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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10 Ways to Lower the Cancer Risk of Grilling

Many people would be surprised to hear that grilling carries potential cancer risks. But each year, the American Institute for Cancer Research publishes guidance for “cancer-safe grilling,” cautioning consumers to avoid two types of compounds that have been tied to cancer. These compounds, called polycyclic aromatic hydrocarbons and heterocyclic amines, get generated when food, especially meat, is cooked on a grill. They have not been proven to cause cancer in people, but lab studies have shown they alter DNA in a way that could lead to cancer.

“Polycyclic aromatic hydrocarbons are formed when any kind of organic matter,” primarily fat that drips off meat and down into the grill grates, “gets burned, because the carbon inside is being combusted in the flames, and those hydrocarbons get carried up in the smoke,” said Rashmi Sinha, senior investigator in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute. The resulting smoke can envelop the meat and coat it in the potentially carcinogenic compounds.

The black char we’ve all seen on grill grates and grilled food? That’s the heterocyclic amines, or HCAs, which occur when high temperatures meet muscle meat, which includes red meat (pork, beef, lamb, goat), poultry (turkey, chicken) and fish. “Grilling — or even pan-frying — at these high temps causes amino acids found in the meat to react with another substance found in meat called creatine,” said Colleen Doyle, managing director of nutrition and physical activity at the American Cancer Society and a registered dietitian. Creatine is found only in muscle meat.

“It’s the reaction of those amino acids and the creatine that form the HCAs, which is why we don’t see HCAs formed when grilling asparagus, squash, peppers and other vegetables.”

As with most lifestyle choices related to dialing up or down one’s cancer risk, the dose makes the poison. Which means if you’re grilling once or twice a year, don’t sweat it. But if you plan to grill often — once or twice a week throughout the summer, say — experts suggest taking some small steps to make a big difference in lowering your exposure to these compounds.

Grill fish, seafood, poultry or plant-based foods rather than red meat and especially processed meats like hot dogs; the World Health Organization considers processed meats a carcinogen and red meat a probable carcinogen. While HCAs are still formed while grilling fish and seafood, Ms. Doyle pointed out that you typically don’t have to cook seafood as long as beef and chicken, which reduces the accumulation of the compounds.

Research suggests that marinating for at least 30 minutes can reduce the formation of HCAs on meat, poultry and fish. The reason for this is not entirely clear to researchers, but one possibility is a kind of shield effect. “If you put a barrier of basically sugar and oil between the meat and the heat, then that is what becomes seared instead of the meat,” said Nigel Brockton, vice president of research at the American Institute for Cancer Research. It also makes your meat more flavorful.

Many kinds of fruits and vegetables are actually protective as far as cancer risk, and they don’t form HCAs when grilled. Several experts recommend using meat as a condiment. Think of alternating cubes of chicken with peppers and onions or peaches and pineapple on a skewer, for instance. This trick, which also works when pan frying, reduces the surface area of meat exposed to the hot surface, Dr. Brockton explained, since the meat is also touching other ingredients throughout the cooking process.

According to Dr. Brockton, cooking your meat with herbs, spices, tea, chili peppers and the like — ingredients with phenolic compounds — can be a helpful approach because “it seems they quench the formation of the potentially carcinogenic compounds because of the antioxidant properties of those ingredients.”

Try to minimize how much smoke you’re breathing in, the Harvard T.H. Chan School of Public Health recommends as part of a helpful resource on healthy summer picnic practices.

The black, crispy crust that you often see on the bony edges of ribs or steak is more likely to contain a higher concentration of potentially carcinogenic compounds. Ms. Doyle also recommends cleaning the grill grates ahead of time, to remove any previously generated char.

“The longer you cook something, the longer the chemical reaction is happening, the higher the amount of HCAs are formed,” Dr. Brockton said. If you partially precook your meat, such as by baking or cooking in the microwave, the layer of HCAs that gets formed won’t be as thick. The same goes for meat cut into smaller pieces, such as with kabobs, because it cooks faster. Grilling in foil can also help protect the food from smoke and speed up the cooking time, according to the Harvard resource on healthy picnics.

“Types of wood can influence HCA formation,” Ms. Doyle said. “Hardwoods, such as hickory and maple, and charcoal all burn at lower temperatures than soft woods, such as pine. Cooking with wood that burns at a lower temperature is desirable.”

To minimize your exposure to polycyclic aromatic hydrocarbons, experts recommend selecting leaner cuts of meat or trimming any visible fat, which can lower the amount that drips down through the grates and comes back up in the smoke. To minimize dripping, Ms. Doyle suggests not piercing your meats while they’re on the grill.

According to guidance from the National Cancer Institute, fewer HCAs are formed if you turn meat over frequently while cooking it on high heat.

