Jul
08
2017

Stem Cells For Osteoarthritis

Many clinicians have used stem cells for osteoarthritis of the knee or other joints for some time. However, objective publications about the effectiveness of stem cells are only coming out now. Both stem cell types, derived from fat or stem cells from the bone marrow, are effective. Most doctors are using stem cells from fat (mesenchymal stem cells), because they are so much easier to harvest.

CNN reported about a man, Bill Marlette who had lost one of his arms in the past. He ended up overusing the other arm and as a result developed end-stage osteoarthritis in his wrist. He could not find relief with conventional methods of anti-inflammatories and pain pills. Next he went to a stem cell expert in Munich, Germany where he was treated with mesenchymal stem cells from his fatty tissue. Only one treatment took away his chronic pain and helped him regain his wrist mobility.

Prof. Dr. Eckhard Alt, an expert in regenerative medicine has previously treated patients with end stage osteoarthritis and had good clinical outcomes with it. As a result the German regulatory agency has approved his treatment protocol.

Dr. David Pearce, executive vice president for research at Sanford Health in South Dakota said that Prof. Dr. Eckhard Alt was the first one to use fat cells as a source of mesenchymal stem cells to treat osteoarthritis. He went on to say: ”Those stem cells don’t have to be programmed in any way, but if you put them in the right environment, they will naturally turn into what the cell type around them is.” The stem cells are harvested with a liposuction procedure. An enzyme mixture is used to separate the stem cells from fat cells, oil and connective tissue. A cell separator can also help separating the stem cells from the rest of the cells and tissue.

As indicated before only one injection was needed to relieve the chronic pain of Bill Marlette’s wrist. Since his return the doctors in the US have followed Bill closely. They took MRI scans and noted that the bony cysts associated with the severe arthritis have disappeared. His wrist and hand strength have returned to normal. The pain is almost gone. There were no side effects whatsoever. Because the stem cells are of the same tissue type as all his other cells of his body, one would not expect any tissue rejection by the immune system. Bill Marlette has not taken any pain pills since his procedure was done in August 2016. And he says: “I have more range of motion with my wrist, shaking hands didn’t hurt anymore,” he said. “My wrist seems to continue to improve, and there’s less and less pain all the time.”

Past experiences treating osteoarthritis with mesenchymal stem cells

  1. A 2014 clinical trial from Korea involved 18 patients with osteoarthritis of the knee where adipose mesenchymal stem cells were injected. The high dose group did best. After 6 months there was significant improvement, also confirmed by arthroscopy. The previous cartilage defect in the femoral and tibial condyles had decreased in size. Range of motion in the knee joints and pain had also improved. There were no adverse effects from the treatment.
  1. Mesenchymal progenitor cells are known to have the potential to develop into cartilage. At the Shanghai Medical College, Fudan University Shanghai, China the following experiment took place in 2015. Human adipose mesenchymal cells were grown in vitro. Later these mesenchymal progenitor cells were injected into the knees of rabbits where osteoarthritis had been experimentally produced. Despite doing xenotransplants (human cartilage to rabbits) with known HLA differences the cartilage grew and cured the osteoarthritis of the rabbits. The new cartilage had human HLA markers and was layered on top of the rabbit cartilage with rabbit HLA markers. At the end of the experiment at 16 weeks all the animals were sacrificed and the tissues were examined under the microscope and HLA marker testing was done also.
  1. A study from Tehran, Iran was carried out on 18 patients with ankle, knee and hip osteoarthritis in 2015. Stem cells derived from the bone marrow were injected into the osteoarthritic joint. Patients were followed clinically and by MRI scans for 30 months. All of the patients had improved significantly with regard to their joint function and pain. The MRI scans also showed thickening of the joint surfaces from new cartilage production.
  1. In a 2016 joint French/German study 18 patients with end stage knee osteoarthritis were treated with stem cells. The stem cells came from adipose tissue that went through a cell separator. The mesenchymal stem cell fraction was injected into the osteoarthritic knees. The study was a phase I study designed to rule out any adverse reactions, but none were found. It also established that there were significant positive improvements in pain and mobility with regard to the affected knees.

