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Myofascial Pain in Athletes

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myoMyofascial Pain in Athletes

Voluntary, or skeletal, muscle is the largest single organ of the human body and accounts for nearly 50% of the body’s weight. The number of muscles in the body depends on the degree of subdivision that is considered and on the number of variable muscles that are included. Not counting heads, bellies, and other divisions of muscles, the Nomina Anatomica reported by the International Anatomical Nomenclature Committee under the Berne Convention lists 200 paired muscles, or a total of 400 muscles. Any one of these muscles can develop myofascial trigger points (MTrPs). MTrPs are hyperirritable tender spots in palpable tense bands of skeletal muscle that refer pain and motor dysfunction, often to another location.

The myofascial pain syndromes (MPS) owe their ever-widening acceptance to the pioneering work of Travell and her later collaboration with Simons. In 1983, they combined their clinical experience in a detailed description of the multiple pain syndromes attributed to this disorder. In doing so, they further defined the major clinical components that are characteristic of myofascial pain, the most important being the TrP, the taut band, and the local twitch response.

Frequency

United States

MTrPs are extremely common and become a painful part of nearly everyone’s life at one time or another. Latent TrPs, which often cause motor dysfunction (eg, stiffness, restricted range of motion) without pain, are far more common than active TrPs that cause pain.

Active TrPs are commonly found in postural muscles of the neck, shoulder, and pelvic girdles and in the masticatory muscles. In addition, the upper trapezius, scalene, sternocleidomastoid, levator scapulae, and quadratus lumborum muscles are commonly involved.

Reports of the prevalence of MTrPs in specific patient populations are available. The data indicate a high prevalence of this condition among individuals with a regional pain complaint, as shown in Table 1.

Table 1. Prevalence of Myofascial Pain

Table

Region Practice Number Studied Prevalence of Myofascial Pain, %
General Medical 172 30
General Pain medical center 96 93
General Comprehensive pain center 283 85
Craniofacial Head and neck pain clinic 164 55
Lumbogluteal Orthopedic clinic 97 21
Region Practice Number Studied Prevalence of Myofascial Pain, %
General Medical 172 30
General Pain medical center 96 93
General Comprehensive pain center 283 85
Craniofacial Head and neck pain clinic 164 55
Lumbogluteal Orthopedic clinic 97 21

The wide range in the prevalences of myofascial pain caused by TrPs is likely due to differences in the patient populations examined and in the degree of chronicity, at least in part. Probably even more important are differences in the criteria used to diagnose MTrPs and, most important, differences in the training and skill of the examiners.

Functional Anatomy

Some isolated large round muscle fibers and some groups of these darkly staining, enlarged; round muscle fibers appear in cross-sections. In longitudinal sections, the corresponding feature is a number of contraction knots. An individual knot appears as a segment of muscle fiber with extremely contracted sarcomeres. This contractured segment has a corresponding increase in diameter of the muscle fiber.

The structural features of contraction knots presents a likely explanation for the palpable nodules and the taut bands associated with TrPs. Three single contraction knots can be seen scattered among normal muscle fibers. Beyond the thickened segment of the contracture muscle fiber at the contraction knot, the muscle fiber becomes markedly thinned and consists of stretched sarcomeres to compensate for the contracture ones in the knot segment. In addition, a pair of contraction knots separated by empty sarcolemma may represent one of the first irreversible complications that result from the continued presence of the contraction knot.

Sport Specific Biomechanics

The activation of a TrP is usually associated with some degree of mechanical abuse of the muscle in the form of muscle overload, which may be acute, sustained, and/or repetitive. In addition, leaving the muscle in a shortened position can convert a latent TrP to an active TrP; this process is greatly aggravated if the muscle is contracted while in the shortened position.

In paraspinal muscles (and likely other muscles, too), a degree of nerve compression that causes identifiable neuropathic electromyographic (EMG) changes is associated with an increase in the numbers of active TrPs. These TrPs may be activated by disturbed microtubular communication between the neuron and the endplate because the motor endplate is involved in the path physiologic process of the peripheral core TrP.

The histopathologic complications that could contribute to the chronicity of the condition and make treatment more difficult include the following:

  • Distortion of the striations (sarcomere arrangement) in adjacent muscle fibers for some distance beyond the contraction knot (see Image 1). This produces unnatural shear forces between fibers that could seriously and chronically stress the sarcolemma of the adjacent muscle fibers. If the membrane were stressed to the point at which it became pervious to the relatively high concentration of calcium in the extracellular space, it could induce massive contracture that could compound the shear forces.
  • The occasional finding of a segment of an empty sarcolemmal tube between 2 contractions knots may represent an additional irreversible complication of a contraction knot.

Latent TrPs can produce other effects characteristic of a TrP, including increased muscle tension and muscle shortening; but these do not produce spontaneous pain. Both active and latent TrPs can cause significant motor dysfunction. The same factors that are responsible for the development of an active TrP can, to a lesser extent, cause a latent TrP. An active key TrP in one muscle can induce an active satellite TrP in another. Inactivation of the key TrP often inactivates its satellite TrP without treatment of the satellite TrP itself.

The intensity and extent of the pattern of referred pain depends on the degree of irritability in the TrP, not on the size of the muscle. MTrPs in small, obscure, or variable muscles can be as troublesome to the patient as TrPs in large familiar muscles.

TrPs are activated directly by acute overload, overwork fatigue, direct impact trauma, and radiculopathy. TrPs can be activated indirectly by other existing TrPs, visceral disease, arthritic joints, joint dysfunctions, and emotional distress. Satellite TrPs are prone to develop in muscles that lie within the pain reference zone of key MTrPs or within the zone of pain referred from a diseased viscus, such as the pain due to myocardial infarction, gastric ulcer, cholelithiasis, or renal colic. A perpetuating factor increases the likelihood of overload stress that can convert a latent TrP to an active TrP.

