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How Psychologists Can Help With Chronic Pain | Central Chiropractor

How Psychologists Can Help With Chronic Pain | Central Chiropractor

Chronic pain is pain that doesn’t go away. Unlike acute pain, that comes on suddenly and can usually be traced directly to a cause, chronic pain lingers and it isn’t easy to tell what is causing it. That is the situation that millions of chronic pain sufferers have been in: there’s no reason as to why they have persistent pain.

 

In actuality, chronic pain in itself can be considered a disease or illness. Most times, pain is a symptom of another illness or problem. If pain becomes persistent, though, it isn’t just a sign of a problem, it is the issue.

 

What can you do about chronic pain?

 

One typically accepted definition of chronic pain is pain that still remains, even when the related injury or disease has been healed. It’s pain that persists 6 months or longer after the associated injury or disease has been managed. Chronic pain not only affects the body physically, it can also affect the mind.

 

Psychologists and Chronic Pain

 

Being referred to a psychologist as part of the chronic pain treatment plan does not necessarily mean your doctor thinks that your pain is only mental. If your doctor refers you it usually means that they are well-aware of the effects pain can have on the mind. It means that the healthcare professional is currently taking a multi-disciplinary strategy to your pain, one which may comprise of psychology, physical therapy, and medications, for example. Since chronic pain is a condition that is multi-faceted, it needs a multi-faceted therapy plan.

 

A Psychologist’s Role

 

Chronic pain does involve an emotional component. Back in 1979, the International Association for the Study of Pain redefined pain. They said that it’s a “sensory and emotional experience. ” A translation: pain has physical and emotional sides, and it exists even if there is no identifiable cause. In other words, the pain simply exists because the individual feels (or thinks he or she feels) it. Persistent pain can have a psychological toll on an individual’s life. The following list of ideas aren’t atypical for a chronic pain patient to have when dealing with the painful symptoms.

 

  • I can not work since I am in so much pain, so I am worthless for my loved ones.
  • I do not even feel like myself anymore since my whole life revolves round this annoyance.
  • I’m so lonely and isolated because no one understands my pain.
  • I’m whining too much about my annoyance, I’m such a weakling! I must just put on a happy face.
  • I can’t even do the simplest tasks anymore. I’m a failure.

 

With thoughts such as that dominating your mind, it can be difficult to fully deal with your pain. The psychological aspect can still make you feel trapped with the pain, although you might be taking actions to take care of the physical elements of your pain. A psychologist can help you deal with the psychological impact of chronic pain.

 

Utilizing behavioral treatment techniques, a psychologist can help you identify and change negative thoughts, ideas that can aggravate your pain. The psychologist can help you cope with anxiety, any depression, or other mood disorders related to chronic pain. What happens in sessions with your psychologist is left up to you, but it’s a time to be completely and totally truthful about how chronic pain is affecting your ideas, relationships, career, and self-esteem. The main goal is to help you live your life fully, restoring your overall health and wellness, mentally.

 

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900
 

By Dr. Alex Jimenez

 

Additional Topics: Wellness

 

Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.

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Common Injections Used to Treat Chronic Pain | Recommended Chiropractor

Common Injections Used to Treat Chronic Pain | Recommended Chiropractor

Many Americans in the United States will visit a healthcare professional’s office reporting some type of pain. While most cases of pain are considered acute, or temporary, resolving after the injury or condition causing the symptoms has healed, a large percentage of individuals will still report pain long after the source has disappeared. This is known as chronic pain. Fortunately, there are a variety of treatment methods which can also help ease these symptoms.

 

Are injections used to treat chronic pain?

 

From physical therapy and chiropractic care, to drugs and medications, numerous types of treatment methods and therapies can be used to treat chronic pain, each more beneficial to certain people than others. Epidural steroid injections and facet joint injections are some of the most common types of injections utilized to ease chronic pain symptoms. For some individuals, injections may be more useful than other forms of treatment. As with any medical procedure, however, it’s important to understand how helpful these can be for each, individual patient.

 

Epidural Corticosteroid Injections for Chronic Pain

 

Although epidural steroid injections (also called epidural corticosteroid injections) can be helpful to confirm a diagnosis, they should be used primarily after a specific presumptive diagnosis has been established. Additionally, injections shouldn’t be used in isolation, but rather in combination with a program strengthening, stressing muscle flexibility, and operational recovery, most commonly associated with chronic pain, in this case.

 

Appropriate follow-up after shots to rate ability and the individual’s treatment response to progress in the rehabilitation program is indispensable. Observation of this response is necessary prior to a second or third shot, although a number of injections can be attempted to decrease pain. Epidural steroid injections are an adjunct treatment, which facilitates participation in an active exercise program and may assist in avoiding the need for surgical intervention.

 

Treatment Rationale

 

The rationale for the use of epidural corticosteroid injection has enhanced with the signs of an inflammatory basis for radicular pain from disc herniation. Although prospective trials are lacking, epidural steroids have been proven to be effective in pain reduction in patients with referred pain. If used in the initial weeks after onset the efficacy is increased.

 

The goal of these injections would be to facilitate an active exercise program and also to progress sufferers through the pain and inflammation phase of healing as quickly as possible. As with all injections, it needs to be a part of a comprehensive treatment plan involving active exercise programs.

 

How the Injection Is Applied

 

To ensure proper needle placement of corticosteroids, fluoroscopic guidance is recommended. Meaning a healthcare professional will use special imaging gear during the injection to be sure the needle is going in at the right place. Some patients may require more than one injection. Repeat shots should be based on goals and the response after the injection. It is not necessary for many patients to experience a set number or “series” of injections. If minimal to no advancement is found following two shots, then further similar shots aren’t warranted. The recent usage of the approach allows the medicine to be delivered in a fashion to the ventral part of the spinal canal. All patients must be followed by consecutive injections (10-14 days later) to assess therapeutic reaction.

 

Utilization of Epidural Steroid Injections

 

Epidural shots and intradiscal injections have been used in treating non-radicular degenerative disc disorder with limited success. In addition, epidural steroids are used in patients with neurogenic claudication from spinal stenosis with mixed outcomes. A number of shots can be tried to decrease pain thought to be at least in part mediated by inflammation.

 

Facet Joint Injections for Chronic Pain

 

The therapeutic advantage of facet injections remains controversial. The controversy starts with the significance of the background and examination with lower back pain. Many patients will complain of back and lower extremity pain with standing, walking, and extension-type pursuits. The examination is normal, and also tests for nerve root inflammation are often negative. Many patients may have increased pain on passive expansion, or extension and rotation.

 

Additionally, radiographic and bone scanning imaging hasn’t been useful in selecting appropriate patients for facet injections. Consequently, the primary job of facet injections remains diagnostic. There is support for the impact of shots or ablations of the nerves. Facet injections should be used for patients who have failed a guided non-operative treatment program that incorporates various manipulation/mobilization methods. They should be done under fluoroscopic guidance and are not suggested in the initial four to six weeks of treatment.

 

Goal of Facet Joint Injections

 

The goal of facet injections is to verify the diagnosis and perhaps assist with pain reduction to be able to alleviate an active physical treatment program. If prior injections were helpful and there’s a recurrence of pain, they can be replicated replicate injections should be limited. This process should be used only in people failing a comprehensive application and in no manner should be considered at the initial management of an incident of acute low back pain.

 

Be sure to seek the proper guidance from an experienced and qualified healthcare professional before attempting any medical procedure, method or therapy. Injections for chronic pain are only one form of treatment used for the mentioned symptoms. Other treatment options can be used alongside these or in place of the above.

 

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900
 

By Dr. Alex Jimenez

 

Additional Topics: Wellness

 

Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.

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Interventional Chronic Pain Management Treatments | Central Chiropractor

Interventional Chronic Pain Management Treatments | Central Chiropractor

Chronic pain is known as pain that persists for 12 weeks or even longer, even after pain is no longer acute (short-term, acute pain) or the injury has healed. Of course there are many causes of chronic pain that can influence any level of the spine, cervical (neck), mid back (thoracic), lower spine (lumbar), sacral (sacrum) or some combination of levels.

 

What treatments do interventional pain management specialists perform?

 

Oftentimes, early and aggressive therapy of chronic neck or back pain can earn a difference that is life-changing. But remember that knowledge is power: Be certain that you know your choices. There are various treatment procedures and treatments available for chronic pain, each completed by a treatment specialists. Interventional pain management specialist treatments may be a fantastic solution for some people with chronic pain symptoms.

 

Interventional Pain Management Specialists

 

Interventional pain management (IPM) is a special field of medicine that uses injections and small processes to help patients control their own chronic pain. Interventional pain management specialists are trained to diagnose and cure ailments, and their goal is to improve patients’ quality of life.

 

IPM’s Role in Treating Chronic Back Pain

 

Pain control plays a big role in chronic pain since many forms of pain can’t be cured, so pain victims must find out how to live with and work around the pain. A pain management specialist can help them locate the pain relief that they need to work in the daily. The interventional treatments are part of a multi-disciplinary approach that might include use of medications, psychology, and therapy. Part of IPM is currently finding treatments that works best for your treatment or combination. Some potential interventional pain management therapies are:

 

Injections

 

Your interventional pain management expert will have you try injections, which send anti inflammatory medications and strong pain-relieving straight. A few examples of injections used for chronic pain are:

 

Epidural steroid injection: This is one of the most commonly used injections. An epidural steroid injection (ESI) aims the epidural space, that is the space surrounding the membrane which holds the spinal fluid around the spinal cord and nerve roots. Nerves traveling through the epidural area and then branch out to other parts of your body, like your thighs. When a nerve root is compressed (pinched) from the epidural space, you’ll have pain that travels down your spine and into your legs (commonly called sciatica, even though the technical medical term is radiculopathy). An epidural steroid injection sends steroids right to the nerve root that’s inflamed. You need 2-3 injections; normally, you shouldn’t have that because of the potential side effects of the steroids.

 

Facet joint injection: Also called facet blocks, facet joint injections are helpful in case your facet joints are causing annoyance. Facet joints in your back allow you to move and provide stability. Though, you will have pain, if they get inflamed. The joint wills numb and can lower your pain.

 

Sacroiliac joint injection: The joint is where your pelvis and spine come and also an aching sacroiliac joint can be extremely debilitating. The injection may reduce inflammation and pain.