General remarks about how stem cells heal osteoarthritis

The example above with end stage osteoarthritis of the wrist was just one example of where osteoarthritis can strike. Perhaps the more common other locations are hips, knees and the facet joints of the lower lumbar spine (causing chronic lower back pain).

The same treatment procedure that was used with Bill Marlette’s wrist can be used for all these other locations. The common factor in osteoarthritis is that the cartilage is getting thinner and thinner until bone rubs on bone causing excruciating pain. It is here where mesenchymal cells can come to the rescue. After they have been injected into the affected joint, the stem cells will assess what needs to be done. They recognize that there is a lack of cartilage. Then they transform themselves into chondrocytes, which are cartilage-forming cells. How can they do that? They are programmed to replace missing cells, particularly cartilage and bone cells. But when they are bound within fatty tissue, they cannot act within a joint that has osteoarthritis. The doctor has to transport the mesenchymal cells into the joint where they can then begin their healing function.

Other methods to treat osteoarthritis

When osteoarthritis is diagnosed, stem cells are only one of several regenerative treatment modalities. Another method is called platelet-rich plasma (PRP) injections. Platelets have a lot of anti-inflammatory substances in them and also growth factors that can stimulate stem cells contained in the synovial membrane, the lining of any joint. In order to get PRP plasma, blood needs to be spun down and the PRP fraction is harvested with a syringe. After three PRP injections were given into the knees of 90 patients with end stage osteoarthritis these patients were followed for two years.

In the beginning before treatment 100% of the patients had symptoms. After one year following the treatment with PRP their knee functions were normal in 67% of them. After two years only 59% had normal knee function. The investigators pointed out that this treatment modality initially helped to a certain point, but then the effects were slowly fading away.

Stem cell treatment of osteoarthritis of the knee

The literature on either bone stem cells or fat stem cell use for osteoarthritis of the knee in man is still sparse. Nobody has done larger clinical trials. Part of the reasons could be that total knee and total hip replacement in orthopedics is very lucrative. We are still in a symptomatic treatment mode. Physicians treat osteoarthritis conservatively with anti-inflammatories and pain pills. When bone rubs on bone, the pain is getting excruciating and the patient is referred to the orthopedic surgeon who happily will do invasive surgical procedures. My own impression in general practice has been that these procedures do not always turn out the way they are supposed to work. Following total hip or knee replacement joint swelling often remains; pain issues are still there. There can be unequal height issues, balancing problems and so on.

Here is a review of mesenchymal stem cell therapy for osteoarthritis.  I am getting the impression that this publication is seen through very conventional medicine eyes. I suspect an attitude change is required by conventional medicine to catch up with what is happening in real life. Some patients will travel abroad to Munich as Bill Marlette did. But others may travel to other places like India, Mexico or wherever medical tourism takes you. Regenerative medicine is there to stay.

Stem Cells For Osteoarthritis

Stem Cells For Osteoarthritis

Conclusion

We have learnt about a case of severe osteoarthritis of the wrist that has been cured in Germany with one injection of mesenchymal stem cells. More common than wrist osteoarthritis is osteoarthritis of the hips, knees and the facet joints of the lower lumbar spine. The same stem cell therapy can be given for osteoarthritis in these locations. I find it very strange that progress in stem cell treatments is so slow in the US. The FDA has decided to be open to clinical trials with stem cell treatments, but progress seems to be much slower than in other countries. Why? We may never know. In the meantime, patients may seek treatments in other countries where such treatments are offered. In real estate sales there is a saying: “Buyer beware”. The same goes for stem cell treatments in another country. Should you contemplate doing this, do your homework; ask about the qualification of the treating physician, about safety records and whether the local authorities have approved this procedure. In the case of Bill Marlette’s osteoarthritis of the wrist the procedure in Munich, Germany had been accepted by the European equivalent of the FDA, the European Medicines Agency. Safety is top priority, effectiveness is next.

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May
27
2017

What Your Shopping Cart Reveals

What your shopping cart reveals is what I studied on several of our trips to the US. As I am retired, my wife and I travel quite a bit in the US and find it interesting to watch what people place into their shopping carts.