With adequate rest and in the absence of perpetuating factors, an active TrP may spontaneously revert to a latent state. Pain symptoms disappear; however, occasional reactivation of the TrP by exceeding that muscle’s stress tolerance can account for a history of recurrent episodes of the same pain over a period of years.

Clinical

History

  • Symptoms
    • Active TrPs produce a clinical complaint, usually pain, that the patient recognizes when the TrP is compressed digitally. The patient is aware of the pain caused by an active TrP, but he or she may or may not be aware of the dysfunction it causes.
    • Latent TrPs characteristically cause increased muscle tension and limit the stretch range of motion, which often escapes the patient’s attention or is simply accepted. The patient becomes aware of pain originating from a latent TrP only when pressure is applied to it. Spontaneous referred pain appears with increased irritability of the TrP; then, the TrP is identified as active.
    • The patient usually presents with complaints due to the most recently activated TrP. When this TrP is successfully eliminated, the pain pattern may shift to that of an earlier key TrP that must also be inactivated. If the key TrP is inactivated first, the patient may recover without further treatment.
    • Patients with active MTrPs usually complain of poorly localized, regional, aching pain in subcutaneous tissues, including muscles and joints. They rarely complain of sharp, clearly localized coetaneous-type pain. The myofascial pain is often referred away from the TrP in a pattern that is characteristic for each muscle. Sometimes, the patient is aware of numbness or paresthesia rather than pain.
  • Dysfunction
    • In addition to the clinical symptoms produced by the sensory disturbances of referred pain, dysesthesias, and hypoesthesia’s, patients can also have clinically important disturbances of autonomic and motor functions.
    • Disturbances of autonomic functions
      • Disturbances of autonomic functions caused by TrPs include abnormal sweating, persistent lacrimation, persistent coryza, excessive salivation, and pilomotor activities.
      • Related proprioceptive disturbances caused by TrPs include imbalance, dizziness, tinnitus, and distorted perception of the weight of lifted objects.
    • Disturbances of motor functions
      • Disturbances of motor functions caused by TrPs include spasm of other muscles, weakness of the involved muscle function, and loss of coordination by the involved muscle, and decreased work tolerance of the involved muscle.
      • The weakness and loss of work tolerance are often interpreted as an indication for increased exercise, but if this is attempted without inactivating the responsible TrPs, the exercise is likely to encourage and further ingrain substitution by other muscles, with further weakening and deconditioning of the involved muscle.
      • The combination of weakness in the hands and loss of forearm muscle coordination makes the grasp unreliable. Objects sometimes slip unexpectedly from the patient’s grasp. The weakness results from reflex motor inhibition and characteristically occurs without atrophy of the affected muscle. Patients are prone to intuitively substitute muscles without realizing that, for instance, they are carrying the grocery bag in the nondominant but now stronger arm.
    • The motor effects of TrPs on the muscle in which they are located are considered in detail under Surface electromyography in Other Tests.
  • Sleep disturbances
    • Disturbance of sleep can be a problem for patients with a painful TrP syndrome. Authors of a series of studies have shown that many sensory disturbances, including pain, can seriously disturb the patient’s sleep.
    • This sleep disturbance can, in turn, increase pain sensitivity the next day. Active MTrPs become more painful when the muscle is held in the shortened position for long periods and if body weight compresses the TrP. Thus, for patients with active TrPs, sleep positioning can be critical to prevent unnecessary disturbances of their sleep.

Physical

Each muscle has a characteristic elicited referred pain pattern that, for active MTrPs, is familiar to the patient. Without a laboratory test or imaging method, diagnosis of MTrPs depends entirely on history and physical examination. MTrP symptoms follow muscle overload, are activated acutely by sudden overload, or develop gradually with prolonged contractions or repetitive activity. The diagnostic skill required depends on considerable innate palpation ability, authoritative training, and extensive clinical experience.

Pain prevents a muscle with a MTrP from reaching its full stretch range of motion and also restricts its strength and/or endurance. Clinically, the lip is a localized spot of tenderness in a nodule within a palpable taut band of muscle fibers. Restricted stretch range of motion and a palpable increase in muscle tenseness (ie, decreased compliance) are more severe in more active MTrPs.

Active MTrPs are identified when patients recognize the pain induced by applying pressure to a MTrP. The taut band fibers usually respond with an MTrP when the taut band is accessible and when the TrP is stimulated by properly applied snapping palpation. The taut band fibers have a consistent twitch response when a needle penetrates the MTrP.

  • Taut band
    • By gently rubbing across the direction of the muscle fibers in a superficial muscle, the examiner can feel a nodule at the MTrP and ropelike indurations that extends from this nodule to the attachment of the taut muscle fibers at each end of the muscle.
    • The taut band can be snapped or rolled under the finger in accessible muscles. With effective inactivation of the TrP, this palpable sign becomes less tense and often (but not always) disappears, sometimes immediately. See Image 2.
  • Tender nodule
    • Palpation along the taut band reveals a nodule exhibiting a highly localized and exquisitely tender spot that is characteristic of an MTrP. When the spot is tested for tenderness, displacement of the algometer by 2 cm produces a statistically significant decrement in pain threshold algometer readings. Clinically, displacement of the application of pressure by 1-2 mm at an MTrP can result in a markedly reduced pain response.
    • This strong localization of tenderness in the vicinity of an MTrP corresponds to the localized sensitivity of the experimental muscle for eliciting TrPs as demonstrated in rabbit experiments. A 5-mm displacement to either side of the trigger spot (at right angles to the taut band) results in almost total loss of response. However, the response fades out more slowly when stimulated over a range of several centimeters from the trigger spot along the taut band.
  • Recognition: Application of digital pressure on either an active or latent MTrP can elicit a referred pain pattern characteristic of that muscle. However, if the patient recognizes the elicited sensation as a familiar experience, this establishes the MTrP as being active and is one of the most important diagnostic criteria available when the palpable findings also are present. Similar recognition is observed frequently when a needle penetrates the MTrP and encounters an active locus.
  • Referred sensory signs: In addition to referring pain to the reference zone, MTrPs may refer other sensory changes such as tenderness and dysesthesias.
  • Local twitch response: Snapping palpation of the TrP frequently evokes a transient twitch response of the taut band fibers. Twitch responses can be elicited both from active and latent TrPs. Hubbard at al showed that no difference was noted in twitch responses whether elicited by snapping palpation or by needle penetration. See Image 3.
  • Limited range of motion
    • Muscles with active MTrPs have a restricted passive (stretch) range of motion because of pain. An attempt to passively stretch the muscle beyond this limit produces increasingly severe pain because the involved muscle fibers are already under substantially increased tension at rest length.
    • The limitation of stretch due to pain is not as great with active movement as with passive lengthening of the muscle; this finding at least partly due to reciprocal inhibition. When the TrP is inactivated and the taut band is released, range of motion returns to normal.
    • The degree of limitation produced by MTrPs is much more marked in some muscles (eg, subscapularis) than in other muscles (eg, latissimus dorsi).
  • Painful contraction: When a muscle with an active TrP is strongly contracted against fixed resistance, the patient feels pain. This effect is most marked when the patient attempts to contract the muscle when it is in a shortened position.
  • Weakness
    • Although weakness is generally characteristic of a muscle with active myofascial MTrPs, the magnitude is varied from muscle to muscle and from subject to subject.
    • EMG studies indicate that, in muscles with active MTrPs, the muscle starts out fatigued, it fatigues more rapidly, and it becomes exhausted sooner than normal muscles. The weakness may reflect reflex inhibition of the muscle by the MTrPs.

