Rewrite Your Experience of Depression and Chronic Pain

Step 7 of Dr. Lavine’s Ten Step Program to Conquer Chronic Illness

Phys­i­cal exhaus­tion and low mood, often insep­a­ra­ble from chron­ic pain, shouldn’t be ignored.  In fact, sur­veys of fibromyal­gia suf­fer­ers show that more than 80% expe­ri­ence an almost over­whelm­ing lev­el of fatigue that at times is worse than the pain.

The emo­tion­al aspect of phys­i­cal fatigue is depres­sion.

Of course, fatigue and depres­sion are com­plex, and self-help guide­lines such as these can’t pos­si­bly address your unique indi­vid­ual issues.  I also rec­om­mend that you con­sult your per­son­al physi­cian, nutri­tion­ist, or men­tal health pro­fes­sion­al as appro­pri­ate.

For Step 7 of Dr. Lavine’s Ten Step Pro­gram to Con­quer Chron­ic Ill­ness, I rec­om­mend two self-help strate­gies.  One is a sim­ple method to address dis­tor­tions of your mood.  The sec­ond involves test­ed sleep strate­gies to improve the quan­ti­ty and qual­i­ty of sleep.

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Weight Loss Secrets

Near­ly every­one wants to lose a few pounds.  In many cas­es, more than just a few.

In fact, it’s been the­o­rized that if every­one who want­ed to lose an extra 10–20 pounds actu­al­ly lost the weight and kept it off, the cumu­la­tive dis­ap­pear­ance of body mass would desta­bi­lize the earth’s orbit and send the plan­et hurtling off into inter­stel­lar space.  (Actu­al­ly, no rep­utable physi­cist has the­o­rized that at all.  I just made it up myself.)

But con­trol of body weight is an impor­tant health and diet con­cern. And it’s a chal­leng­ing med­ical issue.

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Research deepens questions about low back mri

mri machine

The March 25, 2013 edi­tion of JAMA Inter­nal Med­i­cine tells the sto­ry: doc­tors are still order­ing far too many low back MRI’s of ques­tion­able val­ue.

Inves­ti­ga­tors first estab­lished “expert” guide­lines that iden­ti­fied sit­u­a­tions in which MRI’s were like­ly to yield use­ful clin­i­cal infor­ma­tion.

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Frailty Syndrome

For today’s guest arti­cle I’d like to thank Lau­rie G. Jacobs, M.D., direc­tor of the Jack and Pearl Resnick Geron­tol­ogy Cen­ter, Albert Ein­stein Col­lege of Med­i­cine and Vice Chair, Clin­i­cal and Edu­ca­tion­al Pro­grams, Mon­te­fiore Med­ical Cen­ter.

This blog post first appeared in The Doctor’s Tablet, the offi­cial blog of Albert Ein­stein Col­lege of Med­i­cine.

 

Frailty: How a Constellation of Symptoms Leads To Risk

by Lau­rie G. Jacobs, M.D. on March 12, 2013

Elderly Man Walking with Son

Frailty Syn­drome

Frag­ile: This Side Up. Few of us find much ambi­gu­i­ty when faced with a mail par­cel marked with those four words. Yet the relat­ed word “frailty” often caus­es con­fu­sion among doc­tors and patients alike. The word “frail” applies to peo­ple, not things—and that’s where the top­ic becomes tricky.

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Once Again Research Shows MRIs Not Helpful in Understanding Low Back Pain

In March, 2013, the New Eng­land Jour­nal of Med­i­cine pub­lished the results of a Dutch study on the val­ue of MRI in assess­ing patients with sci­at­i­ca.

Sci­en­tists took MRI’s of patients with sci­at­i­ca and fol­lowed up with a sec­ond MRI one year lat­er. They also chart­ed patients’ recov­ery from back pain. Mean­while, some of the patients had under­gone disc surgery. Oth­ers hadn’t.

Those who had had surgery were less like­ly to have a her­ni­at­ed disc show up on their fol­low-up MRI. But the MRI pic­ture of the discs didn’t cor­re­late with free­dom from pain. After one year, those who still had a vis­i­bly her­ni­at­ed disc were equal­ly like­ly to be pain-free.

Even if the MRI showed the disc bulging out and pinch­ing a nerve, it didn’t mean that the per­son was more like­ly to have pain.

Here’s a quote from study author Wilco C. Peul, MD, PhD, Depart­ment of Neu­ro­surgery, Lei­den Uni­ver­si­ty Med­ical Cen­ter, The Nether­lands:
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Dynamic Control of Movement is Key to Low Back Pain

Peo­ple with low back pain often also have poor con­trol of low back move­ment.  For­tu­nate­ly, we’ve come a long way from the days when all we knew about con­trol of low back move­ment was the idea of hav­ing “strong abs”.  The dynam­ic con­trol of pos­ture and spinal move­ment is far more sub­tle.  Sci­en­tists can now quan­ti­fy some of the details:

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Degenerative Spondylolisthesis vs. Isthmic Spondylolisthesis

In spondy­lolis­the­sis, one ver­te­bral body slides for­ward rel­a­tive to its neigh­bor to the south.  There can be sev­er­al dif­fer­ent caus­es of this.  The two most com­mon types of spondy­lolis­the­sis are isth­mic spondy­lolis­the­sis and degen­er­a­tive spondy­lolis­the­sis.

Here are some of the major dif­fer­ences:

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Vertebral Compression Fractures

Every year, more than half a mil­lion peo­ple get a ver­te­bral com­pres­sion frac­ture due to osteo­porot­ic, thin­ning bones.

Among younger peo­ple, motor vehi­cle acci­dents and oth­er trau­ma can also cause frac­tures of the ver­te­brae.  Tumors metas­ta­siz­ing to the spine and weak­en­ing the bones are a third cause.

Each of these cat­e­gories of ver­te­bral com­pres­sion frac­ture presents its own prob­lems.

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Do You Need Folate Supplements?

Folate (also known as vit­a­min B9) plays an essen­tial role in many chem­i­cal reac­tions in your body, includ­ing DNA syn­the­sis and amino acid metab­o­lism.

One impor­tant folate-depen­dent chem­i­cal reac­tion is clear­ing the body of homo­cys­teine by con­vert­ing it to methio­n­ine.  If it doesn’t get bro­ken down prop­er­ly, homo­cys­teine can build up in your artery walls and con­tribute to ath­er­o­scle­ro­sis.

Spinach is a pow­er-packed source of folate, with oth­er dark green leafy veg­eta­bles not far behind (yeah kale!)  Folate is also found in a wide vari­ety of oth­er foods, includ­ing fruits, beans, meats, and more.

Despite its broad avail­abil­i­ty in the Amer­i­can diet, pub­lic health author­i­ties have deter­mined that many peo­ple are at risk of folate defi­cien­cy, and have required that for­ti­fied grains include extra folate.

But nat­ur­al sources of folate, even with for­ti­fied grains added in, may not be enough.

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Guest Article: Your Personal Renewable Energy

Thanks to today’s guest author Fran Park­er,  a psy­chother­a­pist, exec­u­tive per­for­mance coach, and expert in move­ment and non-ver­bal com­mu­ni­ca­tion.

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