- Gum Chewing in Kids Under-Recognized Cause of Headaches
- OIG Advisory Opinion OKs prompt pay discounts – Paid Subscribers
- Should All Antiepileptic Drugs Be Given With Folic Acid?
- Postural Control and Functional Strength in Patients With Type 2 Diabetes Mellitus With and Without Peripheral Neuropathy
- Where the United States Spends its Spine Dollars: Expenditures on different ambulatory services for the management of back and neck conditions – Paid Subscribers
- Manipulation/Manual Therapy in the Treatment of Osteoarthritis
- Why do we gain the weight back after weight loss? – Paid Subscribers
- Chelation Cuts Cardiac Events
- Group Releases Criteria for PCOS Diagnosis
- Statins: Not for everyone…maybe not for anyone
- Sweden Becomes First Western Nation to Reject Low-fat Diet Dogma in Favor of Low-carb High-fat Nutrition
- Drug Therapy for the Treatment of Chronic Nonspecific Low Back Pain – Paid Subscribers
- Chronic Neck pain and Emotional Factors
- Supplement Combo Lessens HIV Progression
- Post-Menopause Brain Drain Tied to Progesterone – Paid Subscribers
- Evaluation of shoulder-specific patient-reported outcome measures: a systematic and standardized comparison of available evidence
- The association between pain diagram area, fear-avoidance beliefs, and pain catastrophising
- The six degrees of freedom motion of the human head, spine, and pelvis in a frontal impact
- How sugar affects the brain – VIDEO – Paid Subscribers
- Adolescent Idiopathic Scoliosis: A 71 Cases Study Ascertaining that Straightening Is Possible, and a New Etiological Hypothesis
- Addressing the Root Causes of Asthma – VIDEO – Paid Subscribers
- Dietary patterns and breast cancer risk among women – Paid Subscribers
- Altered Spinal Motion in Low Back Pain Associated with Lumbar Strain and Spondylosis
- Migration patterns of herniated disk fragments, a study on 1020 patients with extruded lumbar disk herniation
- Back pain’s association with vertebral end-plate signal changes in sciatica
- Management of acute whiplash: a randomized controlled trial of multidisciplinary stratified treatments
- Nutritional Supplements for Pain Management—What’s Real? What’s Hype? Part 1 – Paid Subscribers
- Nutritional Supplements for Pain Management—What’s Real, What’s Hype? Part 2 – Paid Subscribers
- Dietary Fiber Associated With Reduced CV Risk and Lower CRP Levels
- Mitochondrial Dysfunction and Chronic Disease: Treatment With Natural Supplements
- Effects of vitamin D on patients with fibromyalgia syndrome – Paid Subscribers
- MS: Slow Progression With Vitamin D?
- Narrowband Ultraviolet B Phototherapy in Children With Eczema
- Mediterranean Diet May Also Prevent Peripheral Artery Disease
- Asthma, Rhinitis, and Contact Urticaria in Hairdressers Caused by Oxidative Hair Dyes
- Dementia: Is Gluten the Culprit? – Paid Subscribers
- Meditation May Slow Progression to Alzheimer’s
- Top Five Pain Interventions to Avoid – Paid Subscribers
- High Omega-3 PUFA Intake Reduces Type 2 Diabetes Risk
- The relationship between incontinence, breathing disorders, gastrointestinal symptoms, and back pain in women
- Mitochondrial Cytopathy – VIDEO
- How to Cure Irritable Bowel Syndrome in a Few Days – Paid Subscribers
- Bilateral and multiple cavitation sounds during upper cervical thrust manipulation – Paid Subscribers
- Mindfulness Meditation Programs for Stress and Well-Being: A Meta-Analysis
- Dietary Supplements With Omega-3 Fatty Acids and Antioxidants for Dry Eye – Paid Subscribers
- Effects of cervical joint manipulation on joint position sense of normal adults
- Metabolic Syndrome Increases Risk For Severe Knee—But Not Hip—OA
- Hallux Varus
- The Science of Treating Neck Pain – Paid Subscribers
- Rephrasing the Subluxation: Capturing Lightning in a Bottle
- The 15-Second Frailty Screen – VIDEO
Gum Chewing in Kids Under-Recognized Cause of Headaches
Pauline Anderson
January 17, 2014
Treating some headaches in children may be a simple matter of getting them to quit chewing gum.
A new study suggests that excessive gum chewing may be an important but under-recognized trigger for headaches in older children.
The researchers, led by Nathan Watemberg, MD, Child Neurology Unit and Child Development Center, Meir Medical Center, Tel Aviv University, Israel, believe that excessive gum chewing causes headache not through the ingestion of aspartame from the gum, as has been previously suggested, but by putting undue exertion on the temporomandibular joint (TMJ).
“We feel that the mechanical burden is the culprit, as the amount of aspartame in the gum is small and, as this substance is present in sodas and other diet products, one would expect aspartame to be well associated with headaches, which is not the case,” Dr. Watemberg told Medscape Medical News.
He advises that doctors make a point of enquiring about the gum chewing habits of adolescents reporting daily or recurrent headaches. “If the neurological examination is normal and the habit is present, they should first of all discontinue it to see if headaches improve, before embarking on expensive diagnostic procedures, or prescribing medications for the headache,” Dr. Watemberg notes.
Their findings are published in the January issue of Pediatric Neurology.
Full Story (may require free registration): http://www.medscape.com/viewarticle/819390
OIG Advisory Opinion OKs prompt pay discounts
The OIG recently issued an Advisory Opinion (No. 08-03) addressing a provider’s proposed arrangement by which it would offer prompt pay discounts in connection with both inpatient and outpatient services to insured patients, including those covered by Medicare and Medicaid. The prompt pay discounts would range from 5% to 15% depending upon the time payment is made, which may include the time of discharge or within 30 days of discharge. The OIG determined that although the prompt pay discounts could generate prohibited remuneration under the anti-kickback statute, the OIG would not impose administrative sanctions or civil monetary penalties, concluding that several factors were present that constitute a legitimate prompt pay incentive and not a means to induce patients to self-refer. Such factors include: (1) any amounts forgone would not be claimed as debt; (2) the discount would be offered without regard to the reason for the patient’s admission, length of stay, diagnostic-related group, or ambulatory payment classification; and (3) the discount would not be part of a price-reduction agreement between the provider and any third-party payor. In addition, the fact that (1) the provider would not advertise the discounts; (2) third-party payors would be notified of the discounts; (3) all costs associated with the proposed arrangement would be borne by the provider and not be written off to bad debt; and (4) the discounts were certified by the provider to be reasonably related to the amount of collection cost that would be avoided were critical to the OIG’s analysis.
Paid Subscribers Click Here For Full Story and Link To Advisory Opinion Paper Online
Should All Antiepileptic Drugs Be Given With Folic Acid?
Darrell Hulisz, PharmD
November 21, 2013
Folic acid (vitamin B9) is a water-soluble B vitamin that is essential for DNA repair, cell division, and normal cellular growth. Profound deficiency of folic acid during pregnancy has been associated with neural tube defects, such as spina bifida in neonates. Deficiency in adults has been associated with megaloblastic anemia and peripheral neuropathy. In both men and women, low serum levels of folate can increase homocysteine levels, which are correlated with elevated cardiovascular risk. Low folic acid levels during pregnancy in women with epilepsy have been associated with fetal malformation, and older enzyme-inducing AEDs are known to reduce serum folate levels.
