Rami Hashish , DPT has written a great article featured on the Huffington Post about the benefits and drawbacks of both running outside and on the treadmill. Most focusing on a handful of studies, Rami discusses how treadmills reduce the impact on joints while outdoor running can be good for those with Achilles strains. According to the studies he cites, treadmills can lead to reduced running speeds without the user realizing it. He also writes about how to simulate the additional energy required for running outdoors when on a treadmill. Here is an excerpt from his article:

It’s a beautiful day. The sun is shining and glistening off the ocean’s waves, causing a beautiful reflection of colors in the cloudless yet slightly misty morning sky. In other words, it’s a perfect day for an outdoor run. But it’s hot, too. And you have pale skin and burn easily. It’s also early in the morning, meaning that there aren’t too many sunbathers to gawk at, or at least check out discretely under your Ray-Bans. OK, so indoor treadmill running it is!

My good friend Forrest Gump would never contemplate the nuances of such a choice. Rather, he would just run. But we’re not Forrest Gump. So here’s the dilemma: Should you run on a treadmill or overground? To answer this, let’s disregard the rhyme and reason behind the choice and focus solely on the science.

Read Rami's article To Run Outside or on a Treadmill? A Dilemma Foreign to Forrest Gump on Huffingtonpost.com.

Painkillers like opioids are a central element to many forms of treatment and medical procedures because they have been found to be effective in fighting both acute and chronic pain. However, research has begun to show that the actual effectiveness and other side effects of opioids may depend more on a person’s genes than previously thought.

Martin Angst, MD—professor of anesthesia at Stanford University School of Medicine and director of the Stanford Human Pain Research Laboratory—and a team of researchers have found that not only does the effectiveness of opioids have a genetic component, but other adverse side effects do too. “Nausea, itchiness (often accentuated at the nose), dizziness, sleepiness, and respiratory depression (trouble breathing) are all drug side effects that our study showed can be linked to inheritance.” In particular, they found one of the most hated side effects, nausea, to be strongly inherited. They determined this by comparing how identical twins, non-identical twins, and non-related participants reacted to the drugs.

These factors, in turn, are vital issues medical doctors take into consideration when deciding a course of treatment, as some at-risk patients may develop life-threatening complications. “For some patients, a drug’s side effects can be so negative that they outweigh any benefits of pain relief,” Dr. Angst commented. For this reason, patients who suffer adverse effects might be better off taking advantage of alternative methods. This research is an important step for those who would benefit from a more customized treatment plan.

To find out more about Dr. Martin Angst and the study, see Genes may affect painkiller side effects at SFGate.com and an article from Stanford.edu.

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.

Chronic pain has the ability to strip individuals of their productivity, happiness, and well-being. ABC News wrote this great piece about Tiiu Leek and her pain in the workplace, describing how women feel more pain than men do. The article references a relatively new study from The Journal of Pain that showed women generally feel more pain than men. However, this study wasn’t thorough since it didn’t account for confounding factors such as emotional effects or an additional painful disease. Women tend to be better at analyzing and describing their pain to doctors which give the illusion they feel more pain. As a culture, men are expected to complain about pain less as well as talk about their emotions. One’s mental well-being has a huge effect on physical pain, thus conclusive studies are hard to produce.  Nevertheless, the findings reflect what I see as a chronic pain specialist. Here is a telling excerpt from the ABC News article:

Meyer saw 13 doctors before she got a proper diagnosis and the majority were men. “It’s very uncomfortable for them to see real emotion: ‘Tell me the facts, m’am, just the facts.’ I see them tune out.”

Now, she consciously spares the doctor the emotional talk. “I can literally be in so much pain I am crying when the staff is in there, but I pull it together when the doctor is in the room and have no tears at all. And it’s not easy to have to do that.”

She said doctors need to listen more to their female patients – “feelings are a part of the equation … Patients shouldn’t have to shut things down.”

Both Meyer and Leek sit on the leadership circle at For Grace, an advocacy organization that educates, supports and empowers women in pain through annual conferences and legislative outreach.

For Grace’s “Fail First” bill recently got through the California State Assembly’s appropriations committee on a 12-5 vote. If signed by the governor, it will allow women in pain much better access to pain medications, bypassing insurance companies.

As for Leek, she has seen marked improvement in her pelvic pain thought exercise and homeopathic approaches. She also tries to surround herself with positive people.

“My career was lost, but not my optimism,” she said. “I continue to live well. I once read that if you can get through your 60s unscathed, you can have a pretty good life.”

Read this article on ABCnews.com 

As many of you are aware, doctors persistently encourage their patients to exercise every day, even if it’s just a short walk. A little exercise is a lot better than no exercise. A new study of almost 1/2 million shows that walking for as little as 5 minutes a day could significantly increase the quality and longevity of one’s life:

You don’t have to run a marathon, or run at all, to reap impressive health benefits from exercise. In fact, if the average adult walked 6 1/2 hours a month - or about the same amount of time it took that pregnant athlete to finish the marathon - he could add three years to his life, according to a new study.

