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Fixing the pain problem

Pain relief doesn’t have to come in a bottle, however. Physical therapists can provide a safe, drug-free alternative for treating pain.

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The world is in the midst of an opioid epidemic. Sales of prescription opioids have nearly quadrupled since 1999. According to the Centers for Disease Control and Prevention, in 2012 alone, enough opioid prescriptions were written for “every American adult to have their own bottle of pills.”

Photo courtesy of American Physical Therapy Association

Photo courtesy of American Physical Therapy Association

Prescription opioids – medications that reduce pain by interrupting pain signals to the brain – only mask the sensation of pain, and they come with side effects including depression, overdose and addiction, plus withdrawal symptoms when stopping opioid use. Pain relief doesn’t have to come in a bottle, however. Physical therapists can provide a safe, drug-free alternative for treating pain.

When to Choose Physical Therapy

In March 2016, the CDC released guidelines urging prescribers to rely less on opioids in favor of non-drug alternatives. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care and end-of-life care, but for most long-term pain management non-opioid approaches are recommended.

The American Physical Therapy Association, through its national #ChoosePT campaign, is reminding patients that they have the right to choose their method of pain treatment. Physical therapists treat pain through movement and patients get to play an active role in their recovery.

Based on the CDC guidelines, patients should choose non-opioid alternatives, such as physical therapy, when:

The risks of opioid use outweigh the rewards. “Experts agreed that opioids should not be considered first-line or routine therapy for chronic pain,” according to the CDC. “Given the substantial evidence gaps on opioids, uncertain benefits of long-term use and potential for serious harm, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions.”

Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids. As the guidelines note, even in cases when evidence on the long-term benefits of non-opioid therapies is limited, “risks are much lower” with non-opioid treatment plans.

Pain or function problems are related to low-back pain, hip or knee osteoarthritis or fibromyalgia. The CDC cited “high-quality evidence” supporting exercise as part of a physical therapy treatment plan for those familiar conditions.

Opioids are prescribed for pain. Even in situations when opioids are prescribed, the CDC recommends that patients should receive “the lowest effective dosage” and opioids “should be combined” with non-opioid therapies, such as physical therapy. Clinicians should continue opioid therapy only if there is “meaningful improvement in pain and function that outweighs risks to patient safety.”

Pain lasts 90 days. At this point, the pain is considered “chronic” and the risks for continued opioid use increase. In the US, an estimated 116 million Americans are living with chronic pain, but the danger of masking pain with prescription opioids is clear. More than 165,000 people in the US alone have died from opioid pain medication-related overdoses since 1999, and every day more than 1,000 people are treated in emergency departments for misusing prescription opioids.

If you or a loved one needs help managing pain, talk with your health care provider about safe alternatives to opioids. Additional information on the #ChoosePT campaign, including a pain self-assessment that patients can use to facilitate conversations about their care, is available at MoveForwardPT.com/ChoosePT.

Understanding Pain

Before exploring and choosing long-term treatment options, consider these facts about pain:

  1. Pain is output from the brain. While researchers used to believe that pain originated within the tissues of the body, newer evidence indicates that pain does not exist until the brain determines it does. The brain uses a virtual “road map” to direct an output of pain to tissues that it suspects may be in danger. This process acts as a means of communication between the brain and the tissues of the body to serve as a defense against possible injury or disease.
  2. The degree of injury does not always equal the degree of pain. Research has demonstrated that people experience pain in individual ways. While some people experience major injuries with little pain, others experience minor injuries with a lot of pain.
  3. Diagnostic imaging (MRIs, X-rays, CT scans) results may not show the cause of pain. A 2015 study in Spine, which analyzed MRI results of more than 1,200 individuals ages 20-70 who had no symptoms of lower-back pain, found that 87.6 percent suffered from bulging discs. Even most subjects in their 20s had bulging discs – 73.3 percent of males and 78 percent of females, respectively.
  4. Psychological factors, such as depression and anxiety, can make pain worse. Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed prior to a total knee replacement were related to a patient’s experience of long-term pain following the operation.
  5. Your social environment may influence your perception of pain. Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be generated when an individual is in an environment or situation that the brain interprets as unsafe. It is a fundamental form of self-protection.
  6. Understanding pain through education may reduce your need for care. A large study conducted on military personnel demonstrated that those who were given a 45-minute educational session about pain sought care for lower-back pain less than their counterparts.
  7. The brain can be tricked into developing pain in prosthetic limbs. Studies have shown that the brain can be tricked into developing a “referred” sensation in a limb that has been amputated, causing a feeling of pain that seems to come from the prosthetic limb – or from the “phantom” limb. The sensation is generated by the association of the brain’s perception of what the body is from birth (whole and complete) and what it currently is (post-amputation).
  8. The ability to determine left from right may be altered when you experience pain. Networks within the brain that assist you in determining left from right can be affected when you experience severe pain. If you have been experiencing pain and have noticed your sense of direction is a bit off, it may be because the part of the brain that details a path to each part of the body may be impaired.
  9. There is no way of knowing whether you have a high pain tolerance or not. While some people claim to have a “high tolerance” for pain, there is no accurate way to measure or compare pain tolerance among individuals. While some tools exist to measure how much force you can resist before experiencing pain, it can’t be determined what your pain “feels like.”