Causes

Causes of myofascial pain include or are related to the following:

  • The lack of motor unit action potentials due to the endogenous contracture of the contractile elements, rather than a nerve-initiated contraction of the muscle fibers
  • The frequency with which muscle overload activates TrPs, which may reflect the marked mechanical vulnerability of the synaptic cleft region of an endplate
  • The release of substances that could sensitize nociceptors in the region of the dysfunctional endplate of the TrP as a result of tissue distress caused by the energy crisis
  • The effectiveness of essentially any technique that elongates the TrP portion of the muscle to its full stretch length even briefly, which could break the cycle that includes energy-consuming contractile activity
  • Laborers who exercise their muscles heavily every day are less likely to develop active TrPs than sedentary workers who are prone to intermittent episodes of vigorous physical activity. This author’s clinical experience supports this observation.

Author: Auri Bruno-Petrina, MD, PhD, Clinical Trainee, Pemberton Marine Medical Clinic, N Vancouver

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EXERCISE, HEALTH CARE

Modify Breast Cancer Risk

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breastcancerdeseaseWomen Age 30+ Modify Breast Cancer Risk With Exercise

Women over age 30 who regularly exercise decrease their chances of breast cancer, according to a study presented today at the American College of Sports Medicine’s 56th Annual Meeting in Seattle.

The comprehensive study narrowed in on specific age ranges, surveying 4,296 women about their physical activity practices during four key stages of life: 10 to 15 years old; 15 to 30 years old; 30 to 50 years old; and 50 years old and above.

Although incidence of breast cancer did not appear to change in relation to exercise levels between 10 and 30 years of age, women above 30 significantly decreased their chances of contracting the disease if they were more active.

“Regular exercise appears to have protective effects for this age group of women,” said the study’s lead researcher, Lisa Sprod. “Meeting physical activity recommendations can act like a prescription for prevention when it comes to breast cancer.”

Breast cancer is the most prevalent type of cancer in women.

The study supports data that links exercise to risk of breast cancer, particularly as it relates to the consistency of activity through a woman’s lifespan. This research consistently connects the benefits of exercise for women to a favorable effect on hormone levels, body weight, weight gain with age, and immune function.

ACSM guidelines support the 2008 Physical Activity Guidelines for Americans, which recommend that adults participate in at least 150 minutes of moderate-intensity physical activity, which can be achieved in 30-minute segments five days a week. ACSM provides tools for getting started with a physical activity program, including assessments to determine pre-exercise health level and potential barriers to fitness, at http://www.acsm.org/physicalactivity.

Source
American College of Sports Medicine

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Psychological Disorders and Genetics

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geneticsIndividuals Genetically At Risk Of Developing Psychological Disorders Also Benefit The Most From Positive Environments

Certain individuals have long been regarded as particularly susceptible to developing behavioral and emotional problems when they experience negative environmental conditions, due to the fact that they carry so-called ‘vulnerability genes’. Existing research suggests, for instance, that such ‘genetically vulnerable’ individuals are most likely to become impulsive and hyperactive if their mothers smoked while pregnant, to behave anti-socially if subjected to child abuse, and to become depressed if exposed to many negative life events (e.g., divorce, unemployment). But a new evaluation of existing gene-by-environment interaction (GXE) research highlighting such genetic vulnerability to adversity challenges this traditional interpretation of existing evidence. Research published in Molecular Psychiatry suggests that those carrying ‘vulnerability genes’ are not only more likely than others to be adversely affected by negative experiences but to also benefit more than others from positive environments, making them more malleable or plastic, not just vulnerable. This novel interpretation of old and new findings suggests that ‘vulnerability genes’ might be better conceptualized as ‘plasticity or malleability genes’ because carriers are more affected, for better and for worse, by positive and negative environmental conditions.

This new interpretation of GXE research findings proposed by Professor Jay Belsky, Director of the Institute for the Study of Children, Families and Social Issues at Birkbeck, University of London, and his colleagues reframes the nature-nurture debate. “Our analysis of many published findings suggests that one potential solution to the nature-nurture controversy is to appreciate the role played by environmental experience and the role played by heredity in shaping who we are may actually differ across people,” said Prof Belsky. “Some people have genes which make them more malleable than others, and therefore more susceptible to both positive and negative environmental influences. Indeed, those children most adversely affected by poor environmental conditions are often the very same ones who benefit most from good environments. In contrast, other individuals appear to be rather immune to such environmental effects.”