Full Story: http://www.medscape.com/viewarticle/814588
Postural Control and Functional Strength in Patients With Type 2 Diabetes Mellitus With and Without Peripheral Neuropathy
Maíta M. Vaz, BSc
Archives of Physical Medicine and Rehabilitation
Volume 94, Issue 12 , Pages 2465-2470, December 2013
Abstract
Objective
To assess the influence of diabetic neuropathy (DN) on balance and functional strength in patients with diabetes mellitus type 2 (DM2).
Design
Cross-sectional study.
Setting
Diabetes outpatient unit.
Participants
Adults (N=62; age range, 40–65y): 32 with DM2 (19 subjects without DN and 13 with DN) and 30 without DM2 (control group).
Interventions
Not applicable.
Main Outcome Measures
Upright balance, evaluated in 4 situations (fixed platform, unstable platform, with eyes open, with eyes closed), and functional strength, assessed with a five-times-sit-to-stand test, were analyzed using an electromagnetic system, with a sensor placed over C7 to allow maximum trunk displacements in the anterior-posterior and medial-lateral directions. The Berg Balance Scale and the Timed Up & Go test were also used.
Results
Subjects with DM2 had greater anterior-posterior displacement (P<.05) in the unstable platform with eyes closed condition compared with those without DM2, whereas no difference in medial-lateral displacement was observed between these groups. A difference in time was observed in the five-times-sit-to-stand test (P<.05), with subjects in the control group performing the tasks faster than either group of subjects with DM2. Additionally, subjects in the control group showed a higher score in the Berg Balance Scale and performed the Timed Up & Go test in less time compared with subjects in other groups.
Conclusions
Subjects with DM2, with or without DN, showed deficits in postural control and functional strength compared with healthy individuals of the same age group.
Journal Reference: http://www.archives-pmr.org/article/S0003-9993(13)00458-9/abstract
Where the United States Spends its Spine Dollars: Expenditures on different ambulatory services for the management of back and neck conditions
Approximately 6% of US adults reported an ambulatory visit for a primary diagnosis of a back or neck condition (13.6 million in 2008). Between 1999 and 2008, the mean inflation-adjusted annual expenditures on medical care for these patients increased by 95% (from $487 to $950); most of the increase was accounted for by increased costs for medical specialists, as opposed to primary care physicians. Over the study period, the mean inflation-adjusted annual expenditures on chiropractic care were relatively stable; while physical therapy was the most costly service overall, in recent years those costs have contracted.
Paid Subscribers Click Here For Full Text Article
Manipulation/Manual Therapy in the Treatment of Osteoarthritis
Vernon H (2013) Manipulation/Manual Therapy in the Treatment of Osteoarthritis
J Arthritis 3:e107. doi:
Manual manipulation has a long history in the treatment of musculoskeletal pain [1]. Manipulation for the treatment of spinal pain conditions has become widely accepted as a result of numerous clinical trials, systematic reviews and clinical guidelines [2-4]. Surveys of chiropractic practice confirm that the vast majority of patients treated with manipulation present with MSK pain, and the majority of these present with spinal pain (back pain, neck pain) [5]. Manipulation for non-spinal or peripheral joints appears to be provided to a smaller proportion of patients. Accordingly, there has been less research in this area than in the area of spinal pain complaints.
Full Text Article: http://www.omicsgroup.org/journals/manipulation-manual-therapy-in-the-treatment-of-osteoarthritis-2167-7921.1000e107.php?aid=12806
Why do we gain the weight back after weight loss?
The present review, which focuses on data from human studies, begins with an outline of body weight regulation to provide the context for the subsequent discussion of short- and long-term physiological changes which accompany diet-induced weight loss.
Paid Subscribers Click Here For Full Text Article
Chelation Cuts Cardiac Events
Published: Nov 25, 2013
By Todd Neale, Senior Staff Writer, MedPage Today
Chelation Has Benefits in Patients With Diabetes
Chelation reduced major cardiovascular events in patients with diabetes, but not in those without diabetes, a subgroup analysis of the TACT trial showed.
The overall trial results, reported at the American Heart Association meeting last year, showed a significant benefit from chelation therapy using disodium ethylene diamine tetra-acetic acid (EDTA) versus placebo in patients 50 and older who had had a prior myocardial infarction.
But the new analysis — which was presented at this year’s AHA meeting and published inCirculation: Cardiovascular Quality and Outcomes — suggests that the benefit is confined to the patients with diabetes, who made up 37% of the trial population. In that subgroup, the risk of any cardiovascular event — including death, reinfarction, stroke, coronary revascularization, or hospitalization for angina — over 5 years was reduced by 41% with chelation (25% versus 38%; HR 0.59, 95% CI 0.44-0.79). The number needed to treat was 6.5.
“These findings support efforts to replicate these findings and define the mechanisms of benefit,” Gervasio Lamas, MD, of Mount Sinai Medical Center in Miami Beach, Fla., and colleagues wrote in their paper. “However, they do not constitute sufficient evidence to indicate the routine use of chelation therapy for all post-myocardial infarction patients with diabetes mellitus.”
Full Story: http://www.medpagetoday.com/Cardiology/MyocardialInfarction/43100
Group Releases Criteria for PCOS Diagnosis
Image from MedPageToday.com
Published: Oct 28, 2013
By Salynn Boyles, Contributing Writer, MedPage Today
Women with at least two of the three cardinal features of polycystic ovary syndrome (PCOS) should be considered to have the disorder, according to clinical practice guidelines released by the Endocrine Society.
The new guidelines endorse the Rotterdam criteria for diagnosing PCOS, which identifies excess androgen production, ovulatory dysfunction, and polycystic ovaries as the key diagnostic features of the disorder in adult women.
An independent panel convened by the National Institutes of Health (NIH) also endorsed the diagnostic classification system in a report published in January.
A goal of the newly released clinical practice guidelines was to simplify diagnosis and treatment recommendations for PCOS, which affects about 5 million women in the U.S. and is a leading cause of infertility, according to the Endocrine Society guidelines released online Friday and scheduled for publication in the December issue of the Journal of Clinical Endocrinology & Metabolism.
Full Story: http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology/42519
Statins: Not for everyone…maybe not for anyone
Michael Eades, M.D.
Michael Eades, M.D.
Part 2 of the Heart of the Matter aired last night in Australia. And not without a lot of courage on the part of ABC and Dr Maryanne Demasi, who conceived of and put the show together. This program, an absolutely devastating expose of the dangers and general uselessness of statin drugs, was fought tooth and toenail by the mainstream statinators. When you watch the show, you’ll know why.
For years I have been harping on this blog about how statins have been grossly oversold to both the doctors and the public. But this should not come as a surprise since statins as a group are the largest selling class of drugs in the world accounting for God only knows how much profit to the pharmaceutical industry. I’m the last person to gripe about someone making money, but in this case, I have a real problem. Why? Because there is so much Big Pharma money out there that it affects everything. It seeps into doctors lives starting with their medical training right through to retirement.
Sweden Becomes First Western Nation to Reject Low-fat Diet Dogma in Favor of Low-Carb High-fat Nutrition
Brian Shilhavy
Health Impact News Editor
Sweden has become the first Western nation to develop national dietary guidelines that reject the popular low-fat diet dogma in favor of low-carb high-fat nutrition advice.
