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. 

Image Source: medpagetoday.com

 
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: Neck pain sufferers have many effective treatment options, says study

You may want to change how you treat your neck pain as Canadian researchers suggest that exercise and strengthening may not always work to approach neck pain.  Fox News has the full report:

Image Source: www.foxnews.com

Exercise and strengthening may not be the best approach for all kinds of neck- and whiplash-related pain, according to a new analysis by Canadian researchers.

The results directly contradict a 2008 recommendation by the Neck Pain Task Force in Canada. Instead, the new research "suggests that people with neck pain have many options when choosing how to improve it," Janet Freburger told Reuters Health.

"There were no major differences between the types of exercise programs, or (evidence) that exercise in general was beneficial," said Freburger, an associate director at the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. She was not involved in the research.

After reviewing 10 randomized controlled trials for neck pain treatment published since 2008, researchers concluded that certain treatments may be helpful for specific types of neck pain, depending on whether it is mild or severe.

"If you have neck pain, whether it started two days ago or two weeks ago, one of the best things you can do is gently move and stretch your neck muscles," said study author Dr. Pierre Côté, an epidemiologist at the University of Ontario Institute of Technology in Oshawa.

"Longer lasting and more severe neck pain usually requires more work," Côté added.

Neck pain is the fourth leading cause of chronic disability in the U.S., the researchers write in The Spine Journal.

What the researchers did find is that certain exercises appear to help specific kinds of neck pain.

Two randomized control trials - considered medicine's gold standard for evidence - found that qigong, a type of gentle stretching and breathing, reduced low-grade neck pain, when patients were compared to a group that did not do qigong.

Another trial appeared to show that Iyengar yoga, which includes classical yoga poses, helped with milder forms of neck pain.

Interestingly, one study found that patients who were supervised during strengthening exercises did no better than a neck pain group assigned to do exercises at home.

For those who suffered from whiplash-associated neck pain, a study found little difference between a group assigned to do exercises and a group just given advice about self care.

Overall, the trials found that for mild neck pain (considered grades 1 and 2), unsupervised range of motion exercise, over-the-counter painkillers and manual massage were about equally effective.

For persistent grade 1 and 2 neck pain and whiplash pain, supervised qigong and combined strengthening, range of motion and flexibility exercises are better than doing nothing.

"One of the key messages is: move your neck and your condition will probably benefit at least some," Côté said.

"And before physicians prescribe an exercise program for their patients, they should discuss different options with them," he added.

"If a patient is not interested in yoga, then he or she could try strengthening exercises."

Melanie Novak, MD, specializes in the diagnosis and treatment of various types of pain, including complex regional pain syndrome (CRPS), sciatica, joint discomfort, and bursitis, among others.  For more information, visit this website.

REPOST: More than 14 percent of pregnant women prescribed opioids

A study published on the journal Anesthesiology suggests that at least 14 percent of expectant mothers in the U.S. took opioids at some point of their pregnancy to increase their tolerance to pain. Hydrocodone, codeine, and oxycodone were reported to be the most commonly dispensed opioids during pregnancy.

Prescriptions for opioids increased almost threefold in the general population, to more than 200 million between 1991 and 2009, according to the National Institutes of Health. This study found the prevalence of opioid use by pregnant women in the U.S. is significantly higher than in Europe. | Image courtesy of American Society of Anesthesiologists (ASA)

Image source: ScienceDaily.com

More than 14 percent of pregnant women were prescribed opioids (narcotics) for pain at some time during their pregnancy, according to a study posted to the online version of Anesthesiology. Given the surprising rate these medications were prescribed to pregnant women, more research is needed to assess the risk of opioids to unborn babies, the study suggests.

Prescriptions for opioids increased almost threefold in the general population, to more than 200 million between 1991 and 2009, according to the National Institutes of Health. This study found the prevalence of opioid use by pregnant women in the U.S. is significantly higher than in Europe. The rate of opioid use also varied throughout the country with the highest in the South and lowest in the Northeast.

