Karuparthy Column

Management of Chronic Pain
(Continued from last month)

Stress and Chronic Pain

Stress is probably the most ubiquitous and ever increasing problem in today’s fast paced and industrialized world than ever before. This has infinite consequences not only in terms of individual’s health but also in terms of social health of the entire human race.  Because ‘stress’ affects the ‘mind’, which cannot be seen, felt, examined and researched easily, there is no easy solution. This can be compared to pollution, the only other phenomenon of the new industrialized world that is increasingly threatening the physical health of all of us.  Stress can be called pollution of the mind, which is a result of ever increasing number of things to be taken care of before you hit the bed every night.

Stress is nothing but a constant state of heightened alertness and excited state. If you add chronic pain to the stress, you can easily imagine how life can become an unbearable misery.  A vicious cycle starts as soon as the pain continues without abating in a reasonable period of time of natural healing.  Slowly, the patient starts to take more and more painkillers as their effectiveness diminishes as time goes by. Coping with daily demands of life gets harder and harder as the intervals of inadequate pain relief increase. The patient is going to fall behind the schedules and demands in work and social life, and fails to enjoy even simple pleasures of daily living, resulting in frustration and anger. This distress in turn causes hostility, outbursts of temper, insomnia, propensity to make mistakes, feelings of worthlessness, deficiency, being neglected, insecurity etc. As a result the relationships at work and home get strained.

When the patient is under such distress, there is heightened tone of all the muscles of the body. This is more so in the group of the muscles that are affected by chronic pain. These muscles get more spastic and tense. The spastic muscles cause more pain. The increased pain, in turn causes more spasm of the muscles. The spasm and pain go round and round and muscle involved becomes non-functional. The normal muscles around or the muscles on the opposite side of the body will take up the function of the non-functional spastic painful muscles. These muscles can compensate for a while and in time, because of the work overload, they too become spastic and become painful. In this way many different groups of muscles start to hurt. The spastic painful muscles soon get de-conditioned and atrophic.  The atrophic de-conditioned muscles hurt even more. Soon the whole body is in agony.

All the medications in the world only give temporary relief and need to be constantly administered just to live through the day. While physical therapy helps, a catch-22 situation arises because without pain relief physical therapy is difficult and without physical therapy pain relief is not possible. 

Obviously, there is no single magic cure for chronic pain. Unless treatment is at the root level there will not be any abatement in suffering. A realistic solution lies in a holistic approach by integrating immediate relief techniques along with behavioral therapy of modern medicine and strengthening techniques of ancient wisdom like Ayurveda, Acupuncture, Yoga and Mind-Body medicine.

KV, July 2003
Contents

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Abstinence Reduces Sperm Quality
Abstinence longer than two days reduces sperm quality in men having low fertility.  In a study presented on June 30th at the European Fertility Conference, Israeli scientists provided evidence that men with low sperm counts can significantly reduce sperm quality by abstaning from sex and masturbation for longer than a two days. They found that the performance for normal men without any fertility problems sperm quality remained the same whether they abstained from sex for one, two or 10 days before providing a sample. The finding challenges the World Health Organization recommendation that men seeking fertility treatment refrain from sex for between two and 7 days before providing a sample for analysis. The volume of semen increased, as expected after prolonged abstinence, but in men with low sperm counts the quality got worse with the length of time of abstinence. The number and proportion of active sperm fell significantly from day two onwards, reaching a low at day six and remaining low and the percentage of malformed sperm increased after two days of abstinence. In normal men, the percentage of malformed sperm increased after 11 days. The best strategy for couples with no fertility problems who are trying to have a baby is to have sex once every day around the time of ovulation.

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Syndrome X
A new definition of the metabolic syndrome, also known as syndrome X, was developed by the U.S. National Cholesterol Education Panel (NCEP). It incorporates thresholds for five easily measured variables: abdominal obesity, elevated fasting blood triglycerides, low levels of HDL, high fasting blood sugar (glucose) and high blood pressure. A person having any three of the five conditions would be classified as having the syndrome and is cinsidered to be at high risk of developing type 2 diabetes and heart disease, researchers report in the rapid access issue of Circulation: Journal of the American Heart Association.

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Breast Cancer and Diet
Researchers from the Harvard Medical School and Brigham and Women's Hospital in Boston examined the relationship between dietary fat intake and breast cancer risk among 90,655 premenopausal women ages 26 to 46 who were participating in the Nurses' Health Study II.  The study of premenopausal women suggests that high intake of animal fat, especially from red meat and dairy products, is associated with an increase in risk of breast cancer. The increase was associated with intake of animal fat (red meat and high-fat dairy foods) and not vegetable fat. Intakes of both saturated and monounsaturated fat were associated with modest elevations in breast cancer risk.