The switch in dietary advice followed the publication of a two-year study by the independent Swedish Council on Health Technology Assessment. The committee reviewed 16,000 studies published through May 31, 2013….
Drug Therapy for the Treatment of Chronic Nonspecific Low Back Pain
This review endorses the use of COX-2 NSAIDs as the first-line drugs for CNLBP. Tramadol shows no statistically significant effect on pain relief, but has small effect sizes in improving functioning. Among included opioid therapy studies, the overall effects of opioids and the partial opioids agonist drug had statistically significant treatment effects in pain relief for CNLBP patients.
Chronic Pain and Emotional Factors
The determinants of function and disability in neck patients referred to a specialized outpatient clinic
Johansen JB, et al.
Clin J Pain. 2013 Dec;29(12):1029-35. doi: 10.1097/AJP.0b013e31828027a2.
Abstract
AIM/OBJECTIVES/BACKGROUND: Considerable attention has been paid to assessing the risk factors for the development of disability following neck pain (NP) in the general population, but we still lack knowledge regarding disability in NP patients referred to a specialist level of care. This study investigated the associations among the socio-demographic characteristics, work ability, self-reported pain, emotional distress, fear of movement and disability of NP patients referred to a specialised neck and back outpatient clinic. In total, 221 patients participated in this cross-sectional study, which was conducted from December 2007 to December 2009.
METHODS: The associations between demographics, pain reports, emotional distress, fear of movement and the self-reported disability of NP were investigated by correlation and regression analyses.The pain intensity was assessed using the numeric rating scale (NRS), the pain distribution was assessed by the number of pain areas drawn, emotional distress was assessed by the Hopkins Symptom Checklist version 25 (HSCL-25), and the fear of movement was assessed by the Tampa Scale for Kinesiophobia (TSK). The self-rated disability was assessed using the Neck Disability Index (NDI).
RESULTS: The mean NDI score was 41.9 (SD, 16). According to the multiple regression analysis, emotional distress explained 37% of the variance in the NDI, the pain intensity 12%, and the pain distribution and the fear of movement accounted for 4%. The pain intensity and emotional distress were the strongest individual explanatory variables (β-values: 0.36 [95% CI, 1.96-3.56] and 0.33 [95% CI, 0.24-0.51], respectively).
CONCLUSIONS: These results suggest that emotion should be considered in any assessment of patients with chronic NP and targeting emotional factors should be an integral part of treatment strategies.
PubMed Reference: http://www.ncbi.nlm.nih.gov/m/pubmed/23370090/
Supplement Combo Lessens HIV Progression
Published: Nov 26, 2013
By Michael Smith, North American Correspondent, MedPage Today
Early in HIV infection, a combination of multivitamin and selenium supplements slowed the progress of the disease, researchers reported.
In a randomized placebo-controlled clinical trial in Botswana, the combination cut — by about half — the risk of reaching the point of needing antiretroviral therapy, according to Marianna Baum, PhD, of Florida International University in Miami, and colleagues.
But multivitamins or selenium alone had no significant effect, Baum and colleagues reported in the Nov. 27 issue of the Journal of the American Medical Association…..
Full Story: http://www.medpagetoday.com/HIVAIDS/HIVAIDS/43142
Post-Menopause Brain Drain Tied to Progesterone
Image from MedPageToday.com
Estrogen levels after menopause may have no impact on cognitive function, but progesterone levels might, researchers found.
Evaluation of shoulder-specific patient-reported outcome measures: a systematic and standardized comparison of available evidence
Stefanie Schmidt, MPH
J Shoulder Elbow Surg (2013) (Epub ahead of print).
Background
The aim of this study was to perform a standardized and systematic evaluation of the available evidence on multi-item shoulder-specific patient-reported outcome measures that are applicable to a wide spectrum of disorders.
Materials and methods
A systematic review was conducted in PubMed to identify articles with information regarding the development process, metric properties, and administration issues of shoulder-specific patient-reported outcome measures. Two experts independently reviewed all the articles identified for one instrument and applied the EMPRO (Evaluating Measures of Patient Reported Outcomes) tool, which was designed to assess the quality of attributes in a standardized way. An overall EMPRO score and 6 attribute-specific scores were calculated (range, 0-100) to describe the quality of instrument performance.
Results
We identified 11 instruments and 112 articles (2-30 articles per instrument). The American Shoulder and Elbow Surgeons (ASES) shoulder assessment, Simple Shoulder Test (SST), and Oxford Shoulder Score (OSS) were the best rated, with overall scores of 77.4 points, 72.6 points, and 69.7 points, respectively. They have been shown to be valid, reliable, and responsive, with a low administration burden. Acceptable results were also found for the Flexilevel Scale of Shoulder Function, Shoulder Pain and Disability Index, and Dutch Shoulder Disability Questionnaire, but some of their attributes need further evaluation.
Conclusions
Current evidence supports the use of the ASES, SST, or OSS. We recommend the SST for longitudinal studies or clinical trials, the Dutch Shoulder Disability Questionnaire for clinical practice to minimize administration burden, and the ASES or OSS to discriminate among patients’ or groups’ evaluations at one point of time.
Journal Reference: http://www.jshoulderelbow.org/article/S1058-2746(13)00513-2/abstract
The association between pain diagram area, fear-avoidance beliefs, and pain catastrophising
Bruce F Walker
Chiropractic & Manual Therapies 2014, 22:5
Published: 20 January 2014
Background
The development of clinical practice guidelines for managing spinal pain have been informed by a biopsychosocial framework which acknowledges that pain arises from a combination of psychosocial and biomechanical factors. There is an extensive body of evidence that has associated various psychosocial factors with an increased risk of experiencing persistent pain. Clinicians require instruments that are brief, easy to administer and score, and capable of validly identifying psychosocial factors. The pain diagram is potentially such an instrument. The aim of our study was to examine the association between pain diagram area and psychosocial factors.
Methods
183 adults, aged 20–85, with spinal pain were recruited. We administered a demographic checklist; pain diagram; 11-point Numerical Rating Scale assessing pain intensity; Pain Catastrophising Scale (PCS); MOS 36 Item Short Form Health Survey (SF-36); and the Fear Avoidance Beliefs Questionnaire (FABQ). Open source software, GIMP, was used to calculate the total pixilation area on each pain diagram. Linear regression was used to examine the relationship between pain diagram area and the following variables: age; gender; pain intensity; PCS total score; FABQ-Work scale score; FABQ-Activity scale score; and SF-36 Mental Health scale score.
Results
There were no significant associations between pain diagram area and any of the clinical variables.
Conclusion
Our findings showed that that pain diagram area was not a valid measure to identify psychosocial factors. Several limitations constrained our results and further studies are warranted to establish if pain diagram area can be used assess psychosocial factors.
Journal Reference: http://www.chiromt.com/content/22/1/5/abstract
The six degrees of freedom motion of the human head, spine, and pelvis in a frontal impact
Lopez-Valdes FJ, et al.
Traffic Inj Prev. 2014;15(3):294-301. doi: 10.1080/15389588.2013.817668.
