Opioids do not provide any benefit to OTC meds for low back pain

Combination of these two classes of drugs has not been thoroughly evaluated

Low back pain (LBP) is responsible for 2.4% of visits to the emergency department, which results in about 2.7 million visits annually. A significant number of these patients wind up with poor outcomes, with many having functional impairments or needing to take pain-relieving medications up to three months after their visit. There are a variety of medications available to treat LBP, with non-steroidal anti-inflammatory drugs (NSAIDs) being some of the most common and effective for some mild cases. Muscle relaxants are also considered beneficial for short-term pain relief, while opioids are commonly used for moderate or severe LBP; however, high-quality evidence to support the use of these drugs is lacking. The combination of NSAIDs and opioids in treating LBP has also not been adequately investigated, which led researchers to conduct a powerful study called a randomized-controlled trial (RCT). The goal of this study was to determine if adding a muscle relaxant or opioid to an NSAID would lead to any greater benefits for LBP patients.

Large sample of patients randomly divided into three groups

Individuals between the ages of 21-64 who had recently gone to the emergency room for an episode of LBP were recruited and screened to determine if they were eligible. This search led to a total of 323 patients being accepted to the RCT and then randomly assigned to one of three groups: the naproxen + placebo group, naproxen + cyclobenzaprine group or naproxen + oxycodone/acetaminophen group. Naproxen is an NSAID, cyclobenzaprine is a muscle relaxant and oxycodone is an opioid, while the placebo is an inactive pill used to compare results. All patients received 20 500-mg tablets of naproxen, which were to be taken twice a day, as well as 60 tablets of the other medications. They were instructed to take 1-2 of these other medications every eight hours, as needed, and if one tablet was sufficient for relieving pain in 30 minutes, they were told not to take the second. All patients were assessed at the beginning of the study and then one week and three months later for pain, functional impairment and healthcare usage.

Neither added drug brings about any greater improvements than placebo

Overall, results indicated that neither the muscle relaxant nor the opioid provided any added benefit to the NSAID for LBP patients. This was based on the fact that measures of pain, functional impairment and use of healthcare resources were not different between the three study groups at the one-week or three-month check-in. Regardless of the group they were placed in, nearly two-thirds of patients demonstrated significant improvements in their pain and function levels one week later. Unfortunately, 40% of patients were still in moderate or severe pain and nearly 60% were still using medication one week later. At the three-month check-in, nearly one-fourth of patients were still in moderate or severe pain and using medications for it, but only 3% were still using an opioid. This study shows that opioids were not any better than a placebo for relieving pain in LBP patients. Despite their lack of effectiveness, opioids are still commonly used to address painful conditions like these, which has the potential to lead many patients to take a highly-addictive drug that may not even be doing much to relieve their pain. This is why you should strongly consider alternative options like physical therapy for your pain first before taking a dangerous medication that may only lead to further problems down the road.

– As reported in the October ’15 issue of JAMA

Opioids are not found to be more effective for relieving pain

These addictive drugs have been commonly prescribed despite a lack of supporting data

Since the late ’80s and early ’90s, opioids have been commonly prescribed to individuals with chronic-or long-lasting-pain. Over the years, prescribing these drugs has become a standard practice that many doctors assumed was safe and effective, even though there has always been a lack of high-quality research on the benefits and harms of opioids. As a result, opioids have been overprescribed for pain on a massive scale, and at least 300,000 people have died of an opioid overdose since the epidemic started. The epidemic has brought light to the situation and raised questions about prescribing these drugs to patients with chronic pain, and current guidelines now discourage their use in favor of other, safer alternatives; however, studies are still lacking that evaluate the long-term effects of opioids on pain, function and quality of life. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted to compare opioid therapy to non-opioid therapy for patients with back, knee or hip pain over one year.

