Year: 2021

Categories : Ageing Pain ManagementTags :

Cannabis Use Screening in Older People Urged

On By ModernMedia
Cannabis plants. Photo by Harrison Haines from Pexels

Older people who use cannabis to relieve or treat health conditions generally don’t discuss their substance use with doctors, according to a new study. 

In this study of over 17 000 people aged 50 and over in the US, some use cannabis daily and others have mental health problems. The findings were published in peer-reviewed The American Journal of Drug and Alcohol Abuse.

The research is the first to identify where older users obtain cannabis, with the majority saying obtaining it was easy. Those who use cannabis for health reasons are more likely than non-medical (recreational) users to buy it at a medical dispensary (20% vs 5%) and less likely to get it for free (25% vs 46%) or from other sources such as parties (49% vs 56%).

According to the authors, the findings have significant clinical and policy implications especially as more US states are legalising cannabis, which is leading to a rapid rise in uptake among older people. This has implications for other countries such as South Africa, which has recently decriminalised it for personal use.

They urge that doctors should be routinely screening older people for cannabis and other substance use, as well as checking cannabis users for mental health problems, and recommending treatment when necessary. They add that education on the risks of obtaining cannabis and cannabis products from unregulated sources is also vital for this group.

“Cannabis is readily available and accessible to older cannabis users for medical or non-medical purposes,” said Namkee G Choi from University of Texas.

“The findings suggest that some medical users may be self-treating without healthcare professional consultation.

“All older people who take cannabis should consult healthcare professionals about their use. As part of routine care, healthcare professionals should screen for cannabis and other substance use, and for mental health problems.

“They should also recommend services or treatment when indicated. Given the increase in THC (tetrahydrocannabinol) potency, healthcare professionals should educate older cannabis users, especially high-frequency users, on potential safety issues and adverse effects.”

THC content has increased significantly over the past decades. Since 1995, the potency of illicit cannabis plant material seized in the US has consistently increased over time, from approximately 4% in 1995 to approximately 12% in 2014. Among older US adults, cannabis has more than doubled between 2008 and 2019. Reasons include pain relief and treating health issues. However, not much is known about where they obtain cannabis and how much they discuss their use with doctors.

Data for the research was drawn responses from the 2018 and 2019 National Survey on Drug Use and Health (NSDUH), with 17 685 men and women aged 50 and older. This annual national survey measures substance use and misuse and mental illness across the US.

The researchers analysed responses including those on frequency of cannabis use, reasons for taking it, where it was obtained, and how much they utilised healthcare services.

The study found that, overall, 9% used cannabis over the past year and of these, 19% used cannabis for a medical purpose to some extent, eg, to treat chronic pain, depression or diseases like arthritis, while the rest (81%) were recreational (non-medical) users.

The authors also found that people who reported cannabis use as being for medical reasons were over four times as likely than non-medical users to discuss their use with a healthcare professional. Nevertheless, only a minority of medical users did so, which implies that some are self-treating without consulting a doctor.

Medical users were also more likely than non-medical users to more frequently take cannabis, with 40% using it between 200 and 365 days a year.

A higher proportion of older cannabis users had mental illness, alcohol use disorder, and nicotine dependence compared with non-users of the same age, although medical users were less likely to have alcohol problems compared to recreational users.

As well as calling on doctors to do more, the study authors say the NSDUH needs updating to “reflect changing cannabis product commercialization”, such as including products available to older people like cannabidiols, topical solutions and edibles.

Limitations of the study included the relatively small number of medical users and the fact some respondents may have under-reported their cannabis and other substance use.

Source: Medical Xpress

Journal information: The American Journal of Drug and Alcohol Abuse, www.tandfonline.com/doi/full/1 … 0952990.2021.1908318

Categories : Cardiovascular DiseaseTags :

Blood Pressure Meds May Lower Heart Risk Even For the Healthy

On By ModernMedia
Red blood cells. CC0 Commons


Blood pressure-lowering medication can prevent serious cardiovascular conditions such as strokes, heart failure and heart attacks even in adults with normal blood pressure, according to new research published in The Lancet.

