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How long does back pain last? And how can learning about pain increase the chance of recovery?

<p><em><a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p>Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">have it this year</a>.</p> <p>Chronic pain, of which back pain is the most common, is the world’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">most disabling</a> health problem. Its economic impact <a href="https://www.ncbi.nlm.nih.gov/books/NBK92510/">dwarfs other health conditions</a>.</p> <p>If you get back pain, how long will it take to go away? We scoured the scientific literature to <a href="https://www.cmaj.ca/content/cmaj/196/2/E29.full.pdf">find out</a>. We found data on almost 20,000 people, from 95 different studies and split them into three groups:</p> <ul> <li>acute – those with back pain that started less than six weeks ago</li> <li>subacute – where it started between six and 12 weeks ago</li> <li>chronic – where it started between three months and one year ago.</li> </ul> <p>We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain.</p> <p>Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access.</p> <h2>More pain doesn’t mean a more serious injury</h2> <p>Most acute back pain episodes are <a href="https://www.racgp.org.au/getattachment/75af0cfd-6182-4328-ad23-04ad8618920f/attachment.aspx">not caused</a> by serious injury or disease.</p> <p>There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine.</p> <p>Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system.</p> <p>The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement.</p> <p>The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain.</p> <h2>Reduce your chance of lasting pain</h2> <p>Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain:</p> <ul> <li> <p>understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain</p> </li> <li> <p>reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal.</p> </li> </ul> <h2>How to reduce your pain sensitivity and learn about pain</h2> <p>Learning about “how pain works” provides the most sustainable <a href="https://www.bmj.com/content/376/bmj-2021-067718">improvements in chronic back pain</a>. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want.</p> <p>These programs have been in development for years, but high-quality clinical trials <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">are now emerging</a> and it’s good news: they show most people with chronic back pain improve and many completely recover.</p> <p>But most clinicians aren’t equipped to deliver these effective programs – <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">good pain education</a> is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure.</p> <p>When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">been told it’s all in their head</a>.</p> <p>Community-driven not-for-profit organisations such as <a href="https://www.painrevolution.org/">Pain Revolution</a> are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than <a href="https://www.painrevolution.org/find-a-lpe">80 local pain educators</a> and supported them to bring greater understanding and improved care to their colleagues and community.</p> <p>But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222513/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, Post-doctoral Researcher, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-long-does-back-pain-last-and-how-can-learning-about-pain-increase-the-chance-of-recovery-222513">original article</a>.</em></p>

Body

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Socceroos great hospitalised following chest pains

<p>Mark Bosnich had a health scare this week that landed him in hospital. </p> <p>The former Socceroos and Manchester United goalkeeper was exercising at work when he began to experience chest pains. </p> <p>Not wanting to risk it, the  52-year-old made the quick decision to get himself checked out at a hospital in Sydney. </p> <p>The Aussie football great took to X, formerly known as Twitter, to update fans on his condition, straight from his hospital bed on Wednesday night. </p> <p>“Will not be able to see you all tomorrow morning,” he wrote, along with the schedule of matches for the Champions League airing on the streaming platform Stan. </p> <p>“But will be fine by Friday … but join us here in Oz from 6.35am (aedt).”</p> <blockquote class="twitter-tweet"> <p dir="ltr" lang="en">Will not be able to see you all tomorrow morning,but will be fine by Friday…but join us here in Oz from 6.35am(aedt) <a href="https://twitter.com/ChampionsLeague?ref_src=twsrc%5Etfw">@ChampionsLeague</a> Rd 16 <a href="https://twitter.com/PSG_English?ref_src=twsrc%5Etfw">@PSG_English</a> VS <a href="https://twitter.com/RealSociedadEN?ref_src=twsrc%5Etfw">@RealSociedadEN</a> & <a href="https://twitter.com/OfficialSSLazio?ref_src=twsrc%5Etfw">@OfficialSSLazio</a> vs <a href="https://twitter.com/FCBayernEN?ref_src=twsrc%5Etfw">@FCBayernEN</a> <a href="https://twitter.com/StanSportAU?ref_src=twsrc%5Etfw">@StanSportAU</a> <a href="https://twitter.com/UEFA?ref_src=twsrc%5Etfw">@UEFA</a> .xmb <a href="https://t.co/LRL5D9YtOu">pic.twitter.com/LRL5D9YtOu</a></p> <p>— Mark Bosnich (@TheRealBozza) <a href="https://twitter.com/TheRealBozza/status/1757715714583191600?ref_src=twsrc%5Etfw">February 14, 2024</a></p></blockquote> <p>Bosnich was missing from Stan Sport’s Champions League coverage on Thursday and his on-air colleagues, Max Rushden and Craig Foster, explained what had happened. </p> <p>“For those of you who don’t know, he (Bosnich) had chest pains, he’s had a stent put in,” Rushden said during coverage of one of the matches. </p> <p>He was making a lot of noise … and he said ‘I’m going to get it checked out’.</p> <p>“He did, he’s OK. He’s back tomorrow but we are sending you our love Boz, it is very quiet without you.”</p> <p>Fellow Socceroo Foster added: “We miss you buddy. I hope you’re well and feeling OK.”</p> <p>Bosnich's hospital admission didn't stop him from keeping up with the matches as he shared a photo of himself tuning in to Champions League on a tablet, and thanked everyone for their well-wishes. </p> <blockquote class="twitter-tweet"> <p dir="ltr" lang="en">Thank you all for your wonderful messages….will be back 2morrow on <a href="https://twitter.com/StanSportAU?ref_src=twsrc%5Etfw">@StanSportAU</a> for <a href="https://twitter.com/EuropaLeague?ref_src=twsrc%5Etfw">@EuropaLeague</a> Knockout <a href="https://twitter.com/acmilan?ref_src=twsrc%5Etfw">@acmilan</a> vs <a href="https://twitter.com/staderennais_en?ref_src=twsrc%5Etfw">@staderennais_en</a> on air from 6.35am(aedt)…xmb <a href="https://t.co/bVxj93CCWv">pic.twitter.com/bVxj93CCWv</a></p> <p>— Mark Bosnich (@TheRealBozza) <a href="https://twitter.com/TheRealBozza/status/1757893486920302943?ref_src=twsrc%5Etfw">February 14, 2024</a></p></blockquote> <p>During Thursday's game, Rushden was keen for anyone watching to heed the warning from Bosnich.</p> <p>“If you’re not sure about anything, health-wise, get checked,” Rushden said.</p> <p>“Men are useless at talking about it and doing anything about it.</p> <p>“The sooner you find anything is wrong, the better it is. That is our message and that is Bozza’s message too.”</p> <p><em>Images: X</em></p>

Caring

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Mortgage and inflation pain to ease, but only slowly: how 31 top economists see 2024

<p><em><a href="https://theconversation.com/profiles/peter-martin-682709">Peter Martin</a>, <a href="https://theconversation.com/institutions/crawford-school-of-public-policy-australian-national-university-3292">Crawford School of Public Policy, Australian National University</a></em></p> <p>A panel of 31 leading economists assembled by The Conversation sees no cut in interest rates before the middle of this year, and only a slight cut by December, enough to trim just $55 per month off the cost of servicing a $600,000 variable-rate mortgage.</p> <p>The <a href="https://theconversation.com/au/topics/conversation-economic-survey-81354">panel</a> draws on the expertise of leading forecasters at 28 Australian universities, think tanks and financial institutions – among them economic modellers, former Treasury, International Monetary Fund and Reserve Bank officials, and a former member of the Reserve Bank board.</p> <p>Its forecasts paint a picture of weak economic growth, stagnant consumer spending, and a continuing per-capita recession.</p> <p>The average forecast is for the Reserve Bank to delay cutting its cash rate, keeping it near its present 4.35% until at least the middle of the year, and then cutting it to <a href="https://cdn.theconversation.com/static_files/files/3028/The_Conversation_AU_February_2024_Economic_Survey.pdf">4.2%</a> by December 2024, 3.6% by December 2025 and 3.4% by December 2026.</p> <hr /> <p><iframe id="xV821" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/xV821/4/" width="100%" height="400px" frameborder="0"></iframe></p> <hr /> <p>The gentle descent would deliver only three interest rate cuts by the end of next year, cutting $274 from the monthly cost of servicing a $600,000 mortgage and leaving the cost around $1,100 higher than it was before rates began climbing.</p> <p>Six of the experts surveyed expect the Reserve Bank to increase rates further in the first half of the year, while 20 expect no change and three expect a cut.</p> <p>Former head of the NSW treasury Percy Allan said while the Reserve Bank would push up rates in the first half of the year to make sure inflation comes down, it would be forced to relent in the second half of the year as unemployment grows and the economy heads towards recession.</p> <p>Warwick McKibbin, a former member of the Reserve Bank board, said the board would push up rates once more in the first half of the year as insurance against inflation before leaving them on hold.</p> <p>Former Reserve Bank of Australia chief economist Luci Ellis, who is now chief economist at Westpac, expects the first cut no sooner than September, believing the board will wait to see clear evidence of further falls in inflation and economic weakening before it moves.</p> <hr /> <p><iframe id="ZQgno" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/ZQgno/7/" width="100%" height="400px" frameborder="0"></iframe></p> <hr /> <h2>Inflation to keep falling, but more gradually</h2> <p>Today’s <a href="https://www.rba.gov.au/">Reserve Bank board meeting</a> will consider an inflation rate that has come down <a href="https://theconversation.com/the-7-new-graphs-that-show-inflation-falling-back-to-earth-220670">faster than it expected</a>, diving from 7.8% to 4.1% in the space of a year.</p> <p>The newer more experimental monthly measure of inflation was just <a href="https://theconversation.com/the-7-new-graphs-that-show-inflation-falling-back-to-earth-220670">3.4%</a> in the year to December, only points away from the Reserve Bank’s target of 2–3%.</p> <p>But the panel expects the descent to slow from here on, with the standard measure taking the rest of the year to fall from 4.1% to 3.5% and not getting below 3% until <a href="https://cdn.theconversation.com/static_files/files/3027/The_Conversation_AU_2024_economic_survey.pdf">late 2025</a>.</p> <p>Economists Chris Richardson and Saul Eslake say while inflation will keep heading down, the decline might be slowed by supply chain pressures from the conflict in the Middle East and the boost to incomes from the <a href="https://theconversation.com/albanese-tax-plan-will-give-average-earner-1500-tax-cut-more-than-double-morrisons-stage-3-221875">tax cuts</a> due in July.</p> <hr /> <p><iframe id="buC9f" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/buC9f/6/" width="100%" height="400px" frameborder="0"></iframe></p> <hr /> <h2>Slower wage growth, higher unemployment</h2> <p>While the panel expects wages to grow faster than the consumer price index, it expects wages growth to slip from around <a href="https://www.abs.gov.au/statistics/economy/price-indexes-and-inflation/wage-price-index-australia/latest-release">4%</a> in 2023 to 3.8% in 2004 and 3.4% in 2025 as higher unemployment blunts workers’ bargaining power.</p> <p>But the panel doesn’t expect much of an increase in unemployment. It expects the unemployment rate to climb from its present <a href="https://www.datawrapper.de/_/w9h9f/">3.9%</a> (which is almost a long-term low) to 4.3% throughout 2024, and then to stay at about that level through 2025.</p> <p>All but two of the panel expect the unemployment rate to remain below the range of 5–6% that was typical in the decade before COVID.</p> <p>Economic modeller Janine Dixon said the “new normal” between 4% and 5% was likely to become permanent as workers embraced flexible arrangements that allow them to stay in jobs in a way they couldn’t before.</p> <p>Cassandra Winzar, chief economist at the Committee for the Economic Development of Australia, said the government’s commitment to full employment was one of the things likely to keep unemployment low, along with Australia’s demographic transition as older workers leave the workforce.</p> <hr /> <p><iframe id="pAioo" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/pAioo/2/" width="100%" height="400px" frameborder="0"></iframe></p> <hr /> <h2>Slower economic growth, per-capita recession</h2> <p>The panel expects very low economic growth of just 1.7% in 2024, climbing to 2.3% in 2025. Both are well below the 2.75% the treasury believes the economy is <a href="https://treasury.gov.au/speech/the-economic-and-fiscal-context-and-the-role-of-longitudinal-data-in-policy-advice">capable of</a>.</p> <p>All but one of the forecasts are for economic growth below the present population growth rate of 2.4%, suggesting that the panel expects population growth to exceed economic growth for the second year running, extending Australia’s so-called <a href="https://theconversation.com/were-in-a-per-capita-recession-as-chalmers-says-gdp-steady-in-the-face-of-pressure-212642">per capita recession</a>.</p> <hr /> <p><iframe id="TO8bP" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/TO8bP/4/" width="100%" height="400px" frameborder="0"></iframe></p> <hr /> <p>The lacklustre forecasts raise the possibility of what is commonly defined as a “technical recession”, which is two consecutive quarters of negative economic somewhere within a year of mediocre growth.</p> <p>Taken together, the forecasters assign a 20% probability to such a recession in the next two years, which is lower than in <a href="https://theconversation.com/two-more-rba-rate-hikes-tumbling-inflation-and-a-high-chance-of-recession-how-our-forecasting-panel-sees-2023-24-208477">previous surveys</a>.</p> <p>But some of the individual estimates are high. Percy Allen and Stephen Anthony assign a 75% and 70% chance to such a recession, and Warren Hogan a 50% chance.</p> <p>Hogan said when the economic growth figures for the present quarter get released, they are likely to show Australia is in such a recession at the moment.</p> <p>The economy barely grew at all in the September quarter, expanding just <a href="https://www.abs.gov.au/statistics/economy/national-accounts/australian-national-accounts-national-income-expenditure-and-product/latest-release">0.2%</a> and was likely to have shrunk in the December quarter and to shrink further in this quarter.</p> <p>The panel expects the US economy to grow by 2.1% in the year ahead in line with the <a href="https://www.imf.org/en/Publications/WEO/Issues/2024/01/30/world-economic-outlook-update-january-2024">International Monetary Fund</a> forecast, and China’s economy to grow 5.4%, which is lower than the International Monetary Fund’s forecast.</p> <h2>Weaker spending, weak investment</h2> <p>The panel expects weak real household spending growth of just 1.2% in 2014, supported by an ultra-low household saving ratio of close to zero, down from a recent peak of 19% in September 2021.</p> <p>Mala Raghavan of The University of Tasmania said previous gains in income, rising asset prices and accumulated savings were being overwhelmed by high inflation and rising interest rates.</p> <p>Luci Ellis expected the squeeze to continue until tax and interest rate cuts in the second half of the year, accompanied by declining inflation.</p> <p>The panel expects non-mining investment to grow by only 5.1% in the year ahead, down from 15%, and mining investment to grow by 10.2%, down from 22%.</p> <p>Johnathan McMenamin from Barrenjoey said private and public investment had been responsible for the lion’s share of economic growth over the past year and was set to plateau and fade as a driver of growth.</p> <h2>Home prices to climb, but more slowly</h2> <p>The panel expects home price growth of 4.6% in Sydney during 2024 (down from 11.4% in 2024) and 3.1% in Melbourne, down from 3.9% in 2024.</p> <p>ANZ economist Adam Boyton said decade-low building approvals and very strong population growth should keep demand for housing high, outweighing a drag on prices from high interest rates. While high interest rates have been restraining demand, they are likely to ease later in the year.</p> <hr /> <p><iframe id="syk8x" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/syk8x/6/" width="100%" height="400px" frameborder="0"></iframe></p> <hr /> <p>In other forecasts, the panel expects the Australian dollar to stay below US$0.70, closing the year at US$0.69, it expects the ASX 200 share market index to climb just 3% in 2024 after climbing 7.8% in 2023, and it expects a small budget surplus of A$3.8 billion in 2023-24, followed by a deficit of A$13 billion in 2024-25.</p> <p>The budget surplus should be supported by a forecast iron ore price of US$114 per tonne in December 2024, down from the present US$130, but well up on the <a href="https://budget.gov.au/content/myefo/index.htm">US$105</a> assumed in the government’s December budget update.</p> <p><a href="https://theconversation.com/profiles/peter-martin-682709"><em>Peter Martin</em></a><em>, Visiting Fellow, <a href="https://theconversation.com/institutions/crawford-school-of-public-policy-australian-national-university-3292">Crawford School of Public Policy, Australian National University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/mortgage-and-inflation-pain-to-ease-but-only-slowly-how-31-top-economists-see-2024-218927">original article</a>.</em></p>

