Health & Fitness

01/16/20

Researchers are studying a valuable target in regulating the immune response in cancer and autoimmunity. VISTA is a tempering molecule that hinders T cells in the immune system from activating against self-antigens such as cancer cells. Their new publication describes how VISTA controls T-cell responses.

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Sepsis associated with 1 in 5 deaths globally, double previous estimate

Making sense of the self

Interoception is the awareness of our physiological states. But precisely how the brain calculates and reacts to this information remains unclear. Neuroscientists now demonstrate how the insular cortex orchestrates the process. The work represents the first steps toward understanding the neural basis of interoception, which could allow researchers to address key questions in eating disorders, obesity, drug addiction, and a host of other diseases.

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Physicists design 'super-human' red blood cells to deliver drugs to specific targets

A team of physicists from McMaster University has developed a process to modify red blood cells so they can be used to distribute drugs throughout the body, which could specifically target infections or treat catastrophic diseases such as cancer or Alzheimer's.

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Small change for climate change: Time to increase research funding to save the world

A new study shows that there is a huge disproportion in the level of funding for social science research into the greatest challenge in combating global warming -- how to get individuals and societies to overcome ingrained human habits to make the changes necessary to mitigate climate change.

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Hormone resistance in breast cancer linked to DNA 'rewiring'

Global diets are converging, with benefits and problems

Research has shown that diets are changing in complex ways worldwide. International food supply patterns are supporting healthier diets in parts of the world, but causing underweight and obesity elsewhere. They are also having important effects on environmental sustainability, with potentially worrying consequences.

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Walnuts may be good for the gut and help promote heart health

Researchers found that eating walnuts daily as part of a healthy diet was associated with increases in certain bacteria that can help promote health. Additionally, those changes in gut bacteria were associated with improvements in some risk factors for heart disease.

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Cells protect themselves against stress by keeping together

For the first time, research shows that the contacts between cells, known as cell adhesion, are essential for cells to survive stress. The findings also suggest that impaired cell adhesion may sensitize cancer cells to drugs that damage cell proteins and cause stress.

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Walnuts may be good for the gut and help promote heart health

Researchers found that eating walnuts daily as part of a healthy diet was associated with increases in certain bacteria that can help promote health. Additionally, those changes in gut bacteria were associated with improvements in some risk factors for heart disease.

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Whooping cough evolving into a superbug

Pulling the plug on calcium pumps -- potential new treatment strategy for pancreatic cancer

UK scientists have identified a new way to kill pancreatic cancer cells by 'pulling the plug' on the energy generator that fuels calcium pumps on their cell surface. The study reports how switching off the cancer's energy supply causes the pancreatic cancer cells to become 'poisoned' by an irreversible build-up of calcium.

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Pulling the plug on calcium pumps -- potential new treatment strategy for pancreatic cancer

UK scientists have identified a new way to kill pancreatic cancer cells by 'pulling the plug' on the energy generator that fuels calcium pumps on their cell surface. The study reports how switching off the cancer's energy supply causes the pancreatic cancer cells to become 'poisoned' by an irreversible build-up of calcium.

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Diabetic retinopathy: Understanding diabetes-related eye disease and vision loss

Over 30 million people in the United States live with diabetes, and approximately 7.7 million people have diabetic retinopathy, making it the most common cause of vision loss in working-aged adults. The prevalence of diabetic retinopathy has increased significantly over the past 20 years, due to the rise in the number of people diagnosed with diabetes.

How does diabetes affect the retina?

The retina is the light-sensing component located in the back of the eye. It is composed of blood vessels, nerve cells (neurons), and specialized cells called photoreceptors that are involved in directly sensing light. The ability of the retina to sense light requires energy, which is dependent on the oxygen supplied by blood circulating through blood vessels.

In diabetes, elevated blood sugar levels damage the blood vessels of the retina. These damaged blood vessels leak fluid, bleed, and do not provide adequate oxygen to the retina, leading to retinal ischemia. As a result, retinal cells begin to die and the retina is unable to function properly. In addition, diabetes also damages the neurons of the retina directly. Together, these effects cause diabetic retinopathy.