Professor Belsky and his collaborators carefully combed findings from scores of publications highlighting GXE interactions in the leading psychiatric and psychological journals and repeatedly discovered that in many instances those individuals at risk of developing problems when exposed to adversity due to their genetic make-up also functioned better than others lacking these genetic attributes when they experienced good environments. One of the striking observations was that authors of the publications repeatedly failed to note this pattern in their own data. “One often only sees what one goes looking for,” Professor Belsky said.

The findings may point towards a more personal approach to psychosocial interventions. “This could mirror the trend we are now seeing towards personalized medicine, where an understanding of the genetic make-up of an individual determines the type of drugs used to treat the patient based on their DNA.” said Prof Belsky.

“We use the term ‘vulnerable’ to describe people at risk of something negative, whether it be an increased chance of heart disease, or susceptibility to mental illness. Yet there appears to be no opposite term for those being disproportionately liable to benefit from positive experiences – other than ‘lucky!’ This may, in part, explain why the evidence pointing towards this phenomenon has so far gone unnoticed.”

Source: Birkbeck College

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Bathroom Habit Secrets

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bathroomSurvey Flushes Out The Secrets Of Americans’ Bathroom Habits

Whether it’s “powdering your nose” or settling in for a good read, Americans spend a significant amount of time in the bathroom. According to a recent Yankelovich survey, many Americans spend more than 30 minutes each day in the bathroom that adds up to nearly eight days each year – which is more than double that of the average vacation trip. And contrary to popular belief, men spend almost as much time in the bathroom as women.

The findings were released as part of an effort to examine the bathroom habits of the American consumer and explore the reasons why this previously unrecognized “drain” on consumers’ time may be an indication of larger health issues.

No More Excuses

The survey also revealed that one in four Americans at some time have made up an excuse for why they’re going to the bathroom in the first place. Furthermore, men in this group were just as likely to make up an excuse as women, which contradict the thought that men are more open to discussing what happens behind closed doors.

“Making excuses for bathroom habits could be a sign that something else is going on,” Dr. Anish Sheth, Assistant Professor of Medicine, Yale University School of Medicine. “Millions of Americans experience digestive problems, but few know that key to digestive health is maintaining a balance between the ‘good’ and ‘bad’ bacteria in the colon, a vital part of the digestive system. But there are things consumers can do such as taking a probiotic to address digestive symptoms like constipation, diarrhea, gas and bloating, as well as overall colon health.”

Probiotics are live microorganisms, similar to the good bacteria found inside the body. Available mainly through foods and dietary supplements, probiotics – like Phillips’ Colon Health TM can restore intestinal balance by boosting the number of those bacteria that are helpful. Studies have also shown that probiotics may stimulate the immune system and help with overall health.

Travel Woes and Economic Stress

In addition to examining bathroom habits, the survey also identified consumer travel worries and the impact of stress on eating habits, which could both have an effect on the digestive system.

As summer approaches, many Americans are beginning to plan vacations with their friends or families. And something they’d like to leave behind is digestive issues. According to the survey, close to half of all Americans at some time have had or worried about having stomach problems while on vacation. Taking a probiotic can help to eliminate that worry, as probiotics have been shown to help address travel related issues, like traveler’s diarrhea.

In addition, the survey unveiled that a majority of Americans have experienced increased stress because of the current state of the economy. Nearly 40 percent of those Americans report they now eat more comfort food, more snacks and more fast food due to their increased stress levels.

“Stress and poor diet are triggers that could potentially cause digestive problems,” said Dr. Sheth. “Probiotics can be especially helpful when the digestive system is under stress from all sorts of issues ranging from occasional diarrhea, or constipation.”

Maintaining Digestive Health

A large percent of the body’s immune system is found in the digestive tract and the colon is at the heart of it. So it’s easy to see how digestive or colon problems can have a significant health effect.

When taken on a daily basis, probiotics support the digestive system and help restore the balance that is so important to good health. While thinking about the digestive system may not always be top of mind with most people, keeping it healthy is important and sustaining colon health is key to maintaining overall health.

About the Survey

The survey was conducted by Yankelovich, a part of the Futures Company on behalf of Phillips’ Colon Health Probiotic Supplement. Survey results were obtained through online interviews among a representative sample of 1,042 adults 18 and over. Additional findings include:

— 10 percent of those surveyed spend 60 minutes or more in the bathroom a day

— Women are only slightly more likely to make excuses for why they are going to the bathroom than men (26 percent for women compared to 24 percent for men)

— Women are more stressed because of the economy than men (60 percent of women versus 51 percent of men)

— Economic stress had a bigger impact on the eating habits of younger Americans than older Americans (61 percent of Americans aged 18-24 say the eat more comfort food, more snacks and more fast food compared to 29 percent of Americans aged 55 – 64)

About Phillips’ Colon Health

Phillips’ Colon Health is a once-daily probiotic supplement that replenishes good bacteria and helps restore the digestive system’s natural balance. Taking one capsule daily can help promote overall digestive health and support a healthy immune system.

While most probiotic supplements contain only one strain of bacteria, Phillips’ Colon Health is formulated with three strains of the most common and studied bacteria, each supporting a different area of the digestive tract. These bacteria have played a role in the body’s immune since birth:

— Lactobacillus acidophilus helps the body produce vitamin K, lactase, and a variety of antimicrobial agents.

— Bifid bacterium bifidum helps protect the body against diarrhea and other intestinal disturbances.

— Bifid bacterium longum is the most dominant bacteria in the entire body and helps keep the digestive system running smoothly, while blocking the growth of harmful bacteria and boosting the overall immune system.

Phillips’ has been a trusted name in colon health for more than 125 years. In addition to Phillips’ Colon Health, the brand also offers a full line of stimulant-free, cramp-free laxatives that work more naturally with the body.