Typical shopping cart I have observed

The typical shopping cart in a US grocery store seems to consist of white bread, pizza, bacon, hamburger meat, potato chips, cookies, cornflakes, grapes, celery, peppers, strawberries and apples. In addition many people buy prepared breaded chicken strips, milk and an assortment of fruit yogurts.

I like to comment on each of these items, what I am thinking and what precautions you need to be aware of.

White bread and pizza

The problem with white bread and pizza is the wheat, which nowadays is Clearfield wheat. A chemical company from Germany was able to chemically modify the genes of wheat in the 1960’s and 1970’s; in addition they used radiation of the seeds. The farmers liked that the new wheat (called Clearfield wheat) grew with stronger roots, shorter final stems and much larger grains so the yield per acre was higher. This type of wheat was patented under the name of Clearfield wheat and sold all around the world. What was not publicized at the time was that the gliadin content increased manifold from the composition of wheat strains used for thousands of years before. Gliadin gets rid of the glue like substance between the gut cells and causes leaky gut syndrome, something that I heard mentioned at many lectures at several of the Anti-Aging conferences of A4M in Las Vegas. This leads to exposure of immune cells to foreign proteins from the gut, which causes the immune system to hyper react with autoimmune antibodies. As a result, many persons react to wheat with indigestion and digestive problems. They may believe that they react to gluten. It is true that Clearfield wheat also has a higher gluten contents. But any tests for celiac disease will come up empty.

We don’t want to eat this as bread, burgers or pizza: but all of them are baked with the wheat that has been chemically force-hybridized into Clearfield wheat.

Bacon and hamburger meat

A prospective study of 72,113 women over 18 years found a definitive relationship between dietary patterns and cancer and heart attacks. A prudent diet with a high intake of vegetables, fruit, legumes, fish, poultry, and whole grains had a very low cancer and heart attack rate. Conversely a Western diet consisting of high intake of red meat, processed meat, refined grains, French fries, and sweets/desserts led to a higher cardiovascular mortality risk of 22% and a higher cancer mortality risk of 16%.

There is another question you should ask: is it grain-beef or is the beef grass-fed?

Meat from grass-fed beef contains 5-times the amount of omega-3 fatty acids compared to corn- or grain-fed beef. Another issue is corn, if that is fed to beef cattle. There is obviously a deliberate marketing drive claiming that corn-fed beef would have a superior taste.

This link shows that the producers only care about their profit and how much of corn-fed beef they can sell. They do not mention that corn is a GMO crop, so this feed is somehow incorporated into the meat. No one has done long-term experiments to ensure that this meat is safe to eat. Moreover, we do know from measurement that corn-fed meat contains much less omega-3 fatty acids and much more omega-6 fatty acids than grass-fed beef. Cows are meant to be grass-feeding animals. If you want to stay healthy, eat grass-fed beef, but do not consume too much or you put yourself at risk for gout from purine metabolites. Corn-fed and grain-fed beef cattle have a lot more infections including liver disease. To control this, the animals are receiving antibiotics. These antibiotics end up in the meat, which can produce superbugs. These superbgs can enter into humans through the food chain.

Bacon is another food that is not only full of saturated fat, but it contains additives, such as sodium nitrite. Give the matter some thought before you put hamburger meat and bacon into your shopping wagon!

What’s wrong about potato chips, cookies, and cornflakes?

1. Potato chips

Potatoes are rich in carbs, but they are empty carbs. Their glycemic index is in the 70 to 80 ranges. I avoid any carbs that exceed 55 (the upper limit of the low-glycemic index). Strangely enough by the time potatoes are processed into potato chips, the glycemic value is only 51, but this is deceiving. The potatoes have been processed in fat and with tons of salt. We now have a product that surely will be bad for your arteries and cause high blood pressure over the long haul. Another important fact is that potatoes belong to the 12 dirty dozens fruit and vegetables that are heavily sprayed with pesticides (see below).

