What is the healthiest cuisine?

The 2017 World Health Index 1 released earlier this year, which graded 163 countries

based on variables such as life expectancy, causes of death and health risks such as

high blood pressure, malnutrition, the availability of clean water and tobacco use,

resulted in Italy having the highest health index of 93.11. Over a third of the adults in

USA are obese and the number is not dropping. This is a stark contrast especially with

countries like Japan and India where the obesity rates are below 5% 2 . For a rich nation,

Japan has extraordinarily low obesity. Apart from local culture, living environment and

lifestyle, is the local diet an important factor to achieving such a high health index? The

double-cheese pizza or the gooey lasagna, which are loaded with calories and fat can

certainly not lead to the formation of what we can term as “the healthiest cuisine”. What

makes a cuisine healthy or unhealthy? It is interesting to note how different cuisines are

linked by similar ingredients and how specific ingredients help define certain cuisines,

and how foods influence our health.

The Italian tradition of enjoying a leisurely meal is good for digestion. The star

ingredients of this cuisine: tomatoes, olive oil, garlic, oregano, parsley and basil are

what make it extremely healthy. Lycopene in tomatoes may be a protective agent for

breast cancer. Garlic and traditional Italian herbs provide vitamins A and C, and olive oil

helps lower cholesterol, fight heart disease and burn belly fat.

The distinctive flavors in Indian food from its array of aromatic spices are actually

protective against some cancers. Turmeric and ginger help fight Alzheimer's disease.

The rates of Alzheimer's in India are four times lower than in America. Turmeric, a main

ingredient in curry, has anti-inflammatory and healing properties. Yogurt and lentils,

which are commonly used in the Indian cuisine, have significant amounts of folate and

magnesium, and may help stabilize blood sugar.

The Thai Tom Yung Gung soup made with shrimp, coriander, lemongrass, ginger, and

other herbs and spices, possesses properties 100 times more effective than other

antioxidants in inhibiting cancerous-tumor growth. The incidence of digestive tract and

other cancers is lower in Thailand than in other countries. Thai spices like ginger aids in

digestion, turmeric is an anti-inflammatory and lemongrass has long been used in Asian

medicine to help treat colds and ease tummy troubles.

The culinarily diverse South America’s traditional diet of fresh fruits and vegetables

(including legumes) along with high-protein grains like quinoa. In fact, a typical South

American meal of rice and beans creates a perfect protein.

The Mediterranean diet consisting of traditional Greek foods like dark leafy veggies,

fresh fruit, high-fiber beans, lentils, grains, olive oil, and omega-3-rich fish provide lots of

immune-boosting and cancer-fighting ingredients that cut the risks of heart disease,

diabetes, and other diet-related diseases. A traditional Mediterranean diet is associated

with a 25% reduced risk of death from heart disease and cancer, apart from losing more

weight and feeling fuller on this type of diet, which is rich in healthy fats, than on a

traditional low-fat diet. This cuisine also ranks high in terms of health benefits because

of how it is eaten. The Greeks often share small plates of food called ‘meze’. Spanish

tradition of eating the ‘tapas’ (small plates of food) is similar. The Spanish cuisine

consists of lots of fresh seafood, vegetables and olive oil, all of which aid in better

health.

Fresh herbs, lots of vegetables and seafood, and cooking techniques that use water or

broth instead of oils, are the standout qualities of traditional Vietnamese food. This

cuisine relies more on herbs than on frying or heavy coconut-based sauces for flavor,

which makes it lower in calories. Traditional Vietnamese additives including mint, Thai

basil, and red chili have long been used as alternative remedies for all sorts of ailments,

while cilantro and star anise have actually been shown to aid digestion and fight

disease-causing inflammation.

The traditional Japanese cuisine, especially the version eaten on the island of Okinawa

where people often live to 100-plus years, is rich in antioxidant-rich yams and green tea,

cruciferous and calcium-rich veggies like bok choy, iodine-rich seaweed (good for

thyroid), omega-3-rich seafood, shiitake mushrooms (a source of iron, potassium, zinc,

copper, and folate) and whole-soy foods. They prepare these in the healthiest way

possible, with a light steam or a quick stir-fry. They also practice Hara Hachi Bu (eat

until you are eight parts or 80 percent full). These simple diet rules may be why people

in Japan are far less likely than Americans to get breast or colon cancer.

Authentic Mexican cuisine’s emphasis on slowly digested foods like beans and fresh

ground corn may provide protection from type 2 diabetes apart from being heart-healthy

and even slimming. A Mexican diet of beans, soups, and tomato-based sauces helped

lower women's risk of breast cancer, a study from the University of Utah found.

It turns out that countries with big immigrant populations like the US and Australia tend

to have the greatest culinary diversity, the greatest number of ingredients and the

biggest variation between dishes. This is mainly due to immigrants bringing their native

culinary culture with them, which in turn makes the cuisines of their target country

richer. It would be only just to conclude that no cuisine ranks above the other in terms of

being healthy, but there are common elements across eating patterns that are proven to

be beneficial to health. A diet of minimally processed foods closer to nature,

predominantly plants, is decisively associated with health promotion and disease

prevention. Globalization 3 has played a crucial role to help enjoy global cuisines in their

purest state while also consuming meals that are light, nutritious, and incredibly healthy.

References:

1. 2017 healthiest country index. Kelowna Now Web site.

https://www.kelownanow.com/news/news/National_News/17/03/20/2017_healthiest_

country_index/.

2. Bite" BW, "First. How the japanese diet became associated with a healthy

lifestyle. Business Insider Web site. http://www.businessinsider.com/how-the-

japanese-diet-became-associated-with-a-healthy-lifestyle-2016-5.

3. Ross AC, Caballero B, Cousins RJ, Tucker KL. Modern nutrition in health and

disease. 11th ed. Philadelphia: Wolters Kluwer Health; 2012:1-3.

Sports Related Injuries in Pediatrics

According to the Centers for Disease Control and Prevention, more than 38 million children participate in sports in the United States. Of these children, more than 2.6 million adolescents (aged 19 years or younger) are treated in emergency departments annually from sports related injuries. These types of injuries are the most common cause of musculoskeletal injuries in children treated in emergency departments. While the most frequent types of injuries are strains or sprains, other commonly encountered injuries range from scrapes and bruises to serious brain and spinal cord injuries such as concussions. Sports related injuries among adolescents is an especially important topic that deserves special attention due to the specific risk factors that are associated with their younger age.

Sprains and strains are the most common injuries that are encountered in children who participate in some type of sport. Sprains are a result of an injury to a ligament, the bands of fibrous tissues that connect bones at a joint. These injuries can occur when one lands on the side of their foot or twists their knee when the foot is still planted, or for a variety of other reasons. The other type of common injury is a strain which involves an injury to either a muscle or tendon, which is the tissue that connects muscle to bone. Strained muscles might occur when one returns to a sport after having taken a long time off or can be caused by injuries such as twisting one’s ankle for example. While sprains and strains are by far the most common types of injuries seen among young athletes, they are in most cases the simplest to treat.

On the other hand, growth plate injuries as a result of sports accidents are considered more serious and are a unique risk factor that is specifically associated with younger athletes. Growth plates are areas of developing tissues at the end of long bones that are present in growing children and adolescents. As children age, the growth plate is gradually replaced by solid bone.  If any of these associated areas become injured, it can lead to misshapen bones or limbs in the most extreme cases. Fortunately, these are rare and in most cases with the right attention and treatment, growth plate injuries can be treated with no permanent damage. Still, before growth is complete, the growth plates are at risk of fractures which pose a larger risk to children than to adults, whose bones have finished growing.

The most serious sports related injuries are injuries to the brain or spinal cord and should be paid the closest attention. Concussions are a common example in sports, especially contact sports such as football or even soccer. A concussion is an injury to the brain that changes its functioning, usually temporarily. Symptoms manifest in the athlete showing signs of confusion, dizziness, headaches, unsteadiness, and nausea following the accident. While these injuries are most commonly associated with blows to the head, it can also result from the head and upper body being violently shaken. Furthermore, concussions in kids are different than concussions sustained by adults. While in most cases injuries heal faster in kids than adults, studies show that healing rates for concussions sustained by kids are slower than those of adults. Also, children are at a greater risk of suffering a second, more serious injury if the first concussion isn’t fully allowed to heal and can sustain a second concussion from a lesser impact than is generally required to produce one. Repetitive brain trauma, especially starting from an early age can lead to more serious issues later in life. While most mild concussions should heal on their own over time, the biggest mistake made by young athletes, coaches, or parents is trying to return to activity too soon. Thus, with these types of injuries it is best to be especially cautious and to routinely consult with a medical professional.

Sports related injuries in adolescents is common and luckily younger athletes tend to bounce back from mild injuries more quickly than the average adult. However, preventing sports injuries are just as, if not more, important than treating them. There are many ways children can participate in sports in a safe and exciting environment and perhaps avoid any injury. For one, it is advised that children be in enrolled in organized sports through schools or community clubs that are properly maintained and staffed. In addition, it is important that young athletes make sure to use proper equipment, make a habit of warming-up and cooling-down as well as stay hydrated at all times. Conditioning and strengthening muscles is also a good preventative measure to keep your body ready for intense physical activity. Learning the proper technique and fundamentals for any given sport is also recommended to prevent any injuries. However, at times it might not be possible to prevent an injury from happening as any sport carries some potential for injury. Thus, if an accident does occur, it is imperative that athletes do not try to play through the pain. For soft tissue injuries such as a sprain or strain, athletes may follow the R.I.C.E procedure (Rest, Ice, Compress, Elevate). First, reduce use of the injured area for at least 48 hours. Next, ice the area for 20 minutes at a time about 4 to 8 times a day. Use elastic wraps, casts, or splints that can be used to compress an injured area which will reduce swelling. Finally, keep the area elevated above the level of the heart to decrease swelling. For more severe injuries it may be necessary to seek professional treatment.

The nature of sports makes injuries inevitable at times, but that should not stop you from enrolling your child in sports or encouraging them to pursue an active lifestyle. The effects of exercise range far and wide and have been shown to reduce chances of obesity and diabetes as well as helping children build social skills. It also acts as an early step towards teaching kids how to work in teams and can provide many life skills that they can carry with them into their adult lives. By taking the preventative measures mentioned above and teaching young athletes safe habits prior to, during, and post training, injuries can be kept to a minimum as they enjoy leading an active lifestyle.

Motivation for Headaches

In daily life, it is typical for people to experience facial pain or headaches and come to the immediate conclusion that they are experiencing a headache. They are bothersome and can disturb daily function and impact our attention and focus. However, many of us are experiencing headaches at different locations of the head, with different intensities, and from different causes.  People that experience the common headache feel pain that is dull and located on both sides of the head.