"Nearly all women experience some pain during pregnancy," said Brian Bateman, M.D., M.Sc., assistant professor, Harvard Medical School, and study author. "However, the safety of using opioids to manage their pain remains unclear. Ultimately, we need more data to assess the risk/benefit ratio of prescribing these drugs to women and how it may affect their babies."

The study looked at data from a research database of more than 530,000 pregnant women enrolled in a commercial insurance plan who delivered their babies between 2005 and 2011. Their median age was 31. The study investigated which opioids were most often prescribed, what pain was most frequently treated and how the prevalence varied regionally.

Of the more than 530,000 pregnant women, 76,742, or 14.4 percent, were prescribed opioids at some point in their pregnancy. Most opioid exposures were for short courses of treatment, usually less than a week. The percentage of women dispensed an opioid in the first and second trimester was 5.7; in the third trimester it was 6.5 percent. Of these women, 2.2 percent were dispensed opioids three or more times during pregnancy.

Back pain was the most common condition (37 percent) for which opioids were prescribed, according to the study. Other conditions included abdominal pain, migraine, joint pain and fibromyalgia. The most commonly prescribed opioid during pregnancy was hydrocodone (6.8 percent), followed by codeine (6.1 percent), oxycodone (2.0 percent) and propoxyphene (1.6 percent). Prescription patterns varied regionally, according to the study. Opioid use ranged between 6.5 percent and 26.3 percent, with the lowest rate in the Northeast and highest in the South. Arkansas, Mississippi and Alabama all had prescription rates in excess of 20 percent.

In a commentary on the study, Pamela Flood, M.D., professor of anesthesiology, Pain and Perioperative Medicine at Stanford University, Stanford, Calif., notes that "the risk to the fetus of short-term exposure to prescription opioids under medical supervision is difficult to assess and needs to be carefully examined in future studies."

She explains that previous studies have had contradictory findings regarding the risk to the baby. An early U.S. study (1959-1965), and later studies from Sweden and Norway, did not find an association between opioid prescription and birth defects. However, a U.S. National Birth Defects Prevention Study (1997-2005) found associations between codeine and other opioids with birth defects, including atrial and ventricular septal defects, hypoplastic left heart syndrome, spina bifida and gastroschisis in newborns. Additionally, the U.S. national study cites that when opioids are used long-term during pregnancy, "there is a known risk for neonatal opioid dependence and subsequent withdrawal symptoms in the first few days of life."

"Pain occurring at some time during the course of pregnancy is common," said Edward A. Yaghmour, M.D., chair, ASA Committee on Obstetric Anesthesia. "We need to carefully balance medications given to the mother and the risk to her and her baby. For example, we would never stop giving anti-seizure medication or medication for diabetes; the danger in those situations is clear. With opioids, there are simply not enough data to have a clear answer. Untreated severe pain in the mother may also be harmful to the fetus." He noted that, when possible, other treatments and therapies should be the first-line treatment before opioids.

Dr. Melanie Novak specializes in the diagnosis and treatment of various types of pain, including complex regional pain syndrome (CRPS), sciatica, joint discomfort, and bursitis. Learn more about pain management by visiting this website.

REPOST: Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach

People experiencing chronic pain have to target the primary organ causing their discomfort---the brain. According to this WebMD article, Cognitive Behavior Therapy (CBT) helps pain patients manage their negative thoughts and behaviors so they could cope better with their situation. Read on about the advantages of CBT:

Your body is aching and the pain feels unbearable. The last thing you want to hear is, “it’s all in your head.” For people with chronic pain, the discomfort is very real, and they know all too well they feel it in their bodies.

Image Source: www.webmd.com

“If you are lying in bed and hurting, the pain is your whole world,” says Joseph Hullett, MD, board certified psychiatrist and senior medical director for OptumHealth Behavioral Solutions in Golden Valley, Minn.

Enter cognitive behavioral therapy as a method of pain management.