Abstract
Objective: The goal of this study is to characterize the in situ 6-degree-of-freedom kinematics of the head, 3 vertebrae (T1, T8, and L2), and the pelvis in a 40 km/h frontal impact. Methods: Three postmortem human surrogates (PMHS) were exposed to a deceleration of 15 g over 125 ms and the motion of selected anatomical structures (head, T1, T8, L2, and pelvis) was tracked at 1000 Hz using an optoelectric stereophotogrammetric system. Displacements of the analyzed structures are reported in the sagittal and the transverse planes. Rotations of the structures are described using the finite helical axis of the motion. Results: Anterior displacements were 530.5 ± 39.4 mm (head), 434.7 ± 20.0 mm (T1), 353.3 ± 29.6 mm (T8), 219.9 ± 19.3 mm (L2), and 78.9 ± 22.1 mm (pelvis). The ratio between peak anterior and lateral displacement was up to 19 percent (T1) and 26 percent (head). Magnitudes of the rotation of the head (69.9 ± 1.5°), lumbar (66.5 ± 9.1°), and pelvis (63.8 ± 11.8°) were greater than that of the thoracic vertebrae (T1: 49.1 ± 7.8°; T8: 47.7 ± 6.3°). Thoracic vertebrae exhibited a complex rotation behavior caused by the asymmetric loading of the shoulder belt. Rotation of the lumbar vertebra and pelvis occurred primarily within the sagittal plane (flexion). Conclusion: Despite the predominance of the sagittal motion of the occupant in a pure (12 o’clock) frontal impact, the asymmetry of belt loading induced other relevant displacements and rotations of the head and thoracic spine. Attempts to model occupant kinematics in a frontal impact should consider these results to biofidelically describe the interaction of the torso with the belt.
How sugar affects the brain – VIDEO
When you eat something loaded with sugar, your taste buds, your gut and your brain all take notice. This activation of your reward system is not unlike how bodies process addictive substances such as alcohol or nicotine — an overload of sugar spikes dopamine levels and leaves you craving more.
Adolescent Idiopathic Scoliosis: A 71 Cases Study Ascertaining that Straightening Is Possible, and a New Etiological Hypothesis
Jan Polak
Asian Spine J. 2013 December; 7(4): 282–288.
Published online 2013 November 28. doi: 10.4184/asj.2013.7.4.282
Abstract
Study Design
Seventy-one children (23 boys and 48 girls, aged 6 to 18 year-old) with adolescent idiopathic scoliosis (AIS) between 11° and 62°, without braces, have been treated manually, only at the level of the neck.
Purpose
To ascertain that non-surgical straightening of AIS is possible (without brace).
Overview of Literature
So far no disease modifying treatment for AIS existed. Braces can only slow down worsening (and this can only be achieved if they are worn 23 hours a day). Surgery is not without important risks.
Methods
All patients have been treated exclusively with a manual therapy called Brachy-Myotherapy. This method treats spasmed (contractured) muscles by placing them in a shortening position according to a specific protocol.
Results
An average straightening of 8° of AIS was observed, with a maximum of 25°. 94% of cases improved, 67 out of 71. The worst prognosis was, the better results. The more advanced AIS was, the better the results.
Conclusions
A simple and reliable treatment of AIS is possible. AIS seems to be a compensation mechanism of the body, with the aim of keeping the ears, and thus the labyrinths, at a horizontal level for correct equilibrium. When lasting post-traumatic neck muscle contractures causing a permanent side-bending of the skull have been treated, this compensation mechanism becomes irrelevant and scoliosis tends to subside.
Full Text Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863653/
Addressing the Root Causes of Asthma – VIDEO
Paid Subscribers, Click Here for VIDEO
Dietary patterns and breast cancer risk among women
“…the ‘unhealthy’ food pattern was characterized by the consumption of soft drinks, sugars, tea and coffee, French fries and potato chips, salt, sweets and desserts, hydrogenated fats, nuts, industrial juice, refined grains, and red and processed meat…”
Altered Spinal Motion in Low Back Pain Associated with Lumbar Strain and Spondylosis
Joseph S. Cheng
Evidence-Based Spine-Care Journal 2013; 04(01): 006-012
Abstract
Study Design We present a patient-specific computer model created to translate two-dimensional (2D) fluoroscopic motion data into three-dimensional (3D) in vivo biomechanical motion data.
Objective The aim of this study is to determine the in vivo biomechanical differences in patients with and without acute low back pain. Current dynamic imaging of the lumbar spine consists of flexion–extension static radiographs, which lack sensitivity to out-of-plane motion and provide incomplete information on the overall spinal motion. Using a novel technique, in-plane and coupled out-of-plane rotational motions are quantified in the lumbar spine.
Methods A total of 30 participants—10 healthy asymptomatic subjects, 10 patients with low back pain without spondylosis radiologically, and 10 patients with low back pain with radiological spondylosis—underwent dynamic fluoroscopy with a 3D-to-2D image registration technique to create a 3D, patient-specific bone model to analyze in vivo kinematics using the maximal absolute rotational magnitude and the path of rotation.
Results Average overall in-plane rotations (L1–L5) in patients with low back pain were less than those asymptomatic, with the dominant loss of motion during extension. Those with low back pain also had significantly greater out-of-plane rotations, with 5.5 degrees (without spondylosis) and 7.1 degrees (with spondylosis) more out-of-plane rotational motion per level compared with asymptomatic subjects.
Conclusions Subjects with low back pain exhibited greater out-of-plane intersegmental motion in their lumbar spine than healthy asymptomatic subjects. Conventional flexion–extension radiographs are inadequate for evaluating motion patterns of lumbar strain, and assessment of 3D in vivo spinal motion may elucidate the association of abnormal vertebral motions and clinically significant low back pain.
Migration patterns of herniated disk fragments, a study on 1020 patients with extruded lumbar disk herniation
Mohammad Hussein Daghighi, MD
The Spine Journal
Available online 18 December 2013 In Press
Abstract
Background Context
Herniated disc fragments are known to migrate in various directions within the spinal canal. To date, no comprehensive studies have been undertaken to examine the migration patterns of herniated disc material using a standard nomenclature and classification system.
Purpose
To report migration patterns of extruded lumbar disc fragments.
Study Design
A review of magnetic resonance (MR) images.
Patient Sample
A total of 1020 consecutive Azeri patients with symptomatic extruded lumbar intervertebral disc herniation.
Outcome Measures
Migration patterns of extruded lumbar disc fragments in vertical and horizontal planes, and their association with age, gender, body mass index (BMI) and the level of herniation.
Methods
High-quality axial and sagittal MR images of the lumbar spine were used. Disc material that was displaced away from the site of extrusion, regardless of continuity, was considered “migrated”. The migration patterns observed were rostral or caudal in the vertical plane, and central, paracentral, subarticular, foraminal, or extraforaminal in the horizontal plane. The authors declare no conflict of interests or outside sources of support.
Results
In the vertical plane, rostral and caudal migrations were observed in 27.8% and 72.2% of the patients, respectively. The number of rostral migrations increased significantly with increasing age and in higher levels in the lumbar spine (p
In the horizontal plane, central, paracentral, subarticular, foraminal, and extraforaminal migrations were reported in 17.3%, 74.2%, 4.3%, 2.5%, and 1.8% of the patients, respectively. The youngest (median age: 39 years, interquartile range: 13 years) and the oldest (median age: 55 years, interquartile range: 15 years) groups of patients (p<0.001) had the most formainal and extraforaminal migrations, respectively. Radiculopathy was present in 66.5%, 76.8%, 88.6%, 96%, and 27.8% of the patients with central, paracentral, subarticular, foraminal and extraforaminal migrations, respectively (p<0.001). No significant association was found between gender, BMI or the level of herniation and migration pattern in the horizontal plane.
