Pain Research Moving at Snail’s Pace

By Pat Anson, Editor

It often seems like research into new treatments for chronic pain are moving at a snail’s pace.

That's literally the case at the University of Utah,  were scientists are studying conus regius, a small marine cone snail found in the Caribbean Sea. The snail's venom is so potent that it paralyzes and kills its prey.

Researchers have isolated a compound in the snail's venom – called Rg1A4 – that has anesthetic effects that last far longer than opioid pain medication.

When injected into laboratory rats, the compound is cleared from the animal’s body in 4 hours, but its analgesic effect still works 72 hours later.

The duration of that pain relieving effect suggests that Rg1A4 has a restorative effect on some components of the nervous system.

UNIVERSITY OF UTAH PHOTO

"What is particularly exciting about these results is the aspect of prevention," said J. Michael McIntosh, MD, a professor of psychiatry at the University of Utah Health Sciences. "Once chronic pain has developed, it is difficult to treat. This compound offers a potential new pathway to prevent pain from developing in the first place and offer a new therapy to patients who have run out of options."

Most pain medications available today work through a limited number of neural pathways and are not sufficient to completely alleviate chronic pain. Opioids also have risky side effects, such as addiction and respiratory depression.

"RgIA4 works by an entirely new pathway, which opens the door for new opportunities to treat pain," said McIntosh. "We feel that drugs that work by this pathway may reduce burden of opioid use."

Researchers around the world are studying the potential medical benefits of cone snail venom. In addition to its analgesic effects, German scientists have found that peptides in the venom decompose quickly and are unlikely to cause dependency.

A pharmaceutical drug derived from cone snails has already been developed and is marketed under the brand name Prialt. The drug is injected in spinal cord fluid to treat severe pain caused by failed back surgery, injury, AIDS, and cancer.

Magnetic Implant Could Someday Deliver Medication

By Pat Anson, Editor

Over the years scientists have developed a variety of drug delivery systems designed to help patients take medications more safely – from pumps to implants to pills made with abuse-deterrent formulas.

Researchers at the University of British Columbia have now developed one of the strangest ones yet -- a magnetic drug implant -- that could offer an alternative for pain patients who don’t like pills or injections and fear the idea of having a pain pump installed.

“This could one day be used for administering painkillers, hormones, chemotherapy drugs and other treatments for a wide range of health conditions. In the next few years we hope to be able to test it for long-term use and for viability in living models,” said Mu Chiao, PhD, a professor of mechanical engineering at UBC.

COURTESY UBC

The magnetic device – a silicone sponge with magnetic carbonyl iron particles wrapped in a polymer layer – is just six millimetres (about a quarter of an inch) in diameter. The drug is injected into the device and then surgically implanted in the area being treated.

Researchers tested the device on animal tissue in the lab using the prostate cancer drug docetaxel. They found that it was able to deliver the drug on demand even after repeated use. The drug also produced an effect on cancer cells comparable to that of freshly administered docetaxel, proving that drugs stored in the device remain effective.

Passing a magnet over the patient’s skin activates the device by deforming the sponge and triggering the release of the drug into surrounding tissue.

The University of British Columbia released this short video to show how it works:

“Drug implants can be safe and effective for treating many conditions, and magnetically controlled implants are particularly interesting because you can adjust the dose after implantation by using different magnet strengths. Many other implants lack that feature,” said Ali Shademani, a PhD student in the biomedical engineering program at UBC, who was lead author of a study published in the journal Advanced Functional Materials.

Implants such as Probuphine – which was approved last year by the Food and Drug Administration to treat opioid addiction -- cannot be adjusted to deliver different medication levels once they are implanted.

The UBC researchers say actively controlling drug delivery is important not only for treating pain, but for conditions like diabetes, where the required dose and timing of insulin varies from patient to patient.

“This device lets you release the actual dose that the patient needs when they need it, and it’s sufficiently easy to use that patients could administer their own medication one day without having to go to a hospital,” said co-author John Jackson, a research scientist in UBC’s faculty of pharmaceutical sciences.

The 411 on Calmare Scrambler Therapy

By Michael Cooney, DC, Guest Columnist

As a chiropractor who treats various pain conditions caused by injury or disease, my biggest frustration is when our therapies do not achieve a successful patient outcome.

Often, “treatment-resistant” patients are forced to seek out more invasive procedures – surgeries, spinal cord stimulators, or powerful narcotics such as ketamine − where success has been uneven, but side effects can be significant.

I wasn’t comfortable recommending these “next level” neuropathic pain treatments for my patients. So my partner Dr. Robert Kelly and I spent two years looking for a non-invasive therapy that didn’t cause pain or come with added side effects.

Through a contact in Italy, we discovered Calmare scrambler therapy, which treats several types of drug and treatment-resistant pain, a big plus for our practice. After undergoing clinical training to use the machine and eventually testing it on patients, we saw results after just a few treatment sessions, in the majority of cases.

I’ll be honest, our aim in adding Calmare to our treatment offerings was designed to help our patients who were not responding to traditional pain therapies. No one was more surprised than I to experience the global interest in this alternative treatment option.

We have been performing Calmare Therapy since 2011, treating patients from coast-to-coast and as far away as Australia, the UK, South Africa and Brazil.

Today, we treat children, adults and seniors battling CRPS/RSD, fibromyalgia, neuropathy after chemotherapy treatment, and pain that develops after surgery or from diabetes. We have also treated many people with neuropathic pain after a shingles diagnosis.

How Scrambler Therapy “Talks” With the Brain

The brain’s reaction to pain can be compared to learning to play the piano or memorizing a poem. The more the body processes pain, the stronger the connections between pain nerves and the brain become.

When someone is injured, the brain sets up a process to heal the injury. For example, cells carry away dead tissue or it increases blood flow to the injured area. Eventually, the brain realizes the injury has healed, and cuts off the pain message.

But for some people, the brain never sends the all-important message: “There’s no more injury here. You can stop sending that pain signal.”

That’s where Calmare scrambler therapy comes in.

