Every day, the long-term consequences of head injuries become more apparent. In particular, NFL players experience many concussions over the course of their career, leading to the various long-lasting symptoms associated with chronic traumatic encephalopathy (CTS). The disease is characterized by the degeneration of brain tissue, as well as the build up of tau protein. Externally, these symptoms might be expressed through social cues such as depression or aggression.
Together, new research and technology are paving a path for early detection of CTS and the tau protein abnormalities associated with it. Researchers from the University of California Los Angeles used positron emission tomography (PET) scanning with a tracer for tau protein and found significantly elevated binding values among retired players when compared with controls. These results are consistent with already-existing autopsy data coming from players that showed deposits of phosphorylated tau in neurofibrillary tangles.
The technique is also specific and sensitive enough to distinguish Alzheimer’s patients from those experiencing milder forms of cognitive impairment. According to the researchers, “using a tau marker for detection and tracking of neurodegenerative disease is critically important because severity of tau load, rather than amyloid burden, correlates with rates of neuronal loss.” so further studies into anti-tau treatments are on-going.
For further reading on the future of CTS detection, see NFL: PET Scan IDs Brain Damage in Players.
Learn about a medication’s potential interactions with alcohol, prescription medicines, and over-the-counter medicines. You never want to add something new to your body until you know whether its ying will knock your yang out of flow and off balance. In the second part of my two-part series on physicians, patients, and pills I cover five specific tasks patients should engage in with their doctor regarding prescription drugs. Tweet this to your friends and discuss these points with your doctor at your next visit.
You can and should ask your doctor about any new non-prescription remedy. Over-the-counter medications, herbs and supplements are particularly misleading because we think of them as less harmful than their prescription counterparts. Yet every year patients have to undergo emergency organ transplants due to haphazard combinations of seemingly harmless herbals. Only your doctor can tell you which combinations are hazardous or even lethal before it’s too late.
Tell your your doctor about any history of substance abuse. It isn’t your doctor’s job to judge you. It is your doctor’s job to make sure your medications don’t put you in danger, and your doctor can’t do that if you withhold information about your medical history. This necessarily includes your substance abuse history, past or present. If you have a history of substance abuse, you don’t need to worry that you will be left to agonize without pain medication. Telling your doctor your full and complete medical picture only lets her do her job, customizing your pain therapy to your needs.
Never, never and let me say it again… never share prescription medications. By now you know that it can pose unexpected risks. Furthermore, it’s actually illegal! And it can create legal liability if an adverse reaction happens. If you share your prescription, you expose yourself to charges of engaging in the practice of medicine without a license. If someone you care about needs a pill or a prescription, do the responsible thing for them—tell them to see their own physician, not raid your drug cabinet. Please do not pretend to be a pharmacist. You could kill someone.
Don’t doctor shop or fill prescriptions at multiple pharmacies. Doctor shopping is the practice of going to multiple doctors simultaneously to scam prescriptions. It is illegal, and prosecutors are cracking down. Filling prescriptions at multiple pharmacies is a red flag—to your physician, to state drug authorities who monitor your prescription filling actives, and to your insurance carrier. In instances when you have a legitimate need to fill medication at more than one pharmacy, simply discuss this with your physician in advance. If he or she knows why you need to break routine, they can incorporate the appropriate documentation into your chart. Keeping your doctor in the loop by planning your pharmacy changes ahead of time helps him to trust you just as you trust him.
Be willing to submit a urine or blood sample or information needed to monitor your use of painkillers. Don’t be insulted when you’re asked to pee in a cup. If you want to continue to receive easily misused drugs, it’s in your best interest. Doctors are constantly faced with patients who are addicts, either through using illicit drugs or doctor shopping. When a doctor asks for a urine sample, she wants assurance that there is no potentially lethal misinformation that could affect his or her prescription strategy for you.
By complying with requests for fluid samples, you are making life easier on yourself in another way. You’re helping your doctor to weed out abusers from his/her practice so that he/she can focus on practicing medicine with their bona fide patients.
Pills don’t always work the way we think they do. Half a pill doesn’t always mean half the strength, and twice the medication can quadruple dangerous side effects. Well-chosen medications soothe our pain, but a rowdy mix will use our body as a battleground. Trusting your doctor, and allowing your doctor to trust you are absolutely essential elements of quality health care.
As prescription painkiller abuse has risen, the doctor-patient relationship has become more difficult. Doctors must now constantly worry that they are being misled. It’s important to remember that they’re doing this to make sure they’re serving you correctly. Here are five ways to protect the integrity of your prescription.