Vision loss associated with diabetic retinopathy may initially affect central vision due to a condition called diabetic macular edema. This swelling of the macula, a portion of the retina responsible for sharp, central vision, can lead to blurry vision and distortion of images.

Advanced diabetic retinopathy is characterized by the formation of irregular blood vessels that can bleed inside the eye, causing a rapid loss of vision. This results in a sudden, curtain-like vision loss as blood fills up the inside of the eye. Further worsening of advanced diabetic retinopathy can lead to retinal detachment, which requires urgent surgical intervention and can result in permanent, irreversible vision loss if not promptly treated.

What can I do to prevent diabetic retinopathy?

The American Diabetes Association recommends that most people with diabetes keep their A1c level (a measure of average blood sugar levels over the previous two to three months) below 7% to prevent the risk of complications. As blood glucose directly damages retinal blood vessels, there is strong epidemiological evidence that blood sugar control translates to decreased incidence and severity of diabetic retinopathy.

In order to reduce the cardiovascular and microvascular complications of diabetes, which include retinopathy, nephropathy (kidney disease), and neuropathy (nerve damage), it is recommended that people achieve and maintain a normal blood pressure. Blood pressure reduction can delay the onset of diabetic retinopathy, but it is unclear if controlling blood pressure can alter the course of established diabetic retinopathy. Similarly, managing cholesterol is advocated for overall diabetes management, but it is not clear whether doing so reduces the risk of diabetic retinopathy.

How can I find out if I have diabetic retinopathy?

An ophthalmologist can diagnose and begin to treat diabetic retinopathy before sight is affected. In general, people with type 1 diabetes should see an ophthalmologist once a year, beginning five years after the onset of their disease. People with type 2 diabetes should see an ophthalmologist for a retinal examination soon after their diagnosis, and then schedule annual exams after that. You may need to see an ophthalmologist more frequently if you are pregnant or have more advanced diabetic retinopathy.

What can I do to prevent or slow down vision loss if I have diabetic retinopathy?

As mentioned above, damage to the blood vessels deprives the retina of oxygen. Insufficient oxygen leads to production of a signal protein called vascular endothelial growth factor (VEGF). VEGF and its role in eye disease were first discovered at Harvard Medical School.

Currently, there are medications that can bind VEGF and subsequently improve the symptoms of diabetic retinopathy. These “anti-VEGF” agents are injected directly into the eye and can improve diabetic macular edema, and can even improve the severity of diabetic retinopathy. In some people, steroids injected directly into the eye may also improve diabetic macular edema. In some advanced cases of proliferative diabetic retinopathy (the most advanced form of diabetic retinopathy), patients may require retinal laser therapy or retinal surgery to stop or slow bleeding and leakage, to shrink damaged blood vessels, or to remove blood and scar tissue.

The post Diabetic retinopathy: Understanding diabetes-related eye disease and vision loss appeared first on Harvard Health Blog.

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Body's natural signal carriers can help melanoma spread

A new study sheds fresh light on how melanoma cells interact with other cells via extracellular vesicles they secrete. The researchers found that extracellular vesicles secreted by melanoma cells use the so-called hedgehog signalling pathway to intensify the malignant properties of the cells they are targeting. The discovery can help in the development of better treatment and diagnostics for melanoma.

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Creating learning resources for blind students

Mathematics and science Braille textbooks are expensive and require an enormous effort to produce -- until now. A team of researchers has developed a method for easily creating textbooks in Braille, with an initial focus on math textbooks. The new process is made possible by a new authoring system which serves as a 'universal translator' for textbook formats. Based on this new method, the production of Braille textbooks will become easy, inexpensive, and widespread.

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Good connections key to startup success

Mutations in donors' stem cells may cause problems for cancer patients

A new study suggests that extremely rare, harmful genetic mutations present in healthy donors' stem cells -- though not causing health problems in the donors -- may be passed on to cancer patients receiving stem cell transplants, potentially creating health problems for the recipients. Among the concerns are heart damage, graft-versus-host disease and possible new leukemias.