Importantly, the study found the beneficial effects of treatment were similar regardless of the starting blood pressure level, in both people who had previously had a heart attack or stroke and in those who had never had heart disease.

The authors say that the findings have immediate and important implications for global clinical guidelines that typically limit blood pressure-lowering treatment to individuals with high blood pressure (typically above 140/90 mmHg).

“Our findings are of great importance to the debate concerning blood pressure treatment,” said lead author Professor Kazem Rahimi at the University of Oxford. “This new and best available evidence tells us that decisions to prescribe blood pressure medication should not be based simply on a prior diagnosis of cardiovascular disease or an individual’s blood pressure level. Instead, medication should be viewed as an effective tool for preventing cardiovascular disease in people at increased risk of developing heart disease or stroke. Clinical guidelines should be changed to reflect these findings.”

He cautioned, “We’re not saying that everyone must begin treatment. The decision will depend on an individual’s risk factors for developing cardiovascular disease, the potential for side effects and patient choice.”

In many Western countries as well as developing economies like South Africa, heart disease and stroke, linked to high blood pressure, are among the leading causes of death. Blood pressure medication is widely acknowledged as protecting people with a history of heart attack or stroke from having a recurrence, but there is debate about their use in people with normal or mildly elevated blood pressure.

To date, conflicting findings have come from studies examining whether blood pressure-lowering medication is equally beneficial in people with and without a history of cardiovascular disease, and at lower blood pressures warranting treatment (typically considered 140/90 mmHg or higher). This has led to contradictory treatment recommendations around the world.

For the current analysis, the Blood Pressure Lowering Treatment Triallists’ Collaboration pooled data from 344 716 adults in 48 randomised trials to investigate the effects of blood pressure-lowering medications.

Participants were classified as those with a prior diagnosis of cardiovascular disease (157 728 participants – secondary prevention group) and those without (186,988 – primary prevention group, without cardiovascular disease).

Each group was then divided into seven subgroups based on levels of systolic blood pressure at the start of the study. About 20% (31 239) of participants with prior cardiovascular disease and 8% (14 928) of those who had never had cardiovascular disease had normal or high-normal systolic blood pressure at the start of the trials (systolic blood pressure less than 130 mmHg).

Over an average of four years follow-up, 4324 participants experienced at least one major cardiovascular event (ie. heart attack, stroke, heart failure, or death from cardiovascular disease).

With every 5mmHg reduction in systolic blood pressure, the risk of developing major cardiovascular disease decreased by approximately 10% (18 287 vs 24 037 major cardiovascular disease in the intervention and comparator groups, respectively), stroke by 13% (6005 vs 7767), heart failure by 13% (3249 vs 4584), ischaemic heart disease by 8% (8307 vs 11 145), and  cardiovascular disease mortality by 5% (4 825 vs 6 110).

The beneficial effects of the treatment did not differ based on a history of having had cardiovascular disease or the level of blood pressure at study entry.

“It is important that people are considered for blood pressure-lowering treatment based on their cardiovascular risk, rather than focusing on blood pressure itself as a qualifying factor for or target of treatment,” said co-author Zeinab Bidel from the University of Oxford. “We must provide well-rounded guidelines to lower risks for cardiovascular disease that include exercise, nutrition, smoking cessation, and – where appropriate – medication.”

The study has some limitations, such as only investigating the impact of baseline blood pressure and prior cardiovascular disease on treatment effects, so the findings cannot be generalised to other patient characteristics that have not been included in the analysis.

Additionally, effects on diseases other than major cardiovascular disease, including potential treatment side effects, were not specifically examined.

Source: News-Medical.Net

Journal information: The Blood Pressure Lowering Treatment Trialists’ Collaboration., (2021) Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. The Lancet. doi.org/10.1016/S0140-6736(21)00590-0.

