptoms of inflammation. Symptoms can range from swelling, tenderness, redness, and mild pain. However, when circumstances become abnormal, as in many chronic illnesses, the body’s immune response does not return to normal and an inflammatory response can be exacerbated where severe pain and chronic conditions are triggered. For example, congestive heart failure or atherosclerosis can be caused by high cholesterol, diabetic neuropathy can be caused by hyperglycemia, and rheumatoid arthritis can be caused by autoimmune attacks. All of these examples have in common an abnormal situation that produced severe inflammation, ironically causing more damage to the tissue.

When Drugs Alone Don’t Work

There is a broad range of treatments that can treat chronic diseases, from pharmaceuticals to homeopathic alternatives. However, both of those examples just mentioned do not work for everyone, and they too have their fair share of side effects. Along that spectrum is a treatment that may not only reduce the symptoms associated with chronic pain; it is also one of the more organically natural approaches available. That approach would be an anti-inflammatory diet. An anti-inflammatory diet takes on both aspects of a vegan and a Mediterranean diet where these foods work by reducing cholesterol, blood sugar levels, insulin levels, cortisol levels, and other irritants that can lead to chronic inflammation.

Tips For Reducing Inflammation

As we mentioned above, although this is termed an anti-inflammatory diet, the tips below are easy changes to add to your daily regimen; thus do not look at these tips as rules; look at them as a lifestyle change. Do your best to implement some, if not all of these tips after you have consulted with your healthcare provider:

Reduce Red Meat: Red meat is high in saturated fat as well as some traces of trans fats. Both of these fats trigger fat tissue inflammation, which is not only an indicator for heart disease but it also worsens arthritis inflammation. Try to eat plant-based, chicken, or fish as your main dish. Certain types of fish are packed with inflammation-fighting omega-3 fatty acids so try to add in fish a couple times a week.

Cut Out The Sugar: The American Journal of Clinical Nutrition warns that processed sugars trigger the release of inflammatory molecules known as cytokines. Thus it would be wise to cut sugar out of your lifestyle.

Reduce The Refined Carbohydrates: White flour products (breads, rolls, crackers) white rice, white potatoes (instant mashed potatoes, French fries) and many cereals are all known to be refined carbohydrates. A study done by the Scientific American, found that processed carbohydrates are more readily used over fats as the main cause of obesity and other chronic conditions. To keep things short, refined carbohydrates have been shown to directly stimulate inflammation. Opt for whole grains, including barley, buckwheat, oats, quinoa, brown rice, rye, spelt and wheat.

Eat Specific Types of Fruits: Cherries, berries, watermelon, and grapes each have their own level of antioxidants; for example, ascorbic acid (vitamin C), anthocyanins and carotenoids. These antioxidants help rid the body of free radicals that promote inflammation. These fruits high in antioxidants have also been shown to help prevent heart disease and certain cancers as well. Try your best to add a couple of servings of these fruits into your day.

Eat The Right Kinds of Vegetables: Consume eight to nine servings of vegetables each day — make a couple of those servings fruit, if you like. The best vegetables that promote anti-inflammation are cruciferous vegetables (such as broccoli, brussels sprouts, cabbage, and cauliflower), soybeans, bell peppers, carrots, onions, and sweet potatoes for they are all high in vitamins and antioxidants that are responsible for eliminating free radicals; a major pro-inflammatory irritant.

We must stress how important it is to consult your doctor before implementing any of the above tips into your daily meal plan. Your healthcare provider can help you pick and choose which anti-inflammatory foods will work best for you. We hope this quick overview of what inflammation is and how diet can reverse its effects will be beneficial for you. It is worth noting specific foods can promote or shut down the inflammatory cycle. For instance, simple carbohydrates promote it, while vegetables shut it down. So remember although there are no magic foods, putting the right combination of foods into your daily lifestyle can produce remarkable results.

What foods are included in your anti-inflammation diet? Please let us know!