 

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900
 

By Dr. Alex Jimenez

 

Additional Topics: Wellness

 

Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.

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TRENDING TOPIC: EXTRA EXTRA: New PUSH 24/7�? Fitness Center

 

 

About Pain Management (Medicine) Specialists | Southwest Chiropractor

About Pain Management (Medicine) Specialists | Southwest Chiropractor

When affected by chronic pain, an individuals initial concern often involves what type of treatment they should seek for their particular issue. While many doctors are qualified and experienced in treating a variety of injuries and conditions, only some specialists can be classified as pain experts: pain management specialists.

 

What is a pain management specialist?

 

Pain medicine or pain management specialists provide varied treatments, including medications, action modification, therapeutic injections, physical therapy, and alternative kinds of care like acupuncture, manipulation, and music or art therapy for chronic pain. Multidisciplinary pain medicine joins two or more treatments to maximize pain management.

 

Concerning Pain Management Specialists

 

A pain management specialist is a physician or osteopathic physician who treats pain. Although called interventional pain management specialists or pain medicine specialist, a number of these doctors are physiatrists or anesthesiologists. Pain management and medication treatment is a team effort frequently involving the patient’s primary care doctor or other treating doctor, and specialists in radiology, psychiatry, psychology, oncology, nursing, physical therapy, complimentary alternative medicine, and other fields.

 

Education and Training

 

After graduating medical school and finishing a one-year internship, the doctor enters a program in anesthesiology or physical medicine but from different fields such as psychiatry and neurology. Upon completion of a residency program (typically 3 years long), the doctor completes a one-year fellowship for advanced training in pain medicine.

 

Pain medication specialists are board certified. The associations that board certify physiatrists, anesthesiologists, neurologists, and psychiatrists all collaborate to provide the board examination to the subspecialty of pain medicine. Pain medicine and management specialists keep their education and training throughout their careers. There are many opportunities for pain management specialists to remain current with technical and medical improvements in pain medication, such as society meetings and journals.

 

Goals of Pain Management

 

By reducing pain, frequency and intensity, a pain management specialist’s goal is to handle chronic or acute pain. A pain management program can manage your operational goals for activities of daily living besides fixing pain problems. In general, a pain medication program intends to give you a feeling of well-being, increase your level of action (like return to work), and reduce or eliminate your dependence on drugs.

 

Kinds of Pain Treated

 

Pain medicine specialists treat all kinds of pain. Intense pain is described as severe or sharp and may signal something isn’t right. The pain experienced during care is an instance of acute pain. Infection lasting more or even 6 months is described as chronic. This kind of pain is persistent and varies from moderate to severe. Spinal arthritis (spondylosis) pain is often chronic. A good outcome is produced by combining different treatments although chronic pain is difficult to manage.

 

Treatment may include:

 

  • Limit activities that increase pain (activity modification)
  • Prescription medication: Nonsteroidal anti inflammatory medications, muscle relaxants, narcotics (opioids), anti-depressants, and antiseizure drugs. Some antiseizure and antidepressant medications have proven to help manage specific types of chronic pain.
  • Injection therapy: provide pain relief, as well as Injections may help to pinpoint the reason behind pain. Therapies include facet joint anabolic steroid, and joint injections; and nerve rootbranch, peripheral and sympathetic nerve block .
  • Physical Therapy: Heat/ice, massage, spinal traction, transcutaneous electric nerve stimulation (TENS), ultrasound, and therapeutic practice.
  • Pulsed Radiofrequency Neurotomy is a minimally invasive procedure that prevents nerves from sending pain signals to the brain.
  • Rhizotomy utilizes electrodes that are heated to turn off pain signals from nerves that are particular.
  • Spinal Cord Stimulation is an implanted device that produces electrical impulses to block pain perception.
  • Intrathecal Pumps are sometimes referred to as pain pumps. The device is surgically implanted and dispenses doses of medication within the spinal tract.
  • Acupuncture is the insertion of needles to some of 2,000 acupuncture points or the body’s 20 Meridian factors. Acupuncture is central to Traditional Chinese Medicine (TCM), which includes other holistic treatments.
  • Manipulation is performed by chiropractors, osteopathic doctors (DO), and some physical therapists, even though the treatment varies among these careers. Manipulation is described as the use of force or pressure to take care of a disorder.
  • Art and music therapy are approaches to distract your mind. Besides a creative outlet, comfort is promoted by these therapies, provide a way for expression, help to reduce anxiety, raises self-esteem, and are fun.

 

What to Expect During an Appointment

 

Your consultation with interventional pain management specialist is much like other physician visits. Even though there are a number of similarities, the focus is quickly managing it, and on your pain, the cause or contributing factors.

 

Pain medication doctors perform a physical and neurological evaluation, and review your medical history paying special attention to pain history. You may be asked many questions about your pain, such as:

 

  • On a scale from zero to 10, with 10 being the worse pain possible, speed your pain.
  • When did pain begin? When pain began what were you doing?
  • Does pain disperse into different areas of the human body?
  • Is its intensity continuous, or can it be worse at different times of the night or day?
  • What helps to relieve the pain? Why is pain worse?
  • What treatments have you tried? What worked? What failed?
  • Do you take herbal supplements, vitamins, or over-the-counter medications?
  • Can you take prescription medication? If so, what, how much, and how?

 

Most pain medication specialists utilize a standardized drawing of the front/back of the human body to let you indicate where pain is sensed, as well as indicate pain spread and type (eg, gentle, sharp). You may be requested to complete the form each time you stop by the pain physician. The drawing can help to evaluate your treatment progress.

 

Accurate Diagnosis Key to Remedy

 

Pain medication involves diagnosing the cause or source of pain. Making the proper diagnosis may entail obtaining an X-ray, CT scan, or MRI study to confirm the cause of your neck or back pain. When treating spine-related pain (which may include leg or arm signs), additional tests, such as discography, bone scans, nerve studies (electromyography, nerve conduction study), and myelography could be carried out. The identification is essential to a successful treatment program.

 

Some spinal disorders and pain therapy requires involvement including orthopaedic surgeon, neurosurgeon, your primary care doctor, and practitioners in radiology, psychiatry, psychology, oncology, nursing, physical therapy, and complimentary medicine. The pain medicine specialist may consult with and/or consult with spine surgeon or a neurosurgeon to ascertain whether spine surgery is required by your pain issue.

 

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900
 

By Dr. Alex Jimenez

 

Additional Topics: Wellness

 

Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.

blog picture of cartoon paperboy big news

 

TRENDING TOPIC: EXTRA EXTRA: New PUSH 24/7�? Fitness Center

 

 

El Paso, TX Oxidative Stress and Antioxidant Defense

El Paso, TX Oxidative Stress and Antioxidant Defense

Science based Chiropractor Dr. Alexander Jimenez takes a look at oxidative stress, what it is, how it affects the body and the antioxidant defense to remedy the situation.

Esra Birben PhD,1 Umit Murat Sahiner MD,1 Cansin Sackesen MD,1 Serpil Erzurum MD,2 and Omer Kalayci, MD1

Abstract: Reactive oxygen species (ROS) are produced by living organisms as a result of normal cellular metabolism and environ- mental factors, such as air pollutants or cigarette smoke. ROS are highly reactive molecules and can damage cell structures such as carbohydrates, nucleic acids, lipids, and proteins and alter their functions. The shift in the balance between oxidants and antioxidants in favor of oxidants is termed �oxidative stress.� Regulation of reducing and oxidizing (redox) state is critical for cell viability, activation, proliferation, and organ function. Aerobic organisms have integrated antioxidant systems, which include enzymatic and non- enzymatic antioxidants that are usually effective in blocking harmful effects of ROS. However, in pathological conditions, the antioxidant systems can be overwhelmed. Oxidative stress contributes to many pathological conditions and diseases, including cancer, neurological disorders, atherosclerosis, hypertension, ischemia/perfusion, diabetes, acute respiratory distress syndrome, idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease, and asthma. In this review, we summarize the cellular oxidant and antioxidant systems and discuss the cellular effects and mechanisms of the oxidative stress.

Key Words: antioxidant, oxidant, oxidative stress, reactive oxygen species, redox

(WAO Journal 2012; 5:9�19)

Reactive oxygen species (ROS) are produced by living organisms as a result of normal cellular metabolism. At low to moderate concentrations, they function in physiological cell processes, but at high concentrations, they produce adverse modifications to cell components, such as lipids, proteins, and DNA.1�6 The shift in balance between oxidant/ antioxidant in favor of oxidants is termed �oxidative stress.� Oxidative stress contributes to many pathological conditions, including cancer, neurological disorders,7�10 atherosclerosis, hypertension, ischemia/perfusion,11�14 diabetes, acute respiratory distress syndrome, idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease,15 and asthma.16�21 Aerobic organisms have integrated antioxidant systems,� which include enzymatic and nonenzymatic antioxidants that are usually effective in blocking harmful effects of ROS. However, in pathological conditions, the antioxidant systems can be overwhelmed. In this review, we summarize the cellular oxidant and antioxidant systems and regulation of the reducing and oxidizing (redox) state in health and disease states.

OXIDANTS

Endogenous Sources of ROS

ROS are produced from molecular oxygen as a result of normal cellular metabolism. ROS can be divided into 2 groups: free radicals and nonradicals. Molecules containing one or more unpaired electrons and thus giving reactivity to the molecule are called free radicals. When 2 free radicals share their unpaired electrons, nonradical forms are created. The 3 major ROS that are of physiological significance are superoxide anion (O22.), hydroxyl radical ( OH), and hydro- gen peroxide (H2O2). ROS are summarized in Table 1.