Using small electrodes (think EKG pads) judiciously placed in the region of the injury, the device sends a mild electric signal to the brain through the electrodes.

This message overrides the brain’s confused pain signal and corrects it to a “there’s no pain here” message.

We recommend a series of 10 daily scrambler treatments. But in many cases, the pain is lessened for the patient as soon as the first treatment.

The machine we use, the MC-5A Calmare device, has been tested in clinical trials at some of the most prestigious research institutions, including the Massey Cancer Institute at Virginia Commonwealth University, the Mayo Clinic, and the American Society of Clinical Oncology. Their studies reported significant reductions in pain associated with cancer treatment and other chronic pain conditions.

The Value of Alternative Medicine in Treating Neuropathy

The majority of patients we treat with scrambler therapy come to us frustrated and exhausted by the endless search for pain relief. They have often resorted to unproven surgeries, experimental procedures, or have used powerful pain medications that leave them mentally and physically debilitated by the drug’s side effects.

I encourage people with treatment-resistant neuropathy and their families to research and consider less invasive, alternative solutions to combat the effects of chronic pain. In some cases, the cost can be comparable to prescription medications and in-patient co-pays. The outcome can be life-changing.

Regardless of the pain therapy you choose, keep in mind there are treatments that do not involve narcotics, surgery or invasive procedures, which can result in more pain and discomfort.

Keep looking -- network with people who have your medical condition, conduct your own research, and reach out to doctors who understand the value of alternative therapy. Ask the provider to put you in touch with another patient who had the treatment. We enthusiastically offer this service through our Patient-2-Patient program.

There may very well be a solution out there to minimize your pain. But often, it’s up to you to discover it.

Michael J. Cooney has been a doctor of chiropractic for more than 30 years at Rutherford Allied Medical Group and Calmare Therapy NJ in Rutherford, New Jersey. He is one of six certified providers of Calmare in the U.S. Dr. Cooney can be emailed at calmarenj@gmail.com.

Pain News Network invites other readers to share their stories with us.  Send them to:  editor@PainNewsNetwork.org. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Does Changing Your Diet Help With Fibromyalgia?

By Lana Barhum, Columnist

Having lived with fibromyalgia most of my adult life, I know my diet may worsen or improve my pain and other fibromyalgia symptoms. I am not alone in this belief, but the research disagrees. 

Most studies have not shown any specific evidence that fibromyalgia patients should avoid certain foods or add any to their diets to manage symptoms.  Nonetheless, it is still a good idea to take a look at how some foods influence how you feel.

MSG, Gluten and Vitamin D

At least 42% of fibromyalgia patients have reported worsening symptoms after eating certain foods, according to a study in Clinical Rheumatology.  Other studies on fibromyalgia and diet have focused on food additives, gluten, and vitamin D, and found some evidence that they may affect fibromyalgia pain.  

A 2012 study published in Clinical Experimental Rheumatology, assessed fibromyalgia and irritable bowel syndrome (IBS) patients who had excluded monosodium glutamate (MSG) and aspartame from their diets.  After four weeks, 84% of the study participants reported their symptoms had improved by about a third.  Adding MSG back into their diets resulted in a return of symptoms.

The researchers concluded that MSG did, in fact, have an adverse effect on some fibromyalgia patients and removing it from their diets was an easy solution.

"This novel research implicates glutamate as a major adverse excitotoxin in some FM (fibromyalgia) patients. Dietary manipulation is a relatively simple and low cost non-pharmacological intervention that warrants further exploration," reported lead author Kathleen  Holton, PhD.

But another study, published in Rheumatology International, found no relationship between MSG and fibromyalgia pain and symptoms.  The researchers reported no symptom improvement in the group that removed MSG and aspartame from their diets and the group that did not.

While there has been little specific evidence pointing to gluten as a fibromyalgia trigger, some research shows patients respond well when they avoid eating gluten.  Spanish researchers reported in Rheumatology International that fibromyalgia patients who removed gluten from their diets showed notable improvements in pain and symptoms.                                                           

There may also be a link between fibromyalgia pain and low levels of vitamin D, according to a 2014 study out of Austria. That research, reported in the journal Pain, found that study participants who took vitamin D supplements experienced less pain and morning fatigue.   

A 2015 report from the journal Pain and Therapy, also makes a case for a link between Vitamin D deficiency and pain. "Significant improvements in assessment of sleep, mood, pain levels, well-being, and various aspects of quality of life with vitamin D supplementation have been shown,” said researchers Elspeth and Edward Shipton.

More research is needed to further determine if diet and fibromyalgia are actually related.  But doctors do agree eating healthy foods can help patients to feel better and tweaking your diet may improve symptoms.

Making Diet Changes

Here are some ways to help you figure out which foods help and which ones hurt.

Keep a Food Journal.  Many people with fibromyalgia have food sensitivities, but specific “trigger” foods will vary from person to person.  A good way to identify which foods worsen fibromyalgia symptoms and pain is to keep a food journal.  If you find your symptoms consistently worsen after eating certain foods, try eliminating those foods from your diet and see if your symptoms improve.

Eat Healthy. It makes sense for everyone to eat healthy, not just people with fibromyalgia.  Eat a diet that is rich in fruits and vegetables, whole grains, and lean proteins. 

A balanced diet will also give you more energy and improve overall health.

Pick the Right Foods. There are certain foods that may help improve fibromyalgia symptoms and minimize flares.  Vitamin D is one, as studies show deficiency can cause joint and muscle pain.

Vitamin D is one, as studies show deficiency can cause joint and muscle pain. Foods rich in vitamin D include fatty fish (tuna and salmon), dairy products fortified with vitamin D (orange juice, milk, and cereal), beef liver, and egg yolks. Foods containing omega 3 fatty acids, which are found in fatty fish, walnuts and flax seed, may also ease fibromyalgia symptoms by reducing soreness and inflammation.  

My Take

I am strong believer in taking your health into your own hands and experimenting with alternative treatments, including a healthy diet.  Through trial and error, I have figured out which foods help and which foods hurt as I continue to learn how to successfully cope with fibromyalgia. 

