Health Myths: Get the Facts

From the FMS Global News Desk of Jeanne Hambleton (UK)

Courtesy of US Department of Health and Human Services, Centers for Disease Control and Prevention, Office of Women’s Health

You may be making health decisions based on incorrect or outdated information. Make sure that your sources for health information are current and accurate. Also, check with your health care provider if you have any questions about living a healthier life.

You CAN take simple steps everyday to protect yourself against illness and disease. It is important to get appropriate health screenings to find potential problems early and get proper treatment to prevent more serious problems later. Know that the health choices you make can also impact the health of others.

Below are links to health-related myths and rumors you may have heard from others or the internet. Click on a health topic for related myths, facts, and links to more information.

Myth: Cancer cannot be prevented

Fact: Scientists estimate that as many as 50 percent or more of cancer deaths in the United States are caused by social and environmental conditions and unhealthy choices. These conditions and choices can result in an unhealthy diet, obesity, or unhealthy human behaviors such as smoking and physical inactivity. We now know more about how to prevent many cancers including cancers of the lung, cervix, colon, rectum, and skin.

In general, the factors that can help prevent cancer include:

not using cigarettes or other tobacco products

avoiding second-hand smoke

not drinking too much alcohol

avoiding weight gain and maintaining a healthy weight

eating five or more daily servings of fruits and vegetables and a low-fat diet

balancing calories with physical activity

being physically active

protecting skin from sunlight

supporting community efforts to develop a healthy social and physical environment

Breast Cancer

Researchers estimate that a fourth to a third of breast cancers in postmenopausal women may be due to physical inactivity and overweight/obesity.*

Mammography is the best available method to detect breast cancer in its earliest, most treatable stage— an average of 1 to 4 years before a woman can feel a lump. Women aged 40 years or older should have a screening mammogram every 1 to 2 years.

Maintain a healthy weight. Limiting weight gain during childhood and adulthood is likely to reduce the risk of breast cancer. Losing weight if overweight may also reduce risk.

Regular physical activity is likely to reduce the risk of breast cancer.

Community efforts to increase physical activity, such as school-based physical education programs and creation of walking trails, can contribute to increased physical activity in your community.

Cervical Cancer

Cervical cancer can usually be prevented if women are screened regularly at least every three years with a test called the Pap test. The Pap test can find abnormal cells in the cervix. These cells may, over time, turn into cancer, and could take many years to happen. If the results of a Pap test show there are abnormal cells that could become cancerous, a woman can be treated. In most cases, this treatment prevents cervical cancer from developing.

Pap tests can also find cervical cancer early. When it is found early, the chance of being cured is very high. When it is found early and treated, cervical cancer is highly curable. The most important thing you can do to avoid getting cervical cancer is to have regular Pap tests.

Abnormal cells in the cervix and cervical cancer do not always cause symptoms, especially at first. That is why getting tested for cervical cancer is important, even if there are no symptoms.

Community efforts to increase access to and use of cancer screening can lead to greater cancer screening in your community.

Colorectal Cancer

If you are 50 or older, getting a screening test for colorectal cancer could save your life.

Colorectal cancer usually starts from polyps in the colon or rectum. A polyp is a growth that shouldn’t be there. Over time, some polyps can turn into cancer.

Screening tests can find polyps, so they can be removed before they turn into cancer. Screening tests can also find colorectal cancer early. When it is found early, the chance of being cured is good.

Researchers estimate that a fourth to a third of colorectal cancer may be due to physical inactivity and overweight/obesity.*

Maintain a healthy weight. Limiting weight gain during childhood and adulthood is likely to reduce risk of colorectal cancer and losing weight if overweight may reduce risk.

Regular physical activity is likely to reduce the risk of colorectal cancer.

Community efforts to increase physical activity, such as school-based physical education programs and creation of walking trails, can contribute to increased activity in your community.

Community efforts to increase access to and use of cancer screening can lead to greater cancer screening in your community.

Lung Cancer

Avoiding tobacco use is the single most important step Americans can take to reduce the cancer burden in this country.

Secondhand smoke is associated with an increased risk for lung cancer and coronary heart disease in nonsmoking adults. Secondhand smoke is a known cancer-causing agent.

Quitting smoking has immediate as well as long-term benefits, reducing risks for diseases caused by smoking and improving health in general.

Community efforts to limit smoking, such as indoor smoking policies and cigarette taxes, can help reduce smoking and exposure to secondhand smoke.

Skin Cancer

Exposure to the sun’s ultraviolet rays appears to be the most important environmental factor involved in the development of skin cancer. When used consistently, sun-protective practices can prevent skin cancer.

Although anyone can develop skin cancer, some people are at particular risk, including those with light skin color, hair color, or eye color; family history of skin cancer; personal history of skin cancer; chronic exposure to the sun; history of sunburns early in life; certain types of moles or a large number of moles; and freckles, which indicate sun sensitivity and sun damage.

Protect your skin from the sun, by choosing five sun protection options: seek shade, cover up, get a hat, wear sunglasses, and rub on sunscreen.

Breast and Cervical Cancer Screening: Free or Low-Cost Mammogram and Pap Test Contacts

http://apps.nccd.cdc.gov/cancercontacts/nbccedp/contacts.asp

Cancer Prevention and Control

http://www.cdc.gov/cancer/

Cervical Cancer Screening

http://www.cdc.gov/cancer/cervical/basic_info/screening/

Colorectal Cancer: Basic Facts on Screening

http://www.cdc.gov/cancer/colorectal/basic_info/screening/

Lung Cancer

http://www.cdc.gov/cancer/lung/

Skin Cancer and Melanoma Awareness

http://www.cdc.gov/cancer/nscpep/awareness.htm

Skin Cancer: Preventing America’s Most Common Cancer

http://www.cdc.gov/cancer/nscpep/about2004.htm

Skin Cancer Primary Prevention and Education Initiative

http://www.cdc.gov/cancer/nscpep/

Smoking: The Health Consequences of Smoking: Surgeon General’s Report, 2004

http://www.cdc.gov/tobacco/sgr/sgr_2004/Factsheets.htm

Smoking: Secondhand Smoke

http://www.cdc.gov/tobacco/factsheets/secondhand_smoke_factsheet.htm

About the National Breast and Cervical Cancer Early Detection Program

http://www.cdc.gov/cancer/nbccedp/about.htm

Cancer Information Summaries: Prevention http://www.nci.nih.gov/cancertopics/pdq/prevention/ (Non-CDC site)

Steps to a Healthier You
http://www.mypyramid.gov/ (Non-CDC site)

*Weight Control and Physical Activity: International Agency for Research on Cancer- Handbooks of Cancer Prevention, 2002
http://www.iarc.fr/IARCPress/general/prev.pdf (Non-CDC site)

Diabetes

Myth: There’s nothing you can do to prevent type 2 diabetes.

Fact: Diabetes prevention is proven, possible, and powerful. Studies show that people at high risk for type 2 diabetes can prevent or delay the onset of the disease by losing 5 to 7 percent of their body weight. For example, if you weigh 200 pounds, losing only 10 pounds could make a difference. You can do it by eating healthier and getting 30 minutes of physical activity 5 days a week.

Type 2 diabetes, formerly called adult-onset or noninsulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age, even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly.

More than 18 million Americans have diabetes, and 5.2 million cases are undiagnosed. An estimated 41 million U.S. adults aged 40–74 have prediabetes—that is, their blood sugar level is elevated but is not high enough to be classified as diabetes. People with prediabetes are at high risk for developing diabetes.

