Calls have come from the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA) and the Institute of Medicine (IOM) for a shift away from opioid use toward non-pharmacologic approaches to address chronic pain.
Overdose deaths involving prescription opioids have quadrupled since 1999, as have sales of these prescription drugs. From 1999 to 2014, more than 165,000 people --- three times the U.S. military deaths during the twenty years of the
Vietnam War -- have died in the U.S. from overdoses related to prescription opioids. Today, at least half of all U.S. opioid overdose deaths involve a prescribed opioid. In 2014, more than 14,000 people died from overdoses involving these drugs with the most commonly overdosed opioids -- Methadone, Oxycodone (such as OxyContin®), and Hydrocodone (such as Vicodin®) -- resulting in death. Regrettably, overdose deaths resulting from opioid abuse have risen sharply in every county of every state across the country, reaching a new peak in 2014: 28,647 people, or 78 people per day – more than three people per hour. The newest estimates on the cost of opioid abuse to U.S. employers is estimated at $18 billion in sick days, lost productivity and medical expenses. An important non-pharmacologic approach in helping to solve this crisis is chiropractic care. This discussion offers greater understanding of the scope of the opioid situation the elements that have contributed to it and an approach that emphasizes non-pharmacologic care. Collectively, we must begin to extricate ourselves from our current ineffective, dangerous and often fatal reality.
AMERICANS WANT AND DESERVE CHIROPRACTIC CARE
For the overwhelming number of people who suffer with chronic pain, chiropractic care offers a drug-free, non-invasive and cost-effective alternative to opioid drugs. Chiropractic is the largest, most regulated and best recognized of the complementary and alternative care professions. In fact, patient surveys reported in the Annals of Internal Medicine show that chiropractors are used more than any other alternative provider group and patient satisfaction with chiropractic care is very high. Patient use of chiropractic in the United States has tripled in the past two decades. The importance of chiropractic care is further amplified since many individuals are prescribed opioids for back, low back and neck pain, headaches, neuro-musculoskeletal conditions and other related conditions. An estimated 126.6 million Americans (one in two adults) are affected by a musculoskeletal condition.
Low back pain (LBP) accounts for over 3 million emergency department visits per year in the United States alone. Worldwide, LBP affects approximately 84% of the general population, so eventually almost EVERYONE will have lower back pain that requires treatment! There is evidence dating back to the early Roman and Greek eras that indicates back pain was also very prevalent, and that really hasn’t changed. Some feel it’s because we are bipedal (walk on two legs) rather than quadrupedal (walk on four limbs). When comparing the two, degenerative disk disease and spinal osteoarthritis are postponed in the four-legged species by approximately two (equivalent) decades. But regardless of the reason, back pain is “the rule,” NOT the exception when it comes to patient visits to chiropractors and medical doctors. Previously, we looked at the surgical rate of low back pain by comparing patients who initially went to spinal surgeons vs. to chiropractors, and we were amazed! Remember? Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor! So, the questions this month are: How successful IS spinal surgery? What about all those patients who have had surgery but still have problems – can chiropractic still help them?
A review of the literature published in the Journal of the American Academy of Orthopaedic Surgeons showed that in most cases of degenerative disk disease (DDD), non-surgical approaches (like chiropractic care) are the most effective treatment choice. They report the success rate of spinal fusions for DDD is only 50-60%. The advent of artificial disks, which originally proposed to be a “cure” for symptomatic disk disease, has fared no better with possible worse long-term problems that are not yet fully understood. The authors of the review wrote, “Surgery should be the last option, but too often patients think of surgery as a cure-all and are eager to embark on it… Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it.” Another study reported that, when followed for ten years following artificial disk surgery, a similar 40% of the patients treated failed and had a second surgery within three years! Similar findings are reported for post-surgical spinal stenosis as well as other spinal conditions.
So what about the success rate of chiropractic management for patients who have had low back surgery? In a 2012 article, three patients who had prior lumbar spinal fusions at least two years previous were treated with spinal manipulation (three treatments over three consecutive days) followed by rehabilitation for eight weeks. At the completion of care, all three (100%) had clinical improvement that were still maintained a year later. Another study reported 32 cases of post-surgical low back pain patients undergoing chiropractic care resulted in an average drop in pain from 6.4/10 to 2.3/10 (that means pain was reduced by 4.1 points out of 10 or 64%). An even larger drop was reported when dividing up those who had a combination of spinal surgeries (diskectomy, fusion, and/or laminectomy) with a pain drop of 5.7 out of 10 points!
Typically, spinal surgery SHOULD be the last resort, but we now know that is not always practiced. IF a patient has had more than one surgery and still has pain, the term “failed back syndrome” is applied and carries many symptoms and disability. Again, to NOT utilize chiropractic post-surgically seems almost as foolish as not utilizing it pre-surgically!
When I recommend phosphatidylserine (PS) to patients I emphatically recommend iStressedOut™, a convenient, chewable and great tasting tablet available in the office. We need to start someplace and the easiest way is to simply chew 1 tablet 3 times a day for 30 days. During this time you will begin to experience some changes and see how the PS can help you. Some people will feel dramatic changes and relief from stress, others will have more subtle gradual changes.
Phosphatidylserine Will Help With Specific Conditions
There are specific times when I recommend that patients take iStressedOut™ in a specific way.