2. Cookies

Cookies are a mix of various ingredients. Here is a recipe for cookies. This is even a better than average quality cookie recipe as they used unsalted butter as a fat source. In many recipes they use margarine, which is an inferior fat. It contains free radicals from the manufacturing process. It is derived from omega-6 fatty acid vegetable oils. But the worst ingredients of cookies are the nutritionally empty white flour and the sugar. Both together are digested, absorbed as sugar into your blood, and a huge insulin response occurs after you have eaten it. Even the cheap chocolate used for the chips is full of unhealthy table sugar causing your pancreas to overproduce insulin.

3. Cornflakes

As mentioned above corn is a GMO crop and we do not know the long-term effects of GMO food on humans. There are more and more reports about gut dysbiosis, leaky gut syndrome and autoimmune diseases as a result of the breakdown of the gut barrier. Pro-GMO advocates deny these possibilities. I play it safe and stick to organic fruit and vegetables. But cornflakes are also high on the glycemic index (between 77 and 93). Usually there is sugar mixed in, and the starchy component consists of empty calories. It is simply not a sensible food choice!

The dirty dozen: grapes, celery, peppers, strawberries and apples

It is known for some time that certain foods are more contaminated with pesticides than others. Some of these fruit and vegetables contain between 13 and 15 different pesticides from spraying, as this link describes. Potatoes are one of the top contaminated crops among the dirty dozen.

Why is it important to know which crop is contaminated with pesticides? Pesticides are immune disruptors. Vegetables that are supposed to be healthy for us contain residues from insecticides and herbicides that have estrogen-like activities called xenoestrogens.They are known to cause breast cancer in women and prostate cancer in men.

Breaded chicken strips, milk and fruit yogurt

1. Chicken strips

Chicken are fed arsenic type antibiotics for faster growth.

The only way how to protect yourself from this contamination is by buying organic chicken, which I have done since 2001. Also, don’t buy breaded “anything” This brings us back to the wheat story mentioned under “White bread and pizza” above.

2. Milk

Milk in the US often contains antibiotics and genetically modified bovine growth hormone (rBGH), which can cause various cancers in humans as this link shows. Recombinant BGH is banned in Europe and in Canada.

3. Yogurt

Most people like fruit yogurt, which is full of sugar and fruit syrup. Plain yogurt, sweetened with a bit of stevia is healthy. But the moment it is adulterated with minimal amounts of fruit, and high amounts of sugar,this “fruit yogurt” leads to weight gain and hardening of arteries. The best yogurt product is organic 1% or 2% plain yogurt. Use fruit of your choice to make a real fruit yoghurt!

What Your Shopping Cart Reveals

What Your Shopping Cart Reveals

Conclusion

Life is all about decisions. I like to make healthy food choices for myself. When I go grocery shopping, I notice that many people do not seem to give much thought to what they are purchasing. They likely also have never read the details about the type of facts I mentioned above. The ingredients that people buy at the grocery store are the ingredients of the Standard American Diet, a sad state of affairs indeed.

The key is to avoid wheat products because Clearfield wheat leads to leaky gut syndrome and autoimmune diseases. Next avoid processed foods and added sugar. What I have not mentioned above is the importance of cutting down on omega-6 fatty acids and to increase omega-3 fatty acids (fish, fish oil supplements). Omega-3 fatty acids are anti-inflammatory. Omega-6 fatty acids stimulate the arachidonic acid pathway leading to hardening of arteries and arthritis. This leads to stents of the coronary arteries and joint replacements of the hips and knees.

Avoid the dirty dozen of crops and buy them organic instead. Avoid milk products in the US; instead buy them organic to avoid exposure to recombinant bovine growth hormone.

It takes a bit of homework and re-education to eat healthy foods. Start reading labels! If a ten year-old cannot read the name of an additive, it should most likely be a signal for you not to buy this product! The more processed food is, the less nourishing it is likely to be. It is not a huge effort to educate yourself about products, but it does take time to steer away from old habits that are not the best for your health. Ultimately your efforts will pay dividends in terms of good health for years to come!

