Use of Opioid for Chronic pain, traumatic brain injury, stress disorder and lower back pain

I read an article published in the New York times and published yesterday. In the article a doctor named Colin Fernandes tells of the inadequacy of drugs offered to treat some diseases notably trauma and back pain.

As an example, the author describe the case of young veterans, frequently in their 20s, coming back from combat. They mostly have chronic pain and traumatic brain injury, untreated post-traumatic stress disorder, and sleep and mood disorders.

The challenge he faces if to find a balance between pain relief and side effects; For example the only treatment available for these problems is giving opioid painkillers (Percocet or Vicodin). But these drugs affect mood and sleep and he finds himself in the unenviable position of limiting access to pain medications if their use will lead to functional decline.

He he is sobered by the fact that the only study of efficacy of these drugs is a 16 weeks test where in practice the use of these drugs are often maintained on opioids for years or decades.

Colin Fernandes also note that trials suggest that on average, patients given opioids experience an improvement of only 2 to 3 points on a pain scale of 0 to 10 [=not much compared to the side effects]. Side effects and risks are many: chronic constipation, sedation and somnolence, a worsening of mood, opioid-induced hyperalgesia (a paradoxical phenomenon in which pain medications actually increase pain), hypogonadism (impaired endocrine function) and addiction [sic]. Recent studies also suggest an adverse effect on immune function.

Colin concludes that the guiding principle learned in medical school “First do no harm” is easy to understand but as a doctor saying to your patient “There is nothing more I can offer you” is very hard.

Feel free to tell me of your experiences in comments below..

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Two potentially key genes linked to Alzheimer’s disease discovered : Why is it important ?

dna_alzheimersThis is the big news of today : Two potentially key genes linked to the development of Alzheimer’s disease have been uncovered by UK researchers.

What do we know about the disease ?
Professor Julie Williams, who is also chief scientific adviser to the Alzheimer’s Research Trust, said “We have been looking at a specific theory about Alzheimer’s disease but our data shows that there are different things going on. We do not really understand what causes common Alzheimer’s disease. In a few years’ time we might have a very good idea of the full picture.”
Here are a few clues..
First, we know that Alzheimer’s disease is characterized by a build-up of proteins in the brain. Though this cannot be measured in a living person, extensive autopsy studies have revealed this phenomenon.
Second, we don’t really know what causes Alzheimer’s. What we know is that age is the number one factor and two certain genes play an important role.
Among these genes, there are two types a) “risk genes” : they are genes that if present in the individual increase the likelihood of developing the disease b) “deterministic gene” : much rarer than risk genes and only found in a few hundred extended families around the world. If you have it, no doubt you will develop Alzheimer’s.
Why is this discovery important ?
The two genes uncovered by the UK team – CLU and PICALM – are both known to have protective roles in the brain. Changes in the genes may either remove that protective effect or turn the “protectors into attackers”, the researchers said.
One of the team, Professor Kevin Morgan from the University of Nottingham, explained that the pathways highlighted by the discovery include those involved in the turnover of cholesterol and part of the immune system involved in inflammation.
So with these genes, scientist can find ways to lower cholesterol and inflammation in the brain.
The nest question is if we are able in the future to produce drugs to lower cholesterol and reduce inflammation, could we modify the risk of people getting Alzheimer’s disease ?
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Smoking cannabis ? Do it so in moderation.

cannabis_packI came across a post on Marijuana from a Reddit user which i thought was very informative and i reproduce it here. The post relay the user’s experience of smoking post through his your age. The post does not condemn smoking but advise that moderation is the key to enjoy smoking pot.