Source: 10 Ways to Lower the Cancer Risk of Grilling – The New York Times

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23:22 Fri, 01 Jul

Findings About Dostarlimab, A New Antibody Drug, Very Encouraging, Says Expert In Cancer Treatment

According to New York Times, in a small clinical trial, 18 patients took a drug called Dostarlimab for around six months, and in the end, every one of them saw their tumours disappear. The findings concerning dostarlimab, an antibody drug, in experimental treatment of rectal cancer patients is very encouraging but there is need for long-term studies to understand the real impact, an expert in cancer treatment has said.

“This new trial at MSKCC in a small number of patients, with locally advanced rectal cancer patients who had MMR (MisMatch repair) deficiency, have shown total disappearance of tumour without any additional treatment in all 100 percent of them. This is very encouraging but we must note that long term studies are required to understand the real impact,” Dr. (Col.) R. Ranga Rao, Chairman, Oncology, of Paras Hospitals in Gurugram said.

“The drug is still investigational and the trial is limited to patients of a specific type , that constitute about 4 to 5 per cent of rectal cancers. While this is highly encouraging, we must not prematurely jump to conclusions that we have found a cure for all cancers, all stages, and no chemotherapy, surgery is ever required,” he added.

He said it is well recognized that Immunotherapy with PDL 1 blockers in MMRd patients is effective. “Already immunotherapy has made a big difference in the field of cancer of all types. Several earlier trials have shown encouraging responses,” Dr Rao said.

In what appears to be a miracle and ‘first time in history’, a small clinical trial has found that every single rectal cancer patient who received an experimental treatment found that their cancer had vanished.

According to New York Times, in the small clinical trial conducted by Memorial Sloan Kettering Cancer Center, 18 patients took a drug called Dostarlimab for around six months, and in the end, every one of them saw their tumours disappear. Dr Luis A. Diaz J. of New York’s Memorial Sloan Kettering Cancer Center (MSKCC) said this was “the first time this has happened in the history of cancer”.

According to experts, Dostarlimab is a drug with laboratory-produced molecules and it acts as substitute antibodies in the human body. The cancer is undetectable by physical exam; endoscopy; positron emission tomography or PET scans or MRI scans, added Experts. This proves that Dostarlimab can be a ‘potential’ cure for one of the most deadly common cancers.

According to New York Times, patients involved in the clinical trial earlier underwent treatments such as chemotherapy, radiation, and invasive surgery that could result in bowel, urinary, and even sexual dysfunction. The 18 patients went into the trial expecting to have to go through these procedures as the next step. However, to their surprise, no further treatment was needed.

The findings of this trial have shocked experts and they have pointed out that complete remission in every single patient is “unheard-of”. Dr Alan P. Venook, who is a colorectal cancer specialist at the University of California, said that the complete remission in every single patient is “unheard-of”. He hailed the research as a “world-first”. Experts stated that the research was impressive as not all of the patients suffered significant complications from the drug trial.

Critics:

Tesaro, a biotech company based out of Massachusetts developed the drug. Tesaro was acquired by GlaxoSmithKline in 2019, dostarlimab is also known by the brand name Jemparli. Dostarlimab was developed to treat women with recurrent or advanced endometrial cancer.

On August 17, 2021, the FDA approved dostarlimab-gxly (brand name Jemperli) for adult patients with mismatch repair-deficient recurrent or advanced solid tumours, as determined by an FDA-approved test, that have progressed on or following prior treatment and who have no satisfactory alternative treatment options.

Rectal cancer remission

According to reports, 18 patients in the clinical trial took Dostarlimab for around six months and after over 12 months the doctors found that their cancer disappeared. While it’s a small trial so far, the results have been impressive; they were published in The New England Journal of Medicine and featured at the nation’s largest gathering of clinical oncologists in June 2022.


In every case, rectal cancer disappeared after immunotherapy — without the need for the standard treatments of radiation, surgery, or chemotherapy — and cancer has not returned in any of the patients, who have been cancer-free for up to two years.

It’s incredibly rewarding to get these happy tears and happy emails from the patients in this study who finish treatment and realise, ‘Oh my God, I get to keep all my normal body functions that I feared I might lose to radiation or surgery,’ expressed Dr Andrea Cercek, Medical Oncologist, Memorial Sloan Kettering Cancer Center (MSK).

Dr Cercek added, “The most exciting part of this is that every single one of our patients has only needed immunotherapy. We haven’t radiated anybody, and we haven’t put anybody through surgery.” She continued, “They have preserved normal bowel function, bladder function, sexual function, fertility. Women have their uterus and ovaries. It’s remarkable.”