Oct
22
2016

Arthritis Drugs Can Cause Heart Failure

The British Medical Journal has published a research articles in Sept. 2016 showing that arthritis drugs can cause heart failure. This occurs particularly in elderly patients around the age of 77 years and older. This is an age where arthritis is often causing pain, and the pain is regulated with over-the-counter pills. These anti-arthritis drugs belong into the group of anti-inflammatory drugs, called NSAIDs. This stands for “non-steroidal anti-inflammatory drugs”. The study was entitled “Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries…”

Arthritis drugs can cause heart failure shows study

Adult patients above the age of 18 who started 27 different types of NSAIDs between 2000 and 2010 were followed. 92,163 hospital admissions for heart failure were noted; 8,246,403 patients who were not taking NSAIDS served as controls. There were 4 countries involved in this study providing 2.2 million patients from the Netherlands, 7.5 million from Italy, 13.7 million from Germany and 11.1 million from the United Kingdom.

Results of study

NSAID use of up to 2 weeks prior to assessment had a risk of 19% of resulting in a hospital admission for heart failure. A control group of patients who had not taken NSAIDs for at least 6 months or more had no hospital admission risk.

Seven traditional NSAIDs were found to be associated with hospital admission for heart failure. They were: diclofenac (brand name Voltaren), ibuprofen (brand name Motrin), indomethacin (brand name Indocin), ketorolac (brand name Toradol), naproxen (brand name Naprosyn or Aleve), nimesulide (brand name Mesulid and many others), and piroxicam (brand name Feldene). In addition two COX 2 inhibitors, etoricoxib (brand name Arcoxia) and rofecoxib (brand name VIOXX) were also having the same side effects.

  1. The risk for heart failure was not the same for every NSAID. The risks ranged from 1.16-fold to 1.83-fold. Specifically ketorolac had a risk of 1.83-fold, indomethacin 1.51-fold, piroxicam 1.27-fold, diclofenac 1.19-fold, ibuprofen 1.18-fold, and naproxen 1.16-fold. Translated into common language it means that ketorolac had a risk of 83% of causing a hospital admission due to heart failure. In the case of ibuprofen it was only an 18% risk.
  2. The risk for heart failure doubled for diclofenac, etoricoxib, indomethacin, piroxicam, and rofecoxib when used at very high doses. Doubling the risk means a 200% risk. Typically, when an arthritis patient has a flare-up of pain, this is the time when the NSAIDs are usually taken at a higher dose and tend to also be taken for a longer time. Some NSAIDs had a significant risk for heart failure even at a medium dose. This was the case for indomethacin and etoricoxib. The good news was that celecoxib (brand names Celebrex and Celebra) at usual doses did not lead to an increased risk of heart failure.
  3. Dose-response curves were obtained where possible. Here the researchers looked at the effect of low, medium, high and very high doses of NSAIDs in patients. Again heart failure occurrence was studied among those patients. The result clearly showed that low and medium doses of NSAIDs were fairly safe, but high and very high doses of NSAIDs caused heart failure. Etoricoxib, Piroxicam and Rofecoxib were particularly toxic in higher doses. Indomethacin was toxic at medium and high doses. An important exception to the rule was celecoxib (brand names Celebrex and Celebra), which did not cause heart failure, either at low doses or high doses. This is one of the most used NSAIDs, so it is fortunate that it does not cause heart failure.

Discussion of study

The authors of this study discussed why they believe heart failure is developing in patients who take NSAIDs. They argued that NSAIDs inhibit prostaglandin synthesis and the enzymes COX1 and COX2. This is how inflammation and pain gets inhibited, which is a good thing. But at the same time blood supply to the kidneys is reduced, kidney function is impaired, and sodium is retained. This is a bad thing as it leads to fluid retention and fluid overload of the heart resulting in heart failure. As the prostaglandin inhibition is dose-dependent, the authors said this is the reason that the heart failure rate is also dose-dependent when measured in large populations, as was done in this study. A noted exception, as already mentioned, is the popular celecoxib, which does not cause heart failure, even at high and very high doses.

Arthritis Drugs Can Cause Heart Failure

Arthritis Drugs Can Cause Heart Failure

Conclusion

This publication has a lot of statistical power as it was based on research in 4 European countries and involved almost 10 million subjects that were compared to an equally large control population. Because of the size of the study population it was possible to calculate risk ratios for NSAIDs causing heart failure for 27 different types of NSAIDs. Furthermore, the authors succeeded in quite a few cases to calculate risk factors for different concentrations of NSAIDs used. This statistical method is called a dose-response curve. It is a powerful pointer to toxicity when high doses cause heart failure, but low doses don’t.