Diabetes can cause heart disease, stroke, blindness, kidney failure, pregnancy complications, lower-extremity amputations, and deaths related to flu and pneumonia. Heart disease is the leading cause of diabetes-related deaths, and death rates are about 2–4 times higher for adults with diabetes than for those without the disease.

Diabetes and Me: Prevent Diabetes

http://www.cdc.gov/diabetes/consumer/prevent.htm

Diabetes Prevention

http://www.ndep.nih.gov/diabetes/prev/prevention.htm

Am I At Risk for Type 2 Diabetes?
http://diabetes.niddk.nih.gov/dm/pubs/riskfortype2/ (Non-CDC site)

Environmental Health

Myth: You cannot prevent spreading illness on a cruise.

Fact: Each year millions of U.S. citizens enjoy cruise vacations. According to the Cruise Line International Association, in 2003, approximately 8.3 million passengers embarked from North American ports for their cruise vacation. Traveling on cruise ships exposes people to new environments and high volumes of people, including other travelers. Although an infrequent occurrence, this exposure creates the risk for illness, either from contaminated food, water, or – more commonly – through person to person contact. Follow these tips to help prevent the spread of illness:

Wash your hands before and after eating, after touching your face and going to the bathroom, and when your hands are dirty.

Leave the area if you see someone get sick (vomiting or diarrhea) and report it to the cruise staff. You could become sick if you ingest contaminated particles that travel through the air.

Take care of yourself. Get plenty of rest and drink lots of water. Resting helps rebuild your immune system. Drinking water helps prevent dehydration.

Be considerate of other people’s health. If you’re ill before taking a cruise, call the cruise line to determine if there are alternative cruising options.

Cruising Tips

http://www.cdc.gov/nceh/vsp/pub/CruisingTips/cruisingtips.htm

Handwashing Tips and Techniques

http://www.cdc.gov/nceh/vsp/pub/Handwashing/HandwashingTips.htm

Immunizations

Myth: Adults do not need immunizations unless they are traveling outside the country.

Fact: Vaccines aren’t just for travelers and kids. Far too many adults become ill, are disabled, and die each year from diseases that could easily have been prevented by vaccines. Thus, everyone from young adults to senior citizens can benefit from immunizations. Vaccines help prevent infectious diseases and save lives. Vaccines are responsible for the control of many infectious diseases that were once common in this country, including polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, and Haemophilus influenzae type b (Hib).

Vaccines for adults include:

Tetanus-Diphtheria: all adults, every 10 years

Influenza (flu): adults at risk and all those 50 and older

Pneumococcal: adults at risk and all those 65 and older

Hepatitis A and B: adults at risk

Measles-Mumps-Rubella (MMR): susceptible adults

Varicella (chickenpox): susceptible adults

Vaccines for travelers

Adolescent and Adult Immunization Quiz

http://www2.cdc.gov/nip/adultImmSched/

Adult Immunization Schedule

http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm

Vaccine-Preventable Adult Diseases

http://www.cdc.gov/vaccines/vpd-vac/adult-vpd.htm

Pregnancy and Reproductive Health

Myth: Birth defects cannot be prevented.

Fact: Approximately 3000 pregnancies per year in the United States are affected by serious birth defects of the brain (anencephaly) or spine (spina bifida). Up to 70% of these defects can be prevented if a woman consumes the B vitamin folic acid daily before pregnancy and through the first trimester. The U.S. Public Health Service recommends that all women who can become pregnant consume 400 micrograms of folic acid daily to help prevent these serious birth defects. Since half of all pregnancies are unplanned, it is important to take folic acid every day!

Folic Acid

http://www.cdc.gov/ncbddd/folicacid/

Sexually Transmitted Diseases (STDs and HIV/AIDS)

Myth: If you do not have any symptoms, you do not have a sexually transmitted disease/sexually transmitted infection (STD/STI).

Fact: Many STDs/STIs are asymptomatic- without signs or symptoms- while serious damage is being done to a woman’s reproductive organs. The only way to know for sure if you are or are not infected is to be tested. If you suspect you have a sexually transmitted infection or if your sexual partner has symptoms, you can go to your doctor or health department for testing. Talk with a knowledgeable health care provider or counselor both before and after you are tested.

The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

The following STDs may be asymptomatic:

Bacterial Vaginosis

http://www.cdc.gov/std/BV/STDFact-Bacterial-Vaginosis.htm

Chlamydia

http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm

Gonorrhea

http://www.cdc.gov/std/Gonorrhea/STDFact-Gonorrhea.htm

Human Immunodeficiency Virus (HIV)

http://www.cdc.gov/std/hiv/STDFact-STD&HIV.htm

Human Papillomavirus (HPV)

http://www.cdc.gov/std/HPV/STDFact-HPV.htm

Pelvic Inflammatory Disease (PID)

http://www.cdc.gov/std/PID/STDFact-PID.htm

Syphilis

http://www.cdc.gov/std/Syphilis/STDFact-Syphilis.htm

Trichomoniasis

http://www.cdc.gov/std/Trichomonas/STDFact-Trichomoniasis.htm

Smoking and Tobacco

Myth: Low-tar or light cigarettes are not as harmful as regular cigarettes.

Fact: There is no safe tobacco product. The use of any tobacco product can cause cancer and other adverse health effects. This includes all forms of tobacco, including cigarettes, cigars, pipes, and spit tobacco; mentholated, “low-tar,” “naturally grown,” or “additive-free.” The poisonous ingredients in cigarettes aren’t just limited to tar and nicotine. A typical cigarette contains lead, ammonia (a household cleaner), arsenic (used in rat poison), benzene (used in making gas), butane gas, carbon monoxide (a poisonous gas), DDT (a banned insecticide), and polonium 210 (cancer-causing radioactive element). To reduce your risk for lung cancer, stroke, heart disease, and reproductive health problems, avoid all tobacco products and exposure to second-hand smoke.

Light Cigarettes Myth

http://www.cdc.gov/tobacco/christy/myth6.htm

Women and Smoking: A Report of the Surgeon General

http://www.cdc.gov/tobacco/sgr/sgr_forwomen/

Violence

Myth: Rape does not happen very often.

Fact: Rape and attempted rape happen more often than you may think. According to the National Violence against Women survey, 1 in 6 women and 1 in 33 men in the United States have experienced an attempted or completed rape at some time in their lives. In 8 out of 10 rape cases, the victim knew the perpetrator. The first step in preventing sexual violence is to identify and understand vulnerability factors. A vulnerability factor is anything that increases the likelihood that a person will suffer harm. Vulnerability factors for sexual violence include: young age, drug or alcohol use, prior history of sexual violence, multiple sex partners, and poverty.

Sexual Violence

http://www.cdc.gov/ncipc/dvp/SV/default.htm

Sexual Violence: Prevention Strategies and Links

http://www.cdc.gov/ncipc/factsheets/svprevention.htm

The Truth about Rape

http://www.cdc.gov/ncipc/dvp/The%20Truth%20About%20Rape%20Final.pdf

URL: http://www.cdc.gov/women/owh/myths/

Diet Plans for Men

From the FMS Global and UK News Desk of Jeanne Hambleton

Atkins vs. Ornish, South Beach Diet vs. the Zone: Does any weight loss plan really work?