Primary headaches are those that occur independently, coming from structures such as blood vessels, muscles, and nerves or differences in chemical activity in the brain. Secondary headaches, on the other hand, occur due to the patient’s supplementary conditions. The most common primary headache is a tension-type headache which is a squeezing feeling on the head or neck due to the tightening of muscles often caused by stress, anxiety, and fatigue. The mild discomfort is usually on both sides of the head. The duration can vary from minutes to several days but vision, balance, and strength are not affected, which makes tension-type headaches distinct from migraines, another primary headache. Migraines are associated with a throbbing pain on a particular side of the head. They can affect vision, induce light-headedness, and cause nausea. They can last at least a couple hours or a maximum of 2 to 3 days. Another primary headache, the cluster headache, affects one side of the head as well but the pain tends to be sharper. Cluster headaches have more physical attributes such as swelling in eyelid or forehead, drooping eyelids and small pupils, and a runny and stuffy nose. They can occur several times a day.

Secondary headaches on the other hand have a further cause to the pain induced on the nerves of the head. Examples of such causes are alcohol intake, blood clots, concussion, taking pain medication, and panic attacks.

Depending on the severity and recurrence of the headache different approaches may be taken to relieve pain. Professional help may not necessarily be needed as home remedies may be sufficient enough to alleviate the pain.  One can use a heat pack or ice pack for the head or neck. Health meals that do not lead to high blood sugar and regular exercise are encouraged. Because stress is one of the leading causes of primary headache, it is imperative that additional stressors are avoided and that one rests more. To diagnose a headache and prevent further complications, blood tests, sinus x-rays, and brain scans (CT and MRI) are utilized and typically medication is prescribed by the doctor. Different mediation includes abortive (those that target receptors in nerves), rescue medicines (pain relievers), and preventive medicines (help deal with the initial point of headaches.) Typical types of medication to help with pain relief are tricyclic antidepressants, serotonin receptor agonists, anti-epileptic drugs, and beta-blockers.

Not everyone experiences the same kind of headaches – some can become severe, some can become chronic. Although it may be “just a headache,” you needn’t suffer through the pain. It is imperative that a headache-sufferer looks into their options. Once you rid yourself of the pain, you’d be surprised at how much more of your life you can enjoy.


#fightthepain

Rachanne Nabong
Insurance Hardball

Despite all the effort and commotion in Washington, D.C. over the last few months, the Affordable Care Act (ACA) – or “Obamacare” – is still in place. This is not to say, however, that coverage under the ACA will remain the same going forward. In the absence of necessary reform and amidst general uncertainty regarding legislation and budgeting, states and insurers are playing hardball with health insurance. What does that mean for the rest of us? Today, we’ll review some of these recent developments in the ACA marketplace to better prepare for what may lie ahead.

You may have seen headlines here and there: “Major Obamacare insurer pulls out of Ohio,” “From Anthem to Aetna, major health insurers are leaving ObamaCare,” “These 5 places will be hardest hit by those leaving the ACA,” and so on. The reason these companies are leaving state ACA marketplaces is simple. They aren’t making as much money on their investments as they could be elsewhere, and in some cases they aren’t making money at all. One such case can be seen in Alabama, where Blue Cross Blue Shield is spending $1.20 for every $1.00 it collects in premiums. Obviously, this is an unsustainable model. Yet the threats to insurers’ bottom lines continue: cost-sharing reductions (CSRs), a type of federal reimbursement that effectively allows insurance providers to reduce medical expenses for people with lower incomes, are on thin legal ice that the recent presidential administration could break at any time. If funds for CSRs disappear, providers will have even less incentive to insure those with lower incomes. Even providers that profit in the ACA marketplace under the current system would stand to lose a great deal of money due to the importance of CSRs. Faced with this potential scenario, many companies are raising their premiums while others are packing up and abandoning the ACA marketplace in favor of more profitable ventures.

In New York, Governor Andrew Cuomo has made his stance on this type of behavior very clear. In June, he announced that any providers that withdraw from the ACA marketplace will be banned from all other state health programs, such as Child Health Plus and Medicaid. In making this announcement, Governor Cuomo signaled that he was willing to play hardball with insurance providers by speaking their language – money. Banning providers from all programs if they withdraw from one may seem more like a petty swipe than a calculated strategy, but it is important to understand that those other state health programs are generally very profitable for the companies involved. So profitable, in fact, that companies complaining about ACA unsustainability often turn around and beg to service Medicaid in the same breath. By threatening their access to the massive profit to be had in serving New York residents, Governor Cuomo was able to effectively rein in any providers considering leaving the ACA marketplace. In his announcement, he asserted that “the people of New York will not have to worry about losing access to the quality medical care they need and deserve,” and he was correct. Compared to other states, the New York ACA exchange has been more stable and seen fewer insurer dropouts. Note, of course, that he made no such promise about preventing premiums from increasing. Such is the nature of insurance hardball.

So what should we expect going forward? Unfortunately, there are likely to be hefty premium increases across the board in our future. While the ultimate fate of CSRs remains in question, the legal case has been put on hold, effectively maintaining the status quo until the end of the year. Until a reasonable and fiscally sound alternative to the ACA is proposed and passed, uncertainty among providers could leave more counties “bare” (without any insurance plans available on the ACA marketplace) as they withdraw in increasing numbers. For this reason, it is important that you look over your health insurance plan and ensure that you are adequately covered, or begin looking into alternatives immediately if you are in an affected area. Below, you can see a list of companies that are known to be withdrawing or are publicly considering withdrawing from the ACA marketplace in some capacity. As we are currently in the season where providers are announcing whether they plan to participate in the ACA exchange, this list may not be complete or fully up-to-date. Speak with a representative from your provider if you are unsure.

  • Aetna

  • Anthem

  • Humana

  • Medica

  • Minuteman Health

  • Molina Healthcare

  • Harken Health Insurance

  • Wellmark

NYC Pain Specialists offers full out-of-network insurance benefits, and most policies reimburse patients for most of the cost of surgery. Our surgical coordinator will be happy to help you with a quote. Similarly, our patient coordinator can explain our financing plans and help you apply. We offer financing through Advance Care Card, and often can have an answer from the financing company by the time you complete your consultation with our medical staff.


Jonathan Arthur
Rotator Cuff Injuries

Rotator cuff injuries are a common type of shoulder injury, especially among athletes or those with jobs that require physical labor. Chances are, you know someone who has experienced a rotator cuff injury--you may have experienced it yourself to some degree.

If you are a sports fan, you may have heard of your favorite player being taken out of the season due to a rotator cuff injury. While they can certainly be severe in nature, rotator cuff injuries can also be minor and can occur due to a variety of reasons both on and off the field. For instance, one can sustain a rotator cuff injury from playing football for many years or even due to reaching out to break a fall and landing on one’s arm. The major cause for rotator cuff injury, however, is simple wear and tear of over years of use or repetitive movement involving the shoulder. In any case, the first step to the path of recovery is to understand the rotator cuff itself. The next step, not any less important, is to employ the good habits learned in physical therapy as a means to recover and maintain a healthy shoulder.

The rotator cuff is a group of muscles and tendons that surround the shoulder joint. It plays a stabilizing role for the shoulder joint and is responsible for the lifting and rotation of your arms. Oftentimes doctors may tell you to imagine the head of the upper arm bone as a golf ball and the shoulder blade as a golf tee. This should help you visualize the versatility that the shoulder joint is capable of handling. In addition, the rotator cuff acts as a sleeve of sorts, as it can enable the “ball” to spin and roll while remaining attached to the tee.

Two main type of rotator cuff injuries exist: impingements and tears. The main difference is that while a tear is due to an actual tear to the muscle itself, an impingement is due to the rotator cuff muscle swelling and causing pinching between the arm and shoulder bones. These types of injuries can alternatively be classified as acute or chronic. An acute injury is classified as a tear or strain in the rotator cuff that results from a single event such as falling, while a chronic injury is the result of overuse and fatigue, often seen in elderly patients and athletes. Acute injuries are more likely to recover in a shorter time period when given sufficient rest and treatment, though chronic injuries are a bit longer-lasting. Nonetheless, both tears and impingement, acute or chronic, can be treated with a combination of rest, rehabilitation, and physical therapy.

The most common symptoms of an injury to the rotator cuff present as stiffness, weakness, loss of range of motion, and/or varying levels of shoulder pain. Most patients may mention heightened pain in the shoulder at night and a stiffness in the morning when they get out of bed. In addition, lifting the arm overhead or away from you may be difficult and painful. If you are experiencing any or a combination of these symptoms, it may be time to visit a medical professional. In a typical doctor’s appointment, the doctor will typically take a patient background and perform a physical exam in which they physically examine the rotator cuff with stress maneuvers. Such tests may involve asking the patient to hold their arms out in various degrees and applying a downwards force to isolate the origin of the pain. In more severe cases X-rays, MRIs or ultrasounds may be necessary to pinpoint where the injury or pain is coming from.

Once a medical professional has confirmed that a patient is indeed dealing with a rotator cuff injury and not something else, there are a wide range of potential treatment options. Depending on the severity and cause of the original injury, less severe rotator cuff injuries often respond well to rest and rehabilitation. If these options do not work, injections or surgery may be recommended, although the latter is typically reserved for patients with full tears of the rotator cuff muscle. However, for most patients there is a typical order to which recovery takes place. The first step involves pain control and allowing your muscles to rest, achieved through the use of anti-inflammatory medications and wearing a brace that limits shoulder movement. It may be important to note, however, that extensive immobilization is not generally recommended as it may further complicate the injury. The next step is to restore the strength of the muscles with some sort of physical therapy in which therapists will aim to help return the rotator cuff to its original strength and flexibility, as well as addressing any muscle imbalances that may have occurred as a result. In the last step, the patient gradually returns to his/her normal daily activities while incorporating small changes that aim to prevent further distress. For athletes this might be a different throwing motion or lifting motion with an additional stress on correct form.

Rotator cuff injuries can be long and unpleasant since we use and rotate our shoulders in almost everything we do. Not only is it an uncomfortable process to recovery, but it is also an especially inconvenient one. There are many steps you can take in your daily lives to prevent injury and ensure long-lasting, pain-free shoulders. One approach is to view the rotator cuff and the shoulder as part of a comprehensive, not isolated, system. It may not be the best approach to simply focus on strengthening the shoulders to prevent injury. In fact, overdoing it in training or lifting may be putting you back on the path to injury. Instead, consider that the shoulder, shoulder blade, the back, and the hips are all connected, and isolating one part may cause imbalances in other areas. All in all, do not hesitate to consult a professional if you are feeling discomfort or pain in the shoulder. A physical therapist or an experienced trainer will be able to properly address areas of concern and suggest a healthy exercise program. After all, the shoulder joint is involved in almost everything we do. We should undoubtedly want to ensure the longevity of such an important part of our body.


References:

  1. "Rotator Cuff Injuries | MedlinePlus." MedlinePlus Trusted Health Information for You. MedlinePlus, n.d. Web.

