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!
Piriformis syndrome results from compression of the sciatic nerve as it passes underneath a muscle in your buttock called the piriformis. Your piriformis muscle attaches from the lowest part of your spine (sacrum) and travels across to your hip. The muscle helps to rotate your leg outward when it contracts. In most people, the sciatic nerve travels deep to the piriformis muscle. When your piriformis muscle is irritated or goes into spasm, it may cause a painful compression of your sciatic nerve. Approximately ¼ of the population is more likely to suffer from piriformis syndrome because their sciatic nerve passes through the muscle.
Piriformis syndrome may begin suddenly as a result of an injury or may develop slowly from repeated irritation. Common causes include: a fall onto the buttocks, catching oneself from a “near fall,” strains, long distance walking, stair climbing or sitting on the edge of a hard surface or wallet. In many cases, a specific triggering event cannot be pinpointed. The condition is most common in 40-60 year-olds and affects women more often than men.
Symptoms of piriformis syndrome include pain, numbness or tingling that begins in your buttock and radiates along the course of your sciatic nerve toward your foot. Symptoms often increase when you are sitting or standing in one position for longer than 15-20 minutes. Changing positions may help. You may notice that your symptoms increase when you walk, run, climb stairs, ride in a car, sit cross-legged or get up from a chair.
Sciatic arising from piriformis syndrome is one of the most treatable varieties and generally is relieved by the type of treatment provided in this office. You may need to temporarily limit activities that aggravate the piriformis muscle, including hill and stair climbing, walking on uneven surfaces, intense downhill running or twisting and throwing objects backwards, i.e., firewood. Be sure to avoid sitting on one foot and take frequent breaks from prolonged standing, sitting and car rides. You may find relief by applying an ice pack to your buttock for 15-20 minutes at a time, several times throughout the day.
If you experience any of these symptoms, give our office a call 772-286-5277.
Phosphatidylserine(PS) is directly or indirectly implicated in practically every cell membrane from the brain and nervous system to hormone function and the adrenal glands. Although an exhaustive list of possible applications for the phospholipid is not included, the following are the primary scientifically backed reasons why anyone – from professional athletes to weekend warriors, even healthy athletes should consider adding PS from iStressedOut to their health, wellness and recovery regimen.
PS is an essential sports recovery supplement for the serious professional athlete and the weekend warrior.
Taking 2 iStressedOut tabs after every workout is the essential recovery advantage!
We Offer Affordable, Short Term Care For Your Relief Of Most Stress Related Health Issues.
Nowadays, almost every household owns a television, computer, and a smartphone – sometimes several of each. Although these devices make our lives easier, society has seen a significant increase in the amount of physical stress caused by excessive technology usage. Here are a few tech-related injuries that are on the rise and what you can do to prevent them.
1. Text Neck
Staring down at your cell phone places additional stress on your neck, shoulders, and upper back - causing pain with repetitive use. In fact, for every inch that your head tilts forward, your spine undergoes an additional 10 pounds of strain.
Prevent it: Be mindful of your posture while using your tech devices. Position your computer, tablet, or smartphone so that you’re not tilting your head downward. Ideally, when holding your head upright, the center of your screen should be at eye level.
2. Trigger Thumb
Sometimes called “texting thumb”, this condition is another repetitive stress injury caused by all that swiping, scrolling, and tapping on our cellphone screens.
Prevent it: If minimizing your overall screen time isn’t feasible, be sure to rest your hands and fingers. Switch sides often and stretch your muscles periodically. Enable and use voice recognition whenever possible.
3. Carpal Tunnel Syndrome
People with jobs that require a lot of keystrokes are at risk for Carpal Tunnel Syndrome, which is a painful condition of the wrist.
Prevent it: Try to minimize repetitive strain and learn to keep your wrists in a neutral position while working. Use keyboard and mouse wrist rests as not to allow your wrists to press against hard desk edges. Stretch your muscles periodically with an exercise like this.
4. Tech Arm
Holding your smartphone or tablet out in front of you for prolonged periods can cause elbow and shoulder pain.