Conclusions
Caudal and paracentral migrations are the most common patterns of migration in patients with extruded lumbar disc herniation in the vertical and horizontal planes, respectively. Age and the level of herniation may affect the migration patterns of herniated lumbar disc material.
Back pain’s association with vertebral end-plate signal changes in sciatica
Abdelilah el Barzouhi, MD, MSc
The Spine Journal
Volume 14, Issue 2, 1 February 2014, Pages 225–233
Abstract
Background context
Patients with sciatica frequently experience disabling back pain. One of the proposed causes for back pain is vertebral end-plate signal changes (VESC) as visualized by magnetic resonance imaging (MRI).
Purpose
To report on VESC findings, changes of VESC findings over time, and the correlation between VESC and disabling back pain in patients with sciatica.
Study design/setting
A randomized clinical trial with 1 year of follow-up.
Patients sample
Patients with 6 to 12 weeks of sciatica who participated in a multicenter, randomized clinical trial comparing an early surgery strategy with prolonged conservative care with surgery if needed.
Outcome measures
Patients were assessed by means of the 100-mm visual analog scale (VAS) for back pain (with 0 representing no pain and 100 the worst pain ever experienced) at baseline and 1 year. Disabling back pain was defined as a VAS score of at least 40 mm.
Methods
Patients underwent MRI both at baseline and after 1 year follow-up. Presence and change of VESC was correlated with disabling back pain using chi-square tests and logistic regression analysis.
Results
At baseline, 39% of patients had disabling back pain. Of the patients with VESC at baseline, 40% had disabling back pain compared with 38% of the patients with no VESC (p=.67). The prevalence of type 1 VESC increased from 1% at baseline to 35% 1 year later in the surgical group compared with an increase from 3% to 11% in the conservative group. The prevalence of type 2 VESC decreased from 40% to 29% in the surgical group while remaining almost stable in the conservative group at 41%. The prevalence of disabling back pain at 1 year was 12% in patients with no VESC at 1 year, 16% in patients with type 1 VESC, 11% in patients with type 2 VESC, and 3% in patients with both types 1 and 2 VESC (p=.36). Undergoing surgery was associated with increase in the extent of VESC (odds ratio [OR], 8.6; 95% confidence interval [CI], 4.7–15.7; p<.001). Patients who showed an increase in the extent of VESC after 1 year did not significantly report more disabling back pain compared with patients who did not show any increase (OR, 1.2; 95% CI, 0.6–2.6; p=.61).
Conclusion
In this study, undergoing surgery for sciatica was highly associated with the development of VESC after 1 year. However, in contrast with the intuitive feeling of spine specialists, those with and those without VESC reported disabling back pain in nearly the same proportion. Therefore, VESC does not seem to be responsible for disabling back pain in patients with sciatica.
Management of acute whiplash: a randomized controlled trial of multidisciplinary stratified treatments
Jull G, Kenardy J, Hendrikz J, Cohen M, Sterling M.
Pain. 2013 Sep;154(9):1798-806.
Abstract
Acute whiplash is a heterogeneous disorder that becomes persistent in 40% to 60% of cases. Estimates of recovery have not changed in recent decades. This randomized, single-blind, controlled trial tested whether multidisciplinary individualized treatments for patients with acute whiplash (<4 weeks postinjury) could reduce the incidence of chronicity at 6 mo by 50% compared to usual care. Participants (n=101) were recruited from accident and emergency centres and the community. It was hypothesized that better recovery rates were achievable if the heterogeneity was recognised and patients received individualised interventions. Patients randomized to pragmatic intervention (n=49) could receive pharmaceutical management (ranging from simple medications to opioid analgesia), multimodal physiotherapy and psychology for post-traumatic stress according to their presentations. The treatment period was 10 wks with follow-up at 11 weeks and 6 and 12-months. The primary outcome was neck pain and disability (Neck Disability Index (NDI)). Analysis revealed no significant differences in frequency of recovery (NDI ≤ 8%) between pragmatic and usual care groups at 6 months (OR 95%, CI=0.55, 0.23-1.29), P=0.163) or 12 mo (OR 95%, CI=0.65, 0.28-1.47, P=0.297). There was no improvement in current nonrecovery rates at 6 mo (63.6%, pragmatic care; 48.8%, usual care), indicating no advantage of the early multiprofessional intervention. Baseline levels of pain and disability had a significant bearing on recovery both at 6 and 12 mo in both groups, suggesting that future research focus on finding early effective pain management, particularly for the subgroup of patients with initial high levels of pain and disability, towards improving recovery rates.
Nutritional Supplements for Pain Management—What’s Real? What’s Hype? Parts 1 & 2
Paid Subscribers, Click Here for both Parts
Nutritional Supplements for Pain Management—What’s Real, What’s Hype? Part 2
Robert Bonakdar MD, FAAFP
David Rakel MD, FAAFP
In Part 2, Dr. Bonakdar picks up the conversation by talking about riboflavin, feverfew, and magnesium as supplements in the management of headache. He discusses the use of supplements, such as CoQ10 and magnesium for children who suffer from headaches. And then he comments on the role of probiotics in pain management and inflammation.
Dietary Fiber Associated With Reduced CV Risk and Lower CRP Levels
Am J Cardiol 2014 Jan 15;113(2)287-291, H Ning, L Van Horn, CM Shay, DM Lloyd-Jones
Research · January 20, 2014
TAKE-HOME MESSAGE
- The study suggests that dietary fiber has an independent association with lifetime CV risk. In this review of the diets of over 11,000 individuals, a higher dietary fiber intake was associated with a low lifetime CV risk as well as a decrease in CRP levels. This effect was even more pronounced in younger adults.
- The study suggests that dietary fiber has an independent association with lifetime CV risk.
ABSTRACT
Dietary fiber intake might reduce cardiovascular risk factor levels and, in turn, might lower the long-term risk of cardiovascular disease (CVD). A total of 11,113 subjects, aged 20 to 79 years with no history of CVD, from the 2005 to 2010 National Health and Nutrition Examination Survey were included in the present study to examine associations of dietary fiber intake with predicted lifetime CVD risk and C-reactive protein levels. Dietary fiber intake showed a significant gradient association with the likelihood of having a low or an intermediate predicted lifetime CVD risk among young and middle-age adults. In fully adjusted multinomial logistic models, dietary fiber intake was related to a low lifetime CVD risk with an odds ratio of 2.71 (95% confidence interval 2.05 to 3.59) in the young adults and 2.13 (95% confidence interval 1.42 to 3.20) in the middle-age adults and was related to an intermediate lifetime risk of 2.65 (95% confidence interval 1.79 to 3.92) in the young and 1.98 (95% confidence interval 1.32 to 2.98) in the middle-age adults compared with a high lifetime risk. A significant inverse linear association was seen between dietary fiber intake and log-transformed C-reactive protein levels with a regression coefficient ± standard error of -0.18 ± 0.04 in the highest quartile of fiber intake compared with the lowest fiber intake. In conclusion, these data suggest that dietary fiber intake is independently associated with the predicted lifetime CVD risk, especially in young and middle-age adults. A greater amount of dietary fiber intake might be associated with lower C-reactive protein levels.