Categories : Allergies Diet and NutritionTags :

Common Probiotic Altered to Grow in Dairy Products

On By ModernMedia
A glass of milk. Source: Pixabay via Pexels

Researchers at the University of Helsinki have created a strain of the Lacticaseibacillus rhamnosus GG probiotic that can reproduce in dairy products.

Lacticaseibacillus rhamnosus GG, or LGG, is the most studied probiotic bacterium in the world. However, it cannot utilise lactose found in milk or break down the milk protein casein. This makes the bacterium grow poorly in milk and is the reason why it must be added separately to probiotic dairy products.

While attempts have been made to get L. rhamnosus GG to thrive in milk through genetic engineering, strict restrictions have prevented the use of such modified bacteria in human food.

Thanks to a recent breakthrough made at the University of Helsinki, Finland, with researchers from the National Institute for Biotechnology and Genetic Engineering, Pakistan, features have now been successfully added to the LGG probiotic without gene editing, making it able to grow in milk.

The method instead took advantage of conjugation, a DNA exchange technique used in certain bacterial groups to transfer their traits to other bacteria. A bacterium produces a copy of its plasmid, a ring-shaped piece of DNA, and then transfers it to an adjacent bacterium. The spread of plasmids, which carry traits useful for bacteria, can be rapid among bacterial communities – and can also further the spread of problematic traits such as antibiotic resistance.

A specific Lactococcus lactis bacterial strain grown in the same place provided the lactose and casein-utilising plasmid to the Lacticaseibacillus rhamnosus GG.

“The new LGG strain is not genetically modified, which makes it possible to consume it and any products containing it without any permit procedures,” explained project leader Per Sari, Professor of Microbiology at the University of Helsinki.

The new strain can be used as a starting point in the development of new dairy products where the probiotic concentration increases already in the production stage. In other words, the probiotic need not be separately added to the final product. Furthermore, lactose- and casein-hydrolysing bacteria added to milk could help produce products suitable for people with dairy allergies.

This new LGG strain could also be better suited to growing in the infant gut, where it can utilise the casein and lactose in breastmilk to grow, thereby producing more protective lactic acid than the original strain.

“Lactic acid lowers the pH of the surface of the intestine, reducing the viability of many gram-negative pathogenic bacteria, such as E. coli, Salmonella and Shigella, which threaten the health of infants. Moreover, in larger numbers the new LGG strain can potentially be more effective at protecting infants than the old strain. After all, LGG has previously been shown to alleviate infantile atopic dermatitis and boost the recovery of the gut microbiota after antibiotic therapies.”

The researchers are in discussions about further applications of their research.

Source: News-Medical-Net

Journal information: Hussain, N., et al. (2021) Generation of Lactose- and Protease-Positive Probiotic Lacticaseibacillus rhamnosus GG by Conjugation with Lactococcus lactis NCDO 712. Applied and Environmental Microbiology. doi.org/10.1128/AEM.02957-20.

Categories : COVIDTags :

What is India’s ‘Double Mutant’ COVID Variant?

On By ModernMedia
Artistic rendering of SARS-CoV-2 virus, which causes COVID. Photo by CDC from Pexels

While Indian hospitals buckle under COVID cases and even capacity for cremations runs out, a new ‘double mutant’ variant of the virus has emerged.

First announced just one month ago, scientists are already trying to determine if it is driving the surge in Indian cases — and the implications for the rest of the world.

“We need to keep a close eye on this variant,” Katelyn Jetelina, PhD, MPH, of the University of Texas Health Science Center at Houston, wrote in a recent email newsletter.

What ‘double mutant’ means

Officially named B.1.617, the ‘double mutant’ is a bit of a misnomer, because it actually carries 13 mutations, 7 of which are in the spike protein. The nickname comes from two notable mutations found in other variants that appeared together for the first time in this new strain: the L452R and the E484Q mutations.

The L452R mutation in the spike protein was first found in the COVID variant detected in California, which could be up to 20% more transmissible than wild-type strains.

