How Do Painkillers Kill Pain? It’s About Meeting The pain Where It’s At

Without the ability to feel pain, life is more dangerous. To avoid injury, pain tells us to use a hammer more gently, wait for the soup to cool or put on gloves in a snowball fight. Those with rare inherited disorders that leave them without the ability to feel pain are unable to protect themselves from environmental threats, leading to broken bones, damaged skin, infections, and ultimately a shorter life span.

In these contexts, pain is much more than a sensation: It is a protective call to action. But pain that is too intense or long-lasting can be debilitating. So how does modern medicine soften the call?

As a neurobiologist and an anesthesiologist who study pain, this is a question we and other researchers have tried to answer. Science’s understanding of how the body senses tissue damage and perceives it as pain has progressed tremendously over the past several years. It has become clear that there are multiple pathways that signal tissue damage to the brain and sound the pain alarm bell.

Interestingly, while the brain uses different pain signaling pathways depending on the type of damage, there is also redundancy to these pathways. Even more intriguing, these neural pathways morph and amplify signals in the case of chronic pain and pain caused by conditions affecting nerves themselves, even though the protective function of pain is no longer needed.

Painkillers work by tackling different parts of these pathways. Not every painkiller works for every type of pain, however. Because of the multitude and redundancy of pain pathways, a perfect painkiller is elusive. But in the meantime, understanding how existing painkillers work helps medical providers and patients use them for the best results.

Anti-inflammatory painkillers

A bruise, sprain, or broken bone from an injury all lead to tissue inflammation, an immune response that can lead to swelling and redness as the body tries to heal. Specialized nerve cells in the area of the injury called nociceptors sense the inflammatory chemicals the body produces and send pain signals to the brain.

Common over-the-counter anti-inflammatory painkillers work by decreasing inflammation in the injured area. These are particularly useful for musculoskeletal injuries or other pain problems caused by inflammation such as arthritis.

Nonsteroidal anti-inflammatories like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin do this by blocking an enzyme called COX that plays a key role in a biochemical cascade that produces inflammatory chemicals. Blocking the cascade decreases the amount of inflammatory chemicals, and thereby reduces the pain signals sent to the brain. While acetaminophen (Tylenol), also known as paracetamol, doesn’t reduce inflammation as NSAIDs do, it also inhibits COX enzymes and has similar pain-reducing effects.

Prescription anti-inflammatory painkillers include other COX inhibitors, corticosteroids, and, more recently, drugs that target and inactivate the inflammatory chemicals themselves.

Because inflammatory chemicals are involved in other important physiological functions beyond just sounding the pain alarm, medications that block them will have side effects and potential health risks, including irritating the stomach lining and affecting kidney function. Over-the-counter medications are generally safe if the directions on the bottle are followed strictly.

Corticosteroids like prednisone block the inflammatory cascade early on in the process, which is probably why they are so potent in reducing inflammation. However, because all the chemicals in the cascade are present in nearly every organ system, long-term use of steroids can pose many health risks that need to be discussed with a physician before starting a treatment plan.

Topical medications

Many topical medications target nociceptors, the specialized nerves that detect tissue damage. Local anesthetics, like lidocaine, prevent these nerves from sending electrical signals to the brain.

The protein sensors on the tips of other sensory neurons in the skin are also targets for topical painkillers. Activating these proteins can elicit particular sensations that can lessen the pain by reducing the activity of the damage-sensing nerves, like the cooling sensation of menthol or the burning sensation of capsaicin.

Because these topical medications work on the tiny nerves in the skin, they are best used for pain directly affecting the skin. For example, a shingles infection can damage the nerves in the skin, causing them to become overactive and send persistent pain signals to the brain. Silencing those nerves with topical lidocaine or an overwhelming dose of capsaicin can reduce these pain signals.

Nerve injury medications

Nerve injuries, most commonly from arthritis and diabetes, can cause the pain-sensing part of the nervous system to become overactive. These injuries sound the pain alarm even in the absence of tissue damage. The best painkillers in these conditions are those that dampen that alarm.

Antiepileptic drugs, such as gabapentin (Neurontin), suppress the pain-sensing system by blocking electrical signaling in the nerves. However, gabapentin can also reduce nerve activity in other parts of the nervous system, potentially leading to sleepiness and confusion.

Antidepressants, such as duloxetine and nortriptyline, are thought to work by increasing certain neurotransmitters in the spinal cord and brain involved in regulating pain pathways. But they may also alter chemical signaling in the gastrointestinal tract, leading to an upset stomach.

All these medications are prescribed by doctors.

