Apitherapy – Why All Alternative Treatment Options Aren’t The Same

/ Thomas Cohn, MD

apitherapyIf you’ve been following our blog for some time, you know that our goal is to help everyone find a solution to their pain problem. If you find something that works for you, then stick with it. That being said, not all alternative methods are created the same, and some can be downright dangerous.

That’s the lesson we learned when a 55-year-old woman recently died due to complications from apitherapy. For those of you who know your word origins, you might be able to figure out what apitherapy is – bee therapy. More specifically, apitherapy is known as live bee acupuncture.

Apitherapy Gone Wrong

We’re not saying the therapeutic technique is bonkers, because some people swear by it, and as is our motto, we want everyone to find a solution to their individual pain problem, so if it’s working for you, more power to you. That being said, even if it seems safe, it’s clear that we don’t know as much as we thought we did about the therapy technique.

According to the news reports, the 55-year-old woman had been undergoing apitherapy for more than two years without problems. However, during her most recent session, she developed a severe reaction and began wheezing, coughing, and suffering from shortness of breath. She eventually lost consciousness and was taken to an emergency facility. She died a couple weeks later of multiple organ failure. Medical researchers are saying it’s the first documented apitherapy death where the individual had previously been tolerant of the bee stings. Medical researchers who studied the woman’s case concluded that apitherapy is an “unsafe and unadvisable” treatment option.

Like a lot of things in this world, apitherapy has become more popular after being championed by an uninformed celebrity. In 2016, Gwyneth Paltrow touted the “thousands-of-years-old treatment” as something she tried for an old injury. Gerard Butler also said he received a bee sting injection in an attempt to calm inflammation from stunt work, but he ended up hospitalized after having a poor reaction to the injection. He said he felt like his heart might explode and it was as if he had ants crawling under his skin.

What Doctors Are Saying

The theory behind apitherapy is that bee stings cause inflammation, which in turns leads to an inflammatory response from your body. The hope is that the inflammatory response will address both the inflammation from the bee sting along with other local inflammation in the joints.

Doctors say patients considering the therapy should be fully informed of the dangers of apitherapy prior to treatment. They also recommend that measures be taken to identify if someone could have a bad reaction before receiving a full injection, and that practitioners should be trained in how to manage severe reactions and that they should have specific reaction medications on hand. There should also be a system where the patient can receive emergency response care in a quick manor if needed.

“The public need to be very aware of the unorthodox use of allergens such as bee venom,” said Amena Warner, Head of Clinical Services for Allergy UK. “This will come with risk and, in susceptible individuals, can lead to serious life threatening reactions.”

Want To Improve Your Core and Spine? Try This One Exercise

/ Thomas Cohn, MD

plankPlank exercises are a simple way to work on core strength. They can also be used as part of an overall program to build strength and can even be used as part of an aerobic conditioning program. The nice part of this exercise is that they do not require any extra equipment. As one makes them more challenging, weights and balance balls can be added. The most common planking position is holding the position of the body straight while balancing on bent arms at the elbows, and the with the legs stretched out on your toes.

Muscles Used In Planks

Planks look easy but it takes a lot of muscle strength to keep the body in a good position for even 30 seconds. The muscles used include abdominal, back, arm and shoulder. Specific primary muscles are the erector spinae and abdomimal wall muscles. Secondary muscles, or stabiliziers, include the trapezius, rhomboids, rotator cuff, deltoids, pectoralis and serratus anterior, and in the lower body the gluteus maximus, gastrocnemius, and quadriceps. Regular planks use muscles all along the spine, shoulders, abdomen, pelvis and legs.

Once the regular basic plank is routine, it can be made much more difficult to keep things challenging. The next level is doing side planks. This is holding a plank type position on either side of the body. Side planks activate abdominal muscles, some of the spine and shoulder muscles, and a lot of the pelvic, gluteal, hip and upper leg muscles. The nice thing is this a whole different set of muscles that can be strengthened, and again one needs no special equipment.

