Study: Morphine May Increase Pain Severity

Morphine is one of the go-to medicines of people experiencing severe or chronic pain. The opioid painkiller has long been the gold standard treatment for acute pain, but this might change from now on as a new study suggests an unfortunate irony: instead of providing pain relief, the medication could make chronic pain worse and slow down the recovery in some cases.

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The study, published in the Proceedings of the National Academy of Sciences, offers a glimpse into the possible long-term consequences of opiates like morphine and oxycodone. Researchers at the University of Colorado Boulder used genetic and pharmacological interventions, including the novel Designer Receptor Exclusively Activated by Designer Drugs (DREADD) to demonstrate how a course of morphine after nerve injury doubles the duration of neuropathic pain in mouse models. They've found out that morphine activates spinal immune cells, amplifying pain rather than dulling it, even after the painkilling treatment has been stopped.

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Rat models show that "the pain is effectively transitioned to a chronic state, making the pain itself both more severe and longer lasting.” The opioid activates inflammasome, a specific group of signaling proteins in microglia that sends pain signals up to the brain. Previous studies have shown that opioid painkillers make microglia, the immune cells of the brain, more sensitive to activation that is likely a factor that could explain opioid-induced hyperalgesia.

While the results show fundamental clinical implications for pain, researchers stress that they shouldn't be used as the basis for not giving opioids to people in pain. An awareness of the side effects of pain medications coupled with a deeper understanding of pain and the many non-drug alternatives available for pain management promotes a holistic approach to chronic pain. Stress management, diet, and exercise, and gentle manual medicine could go a long way in conquering pain and maintaining an active life without medications.

Dr. Melanie Novak, M.D., uses a multidisciplinary approach in the diagnosis and treatment of all types of pain. Her practice focuses on providing individualized treatment plans that help patients stay on top of their pain best and enjoy life. Read more about pain management here.

What to Avoid Doing in the Event of Back Pain

After a long day at the office, some people experience back pain. Back pain has also been common among students because of their heavy backpacks and bad posture while writing or using their computers. When people experience back pain, they have best avoid normal physical activities for the first few days, and heavy lifting and twisting for the first six weeks, before they can slowly go back to exercising. Having a physical therapist would be advisable for those who are recovering from severe back pain.

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There are some treatments for long-term back pain that are not recommended by the National Institute for Health and Care Excellence (NICE) because of lack of evidence of their effectiveness. The list of such treatments includes: low level laser therapy, traction, lumbar supports, etc.

As mentioned, there are activities that should be avoided while still recovering (unless the doctor advises them). These are contact sports, dancing, sit-ups, racquet sports, and jogging. Avoid wearing high heels, standing for long periods, and smoking. When resting, most people with back pain would just lie on their backs. A pillow must be added under the knees to reduce the pressure. Another option is to lie on a fetal position with a pillow between the legs. Make sure to consult a doctor for all kinds of back pains, especially severe ones, to prevent them from getting worse.

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Dr. Melanie Novak specializes in the diagnosis and treatment of all types of pain. Subscribe to this blog for more information on chronic pain treatment.

REPOST: Chronic pain and painkillers: Why you should consider alternatives

The sustained use of painkillers can lead to serious health problems such as ulcers and liver failure. However, the good news is that there are natural alternatives for pain management that don’t come in the form of a pill. The article below lists four natural suggestions for pain management. 

Physician Offers 4 Natural Ways to End the Pain 

Roughly 100 million Americans suffer from chronic pain lasting more than six months, according to a report from the Institute of Medicine. Throughout the past decade, the use of painkillers such as Vicodin, Percocet and OxyContin has soared by 300 percent. For many – 17,000 people per year, or 46 each day – the treatment is worse than the pain; those are the number of users who die from the medicine, according to the Centers for Disease Control. 

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For every person who dies from the use of painkillers, 30 more are admitted to emergency rooms due to complications. 

“Those figures are appalling,” says Dr. Frank King, a doctor of naturopathy, president of King Bio natural medicine company, and author of The Healing Revolution (www.kingbio.com). 

“Death is just one of the many side effects of heavy-duty pharmaceuticals, and researchers unanimously agree that addiction to painkillers has risen drastically in recent years. People are so focused on pain that they miss the fact that it is a signal of deeper health problems. Don’t shoot the messenger! Listen to the pain, and it will lead you to the root causes.” 

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With decades of experience helping patients, Dr. King offers four natural suggestions for pain management. 

• Identify the root causes of pain. Pain is a signal of deeper problems, similar to the warning light on the dashboard of your car. You can mask the light with duct tape, which is what prescription drugs do with pain. You can cut the wires, which might symbolize a surgical approach. Or you can look for the root causes, which is what our more natural, holistic approach seeks to do. Address the problem, and the pain will subside. 