The E484Q mutation seems very similar to the E484K mutations found in the B.1.351 (South African) and P.1 (Brazilian) variants. These are ‘escape mutations’ because it enables these SARS-CoV-2 variants to evade immune protection with monoclonal antibodies, potentially making vaccines less effective. Thus far, current vaccines appear to be holding up against these variants, according to Jetelina.

The exact significance of these mutations is still being worked out.

“Just because there are two worrisome mutations on one variant doesn’t necessarily mean this is [doubly] contagious or [doubly] deadly. The WHO [World Health Organization] has declared B.1.617 a ‘Variant of Interest’ instead of a ‘Variant of Concern,'” she wrote.

The WHO definition of ‘variant of interest’ is one that has been found to cause community transmission, has been found in numerous COVID cases or clusters, or has been found in multiple countries. A ‘variant of concern’ on the other hand is defined as one that has been associated with or has demonstrated increased transmissibility, increased virulence, a change in clinical disease, or decreased effectiveness in treating or controlling the illness.

What is the significance of this variant?

The B.1.617 variant has spread rapidly in India, becoming the dominant strain in the state of Maharashtra in southwestern India. Maharashtra is India’s second most populous state and also home to India’s financial centre in Mumbai.

In December 2020, 271 million people (about one-fifth of India’s population) were already infected with COVID, and modelling studies suggested that natural infection had already caused India to reach herd immunity. In light of this, India’s health minister announced that the country had successfully contained the spread of the virus.

Yet three months later, the biggest COVID surge yet is happening in India, with a new high of over 340 000 new infections reported daily. Furthermore, experts believe the actual number of infections and deaths may be under-estimated.

Is the new variant possibly to blame for the current surge? Or is it a combination of factors related to people letting their guard down, such as a lack of masking, large gatherings of people mixing and travelling together, and a belief that somehow India was already immune?

No-one has answers to this yet, but a similar situation has already occurred elsewhere in the world.

“We saw the same story in Brazil. The city of [Manaus] had over 70% of people ‘naturally’ infected. But, once P.1. hit, they had a major surge,” Jetelina wrote. “Populations that have high ‘natural’ immunity are getting re-infected. It doesn’t look like natural infection will protect us for long. Get your vaccine.”

The variant has been found in the US and 18 other countries and on all continents, except Africa. Preliminary evidence so far suggests that the Covaxin vaccine, an inactivated virus vaccine made in India, is still protective against the double mutant variant. The trial attracted controversy since it was approved in January without a final phase III clinical trial. Scientists in India have also reported that Covishield, which is a viral vector vaccine like AstraZeneca’s jab, has efficacy against the mutant.

Dr Jetelina nevertheless urged vigilance: “The more this virus jumps from person-to-person (regardless of where it’s at in the globe), the more chances it has to mutate,” she wrote. “The more it mutates, the more chances it has to outsmart our vaccines.”

Source: MedPage Today

Categories : CancerTags :

Avocado Compound May Be Useful in Leukaemia Therapy

On By ModernMedia

Avocados may be good for more than just an expensive toast topping. According to a new study from the University of Guelph a compound in avocados offers a potential route to improved leukaemia therapy.

The compound in questions targets an enzyme that scientists have identified for the first time as being critical to cancer cell growth, explained Dr Paul Spagnuolo, at the Department of Food Science.

The study focus was on acute myeloid leukaemia (AML), which is the most severe form of leukaemia. Most cases occur in people over age 65, with fewer than 10% of patients surviving five years after diagnosis.

Leukaemia cells have elevated levels of an enzyme called VLCAD involved in their metabolism, said Dr Spagnuolo.

“The cell relies on that pathway to survive,” he said, explaining that the compound is a likely candidate for drug therapy. “This is the first time VLCAD has been identified as a target in any cancer.”

Dr Spagnuolo’s team screened nutraceutical compounds among a variety of compounds, searching for any substance that could inhibit the enzyme. “Lo and behold, the best one was derived from avocado,” said Dr Spagnuolo.

