The Importance of An Anti-Inflammatory Diet, Part 1

February 2, 2016 / Thomas Cohn, MD

The diet we eat appears to have more and more significant influence on how healthy we are overall. Diet crazes come and go, but more research is showing that the food we eat does affect many aspects of our life. The main problem is that it is easier to eat whatever foods are available than to choose things that are healthy and helpful to us.

Furthermore the food we eat is processed differently at least initially in each and every person depending on our own genetics and the bacteria that happens to be in our gastrointestinal tract. Lastly, if we are overweight, the fat in our body may be contributing to inflammation. Losing excessive fat, exercising and eating healthy foods are all part of controlling inflammation in our bodies, and that too can contribute to a healthy lifestyle.

Researchers have identified certain foods and diet characteristics that seem to help control inflammation. Below are some suggestions with regards to a diet to control inflammation.

Anti-Inflammatory Diet

1. Start eating fish regularly – At least two meals a week should contain fish that are rich in omega-3 fatty acids. These fatty acids are the ones that are good for you by reducing C-reactive protein and interlukin-6, two proteins that enhance inflammation in the body. Eating a portion of fish like salmon, tuna, sardines, or other cold water fish is ideal.

2. Eat more fruit and vegetables because they are packed with antioxidants – These are compounds that support your immune system and help protect it from dangerous compounds in the environment. They also may help prevent inflammation by protecting compounds in the body from breaking down and needing to be removed and destroyed. The best sources are fresh fruit and vegetables, and when cooking vegetables, just lightly steam or cook them, keeping them crisp. The daily amount should be at 2-3 cups of each a day, that would likely equal at least 2-3 pieces of fresh fruit plus your vegetables. This could also include your salads.

3. Try eating nuts and seeds more often – They are great to substitute for snacks instead of empty calories like sweets. Nuts are full of anti-inflammatory monosaturated fats and are high in protein and fiber. Nuts also tend to fill you up and decrease the desire for more calories. A quarter cup of nuts, such as almonds, walnuts, sunflower seeds or pecans are great for snacks. Keep a jar available and take a few when hunger strikes. Stay away from coated or salted nuts.

4. Beans are often known as the “magical” fruit – They have some unwelcomed properties for some people, producing gas since they may be hard for some to fully digest, but beans have several anti-oxidant and anti-inflammatory compounds. They are also a low cost source of protein, packed with minerals like magnesium, iron and zinc and are high in fiber. Cooked beans can serve as a substitute for meat in sauces, and can be used as a main protein source if properly balanced in a diet. Many vegetarians use beans as their main source of dietary protein and extensive recipes are available in how to incorporate them into meals.

5. Use olive oil as one of your main monounsaturated sources of heart healthy fats – This compound is rich in antioxidants and oleocanthal, a compound that can lower inflammation and pain. The Mediterranean region uses olive oil in most of its cooking, and many use it for salad dressing. It is fine for coating hot pans, but do not try to fry foods with this oil.

On Thursday, we’ll share part 2 which includes five more tips on how an anti-inflammatory diet can help prevent chronic pain.

Finding A Good Pillow For Neck Pain

January 20, 2016 / Thomas Cohn, MD

As Shakespeare once said “Sleep, per chance to dream” is the aspiration of everyone. Having a good pillow is the often the key. If you have neck pain, finding a comfortable pillow is a challenge. There are multiple options in size, stiffness and materials that must be considered. The wrong pillow just makes everything worse from neck pain and headaches, to shoulder and upper back pain. Furthermore, a pillow that is over two years old will often be full of dead skin cells, and possibly mildew, mites, or fungus.