Courtesy of WebMD.com

By Peter Jaret – Reviewed by Matthew Hoffman, MD – WebMD Feature

After four years of following one diet plan after another and watching his weight yo-yo up and down, Marv Leicher finally discovered the secret formula for losing weight and keeping it off successfully.

And he is not sharing it with anyone.

“I wasted enough of my own time following somebody else’s idea of the perfect diet plan,” says Leicher, 42, an insurance claims adjuster in Iowa. “I do not want some poor fool following my advice and then wondering why it is not working for him. The real secret is that there is no one perfect diet. What works for one person would not necessarily work for someone else.”

From one diet plan to the next

Leicher began by following a low-fat diet. For a few months, the pounds dropped away. He bought a new set of pants with a slimmer waist. And before long, the numbers on the bathroom scale started climbing again. Frustrated, Leicher took a friend’s advice and started following the Atkins high-protein/low-carb diet. He started losing weight within the first week. After four months, he was back to wearing his new lean and mean wardrobe.

“I really thought, OK, this is it. I am home free.”

Then came the holidays — office parties, family dinners — and when they were over, Leicher had regained 10 pounds and was on his way back to being overweight.

“That is when I said to myself, ‘Wait a minute. I am a capable guy. This is not rocket science. I should be able to figure this out.’”

So Leicher sat down and made a list of the parts of diets that seemed to work for him. He went through all the rest of the advice that he had heard — eat breakfast, do not eat breakfast; choose healthy snacks, avoid snacks — and added the tips that seemed to help.

“I ended up with six rules. Frankly, I would be embarrassed to show them to anyone else. But they were changes I knew I could make without feeling like I was doing penance for some past sins.”

Within three months, he was back down to his college weight. This time, though, he stayed there. “It has been almost a year, and I do not even really think of myself as being on a diet. This is just the way I eat.”

How popular diet plans score

What works? What does not? With some 38,000 diet books in print — and 2,500 new ones hitting the shelves every year — not to mention magazines trumpeting the ultimate new fad diet in every monthly issue, there is plenty to choose from. Lately, even researchers have got into the act. The National Institutes of Health and university medical centers around the nation have spent many years and millions of dollars to test the Atkins diet versus the South Beach, the American Heart Association diet versus the Zone.

Along the way, there have been genuine surprises. The low-fat diet, widely endorsed by many official groups, has not turned out to be as safe or effective as most experts thought. Some people do manage to lose weight on low-fat diets, but usually weight loss is fairly slow — only a pound or two a month. And while levels of bad cholesterol (LDL) fall, studies show that levels of good cholesterol also drop. Many people on low fat diets also see a rise in triglycerides — an independent risk factor for heart disease.

To almost everyone’s surprise, low-carb/high-protein diets — Atkin’s is the model — have proved much safer and more effective than expected. Here was a diet that featured eggs and bacon and warned people away from bread. Yet study after study has shown that for people who are overweight or obese, high-protein/low-carb diets have real advantages.

“These diets push most of the numbers in the right direction,” says Ronald Krauss, MD, a senior researcher at Children’s Hospital Oakland Research Institute and a spokesperson for the American Heart Association.

“Body weight and body fat go down, triglycerides and LDL cholesterol drop, while at the same time good cholesterol levels remain up. Low-carb diets also improve insulin sensitivity even without weight loss, so they offer better protection against diabetes.”

The best news for dieters is that high-protein/low-carb dieters also shed pounds faster, on average, than low-fat dieters. In the latest of a string of studies that have pitted one popular diet against another, researchers at Stanford put the Atkins, Zone, Ornish, and LEARN diet to the test. After 12 months, volunteers on the Atkins diet had lost more weight — twice as much — as people on any of the other diets.

But if you are looking to dramatically change your shape, the numbers were not all that encouraging. The average weight loss was a scant 10.3 pounds.

In a slew of recent head-to-head studies of popular diets, in fact, the Atkins diet has pulled ahead in the first few months, resulting in more and faster weight loss. Many experts have come around to accept the notion that protein-rich foods may be more satiating than carb-rich foods.

Unfortunately, the Atkins lead typically evaporates by the end of a year. In a 2006 British study that compared four popular weight loss plans, for example, volunteers lost weight faster on the high-protein/low-carb plan. But after a year, all four diets had resulted in about the same weight loss, about 13 pounds. What is more, several studies comparing diets have seen very high drop-out rates. Even with scientists looking over their shoulders, it turns out people have trouble sticking with most diets.

The best diet plan

Disheartening? Sure. But lurking behind the generally glum news about fad diets and popular weight loss programs are individual success stories — and important information for anyone looking to lose weight.

“If you look at all these studies, you find that on almost any diet, some people do very well and others do not lose any weight at all,” says Janet King, PhD, professor of nutrition at the University of California, Berkeley,who chaired the 2005 Dietary Guidelines Advisory Committee for the U.S. High-protein diets may have an initial advantage in jump-starting weight loss.

But all weight loss plans have one thing in common: They restrict certain kinds of foods and thus limit calories. “Most diets work in the short-term, and the reason is that they simplify decisions about what you’re going to eat,” says King. “They take variety out of the diet. Some restrict carbohydrates. Some restrict fat. But the end result is that they offer a way to eat fewer calories.”

The reason some people succeed is also simple: motivation. “What really matters is compliance, which is another way of saying someone is motivated enough to stick with a diet,” says King.

The best diet plan, in other words, is the one that you are most likely to be able to follow for the long haul. And that is likely to be different for different people. Men who are basically vegetarians are going to have a tough time following the Atkins diet. Steak-and-eggs men are not going to stick with a low-fat, mostly veggie diet plan for long.

Kathleen M. Vohs, a psychologist at the University of Minnesota, believes choosing a regimen that most closely matches the way you like to eat is crucial. She offers a provocative reason.

“Studies show that self-control is a limited resource,” says Vohs. “People may have an easy time giving something up the first time. But when people are repeatedly asked to exhibit self-control, that ability begins to erode.”

It is easier to eat a healthy meal for breakfast, in other words, than to stick with a diet plan once dinner rolls around, especially if it means saying no to foods you love. And by extension, it is easier to stick with a diet that does not eliminate most of the foods you love.

One man’s diet plan

That is a lesson Marv Leicher took to heart when he decided to abandon popular diets and fashion his own weight loss regimen. “Basically, I picked and chose from the strategies that seemed easiest for me to follow,” he says. “It was no big deal to give up soft drinks and fruit drinks, so I did that religiously. No liquid calories. I’m not the kind of guy who can eat just half of what’s in front of him, so I gave up trying to divide portions. Instead, I decided, no desserts. At lunch, I used to go out with people from the office. Now I bring a cup of yogurt and some trail mix, and if the weather is good I take a half hour walk and eat a quick lunch. Little stuff like that.”

Little stuff. But for Leicher, it adds up to big results. Over the past year, he’s lost 30 pounds. Best of all, he’s keeping them off.

©2005-2009 WebMD, LLC. All rights reserved.
(http://men.webmd.com/guide/diet-plans-men?ecd=wnl_men_040709)

Vitamin and Mineral Supplements for Men
Why multivitamins and other dietary supplements can be hazardous to your health

Courtesy WebMD.com

By Arthur Allen -Reviewed by James E. Gerace, MD – WebMD Feature

More than half the adults in America regularly use multivitamins and other supplements to boost their immune systems and enhance nutrition, supporting an industry worth more than $20 billion annually. Grocers stock every conceivable vitamin, mineral, and herbal “boost,” and every neighborhood seems to have its own supplement store.