Avocados have already been shown to improve lipid profiles, as well as helping to control weight, likely through increased satiation. His lab previously examined avocatin B, a fat molecule found only in avocados, for potential application in diabetes prevention and obesity management. He’s now keen to see it put to use in leukaemia patients.

“VLCAD can be a good marker to identify patients suitable for this type of therapy. It can also be a marker to measure the activity of the drug,” said Dr Spagnuolo. “That sets the stage for eventual use of this molecule in human clinical trials.”

Around half of patients over 65 diagnosed with AML currently enter palliative care. Some may undergo chemotherapy, but these treatments are often toxic and result in patients dying.

“There’s been a drive to find less toxic drugs that can be used,” he noted.

Referring to earlier work using avocatin B for diabetes, Spagnuolo said, “We completed a human study with this as an oral supplement and have been able to show that appreciable amounts are fairly well tolerated.”
The results of the study were published in the journal Blood.    

Source: Medical Xpress

Journal information: Matthew Tcheng et al, Very long chain fatty acid metabolism is required in acute myeloid leukemia, Blood (2021). DOI: 10.1182/blood.2020008551

Categories : AgeingTags :

Dermal Fillers Can Provide Minor Facelifts

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A new study using 3D imaging shows that dermal fillers can also provide some ‘lifting’ effects, as well as their normal ‘volumising’ effects in facial rejuvenation therapy. 

Dermal fillers are ranked second of the top five non-surgical cosmetic procedures, behind botulinum toxin injections. While dermal fillers have been increasing in popularity, plastic surgeons are trying to work out the best application for facial rejuvenation without surgery. Most studies have used subjective rating systems with little generalisability as a result.

The results of a recent study showed that in addition to ‘volumising’ effects, dermal fillers may also have variable ‘lifting’ effects. Sebastian Cotofana, MD, PhD, of the Mayo Clinic,and colleagues came up with a study to measure the true lifting effect of soft tissue fillers.

In this experimental study, the researchers performed standardised dermal filler injections in facial cadaver specimens, in the areas commonly targeted for facial rejuvenation: the forehead and temple; the midface region, including both the medial (central) and the lateral (sides) areas; and around the mouth and jawline.

Dr Cotofana and colleagues performed before-and-after 3D scans of the facial surface to measure the effects of the injections. 

Dermal filler injections showed significant increases in local soft tissue volume in central areas of the face, consistent with the well-established clinical effects of ‘injectable’ treatment in the forehead, midface, and mouth and chin areas.

Local lifting effects were also seen from central facial injections, with up to one millimetre of vertical ‘lift’ in the forehead area, but this was not seen in the other facial areas.

Injections in lateral facial areas such as the jawline also resulted in local volumising and lifting effects. These lateral facial injections also created ‘additional regional lifting effects’ in neighbouring facial areas. Temple injections resulted in a small but significant lifting effect on the lateral midface and jawline, for example.

Combined injection techniques provided even greater benefits. Added to deep filler injection, a superficial temple injection technique produced an additional 17.5% increase in the lifting effect of the temple, plus a 100% increase in the jawline lifting effect.

“These results indicate that lateral face injections co-influence adjacent lateral facial regions and can thus induce regional lifting effects,” wrote Dr Cotofana and coauthors. The results are consistent with previous knowledge of the in-depth anatomy of the face: filler injections may lead to a change in tension of the connective tissue (fascia) under the skin, resulting in “re-positioning” of the upper skin layers.

In this way, filler injections can provide a small but significant lifting effect in a minimally invasive, repeatable procedure, although they are not as effective as plastic surgery. Besides providing confirmation on previous findings on the lifting effects of facial injectables, the study also “broadens their applicability to the total lateral face…to achieve local and regional lifting effects.”

Source: News-Medical.Net
Journal information: Haidar, R., et al. (2021) Quantitative Analysis of the Lifting Effect of Facial Soft-Tissue Filler Injections. Plastic and Reconstructive Surgery. doi.org/10.1097/PRS.0000000000007857.