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Obesity crisis blamed for a rise in fatty liver disease amongst young adults

One in five young people have fatty liver disease (steatosis), with one in 40 having already developed liver scarring (fibrosis), new research has found. The study is the first to attempt to determine the prevalence of fatty liver disease and fibrosis in young healthy adults in the UK.

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Jumping genes threaten egg cell quality

Hookah smoke may be associated with increased risk of blood clots

In a new study conducted in mice, researchers found that tobacco smoke from a hookah caused blood to function abnormally and be more likely to clot and quickly form blood clots. The findings provide new evidence that hookah smoking may not be a safe alternative to cigarettes.

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Women's blood vessels age faster than men's

Many medical experts have long believed that women simply 'catch up' to men in terms of their cardiovascular risk, but new research shows for the first time that women's blood vessels age at a faster rate than men's. The findings could help to explain why women tend to develop different types of cardiovascular disease and with different timing than men.

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Sticky situation inside blood vessels can worsen stroke damage

Global Study Links Air Pollution to Depression and Suicide

When most people think about the risks associated with air pollution, respiratory issues are the first that come to mind. In fact, in 2016¹ outdoor and inside air pollution contributed to respiratory infections resulting in 543,000 deaths in children under 5. However, the respiratory system is not the only one affected by this.

The World Health Organization reported on published studies from dozens of top experts, which revealed some of the health risks for children that are associated with air pollution. These included obesity, asthma, childhood cancers, infant mortality and adverse birth outcomes. Evidence also suggests exposure before birth increases the risk of cardiovascular and lung disease later in life.

A study by the American Thoracic Society² that was presented at the 2017 International Conference suggested air pollution may also reduce sleep quality. There are a number of health repercussions associated with sleep deprivation and poor quality sleep.

These include an increased risk of accidents,³ cardiovascular disease,⁴ high blood pressure,⁵ cancer⁶ and osteoporosis.⁷ Researchers have also investigated the bidirectional relationship between sleep and depression, finding that when sleep quality improves, it lessens depression symptoms.⁸

Global Studies Link Air Pollution to Suicide and Depression

Air pollution is measured by the size of the particulate matter. Fine particulate matter measures less than 2.5 micrograms (PM2.5) in diameter and is a good indicator of outdoor air pollution. PM2.5 is the focus of many studies.

The particles are important as they are small enough to be inhaled into the lungs and absorbed into the bloodstream.⁹ Once in your body they may deposit in any organ system, including the brain. In recent research, scientists have associated acute exposure to PM2.5 with increased psychiatric emergency room visits for children who are having anxiety and/or have attempted suicide.¹⁰

In a meta-analysis of recent studies by a team from Cambridge University¹¹ it was found that elevated exposure to PM2.5 yielded a 19% increase in the risk of depression for children, as well as a small increased risk for suicide. They evaluated results from 14 studies and 684,859 participants and determined that PM10 was not linked to depression or suicide, indicating the particulate matter may be too large to be absorbed into the bloodstream and affect the brain.

However, in a separate analysis of data from 16 countries researchers reported that an increase in PM2.5 and PM10 was associated with depression and increased numbers of suicide.¹²

The systematic review and meta-analysis¹³ was published in December 2019 in Environmental Health Perspectives. One study author, Isobel Braithwaite from University College of London, commented on the results:

"We already know that air pollution is bad for people's health, with numerous physical health risks ranging from heart and lung disease to stroke and a higher risk of dementia. Here, we're showing that air pollution could be causing substantial harm to our mental health as well, making the case for cleaning up the air we breathe even more urgent.

We found quite consistent results across the studies we reviewed that analysed the relationship between long-term air pollution exposure and depression, even after adjustment for many other factors which could explain the association. The association seems to be similar in magnitude to those that have been found for some physical health impacts of particulate matter, such as all-cause mortality."