The physician can use the information from this publication to select one of the NSAIDs that is least harmful, like celecoxib (brand names Celebrex and Celebra) and tell the patient to use the least amount possible to minimize side-effects. Many aging arthritis sufferers will benefit from this. Hopefully the FDA will review this material and shut down the use of some of the more dangerous NSAIDs or force the manufacturer to attach a black box warning about the drugs that belong into this category. You should review what your favorite NSAID is and discuss this with your physician. Perhaps print a copy of this review and take it with you, in case your health provider has not heard about it yet.

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Aug
06
2016

Pain Treatment

General practitioners see a lot of patients with various pain symptoms for which they seek pain treatment. The underlying conditions might be from an arthritic problem that suddenly becomes symptomatic, or an acute back injury may send pain from the lower back into one of the legs. Others may experience excruciating headaches like migraines or tension type headaches. Often these painful conditions require some immediate pain relievers to treat the pain, but this can turn into a nightmare of drug dependency and may even lead to the development of chronic pain. Here I like to review an article that I found in the June edition of ConsumersReports.org.  In my review I included most of the content, but added a few newer pain treatment modalities.

Acute pain

Here I’m discussing back pain as an example. When a disc bursts in the lower back because the person was lifting an object too heavy to lift, acute pain develops in the lower back. This is often located at the lower lumbar spine level (L5/S1) causing radiating pain into one of the legs.

In a case like this it will often take several weeks before the body can heal this condition.

Chronic pain

It can happen in many cases that the pain will still be there 3 to 6 months down the road. If a disc fragment pushes on the nerve root in the nearby canal through which the nerve root travels, this will cause the muscles supplied by the nerve root to melt away in the leg of the affected side. If nothing is done about this, the acute pain turns into chronic pain, which is much more difficult to resolve. The initial physician may refer the patient to a neurosurgeon who will review the case together with the help of an MRI scan that shows the underlying pathology. The neurosurgeon may determine that a mini discectomy will reduce the pressure onto the nerve root. This surgery may be able to prevent chronic pain from setting in. Once the pressure is relieved, the nerve can start the healing process. It is critical to not miss the point where acute pain crosses over into chronic pain. This happens at around 2 to 3 months into the pain condition. Chronic pain is much more difficult to treat as some of the neurological pain pathways that form after such injuries can persist within the spinal cord or even within the central nervous system, even after successful disc surgery that is done too late. With respect to the example given above, if the patient is operated on too late (1 to 2 years after the injury), the procedure may not be effective in relieving the pain. A chronic pain syndrome has started.

How pain treatment is done

  1. Avoid bed rest

In the past (up to the late 1970’s to mid 1980’s bed rest was the accepted initial mode of treatment. Even though patients often felt some relief of pain initially, this led to muscle atrophy (literally a melting away of muscles) in the muscles that are supporting the spine. These structural changes destabilized the spine and often made the pain more chronic until physiotherapy treatments and active exercises rebuilt the supporting muscles again.

  1. See a physiotherapist

Physiotherapists can use different treatment modalities like traction, a TENS machine, active exercises that all can help to alleviate back pain due to muscle spasm. If there is only a strain, this will often help to resolve your back pain within 4 weeks. But if there is an underlying disc herniation as previously explained, you need to be assessed by a physician in an urgent care center, primary care setting or by an emergency physician in the emergency department of a hospital. When the examination confirms an abnormal reflex from a nerve root compression, a referral to a neurosurgeon or orthopedic surgeon is usually made as previously explained.

  1. Chiropractic treatment

Some people have their backs treated periodically to prevent back troubles. When they get an acute back pain they likely will see the chiropractor again. In cases of a back strain, where one or more muscles are pulled, this approach will be helpful together with some home exercises and swimming to build up muscle strength along the spine. However, in the case of a herniated disc chiropractic adjustments should not be done (physicians say they are “contra-indicated”). Instead the patient should be referred to either a neurosurgeon or an orthopedic surgeon.