This clinical trial could pave the way for treating other forms of cancer in the future. As the trial continues at MSK, Dr Luis Alberto Diaz, Medical Oncologist, Memorial Sloan Kettering Cancer Center (MSK) said, “It’s the tip of the iceberg.” He explains, “We are investigating if this same method may help other cancers where the treatments are often life-altering and tumours can be MMRd. We are currently enrolling patients with gastric (stomach), prostate, and pancreatic cancers.”

Dostarlimab clinical trial reception by the Indian medical community

Since the trial results have been published, it has created a lot of buzz and has got the entire medical community discussing how it could pave the path for future treatment for various cancers, ETHealthWorld spoke to few experts on the drug trial. Commenting on the trial, “It is definitely a big step towards efficient cancer care. The preliminary data on Dostarlimab PD1 monotherapy has been very encouraging in high-risk rectal cancer patients and has been recently presented at the ASCO meeting in Chicago and subsequently published in NEJM.

We would definitely need further studies on larger groups of patients across the globe to establish it as a standard of care for rectal cancer. Trials are also being conducted to study its effectiveness for cervical cancer, and endometrial cancer amongst others,” said Dr Pankaj Kumar Panda, Senior Research Officer, Apollo Proton Cancer Centre.

Source: Findings about Dostarlimab, a new antibody drug, very encouraging, says expert in cancer treatment

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Coping with Grief During a Pandemic

Since the arrival of the coronavirus pandemic, many of us have experienced loss, sadness, anxiety, and grief. You will often hear how losing a loved one changes you for the rest of your life.

You learn to move forward in life carrying with you the cherished memories of this person and the love they brought into this world, into their relationship with you. For many, this is one of the hardest things they will ever experience in their life. It’s never easy, whether you have experienced a sudden loss of a loved one or losing a loved one due to an illness or cancer, that may have included stays in a hospital or hospice setting.

Pre-pandemic, one vital aspect of this process that helped us grieve was being surrounded by our loved ones and friends. Being present with your loved ones as they were in the hospital, being present with loved ones at a viewing or mass, being present with your family and friends at a luncheon after the funeral, just being physically present with others helped us to cope.

Currently, we are almost a year into the isolating effects of the COVID-19 pandemic and unfortunately, like everyone, I have felt loss. Like others worldwide, I missed casual visits with friends and family, holiday gatherings, having my children’s education interrupted, struggling to adapt to zoom and other online video tools, fear of contracting COVID-19, etc.

The list can go on! My family also experienced two personal losses within a very short time frame. Both were my uncles; both were my mother’s brothers. One uncle contracted COVID-19 and passed away in under a month, and my other uncle lost his lengthy battle with cancer.

How the Pandemic Impacts the Grieving Process

In any time period, losing a loved one is a very difficult experience. You will hear individuals experience stages of grief and loss, denial, anger, bargaining, depression, and acceptance. Maneuvering through these stages is often supported in part by aspects that we are missing because of the pandemic. One of the elements that are different is not being able to hug someone, to give or receive a simple embrace!

People often say that you might not remember what people say, but you will remember how they made you feel. An embrace of love, support, and I am here for you without saying a word is missing these days. Further, visitation limitations in hospitals and nursing homes due to the pandemic have strongly impacted the grieving process.

This deepens the void felt in the time with a loved one who is sick leading up to their passing. This may cause us to feel like we missed out on being there, caring for, and helping our sick loved ones feel like they are not alone. Also, some people are nervous about attending the viewing and funerals. Constraints on large gatherings impact how many people can attend, and even those who attend are spaced far apart.

The purposeful distancing helps to keep it safe in the pandemic but takes away some of the comfort in gathering together to mourn. Some wanted to attend but also wanted to make sure they were safe. In regards to my uncle, one family friend explained, “I really wanted to go, have closure, pay my respects and love to him and all of his loved ones,” but due to COVID-19 and his physical health concerns, was not able to attend.

Recommendations to Help with Loss During a Pandemic

This pandemic has had a huge impact on how we cope with grief, and it may lead us to use some new methods to help us through the tough times. If you or someone you know is dealing with a loss, the recommendations below may help to ease the pain and additional loneliness felt when losing a loved one.

Therapy. Seeing a therapist can help you process your grief and sadness.

Group Therapy (Bereavement groups). Attending a bereavement group can help you connect with others who have lost loved ones. It also may help with feeling like you are not alone and learn coping strategies from others that may better support this extremely difficult time for you.

NAMI or other support groups. Joining a group like the National Alliance on Mental Illness (NAMI) or other support groups such as those offered on social media platforms. This will help you broaden your scope of supportive networks. These groups and support networks are often at zero cost and can be extremely beneficial.

Support and Time. There is no specific way to mourn a loved one. For some, it may take a long time to pass through the stages of grief (denial, anger, bargaining, depression, and acceptance). For those supporting someone who lost a loved one, just being present with them (virtually or physically distanced) and encouraging them to talk about their loved one is extremely beneficial.