Opioids

Opioids are chemicals found or derived from the opium poppy. One of the earliest opioids, morphine, was purified in the 1800s. Since then, medical use of opioids has expanded to include many natural and synthetic derivatives of morphine with varying potency and duration. Some common examples include codeine, tramadol, hydrocodone, oxycodone, buprenorphine and fentanyl.

Opioids decrease pain by activating the body’s endorphin system. Endorphins are a type of opioid your body naturally produces that decreases incoming signals of injury and produces feelings of euphoria—the so-called “runner’s high.” Opioids simulate the effects of endorphins by acting on similar targets in the body. Although opioids can decrease some types of acute pain, such as after surgery, musculoskeletal injuries like a broken leg, or cancer pain, they are often ineffective for neuropathic injuries and chronic pain.

Because the body uses opioid receptors in other organ systems like the gastrointestinal tract and the lungs, side effects and risks include constipation and potentially fatal suppression of breathing. Prolonged use of opioids may also lead to tolerance, where more drug is required to get the same painkilling effect. This is why opioids can be addictive and are not intended for long-term use. All opioids are controlled substances and are carefully prescribed by doctors because of these side effects and risks.

Cannabinoids

Although cannabis has received a lot of attention for its potential medical uses, there isn’t sufficient evidence available to conclude that it can effectively treat pain. Since the use of cannabis is illegal at the federal level in the US, high-quality clinical research funded by the federal government has been lacking.

Researchers do know that the body naturally produces endocannabinoids, a form of the chemicals in cannabis, to decrease pain perception. Cannabinoids may also reduce inflammation. Given the lack of strong clinical evidence, physicians typically don’t recommend them over FDA-approved medications.

Matching pain to drug

While sounding the pain alarm is important for survival, dampening the klaxon when it’s too loud or unhelpful is sometimes necessary.

No existing medication can perfectly treat pain. Matching specific types of pain to drugs that target specific pathways can improve pain relief, but even then, medications can fail to work even for people with the same condition. More research that deepens the medical field’s understanding of the pain pathways and targets in the body can help lead to more effective treatments and improved pain management.

Source: How do painkillers kill pain? It’s about meeting the pain where it’s at | Ars Technica

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Trial Finds Vitamin D Supplements May Reduce Risk of Autoimmune Disease

New data from a large placebo-controlled clinical trial investigating the effect of daily vitamin D and omega-3 use indicates the supplements may reduce the risk of developing autoimmune disease. At the five-year follow-up, the trial found those taking vitamin D alone, or in conjunction with omega-3, showed lower rates of autoimmune disease compared to those taking placebo.

Called VITAL, the ongoing trial has enrolled more than 25,000 participants who were randomly assigned to one of four groups: vitamin D and omega 3 (2,000 IU plus 1 gram of fish oil per day), vitamin D plus placebo, omega-3 plus placebo, or double placebo. At the time of recruitment the participants were aged over 50 and generally healthy.

The trial has been running for over five years now and several studies have already been published looking at the effect of these supplementations on cancer risk, cardiovascular risk and depression. For the most part, the trial has found little benefit to vitamin D and omega-3 supplementation in otherwise healthy subjects.

This latest analysis of the trial data looked at the emergence of newly diagnosed autoimmune diseases during the five-year trial. Autoimmune diseases in the trial included rheumatoid arthritis, polymyalgia rheumatica, autoimmune thyroid disease, psoriasis, and inflammatory bowel disease.

Overall, after five years, those taking either vitamin D alone or vitamin D alongside omega-3 displayed significantly lower rates of autoimmune disease compared to those in the placebo group. Little difference was seen in rates of autoimmune disease between the placebo group and those taking omega-3 alone, suggesting the benefits detected were primarily due to vitamin D supplementation.

Another important finding was the longer the trial went on, the lower the risk for autoimmune disease in the vitamin D group. Looking at the data from just the last three years of the trial saw 39 percent fewer cases of autoimmune disease in the vitamin D group compared to placebo. This suggests the greatest benefits of vitamin D supplementation in terms of autoimmune disease comes from a cumulative effect over several years.

“This is the first direct evidence we have that daily supplementation may reduce AD [autoimmune disease] incidence, and what looks like more pronounced effect after two years of supplementation for vitamin D,” said senior author Karen Costenbader.

“We look forward to honing and expanding our findings and encourage professional societies to consider these results and emerging data when developing future guidelines for the prevention of autoimmune diseases in midlife and older adults.”

This study is, of course, not without limitations. Despite the large number of trial participants and the robust protocol there was a relatively small volume of autoimmune disease diagnoses. Due to the slow onset of many autoimmune diseases a longer follow-up will be necessary to better understand the efficacy of these supplements as preventative tools.

