Pain Medicine News
Suicide is the 10th most common cause of death in the United States, and is often related to serious depression, alcohol or substance abuse, or a major stressful event. Given the high correlation between chronic illness and depression, it is not surprising that studies have found suicidal ideation, suicide attempts and suicide completions to be common in patients with chronic noncancer pain. Now, researchers believe that the type of chronic pain also may play a role in risk for suicide.
“About 20% [of patients with chronic pain] most likely have passing suicidal thoughts; 5% have active thoughts; and about 5% have a past history,” said Martin Cheatle, PhD, director of the Pain and Chemical Dependency Program at the University of Pennsylvania, Philadelphia. “So, it is a pretty significant problem.”
Recent research has now expanded its scope to determine what chronic pain conditions are most closely linked to suicide risk. A study conducted in Spain found that suicidal ideation is highly prevalent among patients with severe fibromyalgia, a disorder that is characterized by chronic pain, sleep disturbances and depression (Pain Pract 2014 Jan 17. [Epub ahead of print]). Of 373 patients with fibromyalgia, 179 (48%) reported suicidal ideation. Of those, 148 (39.7%) described what was considered to be passive suicidal ideation and 31 (8.3%) reported active suicidal ideation. Risk for suicide was more commonly related to symptoms of psychological distress (depression, anxiety, sleep quality, mental health) than to physical symptoms of the disease (pain, general health).
Another recent study looked at a broader range of pain conditions, to examine which were most closely related to the risk for suicide. Led by Mark A. Ilgen, PhD, of the Veterans Affairs Ann Arbor Healthcare System and the University of Michigan, the authors examined the associations between baseline clinical diagnoses of arthritis, back pain, migraine, neuropathy, headache or tension headache, fibromyalgia and psychogenic pain, and the extent to which each of these conditions predicted risk for suicide in fiscal years 2006-2008 (JAMA Psychiatry 2013;70:692-697).
Elevated risk for suicide was observed for each of the pain conditions except arthritis and neuropathy. When these analyses were further controlled for concomitant psychiatric conditions, associations between pain conditions and suicide death were reduced. However, significant associations remained for back pain (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.03-1.24), migraine (HR, 1.34; 95% CI, 1.02-1.77) and psychogenic pain (HR, 1.58; 95% CI, 1.11-2.26).
Although this study was conducted among veterans, Dr. Ilgen said it is possible to extrapolate its results to a general population. “However, there are some notable ways in which the sample is different from the general U.S. population,” he told Pain Medicine News, “such as the military background of the sample and the fact that most individuals in the sample were male.
“But this is the largest study of which I am aware to look at the association between pain and suicide,” Dr. Ilgen noted. “We hope that this study will help shed light on this topic and be seen as potentially relevant to both veterans and non-veterans.”
Awareness, Screening Are Key
Clinicians who treat individuals with chronic pain should be aware that these individuals are at elevated risk for suicide, he added. “Treatment providers may want to screen for current suicidal thoughts and plans as well as past suicidal behaviors among patients with chronic pain. They may also want to assess for co-occurring psychiatric disorders in these patients.”
However, Dr. Cheatle pointed out that the care of chronic pain is often very fragmented, due to the nature of the U.S. health care system. Many patients never see a pain specialist and are often treated in the primary care setting. “Primary care doctors often have the least amount of time and they need tools to be able to perform a quick screening and then have an action plan,” he said.
Risk factors for pain patients can be a history of mental disorders particularly depression, a sense of hopelessness, a history of substance abuse and losses in their life. “Patients may lose their work; their family role can change; and often they have a feeling of isolation, which is common for pain patients,” explained Dr. Cheatle. “Pain patients also often are dealing with sleep disorders as well. There is a relationship between sleep deprivation and pain, and mood disorders. Pain can interfere with sleep, and sleep disorders can also cause a change in the perception of pain.”
There are a variety of screening tools for depression and anxiety available that have been used both clinically and in research. It is important to select a tool that will fit the structure and time constraints of the clinic and provider, Dr. Cheatle said. For example, a validated four-item scale may be more practical in a busy primary care practice.
“Screened patients deemed at risk should be referred to a behavioral health specialist for cotreatment,” he said. “And clinicians should be cognizant of the presence of depression and the risk of suicide when prescribing large doses of opioids, as it has to be assumed that some drug overdoses are not accidental.”
—Roxanne Nelson, Pain Medicine News
by: S. D. Wells, Natural News
Fibromyalgia is a disorder that currently affects over 5 million Americans. It is a condition characterized by chronic muscle pain, irritable bowel syndrome, sleep disorders, anxiety and fatigue. Since the cause is not understood, several medications are available for managing symptoms, including analgesics and antidepressants.
Conventional medicine mainly treats and suppresses symptoms using pharmaceuticals rather than looking for root causes of illnesses and disorders. To the contrary, in Europe, where doctors get bonuses for actually healing their patients and curing them of diseases and disorders, attacking the front end of a problem is the first order of business.
If you were getting sick from moldy bread, would you look for a cure from a vaccine or medicine while you kept eating the bread every day? The cure for polluted water is to stop polluting the water, however, millions of Americans who consume synthetic ingredients daily are suffering from short term side effects and long term physiological repercussions.
Could it be that the body’s inability to process, utilize, and excrete these unnatural products, which are approved by the FDA, is the main cause of Fibromyalgia? Some wild guesses at the cause include stress injuries and psychological trauma, or even post-surgery stress. If any of these prove true, then this is the time when the human body needs nutrients the most.
