Neck Pain: An Introduction

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

Rear view of a young man holding her neck in pain, isolated on white background, monochrome photo with red as a symbol for the hardening

Almost everyone has experienced neck pain of some sort during his or her lifetime — and for good reason.  One of the most common causes of such pain is poor posture.  Simple activities such as reading, especially in bed — or sleeping on a pillow that may either be too low or too high — can cause neck pain.  Other activities that can cause neck pain include bending over a desk for hours, maintaining poor posture while watching TV, and positioning a computer monitor either too high or too low.  The key is always to maintain the neck as close to a neutral position as possible.

The best medical care, however, begins with a crucial question:  What is the most serious problem this could be?  Neck pain can be referred from multiple anatomical structures as a result of developmental processes in the embryonic stage.  Serious cardiovascular, neurologic, infectious, or neoplastic etiologies must be considered before attention is focused on common musculoskeletal disorders.

Chronic neck pain is prevalent in Western societies, with about 15 percent of women and 10 percent of men suffering from it at any given time.  People with physically demanding jobs requiring neck flexion and awkward lifting are at high risk of developing chronic neck pain.  It is also common among health care professionals, particularly affecting nurses who are constantly involved in handling tasks that involve reaching, lifting, and pulling.  Dental professionals who work long hours bending over their patients also suffer from neck pain because of postural demands.

The pain is often muscular or ligamentous in origin and is usually self-limited although the pain can be persistent.  Pain is transmitted through nerve endings in the various ligaments and muscles of the neck, vertebral joints, and the outer layer of the intervertebral discs.  When these structures are irritated, strained, or inflamed, pain is felt in the back of the neck, may spread toward the shoulders, and is commonly felt between the shoulder blades.

The natural healing processes result in improvement in almost all cases.  In fact, the pain from serious neck injuries such as fractures, dislocations, and most cervical spine surgeries often resolves after a few weeks or months.  There is usually little if any correlation between neck pain and the degenerative changes that are commonly seen on X-rays.

Neck strain or sprain is the most common type of injury to motor vehicle occupants treated in U.S. hospital emergency departments.  Whiplash injuries can be serious in certain situations.  Severe damage to the spinal cord can be fatal.

Sports and athletics are also common sources of injury to the neck region and should be a particular concern for the younger adult population.

Another common offender is carrying unbalanced loads, such as a heavy briefcase, luggage, or a shopping bag. A careful history is often required to identify such factors as playing a role in neck and shoulder pain.

By Rajinder Hullon, MD

INR-Bookstore-CTA

Binge Eating Disorder

Posted on Posted in Continuing Education, Homestudy, Nutrition, Psychology, Seminars, Webinars

fat-foods-binge-eatingBinge eating disorder is an illness that resembles bulimia nervosa.  Like bulimia, the disorder is characterized by episodes of uncontrolled eating or binging—occurring, on average, at least once a week for three months, according to DSM-5.  However, binge eating disorder differs from bulimia because its sufferers do not purge their bodies of excess food.

Individuals with binge eating disorder feel that they lose control of themselves when eating. While they commonly eat fewer meals than people without eating disorders.  When they do eat, they eat rapidly, consuming large quantities of food and do not stop until they are uncomfortably full.  When binging, they typically do so alone because they feel embarrassed by how much they are eating, and they tend to feel disgusted with themselves, depressed, or very guilty afterward.  Usually, they have more difficulty losing weight and keeping it off than do people with other serious weight problems. Most people with the disorder are obese and have a history of weight fluctuations.

Binge eating disorder is found in about two percent of the general population—more often in women than men.  Recent research shows that binge eating disorder occurs in about 30 percent of people participating in medically supervised weight-control programs.

Because people with binge eating disorder are usually overweight, they are prone to the serious medical problems associated with obesity, such as high cholesterol, high blood pressure, and diabetes. Obese individuals also have a higher risk for gallbladder disease, heart disease, and some types of cancer. Research at the National Institutes of Health and elsewhere has shown that individuals with binge eating disorder have high rates of co-occurring psychiatric illnesses, especially depression.

Cognitive behavioral therapy and interpersonal therapy are the treatments found to produce the greatest degree of remission in patients with binge eating disorder.  Also, there can be improvements in specific eating-disorder psychopathology, associated psychiatric problems such as depression and psychosocial functioning.

Epidemiology of Eating Disorders

Estimates of the incidence or prevalence of eating disorders vary depending on the sampling and assessment methods.

  • Eating disorders have generally been recognized as affecting a narrow population of Caucasian adolescent or adult young women from developed Western countries.  In recent years, data are steadily accumulating to document that:
  • The prevalence of anorexia nervosa and bulimia nervosa in children and younger adolescents is unknown.
  • Approximately 0.5–1 percent of adolescents suffer from anorexia nervosa and 1–5 percent suffer from bulimia nervosa. Female college students are at highest risk of the latter.
  • An estimated 85 percent of eating disorders have their onset during adolescence.
  • Estimates of the lifetime prevalence of bulimia nervosa among women have ranged from 1.1 to 4.2 percent. Some studies suggest that the prevalence of bulimia nervosa in the United States may have decreased slightly in recent years.
  • The reported lifetime prevalence of anorexia nervosa among women has ranged from 0.5 percent for narrowly defined to 4 percent for more broadly defined anorexia nervosa.
  • Estimates of the male-female prevalence ratio range from 1:5 to 1:10 (although 19-30 percent of younger patient populations with anorexia nervosa are male).
  • An estimated five million Americans suffer from eating disorders at any given time, including approximately 5 percent of women and <1 percent of men with either anorexia nervosa, bulimia nervosa, or binge eating disorder.
    • eating disorders have become more common in pre-pubertal children and women in middle and late adulthood in such countries
    • ethnic and racial minority groups in these countries are vulnerable to eating disorders, and
    • there is nothing uniquely “Western” about eating disorders, which are a global health problem.