The trial also solely focused on older healthy adults so there is no indication the results are transferable to younger populations or those already diagnosed with autoimmune disease. However, Costenbader is relatively comfortable recommending the vitamin D/omega-3 combination to those over the age of 50 looking for ways to reduce their risk of autoimmune disease.

“Now, when my patients, colleagues, or friends ask me which vitamins or supplements I’d recommend they take to reduce risk of autoimmune disease, I have new evidence-based recommendations for women age 55 years and older and men 50 years and older,” noted Costenbader. “I suggest vitamin D 2,000 IU a day and marine omega-3 fatty acids (fish oil), 1,000 mg a day – the doses used in VITAL.”

Another recently published study looking at vitamin D and overall mortality tracked more than 20,000 people taking either vitamin D or a placebo for several years. It found no difference in all-cause mortality or from cancer and cardiovascular disease when comparing the vitamin D group and placebo.

Source: Trial finds vitamin D supplements may reduce risk of autoimmune disease

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Hot Tub Health Kick: Why a Long Bath is Almost As Good For You As a Long Run

A soak in a hot tub could be just the thing to relax you after a long day. The warm, bubbly water also eases aches and pains from conditions like arthritis, low back pain, and fibromyalgia.

But hot tubs might not be safe for some people, including pregnant women and those with heart disease. And when they aren’t cleaned well, they pose risks to even healthy people.

Before you buy a hot tub for your backyard or step into those warm waters at the spa or gym, make sure you know a bit about their safety.

Health Benefits

Warm water soothes your body for a few reasons. The heat widens blood vessels, which sends nutrient-rich blood throughout your body. Warm water also brings down swelling and loosens tight muscles. And the water’s buoyancy takes weight off painful joints.

A dip in the hot tub might also help your mental state. Research shows they can promote relaxation and ease stress.

Hot Tub Risks

These warm water whirlpools can pose some risks if you’re not careful.

Infections

Between 2000 and 2014, outbreaks from treated pools and hot tubs were linked to more than 27,000 infections and eight deaths in the United States. When hot tubs aren’t cleaned well, their moist environment is the perfect breeding ground for bacteria.

Pseudomonas, one type of bacteria that thrives in hot tubs, causes infections of the hair follicles and skin. Symptoms include red, itchy bumps on the belly and areas covered by your bathing suit. These bumps can pop up anywhere from a few hours to a few days after you take a dip. The same bacteria cause an infection known as swimmer’s ear.

Other germs that live in hot tubs can also make you sick. Cryptosporidium causes GI infections with diarrhea. Legionella causes a severe type of pneumonia, or lung disease.

Hot Tub Use in Pregnancy

Hot tubs might not be safe for pregnant women because they increase body temperature. Research finds that pregnant women who use a hot tub more than once or for long periods of time are more likely to have babies with neural tube birth defects like spina bifida or anencephaly.

Avoid hot tubs if you can during those 9 months. If you do use a hot tub, turn down the temperature and limit your time in the water to less than 10 minutes.

Heart Risks

Be cautious when using a hot tub if you have heart disease. When you soak in hot water, your body can’t sweat. Your blood vessels instead need to widen to cool you off. This makes your blood pressure drop. In response to falling blood pressure, your heart rate speeds up.

This isn’t a problem for healthy people, but if you have heart disease, it can strain your heart.

Hot Tub Safety Tips

To stay safe, follow these tips:

Ask your doctor. If you’re pregnant or you have a health condition like heart disease, ask your doctor if it’s safe for you to get into a hot tub.

Check the cleanliness. Ask the hotel or gym how often they clean their hot tub, and whether they keep the pH and chlorine concentrations at levels the CDC recommends (a pH of 7.2-7.8, and a free chlorine concentration of at least 3 parts per million). If the water looks murky or slimy, don’t get in.

Avoid crowds. Stay away when a hot tub is full. More people equals more germs. About half of people say they don’t shower before they swim.

Turn down the heat. A temperature of 100 F should be safe for healthy adults. Anything over 104 could be dangerous. Turn it down another couple of degrees if you have a medical condition.

Limit your time. Don’t stay in the hot tub for longer than 10 minutes. If you feel dizzy, overheated, or unwell, get out right away.

Watch where you sit. Don’t sit too close to the heat source. Keep your head, arms, and upper chest out of the water to avoid overheating, especially if you’re pregnant.

Stay hydrated. Drink water while in the hot tub to cool off your body. Avoid alcohol, which can dehydrate you.