  2. "Rotator Cuff Injury." Mayo Clinic. Mayo Foundation for Medical Education and Research, 12 Aug. 2017. Web.

  3. "Rotator Cuff Tear." Virtual Sports Injury Clinic. Sportsinjuryclinic, n.d. Web.

  4. "What Is a Rotator Cuff Tear?" WebMD. WebMD, n.d. Web.


Richard Yoon
Facial Pain: Unlike Headaches or Migraines

You may wake up one day to a sharp, throbbing pain on your forehead. You try to recall what you did yesterday that might be the cause of the aching, but you can’t find any obvious reason. You go to work, but the nagging pain continues. You may be tempted to shrug it off, dismiss it as some ordinary headache that would heal with time. However, sometimes pain escalates to more than what is “normal.”

Sources of facial pain are often the forehead, nose, cheeks, eyes, and mouth, and it is described by many to be stabbing or aching; such pain is usually caused by headaches or injuries. Oftentimes, it is harmless–a natural feeling of pain following physical trauma. Other frequent causes of facial pain, however, include an oral infection, toothache, or an abscess, which is a swelling of pus that forms under the skin. Rarely does facial pain indicate a more serious condition, as pain felt in the face can radiate from another region of the body, such as the ears and the head. Some more serious causes include shingles, sinusitis or a sinus infection, joint disorders, and nerve disorder. In reality, there is a wide range of facial pains, from dull and throbbing to sharp and stabbing. Whatever the case may be, a persistent, unwarranted facial pain is sufficient reason to visit the doctor.

The cause of facial pain is diagnosed based on the location and intensity of the pain. For example, a dull, throbbing pain near the mouth that gets worse when you eat is usually due t o toothache, and a trip to the dentist may be necessary. An aching pain along the cheekbone and eyes that becomes more intense if you lean forward may be an indication of sinusitis. Abscesses and ulcers are associated with throbbing pain at the site, while headaches and migraines are described as aching and stabbing. Trigeminal neuralgia, caused by a damaged or inflamed nerve, occurs when blood vessels apply excessive force on nerves near the brain. These patients suffer from severe, debilitating pain that prevents them from performing everyday activities like walking and eating. A sudden facial pain that seems to radiate from the left chest and arm could be an indication of a heart attack, and immediate medical attention is necessary.

The treatment of facial pain differs with the cause of the pain. Pain due to dental or sinus issues are treated by eliminating it at the source. A dentist can pull out a tooth with an acute cavity or a physician can provide medication to clear a sinus infection. For viral infections like shingles, doctors may prescribe antiviral medications such as acyclovir. Headaches are often treated with non-steroid anti-inflammatory drugs and other pain killers. For more severe cluster headaches and migraines, patients often receive over-the-counter medication such as opioid pain-relievers and antidepressants. Patients with trigeminal neuralgia are treated with occipital nerve blocks and peripheral nerve stimulation, in addition to drugs similar to those for severe headache treatment.

Muscle and joint pain have a different treatment approach. Patients who wake up with facial pain after waking up may be suffering from teeth grinding, or bruxism, while sleeping. Treatments include nightgards and stress management. Poor posture resulting from sedentary jobs that entail hours of work without moving can cause tightening of neck muscles, causing pain to be radiated in the face. Effective treatments include massages and physical therapy.

Chronic facial pain is very difficult to treat because it is a relatively ill-understood symptom, despite the fact that 10% of the adult population and 50% of the elderly population suffer from self-reported orofacial pain. It is also a multi-faceted condition, as it tends to be associated with psychological problems, predominantly depression. As a result of its complexity, a multidisciplinary approach is the optimum treatment for facial pain. For patients with idiopathic facial pain, the most effective way for doctors to alleviate their condition is to let the patients know that the doctors recognize and believe in their pain. Doctors must work together with their patients to create a feasible and reasonable treatment regime to reduce the pain.

The face is one of the most complex regions of the human body, with an incredible number of nerves, muscles, and bones. As a result, facial pain can have various causes and is difficult to diagnose. At one point or other, everyone undergoes facial pain, at varying intensities. As a result, it is important for people to understand the potential indications of facial pain and to seek medical attention when they see the warning signs, for it is always better to be safe than sorry.


References:

  1. http://jnnp.bmj.com/content/71/6/716

  2. https://paindoctor.com/conditions/face-pain/

  3. http://www.healthline.com/symptom/facial-pain

  4. https://medlineplus.gov/ency/article/003027.htm

  5. http://jnnp.bmj.com/content/72/suppl_2/ii27

  6. http://www.tmjhope.org/a-guide-to-the-most-common-types-of-facial-pain/


Mary Yoshikawa
Stress and Kidney Stones

Breaking off a marriage, having a loved one die, getting sued or recovering from a life threatening accident does more than just hurt your wallet or your brain; it also hurts your body. Studies have shown that stress, whether from everyday problems like work stress or big life changing problems, is linked to the cause of kidney stones.

Kidney Stones disease occur in over 200,000 people a year in the United States. Kidney stones are minerals and acid salts that clump together over time into a small pebble shape in your urinary tract and cause immense pain. Many times kidney stones are formed and do not cause pain until it reaches your kidney or bladder. Other than severe pain, if you encounter other symptoms of kidney stones like pain on the side and back, below the ribs that radiate to your lower abdomen and groin, colored urine or foul smelling urine, nausea and vomiting, fevers or chills, you should go to a doctor right away.

There are many causes to kidney stones but one of the most common reason is dehydration causing lack of water in the kidney to dilute uric acid and other toxins in the body. At the same time, the urine in your body may lack substances to prevent crystallization of minerals causing these small but painful stones to form. Kidney stones form in adults between the age of 30 to 50 years old. However, hereditary kidney stone disease can cause stones at an earlier age.

Causes of kidney stones can be deciphered by the type of kidney stone present, allowing less risk of repeating habits or practices that form them. Calcium stones are crystals made of calcium oxalate which is a substance found in food like some fruits vegetables, nuts and chocolate and is made by your liver. Dietary factors, high doses of vitamin D or metabolic disabilities can increase calcium concentration in urine. Struvite stones form due to infection in the urinary tract (UTI). They grow fast with very little warning. Uric acid stones form when you do not drink enough fluids to dilute urine, those who have high protein diet or those with gout, which is a form of inflammatory arthritis. Cystine stones are formed from a hereditary disorder that causes the kidney to let out too much of an amino acid called cystinuria.

In an experiment to correlate stress to kidney stones completed by Miyaoka, 200 patients with kidney stones took a questionnaire to measure stress on a perceived stress scale -10 (PSS-10). Stone characteristics and stress factors were assessed. Results of the experiment showed that the average score was 15.3, with a error range on 1.1. For woman, recent death of a family member or illness, or psychological trauma proved to be significant factors as the patients were going through symptoms of kidney stone disease throughout the time of their crisis.

Austin Urology Institute states that stress, in fact, is an indirect cause of kidney stones. Since the common reason for stone formation is dehydration and high urine concentration, stress can lead to a bad cycle of poor diet, less exercise, and low sleep quality as well as an increase in caffeine intake. Stress sets off a chain reaction of behaviors that cause harm or is unhealthy to the body. Without correct management of stress, kidney stones and other diseases will form in the body.

To prevent the formation of kidney stones, there are a few measures you can take. By decreasing oxalate in your body, you will remove one of the major causes of the most common stones. Through exercise as a stress reducer, drinking more water, less caffeine intake and living a healthier lifestyle by sleeping well and watching your diet can significantly decrease your chances of forming kidney stones.

Walida Ali
Obesity and Pain

In 1940 the American fast food chain McDonald's was founded by the brothers Richard and Maurice McDonald. Today it serves roughly 70 million customers daily all around the world, making it of one of the largest fast food chains in the world. The inescapable offer of cheap food and fast service was definitely a success in the modern period as people became more busy and time more limited. The introduction of fast food chains is believed to be one of the major causes why obesity became a frequent condition among the population. Obesity was first recognized as a global epidemic in 1997 when the cases started to escalate rapidly.  Of course it would be unfair to put the blame of a whole epidemic in the creation of fast food. It is important to understand that the food market as a whole contributed as it went through major changes, including the marketing and industrialization of its products. Genetics can also play an important role; once there is a history of obesity in the family, or even a tendency to gain weight easily, one needs to be extra careful not to develop such condition. Moreover, the discouragement of physical activity as a result of new technologies led to a higher rate of sedentarism, also contributing to the increase in obesity. Why walk to the supermarket if you can order everything online? Why play sports if you can play video games with your friends in the comfort of your house? Everything was simplified by technology, but the outcome of that created a problem bigger than expected.

According to the World Health Organization approximately 500 million adults are obese, with higher incidence among women between ages 50 and 60. In the United States, severe obesity is increasing in an alarming rate, exceeding the overall rate worldwide. There are several health issues that can arise as a result of obesity , including life threatening ones as heart attacks and diabetes. Psychological problems can too take place as the patient feels excluded from the society and shuts themselves inside their homes, not being able to overcome that challenge. After all, what characterizes one as obese? Obesity is defined by weight and height, which together are used to calculate the “Body Mass Index” (BMI), where a BMI greater than 30 kg/m2 reflects obesity. In this article I will talk about the connection between obesity and pain, where one can be triggered by the other.

Pain can become a paralyzing condition, limiting physical activity and encouraging sedentarism. This resultant inactivity can lead to weight gain and easily develop into obesity. Individuals that suffer from chronic pain are in even higher risk due to the possibility of depression as a result of its limitations. Depression is strongly linked to both pain and obesity as it is associated with disturbed sleep and emotional eating. The need to ingest high-caloric food is one of the main causes to weight gain as patients try to find comfort in food and lose control over their diet. The lack of motivation, also caused by the condition, not only renders the person inactive but can too act as a barrier for the road to recovery as there is no stimulus to get up and find help. Moreover the poor quality of sleep can play an important role in weight gain. Approximately 53% of patients experiencing chronic pain have high levels of insomnia and sleep apnea which is known to trigger obesity due to increased appetite and insulin resistance caused by sleep deprivation. Medication for pain and depression can also be an enemy as many can lead to side effects that contribute to obesity.  We can explore the connection between chronic pain and obesity better by considering patients that suffer with fibromyalgia. It is estimated that 80% of people with this chronic pain disorder are overweight or obese. Fibromyalgia and obesity are both identified by the impairment of the communication system between glands and therefore can be targeted from the same source.

