Karuparthy Column

Management of Chronic Pain

(Continued from last month)

Chronic pain and exercise

Chronic pain patients are often advised to do exercises to get better along with analgesic medications and injection therapy in modern approach to pain management. However, as they had this pain for such a long time the usual answer is “I have tried all and they failed to give me any lasting relief. Even the passive physical therapy guided by therapist also hurts them to go through the session.  Many a time many patients tell us that they are active and get lot of exercise every day. They say that they jog a mile or walk few blocks or ride a stationary bike every day or every other day. Some also say that they have two small kids to take care of and you can imagine how much you run around to take care of them. Despite all this they are all in pain. What is the catch?

Passive physical therapy is good for postoperative rehabilitation or acute injury in short term. However physical therapy does not give any lasting benefit once the condition becomes chronic. The chronic pain patients are in a ‘catch 22’, they can’t get better unless they do exercise but they cannot do exercise unless they are better.  This vicious cycle has to be broken some how.

The exercise that patients often think they are getting does not help them. In fact, it constantly exacerbates the pain and makes living more painful. Running, jogging, walking, biking are combined, coordinated activities of the body. This form of exercise involves all the muscles of the body in a coordinated fashion to improve stamina or strength.  This form of exercise is good for the people who are already healthy and do not have any muscle dysfunction anywhere that restricts the coordinated effort of running, jogging and biking. If a patient with chronic pain with localized muscular dysfunction and pain participates in such exercise that part of dysfunctional segment will not be able to participate in the combined activity. This leads to a biomechanical imbalance and patient compensates with other muscle groups to compensate and eventually the other muscles also start to hurt because they cannot take the extra-added strain. In this fashion the pain can spread to the muscles of the whole body, instead of making them better. 

If you have chronic pain you have to focus on the area of the pain and muscles involved and give special attention to get them better. This is like fixing the flat tire of your disabled car before driving any further.  The exercises should be relaxing gentle stretches of the muscles in pain regularly. Once they get better you can do the combined coordinated exercises to improve further the over all health. You should also combine these with gentle breathing techniques that relax during the exercise. This is why the specific prescribed gentle yoga postures combined with breathing techniques slowly unlock the areas of pain and stiffness and bring the balance back. Of course, don't look for quick relief as soon as you start these yoga techniques. It builds health and balance over time. This may be the only way to get out of the catch22 because all the pills and shots wear off over time.   (See below for Pranayama and Tai Chi news)

KV, September 2003
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Developing a Healthy Eating Plan

By eating a variety of foods from each of the five major food groups every day, you can easily meet your daily requirements for protein, energy (calories), vitamins, minerals and fiber. On a diet of less than 1,600 calories a day, however, it may be difficult to get the recommended amount of all the vitamins and minerals from food alone. If so, it may be prudent to take a balanced multivitamin and mineral tablet that provides up to 100 percent of the RDA for each nutrient. This chart shows the average calorie count for a serving of food within each food group:

Food Group	Amount	Calories
Milk & Milk Products	1/2 cup of milk or yogurt    1/4 oz. natural cheese    1 ounce processed cheese	45 to 75
Protein Products	1/2 cup cooked dried beans or lentils or 4 to 6 tablespoons peanut butter or    2 to 3 ounces lean meat, poultry or fish    (2 tablespoons peanut butter count as 1 oz. lean meat)	100 to 165
Grains, Breads & Cereals	1 slice whole-grain bread    1 ounce cold whole-grain cereal    1/2 cup cooked cereal or pasta    1/2 cup cooked brown rice	80-150
Fruits and Vebgetables	Fruit    1 small whole    1/2 cup chopped, cooked or canned    3/4 cup fruit juice    Vegetable     1/2 cup raw or cooked    1 cup raw leafy greens    3/4 cup vegetable juice	60 25
Oils/Fats	1 to 2 tablespoons vegetable oil such as olive, canola, flax etc.	100 to 200

Pick foods from the vegetable, fruit, and whole grain groups as top priority. If you like and cannot abstain from certain high-calorie or high-fat foods, try eating smaller portions rather than eliminating them completely.  
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Exercise May Cut Breast Cancer Risk
 