Sleep – if you are having trouble falling asleep then chew 1 tablet of iStressedOut™ 30 minutes before bedtime; 1 tablet 90 minutes before bedtime; and 1 tablet 2.5 hours before bedtime. If your bedtime is 10:30pm then you take your iStressedOut™ in the following timing:
Chew 1 tab at 7pm Chew 1 tab at 9pm Chew 1 tab at 10pm
After Exercise – If you are working out at least 3 times a week for a minimum 60 minutes then make sure that one of the times you take iStressedOut™ is immediately after working out. Chew 1 to 2 tabs after workouts. Initially start by chewing just 1 tablet after workouts for about 2 weeks and see how you do. If you continue to feel residual muscle soreness after workouts or there is some improvement, then increase your iStressedOut™ to 2 tabs after workouts.
Under Stress – if you know ahead of time that you are heading into a stressful situations like giving a presentation, going for your job review or interview, or going to your in-laws – then you can pre-load with iStressedOut™, a pre-emptive strike if you will, to ward off the increase in cortisol levels before they get out of control. Chew 2 iStressedOut™ about 30 minutes before your anticipated stressful situation.
Before Exams – Do you get nervous before and during exams? Do you under perform during exams and finals inspite of doing well for the entire semester leading up to finals? For these students I recommend chewing 1 iStressedOut™ 1 hour before the exam and a 2nd tablet 30 minutes before the exam begins. The ideal situation would be consistently taking iStressedOut™ 1 tab 3 times a day for the weeks and month before exams even begin.
Anxiety – if you have a history of anxiety and panic attacks there will be a transition period where your cortisol levels will gradually decrease. We want to try and prevent the anxiety and panic attacks from even getting started by initially taking iStressedOut™ 1 tab 3 times a day. If and when you find yourself slipping into an anxiety attack you can chew 1 iStressedOut™ tablet every hour until you calm down.
Statistics suggest that low back pain (LBP) will plague most of us at some point in our lives, if it hasn’t already. Most healthcare professions that manage patients with low back pain focus on pain management. In fact, studies have reported that 67% of patient satisfaction is driven by pain elimination. One of the most common strategies for reducing pain is managing inflammation. The “easiest” way to do this (according to the many TV commercials and magazine advertisements) is to take one of the many non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen (Advil, Nuprin), Piroxicam Flurbiprofen, and Indomethacin. Let’s take a closer look to see if this is a good or bad idea!
In a recent March 2015 article, researchers investigated the use of NSAIDs between 1993 and 2012 in patients who had fractures that failed to heal, technically called “non-union fractures.” They found that non-union fractures increased during years when NSAID use was increasingly recommended for patients with fractures and dropped in years when NSAID use declined. This isn’t the first study to report poor fracture healing results from NSAIDs when they’re used as the primary form of pain relief and in fact, studies on this subject date back to the early 1990s. So how does this equate to LBP? Most directly, fractures are one of the many causes of LBP, so for that population, the answer is clear. However, LBP is much more commonly caused by sprains (ligament injuries) and strains (muscle/tendon injuries), as well as cartilage injury. Here too, studies show that the healing rate of sprains, strains, and cartilage is also delayed when NSAIDs are used as the primary pain relief approach. This healing delay is reportedly due to NSAIDs’ inhibition of “proteoglycan synthesis,” a component of ligament and cartilage tissue regeneration and repair. NSAIDs also inhibit release of prostaglandins (especially prostaglandin E2), which is needed for tissue repair. These effects are ESPECIALLY observed with long-term use, but recent studies show injured athletes are best off NOT taking NSAIDs AT ALL as these drugs delay the healing process and thus the athlete’s ability to return to their sport.
In a January 2015 study, researchers criticized the common use of NSAIDs in elderly patients for the treatment of non-cancerous pain. They found 75% of the elderly population studied was prescribed NSAIDs which, in retrospect, the researchers determined to be inappropriate! Because NSAIDs interfere with healing, the net effect is an ACCELERATION of osteoarthritis and joint deterioration! In 1995, a North Carolina School of Medicine study compared four groups of patients with soft tissue injuries (tendon strains): Group 1 received NO treatment (control group); Group 2 received exercise only; Group 3 received exercise AND Indomethacin; and Group 4 received Indomethacin only. At 72 hours post-injury, ONLY the exercise group had an INCREASE in prostaglandins (E2 particularly – necessary for healing). This effect was even more profound at 108 hours after injury. The research team also found DNA synthesis in the fibroblasts (an important part of the repair mechanism) was greatest in the exercise group and was completely lacking in the NSAID-only group.
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.
Phosphatidyl Serine(PS) supplementation has shown to be beneficial for children with attention-deficit hyperactivity disorder.109,110 Phosphatidyl serine is described as a super prescription for ADHD because it helps brain cells function properly. PS may stabilize the function of brain cells by normalizing brain-lipid content. Remarkably, one study found that almost 90 percent of subjects administered 200 to 300 mg of phosphatidyl serine daily experienced improvement in ADHD symptoms. ( 2 tabs of iStressedOut™ per day)
A fantastic ground breaking study examined 36 children, aged 4-14 years, with no history of any previous drug treatment related to ADHD, received 200 mg day of PS for 2 months. The results showed that PS supplementation produced significant improvements in ADHD symptoms’ short-term auditory memory and working memory; mental performance to visual stimulation as well as inattention and impulsivity. PS was well-tolerated and showed no side effects. 111
We Offer Affordable, Short Term Care For Your Relief Of Most Stress Related Health Issues. Phosphatidyl Serine is now in stock at our Stuart office!
Cliff Atwell, B.S., D.C.