Conversely, overweight patients have higher risk of developing fibromyalgia and may even present worse symptoms than those in a normal weight range. It has been observed that individuals with a high BMI usually experience higher intensities of pain. It is a combination of factors that contribute to such incidence, including mechanical stress, chemical mediators that cause inflammation, lifestyle issues as well as depression and sleep deprivation. The mechanical stress caused by heavy weight affects mainly joints and the spine. Obesity completely alters the body mechanics, which leads to structural pain, cartilage damage and even increases the risk of developing arthritis as the joint becomes more strained with the weight. The predisposition of obese individuals developing arthritis is also linked to chemical mediators. The fat stored in the body is called adipose tissue and it is an active tissue that produces chemicals as well as discharging it around the body. Some of these chemicals released provoke inflammation which accentuates the perception of pain. Obesity is sometimes recognized as a chronic inflammatory state due to these chemicals.

The comorbidity of pain and obesity becomes clear when we consider how inactivity promotes obesity that in turn highlights pain, creating an even larger barrier for the practice of physical activity; running into a vicious cycle. Treatment should involve the targeting of both conditions, as the presence of one may intensify the other - there is no point in performing a bariatric surgery in an obese individual if they won’t be able to maintain a healthy lifestyle afterwards. In a real case scenario a 11 year old girl was a candidate for a bariatric surgery, but she also had severe pain in her legs causing them to bend due to her weight. After careful consideration it was decided to perform surgery in her legs first so that she would be able to walk normally before undergoing the bariatric surgery. It can be observed that in this situation the pain factor was targeted first so that the outcome of the weight loss through surgical intervention would be successful. Inversely losing weight through behavioral intervention may help in pain rehabilitation and the quality of life of such individual. It is however a demanding task to maintain eating and exercising habits for a long-term and it can become challenging to overcome this condition once you have the history. In order to defeat obesity and the pain related to it you need to be focused and aware of the benefits as well as developing a  long-term strategy with a professional to maintain the accomplishments.






References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508090/

  2. https://www.practicalpainmanagement.com/treatments/pharmacological/obesity-pain-management

  3. https://fibromyalgianewstoday.com/2015/08/05/link-chronic-pain-obesity/

  4. http://www.arthritis.org/living-with-arthritis/comorbidities/obesity-arthritis/fat-and-arthritis.php

  5. https://www.livescience.com/18321-obese-pain-inflammation.html

Rachel Rodrigues
AAAASF Accreditation

The American Association for Accreditation of Ambulatory Surgery Facilities, or AAAASF, is an organization founded in 1980 for the purpose of enforcing higher standards in America’s medical facilities. Having accredited thousands of facilities worldwide, AAAASF is considered by many medical experts to be the “golden standard in accreditation.” AAAASF examines every aspect of the medical facility, from the hygiene standards of the operating rooms, to the qualifications of the staff, to the data which they track and review. By ensuring that a hospital has met its high standards of safety and quality, the AAAASF allows patients to know where they can receive the best healthcare possible. Here at the NYC Pain Specialists, we have received such accreditation, confirming our ability to meet the highest standards of modern medicine and provide the best possible services made available to our patients.

In order to qualify for AAAASF accreditation, this facility has to satisfy several basic mandates, meet the required standards for maintaining and using an operating room, and proper maintenance and usage of a recovery room. There are also standards defining the maintenance of general safety within the facility, and the proper utilization of IV fluids, anesthesia, and medications. Furthermore, the facility is required to maintain its medical records appropriately, retain competent personnel, and the means to properly govern said personnel. Finally, the facility must meet several standards regarding the quality of its care towards its patients. At all times, a AAAASF accredited facility is required to adhere to the Life Safety Code and the Health Care Facility Code, both of which are detailed by the AAAASF.

The basic mandates of the AAAASF establish some fundamental rules which the facility must adhere to. They specify information which must be disclosed to the AAAASF, as well as the frequency at which said information is disclosed.

The basic mandates are as follows:

  • Patients receiving anesthesia other than local or topical anesthesia must be supervised by a responsible adult for 12-24 hours after application, depending on the procedure performed and the anesthesia used.

  • Any changes in the ownership of the facility must be reported to the AAAASF within thirty days of the change.

  • Any deaths occurring in the facility, or any deaths occurring within 30 days of an operation performed at this facility, must be reported to the AAAASF within five business days after the facility is notified of said death.

  • All medical professionals within the facility must be certified, or eligible for certification, by a national organization correlating with their profession. Said organizations are as follows: The American Board of Medical Specialties for Medical Doctors (M.D.), the American Osteopathic Association Bureau of Osteopathic Specialists for Doctors of Osteopathy (D.O.), the American Board of Foot and Ankle Surgery for podiatrists, and the American Board of Oral and Maxillofacial Surgery for oral and maxillofacial surgeons.

  • The director of the facility must be responsible in establishing and enforcing policies which protect its patients, in addition to monitoring staff in order to ensure compliance with said policies. Furthermore, the facility must display and encourage adherence to the AAAASF Patient’s Rights, which gives patients the rights to consent to their healthcare, the rights to know about the healthcare they're receiving and the people giving said healthcare, and the general right to doctor-patient confidentiality (these being a very brief summary of the patient rights. The full document can be found on the AAAASF website, as well as any AAAASF accredited facility).

  • All medical professionals must be given unrestricted hospital privileges in their specialty.

  • The AAAASF must be allowed to conduct onsite inspections of the facilities on a regular basis.

The AAAASF also details how operating rooms should be maintained and how operations should be carried out. Numerous regulations ensure that surgery can occur with minimal risk towards the patient. These regulations are as follows:

  • There must be a pre-emptive “time-out” before each operation, in order to verify that the patient is receiving the correct treatment, and that all materials and personnel required for the operation are here and accounted for.

  • The operating room, as well as the waiting rooms and lavatories should all maintain a clean and “professional” appearance.

  • The waiting rooms, operating rooms, and recovery rooms should all be physically segregated from each other, as well as from the general office area.

  • The operating suite of the facility must contain operating rooms (at least one of which is designated solely for operations), a prep/scrub area, a clean area and/or a dirty area, and a recovery room. Furthermore, an exam room must also be able to function as an operating room.

  • Operating rooms must have ample space both for the storage of necessary materials and to accommodate all necessary personnel for each procedure.

  • Operating rooms must be hygienic, well lit, and properly ventilated. Their temperature should always remain between 68 and 72 degrees Fahrenheit, and they should be equipped to deter the entrance of both unwanted persons and any pests or outside germs.

  • All messes must be cleaned with proper germicides, and all operating rooms should have at least one autoclave present in order to sterilize equipment. The floor should be built with smooth, washable tiles that are always free of particulate matter.

  • All ambulatory surgery staff must have knowledge of how to detect and stop infections, and protocols must exist to aid in this endeavor. Reported infections must be logged, and techniques used to prevent infections must be regularly used.

  • Each operating room must be equipped with: an EKG monitor with a pulse readout, a pulse oximeter (both for use in the operating room and the recovery room), blood pressure monitoring equipment, a standard defibrillator or an Automated External Defibrillator Unit (AED Unit), pneumatic boots or a substitute, a source of oxygen and every possible means of delivering that oxygen to a patient, a means of cauterizing wounds, as well as an electrocautery with appropriate grounding plate/disposable pad, and an anesthesia machine with a proper failsafe and the means to deliver said anesthesia equipped. This equipment must be regularly inspected by a biomedical engineer.

  • Each operating room must be equipped with emergency power and emergency supplies.


By following the aforementioned medical standards, AAAASF accredited facilities are able to ensure the highest quality medical care for their patients. Facilities accredited by the AAAASF will be capable of treating a wide variety of different injuries, and will be able to accompany any patient it takes in. By ensuring a professional staff and efficient logistics within the facility, the AAAASF minimizes risks to the patient and ensures that they receive treatment as soon as possible. As an AAAASF accredited facility, the New York City Pain Specialists is able to meet the lofty standards put forth by the AAAASF, and is thus able to provide some of the highest quality medical care in the nation. This is all done to ensure our patients will always receive the treatment they need.

Citations:

  1. “What Is Accreditation.” Aaaasf.org, www.aaaasf.org/who-we-are/what-is-accreditation.

  2. “Patient Bill of Rights.” Aaaasf.org, www.aaaasf.org/patients/patient-bill-of-rights.

  3. “AAAASF Releases Latest List of Facilities Receiving Accreditation.” Rehab Managment, www.rehabpub.com/2016/04/aaaasf-releases-latest-list-facilities-receiving-accreditation/.

  4. ASC Standards and Checklist. www.aaaasf.org/docs/default-source/accreditation/standards/standards-manual-and-checklist-v6-7-(asc).pdf?sfvrsn=22.


George Galanis
The Standard American Diet and Chronic Pain

When we think about diets, we typically think about weight and restricting calories. But simply restricting calorie intake may have adverse effects.  When we consume foods, it's important to remember what will really make our bodies healthy, and ultimately happiest. If you are suffering from chronic pain, many studies have been shown that a diet with a focus on plant-based foods can have beneficial effects.

The Standard American Diet (SAD) consists of excessive amounts of meat, refined grain products, and dessert foods. True to popular belief, SAD has a low intake of both fruits and vegetables. Twenty-five percent of Americans eat a single fruit serving in one day, and ten percent eat the minimum recommended amount of vegetables. Also, SAD is profuse in meat, dairy, sugar, fat, and processed foods. Because of such abundance and accessibility of these foods in America, we tend to have excess amounts of these foods. Sixty-three percent of America’s calories come from refined and processed foods, twenty-five percent come from animal-based foods, and a mere twelve percent come from plant based foods. Sadly, six percent of the plant based calories come from French fries. These statistics are almost hard to believe. Although we have been hearing these facts for possibly a decade, the consequences of SAD are often undermined.

Degenerative diseases, inflammation, and chronic pain are all tied to diet, and more specifically SAD. A study from 2002 determined that most degenerative diseases are caused by a diet-induced proinflammatory state. For example obesity and chronic pain are frequently comorbid, and they are both inflammatory issues. Pain is the result of inflammation. When we consume refined sugars, refined flour, and omega-6 oils. Instead of obtaining our essential fatty acids from whole food sources, we are replacing these necessary oils with oils from calorie dense foods with low nutritional value. Many studies indicate this direct link between poor diet quality and increased pain.

Some diseases and conditions that have been found to be linked to SAD are: greater risk of Alzheimer’s disease, atherosclerosis, breast pain, heart disease, and inflammatory bowel disease, greater risk of pancreatic cancer, prostate cancer, and enlarged prostate and heart attack. Inflammation is our immune response to tissue damage and infection. Our immune systems work in response to toxins as part of a healing mechanism and will cause pain.  However, it involves many signaling pathways in our body and is not as simple as it seems. This is why it is important to approach prevention, and possibly cure, inflammation in an interdisciplinary way.