  1. Medication for pain

Often physicians prescribe Tylenol with codeine, hydrocodone (Vicodin), oxycodone (OxyContin, Percocet) or morphine for pain relief. All narcotic medication have side-effects; they can cause constipation, can cause vomiting, make you feel dizzy and can lead to falls, particularly in elderly patients. These falls can cause hip fractures and other fractures that complicate the recovery from the original pain. Never exceed the dosage of pain medicine prescribed on the label, and if it does not relieve the pain, see your physician again for a reassessment to rule out any complications. Often people with back pain also have depression. To address this issue your physician may prescribe an antidepressant like duloxetine (Cymbalta), which has been approved by the FDA for treatment of lower back pain. But there are two rare, but important side effects to know about. Cymbalta can cause lowering of blood pressure, which leads to dizziness. This can cause serious falls with the danger of fractures. The other complication is the risk of liver failure.

Side effects of pain treatment

  1. While there seems to be an urgency to treat a patient who is in pain with pain medication, the treating physician must not forget that pain medication is potentially addicting and patients often use higher doses than advisable. However, pain medication has a narrow therapeutic window meaning that the toxic levels are not much higher than the drug levels necessary to relieve pain.
  2. There are medications that are only marginally effective, if at all. Glucosamine and chondroitin are used for relief of arthritic pain in osteoarthritis sufferers. They are eliminated by a liver enzyme system that also eliminates blood thinners. If a patient is on blood thinners, the addition of glucosamine and chondroitin can lead to dangerous bleeding. Instead of using glucosamine and chondroitin when you experience pain and inflammation in joints, reduce your activities, but stay as active as you can to avoid your symptoms from getting worse.
  3. When a patient has a severe migraine headache it is tempting to want to rule out a brain tumor. But a CT scan exposes the patient to dangerously high radiation doses that over time could cause brain cancer or leukemia. There are physical examination methods to rule out a brain tumor. If the findings are positive, an MRI scan can be used to get much more detail of the brain than a CT study would reveal. MRI scans do not have undesirable side effects.
  4. Before you rush into using anti-inflammatory drugs, use gentle movement to remobilize the painful joint, back or limb. Activities like swimming, walking or yoga can reduce pain and allow you to recover from a painful condition according to a Cochrane Library analysis of 61 studies.
  5. For more pain relief NSAID (non steroidal anti inflammatory drugs) pain relievers like ibuprofen (Advil) or naproxen (Aleve) for a brief period will also help. The problem with long-term use of NSAIDs is that it can cause kidney damage. With longer use of NSAIDs there is also a danger of stomach bleeding, heart attacks and strokes.
  6. The pain drug acetaminophen (Tylenol) has a narrow therapeutic window and is less effective in pain relief than the NSAIDs. The FDA has recommended as the highest daily dose 4000 mg of acetaminophen. But if you are a heavy drinker or you have liver disease, your daily dose of acetaminophen should not exceed 3250 mg to avoid liver toxicity. Long-term use of acetaminophen can also damage your kidneys, therefore the recommendation to use acetaminophen only for a short period of time (a few days).
  7. Migraine headache drugs: The newer migraine drugs, called triptans temporarily narrow widened blood vessels. This relieves severe migraines within about 2 hours. However, these medications are not recommended for those with high blood pressure, chest pain, heart disease or circulation problems in the legs, as blood vessel constriction could bring on heart attacks or worsen circulation problems.

Common sense approach to pain treatment

The key for any pain condition is to treat the pain right away to minimize the impact that pain has on you and to prevent developing chronic pain, which is more difficult to treat.

Here are some examples.

