National Task Force Urges Depression Screenings for Adults

By Miranda Wilcox
Herald Democrat

…doctors should screen all adults
for depression…

Depression Screening
The U.S. Preventative Services Task Force announced their newest recommendation on Tuesday, that doctors should screen all adults for depression.

Get e-CESD Depression Screening App for Your Practice

“If you don’t screen then you don’t find out that the person has depression, and the result of that is, if you look at population-based data, half of the people with depression in the United States never get diagnosed,” said University of Texas Southwestern Medical Center Professor of Psychiatry Madhukar Trivedi.

Trivedi cited the sweeping impacts of depression, including:

Doctor with patient forms

  • the fact that people with depression live 13 years less than people without depression;
  • an average of 41,000 people kill themselves every year by suicide; and
  • three to four hours per week of productivity is lost for people who have depression compared to those who don’t.

Read More National Task Force Urges Depression Screenings for Adults


The 10 Best Gifts for People with Chronic Pain

You’re stumped on ideas for the perfect gift to give the person in your life who lives with chronic pain. You want them to open your beautifully wrapped present and know that you put some thought and effort into finding the best gift they have ever received. You hope they will understand how special they are to you as they enjoy your meaningful gift.

The Community Pain Center has done the hard part for you with this list of ideas.

  1. Your special someone can relax and relieve tension while soothing achy muscles with Village Naturals bath soaks and oils, foaming body washes, and lotions. Eucalyptus, spearmint, and menthol work with Dead Sea salt and Epsom salt to unwind stress and quiet the body. Save with this coupon for Village Naturals’ fast-acting therapeutic products.

Village Naturals
Read More The 10 Best Gifts for People with Chronic Pain


Can Chiropractic Care Help
Your Neck Pain?

By Micah Hamilton, DC

Approximately 70% of the population will experience neck pain in their lifetime (3). Neck pain can happen for many reasons, but what is the best option for getting rid of neck pain?

If you find yourself not getting anywhere with that nagging neck pain, it may be time to take a look at some alternative solutions.

Many Americans will try and decrease their pain with non-steroidal anti-inflammatory drugs (NSAIDs), which include names such as Advil, Aleve, Motrin, ibuprofen, naproxen, etc. Yet is that the safest option to treat your neck pain?

Research has shown that NSAIDs increase the risk of heart disease, cause over 200,000 hospitalizations and between 10,000-20,000 deaths each year (2). With these alarming statistics many people are seeking a natural alternative, rather than medications, for treating their pain.

To understand how chiropractic can help with neck pain it is important to understand what chiropractic is.

Chiropractic is the largest drug-free health care profession in the world.

Chiropractors focus on the relationship between structure and function, meaning that they detect and correct specific misalignments of the spine and extremities that can be causing irritation, inflammation and malfunction of the nervous system. Many times this is done through a specific chiropractic adjustment, also known as manipulation. By applying a skilled adjustment to spinal vertebrae, the objective is to restore normal biomechanics while stimulating mechanoreceptors (sensory receptors) deep in the joint, which decreases the response of nociceptors (nerve cells) that are responsible for sending pain signals to the brain. These adjustments can increase joint range of motion and reduce pain.

Read More Can Chiropractic Care Help Your Neck Pain


My Painful Stumble from Furious to Fit

By Leah Tyler

One fateful day in 2011, I stood before my bathroom mirror and watched myself descend into a full-fledged rage attack. My mere 34 years of existence had hit me pretty hard.

I was 100 pounds overweight, riddled
with pain, ravaged by illness, and utterly
incapable of participating in my own life.

Although I had narrowly escaped death and was technically lucky to be alive, it sure didn’t feel that way. I had absolutely no idea how to pick up the shattered pieces of my reality and move forward, but knew I had to do something to curtail the uncontrollable fury gobbling up my sanity. My at-home yoga practice clearly wasn’t doing the trick, so I decided to start running.

But that’s the most misleading way to phrase it. Because I was so out of shape and in so much pain, all I could do was shuffle at a fast trot for 5 out of every 90 steps. Literally. So that’s what I did, every other day when I walked my dogs. After a few weeks, I was trotting ten steps and walking eighty. Over time I kept whittling away the ratio, until the day finally came when I was running a block at a time. It took many months, and my efforts were rewarded with ungodly amounts of pain. I’d hobble up the stairs, gulp down extra pain meds, and lay around moaning about how bad I hurt. But my rage was tempered, and I even lost a little weight, so my progress kept me going.

Years before, in the early days of my journey with chronic illness, I started researching nutrition. This inspired me to try pretty much every diet, cleanse, potion, philosophy, and ideology imaginable claiming to offer the true key to health. While none of them fixed me, the more I shunned preservatives, chemicals, refined, and processed, the better I felt. Marginally. I delved deeper into my quest to understand the human body’s relationship with food and uncovered the startling truth about the dangers of yo-yo

For the first time in my life it became
urgently clear whatever modifications
I decided to implement had to be forever.