About Bayer Consumer Care

The Consumer Care Division of Bayer HealthCare LLC, is headquartered in Morristown, N.J. Bayer’s Consumer Care Division is among the largest marketers of over-the-counter medications and nutritional supplements in the world. Some of the most trusted and recognizable brands in the world today come from the Bayer portfolio of products. These include Bayer® Aspirin, Aleve®, Alka-Seltzer Plus®, Bactine®, Citracal®, RID®, Phillips’® Milk of Magnesia, Midol®, Alka-Seltzer®, One A Day®, One A Day® Prenatal and FlintstonesTM vitamins.

Source: Bayer Healthcare Consumer Care

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Definition of Substance Abuse

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substanceabDefinition of Substance Abuse
Substance abuse: The excessive use of a substance, especially alcohol or a drug. (There is no universally accepted definition of substance abuse.)

A definition of substance abuse that is frequently cited is that in DSM-IV, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the American Psychiatric Association. The DSM-IV definition is as follows:

    A. A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

1.     Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household)

2.     Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

3.     Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct

4.     Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)

  • B. The symptoms have never met the criteria for Substance Dependence for this class of substance.

Drug Abuse and Addiction

Many people do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse. They mistakenly view drug abuse and addiction as strictly a social problem and may characterize those who take drugs as morally weak. One very common belief is that drug abusers should be able to just stop taking drugs if they are only willing to change their behavior. What people often underestimate is the complexity of drug addiction-that it is a disease that impacts the brain and because of that, stopping drug abuse is not simply a matter of willpower. Through scientific advances we now know much more about how exactly drugs work in the brain, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and resume their productive lives.

What is drug addiction?

Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use despite harmful consequences to the individual that is addicted and to those around them. Drug addiction is a brain disease because the abuse of drugs leads to changes in the structure and function of the brain. Although it is true that for most people the initial decision to take drugs is voluntary, over time the changes in the brain caused by repeated drug abuse can affect a person’s self control and ability to make sound decisions, and at the same time send intense impulses to take drugs.

It is because of these changes in the brain that it is so challenging for a person who is addicted to stop abusing drugs. Fortunately, there are treatments that help people to counteract addiction’s powerful disruptive effects and regain control. Research shows that combining addiction treatment medications, if available, with behavioral therapy is the best way to ensure success for most patients. Treatment approaches that are tailored to each patient’s drug abuse patterns and any co-occurring medical, psychiatric, and social problems can lead to sustained recovery and a life without drug abuse.

Similar to other chronic, relapsing diseases, such as diabetes, asthma, or heart disease, drug addiction can be managed successfully. And, as with other chronic diseases, it is not uncommon for a person to relapse and begin abusing drugs again. Relapse, however, does not signal failure-rather, it indicates that treatment should be reinstated, adjusted, or that alternate treatment is needed to help the individual regain control and recover.

What happens to your brain when you take drugs?

Drugs are chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs are able to do this: (1) by imitating the brain’s natural chemical messengers, and/or (2) by over stimulating the “reward circuit” of the brain.

Some drugs, such as marijuana and heroin, have a similar structure to chemical messengers, called neurotransmitters, which are naturally produced by the brain. Because of this similarity, these drugs are able to “fool” the brain’s receptors and activate nerve cells to send abnormal messages.

Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters, or prevent the normal recycling of these brain chemicals, which is needed to shut off the signal between neurons. This disruption produces a greatly amplified message that ultimately disrupts normal communication patterns.

Nearly all drugs, directly or indirectly, target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that control movement, emotion, motivation, and feelings of pleasure. The overstimulation of this system, which normally responds to natural behaviors that are linked to survival (eating, spending time with loved ones, etc), produces euphoric effects in response to the drugs. This reaction sets in motion a pattern that “teaches” people to repeat the behavior of abusing drugs.

As a person continues to abuse drugs, the brain adapts to the overwhelming surges in dopamine by producing less dopamine or by reducing the number of dopamine receptors in the reward circuit. As a result, dopamine’s impact on the reward circuit is lessened, reducing the abuser’s ability to enjoy the drugs and the things that previously brought pleasure. This decrease compels those addicted to drugs to keep abusing drugs in order to attempt to bring their dopamine function back to normal. And, they may now require larger amounts of the drug than they first did to achieve the dopamine high-an effect known as tolerance.

Long-term abuse causes changes in other brain chemical systems and circuits as well. Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate, which can impair cognitive function. Drugs of abuse facilitate no conscious (conditioned) learning, which leads the user to experience uncontrollable cravings when they see a place or person they associate with the drug experience, even when the drug itself is not available. Brain imaging studies of drug-addicted individuals show changes in areas of the brain that are critical to judgment, decision-making, learning and memory, and behavior control. Together, these changes can drive an abuser to seek out and take drugs compulsively despite adverse consequences-in other words, to become addicted to drugs.

Why do some people become addicted, while others do not?

No single factor can predict whether or not a person will become addicted to drugs. Risk for addiction is influenced by a person’s biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction. For example:

  • Biology. The genes that people are born with-in combination with environmental influences-account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction.
  • Environment. A person’s environment includes many different influences-from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and parental involvement can greatly influence the course of drug abuse and addiction in a person’s life.
  • Development. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability, and adolescents experience a double challenge. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it is to progress to more serious abuse. And because adolescents’ brains are still developing in the areas that govern decision-making, judgment, and self-control, they are especially prone to risk-taking behaviors, including trying drugs of abuse.

Prevention is the key

Drug addiction is a preventable disease. Results from NIDA-funded research have shown that prevention programs that involve the family, schools, communities, and the media are effective in reducing drug abuse. Although many events and cultural factors affect drug abuse trends, when youths perceive drug abuse as harmful, they reduce their drug taking. It is necessary, therefore, to help youth and the general public to understand the risks of drug abuse and for teachers, parents, and healthcare professionals to keep sending the message that drug addiction can be prevented if a person never abuses drugs.