Tags: chronic inflammation, chronic pain, dairy, fibromyalgia, fruits and vegetables, healthy diet, inflammation, joint pain, Mediterranean diet, red meat, whole grains

References:

  1. Esposito K, Chiodini P, Maiorino MI, Bellastella G, Panagiotakos D, Giugliano D. Which diet for prevention of type 2 diabetes? A meta-analysis of prospective studies. Endocrine 2014;47:107–116
  2. Esposito K, Maiorino MI, Petrizzo M, Bellastella G, Giugliano D. The effects of a Mediterranean diet on the need for diabetes drugs and remission of newly diagnosed type 2 diabetes: follow-up of a randomized trial. Diabetes Care 2014;37:1824–1830
  3. Estruch R, Ros E, Salas-Salvadó J, et al.; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013;368:1279–1290
  4. Li S, Shin HJ, Ding EL, van Dam RM. Adiponectin levels and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 2009;302:179–188
  5. Wang X, Bao W, Liu J, et al. Inflammatory markers and risk of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care 2013;36:166–175

10 Awesome Methods for Treating Low Back Pain

Back pain is one of the most widespread pain conditions in the U.S, with approximately 80-90% of the population experiencing it at some point in their life. If you have experienced lower back pain, you can speak for others in saying that it can be a very debilitating condition to live with. Fortunately, there are many different treatments for low back pain. However, we cannot stress how important it is to get an appropriate diagnosis as to what is causing your back pain. It could be as simple as an impinged nerve or something more severe that may require more serious treatment, such as surgery. For those who have a non-serious diagnosis, and your back pain is mild-to-moderate, we have compiled a list of 10 tips that may help in reducing your back pain.

1. Low-Inflammation Diet

The majority of cases of low back pain may be caused by inflammation or impingement of the nerve roots exiting the spine. Thus eliminating inflammatory foods from your diet can be a great way to help control pain. Gluten, dairy, and sugar are common inflammatory foods. The good news is that there are all kinds of options to make these changes easier. There are also many delicious anti-inflammatory foods to add to your diet; for example, fish high in omega-3 fatty acids, cherries, ginger, almonds, and turmeric.

2. Weight loss

This also fits with tip number 1. The lower back is in some sense a weight bearing aspect of our bodies. Thus the heavier we are, the more weight we are going to be placing on our lower backs. This can lead to further impingement of nerves or even arthritis later down the road. Also, for those who have gained weight and are carrying it mostly in their belly, the lumbar curve can become overly pronounced (i.e. lordosis), placing extra strain on the lumbar vertebrae that results in low back pain. Losing weight and adding muscle to the core can decrease this strain and help support the spine

3. Exercise

In many cases, low back pain may be caused by inadequate use of the muscles in the body, and the key treatment to start with is exercise. Low impact exercise like walking is a great place to start, and swimming, a low impact exercise that utilizes the whole body, is even better. Talk to your doctor then start your new exercise plan slowly, adding length to the workout or intensity as you build strength.

4. Physical Therapy

Often used in conjunction with other methods of pain relief, physical therapy can be a great way to learn proper and appropriate rehabilitation techniques for low back pain. Exercise is great, but many people with good intentions hit the gym and use equipment improperly, causing further injury. A physical therapist can work in conjunction with your doctor to help design a specific program that teaches proper form to get the most benefits.

5. Prescription Medications

While we do not recommend prescription medication for long-term chronic pain, some prescription medications can be very effective in treating short-term, acute back pain. Opioids have a controversial history that includes an increase in the rates of dependence and a decrease in effectiveness, but in some specific cases they may help offer short-term relief of low back pain.

6. Over-The-Counter Medications

Sometimes all your low back needs is a mild anti-inflammatory over-the-counter drug like ibuprofen to provide you with the relief you are looking for. Again, these medications have their share of risks, especially when used for long-term pain conditions. A major side effect of non-steroidal anti-inflammatory drugs (NSAID’s) is their prevalence of causing gastrointestinal bleeding. Nonetheless, for an acute injury or in the case of a minor back strain, NSAIDs and analgesic may be a safe, effective treatment.

