Posted by Doctor under Articles, Chronic Back Pain, Great Results, Peripheral Neuropathy, Testimonials on Thursday, February 18th, 2010 10:10 pm
79 year old man gets relief from chronic pain in 3 treatments! Listen to this!
Archives of Internal Medicine article (Free)
Archives of Internal Medicine commentary (Subscription required)
American College of Physicians/American Pain Society guideline on managing low back pain (Free)
General practitioners rarely follow guidelines when managing new episodes of low back pain, reports the Archives of Internal Medicine. (The analysis was conducted in Australia, but the guidelines assessed match those in the U.S.)
Researchers examined data on some 1700 visits to GPs for new low back pain from 2005 to 2008, after national guidelines for treating musculoskeletal pain were released. Among the findings:
Although guidelines recommend acetaminophen as a first-line analgesic, it was prescribed for only 18% of patients. NSAIDs and opioids were prescribed for 37% and 20%, respectively.
These findings were similar to those from the period before guideline publication.
The authors conclude: “The results indicate that in most cases, usual care is not evidence-based care and so is not likely to provide the best outcomes.”
Effect of phototherapy on delayed onset muscle soreness.Douris P, Southard V, Ferrigi R, Grauer J, Katz D, Nascimento C, Podbielski P.
Department of Physical Therapy, School of Health Professions, Behavioral and Life Sciences, New York Institute of Technology, Old Westbury, New York 11568-8000, USA. pdouris@nyit.edu
OBJECTIVE: The purpose of this study was to investigate the effects of phototherapy on delayed onset muscle soreness (DOMS) as measured using the Visual Analog Scale (VAS), McGill Pain Questionnaire, Resting Angle (RANG), and girth measurements.
BACKGROUND DATA: Previous research has failed to prove the beneficial effects of phototherapy on DOMS.
METHODS: This was a randomized double-blind controlled study with 27 subjects (18-35 years) assigned to one of three groups. The experimental group received 8 J/cm2 of phototherapy each day for five consecutive days using super luminous diodes with wavelengths of 880 and visible diodes of 660 nm at three standardized sites over the musculotendinous junction of the bicep. The sham group received identical treatment from a dummy cluster. The controls did not receive treatment. The study was completed over five consecutive days: on day one baseline measurements of RANG and upper arm girths were recorded prior to DOMS induction. On days 2-5, RANG, girth, and pain were assessed using VAS and the McGill Pain Questionnaire.
RESULTS: The experimental group exhibited a significant decrease in pain associated with DOMS compared to the control (p=0.01) and sham groups (p=0.03) based upon the VAS at the 48-h period. The McGill Pain Questionnaire showed a significant difference in pain scores at the 48-h period between the experimental and the sham groups (p=0.01). There were no significant differences day to day and between the groups with respect to girth and RANG.
CONCLUSION: The results of this study provide scientific evidence that phototherapy as used in this study provides a beneficial effect to patients who may experience DOMS after a novel exercise session.
PMID: 16875447 [PubMed - indexed for MEDLINE]
Effect of 655-nm low-level laser therapy on exercise-induced skeletal muscle fatigue in humans.Leal Junior EC, Lopes-Martins RA, Dalan F, Ferrari M, Sbabo FM, Generosi RA, Baroni BM, Penna SC, Iversen VV, Bjordal JM.
Laboratory of Human Movement, University of Caxias do Sul, Caxias do Sul, RS, Brazil. ecplealj@ucs.br
OBJECTIVE: To investigate if development of skeletal muscle fatigue during repeated voluntary biceps contractions could be attenuated by low-level laser therapy (LLLT).
BACKGROUND DATA: Previous animal studies have indicated that LLLT can reduce oxidative stress and delay the onset of skeletal muscle fatigue.
MATERIALS AND METHODS: Twelve male professional volleyball players were entered into a randomized double-blind placebo-controlled trial, for two sessions (on day 1 and day 
at a 1-wk interval, with both groups performing as many voluntary biceps contractions as possible, with a load of 75% of the maximal voluntary contraction force (MVC). At the second session on day 8, the groups were either given LLLT (655 nm) of 5 J at an energy density of 500 J/cm2 administered at each of four points along the middle of the biceps muscle belly, or placebo LLLT in the same manner immediately before the exercise session. The number of muscle contractions with 75% of MVC was counted by a blinded observer and blood lactate concentration was measured.