So are vitamins and mineral supplements for men really necessary?

Based on the current evidence, the answer is a definitive “no.” “For me,” says Christian Gluud, MD, a vitamin researcher at Copenhagen University Hospital in Denmark, “the simple answer is do not use them.”

“Except for certain defined population groups,” says Irwin H. Rosenberg, MD, director of the nutrition and NeuroCognition Laboratory at Tufts University, “there is no evidence that supplemental vitamins and minerals are beneficial for your health.”

He goes on to tell WebMD, “There is no indication that a poor diet is going to be made into a good diet by taking multivitamins.”

Vitamin and mineral supplements can lead to early death

It is not just that vitamin and mineral supplements provide little benefit for the healthy middle-aged man. Large doses of the pills can actually make you sick and reduce your lifespan. A review of 68 randomized trials of high-dose antioxidant supplements such as vitamins C and E found a 5% higherrisk of death in those who took them.

The study, published in February in the Journal of the American Medical Association (Gluud is the lead author), found an even greater risk of death for vitamin users in a subset of 47 carefully conducted trials.

At first glance, this seems contradictory. Over the past three decades, many studies have found that eating fresh fruits and vegetables, which contain high amounts of antioxidants and other vitamins and minerals, can add years to a healthy life. But there are obviously components of a healthy lifestyle that can not be bottled.

“Multivitamins are not a shortcut,” Gluud says. “You are better off eating a varied diet instead of risking the increased mortality of taking these supplements.”

Multivitamins and the middle-aged man

To be sure, vitamin supplements can be beneficial for certain groups of people. After the age of 55 or so, your body starts to lose the capacity to make vitamin D from sunshine, and adding a vitamin D pill may be a good idea.

The elderly also lose the ability to absorb vitamin B12 from their diet, and some of this deficiency can be met by taking a B12 supplement. Cancer patients, or people eating fewer than 1,000 calories a day, may have vitamin deficiencies. Vegans may need some B vitamins and iron unless they are meticulous about getting these nutrients from their diet.

“There really is no strong evidence to support the need of the average 35- to 55-year-old man to take a multivitamin,” says Cheryl Rock, MD, professor of nutrition in the Department of Family and Preventive Medicine at the University of California, San Diego, School of Medicine.

“If you’re concerned about your nutritional levels, a doctor can order tests. It is quite easy to find out, for example, if you are deficient in B12 or vitamin D. And usually one visit with a dietician will be covered by health insurance.”

So far, the evidence of benefit, and harm, from supplements comes from careful studies of large doses of particular vitamins and minerals. There is almost no evidence of health effects from multivitamins. Taking a once-a-day vitamin pill is probably as harmless as it is pointless, except for the manufacturer that can produce a bottle of pills for a few cents and market it for $9.99, nutrition experts say.

Do multivitamins work if you think they do?

There can be, of course, a placebo benefit from a multivitamin or other supplement — the benefit of feeling in control of your health and hopeful of the results. “Even in the face of evidence that multivitamins lack efficacy, people are still going to take them,” says Marion Nestle, PhD, professor of nutrition at New York University and author of What to Eat.

“You’re dealing here with something that goes beyond science and has to do with belief systems.”

Nestle notes that when the recent JAMA study came out, many scientists interviewed about its findings said they would still keep taking vitamins. (Nestle, for one, does not regularly take supplements: “Sometimes when I need a placebo, I’ll pop one.”)

An unhealthy dose of heavy metal

But buyers beware. Some pills contain less or more of a vitamin than promised, and it is not unusual to find heavy metals like lead in the pills, according to chemical analyses by the commercial laboratory ConsumerLab.com, which tests vitamins for sports teams and others.

To be sure, the existence of a vast industry selling products that are potentially dangerous and probably of marginal value strikes some as troubling. We have Congress to thank for the virtually unregulated state of the supplement industry.

The 1994 Dietary Supplement Health and Education Act effectively handcuffed regulation of dietary supplements by the Food and Drug Administration. The term “supplements” includes everything from vitamins and minerals to herbal supplements such as ephedra, saw palmetto, ginkgo biloba, and other substances, some of which have powerful pharmacological effects. Purveyors of these substances are not required to prove their efficacy, and the FDA must show they are dangerous before removing them from the market. The supplement maker has no obligation to test the safety of the product.

Since passage of the bill, the market in vitamin and mineral supplements has ballooned from an estimated $3.3 billion in 1990 to well over $20 billion.

How did vitamin and mineral supplements get such a good rep?

A body of research conducted in the 1980s and 1990s seemed to show benefit from vitamin and mineral supplements in preventing chronic diseases like cancer and osteoporosis and heart disease. But reviews of these studies showed that much of the benefit attributed to supplements was actually attributable to the overall better health practices of those who took them. In other words, people who took vitamin supplements also tended to eat better, smoke less, and get more exercise, says Rosenberg.

Many people have started taking supplements containing antioxidants because of research gathered over the past three decades showing these compounds help slow cell damage. But a well-fed population is already ingesting enough to overcome oxidative stress, and adding more antioxidants probably would not lower the risk of chronic diseases, says Rock.

Foods rich in antioxidizing compounds range from walnuts, blackberries, artichokes, and pecans to brewed coffee and chocolate cupcakes. Yet these products are not equally good for you, and you obviously would not want to build a diet exclusively around antioxidants.

SOURCES: Bjelakovic, G. et al., Journal of the American Medical Association, Feb. 28, 2007; vol 297(8): pp 842–57. Huang et al., American Journal of Clinical Nutrition, 2007; vol 85 (suppl): pp S265–S268. Gad, S.C. and S.E., International Journal of Toxicology, 2003; vol 22: pp 381–385. Fletcher, F., JAMA, June 19, 2002; vol 287(23): 3116–3126. Halvorsen, B. et al., American Journal of Clinical Nutrition, 2006; vol 84: pp 95–135. Morris, M.C. et al., Archives of Neurology, April 2005; vol 12: pp 641–645. Christian Gluud, MD, Copenhagen University Hospital. Irwin H. Rosenberg, MD, director, Nutrition and NeuroCognition Laboratory, Tufts University. Cheryl Rock, MD, professor of nutrition, Department of Family and Preventive Medicine, University of California, San Diego, School of Medicine. Marion Nestle, PhD, professor of nutrition, New York University; author of What to Eat (North Point Press, 2007). Paul M Coates: testimony before the Committee on Government Reform, US HR, March 9, 2006. ConsumerLab.

©2005-2009 WebMD, LLC. All rights reserved.
(http://men.webmd.com/guide/vitamin-mineral-supplements-men)

Dual action

From Jeanne Hambleton’s FMS Global News Desk
By Sandra Flahive (FiftySomething) January 10 2009

Bill and Susan Steffey of Grimes both have seen great physical improvements since they began exercising together at the Wellness Center at Mercy Medical Center.

Susan, 55, first started a regular workout regimen in July on the advice of her rheumatologist. Bill, 60, joined her a couple months later, hoping to lose weight and lower his cholesterol.

Three days a week, the couple attends a low-impact aerobics class that’s especially tailored to older adults. They warm up on the treadmill before class. Afterward, Bill hits the weights while Susan gets on the elliptical machine.