Finding The Perfect Pillow

The first thing in getting a pillow is to determine the position you sleep in such that the support will keep your head in a “neutral alignment” position. If you sleep on your back, a thinner pillow with a possible extra bit of cushioning in the bottom third cab help maintain the curve of the neck. A side sleeper will need a fuller and firmer pillow to keep the head from tilting. Sleeping on the stomach often requires only a very thin pillow for the head position. A second pillow that helps maintain body position may also be helpful to improve comfort and to prevent pain. If you change your position during the night, you may have to decide how to combine features to maintain the most neutral alignment.

Pillows are also filled with a variety of different materials. The most common are a variety of feathers, foam, polyester fiberfill, and some are filled with weird materials like water, rice or beads. Classically, pillows used to be either feathers and down, or cotton with wool. A 50-50 mix of down and feathers has been traditionally considered one of the best to provide comfort, support, and allow for adjustments of the cushioning to provide a quality sleep. However, for those with allergies and asthma, down or feathers may cause difficulties. A mix of cotton/wool is another traditional material, but tends to be quite firm and not very adjustable. Polyester fiberfill is an artificial hypoallergenic material that can be designed to mimic down pillows in comfort, and memory foam has become popular over the last several years. Memory foam can continuously mold and adjust to the neck and body position. Today, there are a bunch of different types of foam including cool foams, mold resistance foam and hypoallergenic foam.

Specialty Pillows

Specialty pillows are often expensive and have many designs, shapes, claims and materials. Cervical pillows are made in shapes to cradle the neck supposedly in a neutral position, but studies have usually shown these to be no better than regular designs. Water pillows recommended by some professionals supposedly can be adjusted to customized density and support, but may have odd motion. Bead, wheat or rice pillows claim to provide customized position into a neutral position, but tend to be quite firm and heavy.

The bottom line in choosing a pillow is that everyone has different preferences that may be the best for you. The fancy claims and expensive costs do not make a perfect pillow. First, determine your sleep position, as this will give you an idea of the thickness you might like, then find your preferred firmness. Stay away from down/feathers if you have asthma or allergies. The best option often is trying out various types of pillows at the store if at all possible while lying down. Have someone with you to make sure your neck is in a good neutral position, and if it is the right comfort level, you may have found the winner. Remember, it is comfort and not necessarily cost that is key.

MRIs Can Predict Chronic Pain After Whiplash Injury

January 15, 2016May 10, 2016 / Thomas Cohn, MD

Whiplash occurs when a person’s head is thrust forward or backward in a violent motion, over stressing the muscles and soft tissues in the area. The most common cause of whiplash is a car accident, especially accidents involving a rear-end collision. In this scenario the person who gets rear-ended will be thrust forward, but their head will usually snap backwards as their body is propelled forward.

Depending on the severity of the whiplash, most patients recover from their injury within 1-2 months, but others aren’t so lucky. For some, neck pain due to a whiplash injury becomes chronic, and symptoms remain for months or even years.

Luckily, we’re getting better at assessing whiplash symptoms and predicting who may suffer from long-term symptoms. With help from special MRI imaging, doctors are able to pinpoint with a fair degree of certainty which patients will develop chronic pain, disability and PTSD in the wake of a whiplash injury.

Chronic Pain Prediction

According to researchers at Northwestern Medicine, doctors can predict which patients will develop long-lasting symptoms within the first 14 days from the date of injury. By pinpointing which patients are likely to suffer long-term symptoms, doctors can better treat patients and help prevent potential setbacks down the road.

“This opens up a new door for research on whiplash,” said lead researcher James Elliott said. “For a long time whiplash has been treated as a homogenous condition. Our study has shown these patients are not all the same; they have different clinical signs and symptoms.”

The special MRI technique measures the fat/water ratio in the muscles of a person’s neck, and scientists uncovered that patients who would go on to suffer long-lasting symptoms had larger ratios of fat in their neck muscles. They believe this fatty infiltration could lead to atrophy of the muscles, and their findings were consistent no matter the size or BMI or the patient.

Elliot believes the findings may be most significant for individuals who suffer from PTSD in the wake of a whiplash injury or a traumatic car crash. If a person is deemed at-risk for emotional instability after an accident, doctors can help them get the treatment they need earlier, which can lead to better outcomes.