Veterans dealing with pain serve as the study group

Veterans with chronic low back pain (LBP) or moderate-to-severe hip or knee osteoarthritis were invited to participate in the RCT. These individuals were screened to determine if they were eligible, and 240 were accepted and then randomly assigned to either the opioid or non-opioid therapy group. Patients in the opioid group received a combination of different drugs at various times over one year that included morphine, oxycodone, hydrocodone and fentanyl. Patients in the non-opioid group received a completely different combination of drugs that included acetaminophen, non-steroidal anti-inflammatory drugs and lidocaine, amongst others. All patients were monitored regularly over one year, and at the end of the study they were evaluated for pain-related function and intensity of pain, both of which were assessed on a scale from 0-10 (higher score indicates more pain).

Opioids and non-opioids lead to very similar outcomes

Overall, results showed that patients who received opioids improved to a very similar extent compared to those who received non-opioids. In particular, the opioid group improved from a score of 5.4 at the start of the study to 3.4 one year later in pain-related function, while the non-opioid group improved from 5.5 to 3.3. Regarding pain intensity, both groups reported a 5.4 at the study start, but the opioid group improved to 4.0 and the non-opioid group improved to a 3.5. This means that the non-opioid group actually improved by 0.5 points more than the opioid group, which was considered a small but significant difference. In addition, opioid group patients experienced significantly more negative symptoms related to their medications than the non-opioid group. This is the first study to compare opioids versus non-opioids in the long-term, and it provides strong evidence that opioids should not be the first line of treatment for chronic musculoskeletal pain. Additional research is now needed to confirm these results, but this study is considered a major breakthrough that has filled a gap in the evidence on opioids for chronic pain. Determining the best way to prescribe opioids will continue to be a controversial topic, but these findings will likely be referenced in any related discussion. The study should also urge doctors to prescribe alternatives to opioids like physical therapy, which is a risk-free treatment that has been proven to help many painful conditions such as back pain and osteoarthritis. Patients should be aware that they can see a physical therapist directly, without a referral, if they are in pain and seeking out a safer alternative to opioids.

– As reported in the March ’18 issue of JAMA

Guidelines recommend education, physical therapy, and exercise

Guidelines are necessary to assist doctors with treatment recommendations

Low back pain (LBP) is one of the most common of all sources of disability. More than 80% of people will experience LBP at least once in their lives, and it has become the number one reason people visit a doctor for pain that affects the muscles or bones. There are many treatments available for LBP, and it may be difficult for some doctors to determine which is the best possible approach for each patient. To help with this process, a number of guidelines have been developed, which include various recommendations that are intended to create the best possible outcomes for patients. Unfortunately, the quality of some of these guidelines is not very high, which can lead to medical professionals recommending treatments that are ineffective, expensive, or even harmful. For this reason, a team of researchers decided to conduct a study called a systematic review of all the treatment guidelines available. The goal of the review was to identify which conservative (non-surgical) treatments were found to be most effective for LBP and which should not be recommended.

13 studies are analyzed in the review

Researchers searched through 10 major medical databases for studies that included guidelines on the best treatments for LBP. They only accepted studies that targeted adults and/or children with guidelines on conservative treatments or treatment protocols for LBP. Out of 2,504 studies identified, 75 were assessed in greater detail, and 13 of these fit the necessary criteria for the review. All accepted guidelines were then analyzed in detail and compared to one another to determine which treatments are best for LBP. The quality of each study was also assessed and given a rating to indicate how reliable their guidelines were.

Education, activity, and therapy are all central to effective treatment for LBP

The results of this study identified a number of treatments that were recommended by all of the guidelines reviewed. For acute LBP (pain that has only lasted for up to six weeks), the following recommendations were found in all the guidelines: advice and/or education, returning to activities or staying active, acetaminophen (Tylenol) and a hands-on form of physical therapy called spinal manipulation. The same treatments were also recommended for chronic LBP (pain that lasts for longer than six weeks), and additional recommendations for specific back exercises were found in the guidelines as well. The researchers also reported that of the 13 guidelines reviewed, 10 were found to be of high quality. Finally, it was pointed out that a recent study challenged the effectiveness of acetaminophen for treating acute LBP, which calls this recommendation into question. Based on these findings, it appears that education and advice, staying active, physical therapy that includes spinal manipulation and performing specific back exercises are the most commonly recommended treatments for LBP based on available guidelines. The fact that most of these guidelines were of high quality also indicates that their recommendations are strongly supported and reliable. Medical professionals treating patients with LBP should, therefore, consult these guidelines and recommend treatments accordingly in order to produce the best possible results.