Superoxide anion is formed by the addition of 1 electron to the molecular oxygen.22 This process is mediated by nicotine adenine dinucleotide phosphate [NAD(P)H] oxidase or xanthine oxidase or by mitochondrial electron trans- port system. The major site for producing superoxide anion is the mitochondria, the machinery of the cell to produce adenosine triphosphate. Normally, electrons are transferred through mitochondrial electron transport chain for reduction of oxygen to water, but approximately 1 to 3% of all electrons leak from the system and produce superoxide. NAD(P)H oxidase is found in polymorphonuclear leukocytes, monocytes, and macrophages. Upon phagocytosis, these cells produce a burst of superoxide that lead to bactericidal activity. Superoxide is converted into hydrogen peroxide by the action of superoxide dismutases (SODs, EC 1.15.1.1). Hydrogen peroxide easily diffuses across the plasma membrane. Hydrogen peroxide is also produced by xanthine oxidase, amino acid oxidase, and NAD(P)H oxidase�23,24 and in peroxisomes by consumption of molecular oxygen in metabolic reactions. In a succession of reactions called Haber�Weiss and Fenton reactions,H2O2 can breakdown to OH2 in the presence of transmission metals like Fe21 or Cu21.25

Fe31 +�.O2�?Fe2 +�O2 Haber Weiss

Fe2 +�H2O2�?Fe3 +�OH�+ .OH Fenton reaction

O 2 �itself can also react with H2 O2 and generate OH�.26,27 Hydroxyl radical is the most reactive of ROS and can damage proteins, lipids, and carbohydrates and DNA. It can also start lipid peroxidation by taking an electron from polyunsaturated fatty acids.

Granulocytic enzymes further expand the reactivity of H2O2 via eosinophil peroxidase and myeloperoxidase (MPO). In activated neutrophils, H2O2 is consumed by MPO. In the presence of chloride ion, H2O2 is converted to hypochlorous acid (HOCl). HOCl is highly oxidative and plays an important role in killing of the pathogens in the airways.28 However, HOCl can also react with DNA and induce DNA�protein interactions and produce pyrimidine oxidation products and add chloride to DNA bases.29,30 Eosinophil peroxidase and MPO also contribute to the oxidative stress by modification of proteins by halogenations, nitration, and protein cross-links via tyrosyl radicals.31�33

Other oxygen-derived free radicals are the peroxyl radicals (ROO$ ). Simplest form of these radicals is hydro- peroxyl radical (HOO$ ) and has a role in fatty acid peroxidation. Free radicals can trigger lipid peroxidation chain reactions by abstracting a hydrogen atom from a side- chain methylene carbon. The lipid radical then reacts with oxygen to produce peroxyl radical. Peroxyl radical initiates a chain reaction and transforms polyunsaturated fatty acids into lipid hydroperoxides. Lipid hydroperoxides are very unstable and easily decompose to secondary products, such as aldehydes (such as 4-hydroxy-2,3-nonenal) and malondialdehydes (MDAs). Isoprostanes are another group of lipid peroxidation products that are generated via the peroxidation of arachidonic acid and have also been found to be elevated in plasma and breath condensates of asthmatics.34,35 Peroxidation of lipids disturbs the integrity of cell membranes and leads to rearrangement of membrane structure.

Hydrogen peroxide, superoxide radical, oxidized glutathione (GSSG), MDAs, isoprostanes, carbonyls, and nitrotyrosine can be easily measured from plasma, blood, or bronchoalveolar lavage samples as biomarkers of oxidation by standardized assays.

Exogenous Source of Oxidants

Cigarette Smoke

Cigarette smoke contains many oxidants and free radicals and organic compounds, such as superoxide and nitric oxide.36 In addition, inhalation of cigarette smoke into the lung also activates some endogenous mechanisms, such as accumulation of neutrophils and macrophages, which further increase the oxidant injury.

Ozone Exposure

Ozone exposure can cause lipid peroxidation and induce influx of neutrophils into the airway epithelium. Short-term exposure to ozone also causes the release of inflammatory mediators, such as MPO, eosinophil cationic proteins and also lactate dehydrogenase and albumin.37 Even in healthy subjects, ozone exposure causes a reduction in pulmonary functions.38 Cho et al39 have shown that particulate matter (mixture of solid particles and liquid droplets suspended in the air) catalyzes the reduction of oxygen.

Hyperoxia

Hyperoxia refers to conditions of higher oxygen levels than normal partial pressure of oxygen in the lungs or other body tissues. It leads to greater production of reactive oxygen and nitrogen species.40,41

Ionizing Radiation

Ionizing radiation, in the presence of O2, converts hydroxyl radical, superoxide, and organic radicals to hydrogen peroxide and organic hydroperoxides. These hydroperoxide species react with redox active metal ions, such as Fe and Cu, via Fenton reactions and thus induce oxidative stress.42,43 Narayanan et al44 showed that fibroblasts that were exposed to alpha particles had significant increases in intracellular O2 2. and H2O2 production via plasma membrane-bound NADPH oxidase.44 Signal transduction molecules, such as extracellular signal-regulated kinase 1 and 2 (ERK1/2), c-Jun N-terminal kinase (JNK), and p38, and transcription factors, such as activator protein-1 (AP-1), nuclear factor-kB (NF-kB), and p53, are activated, which result in the expression of radiation response�related genes.45�50 Ultraviolet A (UVA) photons trigger oxidative reactions by excitation of endogenous photosensitizers, such as porphyrins, NADPH oxidase, and riboflavins. 8-Oxo-7,8- dihydroguanine (8-oxoGua) is the main UVA-mediated DNA oxidation product formed by the oxidation of OH radical, 1-electron oxidants, and singlet oxygen that mainly reacts with guanine.51 The formation of guanine radical cation in isolated DNA has been shown to efficiently occur through the direct effect of ionizing radiation.52,53 After exposure to ionizing radiation, intracellular level of glutathione (GSH) decreases for a short term but then increases again.54

Heavy Metal Ions

Heavy metal ions, such as iron, copper, cadmium, mercury, nickel, lead, and arsenic, can induce generation of reactive radicals and cause cellular damage via depletion of enzyme activities through lipid peroxidation and reaction with nuclear proteins and DNA.55

One of the most important mechanisms of metal- mediated free radical generation is via a Fenton-type reaction. Superoxide ion and hydrogen peroxide can interact with transition metals, such as iron and copper, via the metal catalyzed Haber�Weiss/Fenton reaction to form OH radicals.

Metal31 1 $O2 /Metal21 1 O2 Haber Weiss Metal21 1 H2 O2 /Metal31 1 OH 2 1 $OH Fenton reaction

Besides the Fenton-type and Haber�Weiss-type mechanisms, certain metal ions can react directly with cellular molecules to generate free radicals, such as thiol radicals, or induce cell signaling pathways. These radicals may also react with other thiol molecules to generate O22.. O22. is converted to H2O2, which causes additional oxygen radical generation. Some metals, such as arsenite, induce ROS formation indirectly by activation of radical producing systems in cells.56

Arsenic is a highly toxic element that produces a variety of ROS, including superoxide (O2 2), singlet oxygen (1O2), peroxyl radical (ROO ), nitric oxide (NO ), hydrogen peroxide (H2O2), and dimethylarsinic peroxyl radicals [(CH3)2AsOO ].57�59 Arsenic (III) compounds can inhibit antioxidant enzymes, especially the GSH-dependent enzymes, such as glutathione-S-transferases (GSTs), glutathione peroxidase (GSH-Px), and GSH reductase, via bind- ing to their sulfhydryl (�SH) groups.60,61

Lead increases lipid peroxidation.62 Significant decreases in the activity of tissue SOD and brain GPx have been reported after lead exposure.63,64 Replacement of zinc, which serves as a cofactor for many enzymes by lead, leads to inactivation of such enzymes. Lead exposure may cause inhibition of GST by affecting tissue thiols.

ROS generated by metal-catalyzed reactions can mod- ify DNA bases. Three base substitutions, G / C, G / T, and C / T, can occur as a result of oxidative damage by metal ions, such as Fe21, Cu21, and Ni21. Reid et al65 showed that G / C was predominantly produced by Fe21 while C / T substitution was by Cu21 and Ni21.

ANTIOXIDANTS

The human body is equipped with a variety of antioxidants that serve to counterbalance the effect of oxidants. For all practical purposes, these can be divided into 2 categories: enzymatic (Table 2) and nonenzymatic (Table 3).

Enzymatic Antioxidants

The major enzymatic antioxidants of the lungs are SODs (EC 1.15.1.11), catalase (EC 1.11.1.6), and GSH-Px (EC 1.11.1.9). In addition to these major enzymes, other antioxidants, including heme oxygenase-1 (EC 1.14.99.3), and redox proteins, such as thioredoxins (TRXs, EC 1.8.4.10), peroxiredoxins (PRXs, EC 1.11.1.15), and glutaredoxins, have also been found to play crucial roles in the pulmonary antioxidant defenses.

Since superoxide is the primary ROS produced from a variety of sources, its dismutation by SOD is of primary importance for each cell. All 3 forms of SOD, that is, CuZn- SOD, Mn-SOD, and EC-SOD, are widely expressed in the human lung. Mn-SOD is localized in the mitochondria matrix. EC-SOD is primarily localized in the extracellular matrix, especially in areas containing high amounts of type I collagen fibers and around pulmonary and systemic vessels. It has also been detected in the bronchial epithelium, alveolar epithelium, and alveolar macrophages.66,67 Overall, CuZn- SOD and Mn-SOD are generally thought to act as bulk scavengers of superoxide radicals. The relatively high EC-SOD level in the lung with its specific binding to the extracellular matrix components may represent a fundamental component of lung matrix protection.68

H2O2 that is produced by the action of SODs or the action of oxidases, such as xanthine oxidase, is reduced to water by catalase and the GSH-Px. Catalase exists as a tetra- mer composed of 4 identical monomers, each of which con- tains a heme group at the active site. Degradation of H2O2 is accomplished via the conversion between 2 conformations of catalase-ferricatalase (iron coordinated to water) and com- pound I (iron complexed with an oxygen atom). Catalase also binds NADPH as a reducing equivalent to prevent oxidative inactivation of the enzyme (formation of compound II) by H2O2 as it is reduced to water.69

Enzymes in the redox cycle responsible for the reduction of H2O2 and lipid hydroperoxides (generated as a result of membrane lipid peroxidation) include the GSH-Pxs.70 The GSH-Pxs are a family of tetrameric enzymes that contain the unique amino acid selenocysteine within the active sites and use low-molecular-weight thiols, such as GSH, to reduce H2O2 and lipid peroxides to their corresponding alcohols. Four GSH- Pxs have been described, encoded by different genes: GSH- Px-1 (cellular GSH-Px) is ubiquitous and reduces H2O2 and fatty acid peroxides, but not esterified peroxyl lipids.71 Esterified lipids are reduced by membrane-bound GSH-Px-4 (phospholipid hydroperoxide GSH-Px), which can use several different low-molecular-weight thiols as reducing equivalents. GSH-Px-2 (gastrointestinal GSH-Px) is localized in gastrointestinal epithelial cells where it serves to reduce dietary peroxides.72 GSH-Px-3 (extracellular GSH-Px) is the only member of the GSH-Px family that resides in the extracellular compartment and is believed to be one of the most important extracellular antioxidant enzyme in mammals. Of these, extracellular GSH-Px is most widely investigated in the human lung.73