Both have lost weight since they began exercising regularly. Susan, who has arthritis, fibromyalgia and a pulmonary disease, says her muscles and joints are stronger and her lung capacity has improved.

Through weight training, Bill says he has been able to strengthen his bad knee and can now get up stairs without using the handrail to pull himself up.

“Neither one of us will go without the other one,” Susan says of their workouts. “That’s a huge motivator because you feel guilty. And we’ve made great friends.”

It has also given them a chance to spend more together and become closer, she says.

Because his wife’s health and stamina have improved, they are considering taking vacations, Bill says. That includes travelling to Indianapolis for a NASCAR race in July.

“Now that she is working (out) … she has got a little stronger, and we are talking about doing those things again together,” he says.

What a difference a year makes. A year is about how long Ankeny couple Bill Riley Jr. and his wife, Bridget, have been regulars at the Aspen Active Fitness Center in the West Glen Town Center.

With the help of their respective personal trainers, the Rileys say their lives have changed dramatically. The two – who were not regular exercisers – now give each other workout tips, regularly check on one another’s progress and have bought fitness equipment to use at home.

They say they feel better, have replaced body fat with muscle, eat more healthfully and are excited about the future.

“We are enjoying this. We are feeling that we are doing something for ourselves and not just letting ‘old man time’ chip away at us,” says Bill, 51. “We are feeling a lot better about being 60, 65, 70. We plan on being very active … and you cannot do that without your health. We made the decision to start that now, and we are glad we did it.”

In the past, fitness clubs had been intimidating and uncomfortable places for him and his wife, Bill says. Then he met certified personal trainer Mickey Pesek at Aspen Athletic Fitness Center.

“The personal training has made a huge difference in our outlook and opinions of joining a gym,” says Bill, whose triglycerides, cholesterol and blood pressure have decreased.

Bridget, an oncology nurse, says several factors influenced her to join her husband in getting fit: turning 50, her mother having a massive stroke a year ago and seeing how good her husband was feeling.

Bridget works with certified personal trainer Trista Manikowske. “She makes me feel confident and accomplished,” she says. “It is probably the best I have felt health-wise since I was 20.”

She says she feels healthier, has a better attitude about herself and sleeps better. The couple rarely eats out anymore, she says, and have added more fish and protein to their diet.

“We talk about growing old together and walking together and being outdoors. We talk about doing vacations that involve a lot of walking … and keeping our hearts healthy and blood pressure good,” Bridget says.

Setting goals together helps the two individuals be supportive of, and accountable to, each other, says Manikowske, the personal trainer. It is also a good idea to write down those goals.

“People with written goals accomplish five to 10 times as much as people who have never taken the time to actually write them down. It helps you remember what they are,” she says.

7 Tips for Exercising in Tandem
Certified trainers Trista Manikowske and Mickey Pesek offer these suggestions for couples working together toward physical fitness.

• Make a plan together and stick to it. Devise a workout schedule and, if you are working out separately, ask each other questions about your progress.

• Decide on a reward for meeting your goals. Looking forward to a vacation, for example, can motivate and encourage you.

• Find fun physical activities you can do together.

• Plan healthful meals, shop for groceries and cook as a couple.

• When going out to eat, split portions with each other.

• Get the whole family involved in eating more healthfully and exercising.

• For a spouse or significant other reluctant to get more physically active, give a gym membership as a birthday or anniversary gift or invite the person to work out with you. Some personal trainers offer “buddy sessions,” where two people get personal training together for an hour.

Good advice….My thanks to the Desmoine Register http://www.desmoinesregister.com/article/20090110/FIFTYSOMETHING/301110005/-1/SPORTS12

Great expectations — Study looks at why placebo effect varies from person to person

ANN ARBOR, Mich. — Why do some people experience a “placebo effect” that makes them feel better when they receive a sham treatment they believe to be real — while other people don’t respond at all to the same thing, or even feel worse”

A new study from the University of Michigan Health System may help explain why.

Using two different types of brain scans, U-M researchers have found that the extent to which a person responds to a placebo treatment is closely linked to how active a certain area of their brain becomes when they’re anticipating something beneficial.

Specifically, the research finds strong links between an individual’s response to a placebo “painkiller”, and the activity of the neurotransmitter known as dopamine in the area of the brain known as the nucleus accumbens. That’s a small region at the center of the brain that’s involved in our ability to experience pleasure and reward, and even to become addicted to the “high” caused by illicit drugs.

The new research, published in the July 19 issue of the journal Neuron, builds on research previously published by the same U-M team in 2005. That study was the first to show that just thinking a placebo “medicine” will relieve pain is enough to prompt the brain to release its own natural painkillers, called endorphins, and that this corresponds with a reduction in how much pain a person feels.

“Receptors for both endorphins and dopamine are clustered heavily in the nucleus accumbens. So, taken together, our studies delve directly into the mechanisms that underlie the placebo effect,” says senior author and U-M neuroscientist, psychiatrist and brain-imaging specialist Jon-Kar Zubieta, M.D., Ph.D. “This is a phenomenon that has great importance for how new therapies are studied, because many patients respond just as well to placebo as they do to an active treatment. Our results also suggest that placebo response may be part of a larger brain-resiliency mechanism.”

For the current study, Zubieta and his colleagues — led by neuroscience graduate student David J. Scott — combined information from two types of brain scan to come to their conclusions. They performed PET (positron emission tomography) scans on the brains of 14 healthy volunteers, and fMRI (functional magnetic resonance imaging) scans on those 14, and on 16 other healthy volunteers.

The PET scans focused on brain dopamine, looking at its activity as volunteers were told to expect, and then received, a painful injection of saline solution in their jaw muscle. They were then told to expect, and then received, an injection that they were told could either be a painkiller or a placebo. (Both were in fact placebos.) The fMRI scans looked at volunteers’ brains while they played a game. Before each round, they learned that a correct answer would win or lose an amount of money, up to $5.

The PET scans were made using 11C-raclopride, which combines a drug that binds preferentially to dopamine receptors with a short-lived radioactive form of carbon that can be “seen” on PET scans. Throughout the PET scanning session, volunteers were asked to rate their level of pain on a numerical scale, and to describe any emotions they were experiencing.

Before the painful injection began, but after the volunteers had been told it was coming, they were also asked to guess how much pain relief they’d get from the “painkiller” if they received it. Half the volunteers were women, all in the same stage of their monthly cycle to avoid differences in hormonal state that might affect tolerance of pain – another topic that Zubieta’s team has studied.

The PET scans and pain ratings revealed that as a group, the volunteers experienced significant pain relief from the placebo. But when researchers looked at each individual’s results, they found that only half of the volunteers reported less pain when they received the “painkiller” placebo.

These placebo responders, as they were dubbed, had significantly more dopamine activity in their left nucleus accumbens than the other volunteers, beginning when they were told the painkiller medicine was about to begin flowing into their jaws. It also turned out that these individuals had also all anticipated the “painkiller” would give good pain relief before they even received it.

Meanwhile, of the seven individuals who didn’t experience the placebo effect, four actually reported feeling more pain when the “painkiller” was delivered – a phenomenon that has been dubbed the “nocebo” effect and has been observed in other situations.

Just to make sure that the volunteers’ pain ratings weren’t affected by the fact that they always received painful injections followed by placebo “painkiller”, the researchers put a separate group of 18 male volunteers through the same experience twice, but no placebo was actually given, and actual PET scans were not done. Their pain and emotion ratings were significantly different from those of volunteers who received placebo.