-As reported in the February ’17 issue of the European Journal of Pain

Muscle Trigger Points

Muscle trigger points can be a source of sometimes debilitating pain. These trigger points may feel like tiny pea-sized indurations inside muscles or may sometimes even be as large as your thumb. The pain you feel may vary from low grade to severe and may occur at rest or only on movement. It is often felt like a dull aching steady pain that lies deep inside a muscle. Very often the pain or tenderness may be felt far away from the actual causal site. These muscle trigger points are very tender that can make you wince with pain and pull away when pressure is applied to these spots.

Trigger points can occur in any muscle, but is usually found in muscles that are used the most or repetitively. Our neck and low back muscles are very susceptible to the development of muscle trigger points, as are the muscles of the shoulder blades, In our fast paced life of today, finding quick and easy relaxation methods is a boon. Below is a video that demonstrates a simple method, using tennis balls, to help you get rid of those muscle trigger points in your body, especially those that are located in the shoulder blades and low back.

Muscle trigger points are not the same thing as a muscle spasm. A spasm involves a violent contraction of the whole muscle, whereas a trigger point is a local contraction in only a small part of a muscle. A strain or tear involves physical damage to the muscle or tendon fibers. Such damage has not been demonstrated in studies of trigger points.  However, such injuries may predispose one to developing “muscle trigger points”.

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Patients receiving expensive and risky treatment for knee surgery

Knee condition is one of the leading causes of disability in the country

Osteoarthritis is a painful condition that develops when cartilage breaks down over the course of time. This is why it’s often called “wear and tear” arthritis. Osteoarthritis can occur in any joint in the body, but the hips and knees are affected most frequently. Knee osteoarthritis is a very common condition that affects more than 10% of the adult population, and it’s considered a leading cause of disability in the U.S. Conservative (non-surgical) treatment that includes physical therapy is typically recommended as the first line of treatment for knee osteoarthritis, but surgery may be necessary for patients that fail to improve. Total knee replacement is the most common surgical procedure used to treat these patients, and it often leads to successful outcomes with less pain and better knee function afterward. Before getting to the point when surgery is needed, knee osteoarthritis patients may undergo a variety of different treatments. There is a set of treatment guidelines from the American Academy of Orthopaedic Surgeons (AAOS) that all doctors should be following when making these decisions, but many doctors continue to prescribe treatments that are not recommended. To get a better idea of what types of treatments doctors are prescribing knee osteoarthritis patients before surgery and how much it’s costing, a study was conducted.

Large database examined for patterns in treatment recommendations

A large database used for recording information on patients who had a total knee replacement surgery served as the main source of data for the study. Researchers identified 86,081 patients who fit the necessary criteria for the study and examined the treatments that they received prior to having surgery. Based on the guidelines for treating knee osteoarthritis, they chose to analyze the use of eight treatments, which included physical therapy, braces, injections and both over the counter and prescription pain medications, including opioids.

None of the top three treatments used are supported as effective

Results showed that in the year prior to having knee replacement surgery, most patients (66%) received at least one of the analyzed treatments for their knee osteoarthritis, which cost an average of $506 per patient. The three most commonly used treatments were corticosteroid injections, hyaluronic injections, and opioids. For the injections, one of two different chemicals—either a corticosteroid or hyaluronic acid—is injected directly into the knee to reduce pain. In total, these three treatments accounted for about 43% of the costs associated with managing knee osteoarthritis; however, none of them are recommended by the guidelines as effective interventions for this condition. In addition, the hyaluronic injections were responsible for approximately 30% of patients’ costs, even though the guidelines strongly recommend against using them. This shows that many patients with knee osteoarthritis are being given treatments that are not recommended, which could cost them more and do not even lead to successful outcomes. Patients dealing with knee osteoarthritis should, therefore, seek out only treatments that follow the AAOS guidelines, which will help them experience the best possible outcomes and avoid surgery unless it is completely necessary.