Read More My Painful Stumble from Furious to Fit


Vulvodynia: A Real Pain in the Vagina

By Jessie Carr

In my 18 years of battling various chronic illnesses, with all the terrible symptoms and the terrible doctors and the even more terrible social and emotional challenges of being a “sick” person, nothing has been so debilitating as my ongoing war with

In the early days of my diagnosis, when I turned to the Internet for information and a glimmer of hope (as I am sure you, Dear Reader, are also doing), a sentence like that would have moved me to yet another round of tears. But I will not mince words.

I owe that to my fellow sufferers who live in a world where the utterance of the word “vagina” is often met with snickers or blushing or disgust, when of course the vagina is just another body part—an important one at that—and sometimes it gets sick, too.

I make this ominous proclamation to
underline the gravity of this condition
and to validate your suffering.

But I will follow it up with an equally important proclamation: this condition is manageable, and you will be able to enjoy your life again one day. I won’t lie: it may not be easy. But it will happen.

So, altogether now, let’s do this.
Read More Vulvodynia: A Real Pain in the Vagina


Exercise: How a Little Goes a Long Way

By David L. Katz, MD; Chief Medical Officer of the Community Pain Center


Mechanistically, exercise is entirely dependent on action potentials, while its incredible benefits may be characterized as the potential of action to enhance our lives. Ironically, perhaps, the luminous potential of action to promote our health is in a very fundamental way the exact opposite of the action potentials from which it derives.

I imagine that may be about as clear as the way through a Tough Mudder. No worries; I’ve got Windex.

An action potential refers to the mechanism that underlies the firing of our nerve cells, or neurons.

Famously, action potentials are “all or nothing.”
Active nerve cells
At rest, there is a slight electrical gradient maintained across the cell membrane of a neuron. That slight charge is energy dependent, requiring the constant work of ion channels that traverse the cell membrane, shuttling positively and negatively charged ions in opposite directions. When we talk about “resting energy expenditure,” or “basal metabolism,” these are the kinds of functions represented; our cells are always working even when we are not.

That electrical gradient is, quite literally, an “action potential,” because it primes the cell to take the one action it owns: depolarizing. When a stimulus reaches a neuron, if it is strong enough, it reverses the electrical charge at the site of contact. That reversal of charge, or depolarization, then courses along the length of that nerve cell, rather like a fast moving wave.

If the nerve cell in question is a sensory neuron, the result of that wave is that we feel or perceive something—a caress, a color, a shiver, or a symphony.

If it is a motor neuron, it ends at a muscle cell, which in turn is stimulated to contract. When a whole lot of muscle cells contract in unison, we have the familiar command over our moving body parts; such as my fingers, currently dancing over this keyboard.

We could, of course, go much deeper into the weeds, but that’s the relevant gist. What matters for today’s story is that the depolarization of every neuron, or muscle cell (myocyte) for that matter, is all or nothing. The stimulus reaching it is either enough to excite full depolarization, or it is not. There are no partial responses; there is no dose response curve.

Read More Exercise: How a Little Goes a Long Way


Holistic Medicine: How to Define It

By David L. Katz, MD; Chief Medical Officer of the Community Pain Center


We are probably all familiar with things that are tough to define, but that we recognize when we see them. No, I’m not planning on talking about that one

The term I have in mind is: holistic.

Healthy concept, Spirit, Body and Mind

I practice holistic medicine. Specifically, for the past decade, I have directed a rather unique clinic that provides what we call ‘evidence-based integrative care.’ We have published and presented details of the model.

People tend to have a strong sense of what holistic means, whether or not they can actually define it. Detractors see it as an indication of quackery–without looking past the label. Proponents embrace it as an emblem of virtuous humanism. Holistic is good, and all else … less so.

But if that is really true — if holistic care is better (I’m among those who believes it is) — then a workable definition is important. First, so that people who want to sign up for holistic care — to give it, or receive it — know what they are signing up for, exactly. And second, and more importantly, because you can’t practice what you can’t define. Unless we can say just what holistic care is, it can’t be taught, tested, replicated, or improved.

The medical version of TheFreeDictionary tells us that

Holistic care is: “a system of comprehensive or total patient care that considers the
physical, emotional, social, economic, and
spiritual needs of the person; his or her
response to illness; and the effect of the illness on the ability to meet self-care needs.”

I am comfortable with this in theory, but not in practice. In practice, it begs the question: how, exactly, do you do that? What does considering ‘physical, emotional, social, economic, and spiritual needs’ look like in a doctor/patient encounter? What is a clinician actually supposed to do in a room with a patient so that the care that transpires between them is holistically concordant with this definition?