“These patients have shown to not respond well to traditional rehabilitation such as physical therapy,” Elliott said. “It appears that they may require a more concerted effort for pain management from their physician and help from a psychologist.” Emerging, yet preliminary evidence suggests this to be a reasonable strategy.

The Link Between Dry Eyes and Chronic Pain

January 11, 2016 / Thomas Cohn, MD

Dry eyes can be painful, but new research suggests that people who suffer from dry eyes may be more likely to suffer from other chronic pain conditions.

New findings out of the University of Miami Miller School of Medicine suggests that dry eyes could indicate an underlying neurological issue that could also cause pain in other parts of the body. For their study, researchers examined 154 patients with dry eye and measured their levels of reported pain and their dry eye symptoms using three different tools. Once the researchers had their measurements, they group patients into two groups – Dry eyes with high levels of chronic pain and dry eyes with low levels of chronic pain. When looking at these two groups it became apparent that individuals with high levels of chronic pain also expressed more neuropathic type dry eye symptoms. Those patients also exhibited some other concerning trends.

“Dry eye patients in our study reported higher levels of ocular and non-ocular pain associated with multiple chronic pain syndromes, and had lower scores on depression and quality-of-life indices consistent with a central sensitivity disorder,” said study co-author Dr. Roy C. Levitt.

Dry Eyes and Chronic Pain

Researchers believe the findings from the dry eye study can help doctors uncover root causes of ocular issues, and they can help doctors better manage all expressed symptoms.

“Traditionally, eye specialists have treated dry eye with artificial tears or topical medications for the surface of the cornea. However, even if these treatments improve some dry eye symptoms, many patients continue to report underlying ocular and non-ocular pain,” said lead author Dr. Anat Galor, MSPH, associate professor of clinical ophthalmology.

Building on that point, Dr. Galor concluded that doctors should consider dry eyes as a possible side effect of a chronic pain condition when diagnosing a patient.

“Our highest priority is educating physicians that dry eye represents an overlapping chronic pain condition,” said Dr. Galor. “Consequently, a multidisciplinary approach should be considered in the diagnosis and pain management of dry eye patients.”

Related source: HCPLive.com

Is Your Chronic Pain an Addiction?

January 8, 2016 / Thomas Cohn, MD

New research out of Northwestern University suggests that chronic pain can rewire your brain so a person actually becomes “addicted” to chronic pain.

The new research published in Nature Neuroscience examined how brain neurons in rats were affected by negative emotions and pain. When looking at the rodents, researchers noted that some rats experienced a hyper-excitable collection of neurons after an injury or pain. These neurons not only controlled some negative emotions, but their hyper-expression was also associated with a drop in the neurotransmitter dopamine, which plays a large role in our reward motivation. In essence, the brain was misconstruing why these neurons were firing, and it slowly became addicted to their hyper-expression. In essence, your body becomes addicted to pain.

“The study shows you can think of chronic pain as the brain getting addicted to pain. The brain circuit that has to do with addiction has gotten involved in the pain process itself,” explained corresponding author A. Vania Apkarian, PhD, adding that pain is both sensory and emotionally based.

New Understanding, New Solution?

With their new understanding of how some people’s body’s perceive pain, Dr. Apkarian began working on new ways to treat chronic pain. Using a combination of two different drugs, they were essentially able to rewire the brain so it stopped seeing pain as a rewarding behavior.

“It was surprising to us that chronic pain actually rewires the part of the brain controlling whether you feel happy or sad. By understanding what was causing these changes, we were able to design a corrective therapy that worked remarkably well in the models,” said the study’s lead author Dr. D. James Surmeier. “The question now is whether it will work in humans.”

The team hopes to take their study to the next stage and see if it produces a similar positive affect in humans whose brain’s have been affected by chronic pain.