Prevent it: Switch arms often to give your elbows a break from being in an awkward position. For time-consuming tasks, switch to an ergonomically-correct workstation.
There are many ways you can still use your devices and prevent these digital disabilities, but ultimately, reducing your screen time is the best course of action. Take frequent tech breaks and move your body to combat a sedentary lifestyle. If you do experience pain in the neck, thumb, wrist, or elsewhere, give our office a call at 772-286-5277.
Review the latest news:
*Avoiding surgery for rotator cuff tears
*Transverse friction massage is superior for lateral epicondylopathy
*Muscle energy tops mobilization for restoring shoulder ROM
*Chiropractic care excels for lumbar stenosis
*Ultrasound and TENS may not work for….
5 Treatments That Work
1. Journal of Shoulder & Elbow Surgery: “Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. The operative and nonoperative outcomes at 5-year follow-up were not significantly different. 75% of patients remained successfully treated with nonoperative treatment at 5 years.” Boorman RS, More KD, Hollinshead RM, et al. What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2018;27(3):444-448.
2. A study comparing the effectiveness of three common strategies for lateral epicondylitis (splinting/ stretching, cortisone injection, and transverse friction massage) concluded: “At 6-month follow-up, only patients in the deep friction massage group demonstrated a significant improvement in all outcome measures, including VAS pain score, DASH score, and grip strength.” Yi R, Bratchenko WW, Tan V. Deep Friction Massage Versus Steroid Injection in the Treatment of Lateral Epicondylitis. Hand (N Y). 2018 Jan;13(1):56-59. doi: 10.1177/1558944717692088. Epub 2017 Feb 1.
3. JMPT: “Patients with mild to moderate carpal tunnel syndrome benefit from manual therapy including neurodynamic techniques.” Wolny T et al. The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial. J Manipulative Physiol Ther. 2018 Dec 26. pii: S0161-4754(18)30334-8. doi: 10.
4. “Posterior shoulder tightness, defined as limited glenohumeral horizontal adduction and internal rotation motion, is a common occurrence in overhead athletes. (This study found) the application of muscle energy techniques to the horizontal abductors provides acute improvements to glenohumeral horizontal adduction, while joint mobilizations provide no improvements.” Reed, ML et al. Acute effects of muscle energy technique and joint mobilization on shoulder tightness in youth throwing athletes: a randomized controlled trial. Int J Sports Phys Ther. 2018 Dec; 13(6): 1024–1031.
5. A JAMA randomized clinical trial of 259 lumbar spine stenosis patients compared the effectiveness of three non-surgical options:
The results: “manual therapy/individualized exercise had greater improvement of symptoms and physical function compared with medical care or group exercise.” Schneider MJ, Ammendolia C, Murphy DR, et al. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA Netw Open.2019;2(1):e186828. doi:10.1001/jamanetworkopen.2018.6828
5 Less Promising Interventions
6. A Cochrane Database systematic review concluded: “Acupuncture and laser acupuncture may have little or no effect in the short term on symptoms of carpal tunnel syndrome in comparison with placebo or sham acupuncture.” Choi GH. Et al. Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome. Cochrane Database Syst Rev. 2018 Dec 2;12:CD011215. doi: 10.1002/14651858.CD011215.pub2. [Epub ahead of print]
7. A study of 54 patients concluded “the addition of therapeutic ultrasound did not improve the efficacy of conservative treatment for plantar fasciitis.” Yigal Katzap, Michael Haidukov, Olivier M. Berland, Ron Ben Itzhak, and Leonid Kalichman. Additive Effect of Therapeutic Ultrasound in the Treatment of Plantar Fasciitis: A Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy 2018
8. A clinical trial of 97 patients: “This study does not support the use of TENS in the treatment of patients with chronic LBP.” Garaud T. et al. Randomized study of the impact of a therapeutic education program on patients suffering from chronic low-back pain who are treated with transcutaneous electrical nerve stimulation. Medicine (Baltimore). 2018 Dec;97(52):e13782. doi: 10.109