Mitochondrial Dysfunction and Chronic Disease: Treatment With Natural Supplements
Garth L. Nicolson, PhD
Altern Ther Health Med. 2014;20 (suppl 1):18-25.
ABSTRACT
Loss of function in mitochondria, the key organelle responsible for cellular energy production, can result in the excess fatigue and other symptoms that are common complaints in almost every chronic disease. At the molecular level, a reduction in mitochondrial function occurs as a result of the following changes: (1) a loss of maintenance of the electrical and chemical transmembrane potential of the inner mitochondrial membrane, (2) alterations in the function of the electron transport chain, or (3) a reduction in the transport of critical metabolites into mitochondria. In turn, these changes result in a reduced efficiency of oxidative phosphorylation and a reduction in production of adenosine-5’-triphosphate (ATP). Several components of this system require routine replacement, and this need can be facilitated with natural supplements. Clinical trials have shown the utility of using oral replacement supplements, such as L-carnitine, alpha-lipoic acid (α-lipoic acid [1,2-dithiolane-3-pentanoic acid]), coenzyme Q10 (CoQ10 [ubiquinone]), reduced nicotinamide adenine dinucleotide (NADH), membrane phospholipids, and other supplements. Combinations of these supplements can reduce significantly the fatigue and other symptoms associated with chronic disease and can naturally restore mitochondrial function, even in long-term patients with intractable fatigue.
Effects of vitamin D on patients with fibromyalgia syndrome
…”Optimization of Vitamin D levels in FMS had a positive effect on the perception of pain.”…
Paid Subscribers Click Here for more
MS: Slow Progression With Vitamin D?
Image from MedPageToday.com
Published: Jan 20, 2014 | Updated: Jan 21, 2014
By John Gever, Deputy Managing Editor, MedPage Today
Patients with relatively high vitamin D levels in the year after a first multiple sclerosis-like attack showed, over the next 4 years, markedly lower levels of MS disease activity and disability progression than those with lower levels, researchers found.
Each 20 ng/mL increment in serum levels of 25-hydroxyvitamin D (25-OH-D), the active metabolite of vitamin D, averaged during the first 12 months of participation in a clinical trial of interferon-beta (Betaseron) was associated with nearly 60% lower rates of new MRI lesions and clinical relapses (both P<0.05) during subsequent follow-up relative to those with smaller or no increases in 25-OH-D levels, according to Alberto Ascherio, MD, DrPH, of Harvard School of Public Health, and colleagues.
Higher 25-OH-D levels shortly after the initial clinical attack were also associated with significantly smaller T2 lesion volumes later on, and there was a trend toward less brain atrophy as well, the researchers reported online in JAMA Neurology. Disability as measured by the Expanded Disability Status Score (EDSS) was lower in those with high 25-OH-D levels at the trial’s 5-year mark as well (mean difference 0.17 points, P=0.004).
Narrowband Ultraviolet B Phototherapy in Children With Eczema
Br J Dermatol 2014 Jan 13;170(1)150-156, S Darné, SN Leech, AE Taylor
Research · January 21, 2014
TAKE-HOME MESSAGE
- While narrow-band UVB (NBUVB) therapy is sometimes used to treat children with atopic dermatitis, its use is based on limited retrospective data. This prospective cohort study examined NBUVB therapy in patients with moderate to severe atopic dermatitis. The use of NBUVB compared with no treatment led to significant improvement in both objective and subjective measures of severity, including affected surface area at the end of 12 weeks of treatment. Objective measures were still improved at 3 and 6 months post treatment.
- Use of NBUVB is effective in patients with moderate to severe atopic dermatitis and produces durable improvement.
Commentary By: Sharmela Darné MD
When one is seeing a child with moderate to severe eczema in clinic, it is useful to be able to give him or her an expected outcome with phototherapy. In this study, NBUVB resulted in an improvement in objective SASSAD score of 61% in children treated with NBUVB compared with a worsening of 6% in the control cohort. Overall, 40% of children were clear at the end of a 12-week course, and 29% remained clear at 6 months after treatment. These are useful figures to tell parents.
All the children managed the practical aspects of the treatment very well as exposure times are short for this modality; parents could keep talking to them and could see them through a transparent window in the cabinet. The youngest child was just under 4 years of age and had severe eczema. He was able to undertake therapy as he was accompanied by his parent (who was fully clothed and wore a face visor) in the cabinet, with his parent turning him around at half time so that both sides of his body received UV.
Anecdotally, we found that the eczema would improve toward the end of the course of treatment; so, it is worth getting children to complete the full course (24 exposures given twice weekly in this study). In fact, more were clear at the 3-month follow-up; so, maximal improvement is probably seen after the course. Skin cancer risk is a pertinent question when exposing young skin to phototherapy (discussed in the paper). However, it is safer than the alternatives (systemic immunosuppression) in this therapeutically challenging group.
Mediterranean Diet May Also Prevent Peripheral Artery Disease
IMNG Medical Media, 2014 Jan 21, MA Moon News January 21, 2014
Two variations of the Mediterranean diet were associated with a lower risk of peripheral artery disease, compared with a control diet, in a secondary analysis of the PREDIMED randomized clinical trial, as reported in a Research Letter to the editor in the January 22/29 issue of JAMA.
Among older adults at high cardiovascular risk, following a Mediterranean diet supplemented by extra virgin olive oil (EVOO) for a median of 5 years was associated with a reduced risk of PAD (hazard ratio, 0.34), compared with the control diet. Similarly, following a Mediterranean diet supplemented with extra nuts was associated with a reduced risk of PAD (HR, 0.50), said Miguel Ruiz-Canela, Ph.D., of the department of preventive medicine and public health, University of Navarra, Pamplona (Spain), and his associates in the PREDIMED (Prevencion con Dieta Mediterranea) trial….
Asthma, Rhinitis, and Contact Urticaria in Hairdressers Caused by Oxidative Hair Dyes
Ann. Allergy Asthma Immunol. 2014 Jan 01;112(1)46-52, E Helaskoski, H Suojalehto, H Virtanen, L Airaksinen, O Kuuliala, K Aalto-Korte, M Pesonen
Research · January 21, 2014
ABSTRACT
BACKGROUND
Oxidative hair dyes commonly contain paraphenylene diamine (PPD) and its derivatives, a well-known cause of delayed hypersensitivity among both consumers and hairdressers. They are also considered possible causes of occupational respiratory diseases. Despite the widespread use of hair dyes, there are only a few reports of asthma, rhinitis, and contact urticaria caused by PPD and related compounds.
OBJECTIVE
To characterize patients with occupational asthma, rhinitis, or contact urticaria associated with oxidative hair dyes and to evaluate the diagnostic methods.
METHODS
We reviewed the patient files of the Finnish Institute of Occupational Health for the period January 1, 2001, through May 31, 2011, to identify patients diagnosed as having asthma, rhinitis, or contact urticaria associated with oxidative hair dyes. The diagnoses of asthma and rhinitis were based on specific inhalation challenges with hair dye products. Skin prick tests were performed with hair dye ingredients as hapten conjugates of human serum albumin and with hair dye products and ingredients as is. Open skin tests confirmed the diagnosis of contact urticaria.