Fitness

6 Exercise safety tips

Now, as social restrictions ease, you may find yourself stepping up your workouts, whether you’re training for an event or working to improve your game in a recreational league.

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In the wake of the COVID-19 pandemic, many Americans are more aware of their health and wellness. Now, as social restrictions ease, you may find yourself stepping up your workouts, whether you’re training for an event or working to improve your game in a recreational league.

Sprains, strains and injuries can happen to even the most seasoned athletes. When you’re testing your limits, even a minor injury can alter your performance. Consider products and supports like these from the CURAD Performance Series product line, available at Walmart and Amazon, to help you get back in the game quickly and safely.

Find more resources to support your fitness journey at CURAD.com.

Keep Dirt and Germs Away

The more active you are, the harder it can be to find a bandage that stays with you all day or all game long.

Spray Away Sore Spots

Controlling mild pain can help keep you at the top of your game, and a topical analgesic works fast to heal common pain brought on by fitness and exercise, such as pain in knees, feet, shoulders and backs.

Put Pain in the Past

When recovery becomes the name of the game and pain relief is needed after daily workouts or bodily injuries. Cold packs work to heal bruises, reduce swelling and relieve headaches and general pain points while microwavable heat packs provide satisfying heat therapy to address sore and stiff joints, muscle cramps and tension.

Reduce Impact of Knee Strain

Weak, injured or arthritic knees can come from many sources, including tendonitis and a wide range of conditions that result in strain or overuse. An adjustable band can provide support for on-field sports and during workouts or everyday activities.

Manage Pain and Relieve Pressure

If you participate in endurance and strength exercises or certain sports, you may ask a lot of your joints. Kinesiology tape can be configured a multitude of ways to help reduce pain and improve blood circulation, as well as relieve tension and pressure.

Control Back Strain

When your back is strained, your body and performance can suffer. A mild or moderate sprain can benefit from strong support and compression.

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Fitness

Exercise can provide relief for dry, itchy eyes

A significant increase in tear secretion and tear film stability after participating in aerobic exercise can be another remedy for relieving dry, itchy eyes.

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Photo by Quinten de Graaf from Unsplash.com

A team led by researchers from the University of Waterloo discovered that a significant increase in tear secretion and tear film stability after participating in aerobic exercise can be another remedy for relieving dry, itchy eyes. 

Every time we blink, our eyes are covered in tear film—an essential protective coating necessary for maintaining healthy ocular function. Healthy tear film comprises three layers–oil, water, and mucin–that work together to hydrate the ocular surface and protect against infection-causing irritants like dust or dirt.

When any part of the tear film becomes unstable, the ocular surface can develop dry spots, causing eye symptoms like itchiness or stinging and burning sensations.

“With so much of our activity tied to screen usage, dry eye symptoms are becoming increasingly common,” said Heinz Otchere, a PhD candidate in vision science at Waterloo. “Instead of having to use eye drops or other alternative treatments, our study aimed to determine if remaining physically active can be an effective preventative measure against dryness.”