Money & Banking

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Mother dies after ambulance fails to arrive

<p>A mother from Queensland has tragically died while waiting for an ambulance, after she called 000 complaining of chest pain. </p> <p>Cath Groom called paramedics just before 10:30pm on Friday after growing increasingly concerned about persistent chest pain, but was left waiting more than an hour and a half for the ambulance to arrive. </p> <p>Given the nature of Groom's symptoms, her case was deemed urgent, and she should've been tended to by paramedics within 15 minutes. </p> <p>It is believed that Cath was found dead by her teenage son while still waiting for the ambulance to arrive, the day before her 52nd birthday. </p> <p>Her friends and family have taken to social media to pay tribute to the “amazing mother” and to express their “deepest shock, grief and sadness” at the news of her sudden passing. </p> <p>“She was and will always be my favourite human on this earth, I loved her to bits we were like a brother and sister I’m going to be lost without her,” one person wrote. </p> <p>“What an absolute shock. Such a beautiful girl taken way too soon,” another said. </p> <p>Ms Groom had long been a single mum after she was left to raise her son on her own after her husband died when the boy was just a baby. </p> <p>“Rest In Peace Sis, may you rest easy now with Dad and your life’s love and husband Warren,” her sister wrote on social media.</p> <p>The shock death has renewed calls for the Queensland and federal government to address ambulance delays, with Australian Medical Association Queensland president Dr Maria Boulton saying the state’s healthcare system is “not good enough”. </p> <p>“This is what happens because the system is under such strain, we know that our healthcare workers do the best they can in a system that is completely broken,” she told the <em>Today Show</em>. </p> <p>“This is not on them but it also affects them because they don’t want to lose any lives.”</p> <p><em>Image credits: Facebook</em></p>

Caring

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How to get rid of sciatica pain: solutions from back experts

<p><strong>The scoop on sciatica pain</strong></p> <p>Fun fact: The sciatic nerve is the largest nerve in the human body. It runs from the lower back down each side of your body, along the back of the hips, butt cheeks, and knees, down the back of the calf, and into the foot. It provides both sensory and motor nerve function to the legs and feet.</p> <p>Not-so-fun fact: Sometimes this nerve can get compressed in the spine at one of the roots – where it branches off the spinal cord – and cause pain that radiates down the length of the nerve. This is a dreaded condition known as sciatica. It is estimated that between 10 and 40 percent of people will experience sciatica in their lifetime.</p> <p>“Sciatica is the body telling you the sciatic nerve is unhappy,” says E. Quinn Regan, MD, an orthopaedic surgeon. “When the nerve is compressed at the root, it becomes inflamed, causing symptoms,” Dr Regan says. These symptoms can range from mild to debilitating.</p> <p>While sciatica can often resolve on its own, easing symptoms and feeling better usually requires some attention and careful behaviour modifications. Rarely, you may need more medical intervention to recover fully.</p> <p>Here’s everything you need to know about sciatica, including symptoms, how it’s diagnosed, how it’s treated, and what you can do to prevent it from recurring.</p> <p><strong>Symptoms of sciatica</strong></p> <p>Sciatica is quite literally a pain in the butt. The telltale symptom of sciatica is pain that radiates along the nerve, usually on the outside of the butt cheek and down the back of the leg. It usually only happens on one side of the body at a time. Sciatica doesn’t necessarily cause lower back pain, though it can.</p> <p>Dr Regan says that people with sciatica describe the pain as electric, burning, or stabbing, and in more severe cases, it can also be associated with numbness or weakness in the leg. If sciatica causes significant muscle weakness, to the point of losing function, and/or the pain is so bad you can’t function, it’s time to get immediate help, Dr Regan says.</p> <p>Another symptom that warrants a trip to the ER and immediate medical intervention: bowel or bladder incontinence. “That means there’s a massive compression, and the pressure is so severe it’s harming the nerves that go to the bowel and bladder,” says orthopaedic surgeon Dr Brian A. Cole. This is rare, but when it happens, it’s imperative to decompress the nerve immediately, he says.</p> <p><strong>The main causes of sciatica</strong></p> <p>The most common cause of sciatica is a herniated or slipped disc. A herniated or slipped disc happens when pressure forces one of the discs that cushion each vertebra in the spine to move out of place or rupture. Usually it’s caused when you lift something heavy and hurt your back, or after repetitive bending or twisting of the lower back from a sport or a physically demanding job.</p> <p>Sciatica also can be caused by:</p> <ul> <li>a bone spur (osteophyte), which can form as a result of osteoarthritis</li> <li>narrowing of the spinal canal (spinal stenosis), which happens with normal wear-and-tear of the spine and is more common in people over 60</li> <li>spondylolisthesis, a condition where one of your vertebrae slips out of place</li> <li>a lower back or pelvic muscle spasm or any sort of inflammation that presses on the nerve root</li> </ul> <p>Some people are born with back problems that lead to spinal stenosis at an earlier age. Other potential, yet rare, causes of sciatic nerve compression include tumours and abscesses.</p> <p><strong>Could it be piriformis syndrome?</strong></p> <p>Something known as piriformis syndrome can also cause sciatica-like symptoms, though it is not considered true sciatica. The piriformis is a muscle that runs along the outside of the hip and butt and plays an important role in hip extension and leg rotation.</p> <p>Piriformis syndrome is an overuse injury that’s common in runners, who repetitively strain this muscle, leading to inflammation and irritation. Because the muscle is so close to the sciatic nerve, piriformis syndrome can compress the nerve and cause a similar tingling, radiating pain as sciatica. The difference is that this pain is not caused by compression at the nerve root, but rather, irritation or pressure at some point along the length of the nerve.</p> <p><strong>Sciatica risk factors </strong></p> <p>Anyone can end up with a herniated disc and ultimately sciatica, but some people are more at risk than others. The biggest risk factor is age. “The discs begin to age at about age 30, and when this happens they can develop defects,” Dr Regan says. These defects slowly increase the risk of a disc slipping or rupturing.</p> <p>Men are three times more likely than women to have a herniated disc, Dr Regan says. Being overweight or obese also increases your chance of injuring a disc. A physically demanding job, regular strenuous exercise, osteoarthritis in the spine, and a history of back injury can also increase your risk. Sitting all day doesn’t help either, Dr Cole says. “You put more stress on your back biomechanically sitting than anything else you do.”</p> <p>Certain muscle weaknesses and imbalances can also make you more prone to disc injury and, consequently, sciatica. “People with weak core muscles and instability around the spine might be more prone to this since the muscles need to stabilise the joints of the vertebrae in which the nerves exit,” says Theresa Marko, an orthopaedic physical therapist.</p> <p><strong>How sciatica is diagnosed</strong></p> <p>If your symptoms suggest sciatica, your doctor will do a physical exam to check your strength, reflexes and sensation. A test called a straight leg raise can also test for sciatica, Dr Regan says. How it’s done: Patients lie face up on the floor, legs extended, and the clinician slowly lifts one leg up. At a certain point, it may trigger sciatica symptoms. (The test can also be done sitting down.)</p> <p>Depending on how severe the pain is and how long you’ve had symptoms, doctors may also do some scans (MRI or CT) on your spine to figure out what’s causing the sciatica and how many nerve roots are impacted.</p> <p>Scans can also confirm there isn’t something else mimicking the symptoms of sciatica. Muscle spasms, abscesses, hematomas (a collection of blood outside a blood vessel), tumours and Potts disease (spinal tuberculosis) can all cause similar symptoms.</p> <p><strong>Managing mild to moderate sciatica </strong></p> <p>Resting, avoiding anything that strains your back, icing the area that hurts, and taking nonsteroidal anti-inflammatories (NSAIDs) like ibuprofen and naproxen, are the first-line treatment options for sciatica, Dr Regan says. If you have a physically demanding job that requires you to lift heavy things, taking some time off, if at all possible, will help.</p> <p>While it’s important to avoid activities that might make things worse, you do want to keep moving, says Marko. “Research now advises against bed rest. You want to move without overdoing it.”</p> <p>A physical therapist can help you figure out what movements are safe and beneficial to do. For example, certain motions – squatting, performing a deadlift, or doing anything that involves bending forward at the waist – can be really aggravating. Light spine and hamstring stretching, low-impact activities like biking and swimming, and core work can help. “In general, we need the nerve to calm down a bit and to strengthen the muscles of your spine, pelvis and hips,” Marko says.</p> <p>“Within a week to 10 days, about 80 percent of patients with mild to moderate sciatica are going to be doing much better,” Dr Regan says. Within four to six weeks, you should be able to return to your regular activities – with the caveat that you’ll need to be careful about straining your back to avoid triggering sciatica again.</p> <p><strong>Treating severe sciatica</strong></p> <p>If you’re trying the treatment options for mild to moderate sciatica and your symptoms worsen or just don’t get better, you may need a higher level of treatment.</p> <p>If OTC pain relievers aren’t cutting it, your doctor may prescribe a muscle relaxant like cyclobenzaprine (Flexeril).</p> <p>An epidural steroid injection near the nerve root can reduce inflammation and provide a huge relief for some people with sciatica. The results are varied, and some people may need more than one injection to really feel relief.</p> <p>Surgery is usually a last resort, only considered once all of the conservative and minimally invasive options have been exhausted. Dr Regan notes that a small percentage of people with sciatica end up needing surgery – these are usually patients who have severe enough sciatica that their primary care doctors have referred them to spinal specialists. And only about a third of patients who see spinal specialists may end up having surgery, he says.</p> <p>Surgeries to relieve disc compression are typically quick and done on an outpatient basis, according to Dr Cole.</p> <p><strong>Preventing sciatica in the future</strong></p> <p>“Once you have a back issue, you have a higher chance of having a back issue in the future,” Dr Regan says. Which means that your first bout of sciatica isn’t likely to be your last. It’s important to adopt a healthy lifestyle to reduce the risk of sciatica striking again.</p> <p>Building core strength is key. “Think of your midsection as a box, and you need to target all sides,” Marko says. “By this, I mean abdominals, obliques, diaphragm, pelvic floor, glutes and lateral hip muscles.” These muscles all support the spine, so the stronger they are, the better the spine can handle whatever is thrown its way.</p> <p>If there’s an activity you enjoy that aggravates your back, ditch it for an alternative. For example, running can trigger back pain and sciatica in some people, Dr Regan says. If you’re prone to it, try a new form of cardio that’s gentler on your back, like swimming, biking, or using the elliptical. Even just logging fewer kilometres per week can help reduce your risk.</p> <p>Dr Regan also recommends making sure you learn how to weight train properly. Lifting with the best form possible, learning your limits, and reducing weight when you need to will help keep your back safe from disc injuries.</p> <p>Making small changes to your daily life and workouts can help keep your back healthy and minimise the time you have to waste dealing with sciatica in the future.</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.com.au/backtips-advice/how-to-get-rid-of-sciatica-pain-solutions-from-back-experts" target="_blank" rel="noopener">Reader's Digest</a>. </em></p>