In order to counteract these diseases, the one of the simplest approaches we should try is to change dietary guidelines. When faced with chronic pain, reducing intake of carbohydrates, processed sugars, and meats can reduce inflammation and therefore pain.  Whole foods and plant-based diets have been shown to prevent and even reverse some chronic diseases. A whole food, plant-based diet consists of vegetables, fruits, whole grains, tubers and legumes. It reduces intake of meat, dairy, eggs, bleached flour, refined sugar, and oil. Antioxidants and essential fatty acids are found in a whole food, plant based diet, and an absence or imbalance of these important nutrients can promote inflammation and disease.  The importance of our diets is shocking, but SAD is even more shocking. If we continue to consume these kinds of foods, our bodies will suffer. Most treatment programs for degenerative diseases or diseases that cause inflammation include nutritional protocols.

An anti-inflammatory diet can help relieve pain, even as you age. Vegan diets, or diets with reduced intake of dairy products and meat and increased consumption of vegetables, can control insulin and cholesterol levels and decrease inflammation. When we are in chronic pain, it is important not to underestimate the necessity of a healthy diet. If Americans begin to follow dietary guidelines, perhaps pain and inflammation will be reduced.

Abigail Jawahar
The Most Common Signs of Fatigue

It is extremely common to hear someone say “I’m so tired today” or other phrases. The causes of this temporary tiredness are usually identifiable–perhaps lack of sleep the night before or stress from having to complete a large amount of work. Not surprisingly, they can usually be remedied easily, such as with sleep or relaxation. However, this is significantly different from fatigue, which lasts longer and is not relieved with rest. Fatigue is a state of constant tiredness and weariness to the point where it affects one’s energy levels, concentration, emotional and psychological well-being. The causes are usually more severe and serious than a bad night’s sleep or stress from work, as fatigue develops gradually. Generally, disorders, diseases, or lifestyle habits are the factors behind fatigue.  

Although fatigue is common, it can be a sign of underlying illness. It is important to know that certain conditions such as hypothyroidism, adrenal insufficiency, anemia, diabetes, depression, endocarditis, and sleep apnea can cause fatigue. However, more often than not, the cause of fatigue is less severe. The three main types of fatigue are physical fatigue, emotional fatigue, and psychological fatigue, all of which will be briefly discussed. Physical fatigue can possibly stem from underlying medical condition or physical overexertion, such as in sports. Other sources can be a state of constant busyness or an unhealthy diet. Of course, this is not to say that constantly being busy or having an unhealthy diet will definitely cause fatigue, or that it is the sole reason for fatigue. Emotional fatigue results from dealing with personal life events. Emotions such as grief, confusion, anger, fear, and/or dread can become so intense that they leave the body in a continuously distressed state. When the body is tense and constantly stressed, you can quickly exhaust all of your energy and become overwhelmed by simple tasks. Constant worrying can make it difficult to have a good night’s rest, adding on to one’s fatigue. However, it is important to note that prolonged sleeplessness is a small part of emotional fatigue, and is different from not being able to sleep well one night due to short-term stress. Lastly, there is psychological fatigue, which occurs when there is a significant decrease in the abilities of our skills and output due to emotional and attitudinal factors. Psychological fatigue also has to do with one’s attitude towards life and daily actions, as well as motivation levels.

Since fatigue is usually a symptom or result of something, after determining which type(s) of fatigue is present, it is important to obtain treatment for it, whether through medication or lifestyle changes. For example, if hypothyroidism is the sole cause for fatigue, there is medication that can be taken to treat hypothyroidism, which may in turn decrease or eliminate one’s fatigue. Of course, there may be more complex cases, such as when there are both physical and psychological factors present. Another key point to remember is that there may be a delay between the beginning of treatment and absence of fatigue. For example, depression is not like a common cold in that it can be cured relatively quickly with medication and rest. Those with depression require more time to recover, which would then require more time for fatigue to be reduced or eliminated.

When it comes to fighting fatigue, these tips can be separated into four categories. Dietary suggestions include eating a balanced diet, cutting down on caffeine to rely less on it, not skipping meals, not overeating, staying hydrated, and eating iron-rich food. While these tips seem like general advice given when it comes to diets and eating healthy, they are important in providing one’s body with energy for the day, or even long term. Without proper eating, it is difficult to maintain high energy levels and stay motivated in one’s daily life. Sleeping suggestions involve avoiding naps, sleeping the required hours per night, avoiding sleeping pills, and relaxation (not overthinking) in bed. Lifestyle tips which would help prevent fatigue are to not smoke, not excessively consuming alcohol or drugs, and to exercise. Psychological tips, which is helpful for those suffering from psychological fatigue, include going to therapy, finding someone to talk to, changing up lifestyles, and decreasing stress factors. These tips may seem to be common knowledge or perhaps easier said than done, but without putting in the effort, results would not be seen! It is therefore crucial to figure out what is the cause behind fatigue, and come up with ways to not only treat it, but also to prevent it from reoccurring in the future.

Stephanie Chan
The Autism Spectrum: A Breakdown

           Autism, now known as Autism Spectrum Disorder (ASD), is generally stereotyped to be disability related to a person’s intellect and their ability to interact with others. Along with many other misconceptions, these disabilities tend to be generalized amongst the whole population of people who suffer from it. In truth, symptoms to autism come in a range and its effects are different on different people, which is why its full name respects the range. While it may hurt and hinder some people extremely, symptoms caused by Autism do not affect the lives of others with it. true for the whole population of people with Autism.

       According to the Center of Disease Control and Prevention, almost 1 in 68 children tend to identify as autistic. Autism is diagnosed early in life, usually within two years after birth. Older people tend to raise concern of autism based on their unusual behavior towards others, at school, work or other areas in life. Doctors usually identify and connect behaviors like limited repetitive actions, having intense interest in certain a topic and entertaining oneself in that one thing, or lack of social interactions to ASD. There are also positive effects provided by Autism. Patients with ASD tend to have above average intelligence, excel in mathematics, science or the arts. They are also very detailed people with good memory and have strong visual and auditory learning capabilities. If any of the symptoms mentioned above are present in your child, it is crucial to go to your doctor for an official diagnoses and start thinking of ways to help.

       There are four different disorders that is found under the ASD range. Asperger’s syndrome, which lies on the milder side of the spectrum, tend to cause people to have a harder time socially although does not very much effect their intellect or language. The classic case of ASD is the Autistic Disorder, which is most commonly what people assume Autism is. People with this disorder have significant language delays, intellectual disabilities, communication challenges, social challenges and unusual behaviors, placing it on the more extreme side. Next,  the Pervasive Development Disorder (PDD-NOS), or “atypical autism” whose symptoms are in between the mild and u cases of Autism, putting majority of people diagnosed with Autism under this specific type. The last type of disorder under the ASD umbrella the childhood disintegrative disorder, which is the rarest of them all. This disorder develops in normal children between the ages of 2 and 4 who at some point start to rapidly lose their social, language and mental skills. In addition, with disintegrative disorder, these children also tend to obtain a seizure disorder.

       The struggle of understanding social cues, learning and communicating, it makes life hard for those with Autism. That is why, if you know someone struggling with AST, it is important to know how to help them. To make their lives easier, it is important to make sure the child is safe around their environment and having a safe zone at home—which is a spot at home where they can relax, feel secure and safe. By being consistent in their learning and interactions techniques at school, therapy and even at home, children with ASD have a better chance of learning and understanding. By sticking to a routine, schedule and interaction aids with consistency. Children with this disorder are prone to sensitivity and should be rewarded for good behavior as a positive reinforcement since unhappy feelings may cause them to react in a tantrum. While connecting can be difficult, communication is always key. That is why it’s important to understand where a diagnosed child lies on the Autism spectrum and how to go about taking care of them.

Walida Ali
Treating Insomnia

The average human adult needs about 7-8 hours of sleep at night, however, we may have all at one point encountered the all too familiar situation of the tossing and turning on our beds, being unable to fall asleep. This condition is known as acute insomnia, which may last for a few days to a week and is usually the aftermath of some traumatic or stressful event. Insomnia is one of the most common disorders that affect people in the world, with roughly 60 million Americans affected by it. Some symptoms include difficulty falling asleep, waking up during the night, waking up too early, inability to fall back asleep, daytime tiredness, and decrease in attention span. Although classic remedies like cookies and warm milk are thought to help people sleep better at night, in reality when milk was scientifically tested, it failed to affect sleeping patterns. Art Spielman, M.D., professor of psychology at the City University of New York and insomnia expert further explains saying, “Tryptophan-containing foods (including milk) don’t produce the hypnotic effects pure tryptophan does, because other amino acids in those foods compete to get into the brain.” So then, how do we tackle the monsters in our mind and get the chance to have a good night’s sleep for once?

Insomnia is generally categorized into two types: acute and chronic insomnia. Acute insomnia is usually caused by ongoing life stress like the death of a loved one or a divorce, emotional or physical discomfort, environmental factors like noise or light, illness, or interferences in normal sleeping patterns like a night shift or jetlags. This can normally be treated by adjusting your sleeping habits or changing any of the issues that have had an effect on someone’s sleep and can so help re-establish a restful sleep for most patients suffering from insomnia. On the other hand, with chronic insomnia the case is not that simple. Usually caused by more complex mental and physical health problems like depression, anxiety, chronic pain or stress, there are ways in which chronic insomnia can be tackled with too. One popularly used method is that of pharmacotherapy, the usage of drugs that help relieve symptoms and induce better sleep. Drugs like zolpidem, eszopiclone or benzodiazepines are US-FDA approved drugs for the treatment of insomnia, however, they must be prescribed by a doctor after thorough physical examination and only the recommended dose must be taken shortly before bed.  Sleep medications usually provide instant relief during a high period of distress. They may not, however, be the best option for long term treatment, as patients can develop an addiction or experience bothersome side effects like headaches, dizziness, or weakness. Thus, nonpharmacologic strategies have been introduced to counteract these issues.

Cognitive Behavioral Therapy (CBT) is an example of a nonpharmacologic strategy that helps identify and replace thoughts and behaviors that cause or worsen sleep problems, hence, promoting better sleep. It differs to sleep medication in the way that while drugs only relieve symptoms, CBT allows the patient to determine the underlying cause of their insomnia and addresses it. There are two aspects to the CBT therapy: the cognitive and the behavioral. Allowing the patient to recognize and work accordingly to change habits that affect their sleeping schedule is the cognitive aspect of the CBT. Cognitive therapy helps the patient to eliminate or control negative thoughts and emotions which often disturbs a patient’s sleep. Whereas, the behavioral aspect of CBT allows a patient to develop new habits which help promote better sleep and avoid bad practices which hinders sleep quality. Therapy might be slightly different depending upon each type of patient. Thus, a sleep therapist may recommend a variety of CBT techniques in accordance to a patient’s need. Some CBT techniques include, stimulus control therapy, sleep restriction, sleep hygiene, relaxation trainings and biofeedback. The most effective treatment for a patient will be a personalized combination of these techniques in accordance to their need.   