Aspartame (Nutrasweet), food additives (especially MSG), sugar, fructose, simple carbohydrates, caffeine, gluten, fried and junk food, dairy and nightshades (tomatoes, peppers, and potatoes) are all foods that I have either eliminated or minimized from my diet.  Cutting them out of my diet has made fibromyalgia flares less frequent. 

In addition, I take vitamin D supplements, since my levels are often low, and eat foods rich in omega 3 fatty acids, such as fish, walnuts, and eggs, to manage inflammation, as I also suffer from rheumatoid arthritis.

While I don’t know for certain if my diet is the reason for fewer flare-ups, I do know that avoiding certain foods and eating healthy ones benefits my overall health.  And when my body feels healthier, I am better able to cope with fibromyalgia pain and symptoms.

The specific foods that help and hurt will be different for you, but a healthy diet can help you manage fibromyalgia symptoms and pain and improve your health overall.  And, it is definitely worth a try to find out. 

Lana Barhum is a freelance medical writer, patient advocate, legal assistant and mother. Having lived with rheumatoid arthritis and fibromyalgia since 2008, Lana uses her experiences to share expert advice on living successfully with chronic illness. She has written for several online health communities, including Alliance Health, Upwell, Mango Health, and The Mighty.

To learn more about Lana, visit her website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Acupuncture Effective in Treating Pain and Depression

By Pat Anson, Editor

Acupuncture can boost the effectiveness of medical care and lessen the severity of chronic pain and depression, according to a new study led by British researchers.

In a meta-analysis (a study of studies) of 29 clinical trials involving nearly 18,000 patients with chronic neck, lower back, knee or headache pain, researchers found that acupuncture significantly reduced the severity of pain when combined with standard medical care such as anti-inflammatory drugs.

Acupuncture is an ancient Chinese form of treatment that involves the insertion of fine needles into acupuncture points on the body. About four million acupuncture sessions are provided each year in the UK, about half of them for pain relief. The evidence to support such treatment has been limited.

"There has been a question mark for many years over whether policy and decision makers should or should not provide wider access to acupuncture,” said Hugh MacPherson, PhD, a professor of acupuncture research at the University of York.

“Our aim was to bring together data from high quality clinical trials and provide a robust evidence base that will help reduce this uncertainty and support commissioners and health professionals in making informed decisions backed up with research."

The study, published in the National Institute for Health Research (NIHR) Journals Library, found that the addition of acupuncture -- compared to standard medical care alone -- significantly reduced the number of headaches and migraine attacks and reduced the severity of neck and lower back pain.  Acupuncture also reduced the pain and disability of osteoarthritis, which led to patients using less anti-inflammatory medication to control pain.

The research team also conducted a new clinical trial for depression, in which 755 patients were provided with acupuncture, counseling or antidepressants. They found that both acupuncture and counseling significantly reduced the severity of depression, and that the benefits were sustained up to 12 months after treatment.

"In the largest study of its kind, we have now provided a solid evidence base to show that not only can acupuncture and counseling bring patients out of an episode of depression, but it can keep the condition at bay for up to a year on average," said MacPherson, who added that antidepressants don’t work well for more than half of patients.

Researchers admit the benefits of acupuncture are partially associated with a placebo effect, which has contributed to uncertainty about it's clinical effectiveness. However, when compared with sham acupuncture – in which fake needles are used or inserted in the wrong locations – they say “real” acupuncture provides substantially more pain relief.

“Our new data provides a significant step forward in treating chronic pain and managing depression, because patients and health professionals can now make decisions on acupuncture with more confidence. Not only is it more cost effective, but it reduces pain levels and improves mood levels, which could reduce over reliance on drugs that can sometimes result in unwanted side effects," MacPherson said.

Acupuncture is one of the most widely practiced forms of alternative medicine. As many as 3 million Americans receive acupuncture treatments, most often for relief of chronic pain. While there is little consensus in the medical community about acupuncture’s value, a large study in the Archives of Internal Medicine found that  “acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option.”

Early Detection and Diet May Help Prevent Osteoporosis

By Pat Anson, Editor

The key to good bone health – and preventing fractures later in life – may lie in anti-inflammatory diets and earlier detection of bone loss, according to two new studies.

Researchers at the University of Michigan are studying new ways to identify women at risk of osteoporosis, a loss in bone density that raises the risk of fractures and disability. Breaking a bone in your spine or hip doubles your chances of developing chronic widespread body pain, especially if you are older.

"It's been considered a silent disease," says Karl Jepsen, PhD, associate chair of research and professor of orthopaedic surgery at Michigan Medicine. "One of the biggest challenges when you're looking at age-related bone fragility is to identify people who will fracture."

Jepsen is the lead author of a study published in the Journal of Bone and Mineral Research, which followed nearly 200 women for 14 years as they transitioned through menopause.

"Current identification for bone fragility takes place when the patient is around 65 years of age," Jepsen explains.

"We were hopeful that this study would give us an opportunity to identify those patients as early as 30 years before they fracture based on their bone traits. That means we would have an opportunity to intervene before the fracture happens, instead of after the fact."

Jepsen and his colleagues started following the women in 1996. Participants who enrolled had to be between 42 and 52 years of age and had at least one menstrual period in the previous three months. The women had bone density scans and other tests annually to measure changes in their bone mineral density.

Researchers found that the women experienced a wide variation in bone mineral content and bone area within the hip as they went through menopause, a finding that was unexpected.

"Our results were opposite to all expectations of how we assumed this would work," Jepsen says. "We found some women appeared to have hip bones that were increasing in strength during the menopausal transition while others seemed to be losing strength."

Jepsen said his study demonstrates that bone changes can be tracked individually in women during menopause, when treatment can begin earlier to prevent bone loss. Hormones and bisphosphonate drugs are currently used to help strengthen bones.

“Our goal is to use simple bone traits to identify those women that may benefit from early intervention when it comes to bone fragility, instead of the current strategy, which treats individuals after they have lost appreciable bone mass and strength," he said.