RESULTS: Compared to the first session (on day 1), the mean number of repetitions increased significantly by 8.5 repetitions (+/- 1.9) in the active LLLT group at the second session (on day 8), while in the placebo LLLT group the increase was only 2.7 repetitions (+/- 2.9) (p = 0.0001). At the second session, blood lactate levels increased from a pre-exercise mean of 2.4 mmol/L (+/- 0.5 mmol/L), to 3.6 mmol/L (+/- 0.5 mmol/L) in the placebo group, and to 3.8 mmol/L (+/- 0.4 mmol/L) in the active LLLT group after exercise, but this difference between groups was not statistically significant.
CONCLUSION: We conclude that LLLT appears to delay the onset of muscle fatigue and exhaustion by a local mechanism in spite of increased blood lactate levels.
PMID: 18817474 [PubMed - indexed for MEDLINE]
Effects of low-level laser irradiation on rat skeletal muscle injury after eccentric exercise.Liu XG, Zhou YJ, Liu TC, Yuan JQ.
Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China.
BACKGROUND AND OBJECTIVE: The effect of photobiomodulation on delayed onset muscle soreness remains unknown. This study represents the first investigation of this treatment using an animal model.
METHODS: Seventy-two Sprague-Dawley rats were randomly divided into five groups: sedentary control group, exercise control group and three exercise-plus-laser groups. Downhill running was used to induce muscle injury in the gastrocnemius muscle. He-Ne laser irradiations were administered to the injured muscles immediately and at 18 and 42 h after exercise in the three exercise-plus-laser groups at 12, 28, and 43 J/cm2, respectively. Histological examination and serum creatine kinase (CK), muscle superoxide dismutase (SOD) and malondialdehyde (MDA) analyses were done at 24 and 48 h after exercise.
RESULTS: The exercise control group exhibited a marked inflammation in the gastrocnemius muscle and significant elevations in serum CK activity and muscle MDA level after downhill running. He-Ne laser irradiation at 43 J/cm2 inhibited muscle inflammation, significantly enhanced muscle SOD activity and significantly reduced serum CK activity and muscle MDA level at both 24 and 48 h after exercise, whereas the irradiation at 12 or 28 J/cm2 slightly inhibited muscle inflammation and significantly reduced serum CK activity at 48 h after exercise only (P < 0.05).
CONCLUSIONS: Low-level He-Ne laser therapy could exert therapeutic effects on eccentric exercise-induced rat muscle injury through enhancing muscle anti-oxidative capacity and reducing the inflammatory reaction. The photobiomodulation was dose-dependent, and the 43 J/cm2 dose was the most efficient among the doses used.
PMID: 19697999 [PubMed - in process]
The FDA has approved liraglutide (Victoza) to help control blood sugar in adults with type 2 diabetes. The drug is not recommended as a first-line treatment.
Liraglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist and will be available as a once-daily injection.
Results of clinical trials of liraglutide suggested an increased risk for pancreatitis, compared with other diabetes medications. The most frequent side effects included headache, nausea, and diarrhea. Animal studies showed an increased risk for tumors of the thyroid gland, but it is not clear whether the drug also causes thyroid problems in humans.
As part of the drug’s approval, the company must conduct additional studies on cardiovascular safety and other adverse effects.
FDA news release (Free)
FDA Q&A on liraglutide safety (Free)
The side effects are worse than the disease. Why not try a natural approach to control your blood sugar, which includes eating right (probably not what you’ve ever been told), proper supplements and exercise? Too hard? Easier to just take a pill or shot? Take control of your health today.