If the aforementioned treatments do not work out for you, fret not. There are various other alternative treatments for insomnia which have supposedly worked for fellow patients. Acupressure has been reported to help patients feel relaxed and has promoted better and easier sleep. Physical exercises like Tai-chi and Yoga also help destress the mind and contribute to physical fitness as well as improvement in mood, and so helps sleep better. Psychiatric help and hypnosis has also proven to be of great help to some patients. If you or a loved one is suffering from Insomnia, it is best to contact your healthcare provider, as they are the best source of information for any questions or concerns. Good sleep is an integral part of good human health, so let us all try to catch some proper zzz’s!  

 

References:

  1. "Insomnia - Treatment." Mayo Clinic, 2017, http://www.mayoclinic.org/diseases-conditions/insomnia/diagnosis-treatment/treatment/txc-20256979.

  2. "Insomnia Treatments." Uptodate.Com, 2017, https://www.uptodate.com/contents/insomnia-treatments-beyond-the-basics.

  3. “Drugs To Treat Insomnia.” WebMD, 2017, http://www.webmd.com/sleep-disorders/insomnia-medications#1


 

Milaskha Mukhia
LGBT+ Related Pain & The Impact of Stigma

It is no surprise that members of lesbian, gay, bisexual, and transgender communities face discrimination and barriers to health care. Less discussed is how members of the LGBT+ communities combat both physical and psychological pain. Although many members of the LGBT community experience disproportionate rates of chronic pain and mental health, certain barriers to healthcare unfortunately perpetuate the relationship between stigma and poor health. The following article will discuss a variety of LGBT+ pain conditions, ultimately explaining the complicated relationship between physical and mental pain.

Before discussing the implications of physical pain, it is imperative to acknowledge the psychological role of stigma in pain. Experiencing discrimination plays a huge part in the relationship between physical and mental health. In general, studies have shown that lesbian, gay, and bisexual individuals often report more physical health complaints than heterosexual individuals (3). It is estimated that these reports are associated with experiencing discrimination. The minority stress theory is one hypothesis which may explain pain disparities among LGBT individuals. According to this model, stressors associated with stigma (i.e. homophobic jokes, hate crimes, etc.) cause a great level of anxiety, ultimately resulting in negative health outcomes (2). Examples of such health outcomes range anywhere from pelvic pain to chronic migraines. Severity and type of pain often depends on social status and health conditions associated with certain identities.

For example, gay and bisexual men experience HIV-related pain at disproportionate rates. Although antiretroviral therapy (ART) is a beneficial method of HIV treatment, it is not uncommon for HIV-positive patients to experience comorbid symptoms of chronic pain (7). The etiology of such pain may be mediated by psychological implications of HIV. For example, depression, chronic pain, and pain severity are highly correlated (8). In one study, HIV-positive patients with moderate-severe chronic pain had significantly higher levels of depression symptoms than those without chronic pain (8).  Psychological pain associated with HIV involves both substance abuse (i.e. using illegal drugs)  and risky sexual behaviors (i.e. unprotected sex) (4). It is important to note that substance abuse may be both a cause and and effect of HIV-related pain.

Both psychological and physical pain directly impact the transgender community at high rates as well. For example, transgender men report high rates of pelvic pain associated with menstruation as well as the emotional pains of chronic stress and PTSD  (6). Furthermore, transgender men taking testosterone report pain associated with cyclical testosterone dosing, pelvic, vaginal, or orgasmic pain (6). Transgender individuals also report significant rates of chest pain which is often a result of anxiety and depression (5). Perioperative pain management, or interdependency between doctor and patient, is a critical and supportive method of helping transgender individuals manage pain.

Pain symptoms are often exacerbated by psychological health. For example, transgender patients often experience gender dysphoria, which involves the stress of feeling incongruence between gender identity and biological phenotype. Coupled with the stress of pain management, social and psychological factors which negatively impact transgender individuals must be taken into consideration when assessing overall health.

Coping mechanisms for dealing with LGBT-related pain often involve substance abuse. According to a 2008 study which analyzed health outcomes among lesbian, gay, and bisexual individuals, participants who abused substances were significantly more likely to experience homophobia and internalize negative beliefs about homosexuality (1). As previously mentioned, transgender men experience elevated rates of chronic pain associated with menstruation. It is estimated that 35% of transgender people with chronic pelvic pain additionally experience depression and/or PTSD (6). It is therefore no surprise that the linkage between substance abuse may correlate with mental health conditions as well as chronic pain. To combat the negative effects of psychological and physical pain, it is recommended that members of the LGBT community seek effective coping strategies such as therapy, community outreach, and consultations with medical professionals.

Treatment for LGBT-related pain various across dimensions based on the experience of the individual. For example, transgender individuals may use nonsteroidal anti-inflammatory drugs (NSAIDS) to cope with health conditions such as vaginitis, STIs, or cervicitis to name a few (8). Oftentimes, treatment for gender-related issues may perpetuate pain itself. Cyclical testosterone dosing, for instance, is often associated with pelvic pain as well as orgasmic and penetration pain (8). Patients experiencing pain associated with gender and sexual orientation should always consider speaking to medical professionals for both mental and physical health. HIV-related spondyloarthropathy, a type of chronic joint pain, may be treated with NSAIDs such as indomethacin zidovudine as well (9).

As with any cluster of medical conditions, LGBT+ related pain is complicated, yet not unmanageable. According to Dr. Nadav Antebi-Gruzka, who researches resilience among LGBT+ individuals, “context really matters.” Patients experiencing pelvic pain associated with gender dysphoria, for example, may require more access to mental and physical health resources. Alternatively, providing LGBT+ patients with a welcoming, accepting environment when seeking medical attention may allow said patients to experience better health outcomes. According to Dr. Antebi-Gruszka, society-level resilience which promotes overall health includes programs and campaigns that eliminate stigma and create supportive communities. As always, pain should be recognized as a physical and psychological condition. By promoting this sort of awareness, as well as compassion and empathy within the medical community, members and allies of the LGBT+ community can fight the negative health outcomes of social stigma.


 

Citations

  1. Weber, G. (2008). Using to numb the pain: Substance use and abuse among lesbian, gay, and bisexual individuals. Journal of Mental Health Counseling, 30(1), 31-48.

  2. Meyer, I. (1995). Minority Stress and Mental Health in Gay Men. Journal of Health and Social Behavior, 36(1), 38-56. Retrieved from http://www.jstor.org/stable/2137286

  3. Cochran, S. D., & Mays, V. M. (2007). Physical health complaints among lesbians, gay men, and bisexual and homosexually experienced heterosexual individuals: results from the California Quality of Life Survey. American journal of public health, 97(11), 2048-2055.

  4. Brennan-Ing, M., Porter, K. E., Seidel, L., & Karpiak, S. E. (2014). Substance use and sexual risk differences among older bisexual and gay men with HIV. Behavioral Medicine, 40(3), 108-115.

  5. Pisklakov, S., & Carullo, V. (2016). Care of the Transgender Patient: Postoperative Pain Management. Topics in Pain Management, 31(11), 1-8.

  6. Abercrombie, P. D., & Learman, L. A. (2012). Providing holistic care for women with chronic pelvic pain. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41(5), 668-679.

  7. Merlin, J. S., Zinski, A., Norton, W. E., Ritchie, C. S., Saag, M. S., Mugavero, M. J., ... & Hooten, W. M. (2014). A conceptual framework for understanding chronic pain in patients with HIV. Pain Practice, 14(3), 207-216.

  8. Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People; 2nd edition. Deutsch MB, ed. June 2016.

  9. Lane, N. (1998, October). Comprehensive, up-to-date information on HIV/AIDS treatment and prevention from the University of California San Francisco. Retrieved April 13, 2017, from http://hivinsite.ucsf.edu/InSite?page=kb-00&doc=kb-04-01-15

Caitlin Monahan
Private vs. Federal Insurances: A Breakdown

One of the nation’s biggest ongoing debates is on the topic of insurance. Private and public health care have been constantly competing on the grounds of customer satisfaction and benefits to the country’s economy. Private insurance companies are favored for supposedly having better benefits, higher coverage, greater choice for consumers and adding competition to the marketplace. Public insurance, primarily Medicare, is favored for being simple, with benefits that are constant throughout the population, lower costs, and aiding with steady movement through changes in the healthcare system. Through a study made by the Federal Office of the Actuary on Medicare, Medicaid, and private health insurance company spending, it shows  that private companies are having to pay more for their customers per capita at an increasingly higher rate than public insurance. This may be because private insurance companies are responding to demands of higher coverage while public insurance remains consistent. [1]

Medicare is a health insurance program funded by the federal government usually for people who are 65 years or older, with certain exceptions for people with disabilities and particular diseases. Citizens will usually get a letter to sign up for Medicare before they turn 65, and if they decline and decide to sign up later on they may have to pay a penalty. In the case of people over 65 that are still working, they may stay with their work insurance and sign up for Medicare as soon as they decide to retire. Medicare plans can be given either through original Medicare or through approved private companies. Funding for the insurance plan comes from federal and state sources. [2]

Part A of Medicare is the hospital insurance that covers services related to hospital care. Part B is medical insurance including outpatient care and medical supplies, Part C is Medicare Advantage Plans, and Part D is prescription drug coverage. In Medicare, the periodic payment for health coverage is called a premium. If a person has paid Medicare taxes while working, they will not have to pay for Part A after they sign up for Medicare, because they are automatically signed up. Any other plan, the person has to sign up for in the window of time around their 65th birthday. According to Medicare.gov, after including Social Security benefits, Part B premium payment is around $109. Part D varies depending on coverage and income. Part C of Medicare, also known as Medicare Advantage plans, is a special type of plan Medicare provides where the customer is taken out of Medicare and placed with a private insurance company. The patient then becomes subject to all of the private insurer’s conditions and policies. When choosing between Medicare and private insurance for high-cost services, consumers should weigh out the costs between the two. While regular Medicare plans usually have higher premiums, they are more flexible for the patient and provide consistent care. A patient with this type of plan can be attended at any hospital or clinic that takes Medicare. For patients with medicare Advantage plans (MA), the private insurance company sets all the rules for them, including which hospitals they can go to and whether they need doctor referrals or not. MA plans tend to have lower premiums but it comes a cost, and generally the lower the premium, the more restrictive the insurance plan becomes. When choosing between workplace insurance and Medicare, it is necessary to outweigh the costs. Additionally, some workplace insurances have compensation accounts to pay extra costs when people leave their plan. This can result in a more appealing reason to switch to Medicare, assuming the payments will be lower.

As of a 2002 study, people with Medicare were more satisfied with their health insurance than consumers with private insurance.[3] The higher levels of satisfaction were probably due to more confidence in constant payments, for private insurance customers were more anxious with the costs of their healthcare plan.[4] The more stable health care plans and less financial difficulty of Medicare make it have “a level of security that is not typically found in employer or individual coverage markets.”[3] With a decrease in health, certain public health care consumers must pay for a larger portion themselves. For those below the poverty line, annual health expenditures almost double, and most of the burden goes onto Medicaid. Interesting enough, as age increases, the share of expenditures paid for by Medicaid rises while Medicare decreases. This is because as people get older, they often find themselves in elderly homes, a service Medicare does not pay for. When the elderly choose to live in a nursing home they many times pay for it with the last of their funds, lowering their wealth enough to qualify for Medicaid.