Anti-Inflammatory Diet Improves Bone Health

Anti-inflammatory diets -- which tend to be high in vegetables, fruits, fish and whole grains -- could boost bone health and prevent fractures, according to a study at The Ohio State University.

Researchers analyzed dietary data from over 160,000 women enrolled in the landmark Women's Health Initiative by assigning inflammation scores based on 32 foods that the women reported consuming. Researchers also looked at bone-mineral-density data from over 10,000 women and collected fracture data for the entire study group.

They found a correlation between high-inflammatory diets and fractures in post-menopausal younger than 63. Women with the least-inflammatory diets also lost less bone mineral density.

"This suggests that as women age, healthy diets are impacting their bones," said Tonya Orchard, an assistant professor of human nutrition at Ohio State's Food Innovation Center. "These women with healthier diets didn't lose bone as quickly as those with high-inflammation diets, and this is important because after menopause women see a drastic loss in bone density that contributes to fractures,"

The study, which appears in the Journal of Bone and Mineral Research, was observational -- meaning it does not definitively link diet to bone health. But it adds to a growing body of evidence that inflammation can increase osteoporosis risk.

"By looking at the full diet rather than individual nutrients, these data provide a foundation for studying how components of the diet might interact to provide benefit and better inform women's health and lifestyle choices," said Rebecca Jackson, the study's senior author and director of Ohio State's Center for Clinical and Translational Science.

Previous studies have connected high levels of inflammatory markers in the blood to bone loss and fractures in older women and men. The new findings suggest that women's bone health could benefit when they choose a diet higher in beneficial fats, plants and whole grains.

Spinal Cord Stimulators Reduce Opioid Use

By Pat Anson, Editor

Most patients who have a spinal cord stimulator significantly reduce their use of opioid pain medication one year after their implant, according to new industry-funded research.

In an analysis of private and Medicare insurance claims from 5,476 patients who received a spinal cord stimulator (SCS), opioid use declined or stabilized in 70 percent of the patients. Opioid use was higher among patients who had the stimulator removed.

The study, presented at the annual meeting of the North American Neuromodulation Society (NANS), was sponsored by Abbott (NYSE: ABT), a manufacturer of SCS systems and other medical devices.

"Given the epidemic of opioid addiction and abuse, these findings are important and confirm that spinal cord stimulation therapy can offer strong benefits for patients struggling with chronic pain," said Ashwini Sharan, MD, president of NANS and director of Functional and Epilepsy Surgery at Vickie and Jack Farber Institute for Neuroscience.

"Based on these results, we concluded it may be possible to improve outcomes by offering our patients spinal cord stimulation earlier, before opioid dependence and addiction can occur."

Spinal cord stimulators have long been considered the treatment of last resort for chronic back and leg pain, because the devices have to be surgically implanted near the spine and connected to batteries placed under the skin. The implants send electrical impulses into the spine to mask pain.

Some patients find the stimulators ineffective and have them removed. According to one study, only about half of patients who received a traditional SCS device have a 50 percent reduction in their back and leg pain.

New technologies have been developed to make the devices more effective, easier to recharge and to reduce complications such as paresthesia – a tingling or buzzing sensation.

And with government regulators and insurers discouraging the use of opioid pain medication, the medical device industry is urging patients and doctors to take another look at SCS devices.

X-RAY OF PATIENT WITH MEDTRONIC SCS DEVICE

"As our society has been seeking ways to stem opioid abuse and addition, our company offers treatment options that can reduce their exposure to opioid medication," said Allen Burton, MD, medical director of neuromodulation at Abbott in a news release. "Data like these are critical to helping us demonstrate that spinal cord stimulation can reduce exposure to opioids while giving patients comprehensive pain relief."

Abbot recently purchased St. Jude Medical, giving the medical device maker its first exposure to the SCS and neuromodulation market, which has an estimated value of $5.3 billion.

"Non-medical pain relief is a focus with attention on the dangers of pain medication and the need to find alternatives to reduce chronic pain," said Bruce Carlson, Publisher of Kalorama Information, a research firm that tracks the neuromodulation market. "Abbott builds on its cardiovascular device properties with this deal, and that is a big focus of press coverage.  St. Jude's impressive spinal cord offering should not be obscured in this transaction."

Even a Little Exercise Is Better Than None

By Pat Anson, Editor

We often hear from pain sufferers who say they’d like to exercise more, but can’t because their pain levels have left them bedridden or stuck on a couch. Others believe a workout at the gym will only make their pain worse.

But two new studies have found that you don’t need to be a gym rat to get the health benefits from exercise.

You may not even need to stand up!

Federal guidelines suggest a minimum of 150 minutes of exercise a week are needed to promote good cardiovascular health. But researchers at Northwestern University wanted to see if a lesser goal could improve overall health.

They measured the physical activity of 1,600 adults with osteoarthritis in their hips, knees or feet; and found that just 45 minutes of moderate physical activity a week improved their function and reduced pain

"We were interested in seeing what kind of physical activity might be beneficial to promote good function down the road,” said Dorothy Dunlop, a professor of rheumatology and preventive medicine at Northwestern University Feinberg School of Medicine.

“We found moderate-intensity activity rather than light activity, such as pushing a grocery cart, to be more valuable to promote future function."

Using sophisticated accelerometers to monitor movement, the researchers found that participants who engaged in moderate activity, such as brisk walking, for at least 45 minutes a week were 80 percent more likely to improve or sustain high future function.

The findings, published in the journal Arthritis Care & Research., were true for both men and women. The beneficial effects of the exercise were also long term. About a third of participants improved or had high function after two years.

"The federal guidelines are very important because the more you do, the better you'll feel and the greater the health benefits you'll receive," Dunlop said. "But even achieving this less rigorous goal will promote the ability to function and may be a feasible starting point for older adults dealing with discomfort in their joints.”

"Even a little activity is better than none," she added

Chair Yoga Relieves Pain of Osteoarthritis

A second study at Florida Atlantic University found that “chair yoga” is an effective way to reduce pain and improve quality of life in older adults with osteoarthritis.