Let’s acknowledge that platitudes don’t really help. Of course, a holistic practitioner looks beyond a battered body part to the whole body; looks beyond the body to the mind and spirit; looks beyond the individual to the body politic of which they are an intimate part; and, if responsible, looks at the body of pertinent scientific evidence as well.
Read More Holistic Medicine: How to Define It


Chronic Pain and Poor Sleep: A Vicious Cycle

By Gerard J. Meskill, MD


Chronic pain is extremely common in America, and it can affect sleep quality. According to the 2015 Sleep in America Poll (1),
21 percent of Americans experience chronic pain, while another 36 percent have experienced acute pain in the past week.

Most people with chronic pain find their symptoms worse while lying in bed trying to sleep, when the external stimuli of the world are no longer providing distraction from their ailments.

Poor sleep can make pain syndromes worse, and worsening of the pain syndrome can feed into perpetuation of poor sleep quality.

Sleep deprivation is an enormous problem in this country as it is. One in three individuals without pain report in the past week that they don’t always or often get a good night’s sleep, the sleep they need to feel their best, or have had trouble falling or staying asleep. In the sub-population of those suffering with pain, it is even worse. According to the National Sleep Foundation (2), people with chronic pain average 42 minutes of sleep debt nightly. Furthermore, only 45 percent of those with acute pain and 37 percent of those with chronic pain report good or very good sleep quality. More than half of those individuals with sleep difficulties and pain report that their poor sleep interfered with their work. This can jeopardize employment and further deteriorate quality of life.

Mature Man having trouble Sleeping


There are many reasons why chronic pain can impair sleep quality. The obvious one is that dealing with pain while trying to fall asleep makes sleep initiation more difficult. Once sleep finally is achieved, any arousal out of sleep allow for perception of the pain phenomenon again, thus prolonging the time it takes to fall back asleep. Since sleeping lowers our overall sleep drive, it is more difficult to fall back asleep with each awakening. As this pattern continues, the way the brain perceives the bed and sleep changes. Much like the Russian psychologist Pavlov taught his dog to associate the sound of a bell with food, the brain starts to anticipate difficulty sleeping every time an individual suffering from insomnia gets into bed. This leads to increased adrenaline levels (“The Fight or Flight” response), which makes it even harder to fall asleep.
Read More Chronic Pain and Poor Sleep: A Vicious Cycle


A Holistic View of Evidence-Based Medicine

By David L. Katz, MD; Chief Medical Officer of the Community Pain Center


On April 29, 2014, I was on the Katie Couric Show to discuss Integrative Medicine. Somewhat ironically, I returned from Manhattan that same day to a waiting email from a colleague, forwarding me a rather excoriating critique of integrative medicine on The Health Care Blog, and asking me for my opinion. The juxtaposition, it turns out, was something other than happenstance. The Cleveland Clinic has recently introduced the use of herbal medicines as an option for its patients, generating considerable media attention. Some of it, as in the case of the Katie Couric Show, is of the kinder, gentler variety. Some, like The Health Care Blog—is rather less so. Which is the right response? One might argue, from the perspective of evidence-based medicine, that harsh treatment is warranted for everything operating under the banner of “alternative” medicine, or any of the nomenclature alternative to “alternative”—such as complementary, holistic, traditional, or integrative.

One might argue, conversely, for a warm embrace from the perspective of patient-centered care, in which patient preference is a primary driver.

I tend to argue both ways, and land in the middle. I’ll elaborate.

Scientist using pipette in laboratory

First, I am a card-carrying member (well, I would be if they issued cards) of the evidence-based medicine club. I am a conventionally trained Internist, and run a federally funded clinical research laboratory. I have taught biostatistics, evidence-based medicine, and clinical epidemiology to Yale medical students over a span of nearly a decade. I have authored a textbook on evidence-based medicine.

But on the other hand, I practice Integrative Medicine, and have done so for nearly 15 years. And I represent Yale on the steering committee of the Consortium of Academic Health Centers for Integrative Medicine.
Read More A Holistic View of Evidence-Based Medicine


Animal-Assisted Therapy for People with Chronic Pain

By Kristen Counts, MOT, OT/L


This notion of animals as having a healing
effect on humans is almost intuitive,
considering our history in seeking
their companionship.

Background Information

Humans have been in close partnership with animals throughout most of recorded history. We have depended on their working with us for our survival as they have tended livestock, guarded our homes, and hunted for game, among other types of work. Evidence of animals as companions has also been traced to the very beginnings of human history. The symbiotic relationship continues today and is gaining recognition as a therapeutic modality. This notion of animals as having a healing effect on humans is almost intuitive, considering our history in seeking their companionship. When looking at the therapeutic value of the human-animal bond in alleviating pain and associated symptoms, research is in its initial stages.

Man with pets

Animal-assisted therapy (AAT) is the term most often used when animals are utilized as a therapeutic modality. AAT is used in a variety of settings by nurses, occupational therapists, physical therapists, speech and language pathologists, and psychologists, along with additional health professionals. It is utilized for a variety of conditions in children, adults, and older adults.

Read More Animal-Assisted Therapy for People with Chronic Pain