Source: National Institute on Drug Abuse

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Sleep Apnea Awareness

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sleep_apnFlorida: Congressman Gus Bilirakis Introduces Sleep Apnea Awareness Bill to Congress
Sleep apnea is a dangerous disorder that is often undiagnosed and untreated. Florida dentists in the I HATE CPAP! network applaud the Congressman and have been working with http://wwwihatecpap.com founder to promote diagnosis

GURNEE, IL, May 25, 2009 /Medical News Articles/ — Congressman Gus Bilirakis (R-Fla.) introduced House Resolution 384, “Sleep Apnea Awareness,” which resolves that the House will support raising public awareness of sleep apnea and encourage all Americans to educate themselves and others about the consequences of sleep apnea and its potential treatments. Dr Ira L Shapira a Diplomat of the American Board of Dental Sleep Medicine applauds the Congressman and urges everyone to contact their representatives and senators to support passage of important legislation that will make the nations roads safer and lower health care costs. Dr Shapira is the founder of http://www.ihatecpap.com that promotes diagnosis and treatment of sleep apnea. CPAP is the gold standard of treatment for sleep apnea but the majority of patients do not tolerate the treatment. Dr Shapira does not hate CPAP but offers information on oral appliances that treat sleep apnea and that have been shown to be better tolerated than CPAP. Information on oral appliance treatment of sleep apnea can be found at http://www.ihatecpap.com/oral_appliance.html

Below is text of the full resolution:
HRES 384 Recognizing the importance of increased awareness of sleep apnea, and for other purposes.
Whereas sleep apnea is a common condition that affects more than 12,000,000 Americans, according to the National Heart, Lung, and Blood Institute at the National Institutes of Health;
Whereas there are several types of sleep apnea that cause people with this condition to repeatedly stop breathing throughout the night, often many times;
Whereas sleep apnea is a chronic condition that disrupts sleep three or more nights each week, leading to excessive daytime sleepiness;
Whereas sleep apnea becomes more common with age, and 1 in 10 people over the age of 65 suffers from it;
Whereas sleep apnea is more common in men than women, and more than half of the people with sleep apnea are overweight;
Whereas sleep apnea can strike anyone, at any age, at any time, including children;
Whereas untreated sleep apnea can lead to high blood pressure, heart attack, stroke, obesity, and diabetes;
Whereas untreated sleep apnea can also increase the chance of having work-related or driving accidents and adversely impact the quality of life of those suffering from this condition in other ways;
Whereas lifestyle changes, mouthpieces, surgery, and/or breathing devices can successfully treat sleep apnea in many people; and
Whereas the lack of public awareness of this serious condition leads to many undiagnosed and untreated cases: Now, therefore, be it
Resolved, That the House of Representatives–
(1) supports raising public awareness of sleep apnea; and
(2) encourages all Americans to educate themselves and others about the consequences of sleep apnea and its potential treatments.

I HATE CPAP LLC is a major organization that has worked diligently to increase public awareness of the dangers of sleep apnea. http://www.ihatecpap.com/sleep_apnea_dangers.html

Several Florida dentists have joined this effort in promoting diagnosis and treatment of sleep apnea. These dentists recognize that awareness of sleep apnea without treatment is insufficient. The Gold Standard of treatment for Sleep Apnea is CPAP but unfortunately only 23-45% of patients tolerate CPAP. Most patients prefer Comfortable Oral Appliances offered by Dental Sleep Medicine to CPAP. Unfortunately many patients are never offered oral appliances. Oral appliances are considered a first line of treatment for obstructive sleep apnea by the American Academy of Sleep Medicine. They are also considered an alternative treatment for severe apnea when patients do not tolerate CPAP. Most patients do not tolerate CPAP treatment and many who do tolerate use it for only 4-5 hours a night.

The following Florida dentists applaud Congressman Bilirakis bill. Contact them as your first step to better sleep.

Dr Joseph M Barton DMD Jacksonville, Florida http://www.jacksonville.ihatecpap.com/

Dr Jill Morris Sarasota, Florida http://www.jacksonville.ihatecpap.com/

Dr Farokh Jiveh West Palm Beach, Florida http://www.palmbeach.ihatecpap.com/

These dentists are helping to bring better sleep and better lives to the citizens of Florida. If you have questions about sleep apnea or are interested in an alternative to CPAP contact them today. Le Congressman Gus Bilirakis know that you appreciate his excellent work.

To learn more about the dangers of sleep apnea go to http://www.ihatecpap.com/sleep_apnea_dangers.html

A recent study showed that snoring even when apnea is not present greatly increases the risks of carotid atherosclerosis and stroke.

Ira Shapira
Sleep and Health Journal
Section editor/author
1810 Delany Road
Gurnee, Illinois
USA 60035

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Used Medical Equipment

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used_medNew website provides global platform for buying or selling used medical equipment

MedWOW.com is an innovative online marketplace specifically designed for used medical equipment professionals. The site connects buyers, sellers and service providers from around the world through unique online tools and features.

NICOSIA, CYPRUS, May 22, 2009 /Medical News Articles/ — MedWOW.com is an innovative online marketplace specifically designed for used medical equipment professionals. The site connects buyers, sellers and service providers from around the world through unique online tools and features.

Key players in the pre-owned medical equipment industry now have a new source to turn to for conducting business thanks to MedWOW’s recently launched marketplace, which provides an ideal online platform for buying and selling used medical equipment on a global scale.

The site has been designed to fully integrate tools and services which overcome factors that have been significantly holding back the online trade in the global pre-owned medical equipment industry thus far.

Features such as the site’s sophisticated medical equipment catalog and search engine, a pre-purchase inspection service, and the multilingual interface are just some of MedWOW’s many features that help it attain its ultimate goal of providing its users with a secure, quick, and user-friendly platform to turn to for their used medical equipment needs.

MedWOW facilitates the communication between international users through the multilingual Questions and Answers mechanism, where buyers and sellers communicate through a list of professionally written questions and answers that are unique for each specific device; the questions and answers are automatically translated into the user’s preferred language.