“It doesn’t take a lot. You don’t have to be super intense, like a triathlon or an Alcatraz swim,” said Dr. Moshe Lewis, a California Pacific Medical Center physician who specializes in pain management and sports medicine. “Only 15 minutes a day, that’s not much. It’s great for people to know that walking around, doing some stairs, that’s getting a cardiac regimen going.”

One study of more than 400,000 adults in Taiwan - the same one that showed minimal exercise can add years to someone’s life - found that 15 minutes of moderate exercise, six days a week, reduced the risk of death by 14 percent compared with people who aren’t active at all.

U.S. guidelines suggest at least 30 minutes of exercise five days a week, and doctors generally agree that more exercise is better than less. Still, just getting patients out the door for a few short walks a week could do wonders.

Read this 2 page article on SFgate.com

Many students, celebrities, soldiers, and even company owners are turning to meditation to help them with their daily activities. ABC News has written a great article on the benefits of meditation. The article even includes tips and opinions on meditation from the Dalai Lama himself.

A quiet explosion of new research indicating that meditation can physically change the brain in astonishing ways has started to push into mainstream.

Several studies suggest that these changes through meditation can make you happier, less stressed – even nicer to other people. It can help you control your eating habits and even reduce chronic pain, all the while without taking prescription medication.

Read on ABC News: Re-Wiring Your Brain for Happiness: Research Shows How Meditation Can Physically Change the Brain
More reading: Meditation 101: Tips for Beginners

Another study on exercise has been released and to no one's surprise, it suggests that daily exercise can increase the quality and longevity of your life. ABC News has a great overview of the latest findings:

A little exercise goes a long way, a new study suggests. So little that 15 minutes of it per day reduces one’s risk of cancer and adds an average of three years to a person’s life.

Taiwanese researchers examined more than 400,000 study participants in a 12-year period, where patients self-reported their weekly exercise regimen and were then placed in one of five groups: inactive, low, medium, high or very high exercise activity.

Read the entire article on ABCnew.com

In light of the following article, I have always strongly encouraged my patients to actively involve their family by bringing them to visits. In addition, I strongly recommend participation in the California Neuropathy Support Group and to openly discuss their feelings with our healthcare team:

Abuse of narcotic pain relievers, insomnia drugs and anxiety drugs by women is landing a growing number of them in emergency rooms for drug-related suicide attempts.

A recent report by the federal Substance Abuse and Mental Health Services Administration shows a 49 percent rise in emergency department visits for drug-related suicide attempts by women aged 50 and older between 2005 and 2009.

While some of the increase can be attributed to population growth of women in this age group, the study found stark increases in emergency department visits for drug-related suicide attempts involving drugs that treat anxiety, insomnia and pain, such as hydrocodone and oxycodone products.

Michael Dulle, clinical director of the Salt Lake substance abuse treatment center Odyssey House, said he is personally aware of five to eight female patients, ages 50 and up, who have been hospitalized for accidental overdoses or suicide attempts from prescription drugs in the past 18 months.

Read the rest of this article on Deseret News

The American College of Sports Medicine and American Diabetes Association have released a joint position statement for exercise in the management of patients with type 2 diabetes.

Research has shown that regular physical activity (PA) may prevent or delay diabetes and its complications, but most people with type 2 diabetes are not physically active. One of the key recommendations for patients with diabetes is to perform moderate-to-vigorous aerobic exercise for at least 150 minutes a week spread out at least 3 days during the week. These patients should go no more than 2 consecutive days between sessions of aerobic activity. Aerobic activity alone, however, typically will not provide the full benefits of exercise. The recommendations indicate that resistance exercise (strength training) is an important component of managing diabetes. The most recent studies have reinforced the additional benefit of combining aerobic and resistance training.

Patients in consultation with their physician should consider starting out with with brisk walking, gardening, or housework as initial motivation to become less sedentary. After that, as one makes progress, it is important to ramp up the intensity and duration gradually.

Since a lot of my patients use potentially addictive drugs, I always have important discussions on how to avoid substance abuse. This NYTimes article is a great summary of why we get addicted and how dangerous it is. On the 3rd page, the article discusses how medical doctors are not trained to manage chronic pain so they simply prescribe more dangerous and addictive drugs.

The toll from soaring rates of prescription drug abuse, including both psychiatric medications and drugs for pain, has begun to dwarf that of the usual illegal culprits. Hospitalizations related to prescription drugs are up fivefold in the last decade, and overdose deaths up fourfold. More high school seniors report recreational use of tranquilizers or prescription narcotics, like OxyContin and Vicodin, than heroin and cocaine combined.