Something else to consider is the seemingly long periods of time that patients have to wait for an appointment with a specific doctor. Depending on the type of insurance that is accepted by different doctors and the specialization of the doctor, wait time could be up to months.[6] In a study done on dermatologists, it was concluded that between private and public insurance, it was necessary to draw a distinction between Medicare and Medicaid. Medicare and private insurance had similar wait periods for an appointment while Medicaid patients were rejected treatment by a physician at higher rates than the other two. Medicaid’s overall acceptance rate came in at 32%, while Medicare and private insurance were at 85% and 87% respectively.[6] Basically, the higher the physician is getting paid through the insurance and is feeling like he or she deserves, the more likely they are to treat a patient. It is necessary to understand, however, that regardless of the similarity between Medicare and private insurance acceptance rate, Medicare is simply accepted in a larger network than private companies. A person with private insurance must comply to the specific network the insurance provides, and there are usually no out-of-network services. If they do, the costs of having them outweigh the necessity.

Some elderlies choose to supplement their Medicare insurance with private insurance, where the supplemental insurance will pay the costs the primary insurance doesn’t cover.[5] If Medicare is the primary insurance, then a customer might have to pay for Part B premium before secondary insurance kicks in. If Medicare is the secondary insurance, then the deductible fee has to be paid before Medicare starts paying. When a person continues to work after 65 with their employee insurance, Medicare is the secondary insurance. After that, Medicare becomes primary.

The Commonwealth study shows that more Medicare people rate their health insurance as excellent than private insurance holders, but our healthcare system in the United States is far from perfect.[4] In most cases, Original Medicare are a considerable alternative to private insurance plans or Medicare Advantage plans,with more stable and flexible plans. A person that might not make many hospitals visits might be better off with a MA plan with cheaper premiums, but most elderly with regular doctor visits would benefit more from Original Medicare that might possibly just have higher coverage. It is important to stress the importance of choosing the correct plan from the beginning. While switching from Medicare to Medicare Advantage might not have any extra costs, adding supplemental plans when switching from MA to Medicare gives a heavy penalty that is probably not worth it. Anyone over 65 with the availability to apply for Medicare should and determine the best plan for their own medical needs.

 

Sources:

  1. “Public vs. Private Health Insurance on Controlling Spending” Drew Altman. The Kaiser Family Foundation, Wall Street Journal Think Tank (April 26, 2015)

  2. Medicare.gov

  3. "Medicare vs. Private Insurance: Rhetoric and Reality," Karen Davis, Cathy Schoen, Michelle Doty et al., Health Affairs Web Exclusive (October 9, 2002)

  4. The Commonwealth Fund 2001 Health Insurance Survey

  5. “Does Supplemental Private Insurance Increase Medicare Costs?” Lee A. Lillard, Jeannette Rogowski et al., Working Paper Series 95-16 (July 1995)

  6. “Medicare, Medicaid, and access to dermatologists: the effect of patient insurance on appointment access and wait times,” Jack Resneck, Mark J Pletcher, Nia Lozano et al., Journal of the American Academy of Dermatology V. 50 Issue 1 (January 2004)

 

Naile Ruiz
Allergies, and Diseases, and Vaccines, Oh My!

If you’re a human, like me, I’m sure you’ve sneezed at least once in your lifetime. While sneezing is a normal, semi-autonomous bodily function that your body uses to expel things that irritate your nasal mucous membrane, it can sometimes mean that there’s something else going on. This something else could be a few different things such as a viral infection, a bacterial infection, or pollen. Bodily infections are obviously harmful but what about pollen? Pollen seems pretty harmless, right? Despite this, many people suffer from allergies, with pollen being a common allergen.

        Allergies probably aren’t a foreign concept to you. Many people, myself included, have suffered or suffer from allergies, whether it be to pollen, gluten, or anything else. But why exactly do allergies happen? One person’s body might not react to pollen at all, yet another person experiences itchy eyes and goes into a sneezing fit whenever they smell a flower. The answer has to do with the immune system. An allergic reaction occurs when your immune system mistakes something harmless for a harmful pathogen, thus it mounts an immune response against the perceived threat.

        This begins when a type of white blood cell in your body called a T cell responds to a new, foreign antigen (the allergen) and thinks it’s dangerous. It then interacts with another type of white blood cell called a B cell. The B cell can create and secrete antibodies which will then circulate in the blood and bind to a specific receptor on the outside of other immune cells called basophils and mast cells. These immune cells are now able to cause an acute inflammatory response which results in the typical allergic reactions, such as sneezing, or getting rashes.

        So you now know a bit more about allergies. However, other threatening agents are out there, like the aforementioned viruses and bacteria. I say agents rather than organism because viruses aren’t considered living organisms by many. They’re small infectious particles of proteins and nucleic acids that infect the cells of living organisms and use them to replicate themselves. When the viruses aren’t inside a host cell they are called virions and they are sometimes covered by an envelope of lipids.

        Several illnesses such as the flu are caused by viruses. The flu, or influenza, has many symptoms such as a runny nose, sore throat, a fever, headaches, muscle pains and more. Influenza is an airborne disease and can also be spread by touching surfaces that have been contaminated with the virus and then putting your hands in your mouth or on your eyes. That’s why it’s important to always wash your hands, especially during flu season.

        There are antiviral drugs that help treat influenza, such as oseltamivir, but vaccination can prevent viral infections and is usually recommended for a lot of other viruses such as Hepatitis. Vaccination works by administering a weakened or nonfunctional version of a pathogen into the body. The body then mounts an immune response and is able to memorize the disease due to adaptive immunity. Adaptive immunity is basically how your body remembers a disease that it encountered in the past so that it’ll be able to quickly eliminate that disease if it is ever encountered again in the future. Vaccinations are the reason why diseases like polio are very rare nowadays. However, it is important to note that sometimes multiple vaccines may be necessary as the disease could rapidly evolve, thus your body will no longer be able to recognize it. Rapidly evolving diseases are difficult to become immune to.

Asides from influenza, an even more common viral disease is the common cold. Although you’re probably familiar with the common cold, you may not know that there are actually over two hundred different viral strains that can cause the common cold, with the most common strains being rhinoviruses. The common cold is also airborne and can be spread the same way as influenza. You can reduce your chances of getting the disease by washing your hands, just like with influenza. Unfortunately though, it’s difficult to vaccinate against the common cold because it mutates rapidly, but also because of all the different viral strains that are involved with this disease.

You’ve learned a little about viral diseases, but not all diseases are caused by viruses. Some are a result of microscopic organisms called bacteria. Bacteria are single celled creatures that are found virtually everywhere on Earth, including the human body! Although bacteria can cause disease, some of them are very beneficial to us. There are bacteria in our gastrointestinal (GI) tract that help with digestion and can create vitamins that we need to stay healthy. They even help to prevent dangerous bacteria from infecting the GI tract.

There are relatively few pathogenic bacterial species, but a well-known one is the streptococcus bacteria that causes strep throat. There are different ways of treating bacterial infections such as using nonsteroidal anti-inflammatory drugs (NSAIDs), or antibiotics. Although antibiotics have been a common treatment for many years, we’re currently faced with a serious problem involving their use.

Just like how we humans can gain immunity to certain diseases, bacteria are able to gain immunity to antibiotics, although through different means. There are a number of causes for bacteria evolving to become resistant to antibiotics. A big reason is because of the increase in antibiotics being prescribed and people not finishing their antibiotics or missing doses because the symptoms of the disease have lessened or disappeared. Another reason is that antibiotics being unnecessarily prescribed, such as to treat a viral infection even though antibiotics are completely useless against viruses.

The most important takeaway from this is to always finish your antibiotic regimen, even if you think you no longer need it. Hopefully in the near future we’ll discover a way to reverse bacterial resistance, but for now the best thing you can do is to try to remain healthy! Regular exercise, a good diet, and of course, remember to wash your hands!

Namdi Nwasike
The Link Between Pain & Geriatrics

Geriatric patients suffering with chronic pain are often undertreated, and as the elderly population continues to rise, issues regarding pain in the geriatric population is likely to increase. Therefore, pain management in elderly patients is an ongoing challenge that primary care physicians and other health officials must face by improving the quality of care.

The improper assessment of pain, the underreporting of pain by elderly patients, the debate about addiction and opioids, and the normal relationship between pain and aging are common reasons that there is lessened treatment for elderly patients suffering with pain. Physicians often blame undertreatment on improper training and pain assessment, along with the hesitation to prescribe opioids. As a consequence of undertreatment, many patients have suffered through mental illness including depression, anxiety, and social isolation. Patients have also faced cognitive impairment, immobility, and sleep disturbances.

Another important aspect of pain experienced by geriatric patients to understand is that their pain perception may be different than that of other age groups because of the atypical symptoms of diseases presented in older individuals, and the medications often used to treat the atypical symptoms in these patients can often have negative side-effects.
 

It may be difficult to assess pain in older individuals because they often see a correlation between pain and aging. Elderly patients often fear that there may be a more serious underlying problem that they want to avoid. They also tend to accept pain as a punishment as a result of their past actions. Thus, if you or someone you know is experiencing pain, it is important not to make assumptions, and to seek a physician to assess the pain.

To increase the efficacy of pain assessment doctors, patients, and families must understand that symptoms presented may be atypical. Physicians should also regularly ask about pain in their geriatric patients because it has been characterized as a vital sign. Pain can be assessed, even in patients who are cognitively impaired, using screening tools and questioning. For example, a verbally administered zero to 10 scale, 10 being the worst possible pain, is effective in measuring the level of pain in geriatric patients. Older patients and patients with cognitive impairment may have difficulties using this scale but there are other tools that can be used to assess the levels of pain including a visual analog scale, numerical scale, pain thermometer scale, and pain faces scale. Additionally, pain logs should be encouraged by physicians.

These are simple measures that can be taken to improve the effectiveness of pain treatment in geriatric patients. It is important to be sensitive to, and educated on, the matter because pain in the elderly may often present differently that pain in other age groups. To conclude, communication between physicians, patients and families,  proper training, and education on pain in the geriatric population are key factors that can help improve pain treatment in elderly patients.

Samantha Scerbo
Managing Pain with Exercise

Those who have dealt with chronic pain may be all too familiar with the fact that it can hinder their ability to carry out daily tasks. In the past, doctors used to prescribe bed rest for back pain and other chronic pain conditions but research shows that it may actually be making the problem worse. As tempting it may be to lie in bed and rest all day, exercise has proved to be a more effective treatment in helping people manage chronic pain and/or fatigue.