Fifty-two participants were divided into two groups—athlete and non-athlete—to participate in an exercise session. Participants in the athlete group exercised at least five times per week, while non-athlete participants exercised no more than once per week. Researchers, which included experts from the University of Cape Coast in Ghana, performed visual examinations before and five minutes after each exercise session, where tear secretion and tear break-up time were assessed.

While participants in the athlete group showed the largest increase, Otchere says all participants experienced a meaningful boost in tear quantity and tear film stability after the exercise session. 

“It can be challenging for people to regularly exercise when the demand is there to work increasingly longer hours in front of screens,” Otchere said. “However, our findings show physical activity can be really important for not just our overall well-being, but for our ocular health too.”

The study, Differential effect of maximal incremental treadmill exercise on tear secretion and tear film stability in athletes and non-athletes, was co-authored by Otchere, the University of Cape Coast’s Samuel Abokyi, Sekyere Nyamaah, and Michael Ntodie, and Ghana’s Our Lady of Grace Hospital’s Yaw Osei Akoto. It was recently published in the Experimental Eye Research journal.

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Fitness

Late-life exercise shows rejuvenating effects on cellular level

Late-life exercise mitigates skeletal muscle epigenetic aging.

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Photo by Caley Vanular from Unsplash.com

For people who hate exercising, here comes some more bad news: it may also keep you younger. Not just looking younger, but actually younger, on an epigenetic level. By now, the benefits of exercise have been well established, including increased strength of bones and muscles, improved mobility and endurance, and lower risk of heart disease, diabetes and high blood pressure.

But younger?

A study recently published in Aging Cell, “Late-life exercise mitigates skeletal muscle epigenetic aging,” suggests this could be the case. The paper was written by a team of seven researchers across three institutions, including Kevin Murach, an assistant professor in the Department of Health, Human Performance and Recreation at the U of A. Murach’s grant from the National Institute of Health funded the study, and he was one of three co-first authors.

Bootcamp for Mice

While the paper is dense with data, reflecting the use of several analytic tools, the experiment that generated the data was relatively straightforward. Lab mice nearing the end of their natural lifespan, at 22 months, were allowed access to a weighted exercise wheel. Generally, mice require no coercion to run and will do so voluntarily. Older mice will run anywhere from six to eight kilometers a day, mostly in spurts, while younger mice may run up to 10-12 kilometers. The weighted wheel ensured they built muscle. While there isn’t a direct analogue to most human exercise routines, Murach likened it to “a soldier carrying a heavy backpack many miles.”

When the mice were studied after two months of progressive weighted wheel running, it was determined that they were the epigenetic age of mice eight weeks younger than sedentary mice of the same age — 24 months. Murach noted that while the specific strain of mice and their housing conditions can impact lifespans, “historically, they start dropping off after 24 months at a significant rate.” Needless to say, when your lifespan is measured in months, an extra eight weeks — roughly 10 percent of that lifespan — is a noteworthy gain.

Methylation, My Dear Watson

The science behind this, while complicated, hinges largely on a biological process known as DNA methylation. A recent New York Times article discussing Murach’s work on muscle memory described methylation “as a process in which clusters of atoms, called methyl groups, attach themselves to the outside of genes like minuscule barnacles, making the genes more or less likely to turn on and produce particular proteins.”

As the body ages, there tends to be increased DNA methylation, or even hypermethylation, at promoter sites on genes in muscle. “DNA methylation changes in a lifespan tend to happen in a somewhat systematic fashion,” Murach explained, “to the point you can look at someone’s DNA from a given tissue sample and with a fair degree of accuracy predict their chronological age.” Due to this, researchers can use one of a number of “methylation clocks” to determine the age of a DNA sample.

DNA Methylation, Aging and Exercise

While the paper strengthens the case for exercise, there is still much that needs to be learned. Though the connection between methylation and aging is clear, the connection between methylation and muscle function is less clear. Murach is not yet prepared to say that the reversal of methylation with exercise is causative for improved muscle health. “That’s not what the study was set up to do,” he explained. However, he intends to pursue future studies to determine if “changes in methylation result in altered muscle function.”

“If so, what are the consequences of this?” he continued. “Do changes on these very specific methylation sites have an actual phenotype that emerges from that? Is it what’s causing aging or is it just associated with it? Is it just something that happens in concert with a variety of other things that are happening during the aging process? So that’s what we don’t know.”

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