Brisk walking for just an hour or two weekly can help older women reduce their risk of breast cancer by nearly 20 percent, even if they have used hormone pills for symptoms of menopause, a study found. The findings appear in September 10th Journal of the American Medical Association. A separate study in JAMA found that moderate exercise combined with dieting is effective in helping younger women lose weight and improve cardiovascular fitness. Both studies add support to less stringent recommendations from the federal Centers for Disease Control and Prevention and the American College of Sports Medicine that recommend a minimum of 30 minutes of moderate-level activity like brisk walking most days of the week to reduce the risk of heart disease and other chronic health problems. Some experts say an hour of moderate-intensity exercise daily is optimal.
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Best, Worst Snacks For Kids Listed
 
While children need to exercise to keep their waistlines trim, schools could do their part by offering healthier snacks in school in place of junk food and sodas. As part of a campaign to reduce the number of sugary soft drinks and candy bars sold in schools, the Center for Science in the Public Interest put out a list of some of the worst snacks for children.

Chips Ahoy! and Oreo cookies, high in fat, topped the list of the worst snacks, followed by Pepsis and Coca-Colas, artificial fruit juices, Hostess snack cakes, and Keebler Club & Cheddar Sandwich Crackers. The group also deemed candy bars like Kit Kat Big Kat and Snickers as bad snacks, along with Starburst Fruit Chews.

Children should cut back on sweet and fatty food to help curb the nation's growing obesity problem and to prevent development of diabetes, heart disease and other illnesses associated with being overweight. Fifteen percent of children age 6 to 19 are overweight, according to the Centers for Disease Control and Prevention.
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Another Push for Walking
 
Women who want to lose a lot of weight should walk briskly for an hour a day while cutting calories, says a new study in September 10th Journal of the American Medical Association. Even walking for 30 to 40 minutes can help women shed quite a few pounds. The findings at the end of the year: The women who exercised for 50 to 60 minutes a day and consumed about 1,500 calories a day lost and kept off 12% to 14% of their starting weight, or about 25 to 30 pounds. They were burning 2,000 calories or more a week with exercise. Those who exercised 30 to 40 minutes a day and consumed about 1,500 calories lost and kept off 9% of their starting weight, or about 16 to 20 pounds. They were burning about 1,000 to 1,500 calories a week with exercise.

And last September, a report from the National Academies' Institute of Medicine recommended that Americans do at least an hour of some physical activity, such as walking, playing tag, biking, a day to control their weight.

Check out the following tips to add variety & intensity in your walking program.

Start with easy 20 to 30 minute walking sessions two or three times a week, in case you are a beginner else you can omit this step. Even if you feel great, try to hold yourself back for a few days because it may take your body that time to respond to the new training load. Develop short-term goals (ie. "I will walk for 20 minutes after lunch every day this week") and reward yourself for accomplishing them.
Maintain good posture throughout: Walk tall. Look forward, (not at the ground) gazing about 20 feet ahead. Your chin should be level and your head up. Shoulders down, back and relaxed. Chest forward. Tighten your abs and buttocks. Flatten your back and tilt your pelvis slightly forward. Pretend you are walking along a straight line. Bend your arms in slightly less than a 90 degree angle. Cup your hands gently. Swing arms front to back (not side to side - arms should not cross your body.) Do not swing elbows higher than your sternum (breast bone). Swing your arms faster and your feet will follow.
To read the complete article on ways to intensify your walking program, log on to http://ww w.womenfitness.net/walk_prog.htm.
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Cigarette Smoke Affects Peripheral Organs
 
It is well known that smoking cigarettes can directly and often fatally damage the lungs. But new research, with support from the National Institute for Biomedical Imaging and Bioengineering and the National Institute on Drug Abuse, National Institutes of Health, and the Department of Energy, shows that cigarette smoke also decreases levels of a critical enzyme called monoamine oxidase B (MAO B) in the kidneys, heart, lungs, and spleen. Too much or too little of this crucial enzyme can have an effect on a person's mental or physical health.  

Smoking affects every part of the body, including the gastrointestinal tract. In every puff, cigarette smokers inhale over 400 toxins and 43 known carcinogens. From the lungs, these toxins have easy access to the bloodstream, which allows them to circulate throughout the body. While everyone is familiar with the links between smoking and lung cancer, emphysema and coronary artery disease, few people think about the effects of smoking on the digestive system.