The numbers have alarmed drug policy experts, their foreboding heightened by the realization that the usual regulatory tools may be relatively unhelpful in this new crisis.

As Dr. Volkow said to a group of drug experts convened by the surgeon general last month to discuss the problem, “In the past, when we have addressed the issue of controlled substances, illicit or licit, we have been addressing drugs that we could remove from the earth and no one would suffer.” But prescription drugs, she continued, have a double life: They are lifesaving yet every bit as dangerous as banned substances. “The challenges we face are much more complex,” Dr. Volkow said, “because we need to address the needs of patients in pain, while protecting those at risk for substance use disorders.”

Click here to read the rest of this article on New York Time’s website.

HEALTH: New Study Finds Serious Health Issues Linked To Texting, Video Games

Last week I was featured on KTVU's Channel 2 10 O'Clock news to discuss the implications of a new study correlating increased hand pain with prolonged use of handheld devices such as cell phones and video game controllers. The video is short (1 minute and 45 seconds); I make an appearance at the 1 minute mark. You can see me discuss why pain arises when using texting or gaming devices and what I think the implications are.

 

Watch the video on KTVU Channel 2 News

 

Osteopaths use a broad range of gentle hands-on techniques including soft tissue stretching, deep tactile pressure, and mobilization or manipulation of joints.

 

The philosophy of Osteopathy is what sets it apart from other medical disciplines. The key principles are based on all parts of the body functioning together in an integrated manner. If one part of the body is restricted, then the rest of the body must adapt and compensate for this, eventually leading to inflammation, pain, stiffness and other health conditions. When the body is free of restrictions in movement, Osteopathic treatment assists the body with pain minimization, reduced stress and greater mobility providing the body with the opportunity to heal itself.

 

What has the research shown us about osteopathic manipulative treatment?

 

The National Center for Complementary and Alternative Medicine states that overall, studies have shown that spinal manipulation can provide mild-to-moderate relief from low-back pain and appears to be as effective as conventional medical treatments. In 2007 guidelines, the American College of Physicians and the American Pain Society include spinal manipulation as one of several treatment options for practitioners to consider using when pain does not improve with self-care. Recent research into spinal manipulation for low-back pain has begun to look at the effects of different forms of manipulation, as well as treatment duration and frequency. Studies have found that spinal manipulation provides relief from low-back pain at least over the short term (i.e., up to 3 months), and that pain-relieving effects may continue for up to 1 year. Spinal manipulation is generally a safe treatment for low-back pain. Serious complications are very rare.

 

If you’re interested in trying it, how would you go about finding a qualified practitioner?

 

The best way to find a good osteopath is by asking for referrals from friends, doctors, or other health experts. Health food and supplement stores will often have advertising material from osteopaths and other holistic health practitioners, but the best way to locate a really good osteopathic doctor is by finding somebody who experienced great results with osteopathy – and finding out who she or he saw. On the web start with the American Osteopathic Association here, www.osteopathic.org

Nation Public Radio (NPR) has a great article summarizing recent scientific evidence that found that holistic meditation can "tame pain after just a few training sessions." By simply meditating a few times, you might see health benefits:

Meditation has long been touted as a holistic approach to pain relief. And studies show that long-time meditators can tolerate quite a bit of pain.

Now researchers at Wake Forest Baptist Medical Center have found you don't have to be a lifelong Buddhist monk to pull it off. Novices were able to tame pain after just a few training sessions.

Sounds a bit mystical, we know, but researchers using a special type of brain imaging were also able to see changes in the brain activity of newbies. Their conclusion? "A little over an hour of meditation training can dramatically reduce both the experience of pain and pain-related brain activation," Fadel Zeidan, a neuroscientist and the study's lead author, tells Shots. That finding's a first, Zeidan says.

Click here to read the NPR article "Even Beginners Can Curb Pain With Meditation"

A new study in the Archive of General Psychiatry suggests a link between alcoholism and obesity within the United States.The prevalence of obesity has risen sharply in the United States in the past few decades. Etiologic links between obesity and substance use disorders have been hypothesized.

The results of the study:

In 2001-2002, women with a family history of alcoholism (defined as having a biological parent or sibling with a history of alcoholism or alcohol problems) had 49% higher odds of obesity than those without a family history (odds ratio, 1.48; 95% confidence interval, 1.36-1.61; P < .001), a highly significant increase (P < .001) from the odds ratio of 1.06 (95% confidence interval, 0.97-1.16) estimated for 1991-1992. For men in 2001-2002, the association was significant (odds ratio, 1.26; 95% confidence interval, 1.14-1.38; P < .001) but not as strong as for women. The association and the secular trend for women were robust after adjustment for covariates, including sociodemographic variables, smoking status, alcohol use, alcohol or drug dependence, and major depression. Similar trends were observed for men but did not meet statistical significance criteria after adjustment for covariates.

Read an overview of the study at The Archive of General Psychiatry