‘I smoked pot daily for almost 10 years starting when I was 14 years old. I struggled with it for many years, and even thought for awhile that I could not live without it.
From the time I was 14 to 22, I remember I couldn’t go to a movie without smoking out in the parking lot. I couldn’t go out to dinner with my family without sneaking a toke in the bathroom. I couldn’t go to my college classes without taking a couple hits during the drive to class. When I couldn’t afford it I would steal some from my brother. I was smoking 1/8th a week (about 50-60 dollars for the good stuff where I lived).
I remember taking huge bong rips, impressing my friends with my lung capacity. Sadly, it is not nearly the same as it once was. I remember having heart palpitations when I smoked too much, sending myself into panic attacks that didn’t remit for years. I remember developing social anxiety and struggling to make close relationships with other people. I remember my lungs aching from all the ounces and ounces I went through. A few times I even vomited when I coughed so hard from a huge hit that didn’t go down smoothly. I remember knowing that I could do something if I ‘really’ wanted to, but more often than not, not caring enough to do it because I was too stoned and feeling lazy. I sold pot to people, and nearly lost my head when my parents found out.
Marijuana was a problem, but I still didn’t have the awareness of that because I rationalized all the problems away. I could still ‘function’, managing to keep a girlfriend and get B’s and A’s in my classes at a public university. I still lived at my parent’s house, worked a part-time job, and played in a band. Life was pretty good, but deep down inside I knew something wasn’t right.
From the ages 22 to 24 I learned a little self control, mostly because I realized I wasn’t satisfied with the status quo. I found I was able to reduce my tolerance, still get high, and function ‘better’ if I smoked about 1/8th a month (which for some people is very little). I managed to get into graduate school. It was there that I learned how much pot had affected my life, and not for the better. Looking back, all those years were a haze. Sure, I remember significant events, but not with the clarity that I do now. I have friends who can quote movie lines, knowing I was there, and I can barely remember seeing the film at all. I remember significant emotional dissonance, meaning that I would feel one way about something when I was high, but feel another way entirely when I was sober. This was certainly a problem for my relationships with women. Pot was a coping strategy for a long time, anytime I was upset or needed to feel better I would smoke. I didn’t learn the necessary emotional coping skills I needed to function without it. As much as pot would make me appreciate things and make me mellow out, I found that appreciation for things is just as good sober, albeit different. I learned these things because I had to, not because I chose to.
When I first started graduate school the demands were so intense I didn’t smoke at all for 2 years. There was no way I could function and smoke at the level expected of me. Details were important, and the memory side effects of pot were too much to handle. During undergrad it was much easier, but this was a whole new realm. It wasn’t until I got a handle on my stress level and learned a thing or two about relaxation that I found I could mix things up a little.
Now I smoke about 1/4 ounce a year (~100 bucks worth) and this includes sharing with friends. Basically I smoke once a week, 1 or 2 small hits and I’m done. Just to chill. I do it at home alone relaxing or with a close group and we sit and drink wine and laugh. As many have noted, moderation is key. But it took several years to learn that. I know that many people who fall into the same habits I had don’t have the resources or self-control necessary to cope and deal with the effects of prolonged and heavy marijuana use. For many people it is a significant problem, and it is easy to rationalize all of those problems away. But sometimes I wonder, are they functioning at their full capacity? I know I wasn’t.
Moving away from my own experience, my work in the mental health field has shown me the deleterious effects of prolonged and heavy marijuana use. Generally speaking, it significantly interrupts the mind-body connection, such that people have problems integrating their thoughts with their emotions, and as a result behavior is affected. Anecdotally, it manifested with how I would feel about things when I was sober versus high, resulting in cognitive dissonance (i.e., stress). Also, it makes sense that when someone rewards their brain with feel good chemicals (such as THC), they feel less motivated to accomplish things that would incur long-term rewards. Not the case with everyone, of course… but certainly the case with more than most would admit. Our brains have hundreds of complex feedback mechanisms, and pot interrupts them on many levels.
Fortunately, I learned my lessons about heavy use, mostly out of necessity to achieve my goals. Like anything else, pot is not harmless with heavy use. But in moderation, it can add to some of the joys of life.
I’m 28 and 1 year away from my PhD in neuropsychology.’

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Eleven benefits of eating apples

Best Health published a simple article about the benefits of eating apples. Thought that was a good read for a Saturday!

Things to note about apples
1. Over the list of the top 100 food containing anti-oxydants, two types of apples-Red Delicious and Granny Smith—ranked 12th and 13th respectively. One of the best aspect of detoxification is that it keeps your liver healthy.
2. Apple and other fruits do fight against aging in the brain hence fighting against Alzheimer’s disease
3. Some research also shows that people who eat fruits and other high-fibre foods gain a certain amount of protection against Parkinson’s disease
4. Several compounds inside apples help fight against cancer : the American Association for Cancer Research states that the consumption of flavonol-rich apples could help reduce your risk of developing pancreatic cancer by up to 23 per cent. But to benefit from this you have to eat the skin of the apples which contains the cancer reducing components
5. Apples fight against diabetes, a study shows that Women who eat at least one apple a day are 28 percent less likely to develop type 2 diabetes
6. Apples are rich in soluble fibre which acts against blood sugar swings
7. Also the fibers inside the apple binds with fats in the intestine and this translates into lower cholesterol levels. Lower cholesterol level means a reduced risk of forming gallstones.
8. Also, fibers do fight against constipation and irritable bowel syndrome
9. Fibers make you feel full and help you control your food intake
10. Only red apples contain quercetin, a particular type of anti-oxydant which fortifies your immune system.
11. Some studies have shown that eating antioxidants often can help reduce the risk of developing cataracts

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