Meeting EU Pollution Limit May Have Global Effect

There was also a connection between PM10 particulate matter exposure and the number of suicides reported in the studies. Researchers found the risk was significantly higher on days after a three-day period when levels of PM10 were higher, rather than after less polluted time periods.

In these studies, confounding factors such as weather changes and the day of the week did not account for short-term changes in suicide risk, nor did socioeconomic factors or neighborhoods. The evidence was stronger for suicide with PM10 and less for depression. Another study author, Joseph Hayes, said:

"Our findings correspond with other studies that have come out this year, with further evidence in young people and in other mental health conditions. While we cannot yet say that this relationship is causal, the evidence is highly suggestive that air pollution itself increases the risk of adverse mental health outcomes.

A lot of what we can do to reduce air pollution can also benefit our mental health in other ways, such as enabling people to cycle or walk rather than drive, and enhancing access to parks, so this adds support to the promotion of active travel and urban green spaces."

The scientists hypothesized that if the relationship were causal, the global risk of depression could go down by 15% if exposure was reduced from PM 2.5 from 44 µg/m3 to 25 µg/m3. The global levels of PM 2.5 ranged from 114 µg/m3 in Delhi to 6 µg/m3 in Ottawa, Canada.

Within the U.K., they found the average level was 12.8 µg/m3. The WHO recommends a limit of 10 µg/m3, which the researchers estimated could reduce the risk of depression by about 2.5%. While the goal of the WHO is 10 µg/m3, even meeting the less stringent EU guideline of 25 µg/m3 could have a significant global impact on mental and physical health. Braithwaite went on to say:¹⁴

“We know that the finest particulates from dirty air can reach the brain via both the bloodstream and the nose, and that air pollution has been implicated in increased [brain] inflammation, damage to nerve cells and to changes in stress hormone production, which have been linked to poor mental health.”

Premature Death in Seniors Linked to Air Pollution

A second vulnerable population is the elderly. Harvard researchers¹⁵ released a study in 2017 in which they described finding long-term exposure to PM 2.5 and ozone increased the risk of early death. This occurred even when air pollution levels were below the National Ambient Air Quality standards set by the EPA.

Lowering the level of PM 2.5 by just 1 µg/m3 was estimated to save 12,000 lives every year. The researchers used Medicare claims of 60 million people in the U.S. over age 65 through a 7-year period. The extensive base of information on which the findings were based resulted in the researchers calling it “a study of unprecedented statistical power because of the massive size of the study population.”

Pollution Lowers IQ and Damages Life Expectancy

As might be expected, PM2.5 doesn't affect just mood or the cardiovascular system. Data¹⁶ collected in China revealed that language and arithmetic skills were affected to such an extent that for each person affected, it was like losing a full year of education.

According to researcher Derek Ho, Ph.D., from Hong Kong Polytechnic University, the results of the study are like the results from his study. He believes the effect of air pollution on cognition is important and may occur as it “can potentially be associated with oxidative stress, neuroinflammation, and neurodegeneration of humans.”¹⁷

The estimated number dying an early death from exposure to air pollution is nearly double the previous estimate.¹⁸ This new data show air pollution caused 8.8 million premature deaths in 2015. Comparatively speaking, WHO¹⁹ estimates the global number of premature deaths from smoking is 7 million per year, less than the number killed by air pollution.

Precautions May Limit Exposure to Air Pollution

There are significant physical and mental health risks associated with exposure to air pollution that may shorten your life and impede your ability to live independently as you age. It is wise to take precautions to limit your exposure to pollution outdoors and inside your home.

Limit outdoor exercise during peak commuting hours
Avoid running or riding your bike along major highways
Pay attention to the Air Quality Index (AQI) in your local area
In heavy traffic, pull air from inside the car for heating and air conditioning
Regularly air out your car, especially if it's new. Plastics, carpet, solvents and audio equipment contribute to a chemically toxic mix in your car's cabin. For more information see, "What’s in That New Car Smell?"