The site’s members are encouraged to make educated transactions by having access to the right tools to conduct research prior to closing a deal. Buyers have access to professionally written Buying Tips for each specific device, and the Original Manufacturer Specifications for each specific model. Sellers have access to buyer’s Wanted Item requests and to a variety of traffic and market reports that assess their performance on the site, provide valuable market insight, trends and activities.

With health institutions turning to the pre-owned medical equipment market more so now than ever, due to the current global economic recession, MedWOW offers the perfect solution – a reliable and safe platform to buy, sell or auction used medical equipment online.

Press Release Contact Information:

Eric Be
MedWOW
Marketing
Nicosia
Nicosia, Nicosia
Cyprus 2460

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Vegetarian omega-3

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flaxNew vegetarian omega-3 from Echium seed oil offers fish oil benefits. In the wake of National Vegetarian week, nutrition scientist Dr Nina Bailey discusses a new vegetarian source of omega-3 fatty acids from echium seed oil, which converts to long-chain fatty acids up to 5 times more effectively than flaxseed.

CAMBRIDGE, UK, May 22, 2009 /Medical News Articles/ — In support of National Vegetarian Week 2009, nutrition scientist Dr. Nina Bailey seeks to raise the importance of incorporating omega-3s into the vegetarian diet, and proposes ways to do so without compromising on ethics.

At over 7% of the UK population, a significant 4 million and growing steadily, [1] vegetarianism is an ever-increasing preference for many people, especially among the younger generation, up to 12% of whom opt to cut meat and fish out of their diet. Whether because of the increasing availability of vegetarian options in supermarkets and restaurants, growing concern over the environmental impact of animal farming, animal welfare, or attractive appeal as a healthy lifestyle option, the vegetarian demographic has shed its sandal-wearing, lentil-eating image and now boasts a diverse population, young and old, of various ethnicities and backgrounds.

Whilst scientific evidence does indicate that a plant-based diet offers significant health benefits in terms of heart disease, strokes, lower incidence of certain cancers, a healthy body weight and longer life expectancy, [2],[3],[4] vegetarians, like meat-eaters, still need to eat a well-balanced diet and ensure they get enough fiber from whole grains, fresh fruit and vegetables, enough of the right types of protein and amino acids (which certain types of vegetable provide in plentiful quantity), as well as another type of essential nutrient – omega fatty acids. Necessary for the formation of healthy cell membranes, humans rely on these good fats not only for brain function, but also for the production of hormone-like substances called eicosanoids, which regulate several important functions including blood pressure and clotting, inflammation, the immune system and fluid balance.

Moreover, according to Dr Nina Bailey, “Low levels of omega fatty acids in the diet have been linked with increases in learning problems, mood disorders, circulatory problems, and skin conditions among the general population. By addressing these deficiencies and including the right types of omega-3 fatty acids in the diet, it is possible to address some of the symptoms associated with these problems.

“For vegetarians, this can be difficult, since the important omega-3s EPA and DHA derive mainly from oily fish. Whilst many vegetarians do consume flaxseed, the short-chain omega-3 ALA is a distant relative from the long-chain fatty acids, and the conversion rate tends to be very poor. Algal sources can offer an alternative but these tend to be high in DHA, with low quantities of EPA. EPA is important for neurological function as well as the production of eicosanoids, whose role in inflammation is critical.”

Whilst the vegetarian diet tends to be very healthy – with lower total fat, saturated fat and cholesterol intake than their meat-eating counterparts – their consumption of important long-chain omega-3s (found mainly in oily fish, with some levels in enriched eggs) is significantly lower, which is also reflected in tests of plasma levels. [4] The government recommendation for two portions of fish weekly to achieve a daily intake of 0.45 g omega-3, is plainly not an option for vegetarians, and so vegetarians have, until recently, been reliant upon flaxseed oil to provide the short-chain omega-3 ALA, with the idea that the body will convert this to the important long-chain omega-3s such as EPA and DHA.

The problem is that the conversion of ALA in flaxseed oil to EPA and DHA in the body is reliant upon the presence of certain enzymes, making it a slow and inefficient process – particularly so when enzyme activity is impaired for any reason. Factors limiting this process in the body include stress, ageing, alcohol, caffeine, low levels of vitamins and minerals, as well as viral infections and diabetes.

The good news is that another, more efficient precursor, has recently been launched in the UK, in the form of SDA from echium seed oil. Indeed SDA is a closer relative to the important long-chain omega-3 fatty acid EPA than ALA, and is converted to EPA in amounts up to 5 times greater than other vegetarian omega-3 oils containing just ALA.[5] Contained in supplement form in the product Echiomega, SDA bypasses the enzyme ‘blocks’ which easily interrupt the conversion to the important long-chain omega-3 fatty acid EPA, known for its potent anti-inflammatory by-products and mood-regulating effects.

Echium seed oil also contains other beneficial fatty acids, including the powerful anti-inflammatory fatty acid GLA, as well as the omega-9 oleic acid found typically in olive oil and synonymous with the health benefits of the Mediterranean diet. Research also indicates a synergistic effect within echium seed oil, owing to the combination of SDA with GLA, which reportedly elevates EPA levels more efficiently than SDA alone. [6] Echiomega, available from good health food shops or mail order from manufacturer Igennus (see http://www.igennus.com/) is the ideal nutritional supplement for those who are vegan or vegetarian, to boost the levels of the important omega fats in the diet.

References

[1] The Vegetarian Society, Available: http://www.vegsoc.org/news/2000/21cv/introduction.html [Accessed 13th May 2009]

[2] Key, T.J. E Fraser, G.E. et al (1999) Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies, American Journal of Clinical Nutrition 1999 70: 516S-24S.
[3] Fraser G.E. (2009) Vegetarian diets: what do we know of their effects on common chronic diseases? American Journal of Clinical Nutrition. 89: 1607S-1612S.