As the name implies, the Sit-N-Fit Chair Yoga program was developed to help those who cannot stand during exercise or participate in traditional yoga. Chair yoga is practiced sitting in a chair or standing while holding the chair for support.

IMAGE COURTESY OF FLORIDA ATLANTIC UNIVERSITY

In a study of 131 older adults who have osteoarthritis, participants attended 45-minute chair yoga sessions twice a week for 8 weeks.

Researchers measured their pain, pain interference (how it affects one's life), balance, gait speed, fatigue and functional ability; before, during and after the sessions.

Compared to a control group enrolled in a health education program, the chair yoga group showed a greater reduction in pain, pain interference and fatigue during the sessions, as well as an improved gait. The reduction in pain interference lasted for about three months after the chair yoga program was completed.

"The effect of pain on everyday living is most directly captured by pain interference, and our findings demonstrate that chair yoga reduced pain interference in everyday activities," said Ruth McCaffrey, emeritus professor in FAU's College of Nursing and co-author of the study published in the Journal of the American Geriatrics Society.

"The potential impact of this study on public health is high, as this program provides an approach for keeping community-dwelling elders active even when they cannot participate in traditional exercise that challenges their balance," said co-author and principal investigator Patricia Liehr, PhD, a professor in FAU's College of Nursing.

Osteoarthritis is the most common form of arthritis and the leading cause of long-term disability in older adults. It affects about a third of Americans over the age of 65.

Wear, Tear & Care: The Edge Desk

By Jennifer Kilgore, Columnist

Let’s talk about how much I hate sitting.

I have two neck fusions, a permanently messed-up thoracic spine, and bulging discs in the lumbar spine. All of these combined make it very difficult for me to sit for long periods of time. This was a large part of why I had to leave the traditional working world and work from home.

I am always looking for improvements to my physical work setup. I already have a kneeling chair that I’d used in my old office, and even that -- my best option -- is something I can only do for a limited period of time before my back flares.

It seemed that coupling a kneeling chair with a normal desk was sometimes an odd combination because the height difference could mean bending my wrists to type (bad) or adjusting my neck (also bad). For some reason, I couldn’t figure out the right height to put the kneeling chair to correlate with my computer monitor.

So the question became, is there a desk that’s made specifically to work with kneeling chairs?

Why yes! There is!

I backed the Edge Desk on Kickstarter in March 2016. Every square inch of my house is occupied by something and I have no extra space. I bought this desk without caring about that.

As of now the desk is sitting in the middle of my office, where it’s blocking the printer and two bookcases (it’s not a big office).

This thing came fully assembled in a huge box in the middle of December. Now I’ve had enough time to use it and gather my thoughts.

courtesy: edge desk

Thoughts on the Edge Desk

●       It’s ergonomic

There’s something about kneeling that makes you sit up straight. It’s not an uncomfortable sort of straight, though -- a lot of the pressure is taken by your shins and thighs. Most importantly, it doesn’t bother your shins or knees, or at least it shouldn’t. This ensures proper alignment of the spine. I actually also felt like it kept me alert and more awake at my desk in a way that normal chairs do not.

●       It’s compact and light

I am not a strong person. Let’s get this out of the way right now. I am basically an anthropomorphic noodle. However, I can manipulate this desk myself if I try. It’s still something I’d ask my husband to carry for me, were that option to arise -- it’s 25 lbs., though it folds down to an impressive 6 inches and can fit underneath a twin bed for storage. So, once I decide to move it from its current position in the middle of my office, it won’t take up too much room. 

●       Angle of the easel

The really cool thing about this desk is the connected tabletop. It can be flat, or it can tilt at an angle, like an artist’s easel. It can also tilt at a very sharp degree, like an architect’s table.

Most of my work is done on a computer, which this desk can still accommodate, but as some of my spine damage affects my hands, I’ve been trying to think of interesting new activities to work on my manual dexterity. I’ve tried knitting, and now I’m experimenting with calligraphy. This new desk is great for that purpose.

I’m perfectly okay with letting this desk float around my house until we can find a proper place for it. It’s very portable, so at least it won’t be difficult to move around!

courtesy: edge desk

All in all, I quite like the Edge Desk. It’s very good for people who require an ergonomic setup that is gentle on the spine, yet it’s sturdy enough to travel to an office if needed. And it’s a talking piece, because who else has anything like it?

You can purchase the Edge Desk for $350 through the company’s website.

Jennifer Kain Kilgore is an attorney editor for both Enjuris.com and the Association of International Law Firm Networks. She has chronic back and neck pain after two car accidents.

You can read more about Jennifer on her blog, Wear, Tear, & Care.  

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

The Hidden Risk of Eye Strain From ‘Blue Light’

By Pat Anson, Editor

Do you get frequent headaches? Suffer from neck and shoulder pain? Have trouble getting to sleep?

If you spend a lot of time online, the culprit could be high energy visible (HEV) light – also known as blue light – emitted by your smartphone, laptop, desktop computer and other digital devices.

Blue light has a very short wavelength that penetrates deep into the eye. In its natural form, blue light is what makes the sky look blue and can have beneficial effects, such as boosting alertness and elevating mood. But the additional burden of artificial blue light is exposing us to more blue light waves than our eyes can handle.

According to a nationwide survey of nearly 10,000 adults by The Vision Council, nearly 9 out of 10 Americans use digital devices more than two hours per day, and over half regularly use two digital devices simultaneously.

Many don’t realize that prolonged exposure to blue light raises the risk of digital eye strain, age-related macular degeneration (AMD) and cataracts; and can also suppress of the body's natural release of melatonin, the hormone that regulates sleep.

"Patients underestimate how their technology use may be contributing to eye strain and do not consider ways to reduce this stress," says Dr. Justin Bazan, OD, medical adviser to The Vision Council.   

About a third of those surveyed reported having symptoms of digital eye strain, including neck and shoulder pain (30%), headache (23%), blurred vision (22%) and dry eyes (22%). 