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Take the pain out of toothache with these 11 home remedies

<p><strong>Toothache remedy: clove oil</strong></p> <p>Cloves are a traditional remedy for numbing nerves; the primary chemical compound of this spice is eugenol, a natural anaesthetic. Research has shown that, used topically, clove oil can be as effective against tooth pain as benzocaine.</p> <p>Put two drops of clove oil on a cotton ball and place it against the tooth itself until the pain recedes. In a pinch, use a bit of powdered clove or place a whole clove on the tooth. Chew the whole clove a little to release its oil and keep it in place up to half an hour or until the pain subsides.</p> <p><strong>Toothache remedy: cayenne paste</strong></p> <p>The main chemical component of cayenne – capsaicin – has been found to alter some of the mechanisms involved in pain. Mix powdered cayenne with enough water to make a paste.</p> <p>Roll a small ball of cotton into enough paste to saturate it, then place it on your tooth while avoiding your gums and tongue. Leave it until the pain fades – or as long as you can stand it (the concoction is likely to burn).</p> <p><strong>Toothache remedy: swish some salt water</strong></p> <p>A teaspoon of salt dissolved in a cup of boiling water makes an effective mouthwash, which will clean away irritating debris and help reduce swelling. Swish it around for about 30 seconds before spitting it out.</p> <p>Saltwater cleanses the area around the tooth and draws out some of the fluid that causes swelling, according to Professor Thomas Salinas. Repeat this treatment as often as needed. “A hot rinse can also help consolidate the infection until you get to your dentist,” says Dr Salinas.</p> <p><strong>Toothache remedy: soothe with tea</strong></p> <p>Peppermint tea has a nice flavour and some medicinal powers as well. Put 1 teaspoon dried peppermint leaves in 1 cup boiling water and steep for 20 minutes. After the tea cools, swish it around in your mouth, then spit it out or swallow.</p> <p>Also, the astringent tannins in strong black tea may help quell pain by reducing swelling. For this folk remedy place a warm, wet tea bag against the affected tooth for temporary relief. “The fluoride in tea can help kill bacteria, which is especially helpful after a tooth extraction,” says Salinas.</p> <p><strong>Toothache remedy: rinse with hydrogen peroxide</strong></p> <p>To help kill bacteria and relieve some discomfort, swish with a mouthful of 3 per cent hydrogen peroxide solution diluted with water. This can provide temporary relief if a toothache is accompanied by fever and a foul taste in the mouth (both are signs of infection), but like other toothache remedies, it’s only a stopgap measure until you see your dentist and get the source of infection cleared up.</p> <p>A hydrogen peroxide solution is only for rinsing. Spit it out, then rinse several times with plain water.</p> <p><strong>Toothache remedy: ice it</strong></p> <p>Place a small ice cube in a plastic bag, wrap a thin cloth around the bag, and apply it to the aching tooth for about 15 minutes to numb the nerves. Alternatively, that ice pack can go on your cheek, over the painful tooth. Also, according to folklore, if you massage your hand with an ice cube, you can help relieve a toothache.</p> <p>When nerves in your fingers send ‘cold’ signals to your brain, they may distract from the pain in your tooth. Just wrap up an ice cube in a thin cloth and massage it in the fleshy area between your thumb and forefinger.</p> <p><strong>Toothache remedy: wash it with myrrh</strong></p> <p>You can also rinse with a tincture of myrrh. “Myrrh definitely has an effect on infected tissue and can sometimes also interfere with the pain generated by tooth infection,” says Salinas.</p> <p>Simmer 1 teaspoon of powdered myrrh in 2 cups water for 30 minutes. Strain and let cool. Rinse with 1 teaspoon of the solution in a half-cup water several times a day.</p> <p><strong>Toothache remedy: distract with vinegar and brown paper</strong></p> <p>Another country cure calls for soaking a small piece of brown paper (from a grocery or lunch bag) in vinegar, sprinkling one side with black pepper, and holding this to the cheek. The warm sensation on your cheek may distract you from your tooth pain.</p> <p>This technique is an example of the Gate Control theory of pain. By using a distracting stimulus, the ‘gates’ to the pain receptors in your brain close and you don’t feel the original pain as powerfully.</p> <p><strong>Toothache remedy: brush with the right tools</strong></p> <p>“Sensitive toothpaste is very helpful for people with significant gum recession,” says Salinas. When gums shrink, the dentin beneath your teeth’s enamel surface is exposed, and this material is particularly sensitive.</p> <p>Look for pastes that contain sodium fluoride, potassium nitrate or strontium nitrate – ingredients which have been shown to reduce sensitivity, according to Salinas. Switch to the softest-bristled brush you can find to help preserve gum tissue and prevent further shrinking.</p> <p><strong>Toothache remedy: cover a crack with gum</strong></p> <p>If you’ve broken a tooth or have lost a filling, you can relieve some pain by covering the exposed area with softened chewing gum. This might work with a loose filling, too, to hold it in place until you can get to the dentist.</p> <p>To avoid further discomfort, avoid chewing anything with that tooth until you can have it repaired. Just make sure you use sugarless gum, since sugar may actually exacerbate the pain (not to mention that it can cause cavities).</p> <p><strong>Toothache remedy: apply pressure</strong></p> <p>Try an acupressure technique to stop tooth pain fast. With your thumb, press the point on the back of your other hand where the base of your thumb and your index finger meet.</p> <p>Apply pressure for about two minutes. “This works in several ways,” says Salinas. “The pressure can help prevent pain signals from being sent as well as help express some of the fluid that causes swelling.”</p> <p><em>Image credits: Getty Images</em></p> <p><em>This article originally appeared on <a href="https://www.readersdigest.com.au/healthsmart/11-home-remedies-for-a-toothache?pages=1" target="_blank" rel="noopener">Reader's Digest</a>. </em></p> <div class="slide-image" style="font-family: inherit; font-size: 16px; font-style: inherit; box-sizing: border-box; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> </div> <div class="slide-image" style="font-family: inherit; font-size: 16px; font-style: inherit; box-sizing: border-box; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> </div> <div class="slide-image" style="font-family: inherit; font-size: 16px; font-style: inherit; box-sizing: border-box; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> </div>

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What is cognitive functional therapy? How can it reduce low back pain and get you moving?

<p><em><a href="https://theconversation.com/profiles/peter-osullivan-48973">Peter O'Sullivan</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/jp-caneiro-1463060">JP Caneiro</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/peter-kent-1433302">Peter Kent</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a></em></p> <p>If you haven’t had lower back pain, it’s likely you know someone who has. It affects <a href="https://pubmed.ncbi.nlm.nih.gov/22231424/">around 40% of adults</a> in any year, ranging from adolescents to those in later life. While most people recover, <a href="https://pubmed.ncbi.nlm.nih.gov/29112007/">around 20%</a> go on to develop chronic low back pain (lasting more than three months).</p> <p>There is a <a href="https://bjsm.bmj.com/content/54/12/698">common view</a> that chronic low back pain is caused by permanent tissue damage including “wear and tear”, disc degeneration, disc bulges and arthritis of the spine. This “damage” is often described as resulting from injury and loading of the spine (such as bending and lifting), ageing, poor posture and weak “core” muscles.</p> <p>We’re often told to “protect” our back by sitting tall, bracing the core, keeping a straight back when bending and lifting, and avoiding movement and activities that are painful. Health practitioners often <a href="https://theconversation.com/having-good-posture-doesnt-prevent-back-pain-and-bad-posture-doesnt-cause-it-183732">promote and reinforce these messages</a>.</p> <p>But this is <a href="https://bjsm.bmj.com/content/54/12/698">not based on evidence</a>. An emerging treatment known as <a href="https://pubmed.ncbi.nlm.nih.gov/29669082/">cognitive functional therapy</a> aims to help patients undo some of these unhelpful and restrictive practices, and learn to trust and move their body again.</p> <h2>People are often given the wrong advice</h2> <p>People with chronic back pain are often referred for imaging scans to detect things like disc degeneration, disc bulges and arthritis.</p> <p>But these findings are very common in people <em>without</em> low back pain and research shows they <a href="https://pubmed.ncbi.nlm.nih.gov/24276945/">don’t accurately predict</a> a person’s current or future experience of pain.</p> <p>Once serious causes of back pain have been ruled out (such as cancer, infection, fracture and nerve compression), there is <a href="https://pubmed.ncbi.nlm.nih.gov/27745712/">little evidence</a> scan findings help guide or improve the care for people with chronic low back pain.</p> <p>In fact, scanning people and telling them they have arthritis and disc degeneration can <a href="https://pubmed.ncbi.nlm.nih.gov/33748882/">frighten them</a>, resulting in them avoiding activity, worsening their pain and distress.</p> <p>It can also lead to potentially harmful treatments such as <a href="https://pubmed.ncbi.nlm.nih.gov/27213267/">opioid</a> pain medications, and invasive treatments such as spine <a href="https://pubmed.ncbi.nlm.nih.gov/19127161/">injections</a>, spine <a href="https://pubmed.ncbi.nlm.nih.gov/12709856/">surgery</a> and battery-powered electrical stimulation of spinal nerves.</p> <h2>So how should low back pain be treated?</h2> <p>A complex range of factors <a href="https://pubmed.ncbi.nlm.nih.gov/29112007/">typically contribute</a> to a person developing chronic low back pain. This includes over-protecting the back by avoiding movement and activity, the belief that pain is related to damage, and negative emotions such as pain-related fear and anxiety.</p> <p>Addressing these factors in an individualised way is <a href="https://pubmed.ncbi.nlm.nih.gov/29573871/">now considered</a> best practice.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/15936976/">Best practice care</a> also needs to be person-centred. People suffering from chronic low back pain want to be heard and validated. They <a href="https://pubmed.ncbi.nlm.nih.gov/35384928/">want</a> to understand why they have pain in simple language.</p> <p>They want care that considers their preferences and gives a safe and affordable pathway to pain relief, restoring function and getting back to their usual physical, social and work-related activities.</p> <p>An example of this type of care is cognitive functional therapy.</p> <h2>What is cognitive functional therapy?</h2> <p><a href="https://pubmed.ncbi.nlm.nih.gov/29669082/">Cognitive functional therapy</a> is about putting the person in the drivers’ seat of their back care, while the clinician takes the time to guide them to develop the skills needed to do this. It’s led by physiotherapists and can be used once serious causes of back pain have been ruled out.</p> <p>The therapy helps the person understand the unique contributing factors related to their condition, and that pain is usually not an accurate sign of damage. It guides patients to relearn how to move and build confidence in their back, without over-protecting it.</p> <p>It also addresses other factors such as sleep, relaxation, work restrictions and engaging in physical activity based on the <a href="https://www.restorebackpain.com/patient-journey">person’s preferences</a>.</p> <p>Cognitive functional therapy usually involves longer physiotherapy sessions than usual (60 minutes initially and 30-45 minute follow-ups) with up to seven to eight sessions over three months and booster sessions when required.</p> <h2>What’s the evidence for this type of therapy?</h2> <p>Our recent clinical trial of cognitive functional therapy, published in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/fulltext">The Lancet</a>, included 492 people with chronic low back pain. The participants had pain for an average of four years and had tried many other treatments.</p> <p>We first trained 18 physiotherapists to competently deliver cognitive functional therapy across Perth and Sydney over six months. We compared the therapy to the patient’s “usual care”.</p> <p>We found large and sustained improvements in function and reductions in pain intensity levels for people who underwent the therapy, compared with those receiving usual care.</p> <p>The effects remained at 12 months, which is unusual in low back pain trials. The effects of most recommended interventions such as exercise or psychological therapies are <a href="https://pubmed.ncbi.nlm.nih.gov/34580864/">modest in size</a> and tend to be of <a href="https://pubmed.ncbi.nlm.nih.gov/32794606/">short duration</a>.</p> <p>People who underwent cognitive functional therapy were also more confident, less fearful and had a more positive mindset about their back pain at 12 months. They also liked it, with 80% of participants satisfied or highly satisfied with the treatment, compared with 19% in the usual care group.</p> <p>The treatment was as safe as usual care and was also cost-effective. It saved more than A$5,000 per person over a year, largely due to increased participation at work.</p> <h2>What does this mean for you?</h2> <p>This trial shows there are safe, relatively cheap and effective treatments options for people living with chronic pain, even if you’ve tried other treatments without success.</p> <p><a href="https://www.restorebackpain.com/cft-clinicians">Access to clinicians</a> trained in cognitive functional therapy is currently limited but will expand as training is scaled up.</p> <p>The costs depend on how many sessions you have. Our studies show some people improve a lot within two to three sessions, but most people had seven to eight sessions, which would cost around A$1,000 (aside from any Medicare or private health insurance rebates). <!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207009/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/peter-osullivan-48973">Peter O'Sullivan</a>, Professor of Musculoskeletal Physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/jp-caneiro-1463060">JP Caneiro</a>, Research Fellow in physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/peter-kent-1433302">Peter Kent</a>, Adjunct Associate Professor of Physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-cognitive-functional-therapy-how-can-it-reduce-low-back-pain-and-get-you-moving-207009">original article</a>.</em></p>