7. Various Types of Injections

Facet joint injections and medial branch blocks are two minimally invasive surgical procedures that can be used both as a diagnostic tool and as a way to relieve low back pain. In this outpatient treatment, doctors inject a numbing agent either directly into the joint (facet) or into the affected nerve (medial branch). If pain relief is achieved, the treatment is successful and can be repeated up to three times per year. If it is not effective, then the doctor has eliminated a possible cause of pain. Side effects may be minimal and may usually decreased by proper placement of the needle.

8. Massage

Massage is a great way to encourage tight muscles to relax. In the beginning of treatment, patients may only be able to tolerate the lightest of touches. By the end, the massage therapist may be leaning into crunchy places with an elbow, working the kinks out of the deepest tissues in the body.

9. Acupuncture

Acupuncture is an ancient Chinese medical practice that focuses on opening up the energy channels in the body by inserting hair-like needles into specific points in the body. The data concluding that acupuncture is effective in treating chronic pain is mixed, nonetheless many people report pain relief in their lower back pain with few or no side effects.

  1. Biofeedback

Biofeedback training is the process whereby a patient learns to recognize the physical signs of stress in the body brought on by pain. They then learn techniques to help control the stress response, easing the pain and working through it. While this does not necessarily eliminate the physical cause of pain, research has shown that biofeedback training may greatly decrease the sensation of pain in the body. There are no side effects to practicing biofeedback responses, and once the technique is learned the treatment is free.

Lower back pain can be a very debilitating condition to live with. It most certainly can make the simplest tasks a huge burden on your life. Although these 10 tips have been shown to be effective for treating lower back pain, what may work for some, may not work for others. Experiment a little and see what works best for you. Again, please talk to your doctor and get their input as to what they believe is the best regimen for you to implement.

Which treatment options work best for relief of your low back pain? Let us know!

Tags: chronic pain, back pain, diet, weight loss, exercise, physical therapy, massage, acupuncture, pain management

References:

  1. Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D (2007). “Opioids for chronic low-back pain”. Cochrane Database of Systematic Reviews: CD004959.
  2. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ (April 2006). “A Cochrane review of superficial heat or cold for low back pain”. Spine. 31 (9): 998–1006.
  3. Furlan AD, Imamura M, Dryden T, Irvin E (2008). “Massage for low-back pain”. The Cochrane Database of Systematic Reviews (4): CD001929.
  4. Hayden JA, van Tulder MW, Malmivaara A, Koes BW (2005). “Exercise therapy for treatment of non-specific low back pain”. The Cochrane Database of Systematic Reviews (3): CD000335.
  5. Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ (2010). “Behavioural treatment for chronic low-back pain”. The Cochrane Database of Systematic Reviews (7): CD002014.
  6. Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW (2004). “Back schools for non-specific low-back pain”. The Cochrane Database of Systematic Reviews (4): CD000261.
  7. Levin JH (August 2009). “Prospective, double-blind, randomized placebo-controlled trials in interventional spine: what the highest quality literature tells us”. The Spine Journal. 9 (8): 690–703. doi:10.1016/j.spinee.2008.06.447. PMID 18789773.
  8. Malmivaara A, Häkkinen U, Aro T, Heinrichs ML, Koskenniemi L, Kuosma E, Lappi S, Paloheimo R, Servo C, Vaaranen V (February 1995). “The treatment of acute low back pain—bed rest, exercises, or ordinary activity?”. The New England Journal of Medicine. 332 (6): 351–5.
  9. Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW (2008). “Non-steroidal anti-inflammatory drugs for low back pain”. The Cochrane Database of Systematic Reviews (1): CD000396.
  10. Rupert MP, Lee M, Manchikanti L, Datta S, Cohen SP (2009). “Evaluation of sacroiliac joint interventions: a systematic appraisal of the literature”. Pain Physician. 12 (2): 399–418.
  11. Sarno, John E. (1991). Healing Back Pain: The Mind-Body Connection. Warner Books. ISBN 0-446-39230-8.
  12. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E (January 2010). “The association between smoking and low back pain: a meta-analysis”. The American Journal of Medicine. 123 (1): 87.e7–35. doi:10.1016/j.amjmed.2009.05.028. PMID 20102998.
  13. Staal JB, de Bie R, de Vet HC, Hildebrandt J, Nelemans P (2008). “Injection therapy for subacute and chronic low-back pain”. The Cochrane Database of Systematic Reviews (3): CD001824. doi:10.1002/14651858.CD001824.pub3
  14. Van Middelkoop, M; Rubinstein, SM; Kuijpers, T; Verhagen, AP; Ostelo, R; Koes, BW; van Tulder, MW (January 2011). “A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain.”. European Spine Journal. 20 (1): 19–39. doi:10.1007/s00586-010-1518-3.
  15. Van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM (2003). “Muscle relaxants for non-specific low back pain”. The Cochrane Database of Systematic Reviews (2): CD004252.