More than 80% also report that they use digital devices in the hour before going to bed.  Eye exposure before bedtime has been shown to disrupt sleep patterns.

Prolonged blue light exposure is common in children. Three out of four Americans say their children get more than two hours of screen time a day. Half report these children suffer from headaches, neck and shoulder pain, irritated eyes, reduced attention span, poor behavior, or irritability.

The Vision Council says there are a number of easy steps to prevent digital eye strain:

• Follow the 20-20-20 rule, by taking a 20-second break from the screen every 20 minutes and looking at something 20 feet away
• Reduce overhead lighting to eliminate screen glare
• Position yourself at arm's distance away from computer screens
• Increase text size on devices to better define content on the screen

Specialized eyewear is also available with lenses that can block blue light, decrease brightness, minimize glare, and reduce the blurriness and pixilation of screens. The lenses are constructed for the mid-distance range at which users typically view a digital screen, and can be purchased with or without a prescription. 

"The optical industry has recognized and responded to the increase in digital habits and has developed lens and coating technology to protect the eyes from blue light, glare and other environmental stressors, ultimately to improve the way people see," says Ashley Mills, CEO of The Vision Council.

More information about blue light can be found at BlueLightExposed.com.

Is Fibromyalgia Like a Software Problem?

By Lana Barhum

Earlier this year, the British Pain Society released an interesting study on the development of a new method to help doctors better communicate with fibromyalgia patients about their pain and symptoms. 

That narrative, which takes the unusual approach of comparing fibromyalgia to a software problem in a computer, is geared towards motivating patients to focus on exercise and other lifestyle changes, as opposed to pain medication.

"This study provides evidence that a framework incorporating a computer based analogy provides an acceptable story that helps FM (fibromyalgia) patients understand their illness and motivates them to engage in evidence based lifestyle adaptations that enhance recovery," wrote lead author Michael Hyland, PhD, a professor of Health Psychology at Plymouth University in the UK.

Fibromyalgia is a poorly understood disorder characterized by deep tissue pain, fatigue, depression, mood swings and insomnia. The exact cause of fibromyalgia is unknown.

Because the diagnosis of fibromyalgia is difficult and sometimes controversial, many patients struggle to communicate with doctors about their symptoms, pain and treatment. Studies have shown exercise and psychological intervention can improve fibromyalgia symptoms, but many patients feel their pain is best treated with medication. They are often surprised when their doctors suggest non-medicinal treatment options. 

The fibromyalgia narrative developed at Plymouth University is designed to minimize that misunderstanding and assist in communication between patients and their doctors.  It encourages doctors to present the body as “as ‘a very, very clever computer’ where fibromyalgia is caused by a software rather than a hardware problem.”

If there are issues in the software, the computer (the body) can be reprogrammed to correct them.  Essentially, patients are offered an explanation for why they are ill, why the doctor cannot find anything wrong, and what can be done to intervene. 

The narrative was developed with the help of 15 fibromyalgia patients.  The patients said the initial model created by researchers “worked poorly” and was ambiguous, so the researchers modified the narrative to make it more understandable. 

"Under certain identifiable conditions, the body creates ‘stop signals’ that prevent damage and promote recovery. These stop signals include pain, fatigue, nausea and dizziness. If, for whatever reason, the person is unable to respond to those stop signals – that is, they do not stop what they are doing – then over time the stop signals increase and become fixed, and the body is sensitized to anything that creates a stop signal,” wrote Hyland.  

The narrative also provided a basis for exercise and psychological help as ways to correct the body's software.

A second group of 25 fibromyalgia patients evaluated the new model during a 7 week “body reprogramming intervention,” in which they were taught about relaxation techniques, mood enhancement, exercise, diet and lifestyle changes. Only patients willing not to take medication were included.   

Most patients said the intervention was very useful, calling it believable, informative and hopeful. Many also said they had implemented lifestyle changes once they knew the benefits.

“Very informative and so refreshing to find answers to problems I’ve had for over 14 years and wonderful to be able to self believe ‘It’s not in my head’ as I’ve self-doubted so many times,” wrote one patient.

“This has been a revelation and has given our family ‘hope’ where we thought there was none,” wrote the mother of another patient. “This illness has not only affected my daughter but the whole of our family. We have spent years trying self help, but it felt like we were just stabbing in the dark.”

Hyland says hope is an important facet in finding solutions to chronic pain. 

"When patients have no explanation of their illness, they do not have a conceptual model of how and whether they will ever get better. Thus, providing patients with an illness narrative provides information not only about the route into the illness but also the route out,” he wrote.

Lana Barhum lives and works in northeast Ohio. She is a freelance medical writer, patient advocate, legal assistant and mother. Having lived with rheumatoid arthritis and fibromyalgia since 2008, Lana uses her experiences to share expert advice on living successfully with chronic illness. She has written for several online health communities, including Alliance Health, Upwell, Mango Health, and The Mighty.

To learn more about Lana, visit her website.

Can You Color Away Pain?

By Pat Anson, Editor

You might call Mary Hayes a pioneer in adult coloring. Millions of people like her have discovered that coloring a complex floral or geometric design is a great stress reliever.

But Hayes also colors to relieve her pain.

“I can't do a lot of activities, so I wanted something to do that would keep my mind active,” says Hayes, who has suffered most of her life from fibromyalgia, migraines, fatigue and other chronic illnesses.

“I played video games and worked puzzles, but I got tired of that.  I realized I was losing part of my physical self when my mind was engaged. So I started coloring.”

Hayes says she got strange looks when she first started asking for adult coloring books in book stores. That was before the “coloring craze” took off – first in Europe and then the United States.

Today, many craft, hobby and book stores keep a wide selection of adult coloring books. One colorist has sold more than 20 million of her books worldwide.

“I think of coloring as my therapy.  I've been able to express the way my pain makes me feel inside in a way that I cannot express in words,” says Hayes. “It not only engages the mind, it engages the body by adding some movement that could be compared to a yoga-like experience.