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If anxiety is in my brain, why is my heart pounding? A psychiatrist explains the neuroscience and physiology of fear

<p><em><a href="https://theconversation.com/profiles/arash-javanbakht-416594">Arash Javanbakht</a>, <a href="https://theconversation.com/institutions/wayne-state-university-989">Wayne State University</a></em></p> <p>Heart in your throat. Butterflies in your stomach. Bad gut feeling. These are all phrases many people use to describe fear and anxiety. You have likely felt anxiety inside your chest or stomach, and your brain usually doesn’t hurt when you’re scared. Many cultures tie cowardice and bravery more <a href="https://afosa.org/the-meaning-of-heart-qalb-in-quran/">to the heart</a> <a href="https://byustudies.byu.edu/article/bowels-of-mercy/">or the guts</a> than to the brain.</p> <p>But science has traditionally seen the brain as the birthplace and processing site of fear and anxiety. Then why and how do you feel these emotions in other parts of your body?</p> <p>I am a <a href="https://scholar.google.com/citations?user=UDytFmIAAAAJ&amp;hl=en">psychiatrist and neuroscientist</a> who researches and treats fear and anxiety. In my book “<a href="https://rowman.com/ISBN/9781538170380/Afraid-Understanding-the-Purpose-of-Fear-and-Harnessing-the-Power-of-Anxiety">Afraid,</a>” I explain how fear works in the brain and the body and what too much anxiety does to the body. Research confirms that while emotions do originate in your brain, it’s your body that carries out the orders.</p> <h2>Fear and the brain</h2> <p>While your brain evolved to save you from a falling rock or speeding predator, the anxieties of modern life are often a lot more abstract. Fifty-thousand years ago, being rejected by your tribe could mean death, but not doing a great job on a public speech at school or at work doesn’t have the same consequences. Your brain, however, <a href="https://doi.org/10.1006/nimg.2002.1179">might not know the difference</a>.</p> <p>There are a few key areas of the brain that are heavily involved in processing fear.</p> <p>When you perceive something as dangerous, whether it’s a gun pointed at you or a group of people looking unhappily at you, these sensory inputs are first relayed to <a href="https://doi.org/10.1038%2Fnpp.2009.121">the amygdala</a>. This small, almond-shaped area of the brain located near your ears detects salience, or the emotional relevance of a situation and how to react to it. When you see something, it determines whether you should eat it, attack it, run away from it or have sex with it.</p> <p><a href="https://theconversation.com/the-science-of-fright-why-we-love-to-be-scared-85885">Threat detection</a> is a vital part of this process, and it has to be fast. Early humans did not have much time to think when a lion was lunging toward them. They had to act quickly. For this reason, the amygdala evolved to bypass brain areas involved in logical thinking and can directly engage physical responses. For example, seeing an angry face on a computer screen can immediately trigger a <a href="https://doi.org/10.1006/nimg.2002.1179">detectable response from the amygdala</a> without the viewer even being aware of this reaction.</p> <figure><iframe src="https://www.youtube.com/embed/xoU9tw6Jgyw?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">In response to a looming threat, mammals often fight, flee or freeze.</span></figcaption></figure> <p><a href="https://doi.org/10.1038/npp.2009.83">The hippocampus</a> is near and tightly connected to the amygdala. It’s involved in memorizing what is safe and what is dangerous, especially in relation to the environment – it puts fear in context. For example, seeing an angry lion in the zoo and in the Sahara both trigger a fear response in the amygdala. But the hippocampus steps in and blocks this response when you’re at the zoo because you aren’t in danger.</p> <p>The <a href="https://doi.org/10.1176/appi.ajp.2016.16030353">prefrontal cortex</a>, located above your eyes, is mostly involved in the cognitive and social aspects of fear processing. For example, you might be scared of a snake until you read a sign that the snake is nonpoisonous or the owner tells you it’s their friendly pet.</p> <p>Although the prefrontal cortex is usually seen as the part of the brain that regulates emotions, it can also teach you fear based on your social environment. For example, you might feel neutral about a meeting with your boss but immediately feel nervous when a colleague tells you about rumors of layoffs. Many <a href="https://theconversation.com/trump-the-politics-of-fear-and-racism-how-our-brains-can-be-manipulated-to-tribalism-139811">prejudices like racism</a> are rooted in learning fear through tribalism.</p> <h2>Fear and the rest of the body</h2> <p>If your brain decides that a fear response is justified in a particular situation, it activates a <a href="https://doi.org/10.1093/med/9780190259440.003.0019">cascade of neuronal and hormonal pathways</a> to prepare you for immediate action. Some of the fight-or-flight response – like heightened attention and threat detection – takes place in the brain. But the body is where most of the action happens.</p> <p>Several pathways prepare different body systems for intense physical action. The <a href="https://doi.org/10.3389/fnins.2014.00043">motor cortex</a> of the brain sends rapid signals to your muscles to prepare them for quick and forceful movements. These include muscles in the chest and stomach that help protect vital organs in those areas. That might contribute to a feeling of tightness in your chest and stomach in stressful conditions.</p> <figure><iframe src="https://www.youtube.com/embed/0IDgBlCHVsA?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">Your sympathetic nervous system is involved in regulating stress.</span></figcaption></figure> <p>The <a href="https://www.ncbi.nlm.nih.gov/books/NBK542195/">sympathetic nervous system</a> is the gas pedal that speeds up the systems involved in fight or flight. Sympathetic neurons are spread throughout the body and are especially dense in places like the heart, lungs and intestines. These neurons trigger the adrenal gland to release hormones like adrenaline that travel through the blood to reach those organs and increase the rate at which they undergo the fear response.</p> <p>To assure sufficient blood supply to your muscles when they’re in high demand, signals from the sympathetic nervous system increase the rate your heart beats and the force with which it contracts. You feel both increased heart rate and contraction force in your chest, which is why you may connect the feeling of intense emotions to your heart.</p> <p>In your lungs, signals from the sympathetic nervous system dilate airways and often increase your breathing rate and depth. Sometimes this results in a feeling of <a href="https://theconversation.com/pain-and-anxiety-are-linked-to-breathing-in-mouse-brains-suggesting-a-potential-target-to-prevent-opioid-overdose-deaths-174187">shortness of breath</a>.</p> <p>As digestion is the last priority during a fight-or-flight situation, sympathetic activation slows down your gut and reduces blood flow to your stomach to save oxygen and nutrients for more vital organs like the heart and the brain. These changes to your gastrointestinal system can be perceived as the discomfort linked to fear and anxiety.</p> <h2>It all goes back to the brain</h2> <p>All bodily sensations, including those visceral feelings from your chest and stomach, are relayed back to the brain through the pathways <a href="https://www.ncbi.nlm.nih.gov/books/NBK555915/">via the spinal cord</a>. Your already anxious and highly alert brain then processes these signals at both conscious and unconscious levels.</p> <p><a href="https://doi.org/10.1176/appi.ajp.2016.16030353">The insula</a> is a part of the brain specifically involved in conscious awareness of your emotions, pain and bodily sensations. The <a href="https://doi.org/10.1038%2Fs41598-019-52776-4">prefrontal cortex</a> also engages in self-awareness, especially by labeling and naming these physical sensations, like feeling tightness or pain in your stomach, and attributing cognitive value to them, like “this is fine and will go away” or “this is terrible and I am dying.” These physical sensations can sometimes create a loop of increasing anxiety as they make the brain feel more scared of the situation because of the turmoil it senses in the body.</p> <p>Although the feelings of fear and anxiety start in your brain, you also feel them in your body because your brain alters your bodily functions. Emotions take place in both your body and your brain, but you become aware of their existence with your brain. As the rapper Eminem recounted in his song “Lose Yourself,” the reason his palms were sweaty, his knees weak and his arms heavy was because his brain was nervous.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/210871/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/arash-javanbakht-416594"><em>Arash Javanbakht</em></a><em>, Associate Professor of Psychiatry, <a href="https://theconversation.com/institutions/wayne-state-university-989">Wayne State University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/if-anxiety-is-in-my-brain-why-is-my-heart-pounding-a-psychiatrist-explains-the-neuroscience-and-physiology-of-fear-210871">original article</a>.</em></p>

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“Dig a hole in my chest”: Supermodel reveals double cancer fight

<p>Supermodel icon Linda Evangelista has shared the devastating details of her cancer battle, after being diagnosed twice in five years. </p> <p>In a candid interview with <a href="https://www.wsj.com/style/fashion/linda-evangelista-steven-meisel-32909b7b?mod=style_lead_story" target="_blank" rel="noopener"><em>WSJ magazine</em></a>, the 58-year-old revealed why she chose to "keep it quiet" and only tell a handful of people close to her about her health battle. </p> <p>Evangelista was first diagnosed with breast cancer in 2018 after a routine mammogram, and decided to undergo a bilateral mastectomy: a surgical procedure to remove both breasts. </p> <p>"The margins were not good. [I chose this treatment] due to other health factors, without hesitation, because I wanted to put everything behind me and not to have to deal with this.</p> <p>"Thinking I was good and set for life. Breast cancer was not going to kill me."</p> <p>Four years later in 2022, Evangelista felt a lump on her chest and an MRI revealed cancer was present in her pectoral muscle.</p> <p>"I just went into this mode that I know how to do – just do what you've got to do and get through it," she said. "And that's what I did."</p> <p>"Dig a hole in my chest," she recalled telling her doctors.</p> <p>"I don't want it to look pretty. I want you to excavate. I want to see a hole in my chest when you're done. Do you understand me? I'm not dying from this."</p> <p>After another round of surgery, she was told the outlook was good for the future, but there is always a possibility the cancer could return. </p> <p>"Well, once it's come back, there's a chance," she recalled the oncologist's words.</p> <p>"I know I have one foot in the grave, but I'm totally in celebration mode."</p> <p><em>Image credits: Instagram / Getty Images</em></p>

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"I fell asleep in the fire escape": Grant Denyer's pain meds confession