• Make good choices. Most chronic conditions are caused by bad lifestyle choices. Try walking more, eating and sleeping better, eliminating stress and bad habits from your life, and watch pain decrease and health increase. It’s that simple. Moreover, surround yourself with a healing community of like-minded “healing buddies” who support your healthy choices. 

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• Explore natural healing techniques, and if necessary, see a natural healing practitioner. You are your best doctor, on call 24/7. I developed many self-healing techniques that address the needs of every aspect of mind-body health. These techniques are free and easy to implement at home, on the job, and wherever you might be. You might also explore meditation, yoga and other approaches for filling the holes in your wholeness. 

• Look into homeopathy. Homeopathy predates modern medicine. Homeopathic medicines are safe and effective, with no known side effects or negative drug interactions. They target the root causes, not the superficial pain. I have personally seen homeopathy dramatically raise the quality of life and happiness for countless of my patients.
With the appalling death toll due to pharmaceutical pain medication, natural solutions like homeopathy are our safest, brightest hope for the future of pain management. 

About Dr. Frank King 

Dr. Frank King is a chiropractor, doctor of naturopathy, and founder and president of King Bio, an FDA-registered pharmaceutical manufacturing company dedicated to education, research, development, manufacture and distribution of safe and natural homeopathic medicines for people and pets. Dr. King is also the author of, The Healing Revolution: Eight Essentials to Awaken Abundant Life, Naturally! (www.kingbio.com). A fourth-generation farmer, Dr. King raises yak, camel, boar, wisent and American bison sold under the Carolina Bison brand. He is a member of the Homeopathic Pharmacopoeia Convention of the United States.

Dr. Melanie Novak approaches pain management with an individualized treatment plan consisting of conventional medications and physical and behavior therapy. Follow her on Twitter for more educational resources on pain management.

REPOST: Chinese Herb Proves Effective in RA

A new study finds that a Chinese herbal remedy consisting of extracts of Tripterygium wilfordii Hook F (TwHF), also known as the thunder god vine, may be efficacious in the short-term treatment of rheumatoid arthritis. The open-label randomized trial is discussed in the article below. 

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A plant extract used in traditional Chinese medicine was as effective as methotrexate for the short-term treatment of rheumatoid arthritis and was superior when the two agents were given in combination, an open-label randomized trial showed.

At 6 months, 46.4% of patients receiving methotrexate had improved by at least 50% on the American College of Rheumatology (ACR50) criteria, as had 55.1% of those receiving extracts Tripterygium wilfordii Hook F (TwHF) and 76.8% of those given both, according to Xuan Zhang, MD, of the Chinese Academy of Medical Sciences in Beijing, and colleagues.

The differences between the two monotherapy regimens using a noninferiority test was significant (P=0.014), as was the difference between the combination and methotrexate monotherapy groups((P<0.001), the researchers reported online in Annals of the Rheumatic Diseases
 
The study "showed that TwHF monotherapy was not inferior to, and combination therapy of methotrexate and TwHF was better than, methotrexate monotherapy in controlling disease activity in patients with active RA," Zhang and colleagues stated.

"The findings are definitely of interest, as there was a clear treatment effect. This is a compound of interest for further study and development," commented Eric L. Matteson, MD, chief of rheumatology at the Mayo Clinic in Rochester, Minn., who wasn't involved in the study.

The Plant and Its Effects
 
T. wilfordii, known in the West as thunder god vine, has long been utilized in China for its effects on joint pain, local inflammation, swelling, and fever, and is approved for the treatment of rheumatoid arthritis.

The plant contains many active compounds, with diterpenoids being of primary interest.
"Many of the anti-inflammatory and immunoregulatory activities of extracts of TwHF relate to the ability of the major diterpenoids to suppress the transcription of cytokines and other proinflammatory genes," Zhang and colleagues explained.

In a previous report published in Annals of Internal Medicine, researchers led by Raphaela Goldbach-Mansky, MD, of the NIH noted that TwHF also can inhibit cyclooxygenase-2, "which may result in the reduced production of prostaglandin E2 at inflammatory sites and therefore have a direct analgesic effect."

The extract is prepared from the peeled root of the plant, using various extraction methods. "Other parts of the plant -- including the leaves, flowers, and skin of the root -- are highly poisonous and can cause death," cautions the National Center for Complementary and Alternative Medicine on its website.

The extract used in the Chinese randomized trial was pharmaceutical grade, standardized to 1.2 mcg/10 mg of the immunosuppressive and anti-inflammatory diterpenoid triptolide and 36.6 mcg/10 mg of the anti-inflammatory triterpene wilforlide.