Studies have shown that smokers have decreased gastric motility while smoking, which can cause less efficient digestion. Smoking also can cause a weakening of the lower esophageal sphincter, increased stomach acid secretion and reduced pancreatic bicarbonate production. Liver function also can be affected, as smoking may accelerate alcohol-induced liver disease.

The global death toll from smoking is shifting dramatically, with about as many people now dying from smoking in the developing world as in industrialized nations, according to the most thorough estimate to date.

The research, published in The Lancet medical journal, concludes that 4.84 million people died from smoking worldwide in 2000 -- 2.41 million in developing countries and 2.43 million in rich nations.

In an unprecedented global push, the World Health Organization adopted a sweeping anti-tobacco treaty in May.

Developing countries, already grappling with a heavy burden from infectious diseases, have been at the fore in pushing for the convention, saying they need protection from tobacco multinationals who have switched their sales drives from saturated Western markets to Asia and Africa.

There are about 1 billion smokers worldwide.

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New Heart-Healthy Corn
 
A new breed of corn that mixes the conventional seed with a bright-blooming relative offers the promise of helping prevent clogged arteries and reducing harmful cholesterol.

Corn oil and other food products with this heart-healthy strain as an ingredient could appear on supermarket shelves in the world within four years. Scientists bred corn with Eastern gama grass, a purple or orange-bloomed plant, and came up with a corn high in oleic fatty acid -- a type of unsaturated fat that raises levels of good cholesterol to prevent arteries from clogging. Oleic acid also lowers the bad cholesterol that damages the heart.
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New Birth Control Pill
American women have a new option for birth control. This week the Food and Drug Administration approved Seasonale, an oral contraceptive pill that reduces the number of periods a woman has per year, The Associated Press reports. Seasonale's formulation isn't new. It contains the same combination of estrogen and progestin found in other birth control pills. But it's packaged differently, giving women 12 weeks of active pills rather than just three weeks before a week of dummy pills. That means women taking Seasonale would menstruate about four times per year instead of once per month, while getting the same protection from pregnancy as women on other birth control pills. Seasonale comes with warnings and side effects. Women taking it are twice as likely to experience breakthrough bleeding as women on other birth control pills.
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Star Anise Warning
The Food and Drug Administration has a warning for tea drinkers: Stay away from brews containing star anise. The warning comes following some 40 reports of seizures and other side effects from star anise teas. The problem may be that there are two identical-looking types of star anise -- Chinese star anise, which is safe, and Japanese star anise, which is poisonous.

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Cranberries May Help Reduce Stroke Damage
 
Stroke is the third leading cause of death in this country and the most common cause of disability in adults. It occurs when the blood supply to the brain is suddenly stopped, usually through a blood clot (ischemic stroke).

Researchers have found preliminary evidence that cranberries may reduce brain-cell damage associated with stroke. In lab studies using rat brain cells exposed to simulated stroke conditions, a concentrated cranberry extract reduced the death of brain cells by half in comparison to cells that did not receive the extract, according to the scientists.

The study is the first to demonstrate a link between cranberries and protection from stroke, was described at the 226th national meeting of the American Chemical Society, the world's largest scientific society.

According to the National Institutes of Health, there are several proven steps that consumers can take to reduce their risk of stroke, such as lowering their blood pressure, quitting smoking, and keeping heart disease and diabetes in check.
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Running

Running is an excellent form of aerobic exercise. It's relatively inexpensive and convenient to do in most places throughout the year. Moreover, it's one of the most effective calorie-burning exercises, it helps prevent osteoporosis, it strengthens muscles throughout the body, and it improves heart and lung efficiency.

Running doesn't require much in the way of equipment, but good shoes are very important. Everyone has different feet, and the construction of a shoe can compensate for some "abnormalities" in foot structure or gait pattern. If you're buying your first pair of shoes, it's a good idea to go to a sports store where the staff knows how to assess biomechanics (how your foot functions) and can recommend shoes that match your foot and gait type.

A large portion of injuries associated with running can be attributed to poorly designed training programs. Many beginning runners run too many miles too quickly, whereas veteran runners often run too many miles without enough rest and recovery.