<p>Grant Denyer has opened up about the "horrific" time he was on strong pain medication, which at the peak of his reliance, led him to wander off in only his underwear and socks. </p> <p>The former<em> Sunrise</em> presenter recalled the incident on the <em>Jess Rowe Show Podcast</em> and how it left his then-girlfriend Chezzi, with "PTSD" after she spent four hours looking for him in the Sydney CBD.</p> <p>The pair were staying at a hotel in Sydney’s Chinatown when the incident occurred. </p> <p>“I wanted some scotch one night, for whatever reason, and just went wandering around town in my undies, got lost in the fire escape on the way back to the apartment,” he said in the podcast. </p> <p>“I did not know where my apartment was and fell asleep in the fire escape.</p> <p>“It took Chez three or four hours to find me.”</p> <p>In another part of the interview he opened up on the effects of the medication. </p> <p>“When you are under the influence of that kind of power of medication and in that much pain, when you close your eyes at night you go into your worst nightmares immediately and it is every night,” he explained. </p> <p>“So I would come down and think there was a home invasion, I would be crawling down with a broken back to fight off people I thought were there attacking and raping Chez.</p> <p>“This would happen daily.”</p> <p>He added that the pain meds left him in such a daze that whenever he woke up couldn't "differentiate what was real and what wasn’t.”</p> <p>At the time, Denyer had a reliance on both endone and morphine following a monster truck accident in 2008 which left him with a severe spinal injury.  </p> <p>The former <em>Sunrise </em>presenter was training for the Monster Truck Championships at Dapto Showground when the accident occurred, and had only been dating Chezzi for "a couple of weeks", which forced her "straight into carer nurse mode”.</p> <p>Denyer also opened up about the incident on the couple's podcast <em>It’s All True?</em></p> <p>“As soon as you close your eyes you go into your worst nightmares. The things that you are afraid of the most are the first things that happen the moment you fall asleep and you start dreaming.</p> <p>“It is traumatic as every time you sleep and then when you wake up you can’t tell what is real and what isn’t," he said in 2020.</p> <p>Chezzi also explained her side of the story and said that when she found him in the fire exit, he was covered in filth. </p> <p>“It was pretty gross and it broke my heart,” she said.</p> <p>Despite the challenges, the couple's love has prevailed as the pair have been married since 2009 and share three daughters, Sunday, Sailor and Scout.</p> <p><em>Images: Instagram</em></p>

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“Invisible suffering”: Bella Hadid opens up about painful health battle

<p dir="ltr">Bella Hadid has shared a raw update to her fans, giving them further insight into her “painful” health battle with Lyme disease.</p> <p dir="ltr">On Sunday, the model took to Instagram to share a series of photos of her ongoing health battle, including photos of her medical records.</p> <p dir="ltr">“The little me that suffered would be so proud of grown me for not giving up on myself,” she began in the caption.</p> <p dir="ltr">She then thanked her mum, Yolanda Hadid, "for keeping all of my medical records, sticking by me, never leaving my side, protecting, supporting, but most of all, believing me through all of this”.</p> <p dir="ltr">She then continued to say that since contracting Lyme, her symptoms have gotten worse over time and it’s taken a toll on her in ways that are difficult for her to explain, but remained positive despite it.</p> <p dir="ltr">“To be that sad and sick with the most blessings/privilege/opportunity/love around me was quite possibly the most confusing thing ever,” she added before reassuring fans not to worry and that she is “okay”.</p> <p dir="ltr">The model also noted that despite her painful health battle, she “wouldn’t change anything for the world” and would go through it all again, as it has shaped who she is.</p> <p dir="ltr">“The universe works in the most painful and beautiful ways but I need to say that if you are struggling- it will get better,” she added.</p> <p dir="ltr">Bella also said that despite “almost 15 years of invisible suffering” she is grateful for the experience, and has so much “gratitude for and perspective on life” that has made her able to spread ”love from a full cup” and “truly” be herself.</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/Cvmz8ilAcxx/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/Cvmz8ilAcxx/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Bella 🦋 (@bellahadid)</a></p> </div> </blockquote> <p dir="ltr">“I tried to pick the most positive pictures I could because as painful as this experience was, the outcome was the most enlightening experience of my life filled with new friends, new visions and a new brain,” she added before thanking everyone who has supported her throughout this journey.</p> <p dir="ltr">“I’ll be back when I’m ready, I miss you all so much, I love you all so much,” she concluded.</p> <p dir="ltr">The model shared a few photos of herself getting treatment with IVs sticking out of her arm.</p> <p dir="ltr">In a few other photos, the model can be seen resting on the couch as she gets a blood transfusion, with her loyal pup, “Petunia aka Beans,” never leaving her side.</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/Cvm1ImkA-89/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/Cvm1ImkA-89/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Bella 🦋 (@bellahadid)</a></p> </div> </blockquote> <p dir="ltr">This is the model’s first health update after she revealed she was taking time off from modelling due to a flare-up in her Lyme disease.</p> <p dir="ltr"><em>Images: Instagram</em></p> <p dir="ltr"> </p>

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Opioids don’t relieve acute low back or neck pain – and can result in worse pain, new study finds

<p><em><a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/andrew-mclachlan-255312">Andrew McLachlan</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/caitlin-jones-1263090">Caitlin Jones</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>Opioids are the one of the most prescribed pain-relief for people with low back and neck pain. In Australia, around <a href="https://link.springer.com/article/10.1007/s00586-017-5178-4">40% of people</a> with low back and neck pain who present to their GP and <a href="https://qualitysafety.bmj.com/content/28/10/826">70% of people</a> with low back pain who visit a hospital emergency department are prescribed opioids such as oxycodone.</p> <p>But our <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00404-X/fulltext">new study</a>, published today in the Lancet medical journal, found opioids do not relieve “acute” low back or neck pain (lasting up to 12 weeks) and can result in worse pain.</p> <p>Prescribing opioids for low back and neck pain can also cause <a href="https://www.healthdirect.gov.au/taking-opioid-medicines-safely">harms</a> ranging from common side effects – such as nausea, constipation and dizziness – to <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/opioid-harm-in-australia/summary">misuse, dependency, poisoning and death</a>.</p> <p>Our findings show opioids should <em>not</em> be recommended for acute low back pain or neck pain. A change in prescribing for low back pain and neck pain is urgently needed in <a href="https://www.tga.gov.au/resources/publication/publications/addressing-prescription-opioid-use-and-misuse-australia">Australia</a> and <a href="https://www.thelancet.com/commissions/opioid-crisis">globally</a> to reduce opioid-related harms.</p> <h2>Comparing opioids to a placebo</h2> <p>In our trial, we randomly allocated 347 people with acute low back pain and neck pain to take either an opioid (oxycodone plus naloxone) or <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/placebo-effect">placebo</a> (a tablet that looked the same but had no active ingredients).</p> <p>Oxycodone is an opioid pain medicine which can be given orally. <a href="https://www.nps.org.au/radar/articles/oxycodone-with-naloxone-controlled-release-tablets-targin-for-chronic-severe-pain">Naloxone</a>, an opioid-reversal drug, reduces the severity of constipation while not disrupting the pain relieving effects of oxycodone.</p> <p>Participants took the opioid or placebo for a maximum of six weeks.</p> <p>People in the both groups also received <a href="https://www.sciencedirect.com/science/article/pii/S1836955321000941">education and advice</a> from their treating doctor. This could be, for example, advice on returning to their normal activities and avoiding bed rest.</p> <p>We assessed their outcomes over a one-year period.</p> <h2>What did we find?</h2> <p>After six weeks of treatment, taking opioids did not result in better pain relief compared to the placebo.</p> <p>Nor were there benefits to other outcomes such as physical function, quality of life, recovery time or work absenteeism.</p> <p>More people in the group treated with opioids experienced nausea, constipation and dizziness than in the placebo group.</p> <p>Results at one year highlight the potential long-term harm of opioids even with short-term use. Compared to the placebo group, people in the opioid group experienced slightly worse pain, and reported a higher risk of <a href="https://academic.oup.com/painmedicine/article/20/1/113/4728236#129780622">opioid misuse</a> (problems with their thinking, mood or behaviour, or using opioids differently from how the medicines were prescribed).</p> <p>More people in the opioid group reported pain at one year: 66 people compared to 50 in the placebo group.</p> <h2>What will this mean for opioid prescribing?</h2> <p>In recent years, international low back pain guidelines have shifted the focus of treatment from drug to non-drug treatment due to <a href="https://www.thelancet.com/article/S0140-6736(18)30489-6/fulltext">evidence</a> of limited treatment benefits and concern of medication-related harm.</p> <p>For acute low back pain, <a href="https://link.springer.com/article/10.1007/s00586-018-5673-2">guidelines</a> recommend patient education and advice, and if required, anti-inflammatory pain medicines such as ibuprofen. Opioids are <a href="https://link.springer.com/article/10.1007/s00586-018-5673-2">recommended only</a> when other treatments haven’t worked or aren’t appropriate.</p> <p>Guidelines for <a href="https://pubmed.ncbi.nlm.nih.gov/33064878/">neck</a> pain similarly discourage the use of opioids.</p> <p>Our latest research clearly demonstrates the benefits of opioids do not outweigh possible harms in people with acute low back pain and neck pain.</p> <p>Instead of advising opioid use for these conditions in selected circumstances, opioids should be discouraged without qualification.</p> <h2>Change is possible</h2> <p>Complex problems such as opioid use need smart solutions, and another study we recently conducted provides convincing data opioid prescribing can be successfully reduced.</p> <p>The <a href="https://qualitysafety.bmj.com/content/30/10/825">study</a> involved four hospital emergency departments, 269 clinicians and 4,625 patients with low back pain. The intervention comprised of:</p> <ul> <li>clinician education about <a href="https://aci.health.nsw.gov.au/networks/musculoskeletal/resources/low-back-pain">evidence-based management</a> of low back pain</li> <li>patient education using posters and handouts to highlight the benefits and harms of opioids</li> <li>providing heat packs and anti-inflammatory pain medicines as alternative pain-management treatments</li> <li>fast-tracking referrals to outpatient clinics to avoid long waiting lists</li> <li>audits and feedback to clinicians on information about opioid prescribing rates.</li> </ul> <p>This intervention reduced opioid prescribing from <a href="https://qualitysafety.bmj.com/content/30/10/825">63% to 51% of low back pain presentations</a>. The <a href="https://emj.bmj.com/content/early/2023/04/02/emermed-2022-212874">reduction was sustained for 30 months</a>.</p> <p>Key to this successful approach is that we worked with clinicians to develop suitable pain-management treatments without opioids that were feasible in their setting.</p> <p>More work is needed to evaluate this and other interventions aimed at reducing opioid prescribing in other settings including GP clinics.</p> <p>A nuanced approach is often necessary to avoid causing <a href="https://theconversation.com/opioid-script-changes-mean-well-but-have-left-some-people-in-chronic-pain-156753">unintended consequences</a> in reducing opioid use.</p> <p>If people with low back pain or neck pain are using opioids, especially at higher doses over an extended period of time, it’s important they seek advice from their doctor or pharmacist before stopping these medicines to avoid <a href="https://www.healthdirect.gov.au/opioid-withdrawal-symptoms">unwanted effects when the medicines are abruptly stopped</a>.</p> <p>Our research provides compelling evidence opioids have a limited role in the management of acute low back and neck pain. The challenge is getting this new information to clinicians and the general public, and to implement this evidence into practice.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/203244/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/andrew-mclachlan-255312">Andrew McLachlan</a>, Head of School and Dean of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/caitlin-jones-1263090">Caitlin Jones</a>, Postdoctoral Research Associate in Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, Professor, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/opioids-dont-relieve-acute-low-back-or-neck-pain-and-can-result-in-worse-pain-new-study-finds-203244">original article</a>.</em></p>

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Paracetamol versus ibuprofen – which works best and when?