Indoor pollution can be just as dangerous as the PM2.5 and PM10 you inhale outdoors. To reduce energy expenditure most new homes are more airtight than ever before, which means you don’t get as much air exchange. Consider these strategies to reduce your exposure:

Install a high-efficiency particulate air (HEPA) filter on your furnace and/or air conditioning unit.

Vacuum regularly using a HEPA filter vacuum cleaner. Standard bag or bagless vacuum cleaners are a major contributor to poor indoor air quality. Beware of cheaper knock-offs that profess to have "HEPA-like" filters — get the real deal.

Switch to nontoxic cleaning products (such as baking soda, hydrogen peroxide and vinegar) and safer personal care products. Avoid aerosols, commercial air fresheners and scented candles, which can out-gas thousands of different chemicals. Strategies in "Are Household Products Killing Us?" may help reduce your toxic load.

Houseplants can markedly improve the air indoors. For tips and guidelines, see “The 10 Best Pollution-Busting Houseplants.”

Avoid powders, as they float and linger in the air after each use. Many are allergens due to their tiny size and may cause respiratory problems.

Take your shoes off in the house by the door to prevent tracking in toxic particles.

Hang dry-cleaned clothes outside for a day or two to allow the chemicals to dissipate.

Don’t smoke or vape.

Ensure your combustion appliances are properly vented.

Avoid storing paints, adhesives, solvents and other harsh chemicals in your house or in an attached garage.

Eliminate using nonstick cookware, which can release toxins into the air when heated.

Create cross ventilation by opening windows for as little as 15 minutes each day to improve the quality of air you’re breathing. An attic fan may reduce your air conditioning costs and bring in fresh outdoor air.

A high-quality air purifier using photocatalytic oxidation (PCO) is one of the best technologies available. Rather than merely filtering the air, PCO cleans the air using ultraviolet light. PCO transforms the pollutants into nontoxic substances. In addition to using them in your home, portable air purifiers are available to take with you when you work or travel.

Reduce airborne chlorine during a bath or shower with a water filter rated NSF/ANSI 177, which is tested by a third party to for chlorine removal.²⁰

Test for radon, a colorless, odorless gas linked to lung cancer. It can get trapped under your home during construction and may leak into your air system over time. Radon testing kits are a quick and cheap way to determine if you are at risk.

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Opioid Crisis — A Result of Poverty, Availability and Pain

In recent years, the devastating effects of wanton opioid use have become unmistakable, with opioid overdoses killing 47,600 Americans in 2017 alone.¹ As of June 2017, opioids became the leading cause of death among Americans under the age of 50,² and President Trump declared the opioid crisis a public health emergency that year in October.³

I've written many previous articles detailing the background of how the U.S. ended up here. While the opioid crisis was largely manufactured by drug companies hell-bent on maximizing profits, leading to exaggerated and even fraudulent claims about the drugs' safety profile, the increased availability of opioids isn't the sole cause.

A Perfect Storm of Poverty, Trauma, Availability and Pain

As noted in a January 2020 article⁴ in The Atlantic, "researchers … say opioid addiction looks like the result of a perfect storm of poverty, trauma, availability and pain."

Commenting on some of the research cited in that article, David Powell, senior economist at Rand, told The Atlantic that to produce the most lethal drug epidemic America has ever seen "you need a huge rise in opioid access, in a way that misuse is easy, but you also need demand to misuse the product."⁵

Poverty and pain, both physical and emotional, fuel misuse. If economic stress or physical pain (or both) is a factor in your own situation, please be mindful that seeking escape through opioid use can easily lead to a lethal overdose. The risk of death is magnified fivefold if you're also using benzodiazepine-containing drugs.

The Hidden Influence of Poverty and Trauma

Several investigations seeking to gain insight into the causes fueling the opioid epidemic have been conducted in recent years. The findings reveal common trends where emotional, physical and societal factors have conspired to bring us to the point where we are today.