  1. Migraine headaches

    If you have a migraine headache, use an over-the-counter pain reliever like naproxen or ibuprofen to treat the migraine pain very early. A combination of acetaminophen, aspirin and caffeine (like Excedrin Migraine or a generic copy) will also do. This will stop the release of prostaglandins, which would send pain signals to the brain. Heat packs or cold packs on your head can also help in the treatment of a headache. A 2013 study from Germany has shown that migraine sufferers can get rid of their migraine headaches in 60% by having sex. It sounds like a nice idea, but what they have not considered may be the fact that somebody who has a splitting headache is not feeling like sex at all! If your home remedies did not help, see your physician for one of the triptan pills. Sumatriptan or a similar drug constricts blood vessels to the brain. The doctor will also look for common triggering factors that can bring on a migraine. Weak neck and shoulder muscles may respond to physiotherapy strengthening. In women a condition called estrogen dominance is associated with migraines and can be treated with bioidentical progesterone to balance estrogen and progesterone in the body by elevating progesterone concentration.

  2. Acute lower back pain 

    Acute lower back pain usually follows an event where the person lifted something too heavy or injured the back from a fall. The important part is to rule out a fracture. Most of the time there is no underlying fracture, just a muscle strain. A muscle strain usually sorts itself out in time. Stay active as much as possible. But if the back pain does not resolve within a few days, see your physician for more tests. An X-ray may be required to rule out structural changes like a fracture. As explained earlier, an MRI scan may be required to rule out a disc herniation. Instead of neurosurgery, further options nowadays are prolotherapy, stem cell therapy or a combination prolotherapy/stem cell therapy. This type of therapy will also work for knee injuries (meniscal or ligamentous tears).

  3. Hip or knee pain

    Conventional medicine usually treats osteoarthritis with NSAIDs, but may not warn you about the possibility of gastric erosions that can lead to massive stomach bleeding, heart attacks or strokes when using NSAIDs. It also can lead to kidney damage that can cause sudden kidney failure. The key is to use anti-inflammatory medication only for a few weeks. If arthritis persists, it is wiser to seek the advice of a naturopathic physician for prolotherapy treatment. Pain relief is usually achieved with one or two treatments of prolotherapy. If prolotherapy does not succeed, it is best to move on to mixed stem cell therapy with bone marrow and mesenchymal stem cells (from fat cells) as well as PRP (platelet rich plasma). This usually leads to complete healing of osteoarthritis and eliminates the need of total knee or total hip replacement.

  4. Neck and shoulder pain

    This often develops because of poor posture, shoulder tendinitis or neck muscle spasm. Physiotherapy is often successful treating this. If not, intramuscular stimulation (IMS) with acupuncture needles can be used. This may be more successful in interrupting the abnormal neuropathic pain pathways. Alternatively electro acupuncture with a TENS-like device can also be successful. The newest treatment modality is the Weber medical system using a low-dose laser applicator. Prolotherapy can also be used for shoulder and neck problems, if the ligaments are lax. It requires a lot of experience on behalf of the health professional to choose the right treatment protocol for the condition.

  5. Tension headaches

    Anxiety, stress and fatigue can all lead to tension headaches. Initially you may want to drink liquids, as dehydration is related to tension headaches. If your headache is still present after one hour, use naproxen or acetaminophen. Take a warm or cold shower and lie down with a cool cloth on your forehead. If you still have a headache, check with your doctor whether it is indeed a tension headache or a migraine. You may have jaw clenching or teeth grinding during your sleep. If your bite seems off, see a dentist. For stress control use relaxation techniques. Some suggestions sound mundane enough, but they can be effective: Get enough sleep, get enough exercise, and work on improving your posture. A physician trained in trigger point injections with local anesthetics (often anesthetists or general practitioners) can freeze your suboccipital and supraorbital nerves with lidocaine, which I have seen to work in 60% to 70% of cases in my former practice.

Pain Treatment

Pain Treatment

Conclusion

Pain treatment can be confusing as pain itself can be very multifaceted. The key is to search for the cause of the pain and then treat pain very quickly before it has time within 2 to 3 months to turn into a chronic pain condition. Chronic pain is much more difficult to treat. Every effort should be made to treat acute pain successfully. Conventional medicine has to yet learn from naturopathic medicine and alternative medicine practitioners that prolotherapy, stem cell therapy, IMS, trigger point injections with local anesthetics and low-dose laser therapy (Weber medical system) are valuable alternative methods that can successfully treat pain conditions and get incorporated into general medical practice.

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