Categories : Medical Research & TechnologyTags :

A 3D Printed Hydrogel With Self-healing Capacity

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Much research has focused on hydrogels, polymer-based materials containing large amounts of water, but hydrogels with both self-healing and complex construction have proved elusive until now. 

Hydrogels need to fulfil two key criteria if they are to be effective replacements for organic tissue: the ability to form extremely complex shapes, and to self-heal after sustaining damage. Previously, hydrogels created in the laboratory had either the capability of being 3D printed into complex shapes, or had the ability to self-heal. This research realises the first time these two capabilities had been combined into one material.

The development of these materials may now be easier, and cheaper, thanks to the use of 3D printing: the researchers in the MP4MNT (Materials and Processing for Micro and Nanotechnologies) team of the Department of Applied Science and Technology of the Politecnico di Torino, coordinated by Professor Fabrizio Pirri. The researchers detailed their work in the prestigious journal Nature Communications.

In addition, the hydrogel was created using both commercially available materials and printer, thus making the approach proposed extremely flexible and potentially applicable anywhere, throwing open the door for development in the fields of both biomedicine and soft robotics.

The research was carried out in the context of the HYDROPRINT3D doctoral project, funded by the Compagnia di San Paolo, in the frame of “Joint Research Projects with Top Universities” initiative, by the PhD student Matteo Caprioli, under the supervision of the DISAT researcher Ignazio Roppolo, in collaboration with Professor Magdassi’s research group of the Hebrew University of Jerusalem (Israel).
The researchers used the digital pulsed light to create a semi-interpenetrated structure of polymer strands that, when severed, could rejoin in 12 hours at room temperature with no outside intervention. The restored section retains 72% of its initial strength.

“[For] many years, in the MP4MNT group, a research unit coordinated by Dr Annalisa Chiappone and I, specifically devoted to development of new materials that can be processed using 3D printing activated by light,” said Ignazio Roppolo, Researcher, DISAT. “3D printing is able to offer a synergistic effect between the design of the object and the intrinsic properties of materials, making [it] possible to obtain manufactured items with unique features.

“From our perspective, we need to take advantage of this synergy to best develop the capabilities of 3D printing, so that this can truly become an element of our everyday life. And this research falls right in line with this philosophy.”

This research represents a first step towards the development of highly complex devices, which can exploit both the complex geometries and the intrinsic self-healing properties in various application fields. Once biocompatibility studies have been refined, it will be possible to use these structures both for cellular mechanism research and for regenerative medicine applications.

Source: News-Medical.Net

Journal reference: Caprioli, M., et al. (2021) 3D-printed self-healing hydrogels via Digital Light Processing. Nature Communications. doi.org/10.1038/s41467-021-22802-z.

Categories : AntibioticsTags :

Holding off on Antibiotics is Safe and Effective for Patients

On By ModernMedia

According to an analysis published in BMJ Today, delayed antibiotic prescribing is a safe and effective strategy for most patients with respiratory tract infections.

Delayed antibiotic prescribing—also known as ‘just in case prescribing’—is when patients agree to see whether symptoms settle before collecting a prescription, in order to help reduce antibiotic use.

Delayed prescribing was shown to be associated with a similar duration of symptoms as no antibiotic prescribing and is not likely to lead to poorer symptom control than immediate antibiotic prescribing. In children with immediate antibiotics a slight benefit was seen but this was not judged important enough to justify immediate antibiotic prescribing.

Respiratory tract infections affect the sinuses, throat, airways or lungs and include conditions such as the common cold, sore throat, cough and ear infection. While most improve without treatment, antibiotics are still widely being prescribed for these conditions.

It has been suggested in various clinical trials that delayed antibiotic prescribing for respiratory tract infections is probably safe and effective for most patients, but they were unable to examine different groups of patients or complications.

To address this, an international research team set out to assess the effect of delayed antibiotic prescribing on symptoms for patients with respiratory tract infections in the community.