Another study, published in July 18th week Lancet medical journal, conducted at Cambridge University in England and involved 13,070 women who kept diet records from 1993-97, concluded that those who average more than 90 grams of fat a day have roughly double the risk of those who eat just 37 grams.  Women who ate a higher-fat diet were not necessarily fatter; but once the researchers adjusted the results to eliminate skewing by other factors promoting breast cancer, such body weight and total calories eaten, the women who ate the most saturated fat had twice the breast cancer risk as those who ate the least.   Most of the fat in the women's diets was saturated fat, that comes from animal-based food such as meat, fish and dairy products.

A study to be published in the journal Nature Medicine finds that low-level exposure to cadmium, a heavy metal used in batteries, pigments and alloys, and found in some foods and air pollution, increased the risk of breast cancer in rats. Chronic cadmium exposure has already been linked to bone and kidney disease. The findings suggest cadmium exposure could be hazardous to women's health

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Alzheimer's Disease
Overweight women may have a higher risk of Alzheimer's disease compared to women of a healthy weight, according to a study published in the Archives of Internal Medicine. The study involved 392 Swedish men and women aged 70 to 88. Researchers looked at the relationship between body mass index (BMI), a height-to-weight ratio, and dementia. They found no clear link between overweight or obesity and dementia in the small number of men in the study. But they found that women diagnosed with dementia between ages 79 and 88 were typically overweight, with average BMIs of 28.2 to 29.6 during the preceding decade. Women who did not have dementia had lower average BMIs -- just over 25 during the same age range. A person with a BMI of 25 to 30 is considered overweight, and a BMI over 30 is considered obese, The Associated Press reports. The researchers say their findings add to evidence that conditions such as hypertension and diabetes, which are associated with excess weight, are also linked to Alzheimer's disease, the AP says.

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Doting and Longevity
A new theory suggests that natural selection favors animals capable of devoting energy and resources to insuring survival of the next generation. After birth, all mammals, birds, many insects and some fish nurture their offspring. Post-reproductive bottle nose dolphins and pilot whales, for instance, babysit, guard and even breastfeed their grandchildren. And in certain primates, the gender that provides the primary care to offspring tends to have a higher life expectancy. This suggests that nurturing behavior and longevity evolved together over time. The hypothesis appears in the Proceeding of the National Academy of Sciences Online Early Edition the week of July 14. This work was supported by the National Institute on Aging (NIA), part of the National Institutes of Health and the U.S. Department of Health and Human Services.  The thoery was proposed by Ronald D. Lee, Ph.D., of University of California, Berkeley.

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FDA Supports Healthy Food
The Food and Drug Administration (FDA) announced an initiative to help consumers obtain accurate, up-to-date, and science-based information about the health consequences of these products. In a report issued, FDA's Task Force on Consumer Health Information for Better Nutrition unveiled a process for FDA to review such health claims. This process will rely on expertise from the Agency for Healthcare Quality Research and other government agencies, coupled with enhanced consumer studies, to review health claims before they appear in food labeling. In addition to the report, FDA is announcing enhanced enforcement activity against dietary supplement manufacturers and others who make misleading claims about health benefits that are not based on science.  

The report also highlighted the key areas where FDA intends to focus these efforts on providing better nutrition information and health messages to consumers in the coming months:

• The benefits of eating at least several servings a week of foods high in omega-3 fatty acids, for reducing the risk of heart disease. Flax seeds contain omega-3 oils.
• The benefits of eating five to nine servings a day of fruits and vegetables for reducing the risk of some cancers and other chronic illnesses.
• The benefits of replacing solid animal fats that are high in saturated and trans fats with vegetable oils containing unsaturated fats for reducing the risk of heart disease.
• The benefits of substituting nuts for other sources of saturated-fat-containing protein such as meet to help reduce the risk of heart disease.

The scientific information in support of these health benefits has led to their inclusion in recommendations from various scientific organizations, including such government agencies as the National Cancer Institute and the National Heart, Lung and Blood Institute as well as non-governmental organizations such as the American Heart Association. In addition, the "Five a Day" campaign is a hallmark of health education programs throughout the Department of Health and Human Services.

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Omega-3 Fatty Acids
A study published in the Archives of Neurology, funded by the National Institutes of Health, could provide a simple way for people to reduce their risk of Alzheimer's.  The study adds to the evidence that diet may affect a person's chances of developing the mind-robbing disease that affects 4 million Americans. Researchers found that people 65 and older who had omega-3 fatty acid containing foods such as fish, vegetables, nuts etc. once a week had a 60 percent lower risk of Alzheimer's than those who never or rarely ate such foods.  Participants in the latest study also saw a decreased risk of Alzheimer's from eating omega-3 fatty acids found in vegetables, nuts and flax seed.  Earlier studies have shown that animals fed on the omega-3 fatty acids had better learning abilities and memory.  The same researchers found in an earlier study that people who have diets heavy in saturated fats run double the risk of getting Alzheimer's.