In addition, disposal of H2O2 is closely associated with several thiol-containing enzymes, namely, TRXs (TRX1 and TRX2), thioredoxin reductases (EC 1.8.1.9) (TRRs), PRXs (which are thioredoxin peroxidases), and glutaredoxins.74

Two TRXs and TRRs have been characterized in human cells, existing in both cytosol and mitochondria. In the lung, TRX and TRR are expressed in bronchial and alveolar epithelium and macrophages. Six different PRXs have been found in human cells, differing in their ultrastructural compartmentalization. Experimental studies have revealed the importance of PRX VI in the protection of alveolar epithelium. Human lung expresses all PRXs in bronchial epithelium, alveolar epithelium, and macrophages.75 PRX V has recently been found to function as a peroxynitrite reductase,76 which means that it may function as a potential protective compound in the development of ROS-mediated lung injury.77

Common to these antioxidants is the requirement of NADPH as a reducing equivalent. NADPH maintains catalase in the active form and is used as a cofactor by TRX and GSH reductase (EC 1.6.4.2), which converts GSSG to GSH, a co-substrate for the GSH-Pxs. Intracellular NADPH, in turn, is generated by the reduction of NADP1 by glucose-6-phosphate dehydrogenase, the first and rate-limiting enzyme of the pen- tose phosphate pathway, during the conversion of glucose- 6-phosphate to 6-phosphogluconolactone. By generating NADPH, glucose-6-phosphate dehydrogenase is a critical determinant of cytosolic GSH buffering capacity (GSH/ GSSG) and, therefore, can be considered an essential, regulatory antioxidant enzyme.78,79

GSTs (EC 2.5.1.18), another antioxidant enzyme family, inactivate secondary metabolites, such as unsaturated aldehydes, epoxides, and hydroperoxides. Three major families of GSTs have been described: cytosolic GST, mitochondrial GST,80,81 and membrane-associated microsomal GST that has a role in eicosanoid and GSH metabolism.82 Seven classes of cytosolic GST are identified in mammalian, designated Alpha, Mu, Pi, Sigma, Theta, Omega, and Zeta.83�86 During non-stressed conditions, class Mu and Pi GSTs interact with kinases Ask1 and JNK, respectively, and inhibit these kinases.87�89 It has been shown that GSTP1 dissociates from JNK in response to oxidative stress.89 GSTP1 also physically interacts with PRX VI and leads to recovery of PRX enzyme activity via glutathionylation of the oxidized protein.90

Nonenzymatic Antioxidants

Nonenzymatic antioxidants include low-molecular-weight compounds, such as vitamins (vitamins C and E), b-carotene, uric acid, and GSH, a tripeptide (L-g-glutamyl-L-cysteinyl-L- glycine) that comprise a thiol (sulfhydryl) group.

Vitamin C (Ascorbic Acid)

Water-soluble vitamin C (ascorbic acid) provides intracellular and extracellular aqueous-phase antioxidant capacity primarily by scavenging oxygen free radicals. It converts vitamin E free radicals back to vitamin E. Its plasma levels have been shown to decrease with age.91,92

Vitamin E (a-Tocopherol)

Lipid-soluble vitamin E is concentrated in the hydrophobic interior site of cell membrane and is the principal defense against oxidant-induced membrane injury. Vitamin E donates electron to peroxyl radical, which is produced during lipid peroxidation. a-Tocopherol is the most active form of vitamin E and the major membrane-bound antioxidant in cell. Vitamin E triggers apoptosis of cancer cells and inhibits free radical formations.93

Glutathione

GSH is highly abundant in all cell compartments and is the major soluble antioxidant. GSH/GSSG ratio is a major determinant of oxidative stress. GSH shows its antioxidant effects in several ways.94 It detoxifies hydrogen peroxide and lipid peroxides via action of GSH-Px. GSH donates its electron to H2O2 to reduce it into H2O and O2. GSSG is again reduced into GSH by GSH reductase that uses NAD(P)H as the electron donor. GSH-Pxs are also important for the pro- tection of cell membrane from lipid peroxidation. Reduced glutathione donates protons to membrane lipids and protects them from oxidant attacks.95

GSH is a cofactor for several detoxifying enzymes, such as GSH-Px and transferase. It has a role in converting vitamin C and E back to their active forms. GSH protects cells against apoptosis by interacting with proapoptotic and antiapoptotic signaling pathways.94 It also regulates and activates several transcription factors, such as AP-1, NF-kB, and Sp-1.

Carotenoids (b-Carotene)

Carotenoids are pigments found in plants. Primarily, b-carotene has been found to react with peroxyl (ROO ), hydroxyl ( OH), and superoxide (O22.) radicals.96 Carotenoids show their antioxidant effects in low oxygen partial pressure but may have pro-oxidant effects at higher oxygen concentrations.97 Both carotenoids and retinoic acids (RAs) are capable of regulating transcription factors.98 b-Carotene inhibits the oxidant-induced NF-kB activation and interleukin (IL)-6 and tumor necrosis factor-a production. Carotenoids also affect apoptosis of cells. Antiproliferative effects of RA have been shown in several studies. This effect of RA is mediated mainly by retinoic acid receptors and vary among cell types. In mammary carcinoma cells, retinoic acid receptor was shown to trigger growth inhibition by inducing cell cycle arrest, apoptosis, or both.99,100

THE EFFECT OF OXIDATIVE STRESS: GENETIC, PHYSIOLOGICAL, & BIOCHEMICAL MECHANISMS

Oxidative stress occurs when the balance between antioxidants and ROS are disrupted because of either depletion of antioxidants or accumulation of ROS. When oxidative stress occurs, cells attempt to counteract the oxidant effects and restore the redox balance by activation or silencing of genes encoding defensive enzymes, tran- scription factors, and structural proteins.101,102 Ratio between oxidized and reduced glutathione (2GSH/GSSG) is one of the important determinants of oxidative stress in the body. Higher production of ROS in body may change DNA structure, result in modification of proteins and lipids, activation of several stress-induced transcription factors, and production of pro-inflammatory and anti-inflammatory cytokines.

Effects Of Oxidative Stress On DNA

ROS can lead to DNA modifications in several ways, which involves degradation of bases, single- or double- stranded DNA breaks, purine, pyrimidine or sugar-bound modifications, mutations, deletions or translocations, and cross-linking with proteins. Most of these DNA modifications (Fig. 1) are highly relevant to carcinogenesis, aging, and neurodegenerative, cardiovascular, and autoimmune diseases. Tobacco smoke, redox metals, and nonredox metals, such as iron, cadmium, chrome, and arsenic, are also involved in carcinogenesis and aging by generating free radicals or bind- ing with thiol groups. Formation of 8-OH-G is the best- known DNA damage occurring via oxidative stress and is a potential biomarker for carcinogenesis.

Promoter regions of genes contain consensus sequences for transcription factors. These transcription factor�binding sites contain GC-rich sequences that are susceptible for oxidant attacks. Formation of 8-OH-G DNA in transcription factor binding sites can modify binding of transcription factors and thus change the expression of related genes as has been shown for AP-1 and Sp-1 target sequences.103 Besides 8-OH-G, 8,59 -cyclo-29 -deoxyadenosine (cyclo-dA) has also been shown to inhibit transcription from a reporter gene in a cell system if located in a TATA box.104 The TATA-binding protein initiates transcription by changing the bending of DNA. The binding of TATA-binding protein may be impaired by the presence of cyclo-dA.

Oxidative stress causes instability of microsatellite (short tandem repeats) regions. Redox active metal ions, hydroxyl radicals increase microsatellite instability.105 Even though single-stranded DNA breaks caused by oxidant injury can easily be tolerated by cells, double-stranded DNA breaks induced by ionizing radiation can be a significant threat for the cell survival.106

Methylation at CpG islands in DNA is an important epigenetic mechanism that may result in gene silencing. Oxidation of 5-MeCyt to 5-hydroxymethyl uracil (5-OHMeUra) can occur via deamination/oxidation reactions of thymine or 5-hydroxymethyl cytosine intermediates.107 In addition to the modulating gene expression, DNA methylation also seems to affect chromatin organization.108 Aberrant DNA methylation patterns induced by oxidative attacks also affect DNA repair activity.

Effects Of Oxidative Stress On Lipids

ROS can induce lipid peroxidation and disrupt the membrane lipid bilayer arrangement that may inactivate membrane-bound receptors and enzymes and increase tissue permeability.109 Products of lipid peroxidation, such as MDA and unsaturated aldehydes, are capable of inactivating many cellular proteins by forming protein cross-linkages.110�112 4-Hydroxy-2-nonenal causes depletion of intracellular GSH and induces of peroxide production,113,114 activates epidermal growth factor receptor,115 and induces fibronectin production.116 Lipid peroxidation products, such as isoprostanes and thiobarbituric acid reactive substances, have been used as indirect biomarkers of oxidative stress, and increased levels were shown in the exhaled breath condensate or bronchoalveolar lavage fluid or lung of chronic obstructive pulmonary disease patients or smokers.117�119

Effects Of Oxidative Stress on Proteins

ROS can cause fragmentation of the peptide chain, alteration of electrical charge of proteins, cross-linking of proteins, and oxidation of specific amino acids and therefore lead to increased susceptibility to proteolysis by degradation by specific proteases.120 Cysteine and methionine residues in proteins are particularly more susceptible to oxidation.121 Oxidation of sulfhydryl groups or methionine residues of proteins cause conformational changes, protein unfolding, and degradation.8,121�123 Enzymes that have metals on or close to their active sites are especially more sensitive to metal catalyzed oxidation. Oxidative modification of enzymes has been shown to inhibit their activities.124,125

In some cases, specific oxidation of proteins may take place. For example, methionine can be oxidized methionine sulfoxide126 and phenylalanine to o-tyrosine127; sulfhydryl groups can be oxidized to form disulfide bonds;128 and carbonyl groups may be introduced into the side chains of proteins. Gamma rays, metal-catalyzed oxidation, HOCl, and ozone can cause formation of carbonyl groups.129

Effects of Oxidative Stress on Signal Transduction

ROS can induce expression of several genes involved in signal transduction.1,130 A high ratio for GSH/GSSG is important for the protection of the cell from oxidative dam- age. Disruption of this ratio causes activation of redox sensitive transcription factors, such as NF-kB, AP-1, nuclear factor of activated T cells and hypoxia-inducible factor 1 , that are involved in the inflammatory response. Activation of transcription factors via ROS is achieved by signal transduction cascades that transmit the information from outside to the inside of cell. Tyrosine kinase receptors, most of the growth factor receptors, such as epidermal growth factor receptor, vascular endothelial growth factor receptor, and receptor for platelet-derived growth factor, protein tyrosine phosphatases, and serine/threonine kinases are targets of ROS.131�133 Extra- cellular signal-regulated kinases, JNK, and p38, which are the members of mitogen-activated protein kinase family and involved in several processes in cell including proliferation, differentiation, and apoptosis, also can be regulated by oxidants.