Aspartame poisoning, which accounts for 75% of the complaints the FDA receives every year, is often confused with multiple sclerosis and systemic lupus. The symptoms are virtually identical, including muscle spasms, shooting pains, numbness, cramps, and even vertigo. Depression, blurred vision and memory loss also occur and may look awfully familiar.
How many diet drinks and sugar free candies are you consuming in an average day? In what other ways is the average American polluting their system with synthetics that generate incurable disorders? Gluten is a key ingredient for giving many foods their chewiness and adding bulk to packaged food products.
Gluten is everywhere in American grocery stores, including bread, pasta, cakes, oatmeal, salad dressings, and even canned soup. Gluten can interfere with absorption of vital nutrients and cause skin rashes, arthritis, and intense abdominal pain.
Huge pharmaceutical companies are making money from this “epidemic style” disorder. And why are four out of five cases of Fibromyalgia females. Aren’t women consuming more of the diet foods than men?
According to a study by the Annals of Pharmacotherapy, the use of aspartame increases pain for people who have fibromyalgia. Women who decreased their intake of aspartame and MSG (monosodium glutamate) experienced decreases in pain, and then, when the additives were introduced back into their diet, the pain levels increased immediately.
Jump start the healing process by eliminating “excitotoxins,” or poisons, from the diet. Many chemical food agents and additives lead to neurotoxicity when used in excess, especially when consumed on an empty stomach. Neurotoxicity is an umbrella term which covers nearly every single symptom listed under Fibromyalgia.
Natural remedies may include using magnesium, vitamin D, and natural supplements that boost dopamine and serotonin levels. Vitamin B complex is important for balancing the central nervous system. Look into herbs as natural remedies also. Passion flower helps with stress and anxiety. Licorice aids in digestion. Milk thistle, dandelion and reishi mushroom are excellent for cleansing organs like the liver and kidneys, and also for boosting immunity.
In other words, cover your nutritional needs first and always remember, “Let thy food be thy medicine and thy medicine be thy food.” – Hippocrates.
About 8 in 10 Americans will experience back pain at one point or another. Back pain could literally cripple you and cause you to not partake or enjoy many activities. The issue could be so severe that it may leave some so stressed that it seems to control their lives.
There are many potential causes of back pain, without any being known as the primary cause factor. Here are 8 surprising causes of back pain from The Huffington Post.
Irregular exercise is a big contributor to back pain, and the “weekend warriors,” those who are sedentary during the week and push hard on the weekends, are the face of this contributor to pain.
“If you take on something tough after being relatively sedentary, you can seriously hurt yourself,” explains Arya Nick Shamie, M.D., a spokesperson for the American Academy of Orthopedic Surgeons and an associate professor of spine surgery at the University of California – Los Angeles.
And it’s not just the risk of injury while you’re doing the activity you have to worry about. “If you are doing high-impact sports without cross-training first to strengthen your core, your spine won’t have strong enough muscles to support the impact,” says Robert S. Bray, M.D., the founding director of DISC (discmdgroup.com) and a neurological spine surgeon.
He recommends dedicating as little as 15 minutes three times a week to basic core exercises and stretching to help prepare your core for more intense workouts later in the week.
Carrying Your Child
Kids who are heavy can exert a lot of force on your spine, says Shamie, not to mention they’re often struggling and squirming, causing you to twist and bend.
There’s not an ideal position to keep them in, though some are worse than others — “having a person directly on your spine is one of the worst things you can do,” says Bray — so maybe avoid those piggy back rides.
When you’re lifting your child up (or any object, really), focus on keeping your shoulders over your pelvis as you bend your knees, and try not to move too far forward while you grab on. This will help flex your lower back, explains Shamie.
Sitting and Bending
Slouching is, of course, not great for your back. If you sit for a long period of time without proper lumbar support it puts a lot of stress on your discs, says Shamie.
“But the most pressure on your discs comes if you’re seated and lean over to pick something up, and it’s particularly hard on the lower back,” he says.
So if you drop something when you’re sitting in your desk chair, stand up to get it!
“Smoking is horrible for your discs,” says Bray. “Discs deteriorate very rapidly in smokers, and if for some reason you have to do a fusion, it’s almost impossible to perform on someone who smokes.”
No, not the dance (although that can contribute, if you’re really all about the Twist n’ Shout). Any activity that involved repeated rotation of your upper torso against your waist will cause micro trauma to your lower back.
“What we know is, over the years, that can put your low back at higher risk of having damage later in life,” says Shamie. “It’s cumulative.”
Spinal Health Conditions
“There are several causes of back pain that don’t show up on an MR scan and are very serious,” says Bray.
He says the most common are spinal cord tumors, tethered cord syndrome (where the tail that connects your pelvis to your spine — which usually thins, stretches out or breaks as we age — remains attached and causes pain), Team disease (a condition where the blood vessels from the front of the chest wrap around the spine and drain into the muscles, causing compression) and Arnold Chairi syndrome (a syndrome where the bottom of the cerebellum hangs too low and pushes on the top of the spinal cord).
“90 to 95 percent of back pain cases aren’t these types of situations, but if you have pain and the answer isn’t in an MRI scan, visit a well-trained neurosurgeon who can evaluate and look for these types of conditions,” says Bray.
Your spinal discs don’t have blood vessels bringing them nutrients, says Shamie — they are nourished by water, which depletes during the day. “You should try and get at least seven hours of sleep every night, because overnight is when your discs hydrate again,” he says.
A mattress that sags or dips in the center will bend the spine abnormally, says Bray. “We used to think that a very hard mattress was better, but now we know what works best is to sleep on a soft-top mattress with firm coils underneath,” he explains.
It also helps to adjust your pillow based on the way you sleep — a thicker pillow for side sleepers and a thinner one for back sleepers — to reduce neck pain.
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