Cognitive behavioral therapy (CBT) is a form of talk therapy that helps people identify and develop skills to change negative thoughts and behaviors. CBT says that individuals -- not outside situations and events -- create their own experiences, pain included. And by changing their negative thoughts and behaviors, people can change their awareness of pain and develop better coping skills, even if the actual level of pain stays the same.

“The perception of pain is in your brain, so you can affect physical pain by addressing thoughts and behaviors that fuel it,” Hullett tells WebMD.

What can CBT do for you? Cognitive behavioral therapy helps provide pain relief in a few ways. First, it changes the way people view their pain. “CBT can change the thoughts, emotions, and behaviors related to pain, improve coping strategies, and put the discomfort in a better context,” Hullett says. You recognize that the pain interferes less with your quality of life, and therefore you can function better.

CBT can also change the physical response in the brain that makes pain worse. Pain causes stress, and stress affects pain control chemicals in the brain, such as norepinephrine and serotonin, Hullett says. “CBT reduces the arousal that impacts these chemicals,” he says. This, in effect, may make the body’s natural pain relief response more powerful.

To treat chronic pain, CBT is most often used together with other methods of pain management. These remedies may include medications, physical therapy, weight loss, massage, or in extreme cases, surgery. But among these various methods of pain control, CBT is often one of the most effective.
“In control group studies, CBT is almost always as least as good as or better than other treatments,” Hullett says. Plus, CBT has far fewer risks and side effects than medications or surgery.

To help provide pain relief, cognitive behavioral therapy:

• Encourages a problem-solving attitude. “The worst thing about chronic pain is the sense of learned helplessness -- ‘there is nothing I can do about this pain,’” Hullett says. If you take action against the pain (no matter what that action is), you will feel more in control and able to impact the situation,” he says.
• Involves homework. “CBT always includes homework assignments,” Hullett says. “These may involve keeping track of the thoughts and feelings associated with your pain throughout the day in a journal, for example. “Assignments are then reviewed in each session and used to plan new homework for the following week.”  

Image Source: www.webmd.com

• Fosters life skills. CBT is skills training. “It gives patients coping mechanisms they can use in everything they do,” Hullet says. You can use the tactics you learn for pain control to help with other problems you may encounter in the future, such as stress, depression, or anxiety.
• Allows you to do it yourself. Unfortunately, good qualified cognitive behavioral therapists aren’t available in all areas. Luckily, you can conduct CBT on your own as a method of pain control, even if you’ve never set foot in a therapist’s office. “CBT is a cookbook approach. It can easily be applied to self-help and computerized programs,” Hullett says. And the literature supports that these self-help methods can be just as effective for pain management as one-on-one sessions.

Dr. Melanie Novak, diagnoses and treats all types of pain using a multidisciplinary approach. Visit this website for a list of all the procedures she performs.

REPOST: Are you getting pain meds you don’t need?

A new report reveals that patients hospitalized for reasons other than surgery were given opioid pain medications, some of which are more than what is typically prescribed, thus running the risk of overdose. Cindy Kuzma of Fox News looks into the overuse of potent painkillers in the article below.

Image source: Fox News

Oxycontin. Vicodin. Percocet. Opiates like these can make the agony of surgery or cancer more bearable. But potent painkillers come with serious risks—namely addiction and even death.

That’s why health experts have repeatedly warned against their overuse—especially for those with less-severe complaints. But a new report raises questions about whether people are listening.

The findings: Researchers at Beth Israel Deaconess Medical Center in Boston analyzed the records of more than 1 million patients hospitalized for reasons other than surgery, finding that more than half were given some opioid pain medications, such as codeine, morphine, or oxycodone. Of those, one-quarter received the equivalent of 100 milligrams of morphine at one time—enough to pose the risk of overdose, says study author Dr. Shoshana Herzig.

The study couldn’t assess exactly whether all these doses were needed. However, the high rate suggests at least some of them weren’t.