Posted by Doctor under Articles, Autoimmune Disease, Fibromyalgia, Hypothyroid/Hasimoto's, Newsletter on Tuesday, January 12th, 2010 10:13 pm Posted by Doctor under Articles, Hypothyroid/Hasimoto's, Newsletter on Tuesday, January 12th, 2010 9:59 pm Posted by Doctor under Articles, Autoimmune Disease, Hypothyroid/Hasimoto's on Monday, January 4th, 2010 10:27 pmJournal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2008-0798
Celiac Disease
Thyroid Diseases
Related Collections
Thyroid
Autoimmunity
The Journal of Clinical Endocrinology & Metabolism Vol. 93, No. 10 3915-3921
Copyright © 2008 by The Endocrine Society
Risk of Thyroid Disease in Individuals with Celiac Disease
Peter Elfström, Scott M. Montgomery, Olle Kämpe, Anders Ekbom and Jonas F. Ludvigsson
Department of Pediatrics (P.E., J.F.L.) and Clinical Research Centre (S.M.M.), Örebro University Hospital, SE-701 85 Örebro, Sweden; Clinical Epidemiology Unit (S.M.M., A.E., J.F.L.), Department of Medicine, Karolinska Institutet, Karolinska University Hospital, SE-17176 Stockholm, Sweden; Department of Medical Sciences (O.K.), Uppsala University, University Hospital, SE-75123 Uppsala, Sweden; and Department of Primary Care and Social Medicine (S.M.M.), Charing Cross Hospital, Imperial College, W6 8RF London, United Kingdom
Address all correspondence and requests for reprints to: Peter Elfström, Department of Pediatrics, Örebro University Hospital, SE-701 85 Örebro, Sweden. E-mail: peter.elfstrom@orebroll.se.
Background: It has been suggested that celiac disease is associated with thyroid disease. Earlier studies, however, have been predominately cross-sectional and have often lacked controls. There is hence a need for further research. In this study, we estimated the risk of thyroid disease in individuals with celiac disease from a general population cohort.
Methods: A total of 14,021 individuals with celiac disease (1964–2003) and a matched reference population of 68,068 individuals were identified through the Swedish national registers. Cox regression estimated the risk of thyroid disease in subjects with celiac disease. Analyses were restricted to individuals with a follow-up of more than 1 yr and with no thyroid disease before study entry or within 1 yr after study entry. Conditional logistic regression estimated the odds ratio for subsequent celiac disease in individuals with thyroid disease.
Results: Celiac disease was positively associated with hypothyroidism [hazard ratio (HR) = 4.4; 95% confidence interval (CI) = 3.4–5.6; P < 0.001], thyroiditis (HR = 3.6; 95% CI =1.9–6.7; P < 0.001) and hyperthyroidism (HR = 2.9; 95% CI = 2.0–4.2; P < 0.001). The highest risk estimates were found in children (hypothyroidism, HR = 6.0 and 95% CI = 3.4–10.6; thyroiditis, HR = 4.7 and 95% CI = 2.1–10.5; hyperthyroidism, HR = 4.8 and 95% CI = 2.5–9.4). In post hoc analyses, where the reference population was restricted to inpatients, the adjusted HR was 3.4 for hypothyroidism (95% CI = 2.7–4.4; P < 0.001), 3.3 for thyroiditis (95% CI = 1.5–7.7; P < 0.001), and 3.1 for hyperthyroidism (95% CI = 2.0–4.8; P < 0.001).
Conclusion: Celiac disease is associated with thyroid disease, and these associations were seen regardless of temporal sequence. This indicates shared etiology and that these individuals are more susceptible to autoimmune disease.
BJORDAL Jan Magnus ; IVERSEN Vegard ; BRANDAO MARTINS-LOPES Rodrigo Alvaro ;
Progress in biomedical optics and imaging ISSN 1605-7422
2006, vol. 7, no26, [Note(s): 31400G.1-61400G.8]
Society of Photo-Optical Instrumentation Engineers, Belligham, ETATS-UNIS (2001) (Revue)
Objective: Low level laser therapy (LLLT) has been forwarded as therapy for osteoarthritis and tendinopathy. Results in animal and cell studies suggest that LLLT may act through a biological mechanism of inflammatory modulation. The current study was designed to investigate if LLLT has an anti-inflammatory effect on activated tendinitis of the Achilles tendon.
Methods: Seven patients with bilateral Achilles tendonitis (14 tendons) who had aggravated symptoms by pain-inducing activity immediately prior to the study. LLLT (1.8 Joules for each of three points along the Achilles tendon with 904nm infrared laser) and placebo LLLT were administered to either Achilles tendons in a random order to which patients and therapist were blinded. Inflammation was examined by 1) mini-invasive microdialysis for measuring the concentration of inflammatory marker PGE2 in the peritendinous tissue, 2) ultrasound with Doppler measurement of peri- and intratendinous blood flow, 3) pressure pain algometry and 4) single hop test.