Don’t go from hot to cold. Don’t jump straight from the hot tub into the pool to cool off. The cold water could shock your system and spike your blood pressure.

Wash off afterward. Take off your bathing suit and shower with warm water and soap as soon as you finish.

By  Carol DerSarkissian, MD

Source:https://www.webmd.com

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Safety

Sitting in water above normal body temperatures can cause drowsiness which may lead to unconsciousness and subsequently result in drowning. The U.S. Consumer Product Safety Commission (CPSC) recommends that water temperatures never exceed 40 degrees Celsius. A temperature of 37 degrees is considered safe for a healthy adult. Soaking in water above 39 degrees Celsius can cause fetal damage during the first three months of pregnancy.

It is also recommended to install residual-current devices for protection against electrocution. The greater danger associated with electrical shock in the water is that the person may be rendered immobile and unable to rescue themselves or to call for help and then drown.

Hot tubs and spas are equipped with drains that can create powerful suction and between 1980 and 1996, the CPSC had reports of more than 700 deaths in spas and hot tubs, about one-third of which were drownings to children under age five. In the same period 18 incidents were reported to the CPSC involving body part entrapment.

To reduce the risk of entrapment, US safety standards require that each spa have two drains for each pump, reducing the amount of suction. From 1999 to 2007 there were 26 reports to the CPSC concerning circulation entrapments hot tubs and spas, including three deaths.

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References

 

Is Running Actually Good For Your Knees

Contrary to popular belief, a new study from the University of Maryland has found that running could actually be good for your knees. While the study confirms that running pummels the knees more than walking, the process can also help fortify and bulk up cartilage, potentially helping stave off arthritis. Dr Kelly Sheerin, who is the Sports Performance Clinics Manager and a Senior Lecturer at AUT, joins the show to discuss.

You’ll know you’ve arrived as a runner when you get your first lecture on how you’re going to destroy your knees. This “advice” is usually based on the idea that running increases your risk of developing osteoarthritis in your knees. But the truth is, it doesn’t.

Below we’ll look at the evidence and explanation for why that’s the case. We’ll also examine how best to lower your risk of incurring the most common running-related knee injuries. Armed with this knowledge, you should be able to be a living refutation to the idea that running will eventually ruin your knees.

Running and Osteoarthritis in the Knees

This should be stated as clearly as possible: Numerous studies have shown that runners have lower rates of knee osteoarthritis than sedentary people. For example, in one study that followed runners and non-runners for almost 20 years, X-rays showed signs of arthritis in the knees of 20 percent of the runners, but 32 percent of the non-runners.

A potential counterargument against such results is that, when the studies are started, the long-time runners that take part have above-average structural health—they don’t include people who started running but had to give it up because their bodies broke down.

Research has rebutted that idea as well. One study followed more than 2,000 people for several years to see how many developed arthritic knees. The participants gave detailed information about how often and how severely they had knee pain. They also described their current and former exercise habits. In other words, the participants weren’t selected because of whether they were or weren’t runners.

But it turned out that running status did matter. In frequency of knee pain, symptoms of arthritis, and evidence of arthritis on X-ray, current runners had significantly better scores than non-runners. For example, current runners were 29 percent less likely than non-runners to report frequent knee pain. Even former runners were less likely to report knee pain and show signs of arthritis than non-runners. That last finding is the opposite of what should be the case if running ruined their knees and caused them to give up the sport.

There’s also good evidence that running and knee arthritis isn’t a case of play now, pay later, in terms of running increasing your chances of physical limitations as an older person. In one study, researchers matched members of a running club with healthy non-runners; all the study participants were at least 50 years old at the beginning of the study. The researchers followed up with the participants 21 years later. Not only were more of the runners still alive, but they also reported significantly fewer physical limitations.

Part of the researchers’ conclusion was that “running at middle and older ages is associated with reduced disability in later life.”

Why Might Runners Have Lower Rates of Knee Osteoarthritis?

To answer this question, it helps to know current thinking on osteoarthritis.

Arthritis is inflammation in joints, the points in your body where bones come together (knees, hips, wrists, etc.). Osteoarthritis is arthritis characterized by thinning and breakdown of cartilage, the protective tissue at the ends of bones. Osteoarthritis used to be considered a “wear and tear” disease, with body parts seen as analogous to machinery that inevitably breaks down. That model is no longer widely believed by medical experts. Instead, osteoarthritis is considered a disease of the joint, with multiple potential causes.