-As reported in the January ’17 issue of The Journal of Arthroplasty

Craniosacral Therapy, The Healing Code and Access Bars

From being worked upon by a practitioner to be healed, to learning healing techniques to be able to work on yourself  and then to finally learn the ability to be present in your life in every moment, without judgment of you or anyone else, accept everything, reject nothing, and create everything you desire in life – greater than what you currently have, and more than what you can imagine.

A craniosacral therapy session involves the therapist placing their hands on the patient, which allows them to “tune into the craniosacral rhythm”.The practitioner gently works with the spine and the skull and its cranial sutures, diaphragms, and fascia. In this way, the restrictions of nerve passages are said to be eased, the movement of cerebrospinal fluid through the spinal cord is said to be optimized, and misaligned bones are said to be restored to their proper position.

In 2001, Dr. Alex Loyd discovered how to activate a physical function built into the body that consistently and predictably removes this one source of illness, so that the body’s immune system can do its job of healing whatever is wrong in the body. Dr. Loyd named this process The Healing Codes.

Dr. Loyd’s findings have been validated by thousands of people from all over the world who have used The Healing Codes to heal virtually any physical, emotional, or relational issue, as well as to realize tremendous breakthroughs in personal success.

Finally, the purpose of Access Bars is to create a world of consciousness and oneness. Consciousness includes everything and judges nothing. It is our target to get you to the point where you receive from Access the awareness of everything, with no judgment of anything. If you have no judgment of anything, then you get to look at everything for what it is, not for what you want it to be, not for what it ought to be, but just for what it is.

Consciousness is the ability to be present in your life in every moment, without judgment of you or anyone else. It is the ability to receive everything, reject nothing, and create everything you desire in life – greater than what you currently have, and more than what you can imagine.

What if you were willing to nurture and care for you? What if you would open the doors to being everything you have decided it is not possible to be? What would it take for you to realize how crucial you are to the possibilities of the world?

Integrative Healing Dynamics for Autism: The Diet

Integrating Healing Dynamics for Autism encompasses the following treatments:

  • craniosacral therapy
  • visceral manipulation techniques
  • advice on nutrition and diet

Our GOALS in the treatment are as follows:

  • Rebalance the nervous system and release both temporal bones in order to improve: language, learning and focus/ attention,eye contact, social interaction and reduce sleep difficulties
  • Improve intestinal health to reduce gastrointestinal problems (diarrhea or constipation) and ease up toilet training
  • Decrease the body’s physical manifestations of stress via skin rashes/eczema and body pain

These GOALS CAN BE REACHED with:

  • Diet and nutritional supplements, which are discussed below
  • Drugs/Hormones like Baclofen, D-Cycloserine and Oxytocin
  • Manual Therapy viz: Craniosacral Therapy, Visceral Manipulation and Sensory Integration

DIET AND NUTRITIONAL SUPPLEMENTS:

Doctors now know that the body of the child with autism requires very specific care by offering special enzymes for digestion, treatment for yeast infections, attention to digestive issues and nutrient and fatty acid supplementation. Numerous studies have reported that diet and supplemental nutrients may provide moderate benefits to autism patients, including higher scholastic test scores and earlier neurological development.Since every child is unique, results will vary. While there are several diets out there, the Autism Research Institute (ARI) found improvement in:

  • 65% for those applying Gluten-Free Casein-Free (GFCF) Diet, and
  • 66 % for those applying Specific Carbohydrate Diet (SCD)

These typically fall into the acidic food category. Research has found that the body is doomed for disease in an acidic environment. Broadly acidic foods include meat/fish, dairy and sugars (as in sodas as well) and alkaline foods include fruits and vegetables. To regain health (currently suffering from disease) a ratio of 90% alkaline and 10% acidic food choices has been recommended. The test for acidic/alkaline environment(pH) in the body can be easily performed with litmus paper purchased in a drugstore. It has to mandatorily read above pH7. Therefore, the first step by parents of autistic kids should include:

  • Removal of gluten, which is the protein found in wheat, rye, barley, commercial oats, kamut, and spelt.
  • Removal of casein, which is the protein found in dairy.
  • Decrease the amount of sugar they feed their children.
  • The guidance of a qualified nutrition professional is always recommended.