A beginning runner should begin with easy jogging and may combine jogging and walking. No beginner should increase running time or distance by more than 10 percent from week to week. Patience is key.
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Resveratrol Sources
While present in other plants, such as eucalyptus, spruce, and lily, and in other foods such as mulberries and peanuts, resveratrol's most abundant natural sources are Vitis vinifera, labrusca, and muscadine grapes, which are used to make wines. It occurs in the vines, roots, seeds, and stalks, but its highest concentration is in the skin, which contains 50-100 micrograms (µg) per gram. Resveratrol is a phytoalexin, a class of antibiotic compounds produced as a part of a plant's defense system against disease. For example, in response to an invading fungus, resveratrol is synthesized from p-coumaroyl CoA and malonyl CoA. Since fungal infections are more common in cooler climates, grapes grown in cooler climates have a higher concentration.

The resveratrol content of wine is related to the length of time the grape skins are present during the fermentation process. Thus the concentration is significantly higher in red wine than in white wine, because the skins are removed earlier during white-wine production, lessening the amount that is extracted. A fluid ounce of red wine averages 160 µg of resveratrol, compared to peanuts, which average 73 µg per ounce.

http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/resveratrol.html
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Pranayama scores over a jog

Jogging helps, but doing pranayama for thirty minutes every day in the serenity of your home is far more beneficial for your heart and lungs. Now, there is scientific proof for it. A joint study by yoga experts from the city-based Vemana Yoga Research Institute and scientists from National Institute of Nutrition reported that those practising pranayama exhibited better fitness results. Also, the cardio-vascular and cardio-respiratory efficiency improved substantially for yoga practitioners as compared to joggers or walkers.

Pranayama is a basic yogic breathing technique, of which one of the methods is nadisodhana, where breathing is performed through alternate nostrils while sitting in a meditative posture.

The results of the research, conducted by the Vemana Research Institute and the National Institute Of Nutrition, was published in the Journal of Exercise Physiology.

Besides improving physiological functions and physical endurance, the exercise also lowers the lactate level in blood and is beneficial for those suffering from diabetes, asthma and hyper-tension. Previously, studies on nadisodhana have shown an improvement in various cardio-respiratory functions among normal volunteers and also in controlling diseases like diabetes. A few studies have reported increased oxygen consumption during different types of pranayama by direct measurement.
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Tai Chi Chih Boosts Shingles Immunity In Older Adults
 
Fifteen weeks of tai chi chih practice may have helped a small group of older adults increase the levels of immune cells that help protect their body against the shingles virus, according to a new study in the September issue of Psychosomatic Medicine. Tai chi chih practice was also associated with improvements in physical functioning, especially among those who had the most problems with everyday tasks like walking and climbing stairs at the beginning of the study.
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Married Women are Healthier
Women who are in satisfying marriages have a health advantage over unmarried women or those in unsatisfying marriages, according to a study published in the September issue of Health Psychology, a journal of the American Psychological Association (APA). The study, involving middle-aged women over a 13-year period, finds that women in good marriages were less likely to develop risk factors that lead to cardiovascular diseases compared with other middle-aged women.

Study indicates that women in marriages characterized by high levels of satisfaction showed a health advantage when compared with participants in marriages characterized by low levels of satisfaction and with unmarried participants (single, widowed or divorced). This included lower levels of biological and lifestyle cardiovascular risk factors – such as blood pressure, cholesterol levels and body mass index – and lower levels of psychosocial cardiovascular risk factors – such as depression, anxiety and anger. Those women in highly satisfying marriages also showed this same health advantage when compared with women in moderately satisfying marriages, but to a lesser extent.  
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Low-Calorie Diet Can Extend Life
 
It has long been known that laboratory animals live longer on a low-calorie diet. In a study, British researchers compared the effects of different calorie-restricted diets on the mortality of fruit flies. They found that fruit flies on restricted diets lived about 90 days, twice as long as those fed on a normal diet.

But the scientists also found that when heavily fed fruit flies were switched at middle age -- day 14 to 22 -- to leaner diets, then the animals converted from the shorter life pattern of the overfed to the longer-lived pattern of flies that had been on a restricted diet all their lives.
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