Why We’re So Drugged Up
Doctors have good reasons for doling out these doses. National medical organizations have instructed them to treat pain as a vital sign just like blood pressure or heart rate, Dr. Herzig says. And no physician wants a rep as someone who ignores suffering, says Dr. Kenneth Candido, an anesthesiologist at Advocate Illinois Masonic Medical Center in Chicago.

You play a role, too. No stethoscope or lab test can measure pain, so doctors typically ask you to report your discomfort levels on a scale of 1 to 10. Many people struggle to assign a number to agony—everyone experiences pain differently and some tolerate it better than others, Dr. Candido explains. More often than not, patients exaggerate their pain—sometimes on purpose, to get more of the numbing, mind-altering effects of these drugs, Dr. Candido says.

High doses may also stem from patients failing to tell their doctors about prescription or illegal drugs they’re taking at home, he says. And if you doc doesn’t know what you’re pumping into your bloodstream, he may be more likely to write a script. But you should tell your doc of habits at home: Drugs like Valium or even heavy drinking can interact dangerously with narcotics, or make you resistant to their pain-killing effects.

Know this: If your pain is so searing you can’t tolerate it—and milder drugs or techniques don’t help—opioids could be your best choice. But often, that’s not the case. Protect your own health with these suggestions:

• Ask whether your hospital employs pain physicians. These doctors have special training in both using narcotics properly and offering alternatives for pain relief, including nerve blocks and distraction techniques. “Not every doctor has these tools in their armamentarium,” Candido says.

• Some doctors assume once you’re in the hospital, your pain is severe, Herzig says. But in many cases, plain old ibuprofen might actually work better since it treats swelling and inflammation. Ask if there are other options—you’ll take your doc off autopilot.

• About one-fourth of all the patients in the study got a dose of opiates on the day they left the hospital, suggesting they may have walked out with a prescription, Herzig says. Before you fill a script, make sure your doctor has run it through the state-monitoring database. This will cut down on too-high doses.

And while you're at it, make sure you know the top 10 Questions Every Man Must Ask His Doctor.

 Pain physicians like Dr. Melanie Novak have special training in both using narcotics and offering alternatives for pain relief. Get tips on proper pain management from this Twitter account.

REPOST: How Your Knees Can Predict the Weather

Many people who suffer from arthritis and migraine believe that their condition worsens during weather changes. Well, they could be right. The Wall Street Journal reports that scientists have found a link between pain symptoms and weather patterns. 

Image Source: online.wsj.com

The Wolff family of Paramus, N.J., was eyeing the gathering clouds and debating whether to cancel a planned park trip when 6-year-old Leora piped up with an idea: "Let's call Grandma. Her knees always know when it's going to rain!"

Leora's grandmother, Esther Polatsek, says she started being sensitive to the weather in her 20s, when a fracture in her foot would ache whenever a snowstorm approached. Now 66 and plagued by rheumatoid arthritis, Mrs. Polatsek says she suffers flare-ups whenever the weather is about to change.

"It's just uncanny. Sometimes it'll be gorgeous out, but I'll have this awful pain. And sure enough, the next morning it rains," she says. "It may be just a few drops, but it makes my body crazy."
Do weather conditions really aggravate physical pain?

It is one of the longest running controversies in medicine.

Hippocrates in 400 B.C. noticed that some illnesses were seasonal. The traditional Chinese medicine term for rheumatism (fengshi bing) translates to "wind-damp disease."

But modern scholars have gotten inconsistent results in studies that tried to match weather patterns to reported pain symptoms—leading some to dismiss the connection as highly subjective or all in sufferers' minds.

"People's beliefs about arthritis pain and the weather may tell more about the workings of the mind than of the body," concluded the late Stanford psychologist Amos Tversky in the mid-1990s, after comparing the pain reports of 18 rheumatoid-arthritis patients with local weather conditions for a year and finding no connection.