Successful parents begin with simple steps. They serve:

A diet comprising:

  • fresh fruits, vegetables but avoid food that naturally contains salicylates (such as almonds, oranges, raspberries, apples, cherries, grapes, peaches, strawberries, cucumbers, plums, and tomatoes)
  • grass-fed meats whenever possible
  • organic foods to remove antibiotics, hormones and pesticides
  • no pre-packaged, canned or frozen foods
  • no foods that contain preservative, monosodium glutamate and additives like food colors and artificial ingredients
  • big moderation in sugar intake

Nutritional supplements that include:

  • omega-3 fatty acids,
  • higher levels of minerals like calcium, iron, magnesium and chromium
  • nutrient supplements of Vitamin-B6 and Vitamin-C, Folic Acid, Niacin, and dimethylglycine
  • Methyl B12 injections or nasal spray

Finally, do not forget:

  • water, and
  • exercise are very essential to the living cell for it hydration and oxygen “nutrient” supplies.

The secret to success as in anything is to start and persevere and be consisitent. Children thrive on consistency.

Source: https://pHmiracleliving.com Source: https://autism.com

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Visceral Manipulation In Pediatrics

As we already know, visceral manipulation is organ specific fascial mobilization. In other words, our viscera or organs are treated specifically in relation to their associated structures and surrounding connective tissue. In order to maintain good health in the body the viscera must move in harmony with the other structures in the body. If this does not happen, the presence of organ restrictions can create fixed points of tension in our system around which the body now needs to move. This paves the way for disease and dysfunction.

A visceral restriction is just like a myofascial restriction, except that it is within the organ or in the connective tissue outside of the organ. A visceral restriction develops from an inflammatory process, in which an exudate is formed. This exudate thickens and becomes a harder, denser, drier area. Restrictions are caused by infection, birth trauma, in-utero malpositioning, falls, abnormal neural activity, medications and toxicity.

The practitioner can determine the area of greatest restriction by “listening”. “General listening” indicates the site of the greatest tension in the body at that time while with local listening, the practitioner’s hand is attracted more specifically to the level of the restriction. Next, the practitioner identifies by palpation the specific structure that is involved, then embarks on the release that the body needs.

For instance, if a baby has reflux, with “general listening”, the listening goes to the upper stomach. “Local listening” will help identify if the restriction is between the stomach and liver or the stomach and diaphragm (where the esophagus goes through the diaphragm), or perhaps between the esophagus and pleura of the lung.This specific area needs to be treated. This is the basic technique in all “visceral manipulation” sessions.

Treatment

When treating a baby or child with visceral manipulation, the therapist contacts the organ and structure related to that organ, and treats in the direction of ease. For example, if the baby with reflux has tension between the stomach and liver,the therapist contacts the lesser curvature of the stomach with one hand, the left lobe of the liver with the other hand. By contacting these two organs, the organs will start a “listening”, a movement into the direction of ease. In this case, the stomach and liver will pull towards each other until a tissue release is palpated. A release feels like a softening of the tissue. The restriction is freed so that the stomach and liver slide and glide on each other.

After the area is treated, the next step is to re-listen to the body. Very often the listening takes you to the left occipitomastoid suture – the suture between the temporal and occipital bones. Now if we look at our anatomy, we see that the vagus nerve exits in the jugular foramen between these two bones. We may even feel a “line of tension” between the occipitomastoid suture and the upper stomach. This would make sense anatomically because of the pathway of the esophagus and vagus nerve as they both travel through the thorax. Thus, when we “line up the tension”, or engage the two structures between our hands so that we can feel a specific tension, we may release these structures and thus help the child with their symptom of reflux.

The video below talks about the various applications of visceral manipulation in children.

Follow us for more information on visceral manipulation as an invaluable adjunct to good health. 

 

Manipulative Therapies

Manipulative therapies can be defined as methods of resetting a particular body part in order to precipitate a healing response in that body. Quite often the treatment is applied at a distance away from the actual symptoms, to obtain satisfactory results.

There are several types of manipulative therapies, among which most importantly are: osteopathy, craniosacral therapy, visceral manipulation, articular manipulation, neuromeningeal manipulation, chiropractic, massage and reflexology, to name a few.Every method described below has a video following it to present it in greater detail.