Under oxidative stress conditions, cysteine residues in the DNA-binding site of c-Jun, some AP-1 subunits, and inhibitory k-B kinase undergo reversible S-glutathiolation. Glutaredoxin and TRX have been reported to play an important role in regulation of redox-sensitive signaling pathways, such as NF-kB and AP-1, p38 mitogen-activated protein kinase, and JNK.134�137

NF-kB can be activated in response to oxidative stress conditions, such as ROS, free radicals, and UV irradiation.138 Phosphorylation of IkB frees NF-kB and allows it to enter the nucleus to activate gene transcription.139 A number of kinases have been reported to phosphorylate IkBs at the serine residues. These kinases are the targets of oxidative signals for activation of NF-kB.140 Reducing agents enhance NF-kB DNA binding, whereas oxidizing agents inhibit DNA binding of NF-kB. TRX may exert 2 opposite actions in regulation of NF-kB: in the cytoplasm, it blocks degradation of IkB and inhibits NF-kB activation but enhances NF-kB DNA binding in the nucleus.141 Activation of NF-kB via oxidation-related degradation of IkB results in the activation of several antioxidant defense�related genes. NF-kB regulates the expression of several genes that participate in immune response, such as IL-1b, IL-6, tumor necrosis factor-a, IL-8, and several adhesion molecules.142,143 NF-kB also regulates angiogenesis and proliferation and differentiation of cells.

AP-1 is also regulated by redox state. In the presence of H2O2, some metal ions can induce activation of AP-1. Increase in the ratio of GSH/GSSG enhances AP-1 binding while GSSG inhibits the DNA binding of AP-1.144 DNA binding of the Fos/Jun heterodimer is increased by the reduction of a single conserved cysteine in the DNA-binding domain of each of the proteins,145 while DNA binding of AP-1 can be inhibited by GSSG in many cell types, suggesting that disulphide bond formation by cysteine residues inhibits AP-1 DNA binding.146,147 Signal transduction via oxidative stress is summarized in Figure 2.

 

CONCLUSIONS

Oxidative stress can arise from overproduction of ROS by metabolic reactions that use oxygen and shift the balance between oxidant/antioxidant statuses in favor of the oxidants. ROS are produced by cellular metabolic activities and environmental factors, such as air pollutants or cigarette smoke. ROS are highly reactive molecules because of unpaired electrons in their structure and react with several biological macromolecules in cell, such as carbohydrates, nucleic acids, lipids, and proteins, and alter their functions. ROS also affects the expression of several genes by upregulation of redox-sensitive transcription factors and chromatin remodeling via alteration in histone acetylation/ deacetylation. Regulation of redox state is critical for cell viability, activation, proliferation, and organ function.

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Drugs and Medications for Chronic Pain | Central Chiropractor

Drugs and Medications for Chronic Pain | Central Chiropractor

Medications and drugs include a progression: you never start out with the largest dose possible of the most powerful medicine. You begin to help control your pain and other symptoms. Alas, a number of chronic pain sufferers have found that over-the-counter drugs and medications aren’t sufficient for their chronic pain.

 

What medications and drugs are prescribed for chronic pain?

 

While there are a variety of treatment options available to help manage and relieve symptoms of chronic pain, some patients may additionally ask for prescription medications and drugs. There’s many dosages and types of these which doctors can prescribe. The following and their effects are listed below.

 

Prescription Medication Used for Chronic Pain

 

Prescription medication, which is another step on the progression of drugs and medications is usually needed by chronic pain patients. What the doctor prescribes is dependent on your pain level, treatment goals, and general well-being. They will take into account other medications as well as herbal remedies and nutritional supplements, that you are taking. Be sure to tell your doctor about whatever you’re on because of potential drug interactions.

 

Whatever drug your doctor prescribes, you’ll start on the lowest possible dose. You have found the correct medication and dose if that works to relieve your chronic pain. If it doesn’t, then the doctor may consider upping your dose or trying another medication. Some general categories for medications used for pain are:

 

Anti-depressants: You don’t need to be miserable to be prescribed anti-depressants. They could block the mind from getting pain messages, so they’re a sensible option for chronic pain sufferers. Additionally, it is believed that anti-depressants might raise the number of endorphins in your body, and endorphins are a pure pain suppressant.

 

It’s correct that chronic pain often involves a psychological component, especially as the pain appears to take over a patient’s life. Anxiety can make it more difficult to do that, together with fatigue and other consequences of chronic pain, may lead to depression. Anti-depressants may be prescribed as part of a comprehensive treatment program which attempts to help you deal with all elements of pain.

 

Muscle relaxants:�You may take a muscle relaxant, if your pain is caused by muscle sprain, strain, spasm, or anxiety. This medication may help supply you with the pain relief so that you can work on strengthening your muscles.

 

Neuropathic agents: For chronic pain caused by nerve problems (neuropathic pain), doctors may prescribe neuropathic agents. They especially target the nerves, and the way changes in which the brain receives and interprets pain messages.

 

Non-steroidal anti inflammatory medications (NSAIDS): NSAIDs combat inflammation, just as steroids do, but they get it done with no steroids. They work by blocking certain enzymes in the human body, the ones which help alleviate inflammation.

 

Opioids (Narcotics): In the most extreme cases, and only under careful supervision, your physician may also prescribe an opioid, such as morphine or codeine. Opioids are also known as narcotics. They work by attaching to opioid receptors on the surface of the brain, spinal cord, and cells. They then can block pain messages. Opioids alter the interpretation of pain of the brain by changing how pain signals are transmitted.

 

Pain relievers: Prescription-strength pain relievers referred to as pain killers or analgesics, do precisely what their name implies: they relieve pain. They do not reduce inflammation. Pain relievers work by preventing the mind from getting pain signals from your own nerves. Then your brain won’t know about the pain, if pain messages can’t be transmitted by the nerve cells as they do, and then you either won’t feel it or won’t sense it as severely. Most pain relievers belong to one of the above mentioned categories (opioids, NSAID, etc.).

 

Steroid medications: Steroids are medications that are strong. If you have tried prescription-strength non-steroidal anti-inflammatory medications (NSAIDs) and they have not reduced the pain, the doctor may have you try steroid drugs. They block the body from producing the compound that cause inflammation, so they’re used for chronic pain sufferers with an inflammatory condition.

 

Your body gets used to the medication, and that means that you can’t simply stop taking them. You have to give your body time to readjust by tapering your dosages. That is an important thing to bear in mind if you are considering taking steroid drugs or any form of medication listed above. Be sure to contact your healthcare professional and consult all your options before considering the use of strong medications and treatment alternatives.

 

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
 

By Dr. Alex Jimenez

 

Additional Topics: Wellness

 

Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.

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TRENDING TOPIC: EXTRA EXTRA: New PUSH 24/7�? Fitness Center

 

 

Pain Management and Relief with Laser Therapy | Central Chiropractor

Pain Management and Relief with Laser Therapy | Central Chiropractor

You wake up with it. You go to sleep with this. Chronic pain, by definition, does not go away. Millions of people live with chronic back or neck pain every day. Chronic pain is technically defined as pain that persists for 12 weeks or even longer, even after the injury has healed. Thankfully, while many individuals with chronic pain might feel hopeless to attain relief, there are a variety of treatments which may help manage the pain, such as laser treatment.

 

How does laser therapy benefit chronic pain?

 

The idea that light energy can accelerate recovery in tissues, can reduce inflammation and pain, relax muscles, and stimulate nerve wracking with the use of a lase appears to be farfetched. Science, however, tells us these effects may be true. The inquiry is, to what extent does this work and is this based on power and wavelength?

 

“Wavelength and power determine the capacity of this laser to penetrate in the body. Once you are in the infrared spectrum and above 800 nanometers in wavelength, laser power penetrates like x-rays, but to attain depth you need significant energy or power,” Dr. Bruce Coren states.

 

Two Classes of Lasers Used for Chronic Pain

 

There are two classes of lasers being used as a part of physical therapy for chronic pain management and relief; class 3 and 4. “Class 3 lasers are significantly less than 500 milliwatts (mw) in electricity while class 4 lasers are higher than 500 mw,” Dr. Coren stated. Class 3 lasers are occasionally referred to as cold capsules, as well as the treatment might be known as LLLT for low-level laser treatment. In contrast, class 4 laser therapy is sometimes called HPLT for high-power laser treatment.

 

“The vast majority of neuro-musculoskeletal conditions respond better to some higher power and a higher dosage, which can be a function of energy output and time,” Dr. Coren commented. “The top results will be obtained using a laser which has 30 watts of electricity or more. A 10-minute treatment using a 30-watt laser can produce 18,000 joules, which gives a significant pain relieving, anti inflammatory and healing impact.”

 

Patients usually begin to feel better after one or two treatments, even though 5 or more might be needed to solve the issue. “The more persistent and extensive the injury the more treatments are often needed,” he added.