Still, other studies have linked changes in temperature, humidity or barometric pressure to worsening pain from rheumatoid arthritis and osteoarthritis, as well as headaches, tooth aches, jaw pain, scar pain, low-back pain, pelvic pain, fibromyalgia, trigeminal neuralgia (a searing pain in the face), gout and phantom-limb pain.

Scientists don't understand all the mechanisms involved in weather-related pain, but one leading theory holds that the falling barometric pressure that frequently precedes a storm alters the pressure inside joints. Those connections between bones, held together with tendons and ligaments, are surrounded and cushioned by sacs of fluid and trapped gasses.

"Think of a balloon that has as much air pressure on the outside pushing in as on the inside pushing out," says Robert Jamison, a professor of anesthesia and psychiatry at Harvard Medical School. As the outside pressure drops, the balloon—or joint—expands, pressing against surrounding nerves and other tissues. "That's probably the effect that people are feeling, particularly if those nerves are irritated in the first place," Dr. Jamison says.

Not everyone with arthritis has weather-related pain, says Patience White, a rheumatologist at George Washington University School of Medicine and a vice president of the Arthritis Foundation. "It's much more common in people with some sort of effusion," an abnormal buildup of fluid in or around a joint that frequently occurs with inflammation.

Many patients swear that certain weather conditions exacerbate their pain. Consequently, orthopedists, rheumatologists, neurologists, family physicians, chiropractors, physical therapists—even personal trainers—report an increase in grousing among their clients when the temperature drops or a storm approaches.

"I can tell you emphatically there are certain days where practically every patient complains of increased pain," says Aviva Wolff, an occupational therapist at the Hospital for Special Surgery in New York City, and Mrs. Polatsek's daughter. "The more dramatic the weather change, the more obvious it is."

Both the Weather Channel and AccuWeather have indexes on their websites that calculate the likelihood of aches and pains across the country, based on barometric pressure, temperature, humidity and wind. Changes in those conditions tend to affect joints even more than current conditions do, says AccuWeather meteorologist Michael Steinberg, which is why the Arthritis Index shows more risk the day before a storm or a sharp drop in temperature is forecast.

Image Source: online.wsj.com

 Some sufferers say their joints can be more accurate than meteorologists. Rheumatoid-arthritis sufferer Bill Balderaz, 38, president of a digital-marketing firm in Columbus, Ohio, recalls feeling "the worst arthritis pain I've ever had—I could barely move" one day last year, even though it was sunny and clear. By midafternoon, a land-based hurricane known as a derecho with 80 mile-per-hour winds unexpectedly buffeted Ohio and three other states, traveling 600 miles in 10 hours and knocking out power for 10 days. "The storm caught everyone off guard. It was clear one minute and then the skies opened up," Mr. Balderaz says.

Tests on animals seem to bear out the impact of weather. In one study, guinea pigs with induced back pain exhibited signs of increased pain by pulling in their hindpaws in low barometric pressure.

Cold weather seems to raise the risk of stroke, heart attacks and sudden cardiac death, some research shows. Heart-attack risk rose 7% for every 10 degrees Celsius (18 degrees Fahrenheit) drop in temperature, according to a study of nearly 16,000 patients in Belgium, presented at the European Society of Cardiology last month. British researchers studying years of data on implanted defibrillators found that the risk of ventricular arrhythmia—an abnormal heart rhythm that can lead to sudden death—rose 1.2% for every 1.8 degrees Fahrenheit drop, according to a study in the International Journal of Biometerology last month.

Once blamed on physically demanding tasks like shoveling snow, the increased heart risk due to cold may be due to thickening blood and constricting blood vessels, researchers think.

And rising humidity may cause joints to swell and stiffen. In fact, tendons, ligaments, muscles, bones and other tissues all have varying densities, so they may expand or contract in different ways in changing conditions, Dr. Jamison says.

In people with chronic inflammation from arthritis or past injuries, even slight irritations due to the weather can aggravate sensory nerve cells, known as nociceptors, that relay pain signals to the brain. That may explain why some people with neuropathic pain and phantom-limb pain also report weather-related flare-ups.