9. An RCT of 61 TMD patients concluded: “The efficacy of manipulation seems to be limited, in contrast to our expectations. The advantage of manipulation was observed only during the first treatment session.” Nagata K et al. Efficacy of mandibular manipulation technique for temporomandibular disorders patients with mouth opening limitation: a randomized controlled trial for comparison with improved multimodal therapy. J Prosthodont Res. 2018 Dec 15. pii: S1883
10. “Imaging is overused in the management of low back pain (LBP). Interventions designed to decrease non-indicated imaging have predominantly targeted practitioner education alone; however, these are typically ineffective.” Jenkins HJ, Moloney NA, French SD, et al. Using behaviour change theory and preliminary testing to develop an implementation intervention to reduce imaging for low back pain. BMC Health Serv Res. 2018;18(1):734. Published 2018 Sep 24. doi:10.1186/s12913-0
5 Thought-Provoking Studies
11. The fascial system includes solid and liquid fascia, closely inter-linked, without interruption. Each cell communicates with neighboring cells by sending and receiving signals. Therapeutic touch at the skin triggers cell deformation which sends electromagnetic and mechanometabolic messages throughout the entire body–like electricity in water. This concept is known as quantum entanglement. Bordoni B, Simonelli M. The Awareness of the Fascial System. Cureus. 2018;10(10):e3397. Published 2018 Oct 1. doi:10.7759/cureus.3397
*Our friend and mentor Dr. Tom Hyde commented on this research and reminded us of the incredible “Strolling under the skin” video from Dr. Jean-Claude Guimberteau that provides a fascinating look into the fascial system. You can check out the full 28 minute version or this brief clip.
12. A new study mapped carpal tunnel pain vs. paresthesia: “Painful symptoms were clearly centered over the carpal tunnel and were reported much less frequently in the digits. Non-painful sensory disturbances (e.g. numbness, paresthesias) were found to have a much more peripheral and lateral distribution.” Nelson JT et al. Patient Reported Symptom-Mapping in Carpal Tunnel Syndrome. Muscle Nerve. 2018 Dec 14. doi: 10.1002/mus.26398. [Epub ahead of print]
13. Following ankle sprain, the supporting muscle (peroneus longus) undergoes fatty degeneration with resultant loss of strength. This process “increases with increasing frequency of ankle sprain” – with obvious implications for chronic ankle instability. Sakai S et al. Quantity and quality of the peroneus longus assessed using ultrasonography in leg with chronic ankle instability. J Phys Ther Sci. 2018 Dec;30(12):1396-1400. doi: 10.1589/jpts.30.1396. Epub 2018 Nov 21.
14. Q: How thick is an average healthy disc?
A: Generally less than 9mm
An imaging analysis of 240 healthy spines measured the height of the intervertebral disc and compared those measurements against age and gender: “Variation in disc height is determined much more by sex rather than age. The maximum height of the interbody space in the adult lumbar spine was at the L4/5 level (8.9±1.7 mm males, 8.6±1.8 mm females).” Bach K et al. Morphometric Analysis of Lumbar Intervertebral Disc Height: An Imaging Study. World Neurosurg. 2018 Dec 19. pii: S1878-8750(18)32836-5. doi: 10.1016/j.wneu.2018.12.014. [Epub ahead of print]
15. A new JAMA article discussed the link between dementia and chronic pain: “compared with pain-free controls, those with chronic pain showed a more rapid decline in memory and increased probability of dementia.” (Whitlock et al) “These findings are especially relevant for patients with low back pain given that current pharmacotherapy has the potential to cause central nervous system depression and further compromise cognition.“ (Bailey et al) Whitlock EL, Diaz-Ramirez LG, Glymour MM, Boscardin WJ, Covinsky KE, Smith AK. Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders. JAMA Intern Med. 2017;177(8):1146-1153. Bailey DM et al. Low Back pain. Lancet. Volume 392, Issue 10164, P2548, December 15, 2018
Cliff Atwell, B.S., D.C.