 

Properties of High-Power Laser Therapy

 

Dr. Coren spoke about the valuable properties of laser therapy and described their unique benefits and effects:

 

Pain Relief: “Laser therapy decreases nerve sensitivity by decreasing bradykinin; a pain eliciting compound. It normalizes ion channels, known as the gatekeepers. and releases endorphins, the body’s natural pain reliever, and enkephalins, related to endorphins. It also has a pain-blocking effect on certain nerve fibers.”

 

Anti-inflammatory/Healing: “Laser therapy increases ATP, which can be stored energy (ATP is the acronym for adenosine triphosphate). The cells also regenerate faster. Laser therapy causes a widening of veins and the arteries around the injury which helps to remove mobile debris and increase oxygen and nutrients. White blood cell action is enhanced which leads to the more rapid repair procedure. Some molecules that increase inflammation have been reduced, and antioxidants such as superoxide dismutase are increased with laser therapy.

 

Accelerated Tissue Repair and Cellular Growth: “Photons of light from lasers penetrate deeply into tissues and accelerate mobile reproduction and development. As a result of exposure to laser light therapy, the tissues of both ligaments, tendons, nerves and muscles are are repaired faster”, as stated above.

 

Improved Vascular Activity: “Laser light raises the formation of new cells in damaged tissue, which speeds up the recovery process, and closes wounds quickly.”

 

Trigger and Acupuncture Points: “Laser is particularly helpful in extinguishing painful trigger points. It’s also an effective way of stimulating acupuncture points without the distress related to needling.”

 

Reduced Fibrous Tissue Formation: “Laser treatment lowers the formation of scar tissue after tissue damage from repetitive motion injuries, cuts, wounds, scrapes or surgery.”

 

Faster Wound Healing: “Laser light stimulates the building blocks of collagen, which is important for the wound healing of damaged tissues. Collagen is the essential protein needed to replace tissue or to repair injuries. Consequently, the laser is powerful on open wounds and burns.”

 

Stem Cell Activation: “Laser therapy raises the amount of stem cells, which enhances healing.”

 

Where is Laser Therapy Administered?

 

High-power lasers are typically found in physical therapy clinics and chiropractic offices. Neck, back or joint pain usually responds positively to laser therapy.

 

“Lasers are also very powerful for inflammatory conditions, including peripheral neuropathy, tendonitis, bursitis, and capsulitis. Strains, sprains, and repetitive movement injuries all have an inflammatory component and can be successfully treated with laser,” he remarked. “There is no particular condition that reacts more quickly to laser. But some patients will react faster than others for exactly the same state as individual healing rates can vary.”

 

Laser therapy can be utilized as a stand-alone treatment, or with rehabilitative exercise treatment. “Rehabilitative exercises and laser treatment complement each other nicely,” explained Dr. Coren.

 

Laser Therapy Precautions

 

There are a few precautions with laser therapy. Eye protection is needed for both the therapist and patient, and laser shouldn’t be performed over malignancies, pacemakers, spinal stimulators or over the midsection of pregnant women.

 

Recommendations

 

High-power laser therapy is one of the quickest, most productive modalities therapists now have to deal with inflammation and pain. “Regrettably, laser therapy isn’t covered by insurance, and high-power lasers can be hard to find as they are expensive. Most importantly results are achieved by the amount of energy generated, 18,000-30,000 joules per treatment being the sweet spot,” Dr. Coren concluded.

 

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
 

By Dr. Alex Jimenez

 

Additional Topics: Wellness

 

Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.

blog picture of cartoon paperboy big news

 

TRENDING TOPIC: EXTRA EXTRA: New PUSH 24/7�? Fitness Center

 

 

Nutrition Counseling In A Clinical Practice

Nutrition Counseling In A Clinical Practice

Wellness Chiropractor, Dr. Alexander Jimenez takes a look at discussing nutrition with patients in a clinical setting.

How Clinicians Can Do Better

Despite overwhelming evidence that relatively small dietary changes can significantly improve health, clinicians seldom discuss nutrition with their patients. Poor nutritional intake and nutrition-related health conditions, such as cardiovascular disease (CVD), diabetes, obesity, hypertension, and many cancers, are highly prevalent in the United States,1 yet only 12% of office visits include counseling about diet.2 Even among high- risk patients with CVD, diabetes, or hyperlipidemia, only 1 in 5 receive nutrition counseling.2 It is likely that many patients receive most of their nutrition information from other, and often unreliable, sources.

These data may reflect the minimal training, time, and reimbursement allocated to nutrition counseling (and preventive services in general) in clinical practice.3 Most physicians and other health care professionals receive limited education on nutrition in medical school (or other professional schools) or in postgraduate training. Just 25% of medical schools offer a dedicated nutrition course, a decline since the status of nutrition education in US medical schools was first assessed in 1985, and few medical schools achieve the 30 hours of nutrition education recommended by the National Academy of Sciences.4 As a result, physicians report inadequate nutrition knowledge and low self-efficacy for counseling patients about diet.3 In addition, time pressures, especially in primary care, limit opportunities to counsel on nutrition or address preventive issues beyond patients� acute complaints. Lack of time is frequently cited as the greatest barrier to counseling on nutrition and obesity.3

Moreover, nutrition and behavioral counseling have traditionally been non-reimbursed services. Few state Medicaid programs cover nutrition or obesity counseling, and before 2012, Medicare explicitly excluded coverage for obesity counseling; although now a reimbursed service for Medicare beneficiaries, just 1% of eligible Medicare beneficiaries receive this counseling.5 Dietitian counseling is also excluded by Medicare, unless patients have diabetes or renal disease. Although the Affordable Care Act mandates coverage for services graded A or B by the US Preventive Services Task Force, including nutrition counseling for patients with CVD risk factors and obesity counseling for patients with a body mass index of 30 or greater, existing private health insurance benefits are in- consistent, and the covered services are often unclear to both clinicians and patients, thereby limiting use.

Furthermore, health behavior change counseling is often frustrating given the current food environment, in which less nutritious foods tend to be less expensive, larger portioned, more easily accessible, and more heavily marketed than healthier options, making patient adherence 6 to nutrition advice challenging. Conflicting and confusing nutrition messages from popular books, blogs, and other media further complicate patient decision making.

Despite these unfavorable trends, there has been progress in this area. The evidence base supporting the benefits of nutrition intervention and behavioral counseling is expanding. Renewed focus on nutrition education in health care professional training is being driven by both student demand and the health care system. Although time pressures and reimbursement remain impediments, incentives and reimbursement options for nutrition and behavioral counseling are growing, and value-based care and health care team approaches hold promise to better align time demands and incentives for long-term care management. Initiatives to integrate clinical care and community resources offer opportunities to leverage resources that alleviate the clinician�s time commitment. There is evidence of some success; for instance, the amount of sugar-sweetened beverages consumed by individuals in the United States has declined substantially over the past 10 years.7

Clinicians can take the following reasonable steps to include nutrition counseling into the flow of daily practice:

1. Start the conversation. Several short, validated screen- ing questionnaires are available to quickly assess need for nutrition counseling, such as the Starting the Conversation tool8 (Table). This approach can be efficiently used prior to seeing the patient at an appointment, either delivered by medical assistants as part of vital sign assessment or as prescreening paperwork for patients to complete online or in the waiting room.

2. Structure the encounter.�Using methods such as the �5 A�s� (assess, advise, agree, assist, arrange), which has been adapted from tobacco counseling. Motivational interviewing, which has documented efficacy in numerous behavior change settings, is particularly helpful to engage patients who are not yet committed or are hesitant to consider behavioral change.

3. Focus on small steps. Changing lifelong nutrition behaviors can seem overwhelming, but even exceedingly small shifts can have an effect (Table). For example, increasing fruit intake by just 1 serving per day has the estimated potential to reduce cardiovascular mortality risk by 8%, the equivalent of 60 000 fewer deaths annually in the United States and 1.6 million deaths globally.9 Other examples include reducing intake of sugar-sweetened beverages, fast food meals, processed meats, and sweets, while increasing vegetables, legumes, nuts, and whole grains. Emphasize to patients that every food choice is an opportunity to accrue benefits, and even small ones add up. Small substitutions still allow for �treats,� such as replacing potato chips and cheese dip with tortilla chips and salsa, the latter lowering trans fats and saturated fat and increasing whole grain and vegetable intake (Table).

4. Use available resources. Numerous extracurricular resources are readily available for clinicians. The Nutrition in Medicine program offers online, evidence-based nutrition education and tutorials for clinicians and an online, core nutrition curriculum for medical students. The Dietary Guidelines for Americans offers evidence- based and freely available nutrition guidance, tutorials, and tools for clinicians and patients alike. A companion website, Choose My Plate, offers nutrition and counseling advice for clinicians and handy resources for patients, including recently added videos with useful examples of small substitutions that patients will appreciate.

5. Do not do it all at once. Expecting to create long-term behavioral change during a single episode of care is a recipe for frustration and failure, for both the patient and clinician. Empowering and sup- porting patients is an ongoing process, not a 1-time curative event. Use a few minutes at the close of a patient visit to identify opportunities for future counseling, offer to serve as a resource, and be- gin a discussion and support that can be reinforced over time. Take solace in knowing that small initial steps can quickly improve health; for example, reducing trans fats at a single meal (eg, replacing baked goods with fruit or nuts or fried foods with non-fried alternatives) promptly improves endothelial function.10

6. Do not do it all alone.�The primary care physician need not be the sole clinician who provides nutrition counseling. Proactive use of physician extenders (eg, physician assistants, nurses, medical assistants, and health coaches) and referrals can alleviate much of the burden for the busy clinician. Receptionists can distribute assessment and screening questionnaires for patients to complete in the waiting room; medical assistants can document behavioral change progress while assessing vital signs; administrative staff can identify and con- tact patients who are overdue for interaction. Large practices may benefit from including nutrition or health coaches on staff. Referring to clinical specialists and community-based support programs can significantly extend the clinician�s reach.7 In addition to registered dietitians, numerous clinical and community resources are available and often covered by insurance plans. Board-certified obesity medicine specialists, certified diabetes educators, and physician nutrition specialists are available as referrals in many areas. Diabetes Prevention Program group counseling sessions are now covered by Medicare and available throughout communities, such as in many YMCA sites, and electronically.

Summary

Although there is no conclusive evidence that these steps will improve diet and health outcomes for patients, there is virtually no harm in counseling and the potential gains, especially at the population level, are substantial. Nutrition and health behavior change must become a core competency for virtually all physicians and any other health professionals working with patients who have or are at risk for nutrition-related chronic disease.