“When I'm sitting there and coloring, I'm thinking about what colors I want to use and what medium I want to use.  Time moves past so quickly.  I look up at the time and realize I haven't taken a pain pill in hours and that is an amazing feeling.  I think in a way it ties the brain up so tightly, it stops all those pain signals from breaking through.” 

Coloring not only provides pain relief, it’s turned Hayes into artist. Beautiful and complex designs – like the one she colored below – can often take days to complete.

Hayes started connecting with other colorists on Facebook, which is where Jack Plaxe discovered her. Plaxe retired from the world of finance several years ago, formed a company called Color 4 Fun, and started publishing adult coloring books as an avocation.  

“I’m having a good time working with artists around the world creating these books,” Plaxe told PNN. “I don’t have pain, but I color and it’s very, very relaxing. It’s stress relieving.”

Plaxe noticed that many of the colorists he met online suffer from chronic pain, which gave him the idea of publishing his latest book, Color Away the Pain. It features the artistry and personal stories of Hayes and four other colorists who suffer from chronic pain and illness.

“Many of them use coloring as a form of therapy for distraction from their pain. So I’m well aware of the benefit of coloring for people who are pain sufferers,” says Plaxe.

“We color our soul onto those pages.  We can run and be active in colors.  We can express our spirit and self with our personal style.  We are defined by our coloring style and not our disability,” says Hayes. 

“It feels so good to have someone tell someone about my artistry and not my disability.  I can show my work and not have to talk about my latest treatment.  Those things don't disappear, but they are not what defines me anymore.  I found out I have a real talent that I never knew existed.”

To see more of that talent and those of other artists, click here, here or here.

To find the hidden artist in yourself, you can buy a copy of Color Away the Pain from Amazon for $7.95. All royalties from sales of the book will go to the Chronic Pain Research Alliance.

Plaxe also has a Facebook page that offers free advice and instructional videos for beginners.

Color Away the Pain is featured along with several other pain-related books in PNN’s new “Suggested Reading” section.

Quell Relieves Back Pain Without Medication

By Pat Anson, Editor

Like many people who suffer from chronic back pain, Greg Watson has tried a lot of different treatments, including physical therapy, soft tissue manipulation, chiropractic adjustments, trigger point injections and dry needling.

“I did trigger point injections with really big needles,” says Watson, whose back was broken in four places when his bike was hit by a car in 2011. “A lot of interesting ways of relieving pain by triggering an even bigger pain. Some of those things would work temporarily.”

Watson spent five days in the hospital after the accident, where he was “pumped full of morphine.” When he was finally released and sent home, the 45-year old Watson was determined to avoid taking more pain medication. That meant trying all of those alternative therapies, with little success, and living for years with intermittent pain that sometimes reached a 6 or 7 on the pain scale.

A friend recommended that Watson try Quell, a battery powered medical device worn below the knee that uses electric nerve stimulation to relieve pain throughout the body -- a therapy known as neuromodulation.

“I felt it and noticed something right away,” says Watson. “It feels a little bit like pins and needles, and it kind of comes in little waves or pulses. Very low amounts of electricity coming into you.”

It took a couple of days for Watson to feel some pain relief. The biggest improvement he noticed was that he slept better.  

“I would go home and put it on for a few hours and then be able to get a full night’s sleep without having to wake up with leg discomfort in the middle of the night,” said Watson, a city planner in Boston who is an avid runner and bicyclist.

neurometrix image

On bad pain days, Watson will wear the Quell device while sleeping or at work. But mostly he just wears it for a few hours at a time. Watson has found that he’s often able the get through an entire day without even thinking about his pain. 

“There are some days I get a bigger uptick in the amount of pain that comes from that old injury site. But when that’s the case, I just up-ramp the use of it a little more.”

Quell is made by NeuroMetrix (NASDAQ: NURO), which recently won approval for the device to be sold in the Europe Union.

It’s been available in the U.S. since the summer of 2015 and is FDA approved for the treatment of chronic pain.

Quell can be purchased without a prescription, but is not covered by insurance and costs $249 through the company’s website or on Amazon. 

PNN columnist Jennifer Kain Kilgore says Quell “worked brilliantly” in relieving her chronic neck and back pain.

But readers have had mixed results with the device.

“Very expensive, wasn't covered under my Medicare insurance. I tried it for a couple of weeks and simply didn't receive ANY pain relief for my low back and neck. None. I am very disappointed,” wrote one woman.

“I have been using Quell for a month now. I use it mainly at night for the pain that I experience in my hips and legs that keeps me from sleeping,” wrote Pam. “It actually has helped me to ditch the sleeping pills. It helps me fall asleep. I am elated.”

“I am on day 18 of my Quell device. It has eliminated the pain in my knees. No more Bengay, Australian Dream or Blue Emu Cream needed. The pain in my feet and hips has diminished greatly,” said Beth Flood. “It is not perfect, it is not a complete answer, but for what it does and the relief it has offered, it is well worth buying.”

NeuroMetrix recently announced that it was conducting a small clinical study of Quell in 60 adults with chronic low back pain at the Brigham and Women’s Hospital Pain Management Center. The three month study will compare a group of patients using Quell to patients using their “treatment-as-usual.” Participants in both groups will use a smartphone app developed by the Pain Management Center to help them document and manage their pain.

“This study will analyze the potential for Quell to reduce pain and improve quality of life in people suffering from chronic low back pain. We look forward to learning a great deal from this study,” said Shai Gozani, MD, President and CEO of NeuroMetrix in a news release.

In previous small studies of Quell in patients with arthritis, diabetic neuropathy, sciatica or fibromyalgia, over 80 percent said the device relieved their chronic pain and improved their overall health. The largest measured changes were in pain relief, along with improved sleep, general activity and walking ability.

Over two-thirds of the patients said Quell also reduced the amount of pain medication they were taking. That’s an important consideration for Greg Watson.

“Especially if you’re looking to avoid medication. That’s the absolutely most appealing thing about it to me,” he says.

Can Running Help Prevent Osteoarthritis?