“The results of these functional molecular imaging studies indicate that dopamine activity is activated in response to a placebo in a manner that’s proportional to the amount of benefit that the individual anticipates,” says Zubieta, who is the Phil F. Jenkins Professor of Depression in the U-M Medical School’s Department of Psychiatry and a member of U-M’s Molecular and Behavioral Neuroscience Institute, Depression Center and Department of Radiology.

The fMRI scans, which were performed on different days from the PET scans, revealed additional information about how individual expectations correlated with their placebo response. Each volunteer had an fMRI scan that looked at blood oxygenation throughout their brain, which allows researchers to spot areas where neurons (brain cells) are especially active as the individual performs a task or plays a game. In this case, the task was a very simple gambling game, in which subjects were scanned while expecting varying levels of a monetary reward or no reward.

As in the PET scans, the nucleus accumbens was a hotbed of activity as the volunteers were told how much money they could win or lose in the next round; as they waited for the round; and as they pressed the button and learned if they had succeeded in winning or avoiding losing money.

Then, the researchers compared the PET and fMRI scans for the volunteers who had had both types of scan. They also compared the ratings of anticipated placebo effect, the analgesia induced by the placebo during the pain studies, and the emotional changes associated with it. They found that those who expected a placebo to help them and got greater benefit from it (more analgesia, better emotional state) were also those who had the most activity in their nucleus accumbens during the anticipation of receiving a reward in the fMRI money game.

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EMBARGOED FOR RELEASE 12 p.m. ET JULY 18, 2007

In addition to Zubieta and Scott, the study’s authors are Christian Stohler, DMD, formerly of the U-M School of Dentistry and now dean of the University of Maryland School of Dentistry; Christine Egnatuk and Heng Wang of the U-M MBNI; and Robert Koeppe, Ph.D., director of the PET Physics Section in the Nuclear Medicine division of the U-M Department of Radiology. The study was funded by the National Institutes of Health.

Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System

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Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review.

1: Evid Based Complement Alternat Med. 2007 Jun;4(2):165-79. Epub 2007 Feb 5.

Tsao JC.

Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, USA.

Previous reviews of massage therapy for chronic, non-malignant pain have focused on discrete pain conditions. This article aims to provide a broad overview of the literature on the effectiveness of massage for a variety of chronic, non-malignant pain complaints to identify gaps in the research and to inform future clinical trials. Computerized databases were searched for relevant studies including prior reviews and primary trials of massage therapy for chronic, non-malignant pain. Existing research provides fairly robust support for the analgesic effects of massage for non-specific low back pain, but only moderate support for such effects on shoulder pain and headache pain. There is only modest, preliminary support for massage in the treatment of fibromyalgia, mixed chronic pain conditions, neck pain and carpal tunnel syndrome. Thus, research to date provides varying levels of evidence for the benefits of massage therapy for different chronic pain conditions. Future studies should employ rigorous study designs and include follow-up assessments for additional quantification of the longer-term effects of massage on chronic pain.

PMID: 17549233 [PubMed - in process]

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Fibromyalgia: The misunderstood disease

June 1, 2007

A University of Michigan Health Minute update on important health issues.

U-M research gives hope for new treatments, better understanding of chronic pain condition

ANN ARBOR, MI – Fourteen years ago, Josephine* began to experience severe pain throughout her body. As her symptoms became worse, she sought help from a variety of specialists, but no one could diagnose her condition.

“I was told they didn’t know what was wrong with me; the blood tests came back good, x-rays came back clear,” she says. “They had no idea and they’d shuffle me to another doctor, another specialist.” She saw rheumatologists, neurologists, internists, and blood specialists, but there was still no answer.

After more than a year, she was finally diagnosed with fibromyalgia, a chronic and debilitating condition that causes severe pain throughout the body. Ongoing research at the University of Michigan is demonstrating that fibromyalgia may affect millions of Americans, and research using sophisticated imaging techniques is helping the medical community better understand this disease.

“Fibromyalgia is a condition that’s characterized by widespread pain involving the muscles, the joints, and in fact, any area of the body,” explains Daniel Clauw, M.D., director of the U-M Chronic Pain and Fatigue Research Center. “In addition to pain, individuals with fibromyalgia often experience sleep fatigue, difficulties with sleep, and difficulties with memory and concentration, among other symptoms.”

Josephine’s symptoms included extreme fatigue, recurring headaches, chest pains, stomach and intestinal problems, muscle fatigue and weakness, restricted mobility, and anxiety. At her worst point, Josephine was bed-ridden and medicated to the point that she wasn’t functioning due to the pain.

However, there is hope. “Fibromyalgia is gaining respect in both the scientific and the lay community because of all the research that’s been conducted – first, showing that it’s a real disease, and second, showing that there are drugs that specifically work to treat fibromyalgia,” Clauw says. “Our group and others at the University of Michigan have been very involved in looking at the underlying mechanisms of fibromyalgia.”

Clauw and his colleagues use a technique called functional imaging, which allows scientists to look at how different areas of the brain function when people are given painful stimuli. What they have found is that for the same amount of damage or inflammation in the peripheral tissues, a fibromyalgia patient would
feel significantly more pain than the average person. Patients with fibromyalgia can also experience pain throughout their entire body even without any damage or inflammation of the peripheral tissues.

“We think that one of the primary abnormalities in fibromyalgia is an imbalance between the levels of neurotransmitters in the brain that affect pain sensitivity,” Clauw says. With this knowledge, new treatments are being developed to combat the condition’s symptoms. “Although right now there are no drugs approved to treat fibromyalgia, within three years it its likely that there will be three, if not four, drugs specifically approved to treat the condition,” he says.

These drugs fall into two general classes. One class raises the levels of neurotransmitters that normally stop the spread of pain, while another class lowers the levels of neurotransmitters that normally increase the spread of pain.

The American College of Rheumatology estimates that about 3 percent of Americans suffer from fibromyalgia, but Clauw notes that this may not accurately reflect the number of people with this condition. “It’s widely agreed that their definition is very restrictive. In fact, it’s probably more like 5 or 6 percent of Americans,” he says.

There are other misunderstandings about fibromyalgia. Some physicians believe that its symptoms are all psychological. “The doctors say, ‘Well it’s all in your head, you just need to get some extra rest and you’ll be fine, toughen up,’” Josephine remembers. Another misconception about the disease is that it is caused by inflammation in the muscles. Doctors now know that neither of these theories is true. “This is not an inflammatory disorder and this is not a primary psychological condition,” Clauw clarifies. “Pain is always a subjective matter, but everything that we can measure about the pain in fibromyalgia shows that it is real.”

Unfortunately, patients are often misdiagnosed as having disorders such as rheumatoid arthritis, chronic fatigue syndrome, or irritable bowel syndrome. Fibromyalgia has no definitive diagnosis, so doctors must rely on a patient’s medical history and symptoms when diagnosing the illness, excluding conditions that might cause similar amounts of widespread pain.

The condition’s cause is still unknown, although it is probably a combination of genetics and environment. “A person is about eight times more likely to develop fibromyalgia if one of their relatives has it,” says Clauw. “But there are also certain environmental triggers. For example, people develop fibromyalgia after motor vehicle accidents, or after certain types of infections or biological stress,” he continues. Although the disease is more common in women, there are no real demographic factors that can predict its development.