Planks can still be made even harder with a variety of techniques. In a standard plank, a person has four points of supports using the arms and legs. Move to three points of support and the exercise becomes significantly harder. Balancing on the feet and one arm at time stresses more upper body strength. Lifting off one leg requires more abdominal, back and arm stabilization. Maintaining good form for even 30 seconds is extremely difficult. With side planks, one has two points of support in general, so increasing the workload can be achieved with raising and lowering the upper leg, strengthening the hip muscles even more.

For true punishment, planks can be made even more difficult in two ways, decreasing the stability of the platform for the feet or arms, and adding weights to use with the arms or legs. Doing planks with the use of a wobble board, movement ball, half sphere – Bosu, or balance platform adds the challenge of maintaining position without tipping over or falling. Adding light weights of a few pounds to the arms or the legs can add more to the strengthening.

Controlling neck, back, shoulder, and pelvic pain all involve improving your core muscle strength. Working on strengthening does not take a fancy gym with expensive equipment, it can be done simply at home. Start a program with planks and see how difficult working on the core muscles can be.

Words To Live By From Stephen Hawking

/ Thomas Cohn, MD

This week marked the passage of Stephen Hawking. He was one of the most well-known physicists across the globe. He was a remarkable physicist who described theories on the origins of the universe. He worked on explanations of the Big Bang theory and on black holes among other things. He has been considered one of the world’s greatest thinkers and geniuses.

One of the most striking things about him was that at 21, he was diagnosed with ALS and only given two years to live, but he reached the age of 76. For most of his life he was paralyzed completed, and for years unable to talk, communicating through a computer with only eye movements.  Since his twenties he lived his life from his wheelchair.

Words To Remember

Some of his more profound quotes have been published in the last week in tribute to his passing. Two of them are worth thinking about for everyone. The first one is on living with his crippling ALS:

“I accept that there are some things I can’t do. But they are mostly things I don’t particularly want to do anyway…I seem to manage to do anything that I really want.”

The second quote is on life in general:

“One, remember to look up at the stars and not down at your feet. Two, never give up work….Three, if you are lucky enough to find love, remember it is there and don’t throw if away.”

These quotes say a lot about life and having a disability of any sort. Sometimes it is better to let someone else deliver a message. Spend some time thinking about all of what Stephen Hawking said in the above quotes and maybe reflect on how it might impact on your own life.

Have a wonderful week. All the best,

Dr. Cohn.

The Daith Piercing and Fibromyalgia

/ Thomas Cohn, MD

daith piercing fibromyalgiaIf you’re a frequent reader of the blog, you’re probably aware of our work with Dr. Chris Blatchey, a specialist in the United Kingdom who is hoping to help us get a better understanding of the link between headaches and the Daith piercing as a potential treatment option. If you haven’t read his report on the subject, or if you’ve undergone the Daith piercing procedure and haven’t yet taken his survey, please consider taking a few minutes to help advance our understanding of the subject.

Fibromyalgia and Piercing Treatment

We’ve been communicating back and forth throughout this process, and recently we ended up on the subject of using the Daith piercing to treat fibromyalgia. Dr. Blatchley said he’s been in contact with some professional piercers who perform the Daith piercing, and they mentioned that they have seen a rise in the number of patients who are seeking out the Daith to see if it can provide some symptom relief from their fibromyalgia.

According to these conversations, Dr. Blatchley said that it seems that the Daith piercing is less effective for treating some fibromyalgia symptoms than it is for treating migraines. He suggests patients with fibromyalgia see improvement in about 50 percent of cases, but he also notes that the relief could be because their fibromylagia pain was actually misdiagnosed. Fibromyalgia is difficult to diagnose and even harder to treat, but if we can find commonalities between individuals diagnosed with fibromyalgia and successfully treated with options like the Daith piercing, we may be able to grow as a medical community and better serve our patients.