1. Always follow prescription medication directions carefully. When it comes to medication management, there is no substitute for a medical degree. That’s why only your physician can write prescriptions. You should think of your doctor as your personal health expert, who took four years to earn their wings in medical school and then at least three years in residency to perfect their work under an expert’s watchful eye. If you have questions and suggestions, discuss them with your doctor before trying them out. Ask your personal expert, they will have your back.
2. Don’t increase or decrease doses without talking with your doctor. Why risk ending up in the hospital, or worse, when a simple heart-to-heart discussion with your doctor can give you an answer that keeps you safe? A sudden or unplanned change in medication can have bad side effects that you did not bargain for. This is the very reason you see a doctor—he or she can use their expertise to design a medication plan that will protect your health.
Openness, candor, and direct communication are key ingredients for a mutually beneficial physician-patient relationship. Nowhere is this truer than in the risky and emotionally fraught field of pain management. When your pain is at its worst, remember that you should rely on your doctor. If the medication (e.g. pain pills) is not cutting it, tell your doctor. Trusting your doctor will keep you safe, and calling him or her before changing plans will help them to trust you, as well. If you can’t discuss your medication and health openly with a doctor, then perhaps it is time to find a new keeper to entrust with your medical care.
3. Don’t stop taking medication on your own. By now you’ve noticed a theme—if you want your medication to help and not harm, you have to follow your doctor’s instructions. Ending a treatment routine is as complex as starting a new one, so don’t quit your prescriptions cold turkey before their time.
Some medications need to be continued well after the symptoms have disappeared. Antibiotics are an obvious example—if you stop taking them before their time, your infection might bounce back with a brand new resistance to drugs. Other medications, such as antidepressants and prescription painkillers, often need to be gradually and expertly titrated downward before you wean yourself off of them entirely. Let your doctor escort you off of a course of medication rather than taking matters into your own hands.
4. Don’t crush, chew, or break pills. Let’s be real here. If your doctor wanted you to find new uses for the pill, she would have told you that in the office. Don’t mistake your adult medication for a children’s chewable vitamin. Many pills are ingenious drug delivery systems in disguise, covered in layers of coatings to ensure that medication is released slowly and in strategic locations in your digestive tract. Pills are meant to be swallowed whole, so pull out a glass of water and swallow.
5. Be clear about the drug’s effects on driving and other daily tasks. There’s a reason that you need a photo ID to buy alcohol, but a doctor’s legally binding signature for strong painkillers. Prescription pain medications can affect our cognition just the same as alcohol, and sometimes more.
It can be tempting, or even necessary, to use pain killers in moments of extreme discomfort—especially when it disrupts our productivity and our lives. Headaches, a universally common symptom, are frequently the culprit behind these effects and while they can be alleviated with compounds such as acetaminophen and ibuprofen, there are other methods available to those who are concerned about their medicating habits.
In a piece for EverydayHealth I talk about how temperature, light sensitivity, sleep, and other factors can change the way you feel and how to use this knowledge to relieve headaches naturally.
“It is easy to become reliant on drugs — we all live in a fast-paced nation, and there is little understanding when you miss obligations over a headache,” says Moshe Lewis, MD, a pain management specialist in Redwood City, Calif.
For example, acupressure, a procedure that utilizes familiar acupuncture principles but involves instead pressure rather than the insertion of needles, may prove beneficial:
Performed by a qualified practitioner, acupressure can bring relief for headaches and a variety of other pain-related conditions, says Lewis. Japanese research explains that acupressure may work by stimulating the autonomic nervous system, which is why it may have an impact on headache and related conditions such as chronic neck pain. Though recent studies haven’t been done, earlier research on 500 people with frequent headaches found that self-administered acupressure was helpful and worth trying because there are no negative side effects.
Progress was made in the field of controlling chronic pain when neuroscientists at McGill University discovered a chemical that can completely erase memories of pain. The chemical, zeta inhibitory peptide (ZIP), almost seems to be the physical manifestation of the events in the movie Eternal Sunshine of the Spotless mind in which the main character Joel chooses to undergo a process that erases his memory of a painful relationship. Yet, the chemical focuses specifically on the nervous system’s memory of chronic pain due to the fact that pain that lasts for more than a few minutes actually leaves a trace of itself. This would provide a significant improvement for issues such as post-injury sensitivity.
The discovery of the chemical can, however, bring up moral and ethical questions about making changes with the body and mind’s memories but it has been confirmed that it only affects chronic pain, and thankfully leaves other memories intact. While it won’t be seen over the counter, this scientific development will surely make waves in research on other drugs that could make a difference in the lives of people with persistant pain.
To find additional information on ZIP, read about it on Scientific American.