They used individual patient data on a total of 55 682 patients from nine randomised controlled trials and four observational studies to compare average symptom severity between delayed versus no antibiotic prescribing, and delayed versus immediate antibiotic prescribing.

Most of the studies took place in primary care settings with the average age of study participants ranging from 2.7 to 51.7 years.

The researchers accounted for factors including age, sex, previous duration of illness, severity of symptoms, smoking status and underlying conditions. Average symptom severity was measured two to four days after initial consultation on a seven point scale (ranging from normal to as bad as could be).

The researchers found no difference in symptom severity for delayed versus immediate antibiotics or delayed versus no antibiotics.

Symptom duration was slightly longer in those given delayed versus immediate antibiotics (11.4 v 10.9 days), but was similar for delayed versus no antibiotics.

Complications resulting in hospital admission or death were lower with delayed versus no antibiotics and delayed versus immediate antibiotics, but neither result was statistically significant.

Re-consultation rates were significantly reduced and an increase in patient satisfaction were found for delayed versus no antibiotics, but not for delayed versus immediate antibiotics.

Children under 5 years of age showed slightly more severe symptoms with delayed antibiotics than with immediate antibiotics, but this was not considered to be clinically meaningful, and this was not seen in older age groups.

 hey concluded that delayed antibiotic prescribing “appears to be a safe and effective strategy for most patients, including those in higher risk subgroups.”

This was a large, detailed analysis accounting for differences in study design and quality to reduce bias. The researchers nevertheless pointed out some limitations, being unable to exclude the possibility that other unmeasured factors may have affected their results.

Source: Medical Xpress

Journal information: Beth Stuart et al, Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis, BMJ (2021). DOI: 10.1136/bmj.n808

Categories : Pain ManagementTags :

Timing is Key for Psychological Treatment of Chronic Pain

On By ModernMedia

When timed correctly, psychological interventions can reduce the risk of chronic pain, according to a pain expert at the virtual 2021 American Academy of Pain Medicine annual meeting.

“We can look at chronic pain as occurring in a very linear process,” said Ravi Prasad, PhD, of University of California Davis, in a meeting session about multimodal ways to prevent chronic post-surgical pain.

“By definition, pain starts off as something acute,” Dr Prasad explained. The acute phase includes assessments and treatment to try to eliminate pain quickly.

“When the pain condition fails to respond to some of these initial treatments, it starts to enter the subacute category,” Dr Prasad continued. “The patient is still engaged in different medical workups to try to identify the cause of the pain and still participating in treatments, but they haven’t responded to the interventions in the manner expected, meaning the pain continues to persist.” Normally, this comes some 3 to 6 months after the acute phase.

Pain can become chronic when it has plateaued and resists medical treatment for at least 6 months.

“It’s important to recognize these time points exist,” Dr Prasad emphasised. “We can intervene at these different points — and intervene even prior to the experience of acute pain — to try to minimize the likelihood that persistent pain develops.”

There are many factors which contribute to chronic pain. These include environmental stressors, lifestyle factors, unhealthy support systems, limited care access, and patient risk factors such as substance abuse history, adverse childhood experiences, and psychiatric conditions.

Research has shown the most useful predictors of poor pain outcomes after surgery were pre-surgical somatization, depression, anxiety, and poor coping.

“All of these are things that are actually modifiable,” Prasad said. “We can actually do something about these to change the outcomes a person might have.”

Cognitive therapies and relaxation training are two interventions receiving a lot of attention, he noted. Breathing, relaxation exercises, and meditative practices can help patients learn to quiet the nervous system by working on the sympathetic-parasympathetic axis. But cognitive processes also have to be targeted, Prasad observed, and “this is where cognitive behavioral therapy can come in.”

Cognitive behavioural theory is premised on the idea that “by changing the interpretation, we can change the impact of consequences at the emotional, physical, and behavioral level,” Dr Prasad said. “The challenge with this is that our interpretations tend to be automatic.”