They may not remember what you said, but surely will remember how you made them feel. This is especially true with grief – just knowing that you are there, listening, and offering comfort means so much!

Talk. Continue to talk about your thoughts and feelings related to the frustrations, anxiety, sadness, and grief due to the loss of the loved one. Shutting down, avoiding, and isolating can be an instinctual response with grief and understandable due to the significant loss.

Talk about the good times you had with the person, talk about the anger you have related to your situation, talk about the sadness that you have about the loss. The most important thing is to express yourself.

Pictures of your loved one. Looking through pictures of my uncles really helped me and my family. Remembering good times, funny moments, and speaking about their character, values, and personality was extremely beneficial to my family.

Memorialize the loved one. There are various ways you can memorialize your loved one. Some ideas are dedicating and planting a tree, flower, or garden for your loved one, contributing to a local charity, creating an online memorial, or creating a picture box.

Engage in Self-Care. Take care of yourself. Yoga, meditation, walks, music, exercise, gym, and eating right are a few things that can help you during a time of grieving.

Be kind to yourself. Losing a loved one is one of the hardest situations a person can experience. Self-compassion throughout this experience is one aspect that may help you process your grief. This is also easier said than done.

A beautiful quote by Rick Hanson from his book Just One Thing is “you can have compassion for yourself- which is not self-pity. You’re simply recognizing that ‘this is tough, this hurts,’ and bringing the same warmhearted wish for suffering to lessen or end that you would bring to any dear friend grappling with the same pain, upset, or challenges as you.”

By: Patrick McElwaine Psy.D.

Patrick McElwaine is a Licensed Clinical Psychologist and also Licensed Professional Counselor (LPC). He is an Assistant Professor of Counseling Psychology at Holy Family University and a faculty member at the Beck Institute.

Source: Coping with Grief During a Pandemic | Psychology Today

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Healthy Lifestyle May Increase Life Expectancy, Research Suggests

A healthy lifestyle may allow older people to live longer, with women adding three years and men six to their life expectancy, suggests research published in the journal BMJ. In addition, more of those years may be dementia-free. More than 6 million Americans 65 and older have the most common type of dementia, Alzheimer’s, for which there is no cure.

The study found that, at age 65, women with the healthiest lifestyle had an average life expectancy of about 24 years, compared with 21 years for women whose lifestyle was deemed less healthy. Life expectancy for men with the healthiest lifestyle was 23 years, vs. 17 years for men who were less healthy.

The findings came from research that involved 2,449 people who were 65 and older and part of the Chicago Health and Aging Project, which first enrolled participants in 1993.

The current researchers developed a healthy lifestyle scoring system for their participants that encompassed five factors: diet, cognitive activity, physical activity, smoking and alcohol consumption. People were given one point for each area if they met healthy standards, yielding a final summed score of 0 to 5, with higher scores indicating a healthier lifestyle.

As for living with dementia, those with a score of 4 or 5 healthy factors at age 65 lived with Alzheimer’s for a smaller proportion of their remaining years than did those with a score of 0 or 1. For women, the difference for those with a healthier lifestyle was having Alzheimer’s for 11 percent of their final years vs. 19 percent for those with a less healthy lifestyle; for men, it was 6 percent of their remaining time vs. 12 percent.

The researchers concluded that “prolonged life expectancy owing to a healthy lifestyle is not accompanied by an increased number of years living with Alzheimer’s dementia” but rather by “a larger proportion of remaining years lived without Alzheimer’s dementia.”

People who engage in a healthy lifestyle, such as eating a balanced diet, taking regular exercise, and avoiding smoking and excess alcohol consumption, incur many health benefits, including a longer lifespan.

It was not previously known if this benefit was also seen in people living with multiple conditions. Multimorbidity is the presence of two or more long-term conditions, ranging from anxiety and eczema to cancer and schizophrenia. It has become a major worldwide epidemic. People with multiple conditions have poorer health and a higher risk of death compared with others in the population.

Researchers compared the impact of a healthy lifestyle on life expectancy in people with and without multiple conditions. It was the first study to be able to look at the impact of different lifestyle factors.

The key finding is that a healthy lifestyle is equally important for everyone, whether they have multiple conditions or not. Age is a strong risk factor; even so, young and middle-aged adults who live in deprived areas are the most likely to have multiple conditions. Engaging in a healthy lifestyle could be more difficult for people in this group.

The study also found that certain lifestyle factors, such as smoking and physical activity, were more damaging than others. Public health policies and healthcare professionals could therefore focus on these lifestyle habits. This study suggests this approach would have more impact than costly strategies to address multiple risk factors.

By Linda Searing

Source: Healthy lifestyle may increase life expectancy, research suggests – The Washington Post

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