Among them is a 2019 study⁶ in the Medical Care Research Review journal, which looked at the effects of state-level economic conditions — unemployment rates, median house prices, median household income, insurance coverage and average hours of weekly work — on drug overdose deaths between 1999 and 2014. According to the authors:⁷

"Drug overdose deaths significantly declined with higher house prices … by nearly 0.17 deaths per 100,000 (~4%) with a $10,000 increase in median house price. House price effects were more pronounced and only significant among males, non-Hispanic Whites, and individuals younger 45 years.

Other economic indicators had insignificant effects. Our findings suggest that economic downturns that substantially reduce house prices such as the Great Recession can increase opioid-related deaths, suggesting that efforts to control access to such drugs should especially intensify during these periods."

Similarly, an earlier investigation, published in the International Journal of Drug Policy in 2017,⁸ connected economic recessions and unemployment with rises in illegal drug use among adults.

Twenty-eight studies published between 1990 and 2015 were included in the review, 17 of which found that the psychological distress associated with economic recessions and unemployment was a significant factor. According to the authors:⁹

"The current evidence is in line with the hypothesis that drug use increases in times of recession because unemployment increases psychological distress which increases drug use. During times of recession, psychological support for those who lost their job and are vulnerable to drug use (relapse) is likely to be important."

Abuse-related trauma is also linked to unemployment and financial stress, and that too can increase your risk of drug use and addiction. As noted in The Atlantic,¹⁰ when the coal mining industry in northeastern Pennsylvania collapsed, leaving many locals without job prospects, alcohol use increased, as did child abuse. Many of these traumatized children, in turn, sought relief from the turmoil and ended up becoming addicted to opioids.

Free Trade Effects Implicated in Opioid Crisis

Another 2019 study¹¹ published in Population Health reviewed the links between free trade and deaths from opioid use between 1999 and 2015, finding that "Job loss due to international trade is positively associated with opioid overdose mortality at the county level," and that this association was most significant in areas where fentanyl was present in the heroin supply.

Overall, for each 1,000 people who lost their jobs due to international trade — commonly due to factory shutdowns — there was a 2.7% increase in opioid-related deaths. Where fentanyl was available, that percentage rose to 11.3%. The study "contributes to debates in the social sciences concerning the negative consequences of free trade," the authors note, adding:

"Scholars have long focused on the positive effect of international trade on the overall economy, while also noting that it causes layoffs and bankruptcy for some groups.

Recent influential work by Autor, Dorn, and Hanson demonstrates that these negative impacts of trade are actually highly localized, with layoffs, unemployment, and lower wages concentrated in specific labor markets.

This study furthers our understanding of the local consequences of international trade by looking beyond wages and employment levels to the potential impact on opioid-related overdose death."

Opioid Makers Have Had a Direct Impact

The National Bureau of Economic Research has also contributed to the discussion with the working paper¹² "Origins of the Opioid Crisis and Its Enduring Impacts," issued November 2019.

In it, they highlight "the role of the 1996 introduction and marketing of OxyContin as a potential leading cause of the opioid crisis," showing that in states where triplicate prescription programs were implemented, OxyContin distribution rates were half that of states that did not have such programs.

"Triplicate prescription programs" refers to a drug-monitoring program requiring doctors to use a special prescription pad whenever they prescribed controlled substances. One of the copies of each prescription written had to be submitted to a state monitoring agency.

Since it involved additional work, many doctors avoided prescribing drugs requiring the use of triplicates, and as a consequence, Purdue (the maker of OxyContin), did not market its opioid as aggressively in those states.

The fact that triplicate prescription states had lower rates of lethal overdoses led the authors to conclude "that the introduction and marketing of OxyContin explain a substantial share of overdose deaths over the last two decades."

According to this paper, death rates from opioid overdoses could have been reduced by 44% between 1996 and 2017 had triplicate prescriptions been implemented in nontriplicate states.

Importantly, the relationship between triplicate prescription programs and opioid overdose deaths held true even when economic conditions were taken into account, which shows that poverty alone did not contribute to the opioid crisis — aggressive marketing to doctors and the ease with which patients could get the drugs were an inescapable part of the problem.