"Fibromyalgia patients seem to be the most sensitive," says Susan Goodman, a rheumatologist at the Hospital for Special Surgery. She also notes that while some people seem to be extremely sensitive to weather, others with similar conditions aren't, for reasons that aren't clear. That may explain why many studies find no clear association, she says.

Some weather conditions seem to relieve pain. In one study, the warm, high-pressure Chinook winds common to western Canada lessened patients' neuropathic pain, the kind brought on by disease or injury. For other patients, the same climate increased migraines and sinus headaches.

Some pain sufferers say they feel better in warm, dry climates where weather conditions seldom change. When she went to Israel in the 1990s, "I felt like I was 20 years younger when I stepped off the plane," says Mrs. Polatsek, the rheumatoid-arthritis patient.

But studies haven't consistently borne out the benefits of one climate over another. "There really is no place in the U.S. where people report more or less weather-related pain," says Dr. Jamison. He surveyed 557 arthritis sufferers in four cities in 1995 and found that more than 60% believed the weather affected their pain—regardless of whether they lived in San Diego, Boston, Nashville, Tenn., or Worcester, Mass.

Visiting a warm, dry climate may bring temporary relief, Dr. Jamison adds. "But if you live there full time, your body seems to acclimatize and you become sensitive to even subtle weather changes." 

Dr. Melanie Novak specializes in the diagnosis and treatment of various types of pain, including arthritis and migraine. This website provides more information on pain management.

REPOST: The shocking, stabbing pain disorder you've never heard of

About 12 out of 100,000 people are affected by trigeminal neuralgia, a facial pain disorder.  Seeking to promote awareness on the disease, patients organized the International Trigeminal Neuralgia Awareness Day, which took place on October 7.  Read this article from CNN for the story:

(CNN) -- Imagine shocks radiating across your cheek, a knife cutting into your skin or the feeling of hot coal burning your face, but not being able to find relief from the pain for months, or even years.

That's what some trigeminal neuralgia patients say they endure on a regular basis.

Trigeminal neuralgia is a facial pain disorder associated with the trigeminal nerve, which carries sensation from your brain to your face. Slight touches to the face, whether it's a breeze, hair falling onto your temple or simply brushing your teeth, may trigger flashes of pain. The pain is most commonly caused by a blood vessel pushing on the trigeminal nerve. There is no cure.

It affects approximately 12 out of every 100,000 people per year, according to the National Institute of Health, and is more common in women and people over 50.

 

iReporter Leslie Martella and her son Garrett Buckelew, then 12, before his first trigeminal neuralgia surgery. Image Source: www.cnn.com

"Trigeminal neuralgia is an uncommon disease and as a result, most physicians have very little experience with it. That is one of the reasons it's difficult to diagnose," said Ronald Brisman, a New York neurosurgeon who specializes in the disorder.

The unbearable pain and search for a cure, as well as the medical field's unfamiliarity with the disorder, has led a group of about 30 trigeminal neuralgia patients to fight for awareness. Several of them, in addition to others with the disorder, started by sharing their personal stories with CNN iReport.

'I want to imagine a world where nobody has ... this pain'

Nikki Samuel is one of those people. Her goal is to educate others about the disease, as well as let people know about the first International Trigeminal Neuralgia Awareness Day on October 7. Dozens of buildings and structures across the world are lighting up teal for the day.

 

Nikki Samuel on her 40th birthday last year. Image Source: www.cnn.com

"If we know that somebody, somewhere is looking for a cure and not just another medication or an even more invasive, risky procedure, it gives us hope," she wrote in her iReport. "I want to imagine a world where nobody has to survive with this pain."

Samuel started experiencing the facial pain in 2005 and was diagnosed with Atypical Facial Pain. A variety of medications were ineffective and in 2008, the registered nurse from Leicester, England, admitted defeat and resigned from her job.