RESULTS
We describe 11 hairdressers with occupational asthma (5 cases), rhinitis (5 cases), and contact urticaria (3 cases) due to hair dyes. Of the 52 specific inhalation challenges performed, 9 (17%) had positive results. One patient who experienced an anaphylactic reaction when having her own hair dyed had positive skin prick test results to PPD and toluene-2,5-diamine sulfate.
CONCLUSION
Hairdressers are at risk for occupational asthma, rhinitis, and contact urticaria due to oxidative hair dyes. Skin prick testing may be insensitive for detecting immediate hypersensitivity to PPD and related compounds.
Dementia: Is Gluten the Culprit?
Paid Subscribers, Click Here For Full Story
Meditation May Slow Progression to Alzheimer’s
Deborah Brauser
November 26, 2013
Meditation in patients with mild cognitive impairment (MCI) may slow progression to Alzheimer’s disease (AD), new research suggests.
A small, randomized pilot study of adult patients with MCI showed that those who received mindfulness-based stress reduction (MBSR) therapy for 8 weeks had a greater increase in functional connectivity between brain regions related to both MCI and AD than those who received usual care.
These regions included the posterior cingulate cortex, the bilateral medial prefrontal cortex, and the left hippocampus.
In addition, there was “a trend” toward less bilateral hippocampal volume atrophy in the patients who received MBSR compared with the usual-care group.
“This study suggests that an intervention with meditation and yoga may impact the areas of the brain that are most susceptible to developing dementia,” lead author Rebecca Erwin Wells, MD, MPH, who was at Beth Israel Deaconess Medical Center (BIDMC) at Harvard Medical School in Boston, Massachusetts, at the time of the study, told Medscape Medical News.
Dr. Wells, who is now an assistant professor in the Department of Neurology at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, noted that although this was a small, preliminary study, she is “very excited” about the findings.
“MBSR is a relatively simple intervention, with very little downside, that may provide real promise for these individuals. If [it] can help delay the symptoms of cognitive decline even a little bit, it can contribute to improved quality of life,” said Dr. Wells in a release.
The study is scheduled to be published in the November 27 print issue of Neuroscience Letters….
Top Five Pain Interventions to Avoid
In the latest response to the call from the American Board of Internal Medicine (ABIM) Foundation for recommendations on the most overused interventions, the American Society of Anesthesiologists (ASA) has issued its list of top 5 tests and therapies that are of questionable usefulness in the field of pain medicine….
High Omega-3 PUFA Intake Reduces Type 2 Diabetes Risk
Becky McCall
January 22, 2014
A higher level of serum long-chain omega-3 polyunsaturated fatty acids (PUFAs) — an objective biomarker of fish intake — is linked to a lower long-term risk for type 2 diabetes, according to the results of a new prospective, population-based cohort study.
Among dietary factors, the long-chain omega-3 PUFAs, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), from fish and other seafood have gained special interest because of their beneficial effects on the risk for cardiovascular diseases and several risk factors for diabetes, including inflammation, adiposity, hypertension, and dyslipidemia, explain Jyrki K. Virtanen, PhD, adjunct professor of nutritional epidemiology at the University of Eastern Finland, Kuopio, and colleagues in their article published in the January issue of Diabetes Care….
The relationship between incontinence, breathing disorders, gastrointestinal symptoms, and back pain in women
A longitudinal cohort study
Smith MD, et al.
Clin J Pain. 2014 Feb;30(2):162-7. doi: 10.1097/AJP.0b013e31828b10fe.
Abstract
OBJECTIVES: Recent studies suggest a relationship between incontinence, respiratory disorders, gastrointestinal (GI) symptoms, and back pain (BP). However, causality is difficult to infer. This longitudinal study aimed to determine whether the presence or development of one disorder increases risk for the development of another.
METHODS: Women from the Australian Longitudinal Study on Women’s Health were divided into subgroups; those with no BP (n=7259), no incontinence (n=18,480), no breathing problems (including allergy) (n=15,096), and no GI symptoms (n=17,623). Each subgroup was analyzed to determine the relationship between the development of the absent condition and the presence or development of the other conditions. Factors with a previously identified relationship with BP were included in analysis.
RESULTS: Women with pre-existing and/or newly developed incontinence (prevalence ratios [PR]: 1.26 to 2.12) and breathing problems (PR: 1.38 to 2.11) had an increased risk for the development of BP, and women with pre-existing and newly developed BP were more likely to develop incontinence and breathing problems (PR: 1.18 to 2.44 and 1.53 to 2.62, respectively). The presence of GI symptoms was also identified as a risk factor for the development of these conditions.
DISCUSSION: This study provides evidence of a relationship between BP, incontinence, respiratory problems, and GI symptoms in which the presence of one symptom is associated with the development of another. This suggests that common factors may contribute to the development of symptoms across this range of conditions.
Mitochondrial Cytopathy – VIDEO
Although difficult to diagnose, mitochondrial disease is no longer considered rare.
This 20 minute video is an in depth discussion of mitochondrial dysfunction and cytopathy and the complex group of disorders and vast array of symptoms that accompany them.
You will learn why mitochondrial disease is elusive and how to identify the hallmarks of dysfunction and their causes.
The lesson is concluded with a review of the functional medicine testing and treatment options available.
You Will Learn:
- 3 Hallmarks of Mitochondrial Disease
- The Mitochondrial Matrix
- The Importance of Cardiolipin
- Theory of Aging as it relates to the Mitochondria
- Symptoms of Mitochondrial Disease
- Causes of Mitochondrial Disease
- Medications Responsible for Michondrial Damage
- How to Diagnose to Mitochondrial Dysfunction and Cytopathy
- Key Treatment Strategies
Here is the link to access this important video:
http://www.functionalmedicineuniversity.com/public/887.cfm
Take care,
Ron Grisanti, D.C.
How to Cure Irritable Bowel Syndrome in a Few Days – VIDEO
“IBS causes needless misery for millions of people…..But it is fixable!”
Bilateral and multiple cavitation sounds during upper cervical thrust manipulation
…”Cavitation was significantly more likely to occur bilaterally than unilaterally during upper cervical HVLA thrust manipulation. “…
Mindfulness Meditation Programs for Stress and Well-Being: A Meta-Analysis
JAMA Intern Med 2014 Jan 06;[EPub Ahead of Print], M Goyal, S Singh, EM Sibinga, NF Gould, A Rowland-Seymour, R Sharma, Z Berger, D Sleicher, DD Maron, HM Shihab, PD Ranasinghe, S Linn, S Saha, EB Bass, JA Haythornthwaite
Research · January 22, 2014
TAKE-HOME MESSAGE
- This review of 47 RCTs enrolling 3515 participants found moderate evidence that mindfulness programs focused on meditation can provide small improvements in anxiety, depression, and pain. Results showed low evidence of stress/distress reduction and metal health–related quality of life. Little or no evidence was found for a benefit in mood, attention, substance use, eating habits, sleep, or weight.
- More rigorous studies are needed to explore the effects of meditation programs on improving mental health and stress-related behavior.