“Making changes in our interpretation is difficult because we have to become aware of processes that are occurring in our subconscious and make changes in something that’s been with us for a very long period of time,” he acknowledged. “These thought processes can be very resistant to change. But it’s essential we do this if we want to have sustained change in our outcomes.”

It’s not something as simple as turning negative thoughts into positive ones, Prasad added. “Rather, we look at the accuracy and the degree of helpfulness of the thoughts, and modify the thoughts into something that is more accurate and helpful.”

“We know that when people engage in cognitive behavioral therapy, their outcomes are improved. Affective stress is decreased, pain sensitivity decreases, and this can minimize opioid burden,” he continued. He added that there are many psychological-based tools backed by a strong evidence basem including biofeedback training and mindfulness-based stress reduction.

Dr Prasad emphasised however that timing of these treatments is essential.

“The way to optimize timing is to do presurgical screening to identify what’s the most appropriate intervention for the patient,” he said. Some patients may need help before surgery, others can be targeted at the acute or subacute phase. “Regardless, we want to make sure we address symptoms as early as possible and not wait for pain to be in a chronic state.

Source: MedPage Today

Presentation information: Prasad R “Psychological Interventions to Reduce of Persistent Pain” AAPM 2021.

Categories : Exercise General Interest Mental HealthTags :

Hiking Prescribed for Elderly Man Coping with Lockdown

On By ModernMedia

When Jim Snodgrass, 84, was expecting to receive medication to treat his anxiety, he instead was simply given the phone number for the Ramblers, a UK-based society of nature walkers and hikers.

Dr Victor Jack said that he recognised that Jim needed “social connection” and not medication. Hiking itself also has a number of proven physical and psychological health benefits. Some may be immediate, such as decreased blood pressure, decreased stress levels, enhanced immune system functioning, and restored attention, or else occur over time, such as weight loss, decreased depression, and overall wellness.

During the first COVID lockdown in March 2020, Jim was on his own since his wife Sheila died six years previously, said he suffered a breakdown.

The grandfather-of-two said: “I was not feeling good as I was bothered with my nerves so I called the doctor and that’s when I burst into tears on the phone to the receptionist.

“She was so nice to me and got the doctor to call me. I was surprised when he didn’t give me any pills and instead gave me the number for the Ramblers.”

During lockdown doctors could give exemptions to people who lived on their own to meet one other person outside. Then last summer people were allowed to meet in groups to walk.

Presently in the UK, groups of 15 people are allowed to meet outside.

He said: “The Ramblers saved me during the last year of lockdowns. I don’t know where I would be without them with my nerves. Within two miles of walking I’m a different person. Dr Jack is an amazing man as he has saved me from my nerves in the lockdowns with this idea of his.”

Jim has walked 6.4 to 8 kilometres a day in the last year.

He said: “I even went out when the roads were icy and always stayed within a five mile radius of South Queensferry during the lockdowns. I hope my story helps someone else who is feeling bad so they know to join their local Ramblers group too.”

Dr Jack, of South Queensferry Medical Practice, told BBC Scotland his own experience with stress was used to inform Jim’s treatment.

“When Jim told me he liked walking but that he had been walking on his own I was aware that he was actually quite socially isolated as his wife had died,” Dr Jack explained. “He was benefitting from the physical part of walking but not the social side. A few years ago I joined a running club and found it very helpful for stress. This has made me recognise that any sports club has a benefit particularly through the social connection it provides.”

Dr Jack said he had seen numerous patients experiencing mental health issues during the lockdown, especially in those working from home.

Brendan Paddy, director of Ramblers Scotland, said: “Jim is truly an inspiration to us all. It’s amazing to see how he’s improved his health and happiness by getting active with his local South Queensferry Ramblers group.

“Clearly lockdown has been a hugely challenging time, yet we know that many more people like Jim are discovering the revitalising power of walking – with booming numbers enjoying Scotland’s outdoors. I’d urge anyone who’d like a bit more adventure, friendship and fresh air in their lives, to give the Ramblers a go.”

Source: BBC News