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Trans Fatty Acids
Until now, trans fat didn't get the attention its infamous cousin, saturated fat, earned through government warnings and labels.  That's about to change, now that the government is requiring food labels to reveal exact levels of the artery clogger. Doughnuts, french fries, crackers and fried chicken are just some of the tasty foods that include trans fat. But it is as dangerous to the heart as saturated fat and many doctors consider it worse.  Food and Drug Administration regulations unveiled on 9th require nutrition labels to include a new line listing the amount of trans fat in each food right under the amount of saturated fat. Studies have suggested that trans fats may be worse for the heart than unhealthy saturated fats. They can raise levels of "bad" LDL cholesterol and lower levels of "good" HDL cholesterol.

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Abusive Parents
Research shows that violent behavior toward a romantic partner is difficult to change. More needs to be done to develop prevention programs that identify major risk factors for partner violence before adult relationships develop. According to a report in the August issue of the Journal of Consulting and Clinical Psychology, published by the American Psychological Association (APA), children who regularly receive excessive punishment and who witness their parents using violence against each other are at increased risk of being involved in an abusive relationship as an adult.  The 20-year study followed children into adult romantic relationships. In partner violence cases that result in injury, the study finds that being the victim of physical abuse and conduct disorders as a child are also important risk factors.

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Coronary Heart Disease Risk
Compared with people with no parental history of early-onset coronary heart disease (CHD), those with at least one parent who had a heart attack or other coronary event such as chest pain before age 60, had thicker walls in the large carotid arteries of the neck that lead to the brain, researchers report in the rapid access issue of Circulation: Journal of the American Heart Association. Thicker carotid artery walls are associated with a greater degree of atherosclerotic plaque. The study showed that at any age, the average vessel wall thickness of the internal carotid arteries was greater in people with at least one parent who developed CHD before age 60, compared with those without a parental history of early-onset CHD.

 

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Diet v. Statin Drugs
A low-fat vegetarian diet may lower bad cholesterol levels as well as widely-prescribed statin drugs. That's the finding of a small study published in the Journal of the American Medical Association that reinforces a non-drug approach for people who can't or don't want to take cholesterol-lowering medications. The study looked at 46 men and women with high cholesterol. Sixteen of the participants were assigned to eat a strict vegetarian diet high in fiber, soy protein, almonds, and other foods shown to be beneficial to healthy cholesterol levels. Another 16 people followed a very low-fat but not vegetarian diet, and the remaining 14 followed the low-fat diet and also took 20 milligrams of the statin drug lovastatin daily. At the end of the month, people in the vegetarian group had an average drop in LDL cholesterol of 28.6 percent, while those in the low-fat-plus-statin group had a 30.9 percent reduction in LDL levels. Both groups also had similar reductions in C-reactive protein, a marker of heart disease risk.

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Bad News For Ice Cream Lovers
A study released the week of July 21 by the Center for Science in the Public Interest has some bad news for ice cream lovers. The study involved a nutritional analysis of ice cream treats offered at Baskin-Robbins, Cold Stone Creamery, Friendly's, Ben and Jerry's and TCBY. The study found that some of the regular sundaes and treats can have as much fat and calories as a rack of ribs, a steak dinner or two pan pizzas.

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Edible Food Wrap
An edible food wrap is an edible film cut in pre-formed sheets or into envelope-like shapes. It looks like a piece of paper, except that it's made from a highly concentrated puree of a fruit or a vegetable, not from a tree. While a wrap made entirely from fruit or vegetables keeps air from reaching the food, it isn't very water-resistant. This is good because it will dissolve in your mouth. But you don't want it dissolving into your food in the freezer.  The wraps come in a wide variety of flavors, including broccoli, carrot, tomato, mango, peach, pear, apple, papaya and strawberry. The fact that they are biodegradable, unlike plastic and aluminum products, is compatible with the goals of green chemistry, which works to improve the environment or prevent harm to the land and water, according to a work featured in the April 2003 issue of the quarterly magazine, ChemMatters, published by the American Chemical Society. 

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Music and Memory
Children with music training had significantly better verbal memory than their counterparts without such training, according to a new study, reported by psychologists at the Chinese University of Hong Kong, that appears in the July issue of Neuropsychology. The longer the training, the better the verbal memory. These findings underscore how, when experience changes a specific brain region, other skills that region supports may also benefit.  This cognitive side effect may help people recovering from brain injury as well as healthy children.

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Happy People are Immune to Cold
People who are energetic, happy and relaxed are less likely to catch colds, while those who are depressed, nervous or angry are more likely to complain about cold symptoms, whether or not they get bitten by the cold bug, according to a recent study reported by researchers from Carnegie Mellon University the July issue of Psychosomatic Medicine.

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