With this more nuanced understanding of osteoarthritis, running’s potential protection against developing it makes more sense. First, runners tend to have a lower body mass index (BMI) than the average person, and any extra weight increases strain on joints. In one long-term study, runners had lower rates of osteoarthritis and hip replacements than walkers and other more casual exercisers. The researchers cited the runners’ lower BMIs as one of the probable explanations.

Being overweight is also associated with chronic low-grade inflammation throughout the body; by helping you to stay at a good weight, running makes it less likely that your joints will be subject to this potentially damaging inflammation.

There’s also good evidence that, as with the rest of your body, knee cartilage is subject to the use-it-or-lose-it principle. Rather than breaking down your joints, running helps to keep them lubricated and stimulates your body to build new cartilage. Researchers have also found that running conditions your cartilage to become more resilient as it adapts to the demands of running. Sedentary people who have developed osteoarthritis are advised to exercise regularly for these very reasons.

What If Your Knees Are Already in Bad Shape?

It’s one thing to say that running will likely lower your risk of developing knee osteoarthritis. But what if you already have it, or some other chronic knee issue? Is running out of the picture for you?

Research in this area is encouraging. One study followed people who were at least 50 years old and had osteoarthritis in at least one knee. At the end of the eight-year study, runners reported less knee pain, and imaging showed that their arthritis hadn’t progressed.

In a four-month study of middle-aged people, imaging found evidence of damage (not necessarily arthritis) in most of the people’s knees. After half of the study subjects did a four-month marathon training program, MRIs of their knees showed less damage than at the start of the study. That finding meshed with the results of a study that found that, after four months of moderate exercise, knee cartilage health improved in middle-aged people at risk of developing osteoarthritis.

Related Story More Evidence That Running Won’t Ruin Your Knees

“Listen to your body” is excellent advice for all runners. In the case of runners with preexisting knee pain, that means to let your symptoms guide you in how much running, and what type, is tolerable. Take heart that as you go about this trial-and-error process, there’s good reason to believe running won’t worsen your condition over time.

How to Lower Your Risk for Common Knee Injuries

None of this is to suggest that runners are immune to knee injuries. In one study of more than 2,000 runners treated at a sports medicine clinic, knee injuries were three of the five most common types. (The top five were patella femoral syndrome, a.k.a. runner’s knee, iliotibial band syndrome, plantar fasciitis, meniscus tears, and shin splints.)

But it’s important to remember that most running knee injuries, like most running injuries in general, are overuse injuries. They’re caused by more cumulative stress to a given body part than your body is currently equipped to handle. Knee injuries aren’t a given, and they aren’t likely to cause permanent damage unless you ignore them and don’t try to fix the underlying issues that led to the injury.

There’s a growing body of research suggesting that knee injuries are often caused by weakness or instability elsewhere in the body, especially the hips. That’s why strengthening programs for avoiding or overcoming knee injuries often focus on exercises for your quads and glutes. The video below offers six exercises that will help keep your knees—and the rest of your body—in proper working order. Just do the exercises twice a week (or more if you are injury-prone).

If you have a history of knee injuries, you might also benefit from slightly (slightly!) altering your running form.

Backed by research, many sports medicine experts advise increasing your running cadence (the number of steps you take in a minute) by 5 to 10 percent if you can’t seem to shake knee injuries. The reason: A shorter, quicker gait should shift running’s impact forces from your knees to your lower legs. Although there’s no one ideal cadence for all runners, if you can see your feet making first contact with the ground when you run, you’re probably overstriding. Doing so places enormous braking forces on your knees, and is linked to an increased risk of injury.

By The Runner’s World Editors

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The Running Channel

“Running is bad for your joints”. “It will wreck your knees”. “You’ll need a knee replacement in 20 years”. If you’re a runner, you’re probably familiar with some of these comments, mostly from non-runners. So is running ACTUALLY bad for your knees? Watch and find out! ↓↓ Ever been told running’s bad for your knees? What other myths about running do you want to see us look at? Tells us in the comments below ↓↓ Links to studies quoted: Effects of running and walking on osteoarthritis and hip replacement risk, Paul Williams https://www.ncbi.nlm.nih.gov/pubmed/2… Running as a Key Lifestyle Medicine for Longevity, Progress in Cardiovascular Disease journal https://www.sciencedirect.com/science… ——————– CHECK OUT OUR NEW MERCH → teespring.com/en-GB/stores/the-runnin… → FACEBOOK – https://www.facebook.com/OfficialRunn… ← → INSTAGRAM – https://www.instagram.com/runningchannel ← → TWITTER – https://twitter.com/runningchannel ← → STRAVA – https://www.strava.com/clubs/runningc… ← Or get in touch with us by sending an email to hello@therunningchannel.com

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