<p><em><a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>In most cases, pain and fever relief is as simple as a trip to your local supermarket for some paracetamol or ibuprofen.</p> <p>While both are effective at reducing pain, they work in different ways. So deciding which one you should choose is dependent on the type of pain you are experiencing. Sometimes it might be appropriate to take a medication that contains both drugs.</p> <p>In Australia, <a href="https://www.tga.gov.au/paracetamol-practitioner-fact-sheet#:%7E:text=It%20is%20available%20in%20many,Panamax%2C%20Chemist%20Own%20and%20Dymadon.">paracetamol</a> is branded as Panadol, Herron Paracetamol, Panamax, Chemist Own or Dymadon, plus there are generic chemist brands. Nurofen is the common brand name for <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/PICMI?OpenForm&amp;t=&amp;q=ibuprofen">ibuprofen</a>, which is also sold under generic brand names.</p> <p>So how do you know which one to choose and when?</p> <h2>Different blocking actions</h2> <p>While ibuprofen and paracetamol can be taken for similar reasons (pain relief) each works in a slightly different way.</p> <p>Ibuprofen is a <a href="https://www.healthdirect.gov.au/anti-inflammatory-medicines">non-steroidal anti-inflammatory drug</a>, which means it acts by blocking the enzymes that produce a group of chemicals called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081099/">prostaglandins</a>. These chemicals are important for normal body functions such as relaxing blood vessels, preventing blood clotting, secreting protective mucus in the gut and helping the uterus contract. They are also involved in inflammation, pain and fever.</p> <p>It is still not completely understood how paracetamol works. Like ibuprofen, it is thought to act by blocking the enzymes that produce prostaglandins, although through a different mechanism to ibuprofen. There is also good evidence paracetamol <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590544/">interacts</a> with the brain’s <a href="https://www.healthline.com/health/endocannabinoid-system">endocannabinoid system</a> and the “<a href="https://www.physio-pedia.com/Pain_Descending_Pathways">descending pain pathway</a>”, which inhibits the perception of pain.</p> <h2>Is one drug better than the other?</h2> <p>Because they each provide pain relief in different ways, paracetamol can be better at treating some types of pain, while ibuprofen is better at treating other types. But be wary of packaging that claims a medication is useful for targeting pain associated with a specific condition as these claims are <a href="https://www.abc.net.au/news/2017-08-03/nurofen-offers-3.5-million-compensation-to-customers/8770910">not true</a>.</p> <p>Because it reduces inflammation, the <a href="https://www.tg.org.au/">Australian Therapeutic Guidelines</a> state ibuprofen is the better choice for pain associated with osteo- and rheumatoid arthritis, period pain, some types of headache, and for pain that comes from having an operation. Paracetamol does not reduce inflammation but it is a better choice when fever is associated with the pain, like when you have a cold or flu.</p> <p>The Australian government recommends either paracetamol or ibuprofen if you have <a href="https://www.healthdirect.gov.au/covid-19/treating-symptoms-at-home">pain associated with COVID</a>.</p> <h2>What about taking both or ‘piggybacking’ them at intervals?</h2> <p>We can sometimes get better relief when we take both types of medicine at the same time, since each targets a different cause or pathway of the pain. If one pathway does not completely control the pain then it can be useful to target the other one. The effects of each drug <a href="https://www.frontiersin.org/articles/10.3389/fphar.2017.00158/full">can add</a> together for a bigger effect.</p> <p>Combination products that contain both paracetamol and ibuprofen in a single tablet include <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&amp;id=CP-2022-CMI-02442-1&amp;d=20230620172310101">Nuromol</a> and <a href="https://maxigesic.com.au/wp-content/uploads/2021/05/cmi-approved.pdf">Maxigesic</a>.</p> <p>Using a combination product means you can take fewer tablets. However, the doses in these combined products are sometimes less than the maximum recommended dose, meaning they might not work as well when compared with taking the tablets individually.</p> <p>Other times, you can get the best effect by alternating doses of ibuprofen and paracetamol. This keeps the levels of the medication in the body more constant and helps to provide more steady pain relief. This may be particularly useful when treating <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Pain_relief_for_children_-_Paracetamol_and_Ibuprofen/#:%7E:text=So%20that%20your%20child%27s%20pain,too%20much%20of%20either%20medicine.">pain</a> and <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009572.pub2/full?highlightAbstract=therapy%7Cfor%7Cibuprofen%7Calternating%7Cchildren%7Creview%7Cfour%7Ctherapi%7Caltern%7Ccombin%7Cfebril%7Ccombined%7Cparacetamol%7Cfebrile%7Cchild">fever</a> in children. To do this, one drug is given, then a dose of the other drug is given a few hours later, with you continuing to alternate between the two throughout the day.</p> <p>If you are alternating between different pain medicines, make sure you leave <a href="https://www.nhs.uk/medicines/paracetamol-for-children/taking-paracetamol-for-children-with-other-medicines-and-herbal-supplements/#:%7E:text=If%20you%27ve%20given%20your%20child%20paracetamol%20and%20they%27re,1%20medicine%20at%20a%20time">time (at least one hour)</a> between the dosing of each product to get more effective and consistent relief. Only give the recommended dose of each medicine as outlined on the pack. And do not administer more than the maximum recommended number of doses for each medicine per day.</p> <h2>How do the side effects compare?</h2> <p>Side effects from either drug are rare and generally mild.</p> <p><a href="https://www.tga.gov.au/sites/default/files/otc-template-pi-ibuprofen.rtf">Ibuprofen</a> does have a <a href="https://www.webmd.com/rheumatoid-arthritis/features/anti-inflammatory-drugs-rheumatoid-arthritis">reputation</a> for causing stomach problems. These can manifest as nausea, indigestion, bleeding in the stomach, and diarrhoea. For this reason, people with a history of bleeding or ulcers in the gut should not take ibuprofen. Ibuprofen is also known to sometimes cause headaches, dizziness, and higher blood pressure.</p> <p>Because ibuprofen thins the blood, it should also not be taken by people who are taking other medicines to thin the blood; like aspirin, warfarin, and clopidogrel. Ibuprofen should also be <a href="https://www.tga.gov.au/sites/default/files/otc-template-pi-ibuprofen.rtf">avoided</a> by pregnant women and people with asthma. In these cases, paracetamol is the better choice.</p> <p>However, you need to be careful when using these medicines to make sure you don’t use more than is recommended. This is particularly important for <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50296">paracetamol</a>.</p> <p>Paracetamol at the recommended doses is not toxic but too much can lead to liver failure.</p> <p>Because paracetamol is found in lots of different products, it can be hard to keep track of exactly how much paracetamol you have taken and this increases the risk of taking too much.</p> <h2>Both work, both need to be used safely</h2> <p>Paracetamol and ibuprofen are effective medications for the relief of both pain and fever; however, care must be taken to use them safely.</p> <p>Always read the label so you know exactly what products you are using and how much. Only take the recommended dose, and if you need to, write down the time you take each dose. Your pharmacist or doctor can also advise on the best medicine for your pain and fever and how to use the selected medicine safely.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207921/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, Associate Professor of Pharmacology, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, Associate Lecturer, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, Associate Professor of the Sydney Pharmacy School, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/paracetamol-versus-ibuprofen-which-works-best-and-when-207921">original article</a>.</em></p>

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Why does my back get so sore when I’m sick? The connection between immunity and pain

<p><em><a href="https://theconversation.com/profiles/joshua-pate-1399299">Joshua Pate</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/mark-hutchinson-105409">Mark Hutchinson</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a></em></p> <p>Have you ever wondered why your back aches when you’re down with the flu or a cold? Or COVID?</p> <p>This discomfort, common during many illnesses, is not just a random symptom. It’s a result of complex interactions between your immune system and your brain called the “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314453/">neuroimmune synapse</a>”.</p> <p>A fascinating and yet-to-be-understood consequence of this conversation between the immune and brain systems during sickness is that it is particularly noticeable in the <a href="https://academic.oup.com/brain/article/145/3/1098/6370954">lower back</a>. This is thought to be one of the body’s most sensitive regions to neuroimmune threats.</p> <h2>Immunology basics</h2> <p>Our immune system is a double-edged sword. Yes, it fights off infections for us – but it also makes us acutely aware of the job it is doing.</p> <p>When our body detects an infection, our immune system releases molecules including signalling proteins called <a href="https://www.researchgate.net/publication/227831648_The_functions_of_cytokines_and_their_uses_in_toxicology">cytokines</a>. These proteins coordinate our immune system to fight off the infection and talk to our brain and spinal cord to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740752/#:%7E:text=Production%20of%20proinflammatory%20cytokines%20induces,to%20depression%20in%20vulnerable%20individuals.">change our behaviour</a> and physiology.</p> <p>This can result in symptoms like fatigue, loss of appetite, fever and increased sensitivity to pain. Classically, we think of this as a beneficial behavioural change to help us conserve energy to fight off the infection. It’s why we often feel the need to rest and withdraw from our usual activities when we’re sick – and also why we are grumpier than usual.</p> <h2>Invisibly small changes</h2> <p>Part of this self-protective response is a change in how we perceive threats, including sensory stimuli.</p> <p>When we are sick, touch can become painful and muscles can ache. Many changes in behaviour and sensory systems are <a href="https://doi.org/10.1159/000521476">believed</a> to have origins at the nanoscale. When molecular changes occur in part of the brain linked to cognition or mood, we think and feel differently. If these neuroimmune synapse changes happen in the sensory processing regions of the brain and spinal cord, we feel more pain.</p> <p>Such sensory changes, known as <a href="https://www.iasp-pain.org/resources/fact-sheets/allodynia-and-hyperalgesia-in-neuropathic-pain/#:%7E:text=Allodynia%20is%20pain%20due%20to,stimulus%20that%20normally%20provokes%20pain.">allodynia and hyperalgesia</a>, can lead to heightened pain sensitivity, even in areas not directly affected by the infection – <a href="https://www.sciencedirect.com/science/article/abs/pii/S0889159114001731?via%3Dihub">such as the lower back</a>.</p> <h2>Immune memories</h2> <p>This immune response happens with a range of bacterial infections and viruses like COVID or the flu. In fact, the sick feeling we sometimes get after a vaccination is the good work our immune system is doing to contribute to <a href="https://theconversation.com/you-cant-get-influenza-from-a-flu-shot-heres-how-it-works-118916">a protective immune memory</a>.</p> <p>Some of that immune-cellular conversation also alerts our brains that we are sick, or makes us think we are.</p> <p>After some viral infections, the sick feeling persists longer than the virus. We are seeing a long-term response to COVID in some people, termed <a href="https://theconversation.com/when-does-covid-become-long-covid-and-whats-happening-in-the-body-when-symptoms-persist-heres-what-weve-learnt-so-far-188976">long COVID</a>.</p> <p>Women, who generally have a <a href="https://www.nature.com/articles/nri.2016.90">stronger immune response</a> than men, may be more likely to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937378/">experience pain symptoms</a>. Their heightened immune response (while beneficial in resisting infections) also predisposes women to a higher risk of inflammatory conditions like <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980266/">autoimmune diseases</a>.</p> <h2>When to worry and what to do</h2> <p>If the pain is severe, persistent, or accompanied by other concerning symptoms, seek medical attention. Mild to moderate pain is a common symptom during illness and we often notice this in the lower back. The good news is it usually subsides as the infection clears and the sickness resolves.</p> <p>While treating the underlying infection is crucial, there are also ways to dial down sickness-induced neuroimmune pain.</p> <p>Maintaining a diverse microbiome (the collection of microorganisms living in and on your body) by <a href="https://pubmed.ncbi.nlm.nih.gov/31704402/">eating well and getting outside</a> can help. Getting quality sleep, staying hydrated and minimising inflammation <a href="https://karger.com/bbe/article/97/3-4/197/821576/Sickness-and-the-Social-Brain-How-the-Immune">helps too</a>.</p> <p>Amazingly, there is <a href="https://pubmed.ncbi.nlm.nih.gov/34404209/">research</a> suggesting your grandmother’s traditional chicken broth recipe decreases the immune signals at the neuroimmune synapse.</p> <p>Scientists are also <a href="https://pubmed.ncbi.nlm.nih.gov/24799686/">showing</a> mindfulness meditation, cold water therapy and controlled breathing can drive profound cellular and molecular changes to help activate bodily systems like the autonomic nervous system and alter the immune response. These practices might not only help manage pain but also add an anti-inflammatory component to the immune response, reducing the severity and duration of sickness.</p> <p>Heat treatment (with a pack or hot water bottle) might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8401625/">provide some relief</a> due to increased circulation. Over-the-counter pain relief maybe also be helpful but seek advice if you are taking other medications.</p> <h2>All in the mind?</h2> <p>Is this all mind over matter? A little of yes and a lot of no.</p> <p>The little of yes comes from <a href="https://pubmed.ncbi.nlm.nih.gov/26194270/">research</a> supporting the idea that if you expect your breathing, meditation and cold bath therapy to work, it may well make a difference at the cellular and molecular level.</p> <p>But by understanding the mechanisms of back pain during illness and by using some simple strategies, there is hope to manage this pain effectively. Always remember to seek medical help if your symptoms are severe or persist longer than expected. Your health and comfort are paramount.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207222/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/joshua-pate-1399299">Joshua Pate</a>, Senior Lecturer in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a> and <a href="https://theconversation.com/profiles/mark-hutchinson-105409">Mark Hutchinson</a>, Professor, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-does-my-back-get-so-sore-when-im-sick-the-connection-between-immunity-and-pain-207222">original article</a>.</em></p>

Caring

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Sore joints now it’s getting cold? It’s tempting to be less active – but doing more could help you feel better