Clauw recommends that anyone who experiences pain or fatigue that is severe enough to inhibit day to day functioning seek medical attention, even if the symptoms have only lasted a couple of days. “It’s better to get medical attention and appropriate treatment early for this condition,” he says.

As for Josephine, maintaining a positive attitude and acknowledging and accepting the disease has helped her live a more normal life. “I know that I will always have this disease, but now I see myself as a survivor,” she says.

* Not her real name

For more information on fibromyalgia, visit these Web sites:
UMHS Health Topics A-Z

National Fibromyalgia Association

Written by Marissa Mann

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The effect of acclydine in chronic fatigue syndrome: a randomized controlled trial.

1: PLoS Clin Trials. 2007 May 18;2(5):e19.

The GK, Bleijenberg G, van der Meer JW.

Department of General Internal Medicine, Nijmegen Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

OBJECTIVES: It is unclear whether insulin-like growth factor (IGF) function is involved in the pathophysiology of chronic fatigue syndrome (CFS). Unpublished data and reports in patient organization newsletters suggest that Acclydine, a food supplement, could be effective in the treatment of CFS by increasing biologically active IGF1 levels. Here we aimed to measure the IGF1 and IGF binding protein (IGFBP) 3 status of CFS patients compared to age- and gender-matched neighborhood controls, and to assess the effect of Acclydine on fatigue severity, functional impairment, and biologically active IGF1 level (IGFBP3/IGF1 ratio).

DESIGN: A randomized, placebo-controlled, double-blind clinical trial. SETTING: Radboud University Nijmegen Medical Centre, The Netherlands. PARTICIPANTS: Fifty-seven adult patients who fulfilled the US Centers for Disease Control and Prevention criteria for CFS. IGF status of 22 CFS patients was compared to that of 22 healthy age- and gender-matched neighborhood control individuals.

INTERVENTION: Acclydine or placebo for 14 wk.

OUTCOME MEASURES: Outcomes were fatigue severity (Checklist Individual Strength, subscale fatigue severity [CIS-fatigue]), functional impairment (Sickness Impact Profile-8 [SIP-8]), and biologically active IGF1 serum concentrations. Analyses were on an intention-to-treat basis.

RESULTS: There was no difference in IGF status in 22 CFS patients compared to healthy age- and gender-matched control individuals. Treatment with Acclydine did not result in significant differences compared with the placebo group on any of the outcome measures: CIS-fatigue +1.1 (95% CI -4.4 to +6.5, p = 0.70), SIP-8 +59.1 (95% CI -201.7 to +319.8, p = 0.65), and IGFBP3/IGF1 ratio -0.5 (95% CI -2.8 to +1.7, p = 0.63).

CONCLUSION: We found no differences in IGF1 status in CFS patients compared to healthy matched neighborhood controls. In addition, the results of this clinical trial do not demonstrate any benefit of Acclydine over placebo in the treatment of CFS.

PMID: 17525791 [PubMed - in process]

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The Fibromyalgia and Chronic Fatigue Self-Help Group – Quest 4 Life

For Immediate Press Release

Thursday, June 14, 2007 Meeting

6:30 pm at Quest 4 Life in Lenoir, NC

The Fibromyalgia and Chronic Fatigue Self-Help Group meets monthly except July and August. The focus of the group is on Positive Self-Help for those attending. The June meeting will focus on Using Your Talents, Frustrations and Rewards. A special performance by Debra Greene, muscian, vocalist, and poet will be the highlight of the meeting. Debra’s story tells how one with severe pain can use their talents to soothe and ease their pain. For more info, call Nancy at 828-758-2156 or Lindy at 828-754-2064.

“LOVE BEARS ALL THINGS.” ICor.13:7

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JRRD releases single-topic issue on pain and pain management

Effects of depression and pain severity on satisfaction in medical outpatients: Analysis of the Medical Outcomes Study, pg. 143

Patient satisfaction is a critical measure of healthcare quality. We performed this study to see how depression and pain severity affected patient satisfaction in medical outpatients. We analyzed data from the Medical Outcomes Study and found that pain was very common and patients with depression and pain were much more likely to be dissatisfied with their healthcare. These findings may also have care-delivery implications, should dissatisfaction indicate poorer quality of care. Further study is needed to determine the reasons for dissatisfaction with care in patients with depression and pain.

Veterans seeking treatment for posttraumatic stress disorder: “What about comorbid chronic pain” pg. 153

In veterans who were being treated for posttraumatic stress disorder (PTSD), many (66%) were also diagnosed with chronic pain problems by their doctors. This is the first study to show that people with PTSD have pain-related conditions according to their doctors. The veterans who told their primary care doctor that they had pain before PTSD treatment said that their pain was less during and after the PTSD treatment. However, this finding was based on a review of charts, so other reasons could also explain the improvement in pain symptoms. More research about treatment for veterans with pain and PTSD is needed.

Prevalence and correlates of posttraumatic stress disorder and chronic severe pain in psychiatric outpatients, pg. 167

This study contributes to the growing literature on the co-occurrence of posttraumatic stress disorder (PTSD) and chronic severe pain. We found moderate rates of PTSD (46%) and chronic severe pain (40%) in a sample of psychiatric outpatients. In addition, 24% of the sample had both disorders. We found that persons with both disorders were significantly different from those with neither disorder on all variables and that they had greater physical and psychosocial stressors. In addition, persons with either PTSD or chronic severe pain alone were more likely to have a chronic medical condition, higher ratings of psychiatric distress, and more stressful life events than those with neither disorder. Mental health treatment providers should routinely assess and develop management strategies for these two disorders in psychiatric outpatients.

Pain and combat injuries in soldiers returning from Operations Enduring Freedom and Iraqi Freedom: Implications for research and practice, pg. 179

Operations Enduring Freedom and Iraqi Freedom have resulted in a growing number of seriously injured soldiers evacuated to the United States for medical care. Trauma-related pain is almost always present among these war-injured soldiers. Several military and Department of Veterans Affairs programs have been implemented to improve pain care. We describe several of these new approaches. We also present data on the soldiers treated, the services provided, and the effects of treatment. Finally, we identify some of the challenges emerging from work with this population and recommend future research and practice priorities.

Efficacy of selected complementary and alternative medicine interventions for chronic pain, pg. 195

We review published research on commonly used complementary and alternative medicine (CAM) approaches to treating chronic pain. Our findings show that CAM therapies, as a group, have a mixed track record of efficacy. The modalities that have the best track records for pain management include biofeedback, hypnosis, and massage (mostly for low back pain and shoulder pain). In selecting a CAM modality, practitioners must weigh the pros and cons and tailor the interventions to the needs of patients with chronic pain. Other issues relevant to practitioners include additional time and energy investments, need for specialized training to administer the modality, side effects or potential toxic effects, safety in combining CAM and other modalities, likely acceptance by clients and the public, and ease of incorporation into traditional pain management practices.

Preliminary evaluation of reliability and criterion validity of Actiwatch-Score, pg. 223

Restoration of normal physical activity is a primary objective of most chronic pain rehabilitative interventions, yet few clinically practical objective measures of activation exist. We evaluated the measurement properties of the Actiwatch-Score (AW-S). We conducted separate trials to examine concordance between units when worn concurrently at the same and different body sites and to compare the AW-S with a validated optical three-dimensional motion-tracking system. The data indicate that the AW-S has excellent interunit reliability and good criterion validity, but its intersite reliability varies with activity type. These results suggest that this device, and those like it, warrants further investigation and is likely to yield valuable data regarding the optimal application of this technology.