Results: PGE2- levels were significantly reduced at 75, 90 and 105 minutes after active LLLT compared both to pre-treatment levels (p=0.026) and to placebo LLLT (p=0.009). Changes in pressure pain threshold (PPT) were significantly different (P=0.012) between groups. PPT increased by a mean value of 0.19 kg/cm2 [95%CI:0.04 to 0.34] after treatment in the active LLLT group, while pressure pain threshold was reduced by -0.20 kg/cm2 [95%CI:-0.45 to 0.05] after placebo LLLT.
Conclusion: LLLT can be used to reduce inflammatory musculskeletal pain as it reduces inflammation and increases pressure pain threshold levels in activity-induced pain episodes of Achilles tendinopathy.
Apostolos Stergioulas, PT, PhD*, Marianna Stergioula, PT*, Reidar Aarskog, PT, MSc , Rodrigo A. B. Lopes-Martins, MPharm, PhD and Jan M. Bjordal, PT, PhD ,||, From the * Faculty of Human Movement and Quality of Life, Peloponnese University, Sparta, Laconia, Greece, the Institute of Physical Therapy, Bergen University College, Bergen, Norway, the Laboratory of Pharmacology and Phototherapy of Inflammation, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil, and the || Section of Physiotherapy Science, Department of Public Health and Primary Care, University of Bergen, Bergen, Norway Address correspondence to Jan M. Bjordal, PT, PhD, Institute of Physical Therapy, Bergen University College, Mollendalsvn 6, 5009 Bergen, Norway (e-mail: jmb@hib.no ).
Background: Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset.
Hypothesis: The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement.
Study Design: Randomized controlled trial; Level of evidence, 1.
Methods: A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy ( = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm2 and a total dose of 5.4 J per session.
Results: The results of the intention-to-treat analysis for the primary outcome, pain intensity during physical activity on the 100-mm visual analog scale, were significantly lower in the LLLT group than in the placebo LLLT group, with 53.6 mm versus 71.5 mm (P = .0003) at 4 weeks, 37.3 mm versus 62.8 mm (P = .0002) at 8 weeks, and 33.0 mm versus 53.0 mm (P = .007) at 12 weeks after randomization. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favor of the LLLT group.
Conclusion: Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.
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B6 Toxicity
An overdose of pyridoxine can cause a temporary deadening of certain
nerves such as the proprioceptory nerves; causing a feeling of
disembodiment common with the loss of proprioception. This condition
is reversible when supplementation is stopped.[12]
Because adverse effects have only been documented from vitamin B6
supplements and never from food sources, this article only discusses
the safety of the supplemental form of vitamin B6 (pyridoxine).
Although vitamin B6 is a water-soluble vitamin and is excreted in the
urine, very high doses of pyridoxine over long periods of time may
result in painful neurological symptoms known as sensory neuropathy.
Symptoms include pain and numbness of the extremities, and in severe
cases difficulty walking. Sensory neuropathy typically develops at
doses of pyridoxine in excess of 1,000 mg per day. However, there have
been a few case reports of individuals who developed sensory
neuropathies at doses of less than 500 mg daily over a period of
months. None of the studies, in which an objective neurological
examination was performed, found evidence of sensory nerve damage at
intakes of pyridoxine below 200 mg/day. In order to prevent sensory
neuropathy in virtually all individuals, the Food and Nutrition Board
of the Institute of Medicine set the tolerable upper intake level (UL)
for pyridoxine at 100 mg/day for adults. Because placebo-controlled
studies have generally failed to show therapeutic benefits of high
doses of pyridoxine, there is little reason to exceed the UL of 100 mg/
day.
| GOLDILOCKS AND THE THREE BEARS: YOU NEED THE RIGHT DOSE |
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This study (Photomed Laser Surg. 2009 Aug 26) looked at the clinical effectiveness of Low Level Laser Therapy (LLLT) in the treatment of soft tissues, specifically tendinopathy. They also looked at the validity of current dosage recommendations. Twenty-five controlled clinical trials met the inclusion criteria. In the 12 positive studies that showed significantly positive effects, the dosages used closely resembled current recommended guidelines. That means that if your laser is too hot or you have a very low power laser, the likelihood of excellent results is more limited. It is like Goldilocks and the Three Bears. You want to use a laser that is not too hot and not too cold! With tennis elbow the participants’ grip strength was 9.59 kg higher than that of the control group! And for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale! Their conclusion from this well controlled study is that LLLT can be effective when recommended dosages are used. The 12 positive studies provide strong evidence that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy. Not too hot and not too cold! That’s why we use the laser that is just right, like the Apollo, the world’s most powerful, cold laser.
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