Pain as a Source of Addiction

Naturally, physical pain is also a driving force behind the opioid epidemic, especially the inappropriate treatment of back pain with opioids and dentists' habit of prescribing narcotics after wisdom tooth extractions.^13,¹⁴

(While American family doctors prescribe an estimated 15% of all immediate-release opioids — the type most likely to be abused — dentists are not far behind, being responsible for 12% of prescriptions, according to a 2011 paper¹⁵ in the Journal of the American Dental Association.)

Statistics¹⁶ suggest 8 in 10 American adults will be affected by back pain at some point in their life, and low-back pain is one of the most common reasons for an opioid prescription.¹⁷ This despite the fact that there's no evidence supporting their use for this kind of pain. On the contrary, non-opioid treatment for back pain has been shown to be more effective.¹⁸

Research¹⁹ published in 2018 found opioids (including morphine, Vicodin, oxycodone and fentanyl) fail to control moderate to severe pain any better than over-the-counter (OTC) drugs such as acetaminophen, ibuprofen and naproxen, yet most insurance companies still favor opioids when it comes to reimbursement, which makes them culpable for sustaining the opioid crisis, even as doctors and patients try to navigate away from them.

As noted by Dave Chase, author of "The Opioid Crisis Wake-Up Call: Health Care Is Stealing the American Dream. Here's How to Take It Back," in an article for Stat:²⁰

"Our entire health care system is built on a vast web of incentives that push patients down the wrong paths. And in most cases it's the entities that manage the money — insurance carriers — that benefit from doing so …

An estimated 700,000 people are likely to die from opioid overdoses between 2015 and 2025,²¹ making it absolutely essential to understand the connections between insurance carriers, health plans, employers, the public, and the opioid crisis.

We will never get out of this mess unless we stop addiction before it starts … the opioid crisis isn't an anomaly. It's a side effect of our health care system."

According to the American College of Physicians' guidelines,²² heat, massage, acupuncture or chiropractic adjustments should be used as first-line treatments for back pain. Other key treatments for back pain include exercise, multidisciplinary rehabilitation, mindfulness-based stress reduction, tai chi, yoga, relaxation, biofeedback, low-level laser therapy and cognitive behavioral therapy.

When drugs are desired, nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants should be used. Opioids "should only be considered if other treatments are unsuccessful and when the potential benefits outweigh the risks for an individual patient," according to the American College of Physicians' guideline.²³

Struggling With Opioid Addiction? Please Seek Help

It's vitally important to realize that opioids are extremely addictive drugs that are not meant for long-term use for nonfatal conditions. Chemically, opioids are similar to heroin, so if you wouldn't consider using heroin for a toothache or backache, seriously reconsider taking an opioid to relieve these types of pain.

If you've been on an opioid for more than two months, or if you find yourself taking a higher dosage, or taking the drug more often, you may already be addicted. Resources where you can find help include the following. You can also learn more in "How to Wean Off Opioids."

Your workplace Employee Assistance Program
The Substance Abuse Mental Health Service Administration²⁴ can be contacted 24 hours a day at 1-800-622-HELP

Nondrug Pain Relief

The good news is that many types of pain can be treated entirely without drugs. Recommendations by Harvard Medical School^25,²⁶ and the British National Health Service²⁷ include the following. You can find more detailed information about most of these techniques in "13 Mind-Body Techniques That Can Help Ease Pain and Depression."

Gentle exercise	Physical therapy or occupational therapy
Hypnotherapy	Distracting yourself with an enjoyable activity
Maintaining a regular sleep schedule	Mind-body techniques such as controlled breathing, meditation, guided imagery and mindfulness practice that encourage relaxation. One of my personal favorites is the Emotional Freedom Techniques (EFT)
Yoga and tai chi	Practicing gratitude and positive thinking
Hot or cold packs	Biofeedback
Music therapy	Therapeutic massage

In "Billionaire Opioid Executive Stands to Make Millions More on Patent for Addiction Treatment," I discuss several additional approaches — including helpful supplements and dietary changes — that can be used separately or in combination with the strategies listed above to control both acute and chronic pain.

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