[4] Key, T.J. Appleby, P.N. & Rosell, M.S. (2006) Health effects of vegetarian and vegan diets, Proceedings of the Nutrition Society 65: 35-41 Cambridge University Press. See also: Rosell M.S., Lloyd-Wright Z. et al (2005) Long-chain n-3 polyunsaturated fatty acids in plasma in British meat-eating, vegetarian, and vegan men. American Journal of Clinical Nutrition. 82: 327-34.

[5] James MJ, Ursin VM, Cleland LG. (2003) Metabolism of stearidonic acid in human subjects: comparison with the metabolism of other n-3 fatty acids. American Journal of Clinical Nutrition 77: 1140-5.

[6] Miles, E.A., Banerjee, T., et al (2004) The influence of different combinations of g-linolenic acid, stearidonic acid and EPA on immune function in healthy young male subjects. British Journal of Nutrition, 91, pp.893-903.

Press Release Contact Information:

Mina Nazemi
Igennus
Marketing Manager
9 Chesterton Mill, French’s Road
Cambridge, Cambridgeshire
UK CB4 3NP

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Anger Management

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angerWhy Anger Management Skills are Important to your Health

Everybody experiences anger at some point of time or the other. A certain degree of anger is normal and healthy. However, if it gets out of control you can harm not only yourself but also those you come into contact with. Anger is probably the most real of all human emotions. It can increase your determination and will-power to reach the heights of success or it can catapult you into the valleys of fury and rage. By itself, anger is not really dangerous to your well-being. Everything depends on how you deal with it.

We lead a different life as compared to our fore-fathers. Technology has perhaps improved life in many ways but it has also made it difficult and stressful. We have no time to smell the roses. We always have to do something yesterday, right now, today or tomorrow. This leads to overwhelming pressure and stress. Let’s take an example of the average married man. He wakes up in the morning to rush to work sometimes without breakfast. He travels miles to his workplace only to be reprimanded by his boss for late-coming. During the day he has projects to complete and deadlines to meet, all under his immediate supervisor’s watchful eye. If something goes wrong he is held responsible. He returns in the evening to a mischievous child and a wife who grumbles about his never having the time for her. A squabble follows making him feel stressed out, angry and depressed. And this is an average day in the life of a married man. The bad days are a different story altogether.

Anger Management: In this age of unusual stress and pressure, anger management is of paramount importance. It teaches you to accept what you can’t change and channel your energy to feel positive and calm. It is important for people from all walks of life to control and manage their anger. Employees must learn to deal with work pressure and demanding supervisors. Bosses should control their feelings of hostility towards perceived inefficient workers. Couples must stop venting their frustrations on each other. Anger management teaches you all this and much more. Organizations must recognize the need to incorporate anger management into their training programs. Expressing feelings must be encouraged and honest feedback should be provided. This will bring about a sense of harmony and increase productivity at the work-place.

Stress Management and Anger: Stress and anger are two sides of the same coin. Often, we are angry because we are stressed and vice versa. The causes of stress are many. Demands at the workplace, uncompromising supervisors, inefficient employees, strained relationships, health issues and financial worries are some of these causes. If you can learn to beat the heat and manage stress half the battle is won. There are various techniques that can be used to manage stress. Try deep breathing when faced with a tense situation. Yoga and meditation can also work as stress busters. Therapists endorse exercising as a means to release feel good hormones and do away with stress and tension.

All said and done, anger and stress to a certain degree is desirable and healthy. Excessive stress can lead to fits of anger and affect all aspects of life. Managing stress and anger is important for your emotional as well as physical well being.

The most effective way in managing your stress and anger is to learn anger and fear control skills by taking an anger management class. It would be most helpful if the classes focused on anger management, stress management, assertive communication, and emotional intelligence.

By Gregory Kyles, LPC, CEAP, CAMF http://www.ami-tx.com
www.angermanagementinstituteoftexas.com

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Food Additives

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Food Additives that are Good for You

Here are some nutritional ingredients that are good for you:

Calcium:

Calcium is deficient in many of our diets, especially in the diets of teenagers. Calcium is important for healthy bones, teeth, blood clotting, and muscle and nerve function. The most absorbable form of calcium is found in dairy products, but what what if you don’t like dairy products, or can’t tolerate dairy products? One great option is to choose calcium fortified foods. The best known calcium fortified food is orange juice, but look for calcium added to bread and other foods as well. Prebiotics and Probiotics: Probiotics are healthy bacteria that grow in our gut and help keep our digestive system healthy. Prebiotics are the fibers that help support the growth of the probiotics in our gut. Probiotics are naturally found in yogurt and fermented products. Adding the prebiotics like fructooligosaccarhides to foods will help these healthy bacteria flourish and improve our health. Prebiotics can be added to most any type of food, but is commonly found added to yogurt products and in supplement form

Fiber:

Fiber is the undigestible part of plant foods. People on low cab diets often do not get enough fiber in their diets. Fiber is needed for a healthy digestive system, and some fibers will help reduce cholesterol and help to reduce the risk of cardiovascular disease. Oat bran fiber is one example of a healthy fiber that will reduce your risk of cardiovascular diseases. Oat bran fiber is often added to foods like breads, pasta, and snack foods to increase the fiber content.

Anti-Oxidants:

Anti-oxidants are the chemicals found in colorful fruits and vegetables that have special properties to prevent or even treat certain diseases. One example is lycopene, normally found in tomatoes. Lycopene, as well as other anti-oxidants can be added to regular foods, turning them into super-healthy functional foods.

Essential Fatty Acids:

Essential fatty acids and healthy omega 3 oils are needed for healthy nervous system function, healthy brain function, and will work as anti-inflammatories. Adding essential fatty acids to foods will make them even healthier. One example is the addition of an essential fatty acid called DHA to infant formula. Studies show that infants who get adequant amounts of DHA have better brain and eye development.

Proteins and Amino Acids:

Proteins and their individual components called amino acids serve several different functions in our body, most of them related to the structures of our body and for our immune system. Soy protein is an example of a nutritional ingredient that may be added to foods because soy consumption has been shown to reduce the risk of heart disease.

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