A closer look at pain and hepatitis C: Preliminary data from a veteran population, pg. 231

Many veterans who have hepatitis C also experience pain. Researchers are learning how to care for patients who experience hepatitis C and pain. They are also learning how hepatitis C and pain can affect patients’ lives. We review research on the relationship between hepatitis C and pain. We also present findings from a survey given to patients at two Department of Veterans Affairs hospitals. Finally, we suggest how physicians and mental health providers can best care for patients with hepatitis C and pain.

Overview of the relationship between pain and obesity: “What do we know. Where do we go next” pg. 245

Many veterans who struggle with being overweight also experience pain. Researchers are beginning to learn more about how being overweight or obese can affect several health conditions, including pain. We reviewed recent research examining the relationship between pain and overweight/obesity to promote understanding of when, why, and how these conditions occur together. Additionally, we suggest ways researchers can better study the problem of weight and pain to help veterans who experience both.

Medical residents’ beliefs and concerns about using opioids to treat chronic cancer and noncancer pain: A pilot study, pg. 263

Chronic pain from conditions such as arthritis or nerve injuries may be disabling and poorly controlled with aspirin, acetaminophen (Tylenol), or ibuprofen (Advil). In selected cases, opioid analgesics (e.g., morphine), combined with other treatments, can safely and more effectively relieve pain and improve function. We surveyed less experienced doctors and found that they had many fears, concerns, and negative beliefs toward using opioids to treat noncancer pain such as low back pain. If other doctors share these feelings, finding ways to increase their comfort by identifying and treating patients who might safely benefit from opioids to reduce their suffering and disability is important.

Persistent benefits of rehabilitation on pain and life quality for nonambulatory patients with spinal epidural metastasis, pg. 271

We evaluated the long-term effects of a 2-week course of rehabilitation on people with paraplegia caused by cancer compressing the spinal cord. Twelve patients received rehabilitation that focused on transfers, skin care, bladder and bowel management, nutrition, and incentive spirometry. We compared these study patients with a historical control group of 30 patients who had paraplegia from cancer but did not receive rehabilitation. Subjects were followed until death. The study patients had less pain and depression and more satisfaction with life; these benefits persisted for the remainder of their lives. In contrast, the control patients had worsening pain levels, declining satisfaction with life, and higher pain medication use for the remainder of their lives. While our study suggests that rehabilitation benefits people with cancer-related spinal cord injury, it needs to be supported by a randomized study.

Pain and palliative medicine, pg. 279

Pain control is an important part of medical care for patients with advanced illnesses. We summarize available information on pain in different patient groups near the end of life and on developments using behavioral and physical therapy methods to treat pain. Clinical trials to treat pain in patients within healthcare systems are the next topic, followed by ideas on how information technology and clinical databases can be used to guide future patient care. Finally, we present perspectives on how pain control can be studied and further improved within healthcare systems.

Moving to new settings: Pilot study of families’ perceptions of professional caregivers’ pain management in persons with dementia, pg. 295

Pain in persons with severe dementia is often not recognized or treated because these persons cannot communicate their needs. Family caregivers are in the best position to provide information to hospital care personnel about the patients’ needs, including pain. Little research has evaluated the role of the family caregiver when patients move between care facilities. This study describes family caregivers’ experiences when their family members with dementia were admitted to unfamiliar care sites and provides the caregivers’ recommended changes to healthcare settings. This article is relevant to family members and healthcare professionals who care for persons with severe dementia.

Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents, pg. 305

More than 80% of nursing home residents have chronic pain, and of these, many are not getting adequate treatment. Good pain treatment begins with knowing how severe the pain is. Several different pain-intensity tools are available: one uses a number (0–10) scale, another uses words, and a third shows pictures of people in pain. We asked nursing home residents to rate their pain using all three scales. We wanted to know how the pain reported on one scale translated onto another scale. The 42,000 veterans who live in nursing homes and their families will benefit from this study.

Cognitive impairment and pain management: Review of issues and challenges, pg. 315

Research shows that pain is often not recognized in persons with communication problems related to brain disease. Older persons with dementia experience memory loss, and seriously ill and dying patients experience confusion. Treating pain will increase the comfort of all these persons. In this article, we review the types of problems that affect the brain and interfere with pain management, how pain is measured, what pain management approaches help, and future research needs. Those who care for adults with brain-related disease will find this article relevant.

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Now Available Online and in Print–http://www.rehab.research.va.gov

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Aggressive treatment for whiplash does not promote faster recovery

Contact: Amy Molnar
amolnar@wiley.com
John Wiley & Sons, Inc.

Whiplash, the most common traffic injury, leads to neck pain, headache and other symptoms, resulting in a significant burden of disability and health care utilization. Although there are few effective treatments for whiplash, a growing body of evidence suggests that the type and intensity of treatment received shortly after the injury have a long-lasting influence on the prognosis. A new study published in the June 2007 issue of Arthritis Care & Research (http://www.interscience.wiley.com/journal/arthritiscare) examined whether the association between early types of care and recovery time shown in an earlier study was reproducible with whiplash compensated under tort insurance.

A previous study led by Pierre Côté, of the University of Toronto in Toronto, Canada, found that patients compensated under no-fault insurance had a longer recovery if they visited general practitioners numerous times and/or consulted chiropractors or specialists than if they just visited general practitioners once or twice. In the current study, the authors examined patterns of care for 1,693 patients with whiplash injuries who were compensated under tort insurance.

The results showed that increasing the intensity of care to more than 2 visits to a general practitioner, 6 visits to a chiropractor, or adding chiropractic care to general practitioner care was associated with slower recovery. “The results agree with our previous analysis in a cohort of patients compensated under a no-fault insurance scheme and support the hypothesis that the prognosis of whiplash injuries is influenced by the type and intensity of care received within the first month after injury,” the authors state.

They note that effective care, if medically needed, improves the prognosis of patients and that practice guidelines recommend treatment shortly after the injury. However, it may be that doctors responding to pressure from patients use treatments, schedule follow-up visits and refer patients to specialists when not medically needed. “This in turn may lead to adverse outcomes and even prolong recovery by legitimizing patients’ fears and creating unnecessary anxiety,” according to the authors. It is also possible that early aggressive treatment delays recovery by encouraging the use of passive coping strategies. “Reliance on frequent clinical care, a form of passive coping strategy, may have a negative effect on recovery by reinforcing the patients’ belief that whiplash injuries often lead to disability,” the authors state. They cite another study that showed that whiplash patients who used coping strategies such as wishing for pain medication or believing that they couldn’t do anything to lessen the pain had a slower recover than those who did not use such strategies.

Unlike the previous study, the current one did not show a slower recovery for patients who consulted a general practitioner and a specialist. This suggests that the insurance system (tort versus no-fault) can affect the association between certain patterns of care and recovery because it may influence how patients perceive their medical needs, the pressure they put on clinicians to be referred, and how insurers require them to legitimize their injury. The authors conclude that further trials “are essential to understand the influence of health care provision in preventing or facilitating disability.”

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Article: “Early Aggressive Care and Delayed Recovery From Whiplash: Isolated Finding or Reproducible Result”" Pierre Côté, Sheilah Hogg-Johnson, J. David Cassidy, Linda Carroll, John W. Frank, Claire Bombardier, Arthritis Care & Research, June 2007; (DOI: 10.1002/art.22775).

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