Earlier Studies
 
Uncontrolled trials in China reported in the 1980s alleged that more than 400 patients with rheumatoid arthritis had been treated with TwHF, with response rates up to 95% and side effects ranging from 4% to 35%.

To evaluate these claims, a group of researchers led by Peter E. Lipsky, MD, of the Autoimmunity Branch of the NIH conducted a phase I study using an ethanol/ethyl acetate extract at Parkland Memorial Hospital in Dallas.

They enrolled 35 patients, randomizing them to placebo or 180 or 360 mg TwHF per day. By 5 months, 80% and 40% of the high- and low-dose groups, respectively, had achieved an ACR20 response, compared with none of the patients given placebo. Physical functioning and inflammation also improved, Lipsky's group reported in Arthritis & Rheumatism.

Diarrhea was the most common adverse event, followed by nausea and alopecia.
Subsequently, Goldbach-Mansky's group enrolled 121 patients with active disease, randomly assigning them to receive TwHF extract , 60 mg three times per day or sulfasalazine, 1 g twice per day.

After 6 months, 68% of those receiving TwHF and who completed the study had an ACR20 response, compared with 36% of those given sulfasalazine.

ACR50 and ACR70 responses were seen in 54% and 38% of the TwHF patients compared with only 4% for both responses in the sulfasalazine group. More patients in the sulfasalazine group experienced moderate or severe adverse events.

The Randomized Chinese Study
 
At the Peking Union Medical College Hospital, a referral center where 30,000 patients are treated each year for rheumatoid arthritis, two-thirds receive TwHF, which costs about $10 per month. Most patients take it in combination with methotrexate.

"Importantly, in 'real-world' clinical practice, we have observed the considerable effectiveness of the [methotrexate plus] TwHF combination, but this efficacy has not been studied in randomized controlled trials," the researchers noted.

To address this gap, they enrolled 207 patients with active disease, randomizing them to receive 20 mg TwHF pills three times per day, methotrexate in doses beginning with 7.5 mg per week and increasing over a month to 12.5 mg per week, or both.

No placebo tablets were available, but assessments done at weeks 4, 12, and 24 were done by clinicians who were unaware of the assigned treatments.

Patients' mean age was 51, most were women, and mean disease duration was 5.5 years.
On other efficacy measures, noninferiority also was seen for TwHF at 6 months, including the stringent ACR70 response, which was achieved by 30.4% of the TwHF group and 23.2% of the methotrexate group.

And the combination was superior to methotrexate alone on several measures, with higher response rates at 6 months (P<0.05):

ACR20: 92.8% versus 63.8%
ACR70: 43.5% versus 23.2%
Low disease activity: 55.1% versus 27.5%
Remission: 49.3% versus 20.3%

"The combination of the two seemed to be better than either one alone. Using both medications together might be a good way to decrease the amount of methotrexate needed, which is something we're often looking to do to reduce toxic effects that can limit long-term treatment," said Angela Stupi, MD, a rheumatologist from the Allegheny Health Network in Pittsburgh.

In addition, the erythrocyte sedimentation rate (ESR) fell significantly by 3 months in the TwHF and combination groups, but not until 6 months in the methotrexate group.

The rapid ESR decrease was "probably related to the anti-inflammatory activity of TwHF, which has been shown in both laboratory experiments and clinical trials," the researchers explained.

Adverse Effects
 
The most frequent side effects were gastrointestinal, reported by 43.5% of patients on methotrexate, 34.8% of those receiving the combination, and 29% of those given TwHF.

The finding that more patients in the methotrexate group had adverse events compared with TwHF alone or the combination was "curious," according to Matteson. "This could be chance alone or have to do in some undefined way with the open nature of the study," he told MedPage Today.

Three patients in the methotrexate group dropped out because of severe adverse events, as did three from the combination group and one from the TwHF group.

A total of 8.8% of the female patients developed menstrual irregularities during the study. Seven of these were in the TwHF group, five in the combination group, and three in the methotrexate group.
Previous studies have demonstrated anti-fertility effects with TwHF in both women and men, possibly because of effects on T-type calcium influx, the researchers noted.

While the adverse menstrual effects are thought to be reversible, Zhang and colleagues suggested that TwHF might be most appropriately used by patients who are postmenopausal or not interested in fertility.

Limitations
 
"The major weakness of this study was the open-label design and short duration," Matteson said.
The researchers plan to follow the cohort through 2 years and at that point to evaluate radiographic progression.

Another limitation was the low dose of methotrexate used, which is standard in Asia.