At this point, we’re not saying that you should go out and get your ear pierced if you are dealing with fibromyalgia, but it’s an avenue worth exploring if multiple other options have failed. We are just scratching the surface of understanding the true link between the two, but others have had success with the treatment. I just received this message from Angela over the weekend, who just want to reach out and say thanks for continuing to help look for solutions to headaches, fibromyalgia and chronic pain.

“I have fibromyalgia, TMJ (temporomandibular joint dysfunction) and chronic headaches. I got both sides pierced for a total of 20 dollars and haven’t had a headache since. My pain has decreased significantly.”

If you know anybody who has had the Daith piercing, please consider sending them to Dr. Blatchley’s site to help further our understanding of pain pathologies. And if you want to learn more about the Daith piercing, we’ve included some of the blogs we’ve penned on the subject below. The first blog listed has more than 200 comments from readers, and many of them share their experiences with the piercing in the comment section. Feel free to check it out to learn more.

Migraines and Daith Piercings
Early Findings From the Daith Piercing Study
An Update on Daith Piercings

Thanks for reading,
Dr. Cohn

Opioids For Long-Term Pain Relief

/ Thomas Cohn, MD

long term opiodsThe latest copy of the Journal of the American Medical Association has a lead article on the use of opioids in the long-term management of low back pain. The article is a study of some 200 people who were managed either with opioid-type medications or without them. The conclusion was that there was no difference in level of function with the use of opioid medication.

There is a large problem with this study, since it does not distinguish between the wide variety of patients who have back pain. Back pain can be due to everything from spine problems to nerve damage and residual surgical issues. As it has been preached multiple times, opioids are only one tool in the treatment of back issues and there are often many different strategies to control pain.

Opioids and Back Pain

The reality of life is that many different things can cause pain, and treatment should be aimed at the cause of pain. Depending on what is causing the sensory complaints, management will vary based on the individual’s needs. A combination of strategies is often necessary to treat every different component contributing to a problem. Treatments may be simple, such as ongoing exercise, to complex, including injections and surgery. Sometimes simple strategies fail and the only medication that does help are opioids. Since these drugs have tremendous problems, they often are not a good solution especially for long-term use. Pain specialists often know a wide realm of treatment options and can help lead one to better choice or a combination of choices.

The biggest problem with the use of opioids is that they are cheap and they have been pushed in the United States as a great, inexpensive tool to manage any type of pain. It takes a lot of work to manage pain, and in this country many have opted out of the challenges. On top of the drug companies pushing these medications, often the insurance companies are equally complicit by not allowing treatments that may be more expensive. Everything from physical therapy, massage, chiropractors, acupuncture and even fitness centers with athletic trainers are often more beneficial than many medications and may well be cheaper. However, most insurance companies turn a blind eye towards alternative treatment strategies. Now that opioids are a problem, insurance companies still want to say no to alternatives to drugs, but are not willing to pay for the better alternatives.

Alternative Treatment Options

The important message from the study of opioids is that for most people there are better treatment strategies than these drugs for the management of pain in the long term.  For short-term, these medications may be okay. For surgery and several days immediately afterward it may be reasonable to use them. After that time period, medications that are not addictive may be used with the strategy to return the body to normal functional patterns. The body needs to move and relearn normal movement and function. As the body moves and functions as it was originally designed, the body acts appropriately and does not generate pain sensory signals.

If you have a body that cannot move and function normally due to permanent changes, these may constantly send sensory signals that are interpreted as pain. Designing treatments that bring the body as close to normal motion and function as possible can reduce pain. This is difficult and requires significant effort; rarely is there a magic pill that performs this function. If one gets past the thought that life is pain free and then focuses on making life as close to ideal motion and function, then one can improve their quality of life.

The last take home message is that medicine needs to understand that some people honestly have tried everything available to treat their problems and nothing has worked. If they have worked with a legitimate pain expert, sometimes it is found that opioid medications are appropriate in the management of a problem long term. This should be considered a last option in most cases.  Hopefully our culture will get a more realistic understanding of opioids in the management of pain and all those involved in treatment will support the use of reasonable alternative strategies. Initially it may not be cheaper, but a healthier society is likely the final outcome.