Although it seems sometimes that pain originates strictly in the physical realm, our emotions play a huge role in what we physically feel. The common thread between our thoughts and our pain is the brain: it has been observed that the same brain regions become active when one experiences either physical pain or emotional rejection. But if this kind of pain is a result of central nervous system activity and not pain receptors in our hands or feet, it is possible to fight fire with fire. Dopamine is a powerful neurotransmitter that has not only been linked to feelings of happiness and pleasure but has been known to alter our perception of pain. Simply listening to music you love, spending time with a good friend, or being creative releases dopamine in your brain and could lessen the severity of pain you feel.
For further reading, visit Scientific American to learn more about the brain chemistry of emotional wounds.
Many consider pain to be a physical sensation. It seems too obvious that pain originates around the body because that's where many feel it, but in reality pain is created in your mind. Since we perceive the world through our brains as we gather external sensory information from our surroundings, any sort of pain we feel becomes reality. In this way, heartache and mental pain can surprisingly cause physical pain. As acknowledged by the holistic medicinal community, one's mental well-being can effect how their physical bodies feel. In this recent Scientific American article, author Christie Wilcox explores how emotional turmoil caused by those close to us can have very real and physical results:
I know I’m not physically hurt. Though it feels like I’ve been kicked in the stomach with steel-toed boots, my abdomen isn’t bruised. Spiking cortisol levels are causing my muscles to tense and diverting blood away from my gut, leading to this twisting, gnawing agony that I cannot stop thinking about. I can’t stop crying. I can’t move. I just stare at the ceiling, wondering when, if ever, this pain is going to go away.
It doesn’t matter that my injuries are emotional. The term heartache isn’t a metaphor: emotional wounds literally hurt. The exact same parts of the brain that light up when we’re in physical pain go haywire when we experience rejection. As far as our neurons are concerned, emotional distress is physical trauma.
Evolutionary biologists would say that it’s not surprising that our emotions have hijacked the pain system. As social creatures, mammals are dependent from birth upon others. We must forge and maintain relationships to survive and pass on our genes. Pain is a strong motivator; it is the primary way for our bodies tell us that something is wrong and needs to be fixed. Our intense aversion to pain causes us to instantly change behavior to ensure we don’t hurt anymore. Since the need to maintain social bonds is crucial to mammalian survival, experiencing pain when they are threatened is an adaptive way to prevent the potential danger of being alone.
Of course, being able to evolutionarily rationalize this feeling doesn’t make it go away.
I lie flattened, like the weight of his words has literally crushed me. I need to do something, anything to lessen this ache. The thought crosses my mind to self medicate, but I quickly decide against that. Mild analgesics like ibuprofen would be useless, as they act peripherally, targeting the pain nerves which send signals to the brain. In this case, it is my brain that is causing the pain. I would have to take something different, like an opioid, which depresses the central nervous system and thus inhibits the brain’s ability to feel. Tempting as that might be, painkillers are an easy – and dangerous – way out. No, I need to deal with this some other way. Slowly, I sit up and grab the guitar at the foot of my bed.
Where music comes from, or even why we like and create music, is still a mystery. What we do know is that it has a powerful affect on our brains. Music evokes strong emotions and changes how we perceive the world around us. Simply listening to music causes the release of dopamine, a neurotransmitter linked to the brain’s reward system and feelings of happiness. But even more impressive is its affect on pain. Multiple studies have shown that listening to music alters our perception of painful stimuli and strengthens feelings of control. People are able to tolerate pain for longer periods of time when listening to music, and will even rate the severity of the sensation as lower, suggesting that something so simple as a melody has a direct affect on our neural pathways.
So, too, does self expression. Expressive writing about traumatic, stressful or emotional events is more than just a way to let out emotion – college students told to write about their most upsetting moments, for example, were found to be in remarkably better health four months later than their counterparts who wrote on frivolous topics. These positive results of self-expression are amplified when the product is shared w
So, I begin to write. At first, it is just a jumble of chords and words, haphazardly strung together. But, slowly, I edit and rewrite, weaving my emotions into lyrics. I play it over and over, honing the phrasing, perfecting the sound.
The rush of dopamine loosens the knot in my stomach ever so slightly. For now, the agony is dulled. Still, I can’t help but think that I’m never going to really feel better – that the memory of this moment will be seared into my brain, and a mental scar will always be there, torturing me with this intense feeling of loss.
Scientifically, I know I’m wrong. As I close my eyes, I am comforted by the thought that the human brain, though capable of processing and storing ridiculous amounts of information, is flawed. The permanence of memory is an illusion. My memory of this moment will weaken over time. It will be altered by future experiences, until what I envision when I try to recall it will be only a faint reflection of what I actually feel. Eventually, this pain won’t overwhelm me, and I will finally be able to let go.
Read and comment on this article on ScientificAmerican.com.