Chronic pain can be described as any pain that extends beyond the expected healing time and often impairs your ability to do daily activities. This can lead to an inactive lifestyle and in turn, increase your level of pain, leading to deconditioning of the body, thus, putting you at risk for other more severe health problems.

The U.S Department of Veterans Affairs defines a distinct cycle that develops when chronic pain is accompanied with an inactive lifestyle. This cycle begins with disinterest in exercise leading to inactivity and then to muscle weakness, finally ending in decreased fitness and continuation of pain. Daily exercise can end that downward cycle and replace it with a more positive cycle, which begins with exercise, leading to improved aerobic fitness and increased ability to perform daily activities

Research has shown that patients who have dealt with chronic pain or fatigue reported that moderate exercise decreased their fatigue, pain, stress, and other symptoms as well as alleviating joint and muscle pain. At the same time, starting a low intensity exercise regimen improved patients’ health perceptions, physical function and aerobic fitness, while also improving their ability to carry out daily tasks. If you need any more reasons to incentivize you to integrate exercise into your lifestyle, exercise has been praised for years, as offering a variety of health benefits besides decreased pain and fatigue to those with chronic pain. These include decrease in blood pressure, decreased risk for heart disease or stroke, improved sleep, decreased anxiety and depression along with a multitude of other benefits.

Low-intensity exercise such as walking, swimming, riding a stationary bike or using a rowing machine are all good aerobic exercises that those with chronic pain, may benefit from. Stretching exercises such as yoga are good additions to aerobic exercise because they increase blood supply and nutrients to the joints, decrease risk of injury, increase coordination, improve balance, and reduce stress in muscles. However, anyone looking into starting an exercise program should consult a doctor who can take into account your pain, fitness level, and can suggest appropriate activities. A physical therapist an also help you develop a regular exercise plan that is manageable in the long term.

Besides the physical health benefits, exercise has shown to improve people’s perceptions and tolerance of pain. In a study published by Medicine & Science in Sports & Exercise, researchers at the University of New South Wales and Neuroscience Research Australia recruited 12 healthy but inactive adults who expressed interest in exercising, and another 12 similar in age and activity levels but preferred not to exercise. Both groups were then tested for their reaction to pain.

Pain response is largely based on the individual and depends on his or her pain threshold, the point at which we start to feel pain, and pain tolerance, the amount of time that we can withstand the aching before we cease doing whatever is causing it. Scientists leading the study measured the pain thresholds and pain tolerances of both groups. After gathering the baseline, volunteers who said they would like to begin exercising, did so, undertaking a program of moderate stationary bicycling for 30 minutes, three times a week, for six weeks. The other volunteers continued their lives as they had before the study began.

After six weeks, all of the volunteers returned to the lab, and their pain thresholds and pain tolerances were retested. Unsurprisingly, the volunteers in the control group showed no changes in their response to pain. However, the volunteers in the exercise group showed significantly greater ability to withstand pain. Their pain thresholds had not changed (they began feeling pain at the same point they had before, but their tolerance had risen. Mathew Jones, a researcher at the University of New South Wales who led the study, stated that the implications are that the longer we stick with an exercise program, the less physically discomfiting it will feel. The study is also relevant for people struggling with chronic pain. By exercising, patients can increase their pain tolerance and learn to better deal with their discomfort before looking to other alternatives.

While exercise can be extremely effective against chronic pain, it is important to understand that it is part of a combination approach to resolving pain. Other options are prescription pain relieving medication from doctors and physical therapy which tackles the physical side of the inflammation, stiffness, and soreness with exercise, manipulation, and massage. Physical therapy also works to help the body heal itself by encouraging the production of the body’s natural pain-relieving chemicals. However, exercise poses as a very good and effective treatment option that patients can carry out on their own and integrate into leading a healthy lifestyle

Richard Yoon
More on Trigeminal Neuralgia

We have all had experience with pain, and know that it can take on many different forms and affect any portion of our body. Our faces are no exception to this; facial pain, or trigeminal neuralgia, is a chronic condition that is estimated to affect about 15,000 Americans each year. And, while women and people over the age of 50 are more likely to experience this pain, trigeminal neuralgia can affect anyone.

Trigeminal Neuralgia occurs when any of the three trigeminal nerve branches within our face become in some way damaged. Each trigeminal nerve controls the feelings for different parts of our face. The ophthalmic branch affects our eye and forehead area; the maxillary branch controls the middle portion of our faces, including cheeks, nostrils, and upper lip; while the mandibular branch is responsible for our lower lip, lower gum, and jaw muscles. Often, patients with facial pain report a painful sensation in an isolated portion of their face, which is due to these differentiated nerve branches.

But what causes trigeminal nerve damage in the first place? There are several things that can lead to the onset of facial pain. Usually, the pain occurs when the myelin sheath-a type of coating around the nerve-is damaged in some way. This typically occurs when excess pressure is placed upon it by a blood vessel or tumor, but diseases such as multiple sclerosis can also damage it. In other cases, facial pain may be prompted by a stroke, some sort of facial trauma, or brain abnormalities.

Generally, it is quite easy to recognize facial pain, due to its distinctive symptoms and isolated location. Patients with trigeminal neuralgia typically report short periods of intense, shooting or shock-like pain, which is typically triggered by a certain action, such as brushing teeth, speaking, or shaving. These are the symptoms of “classical” trigeminal neuralgia; however, “atypical” trigeminal neuralgia is classified by a duller but constant aching or burning feeling. Usually facial pain occurs on one side of the face, but in rare cases both sides can be affected in what is called bilateral trigeminal neuralgia.

If any of these symptoms seem recognizable to you, it is a good idea to consult with your doctor immediately for a proper diagnosis. When it comes to diagnosing trigeminal neuralgia, your doctor will ask a number of questions regarding the origin of the pain and what typically triggers it. A neurological exam, in which various parts of the face are touched or examined to determine precisely the location of the pain, is also a common procedure. Sometimes, MRI scans are used to determine whether there is an underlying cause to the facial pain, such as a tumor or multiple sclerosis.

The most typical treatment options for trigeminal neuralgia are either medication or surgery. Anticonvulsants or muscle relaxants are the most commonly prescribed drugs to lessen facial pain. These medicines work by blocking the nerve signals that send pain messages to the brain, thereby lessening the painful sensations that the patient feels.

In some cases, surgery is a better option. Surgery is usually used to either damage the nerve itself so that it can no longer malfunction, or to remove the source of what is compressing the nerve and therefore causing the symptoms of pain. Some of the most common of these types of procedures are microvascular decompression and gamma knife radiosurgery. In microvascular decompression, arteries that are in contact with the nerve are relocated, or veins compressing it are removed through a small incision behind the ear. In radiosurgery, a small dosage of radiation is directed at the root of the trigeminal nerve so that it is damaged and the pain is reduced or eliminated. While after microvascular decompression pain may eventually return, results are usually permanent for gamma knife radiosurgery, which can also be repeated multiple times if symptoms persist. In addition to these procedures, different types of rhizotomy procedures may be effective, in which nerve fibers are destroyed to cause targeted facial numbness and lessen the perception of the pain.

No matter what procedure is used, there are numerous options available for those who are suffering from trigeminal neuralgia. If you believe you may be experiencing facial pain, consult your doctor for aid and treatment options.

Allison Karantzis
The Future of Stem Cell Therapy in Pain Management

Stem cells are the baseline of development for any living organism. They originate from different places in our body and, contrary to popular belief, develop throughout our lives.

It is noteworthy to note that there are many kinds of stem cells. For example, embryonic stem cells are only found in the body during the earliest stage of development inside the mother’s womb. Adult stem cells, on the other hand, develop later on and remain a part of the body. Those that remain in your body throughout your life can change slightly as you age. Regardless of the type of stem cell, all of them can make copies of themselves and develop into more specialized cells. These have potential benefits when used in treatments and therapies.

Stem cell therapy involves using stem cells to treat or prevent a disease. The most widely accepted form of stem cell therapy is the usage of bone marrow to treat cancer patients with leukemia and lymphoma. During conventional chemotherapy, both cancerous and healthy cells in a patient’s bone marrow are destroyed, as the radiation cannot distinguish between the two. To help negate this negative affect, a donor’s bone marrow graft is transplanted into the patient to replace the lost healthy cells. These donor cells also produce an immune response in the body that helps kill cancer cells. This is but one of the many potential uses of stem cells as therapeutic technique.

The future of pain management with stem cell therapy is logical and promising. The ability of stem cells to repair and restore allows for exciting treatment possibilities for pain. Stem cells are generally gathered from bone marrow as this is the location where the most stem cells are found. For pain management, stem cells gathered from the back of the hip are conditioned and then injected at the site of damage with the expectation of stem cells assisting in regrowth of healthy cells in the area.

One of the primary concerns with this kind of therapy is the chance of unregulated cell growth. When non-specialized cells, that could develop into anything from a skin cell to a muscle cell, are injected into an area, there is a fear of these cells undergoing spontaneous mutations, foreshadowing the formation of a tumor. One of the conditions where stem cell therapy has been heavily researched is degenerative disc disease and disc herniation. Disc degeneration occurs primarily due to age but can also occur from injury to the spine. This painful condition results in disc weakening and tearing as they no longer support the spine, as well as herniation which is where the disc presses painfully against the spinal nerves. Current treatment methods for this condition include pain treatment with medication, surgery, or injections. Strong drugs such as opioids are dangerous and have a significant amount of side effects. Invasive surgery permanently changes the body’s natural structure and sometimes is unsuccessful. Injections may help reduce pain but do not fix the problem on a cellular level. Stem cells would ideally repair and regenerate the weakened and torn areas. The future beholds clinical trials for this kind of treatment as many studies have indicated the positive effects it would have.

 

So when can stem cell therapy be effectively used?

 

Stem cell therapy is most effective for patients with moderately severe diseases. They cannot be introduced into an area where a structure is missing. If you have a tendon that has been surgically removed, for example, stem cells will not grow it back from nothing. Patients who have a disease of moderate severity and would like to avoid surgery are ideal candidates for stem cell therapy. Stem cells require a template to work from. They jump start the bodies natural healing process and stimulate the stem cells already present in the region as well to help repair any damage.

Many patients who turn to stem cell therapy have been given demoralizing choices initially. Patients who have been told that there is nothing left to do other than surgery, or that this is a chronic condition they will have to learn to live with it, are the kinds of patients who get a new lease on life with stem cell therapy. This is an option that comes from a perspective of healthcare providers who are not necessarily anti-surgery, but understand why someone may want to try alternatives first.

Existing treatment options for stem cell therapy include hip, knee, shoulder, spine, wrist, ankle and elbow treatments for arthritis related pain as well as minor tears and injuries. These treatments are FDA approved and currently put in practice by Industry leader Regenexx. The future of pain management treatment with stem cell therapy is a bright and promising one.

Malini Basu