Osteopathy is a therapy that uses manipulation on the whole body in order to reduce discomfort, improve muscle performance, joint movement and restore the person to full health, by working on the muscles, ligaments and skeleton.

Craniosacral therapy is a gentle, hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system – comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. Using a soft touch generally about the weight of a nickel, practitioners release restrictions in the craniosacral system to improve the functioning of the central nervous system.

Visceral manipulation

is a gentle hands-on therapy that works through the body’s visceral system (the heart, liver, intestines and other internal organs) to locate and alleviate these abnormal points of tension throughout the body. At optimal health, the relationship between the organs (viscera) and structures of the body (muscles, membranes, fasciae and bones) remains stable despite the body’s endless varieties of motion. But when one organ can’t move in harmony with its surrounding viscera due to abnormal tone, adhesions or displacement, it works against all the body’s organs and structures. This disharmony creates fixed, abnormal points of tension that the body is forced to move around. That chronic irritation, in turn, paves the way for disease and dysfunction.

Articular manipulation, another part to the manipulative therapies curriculum, works on the premise that different layers of the body starting right from the deepest layer of bone to the muscles, ligaments, blood vessels and nerves, all working together to create an interdependence and unity of the body’s structure. These layers interact with the central nervous system through neural components and motor components. Specific emotions with specific personalities also have an effect on the CNS which affects all these layers. Keeping a balance in these different layers maintains joint pressure. The pressure inside a joint is important. In a healthy joint exists a negative pressure,. All the joint structures stick together to create a sucking effect inside the joint, a kind of “togertherness”. When dysfunctional the negative pressure decreases (becomes more positive pressure) which destroys the cartilage, and the joint falls apart.

Neuromingeal manipulation is a precise treatment of nerves in the body that are causing pain. This is achieved by rolling or gliding movements of the said nerve combined with movement of the extremities or joints in order to relieve any loss of mobility or tightness the nerve  may have.

Chiropractic is a therapy which involves treatment on the musculoskeletal system with paticular emphasis on the spine and nervous system. it can help shoulder and low back pain and help relieve asthma,constipation and digestive problems.

Massage, another modality in the manipulative therapies family is a very pleasant therapy that utilizes stroking, kneading and other techniques to manipulate the soft tissues of the body. It is ideal for stress relief, relaxation and as a remedial treatment for physical and emotional problems.

Reflexology falls into the manipulative therapies category mainly for its ability to relieve stress and decrease digestive problems. The technique involves applying pressure to points on the feet and sometimes the hands. therapists believe that they can stimulate energy by reflex action to a related muscle or organ and encourage healing.

Follow us for more details on “manipulative therapies”

Visceral Manipulation

The structural integrity of the body and its function are always compromised when there are abnormal tensions in connective tissue. Visceral Manipulation focuses on locating and resolving abnormal tension of connective tissue that links the organs of the body. Correcting these imbalances also release serotonin and can help alleviate chronic irritation and stress, which sometimes is the cause of “dis-ease”.

Strains in the connective tissue of the viscera can result from surgical scars, adhesions, illness, posture or injury. Tension patterns form through the fascial network deep within the body, creating symtoms, sometimes far from their sources for which the body will have to compensate. Thus, viscerospasm, displacement and adhesions can all cause our organs to work inefficiently creating chronic irritation and abnormal points of tension. The main purpose of visceral manipulation is to reinstate the normal mobility and motion in the body’s organs.

Visceral manipulation assists in correcting imbalances throughout the body including musculoskeletal, vascular, nervous, urogenital, respiratory, digestive and lymphatic dysfunction. It evaluates and treats the dynamics of motion and suspension in relation to organs, membranes, fascia and ligaments. Visceral manipulation increases proprioceptive communication within the body, thereby revitalizing a person and relieving symptoms of pain, dysfunction, and poor posture.

Evaluation and treatment of a patient with visceral manipulation methods requires assessment of the structural relationships between the viscera, and their ligamentous or fascial attachments to the musculoskeletal system.

The video below sums what visceral manipulation is about.

Follow  us for more on various treatment modalities and applications of “visceral manipulation”.

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