"Typically, we would use a higher dose of methotrexate than the 12.5 mg per week used in the study," Stupi told MedPage Today.

"With a higher methotrexate dose of 15 to 25 mg, they may have seen a better result in the patients on methotrexate alone," she said.

A graduate of Northwestern University Medical School in Chicago, Illinois, Dr. Melanie Novak is one of the nation's finest specialists in the diagnosis and treatment of all types of pain including headaches, neck and low back pain, and various types of nerve pain. Visit this blog for more in-depth discussions on medical issues, healthcare trends, and disease diagnosis and prevention.

REPOST: Aspirin every other day may prevent colon cancer

So far, the American Cancer Society has ruled against taking aspirin daily to lower the risk of cancer. But such stance might soon change as researchers from Brigham and Women's Hospital discovered that taking aspirin every other day may help prevent colorectal cancer. So is aspirin the new go-to pill for cancer prevention? Read the full article below.





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Many studies have touted the benefits of aspirin, and the latest one has good news for women.

This new research shows that low-dose aspirin may serve as a protection against colorectal cancer. The study was based on a long-term trial in a large group of women, who have been underrepresented in studies on this topic, said lead author Nancy R. Cook, associate biostatistician at Brigham and Women's Hospital and professor at Harvard Medical School. The study is being published this week in the journal Annals of Internal Medicine.

This builds on a significant body of research showing the potential preventative properties of aspirin in many cancers such as melanoma. This study did not find a strong link between aspirin and preventing any other kinds of cancer during the 18-year period, however.

None of this means that aspirin is right for everyone. Always consult a doctor before starting a new medical routine.

The study:

The study included nearly 40,000 women 45 and older who were part of the Women's Health Study. About 34,000 participated in follow-up. Researchers followed the women for up to 18 years from the start of the study.

The study participants were randomly assigned to either take 100 milligrams of aspirin or a placebo every other day. The alternate-day strategy was intended to reduce the side effects of aspirin, Cook said.

Some participants also took vitamin E on the nonaspirin days; the others took a placebo.

Colon cancer spotted by blood test

The results:

In the first 10 years, the researchers did not find an association between aspirin use and colorectal cancer; there seemed to be no benefit over taking a placebo.

But in women who were followed for longer than 10 years, the benefits of taking aspirin became clear: Between 10 to 18 years after the start of the study, researchers observed a 42% reduction in colorectal cancer in the group that was taking aspirin, relative to the women who were not. That averages out to about a 20% reduction over the length of the study.

Researchers did not find that age or other factors were significantly associated with the study results. Socioeconomic status was balanced between the group taking aspirin and those who received placebos.

Other studies have also found a delayed effect in aspirin's preventative properties, Cook said. Cancer usually takes about 10 years to develop from its early stages. It's possible that aspirin delays the formation of polyps, she said. Some studies have suggested that higher doses of aspirin have a shorter latent period - in other words, less time passes before the preventative benefits are seen.

On the downside, women taking aspirin were more likely to develop gastrointestinal bleeding and peptic ulcers, based on the information that women reported about themselves.

The researchers did not find any cardiovascular benefit to taking aspirin every other day, contrary to the preventative properties of aspirin against heart attack and stroke that have been found in many other studies, especially in men.

"We're not quite sure if it was because it was the low dose or because it's different in women than men," Cook said.

Similarly, although other studies have found that aspirin may prevent other kinds of cancers, this study did not find associations with any other kind of cancer. This could also be because of the low dose, but more research would need to be done to confirm.

No benefit to the vitamin E, taken every other day, was observed.

Conclusions:

This study adds to a large body of research that already established the potential of aspirin to prevent colon cancer, which had mostly been shown in men, Cook said. This study highlights the drug's protective potential in women.

Those with an elevated risk of the disease - for instance, a family history of colorectal cancer, or frequent polyps - should consider aspirin, Cook said.

Cook doesn't advocate taking aspirin every other day; daily is easier to remember. But consider the possible downsides as well. Aspirin increases the risk of bleeds; in rare cases, it can promote hemorrhagic stroke or gastrointestinal hemorrhage, Cook said. More commonly, peptic ulcer or gastric upset may occur.

In an accompanying editorial, Dr. Peter Rothwell of Oxford University noted the findings reinforce the idea that risks and benefits of aspirin should be considered separately in men and women.

"People really need to balance risks and benefits, and discuss with doctor whether they should be taking it," Cook said.


Dr. Melanie Novak believes that there’s no substitute to a multidisciplinary approach to health care. The inclusion of physical and behavioral therapy to an individualized treatment plan can be a key to help patients conquer their illness and increase their quality of life. Visit this blog to learn more about different types of therapies and holistic pain care.