<p><a href="https://theconversation.com/profiles/charlotte-ganderton-1170940">Charlotte Ganderton</a>, <em><a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a></em>; <a href="https://theconversation.com/profiles/inge-gnatt-1425767">Inge Gnatt</a>, <em><a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a></em>, and <a href="https://theconversation.com/profiles/matthew-king-1177304">Matthew King</a>, <em><a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a></em></p> <p><a href="https://www.health.gov.au/topics/chronic-conditions/what-were-doing-about-chronic-conditions/what-were-doing-about-musculoskeletal-conditions#:%7E:text=In%20Australia%3A,stiff%2C%20painful%2C%20swollen%20or%20deformed">One in three</a> Australians has a musculoskeletal condition involving joint pain, and the most common cause is arthritis. Around <a href="https://arthritisaustralia.com.au/1in7witharthritis/">3.6 million</a> Australians have arthritis and this is projected to rise to <a href="https://www.arthritiswa.org.au/arthritis/australians-in-the-dark-with-arthritis-one-of-our-most-prevalent-and-costly-diseases/#:%7E:text=Arthritis%20is%20a%20leading%20cause,to%205.4%20million%20by%202030">5.4 million by 2030</a>.</p> <p>For some people with joint pain, cold weather <a href="https://doi.org/10.1186/1471-2474-15-66">seems to make it worse</a>. But temperature <a href="https://doi.org/10.1016/S0304-3959(99)00010-X">is just one factor</a> impacting perceptions of <a href="https://doi.org/10.1097/j.pain.0000000000001776">greater pain</a> during winter. Other factors include those we have some level of influence over, including <a href="https://link.springer.com/article/10.1007/s00702-019-02067-z">sleep</a>, <a href="https://link.springer.com/article/10.1007/s00702-019-02067-z">behavioural patterns, mood</a> and <a href="https://link.springer.com/content/pdf/10.1038/s41598-019-44664-8.pdf">physical activity</a>. Emerging research suggests greater pain levels in winter may also be related to a person’s <a href="https://doi.org/10.1371/journal.pone.0216902">perception of the weather</a>, lack of <a href="https://doi.org/10.1016/j.sjpain.2010.05.030">vitamin D</a> and <a href="https://doi.org/10.1093/rheumatology/kel414">fluctuations in their disease</a>.</p> <p><a href="https://doi.org/10.1002/msc.1191">Physical activity</a> is one of the best treatments to increase function, strength and mobility – and improve quality of life. It also <a href="https://doi.org/10.1002/msc.1191">promotes</a> mental and physical health and <a href="https://www.sciencedirect.com/science/article/pii/S1466853X21000304?via%3Dihub">reduces the risk</a> of other chronic diseases.</p> <p>But pain can be a barrier to exercise and activities you’d usually do. So what can you do about it?</p> <h2>Our brain tries to protect us</h2> <p>When it comes to pain, our brain is very protective: it’s like an inbuilt alarm system and can warn us about impending danger or harm that has occurred so we can respond.</p> <p>But it’s not always a reliable indicator of actual damage or trauma to the skin, muscle or bone, even when it feels like it is. In some instances, this warning system can become unhelpful by setting off “false alarms”.</p> <p>Joint pain and stiffness can also appear to worsen during colder weather, prompting <a href="https://doi.org/10.1177/26335565221100172">fears</a> we could <a href="https://doi.org/10.1002/jor.25151">make it worse</a> if we undertake or overdo movement. This <a href="https://doi.org/10.1016/j.jbspin.2017.07.007">can result in</a> people avoiding physical activity – even when it would be beneficial – which can worsen the pain.</p> <h2>We tend to exercise less when it’s cold</h2> <p>Seasons <a href="https://doi.org/10.1016/j.jshs.2016.07.007">affect</a> how much physical activity we get. Summer months bring warmer weather, longer daylight hours and people get outdoors more. Warmer weather also tends to elicit a positive outlook, a lift in mood and burst of physical activity to fulfil New Year’s resolutions.</p> <p>Cooler months can mean a decline in physical activity and more time being cosy indoors. A reduction in movement and less exposure to light may evoke higher levels of joint pain and can be associated with a reduction in our overall sense of well-being and mood.</p> <p>This can create a cycle where symptoms worsen over time.</p> <figure class="align-center "><img src="https://images.theconversation.com/files/526947/original/file-20230518-19-gzmuv8.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/526947/original/file-20230518-19-gzmuv8.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/526947/original/file-20230518-19-gzmuv8.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/526947/original/file-20230518-19-gzmuv8.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=400&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/526947/original/file-20230518-19-gzmuv8.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/526947/original/file-20230518-19-gzmuv8.jpg?ixlib=rb-1.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/526947/original/file-20230518-19-gzmuv8.jpg?ixlib=rb-1.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=503&amp;fit=crop&amp;dpr=3 2262w" alt="Older woman exercises with weights" /><figcaption></figcaption>But with the right knowledge and support, people <a href="https://doi.org/10.1080/08870446.2022.2126473">can remain engaged in an active lifestyle</a> especially when it’s aligned to personal values and goals. Health professionals such as physiotherapists and GPs can assess any concerns and provide strategies that are right for you.</figure> <h2>How to motivate yourself to stay active in winter</h2> <p>When looking for an approach to help you stay active during the cooler months and beyond, it can be helpful to become aware of the many <a href="https://doi.org/10.1002/msc.1191">interconnected factors</a> that impact you. They include:</p> <ul> <li>biological (your genes, other illnesses you have)</li> <li>psychological (how you think, feel and behave)</li> <li>social (your relationships and social support).</li> </ul> <p>Starting with the end goal in mind can be beneficial, but this can feel overwhelming. Try creating smaller, achievable steps to help get you there, like climbing a ladder. For example, park a short distance from the shops and increase this incrementally to increase your exercise tolerance.</p> <p>A little bit each day can often be less tolling on your body than a big effort once a week.</p> <p>Create goals that are personally meaningful and encourage you to celebrate success along the way (for example, catching up with friends or a healthy snack). Then, as you climb your “ladder”, one rung at a time, you will likely feel more motivated to continue.</p> <p>If you’re not sure where to start, talk to a friend or health provider to help you determine what is realistic and right for your situation. That way you can <a href="https://doi.org/10.1002/msc.1191">work towards your goals in a safe, non-threatening environment</a> and avoid developing fear and avoidance. They can also help you establish goals that align with your aspirations and pain experience.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/200911/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em>Image credit: Shutterstock</em></p> <p><a href="https://theconversation.com/profiles/charlotte-ganderton-1170940">Charlotte Ganderton</a>, Senior Lecturer (Physiotherapy), <em><a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a></em>; <a href="https://theconversation.com/profiles/inge-gnatt-1425767">Inge Gnatt</a>, Lecturer (Psychology), Provisional Psychologist, <em><a href="https://theconversation.com/institutions/swinburne-university-of-technology-767">Swinburne University of Technology</a></em>, and <a href="https://theconversation.com/profiles/matthew-king-1177304">Matthew King</a>, Lecturer, Research Fellow, and Physiotherapist, <em><a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a></em></p> <p>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/sore-joints-now-its-getting-cold-its-tempting-to-be-less-active-but-doing-more-could-help-you-feel-better-200911">original article</a>.</p>

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Back on course: overcoming low back pain for senior golfers

<p>As a retiree and avid golfer, I experienced the debilitating pain of a herniated disc in my lower back. I never thought golf could cause such agony, but I was determined to overcome it and return to the game I love.</p> <p>Low back pain is a common condition among senior-aged golfers, with reported prevalence rates of up to 50%. Which means if you're playing in a foursome with fellow seniors it's likely two of you have low back pain. </p> <p>Why? Because we are more prone to back pain due to age-related changes in the spine, such as disc degeneration, and arthritis. Additionally, poor swing mechanics, lack of flexibility, or poor physical conditioning increase the risk.</p> <p>The golf swing involves a complex sequence of movements that can sometimes place significant stress on the lower back, particularly the lumbar spine. The repetitive twisting, bending, and rotational forces can lead to various types of back injuries, including herniated discs, muscle strains, and degenerative disc disease.</p> <p>After being diagnosed with a herniated disc six weeks ago, my doctor recommended physical therapy treatments with a chiropractor and physiotherapist. I also found relief through regular massage and daily use of a TENS machine. Stretching and strengthening exercises can improve flexibility and core stability. I found simple Qi Gong exercises easy. Qi Gong has been described as like high-powered Tai Chi. The standing exercises appealed to me as I'm stubbornly averse to any exercise requiring laying on the floor.  </p> <p>Within weeks of therapy and home exercises, the pain had subsided enough for me to consider a gentle swing in the backyard. A few easy swings with the 7-iron and all felt good. No added discomfort.</p> <p>To prepare for a game, I enrolled in an online course called 'Pain Free Golf' by Croker Golf System. The course helped me adjust my swing to avoid re-injury.</p> <p>To further protect my lower back, I purchased two helpful devices. A ball pick-up device which attaches to the handle end of the putter ($10 approx. from the local pro shop) to enable retrieving my ball from the cup without bending forward. A second device I found was the 'easy tee-up' ($130 approx. - search “Easy Tee Up” online) which helps me tee up the ball without bending down to the ground.</p> <p>Now, six weeks after my herniated disc incident, I'm playing almost painless golf again, and my game has even improved. I never would have thought that a herniated disc would ultimately improve my golf game, but the experience taught me the importance of taking better care of my body and using the right resources to get back in the swing.</p> <p>To all fellow golfers, take care of yourselves and don't give up hope if you ever find yourself in the same situation. There are plenty of people and resources available to help you get back to playing the game you love - with no or low back pain.</p> <p><em>About the writer: Mike Searles is a Melbourne retiree who loves playing golf.</em></p> <p><em>Image: Shutterstock</em></p>

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This common condition could be the cause of your heel pain

<p>When it comes to our feet, heel pain is one of the most common complaints. According to a 2017 report by podiatry groups My Foot Dr and Balance Podiatry, almost half of people wake up with heel and foot pain at least once a week.</p> <p>If you’re one of them, you’re probably wondering why you’re in so much pain. You might think it’s bruising, but the most common cause of chronic heel pain is actually a condition known as plantar fasciitis.</p> <p>Characterised by a sharp pain that feels like a pencil poking your heels, plantar fasciitis occurs when the fibrous tissue of the foot has been over-stretched, causing inflammation and pain.</p> <p>“Too many cases of heel pain are passed off as bruising or wrongly attributed to heel spurs or Achilles tendonitis,” Sydney-based podiatrist Dr Brenden Brown, founder of A Step Ahead Foot + Ankle Care, explains. “Addressing heel pain really does start with getting the right diagnosis.</p> <p>“Many people suffering from heel pain ignore their condition – hoping rest and time will cure it. Every day I see patients who have put up with their heel pain for months, years even. Unfortunately the ‘zero action approach’ will just prolong the pain.”</p> <p>So, how is plantar fasciitis treated? Well, there’s a number of treatment methods.</p> <p>First, avoid the temptation to go barefoot. “Walking around without shoes puts additional strain on the plantar fascia (the fibrous ligament that runs along the bottom of the foot, from the heel bone to the toes) – particularly first thing in the morning, when the muscles and tissues are tight.”</p> <p>The same goes for thongs, fashionable footwear and other unsupportive shoes, which may only make the issue worse. Instead, Dr Brown recommends “a shoe with a firm shell and a small amount of structured cushioning”. Additionally, the shoe should never bend in the middle.</p> <p>Next, you need to focus on strengthening rather than stretching, which may worsen your pain. “There’s an increasing body of evidence to support strengthening exercises and isometric holds,” Dr Brown says. “These are relatively easy to perform; they don’t require fancy equipment but they help strengthen the plantar.”</p> <p style="text-align: center;"><iframe src="https://www.youtube.com/embed/D8ApCyO9gGc" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p> <p>Ultimately, if you’re experiencing any type of foot pain, it’s essential to seek help.</p> <p>“Choose a practitioner who understands heel pain and is open to new approaches,” Dr Brown recommends. “Ask the right questions to find out whether they’re experienced in dealing with this particular type of foot pain. You can ask: Is this something you treat often? How many patients do you see a day with heel pain? What’s your success rate?”</p> <p><em>Images: Getty</em></p>

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Turning down the volume of pain – how to retrain your brain when you get sensitised