By Pat Anson, Editor

People suffering from aching muscles and joint pain are often told that exercise is the best remedy. It sounds counter-intuitive, but now there’s evidence that running can actually reduce joint inflammation – at least in the knees.

"It flies in the face of intuition," says Matt Seeley, an associate professor of exercise science at Brigham Young University. "This idea that long-distance running is bad for your knees might be a myth."

Seeley and his colleagues conducted a small study of six healthy men and women who ran on treadmills for 30 minutes. Blood samples and synovial fluid from their knee joints were collected both before and after they ran.

The researchers found that two inflammatory markers in the synovial fluid -- cytokines named GM-CSF and IL-15 -- decreased in concentration in the runners after a treadmill session.  Cytokines are small proteins released by cells that play an important role in pain and inflammation.

"What we now know is that for young, healthy individuals, exercise creates an anti-inflammatory environment that may be beneficial in terms of long-term joint health," said Robert Hyldahl, a BYU assistant professor of exercise science.

image courtesy of Nate Edwards/BYU

The findings, published in the European Journal of Applied Physiology, indicate that running may be chondroprotective, which means exercise may help delay the onset of joint diseases such as osteoarthritis (OA), a disorder that leads to thinning of cartilage and progressive joint damage. Nearly 40 percent of Americans over the age of 45 have some degree of knee OA.

“This is the first study to evaluate a wide panel of inflammatory mediators in the knee joints of healthy subjects following running. Our results suggest that running decreases intra-articular inflammation and brings to light a novel potential mechanism for the chondroprotective nature of exercise in non-pathologic knees,” the BYU researchers said.

The researchers now plan to study subjects with previous knee injuries, by conducting similar tests on people who have suffered ACL injuries.

"This study does not indicate that distance runners are any more likely to get osteoarthritis than any other person," Seeley said. "Instead, this study suggests exercise can be a type of medicine."

Wear, Tear & Care: Needling Away Pain

By Jennifer Kain Kilgore, Columnist

One would think that encouraging inflammation is a bad idea, right?

“Let’s stick you with needles, inject a dextrose solution, and create some new tissue. It’ll be great!”

That’s what my dad has been saying since 2004. He had prolotherapy done for his low back in college, and it did wonders for him. I was extremely dubious. It sounded far too strange – injecting a sugar solution? Into my neck?

I have very extensive injuries from two separate car accidents. To sum it up quickly, I have badly-healed thoracic fractures, bulging lumbar discs hitting nerves, and two cervical fusions that cause a lot of post-surgical pain. The idea of purposefully creating more inflammation sounded insane. But after my second fusion, when the pain started increasing no matter how dutifully it was treated, I decided to give it a try.

Prolotherapy, or sclerosing injections, is still considered a bit radical, even though it’s been around since the 1930’s. The reason for the mystery is because there haven’t been enough double-blind studies conducted yet.

It’s a non-surgical ligament and tendon reconstruction injection designed to stimulate the body’s natural healing processes. By creating inflammation, you prod the body to create new collagen tissue and help weak connective tissue become stronger.

Because I live in the Boston area, that meant the drive to the doctor’s office was an hour each way. Most people do each area (lumbar, thoracic, cervical) separately, and each area takes approximately five rounds of shots. For me, that would’ve meant an eternity of needles.

I chose the insane route: five weeks of intense pain, meaning five weeks of all three areas at the same time.

It’s not supposed to hurt that much – people can take an aspirin and go to work after the appointment, grumbling about their aching knee. My pain response has become far more sensitive in my back and neck since the accidents, so what’s like a bee sting for other people is like thick surgical needles for me.

As such, it was hellishly difficult. Each appointment was on a Wednesday and took about fifteen minutes. The doctor injected my low back and then let me rest with an ice pack down the back of my pants. Then he injected my neck, loading me with more ice packs. Then, very gingerly, he approached the mid-back, which was the most damaged of all. He had to consult my MRIs for that one because the bones are not quite where they’re supposed to be.

For me, it took about an hour for the real pain to kick in, which gave me just enough time to drive home. The doctor numbed me with a topical anesthetic as well, so I sat on five ice packs and made the drive back to my house, where I collected all the ice packs in the freezer and arranged them on the recliner. Then I wouldn’t move for about two days. Sleeping was almost impossible without ice packs stuffed into my pajamas; I still can’t sleep on my back, two months later. Sitting like a normal human being was out of the question.

For five weeks, I spent the two or three days after shots recovering from absurd amounts of pain, and then by the time I’d recovered, it was almost time for the next round. My level of pain was far more than what other people online have reported. I also did a lot more shots at once than other people do. My experience was very much abnormal. But, most importantly: Did it work?

Well, yes. It did. Amazingly so. I’d told myself at the beginning that if this procedure controlled even 25 percent of the pain, that would be worth it. That would be worth the driving, the pain, and the out-of-pocket cost that isn’t covered by insurance.

My cervical fusions caused my arms not to work a lot of the time. Typing, writing, and using my hands for general tasks was very difficult and tiring. Additionally, my shoulder blades had what felt like black holes filled with electric fire. Nothing helped it. Nothing worked.

Two weeks into the prolotherapy regimen, my arms were fine and the black holes had disappeared.

I still have a lot of my daily low-grade, all-body pain. I still have massive headaches and neck pain. But my sciatica is also better, I’ve noticed – I was able to go to a rock park called Purgatory Chasm and clamber all over humongous boulders, and afterward I was only sore, not in agony.

So do I think it works? Absolutely. The other great part is that it’s supposed to last for at least a few years. Steroid injections only last a few months. I very much prefer this schedule.

If you can get past the “alternative therapy” label and can scrounge up the money to pay for it, I’d highly recommend prolotherapy. It worked for me, and I’m still waiting to see more of its effects. I hope that it works as well for you.

Jennifer Kain Kilgore is an attorney in the Greater Boston area who also works as a writer and editor in her spare time.  She has chronic back and neck pain after two car accidents.

You can read more about Jennifer on her blog, Wear, Tear, & Care.  

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.