A Healthier You

 

Scott Kahan, MD, MPH Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and George Washington University School of Medicine, Washington, DC.

JoAnn E. Manson, MD, DrPH Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; and Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.

ARTICLE INFORMATION
Published Online: September 7, 2017. doi:10.1001/jama.2017.10434 Conflict of Interest Disclosures: All authors have
completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

REFERENCES

1. Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:E62.
2. Office of Disease Prevention and Health Promotion. Healthy People 2020. www.healthypeople.gov/2020/data-search/Search-the-Data#srch=nutrition. Accessed January 23, 2017.
3. Kolasa KM, Rickett K. Barriers to providing nutrition counseling cited by physicians. Nutr Clin Pract. 2010;25(5):502-509.
4. Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in U.S. medical schools: latest update of a national survey. Acad Med. 2010;85(9):1537-1542.
5. Batsis JA, Bynum JPW. Uptake of the Centers for Medicare and Medicaid obesity benefit: 2012-2013. Obesity (Silver Spring). 2016;24(9):1983-1988.
6. Kahan S, Cheskin LJ. Obesity and eating behaviors and behavior change. In: Kahan S, Gielen AC, Fagan PJ, Green LW, eds. Health Behavior Change in Populations. Baltimore, MD: Johns Hopkins University Press; 2014:chap 13.
7. Rehm CD, Pe�alvo JL, Afshin A, Mozaffarian D. Dietary intake among US adults, 1999-2012.JAMA. 2016;315(23):2542-2553.
8. Paxton AE, Strycker LA, Toobert DJ, Ammerman AS, Glasgow RE. Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals. Am J Prev Med. 2011;40(1):67-71.
9. Mozaffarian D, Capewell S. United Nations� dietary policies to prevent cardiovascular disease. BMJ. 2011;343:d5747.
10. Williams MJA, Sutherland WHF, McCormick MP, de Jong SA, Walker RJ, Wilkins GT. Impaired endothelial function following a meal rich in used cooking fat.J Am Coll Cardiol. 1999;33(4):1050-1055

Physical Therapy for Chronic Pain | Recommended Chiropractor

Physical Therapy for Chronic Pain | Recommended Chiropractor

You hear that you are supposed to stay busy through your chronic pain and you believe, “But how? Actions make my pain worse. Just getting through the day at work is agony, and today the doctor expects me to perform extra tasks?” This is the point where a physical therapist may help.

 

How can a physical therapist help with my chronic pain?

 

Physical therapists can give you a personalized strengthening and workout plan, besides helping you learn how to manage your own “daily life” chronic pain symptoms. The physical therapist will do a thorough physical evaluation to assess your chronic pain and its impact. They will also ask about your therapy goals: do you wish to learn how to better handle your pain? What would be helpful to learn from physical therapy? Using that information, the physical therapist will create a therapy plan especially for you.

 

Physical Therapy is Active and Passive

 

Physical therapy includes both active and passive treatments. Passive treatments help to unwind you and your physique. As you don’t need to actively participate, they’re known as passive. Your physical treatment program may begin with treatments that are passive, but the goal is to get into treatments that are more active. These are exercises which strengthen your body and help you handle the pain that is chronic.

 

Passive physical therapy treatments include:

 

Deep Tissue Massage: This technique targets spasms and chronic muscle strain that perhaps builds up through life stress. You could have spasms or muscular strain because of strains or sprains. The physical therapist uses direct pressure and friction to attempt to release the tension in your soft tissues (ligaments, tendons, muscles).

 

Hot and Cold Therapies: Your physical therapist may alternate between cold and warm therapies. The physical therapist attempts to gain more blood to the target area by applying hot treatment because an increased blood circulation brings more oxygen and nutrients to this region. Blood circulation is essential to remove waste byproducts made by muscle spasms, and in addition, it helps relieve symptoms associated with chronic pain. Cold treatment, also called cryotherapy, slows circulation, helping to decrease inflammation, muscle spasms, and pain. You might be given an ice pack or even be given an ice massage. Another alternative that is part of cryotherapy is a spray which cools the tissues. After cold therapy, your physical therapist may have you stretch the affected muscles.

 

TENS (transcutaneous electric nerve stimulation): A TENS machine stimulates your muscles through factor (but safe) intensities of electrical current. TENS helps reduce muscle spasms, and it might increase the own body’s production of endorphins, your pain killers. The TENS gear your therapist utilizes is big. But a more compact machine for “at home” use is also available. Whether big or small, a TENS unit may be a very helpful therapy.

 

Ultrasound: By increasing blood flow, an ultrasound helps decrease pain, numbness, swelling, stiffness, and muscle spasms. It does this by creating heat that enhances circulation, sending sound waves deep in your muscle cells.

 

At the active portion of physical therapy, your physical therapist will teach you different exercises to increase your flexibility, strength, core stability, and range of motion (how readily your joints move). Remember, your physical therapy program is individualized, taking under account medical history and your health. Your exercises may not be suitable for another person with chronic pain, especially since pain is such a subjective, personal experience.

 

Other Areas of Physical Therapy

 

You will learn to fix your posture and incorporate ergonomic principles in your daily activities, if necessary. This is all part of this “self-care” or “self-treatment” aspect of physical therapy. During physical therapy, you learn good habits and principles that let you take better care of your body. Staying active is an significant part chronic pain therapy. The therapist can help you figure out the best kind of workout for you.

 

7 Tips for Exercising When You Have Chronic Pain

 

Too much of the wrong activity can cause chronic pain to worsen. If jogging or running are out of the question, you may be able to handle and enjoy cycling, which can be easier on painful knees and hips. Other forms of physical therapy, including aerobics done in warm water, help to alleviate inflammation; plus the buoyancy of the water protects the body against the stress of gravity and from movements that may otherwise result in pain. No matter which type of exercise you choose, use caution not to move too fast or too much, or do so much that it becomes worse.

 

7 Tips for Exercising When You Have Chronic Pain

  • Talk to you doctor before you begin an exercise program.
  • Start slowly and gradually increase your efforts as you gain strength, flexibility, and confidence.
  • Move at your own pace. Never try to keep up with a class or a group if doing so is painful.
  • Exercise every day, if possible.
  • Strive for a balanced routine of cardiovascular, strengthening, and stretching exercise.
  • Accept that you will be able to do more on some days than others.
  • Be patient with your progress. Overexertion makes pain worse and can strain muscles.

 

A person’s sleep patterns are improved by exercise. When curative sleep patterns improve, chronic pain symptoms usually do too. Physically active individuals sleep longer and more deeply than people that are sedentary. Exercise also helps to relieve sleep apnea, a common disruptive sleep disorder that that abruptly stops the breath..

 

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
 

By Dr. Alex Jimenez

 

Additional Topics: Wellness

 

Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.

blog picture of cartoon paperboy big news

 

TRENDING TOPIC: EXTRA EXTRA: New PUSH 24/7�? Fitness Center

 

 

What Is Functional Medicine: An Introduction

What Is Functional Medicine: An Introduction

El Paso, Tx. Wellness chiropractor, Dr. Alexander Jimenez examines Functional Medicine.�What it�is and how it can help in having a healthy lifestyle.

The Challenge

Of total healthcare costs in the United States, more than 86% is due to chronic conditions.1 In 2015, health care spending reached $3.2 trillion, accounting for 17.8% of GDP.2 This exceeded the combined federal expenditures for national defense, homeland security, education, and welfare. By 2023, if we don�t change how we confront this challenge, annual healthcare costs in the U.S. will rise to over $4 trillion,3,4 the equivalent�in a single year�of four Iraq wars, making the cost of care using the current model economically unsustainable. If our health outcomes were commensurate with such costs, we might decide they were worth it. Unfortunately, the U.S. spends twice the median per-capita costs of other industrialized countries, as calculated by the Organization for Economic Cooperation and Development (OECD),5 despite having relatively poor outcomes for such a massive investment.6

Our current healthcare model fails to confront both the causes of and solutions for chronic disease and must be replaced with a model of comprehensive care geared to effectively treating and reversing this escalating crisis.This transformation requires something different than is usually available in our very expensive healthcare system.7

A Contributing Factor�Outdated Clinical Model

Despite notable advances in treating and preventing infectious disease and trauma, the acute-care model that dominated 20th century medicine has not been effective in treating and preventing chronic disease.

Adopting a new operating system for 21st century medicine requires that we:

  • Recognize and validate more appropriate and successful clinical models
  • Re-shape the education and clinical practices of health professionals to help them achieve proficiency in the assessment, treatment, and prevention of chronic disease
  • Reimburse equitably for lifestyle medicine and expanded preventive strategies, acknowledging that the greatest health threats now arise from how we live, work, eat, play, and move

This problem can�t be solved by drugs and surgery, however helpful those tools may be in managing acute signs and symptoms. It can�t be solved be adding new or unconventional tools, such as botanical medicine and acupuncture, to a failing model. It can�t be solved by pharmacogenomics (although advances in that discipline should help reduce deaths from inappropriately prescribed medication�estimated to be the fourth leading cause of hospital deaths12). The costly riddle of chronic disease can only be solved by shifting our focus from suppression and management of symptoms to addressing their underlying causes. Specifically, we must integrate what we know about how the human body works with individualized, patient-centered, science-based care that addresses the causes of complex, chronic disease, which are rooted in lifestyle choices, environmental exposures, and genetic influences.

This perspective is completely congruent with what we might call the �omics� revolution. Formerly, scientists believed that once we deciphered the human genome we would be able to answer almost all the questions about the origins of disease.What we actually learned, however, is that human biology is far more complex than that. In fact, humans are not genetically hardwired for most diseases; instead, gene expression is altered by myriad influences, including environment, lifestyle, diet, activity patterns, psycho-social-spiritual factors, and stress.These lifestyle choices and environmental exposures can push us toward (or away from) disease by turning on�or o � certain genes.That insight has helped to fuel the global interest in Functional Medicine, which has that principle at its very core.

A Strategic Response

Functional Medicine directly addresses the underlying causes of disease by using a systems-oriented approach with transformative clinical concepts, original tools, an advanced process of care (see box below), and by engaging both patient and practitioner in a therapeutic partnership.