The Technology Changes; The Pain Does Not

Introduction

No longer is the ever-growing trend of smartphones, tablets, and computers popular solely with the younger generations. People of all ages are now using all the latest and greatest tools; however, the pain that can arise from overusing these devices is nothing new. If you find yourself playing Pokémon-Go on your iPhone for too long, spending hours reading on your Kindle, or replying to numerous emails on your iPad; you run the risk of placing your upper body in some serious pain. Fortunately, if you find your shoulders, neck, and head in pain from using your device for too long, there is an easy fix! Let’s take a look at how our devices can place strain on our bodies and then provide some solutions for correcting the problem.

The Pathology of Too Much ‘Words With Friends’

Let’s start by looking at the anatomy of our upper bodies. Our shoulders are comprised of a number of bones (scapula, clavicle, and upper humerus) that is surrounded by thick and heavy tendons, ligaments, and muscles. Some of these muscles connect with the neck (cervical spine) which is composed of 7 bones, stacked on top of one another (vertebras) that goes all the way up into the back of our heads. Here too, tendons, ligaments, and muscles surrounding the vertebra connect to the bones of the head (occiput). Numerous studies have shown that holding a computer device too low in your lap can force the vertebrae, and the surrounding muscles, to bend forward too much. This may result in shoulder, neck, or head strain to the muscles, nerves, tendons, ligaments, and spinal discs. Fortunately, studies have concluded that when study participants viewed a tablet that was on a table or propped at an angle, there was a reduction in their neck strain and impending pain.

Practical Suggestions for Each Device

Now that we got all the big language out of the way, let’s get into some practical situations with each of your devices providing some tips on how to correct from overstraining your upper body.

Smart Phones

  • We have to put in the obligatory suggestions to never text and drive. This should go without saying when using any device.
  • Sit up straight and have your arms on a table when using a smart phone.
  • If you find yourself straining your vision, get a cheap pair of readers. This will keep you from bending your neck forward towards your phone.
  • Get a case large enough where you are comfortably able to grip the phone thus not straining your arms and hands.

Tablets

  • Get a tablet case that allows you to prop your tablet in an upright position.
  • Again, force yourself to sit up straight. You should almost be looking straightforward towards your tablet for the best position.
  • Take short breaks.
  • Take the time to shift your weight, stretch your upper body, or simply stand up for a couple of seconds to prevents possible stiffness and pain.

Laptops or Desktop Computers

  • Make sure to sit up straight where you’re almost looking at your computer monitor at eye-level.
  • Keep shoulders relaxed and elbows close to your body
  • Keep hands, wrists, forearms and thighs parallel to the floor
  • Avoid placing your laptop in your lap. Yes, ironic, isn’t it?
  • Invest in a good ergonomic chair. These types of chairs almost force you to keep a proper position thus covering all of the steps above.

You most likely picked up on a pattern between these tips. Proper posture is important regardless of the device you’re using where it simply comes down to adjusting the angle of your head and neck. We must stress that if your pain becomes more than just an irritant, please consult your doctor. The last thing you need is an injury that keeps you from doing your job or hobby on any of these devices.

What kind of device do you use and did any of these tips help in relieving any associated pain? Let us know!

Tags: chronic pain, pain management, headache, neck pain, back pain, smartphones, tablets, computers, laptops