Commentary By: David Rakel MD, FAAFP
Meditation Works for Anxiety, Depression, and Visceral Pain
Meditation has many different forms, but most include focusing well on one thing. The focus can be on the present moment, as in mindfulness, or a mantra, as in transcendental meditation. These were the two most common types of meditation evaluated in this meta-analysis, showing effects similar to antidepressants for anxiety and depression. Mindfulness was also found to reduce visceral pain by about 30% (but not as much for musculoskeletal pain); so, consider this for patients with irritable bowel syndrome or reflux disease.
Mindfulness is paying attention to the present moment, on purpose and without judgment. It gets the mind out of memories of the past or desires for the future or the recurring stories that the mind plays over and over. Practice helps one see life as it truly is, and not as the conditioned mind perceives it to be. In fact, practicing mindfulness on one patient at a time can improve diagnostic skills and increase the joy in this profession. Give it a try. The next time you are with a patient and your mind wanders to how many patients are waiting for you, simply bring your attention to the patient in front of you, focusing on one person well.
Dietary Supplements With Omega-3 Fatty Acids and Antioxidants for Dry Eye
….”This follow-up study to earlier clinical trials evaluated the reports of a large cohort of dry-eye patients regarding improvement in symptoms after adding an oral formulation of omega-3 essential fatty acids and antioxidants to the use of artificial tears.”….
Effects of cervical joint manipulation on joint position sense of normal adults
Gong W.
J Phys Ther Sci. 2013 Jun;25(6):721-3. doi: 10.1589/jpts.25.721. Epub 2013 Jul 23.
Abstract
[Purpose] The purpose of this study was to identify the effects of cervical joint manipulation on joint position sense (JPS) of normal adults. [Subjects] Thirty normal adults were divided into a test group of 15 subjects and a control group of 15 subjects. [Methods] The test group was treated with cervical joint manipulation and massage, whereas the control group received only massage. Both groups were evaluated in terms of joint position error (JPE) using a digital dual clinometer before and after the interventions. [Results] The comparision of the pre- and post-test results revealed the test group exhibited statistically significant changes in flexion, extension, left lateral flexion, right lateral flexion, left rotation, and right rotation. On the other hand, the control group showed no statistically significant changes in any of the variables. [Conclusion]Cervical joint manipulation reduced JPE and improved joint position sence. Therefore, we consider its application to the treatment of patients with cervical problems in clinical practice is desirable.
Metabolic Syndrome Increases Risk For Severe Knee—But Not Hip—OA
Image From PainMedicineNews
Clinical Pain Medicine
ISSUE: NOVEMBER 2013 | VOLUME: 11
Madrid—The presence of metabolic syndrome and its components is associated with an increased risk for severe osteoarthritis (OA) of the knee, leading in many cases to joint replacement, according to new research. However, this connection was not true of hip OA. The association with knee OA was found independent of obesity (body mass index [BMI]).
According to senior investigator Anita Wluka, MBBS, FRACP, associate professor, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia, the findings, from a population-based cohort study presented at the 2013 annual meeting of the European League Against Rheumatism, suggest that knee and hip OA have different pathogeneses, although at this point the reasons are speculative.
“Other authors have found an association between the metabolic syndrome and OA,” she told attendees. “This study shows that OA and the metabolic syndrome do not simply coexist, but that the metabolic syndrome is one of the pathways to knee OA, but not hip OA, suggesting a different pathogenesis for these two different diseases. Managing the metabolic syndrome may reduce the burden of knee OA.”
Hallux Varus
Katie Ryan, M.D., and Paul Moroney, M.D.
Image From New England Journal of Medicine
N Engl J Med 2013; 369:2137November 28, 2013DOI: 10.1056/NEJMicm1213412
An otherwise healthy 73-year-old man presented with painless hallux varus (Panel A), a deformity of his left great toe that had been progressing over many years. He reported having a fasciectomy of the right hand for Dupuytren’s contracture, which recurred postoperatively. He now had Dupuytren’s contractures of both hands (see Fig. 1 in the Supplementary Appendix, available with the full text of this article at NEJM.org). There was no relevant family history, and he was not taking any medication. Physical examination confirmed the left hallux varus, for which he required a custom-made shoe, and revealed thickening of the plantar fascia on the medial aspect of the left foot. A preoperative radiograph showed clinically significant deformity of the left first metatarsal (Panel B). During surgery, he underwent fusion of the first metatarsophalangeal joint for correction of the hallux varus, osteotomy of the fifth metatarsal for a bunionette, or tailor’s bunion (see Fig. 2 and Fig. 3 in the Supplementary Appendix), and release of the plantar aponeurosis. Histologic evaluation of the fascia showed fibromatosis characteristic of Ledderhose’s disease, a rare, idiopathic proliferative disorder of the plantar aponeurosis, which may be associated with Dupuytren’s contractures. At follow-up 6 months after surgery, the patient was doing well.
The Science of Treating Neck Pain
…”Following a literature search of controlled clinical trials through December 2011, 560 studies were narrowed to 41 that met the authors’ inclusion criteria and served as the basis for their treatment recommendations, graded as strong, moderate or weak based on the number, quality and consistency of research results. Treatment strategies given strong recommendations for chronic neck pain included…..”
Rephrasing the Subluxation: Capturing Lightning in a Bottle
Image from DynamicChiropractic.com
By Anthony Rosner, PhD, LLD [Hon.], LLC
Dynamic Chiropractic – February 1, 2014, Vol. 32, Issue 03
For all these years, as we know only too well, debates have raged both within and beyond the chiropractic community over subluxation: what it is or even why it is. It has been a question as to not only whether it can be shown as a clinical reality by objective measurements, but also what its attributes really are.
Capturing its essence with a definition most can live with is not unlike the renowned author Mark Twain’s endeavor to pin down the precise word in his writings, about which he declared:
“The difference between the almost right word & the right word is really a large matter – It’s the difference between the lightning bug and the lightning.”1
Capturing this lightning – or the proper definition of subluxation – in a bottle is a goal no one can dispute. Thus it is that the emergence of research with an eye toward systemic and arguably nonmuscular domains responding to spinal manipulation could be credited with the spanking-new, progressive recasting of the chiropractic definition of the S-word set to appear in the fourth edition of the Clinical Practice Guideline issued by the Council on Chiropractic Practice. The definition reads:
“Subluxation is a neurological imbalance or distortion in the body associated with adverse physiological responses and/or structural changes, which may become persistent or progressive. The most frequent site for the chiropractic correction of the subluxation is via the vertebral column.”….
The 15-Second Frailty Screen – VIDEO
Published: Nov 27, 2013
By Elbert Chu, Associate Producer, MedPage Today
Individuals who are frail face increased risks of dependency and mortality.
To explore new efforts to screen for frailty, we turned to John Morley, MD, director of the Division of Geriatric Medicine at the Saint Louis University School of Medicine. In 2007, Morley published a book calledThe Science of Staying Young. In June, he and his colleagues published a paper in theJournal of the American Medical Directors Association that outlined the need for frailty screening.
In this video, we spoke with Morley about implementation of a new tool that adds to the science of preventive care in gerontology. Here, he discusses a new set of five questions for physicians to ask patients older than 70 for a quick evaluation of how FRAIL a patient is. He says it takes just 15 seconds:
Fatigue: Are you fatigued?
Resistance: Do you have difficulty walking up one flight of steps?
Aerobic: Are you unable to walk at least one block?
Illness: Do you have more than five illnesses?
Loss of weight: Have you lost more than 5% of your weight in the past 6 months?