Functional Medicine practitioners look closely at the myriad interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease (see Figure 1).A major premise of Functional Medicine is that, with science, clinical wisdom, and innovative tools, we can identify many of the underlying causes of chronic disease and intervene to remediate the clinical imbalances, even before overt disease is present.

Functional Medicine exemplifies just the kind of systems-oriented, personalized medicine that is needed to transform clinical practice.The Functional Medicine model of comprehensive care and primary prevention for complex, chronic illness is grounded in both science (evidence about common underlying mechanisms and pathways of disease as well as evidence about the contributions of environmental and lifestyle factors to disease) and art (the healing partnership and the search for insight in the therapeutic encounter).

What Is Functional Medicine?

Functional Medicine asks how and why illness occurs and restores health by addressing the root causes of disease for each individual. It is an approach to health care that conceptualizes health and illness as part of a continuum in which all components of the human biological system interact dynamically with the environment, producing patterns and effects that change over time. Functional Medicine helps clinicians identify and ameliorate dysfunctions in the physiology and biochemistry of the human body as a primary method of improving patient health. Chronic disease is almost always preceded by a period of declining function in one or more of the body�s systems. Functional Medicine is often described as the clinical application of systems biology. Restoring health requires reversing (or substantially improving) the specific dysfunctions that have contributed to the disease state. Each patient represents a unique, complex, and interwoven set of environmental and lifestyle influences on intrinsic functionality (their genetic vulnerabilities) that have set the stage for the development of disease or the maintenance of health.

To manage the complexity inherent in this approach, IFM has created practical models for obtaining and evaluating clinical information that lead to individualized, patient-centered, science-based therapies. Functional Medicine concepts, practices, and tools have evolved considerably over a 30-year period, reflecting the dramatic growth in the evidence base concerning the key common pathways to disease (e.g., inflammation, oxidative stress); the role of diet, stress, and physical activity; the emerging sciences of genomics, proteomics, and metabolomics; and the effects of environmental toxins (in the air, water, soil, etc.) on health.

Elements Of Functional Medicine

The knowledge base�or �footprint��of Functional Medicine is shaped by six core foundations:

  • Gene-Environment Interaction: Functional Medicine is based on understanding the metabolic processes of each individual at the cellular level. By knowing how each person�s genes and environment interact to create their unique biochemical phenotype, it is possible to design targeted interventions that correct the specific issues that lead to destructive processes such as inflammation and oxidation, which are at the root of many diseases.
  • Upstream Signal Modulation: Functional Medicine interventions seek to influence biochemical pathways �upstream� and prevent the overproduction of damaging end products, rather than blocking the effects of those end products. For example, instead of using drugs that block the last step in the production of inflammatory mediators (NSAIDs, etc.), Functional Medicine treatments seek to prevent the upregulation of those mediators in the first place.
  • Multimodal Treatment Plans: The Functional Medicine approach uses a broad range of interventions to achieve optimal health including diet, nutrition, exercise and movement; stress management; sleep and rest, phytonutrient, nutritional and pharmaceutical supplementation; and various other restorative and reparative therapies.These interventions are all tailored to address the antecedents, triggers, and mediators of disease or dysfunction in each individual patient.
  • Understanding the Patient in Context: Functional Medicine uses a structured process to uncover the significant life events of each patient�s history to gain a better understanding of who they are as an individual. IFM tools (the �Timeline� and the �Matrix� model) are integral to this process for the role they play in organizing clinical data and mediating clinical insights.This approach to the clinical encounter ensures that the patient is heard, engenders the therapeutic relationship, expands therapeutic options, and improves the collaboration between patient and clinician.
  • Systems Biology-Based Approach: Functional Medicine uses systems biology to understand and identify how core imbalances in specific biological systems can manifest in other parts of the body. Rather than an organ systems-based approach, Functional Medicine addresses core physiological processes that cross anatomical boundaries including: assimilation of nutrients, cellular defense and repair, structural integrity, cellular communication and transport mechanisms, energy production, and biotransformation.The �Functional Medicine Matrix� is the clinician�s key tool for understanding these network effects and provides the basis for the design of effective multimodal treatment strategies.
  • Patient-Centered and Directed: Functional Medicine practitioners work with the patient to find the most appropriate and acceptable treatment plan to correct, balance, and optimize the fundamental underlying issues in the realms of mind, body, and spirit. Beginning with a detailed and personalized history, the patient is welcomed into the process of exploring their story and the potential causes of their health issues. Patients and providers work together to determine the diagnostic process, set achievable health goals, and design an appropriate therapeutic approach.

To assist clinicians in understanding and applying Functional Medicine, IFM has created a highly innovative way of representing the patient�s signs, symptoms, and common pathways of disease. Adapting, organizing, and integrating into the Functional Medicine Matrix the seven biological systems in which core clinical imbalances are found actually creates an intellectual bridge between the rich basic science literature concerning physiological mechanisms of disease and the clinical studies, clinical diagnoses, and clinical experience acquired during medical training.These core clinical imbalances serve to marry the mechanisms of disease with the manifestations and diagnoses of disease.

  • Assimilation: digestion, absorption, microbiota/GI, respiration
  • Defense and repair: immune, inflammation, infection/microbiota
  • Energy: energy regulation, mitochondrial function
  • Biotransformation and elimination: toxicity, detoxification
  • Transport: cardiovascular and lymphatic systems
  • Communication: endocrine, neurotransmitters, immune messengers
  • Structural integrity: sub-cellular membranes to musculoskeletal integrity

Using this construct, it is possible to see that one disease/condition may have multiple causes (i.e., multiple clinical imbalances), just as one fundamental imbalance may be at the root of many seemingly disparate conditions (see Figure 2).

Constructing The Model & Putting It Into Practice

The scientific community has made incredible strides in helping practitioners understand how environment and lifestyle, interacting continuously through an individual�s genetic heritage, psychosocial experiences, and personal beliefs, can impair one or all of the seven core clinical imbalances. IFM has developed concepts and tools that help to collect, organize, and make sense of the data gathered from an expanded history, physical exam, and laboratory evaluation, including:

The GOTOIT system, which presents a logical method for eliciting the patient�s whole story and ensuring that assessment and treatment are in accord with that story:

G = Gather Information

O = Organization Information

T = Tell the Complete Story Back to the Patient

O = Order and Prioritize

I = InitiateTreatment

T = Track Outcomes

  • The Functional Medicine Timeline, which helps to connect key events in the patient�s life with the onset of symptoms of dysfunction.
  • The Functional Medicine Matrix, which provides a unique and succinct way to organize and analyze all of a patient�s health data (see Figure 3).

The patient�s lifestyle influences are entered across the bottom of the Matrix, and the Antecedents,Triggers, and Mediators (ATMs) of disease/dysfunction are entered in the upper left corner.The centrality of the patient�s mind, spirit, and emotions, with which all other elements interact, is clearly shown in the figure. Using this information architecture, the clinician can create a comprehensive snapshot of the patient�s story and visualize the most important clinical elements of Functional Medicine:

1. Identifying each patient�s ATMs of disease and dysfunction.

2. Discovering the factors in the patient�s lifestyle and environment that influence the expression of health or disease.

3. Applying all the data collected about a patient to a matrix of biological systems, within which disturbances in function originate and are expressed.

4. Integrating all this information to create a comprehensive picture of what is causing the patient�s problems, where they are originating, what has influenced their development, and�as a result of this critical analysis�where to intervene to begin reversing the disease process or substantially improving health.

A Functional Medicine treatment plan may involve one or more of a broad range of therapies, including many different dietary interventions (e.g., elimination diet, high phytonutrient diversity diet, low glycemic-load diet), nutraceuticals (e.g., vitamins, minerals, essential fatty acids, botanicals), and lifestyle changes (e.g., improving sleep quality/quantity, increasing physical activity, decreasing stress and learning stress management techniques, quitting smoking). Nutrition is so vital to the practice of Functional Medicine that IFM has established a core emphasis on Functional Nutrition and has funded the development of a set of unique, innovative tools for developing and applying dietary recommendations.

Scientific support for the Functional Medicine approach to treatment can be found in a large and rapidly expanding evidence base about the therapeutic effects of nutrition (including both dietary choices and the clinical use of vitamins, minerals, and other nutrients such as sh oils)13,15,15; botanicals16,17,18; exercise19 (aerobics, strength training, flexibility); stress management 20; detoxification 21,22,23; acupuncture�24,25,26; manual medicine (massage, manipulation)27,28,29; and mind/body techniques 30,31,32 such as meditation, guided imagery, and biofeedback.

All of this work is done within the context of an equal partnership between the practitioner and patient.The practitioner engages the patient in a collaborative relationship, respecting the patient�s role and knowledge of self, and ensuring that the patient learns to take responsibility for their own choices and for complying with the recommended interventions. Learning to assess a patient�s readiness to change and then providing the necessary guidance, training, and support are just as important as ordering the right lab tests and prescribing the right therapies.

Summary

The practice of Functional Medicine involves four essential components: (1) eliciting the patient�s complete story during the Functional Medicine intake; (2) identifying and addressing the challenges of the patient�s modifiable lifestyle factors and environmental exposures; (3) organizing the patient�s clinical imbalances by underlying causes of disease in a systems biology matrix framework; and (4) establishing a mutually empowering partnership between practitioner and patient.

A great strength of Functional Medicine is its relevance to all healthcare disciplines and medical specialties, any of which can�to the degree allowed by their training and licensure�apply a Functional Medicine approach, using the Matrix as a basic template for organizing and coupling knowledge and data. In addition to providing a more effective approach to preventing, treating, and reversing complex chronic disease, Functional Medicine can also provide a common language and a uni ed model that can be applied across a wide variety of health professions to facilitate integrated care.

Functional Medicine is playing a key role in the effort to solve the modern epidemic of chronic disease that is creating a health crisis both nationally and globally. Because chronic disease is a food- and lifestyle-driven, environment- and genetics-influenced phenomenon, we must have an approach to care that integrates all these elements in the context of the patient�s complete story. Functional Medicine does just that and provides an original and creative approach to the collection and analysis of this broad array of information. Using all the concepts and tools that IFM has developed, Functional Medicine practitioners contribute vital skills for treating and reversing complex, chronic disease.

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The Global Leader in Functional Medicine

References
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