<p><em><a href="https://theconversation.com/profiles/joshua-pate-1399299">Joshua Pate</a>, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a></em></p> <p>For every feeling we experience, there is a lot of complex biology going on underneath our skin.</p> <p>Pain involves our whole body. When faced with possible threats, the feeling of pain develops in a split second and can help us to “detect and protect”. But over time, our nerve cells can become over-sensitised. This means they can react more strongly and easily to something that normally wouldn’t hurt or would hurt less. This is called “<a href="https://sitn.hms.harvard.edu/flash/2022/sensitization-why-everything-might-hurt/#:%7E:text=When%20neurons%20responsible%20for%20sensing,subset%20of%20chronic%20pain%20patients.">sensitisation</a>”.</p> <p>Sensitisation can affect anyone, but some people may be more prone to it than others due to possible <a href="https://doi.org/10.1111/jabr.12137">genetic factors, environmental factors or previous experiences</a>. Sensitisation can contribute to chronic pain conditions like fibromyalgia, irritable bowel syndrome, migraine or low back pain.</p> <p>But it might be possible to retrain our brains to manage or even reduce pain.</p> <h2>‘Danger!’</h2> <p>Our body senses possible threats via nerve endings called <a href="https://www.sciencedirect.com/topics/neuroscience/nociceptor">nociceptors</a>. We can think of these like a microphones transmitting the word “danger” through wires (nerves and the spinal cord) up to a speaker (the brain). If you sprain your ankle, a range of tiny chemical reactions start there.</p> <p>When sensitisation happens in a sore body part, it’s like more microphones join in over a period of weeks or months. Now the messages can be transmitted up the wire more efficiently. The volume of the danger message gets turned way up.</p> <p>Then, in the spinal cord, chemical reactions and the number of receptors there also adapt to this new demand. The more messages coming up, the more reactions triggered and the louder the messages sent on to the brain.</p> <p>And sensitisation doesn’t always stop there. The brain can also crank the volume up by making use of more wires in the spinal cord that reach the speaker. This is one of the proposed mechanisms of central sensitisation. As time ticks on, a sensitised nervous system will create more and more feelings of pain, seemingly regardless of the amount of bodily damage at the initial site of pain.</p> <p>When we are sensitised, we may experience pain that is out of proportion to the actual damage (<a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/hyperalgesia">hyperalgesia</a>), pain that spreads to other areas of the body (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327510/">referred pain</a>), pain that lasts a long time (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573040/">chronic or persistent pain</a>), or pain triggered by harmless things like touch, pressure or temperature (<a href="https://www.ncbi.nlm.nih.gov/books/NBK537129/#:%7E:text=Allodynia%20is%20defined%20as%20%22pain,produce%20sensation%2C%20causing%20pain.">allodynia</a>).</p> <p>Because pain is a biopsychosocial experience (biological and psychological and social), we may also feel other symptoms like fatigue, mood changes, sleep problems or difficulty concentrating.</p> <h2>Neuroplasticity</h2> <p>Around the clock, our bodies and brain are constantly changing and adapting. <a href="https://www.ncbi.nlm.nih.gov/books/NBK557811/">Neuroplasticity</a> is when the brain changes in response to experiences, good or bad.</p> <p>Pain science research suggests we may be able to <a href="https://www.nih.gov/news-events/nih-research-matters/retraining-brain-treat-chronic-pain">retrain</a> ourselves to improve wellbeing and take advantage of neuroplasticity. There are some promising approaches that target the mechanisms behind sensitisation and aim to reverse them.</p> <p>One example is <a href="https://pubmed.ncbi.nlm.nih.gov/21306870/">graded motor imagery</a>. This technique uses mental and physical exercises like identifying left and right limbs, imagery and <a href="https://www.physio-pedia.com/Mirror_Therapy">mirror box therapy</a>. It has been <a href="https://www.tandfonline.com/doi/full/10.1080/24740527.2023.2188899">tested</a> for conditions like <a href="https://www.ninds.nih.gov/health-information/disorders/complex-regional-pain-syndrome">complex regional pain syndrome</a> (a condition that causes severe pain and swelling in a limb after an injury or surgery) and in <a href="https://www.ncbi.nlm.nih.gov/books/NBK448188/#:%7E:text=Phantom%20limb%20pain%20is%20the,underlying%20pathophysiology%20remains%20poorly%20understood.">phantom limb pain</a> after amputation. Very gradual exposure to increasing stimuli may be behind these positive effects on a sensitised nervous system. While results are promising, more research is needed to confirm its benefits and better understand how it works. The same possible mechanisms of graded exposure underpin some recently developed <a href="https://mhealth.jmir.org/2019/2/e13080/">apps</a> for sufferers.</p> <p>Exercise can also retrain the nervous system. Regular physical activity can <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.01317.2012">decrease the sensitivity</a> of our nervous system by changing processes at a cellular level, seemingly re-calibrating danger message transmission. Importantly, exercise doesn’t have to be high intensity or involve going to the gym. Low-impact activities such as walking, swimming, or yoga can be effective in reducing nervous system sensitivity, possibly by providing new evidence of perceived <a href="https://doi.org/10.1097/j.pain.0000000000002244">safety</a>.</p> <p>Researchers are exploring whether learning about the science of pain and changing the way we think about it may foster self-management skills, like pacing activities and graded exposure to things that have been painful in the past. Understanding how pain is felt and why we feel it <a href="https://doi.org/10.1111/1756-185X.14293">can help</a> improve function, reduce fear and lower anxiety.</p> <figure><iframe src="https://www.youtube.com/embed/eakyDiXX6Uc?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>But don’t go it alone</h2> <p>If you have chronic or severe pain that interferes with your daily life, you should consult a health professional like a doctor and/or a pain specialist who can diagnose your condition and prescribe appropriate active treatments.</p> <p>In Australia, a range of <a href="https://aci.health.nsw.gov.au/__data/assets/pdf_file/0003/212772/ACI-chronic-pain-services.pdf">multidisciplinary pain clinics</a> offer physical therapies like exercise, psychological therapies like mindfulness and cognitive behavioural therapy. Experts can also help you make lifestyle changes to improve <a href="https://painhealth.csse.uwa.edu.au/pain-module/sleep-and-pain/">sleep</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584994/">diet</a> to manage and reduce pain. A multi-pronged approach makes the most sense given the complexity of the underlying biology.</p> <p>Education could help develop <a href="https://www.sciencedirect.com/science/article/abs/pii/S0738399121006467">pain literacy and healthy habits</a> to prevent sensitisation, even from a young age. Resources, such as children’s books, videos, and board games, are being developed and tested to improve <a href="https://doi.org/10.1016/j.jpain.2022.07.008">consumer and community understanding</a>.</p> <p>Pain is not a feeling anyone should have to suffer in silence or endure alone. <!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/202850/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/joshua-pate-1399299">Joshua Pate</a>, Senior Lecturer in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-technology-sydney-936">University of Technology Sydney</a><br /></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/turning-down-the-volume-of-pain-how-to-retrain-your-brain-when-you-get-sensitised-202850">original article</a>.</em></p>

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John Farnham’s happy health update

<p dir="ltr">John Farnham’s family have shared a positive health update following the singer’s <a href="https://www.oversixty.com.au/health/caring/cruel-and-brutal-john-farnham-s-sons-provide-health-update" target="_blank" rel="noopener">re-hospitalisation</a> in late March.</p> <p dir="ltr">In a statement released on Monday, Farnham’s family shared that he has made a “full recovery” from the serious chest infection.</p> <p dir="ltr">"We're pleased to say that John made a full recovery from a recent chest infection in late March which required hospitalisation," his wife Jill, and sons Robert and James shared.</p> <p dir="ltr">"He is now comfortable and continues to receive ongoing treatment and rehabilitation care.</p> <p dir="ltr">"The family would like to re-iterate their appreciation and deepest respect for all the medical staff that have attended to John over the past eight months and the many thousands of kind messages that (have) been received from across Australia and the world."</p> <p dir="ltr">When the 73-year-old was taken to hospital in March, he had just undergone a gruelling 12-hour surgery to remove a cancerous growth in his mouth seven months prior.</p> <p dir="ltr">His family have consistently shared <a href="https://www.oversixty.com.au/health/caring/cruel-and-brutal-john-farnham-s-sons-provide-health-update" target="_blank" rel="noopener">updates </a>on his health and how proud they are of Farnham’s resilience and strength.</p> <p dir="ltr"><em>Image: Getty Images/Brendon Thorne / Stringer</em></p>

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Do aches and pains get worse in the cold?

<p><em><strong>Andrew Lavender, Lecturer, School of Physiotherapy and Exercise Science, Curtin University, asks if joint and muscle aches get worse in the cold.</strong></em></p> <p>The winter chill is often associated with an increase in aches and pains for many older people, particularly in the joints, but also in the muscles. Some <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Strusberg+I+Mendelberg" target="_blank" rel="noopener">recent studies</a></strong></span> have shown an increase in general aches and pain in older men and women, and in particular a correlation between joint pain and weather conditions in patients with <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/27633622" target="_blank" rel="noopener">rheumatoid arthritis</a></strong></span> or <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/26329341" target="_blank" rel="noopener">osteoarthritis</a></strong></span>.</p> <p>For those without these conditions, any experience of pain with cold or wet weather may be related to changes in physical activity and diet.</p> <p><strong>How does the cold affect our muscles and joints?</strong></p> <p>In investigating a link between weather and joint pain, <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/11838853" target="_blank" rel="noopener">studies have examined</a></strong></span> temperature, barometric pressure, precipitation, humidity and sunshine for their links to pain. The results are somewhat inconclusive because they vary greatly. This is largely because pain is subjective and it’s difficult to isolate a particular cause.</p> <p>Other factors like exercise, mood and diet also have an influence on pain perception. <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/19714599" target="_blank" rel="noopener">Some research focused on the idea</a></strong></span> that atmospheric pressure may have the greatest effect. This is because there are gasses and fluids within joints, and if atmospheric pressure reduces, these gasses and fluids might expand, putting pressure on surrounding nerves causing pain. But this has not been shown clearly.</p> <p>A <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Savage+rheumatoid+arthritis+pain+2015" target="_blank" rel="noopener">recent study found</a></strong></span> the combination of temperature, sunlight exposure and humidity correlates with joint pain in patients with rheumatoid arthritis. But the authors were quick to point out the variability in pain perception and other factors, like exercise and diet, means a clear link still can’t be drawn with confidence.</p> <p><strong>How we can prevent aches in winter</strong></p> <p>There are some things that can help reduce pain during the colder months.</p> <p><strong>Exercise:</strong> joint pain is <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/28355375" target="_blank" rel="noopener">often associated with excess weight</a></strong></span>, so a weight-loss exercise program will help to take the pressure off the joints. Exercise also helps to improve metabolism and blood flow through muscles and joints, which can reduce inflammation, stiffness and pain.</p> <p>Many people tend to be more active in the warmer months when the weather is pleasant and it’s comfortable to be outside. It’s important to continue exercise into winter as a reduction in physical activity in winter for more than two weeks <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Colliander+detraining" target="_blank" rel="noopener">results in loss of muscle strength</a></strong></span> and mass as well as reduced bone density. Being inactive for long periods can lead to a gain in fat mass and overall body weight which puts <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/28142365" target="_blank" rel="noopener">excess pressure on joints that can lead to injury</a></strong></span>.</p> <p>Movements that include large muscles of the legs, arms and torso such as squats, sit-ups and push-ups can be done in a fairly small space, and so are ideal inside during winter. Resistance exercise of this type is important for muscle and bone strength. Like muscles, bones adapt to the stimulus of repeated load bearing making them stronger and less prone to injury. This is <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Beavers+Martin+CHnge+bone+mineral+density+2017" target="_blank" rel="noopener">particularly important</a></strong></span> for older individuals.</p> <p>This doesn’t mean you need to go to a gym and lift heavy weights, although you may consider joining a gym for individual or group exercise sessions. You can get enough stimulation for maintenance of muscle and bone strength through daily tasks and home workouts.</p> <p><strong>Vitamin D:</strong> exercising regularly can help to reduce symptoms in the long term, and getting outdoors for longer periods more often provides <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/27258303" target="_blank" rel="noopener">vitamin D for healthier bones and joints</a></strong></span>.</p> <p>When daylight hours are limited, vitamin D supplements are a good way to continue to get the benefits of this vitamin, which has an important role in bone mineralisation, muscle function and nerve growth. Studies have found daily supplementation with vitamin D <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/22592290" target="_blank" rel="noopener">reduces the risk of bone fracture</a></strong></span> and improves muscle strength for older people.</p> <p>It’s recommended adults get at least 200 to 600 international units (IU) of Vitamin D daily if they’re getting some exposure to sunlight most days. It’s not easy to get vitamin D through diet, but in a country like Australia, where sunlight is available even in winter, this presents less of a problem than for people living in regions that have limited sunlight in winter.</p> <p>The best foods for vitamin D include fatty fish like sardines, mackerel and herring, milk, margarine and vitamin D-fortified soy drinks. But it’s important to remember dietary sources alone are not sufficient to provide enough vitamin D. Sunlight is an important source and supplementation should be considered for those who have limited exposure to the sun in winter.</p> <p><strong>Glucosamine and chondroitin:</strong> glucosamine and chondroitin sulphate help to provide nourishment to cartilage to improve joint function. They make movement of the joint smoother by <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/26881338" target="_blank" rel="noopener">reducing the friction produced</a></strong></span> between the articulating surfaces of the bones. Crustaceans provide a good source of glucosamine, while chondroitin sulphate can be obtained from cartilage of animal bones. Supplementation of these is <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/26881338" target="_blank" rel="noopener">prescribed for patients</a></strong></span> with osteoarthritis to help restore cartilage.</p> <p><strong>Heat therapy:</strong> heat therapy can help greatly when you do have pain. Warm baths or showers, particularly in the morning <span style="text-decoration: underline;"><strong><a href="https://www.ncbi.nlm.nih.gov/pubmed/27403866" target="_blank" rel="noopener">can make a big difference</a></strong></span> to the level of pain and stiffness. Warming the body increases elasticity of the tissue and improves blood flow making movement easier. It also activates neural pathways that <span style="text-decoration: underline;"><strong><a href="http://www.tandfonline.com/doi/full/10.1080/00325481.2015.992719" target="_blank" rel="noopener">reduce the brain’s perception of pain</a></strong></span>.</p> <p><em>Written by Andrew Lavender. Republished with permission of <a href="http://theconversation.com/" target="_blank" rel="noopener"><strong><span style="text-decoration: underline;">The Conversation</span></strong></a>.</em><img src="https://counter.theconversation.com/content/81260/count.gif?distributor=republish-lightbox-advanced" alt="The Conversation" width="1" height="1" /></p> <p><em>Images: Getty</em></p>

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