"I had achieved my dream and there it was, being taken away from me by this relentless, debilitating pain," she said.

It was seven years from her first pangs of pain before she was diagnosed with trigeminal neuralgia. As a way to cope, the 41-year-old has turned to online support groups.

"My online friends have been my lifeline," she said. "Trigeminal neuralgia has taken away many things, but it has given me the chance to 'meet' some amazing people and to make lifelong friendships."

'I have forgotten what a pain-free day feels like'

One of the people Samuel met online was Fred Gerwig, a former high school history teacher from rural West Virginia. Samuel's bravery inspired him to write about his experience, Gerwig said.

 

Fred Gerwig on a good day in March, relatively free of pain. Image Source: www.cnn.com

Leaving his classroom on September 7, 2011, the sunlight seared his eyes, bringing on what he thought was his first migraine. The searing pain never left.

After getting lidocaine injections to treat the migraine a month later, he said he started experiencing strange facial pains.

"There were shocks and pangs in my right cheek," he wrote on CNN iReport. "It felt as if a hot coal was lying on my right eye socket."

Since then, wind, noise and even a random touch have all intensified his never-ending pain.

Gerwig was later diagnosed with two disorders: "atypical" trigeminal neuralgia and a persistent unilateral headache on the same side. The "atypical" form of the disorder is marked by constant aching, burning and pain, according to the National Institute of Neurological Disorders and Stroke.

Numerous migraine and anti-seizure drugs haven't worked for him, and he's not a prime candidate for surgery to relieve pressure on his nerve. There aren't any blood vessels pushing on the trigeminal nerve, so the cause of his case is unknown.

"I have now forgotten what a pain free day feels like, and that changes you," said the stay-at-home dad. "You lose parts of yourself. You lose friends and family that can't deal with the fact that they cannot give you a hug, say a prayer and make you better."

'Watching him suffer has broken me'

Leslie Martella has crossed the country trying to find relief for her 16-year-old son, Garrett Buckelew. He was diagnosed with trigeminal neuralgia when he was 11, she said.

"Watching him suffer has broken me," the mother said. "Garrett used to be an all-star baseball player, gifted student with high academic scores and awards, with tons of friends, and now he barely leaves our home."

Buckelew has had four surgeries to alleviate his pain, and four more surgeries after a complication occurred during one of the procedures.

"Trigeminal neuralgia has taken over our lives and is relentless," she said. "It has robbed my child of his life."

The Huntsville, Alabama, mom wishes people knew about the real pain that patients with this invisible illness experience.

"If Garrett walked around with a hatchet sticking out of his face, then people would get it, but trigeminal neuralgia is invisible, and I hate it."

'I am a trigeminal neuralgia warrior'

When a flash of pain shot from her eye to her jaw one day in 1998, Patti SanFilippo hurried to the mirror looking for a mark on her face. There was nothing there.

The Bloomsburg, Pennsylvania, resident tried to describe the pain to her doctor, but she felt like a lunatic. She spent five years struggling to find answers before she was diagnosed.

Even after multiple medications and surgeries to treat the disorder, none have helped ease her facial pain.

"A typical day in my life knows no real time and follows no structure. Pain wins over all else and many days are spent in bed," she said. "I have missed many family functions, important birthdays and reunions with friends because the pain won on those days."

To stay positive, SanFilippo calls herself a "trigeminal neuralgia warrior." Surviving the "horrendous pain, the harsh medications and lack of awareness" has inspired her to fight for help and understanding of this outwardly invisible disorder.

"If my story has been read and shared then I know I did my part to start people learning, talking about and becoming more aware that such an evil condition exists and needs attention so desperately," she said. "It's hopefully just the beginning, there is still so much that needs to be done."

Melanie Novak, MD, specializes in the diagnosis and treatment of various types of pain, including complex regional pain syndrome (CRPS), sciatica, joint discomfort, and bursitis, among others.  Visit this Facebook page for more updates on her practice.