RegisterNow-CTA2

About Systemic Lupus Erythematosus (SLE)

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

bhmkclteeodsgq5wrqwaSystemic lupus erythematosus (SLE) is an autoimmune disease that can cause damage to the heart, lungs, kidneys, joints, skin, brain, and blood vessels.   It is characterized by flare-ups, and symptoms, ranging from mild to severe, including extreme fatigue, chest pain, anemia, swelling in legs and near the eyes, painful joints, fever, skin rashes, hair loss, and kidney problems.

At least 1.5 million Americans suffer from lupus.  The ratio of female to male is 9:1 according to the Lupus Foundation of America.   African-American women are far more likely to be affected than are Caucasian women.   Recent research points to a strong genetic role, but environmental and hormonal factors seem to be involved in lupus as well.

Diagnosis can be difficult and may be delayed because the onset of symptoms is hard for patients to pinpoint and because the wide variety of symptoms overlap with many other conditions.  To diagnose lupus, the clinician takes a careful history, performs a physical exam, and orders anti-nuclear antibodies and other laboratory tests.

Although lupus can be life-threatening, some 80 to 90 percent of sufferers can expect to live a normal lifespan if they are carefully monitored and treated.

Management of lupus is directed at preventing flare-ups, treating symptoms, and preventing or slowing damage to organs.  According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the principal medications include:

  • NSAIDs to reduce inflammation.
  • Anti-malarials such as hydroxychloroquine (Plaquenil®) to prevent flare-ups.
  • Corticosteroids such as prednisone (Deltasone®), hydrocortisone, methylprednisolone (Medrol®), and dexamethasone (Decadron®, Hexadrol®) to reduce inflammation.
  • Immunosuppressive agents such as cyclophosphamide (Cytoxan®) and mycophenolate mofetil (CellCept®) to inhibit an overactive immune system.  Belimumab (Benlysta®) is a B-lymphocyte stimulator protein inhibitor that was approved by FDA 2011 for patients with lupus who are receiving other standard therapies.  It may reduce the number of abnormal B cells thought to be a problem in lupus.
  • Methotrexate (Folex®, Mexate®, Rheumatrex®), a disease-modifying antirheumatic drug, may be used to help control the disease in some patients.

Other treatments may include hormonal therapies such as dehydroepiandrosterone (DHEA) and intravenous immunoglobulin, which may be useful for controlling lupus when other treatments haven’t worked.

A variety of self-care and complementary approaches can be useful, including exercise, diet, the avoidance of sun exposure, and skin protection.  Patients are advised to recognize early signs of a flare-up and get immediate medical attention.

Findings from prospective human studies have strengthened the evidence of a connection between lupus and vitamin D status.  There is evidence that increased vitamin D levels (via supplementation) may help reduce inflammation.  A reasonable dose would be 2000 IU of vitamin D3 on a daily basis.  Vitamin D levels are easily checked.

homestudy

Avoiding Holiday Weight Gain

Posted on Posted in Continuing Education, Homestudy, Psychology, Seminars

pumpkin-pie-520655_640Turkey, stuffing, mashed potatoes, gravy, sweet potato casserole, cranberry sauce, more mashed potatoes, pumpkin pie, pecan pie, cherry pie, triple chocolate cheesecake, cookies, fudge, fruitcake. Okay, pass on the fruitcake. Is it any wonder why the vast majority of exercise equipment is sold in the month of January? This year, with a little foresight and planning, things could be different.

Prevention has always been preferable to cure. A few weeks of “preventive dieting” is not a bad way to avoid the shock and horror of stepping on the scale in January. It need not be as stringent as clear liquids and lettuce from Thanksgiving to New Year’s. That would be cruel and unusual punishment. However, a few, simple, common sense measures really can make a significant difference:

  • Have a healthy breakfast with some protein and whole grains. People who routinely eat breakfast (not a crème-filled doughnut) consume an average of two hundred calories less per day than people who skip breakfast.
  • Try not to drink calories. Avoid sugary beverages such as sodas, sweetened tea, lemonade, juice drinks. Diet sodas may be tempting, but they can actually cause an increase in appetite.
  • Cut back on alcohol for several weeks. Save the wine or cocktails for the really special meals. Alcohol consumption generally increases significantly from Thanksgiving through New Year’s. Unfortunately, alcohol is loaded with empty calories and can slow metabolic rate. It also disrupts normal sleep architecture.
  • Preserve and protect sleep. Multiple studies now confirm that sleep deprivation in both children and adults is associated with weight gain. There is no mystery. Even one night of inadequate sleep can adversely affect numerous hormones, including cortisol, thyroid, growth hormone, leptin, and ghrelin. Metabolic rate can drop and appetite increases. The result is weight gain. Ease up on the late nights and parties.
  • Aim for 30 minutes of exercise every day. There’s no need to wait for January 2. The benefits of exercise are legion. Apart from the improvement in conditioning, strength, and flexibility, exercise is a terrific way to cope with holiday stress, improve sleep quality, and possibly escape annoying relatives for a while.
  • Have a light, high-protein snack before heading off to a party. Working all day, skipping dinner, and arriving at a party in a state of semi-starvation is a recipe for overindulgence. Some yogurt, a little cottage cheese, or a small bowl of cereal before leaving the house can boost self-control in the face of tempting treats.
  • Downsize plates, bowls, glasses, and mugs. Most people will eat whatever food is presented on a plate, whether it’s 10 inches or 6 inches. Use small luncheon plates or salad plates at home for every meal. This is a great strategy for year-round weight control.
  • Split dessert with a friend even at the “big event” meals. TUMS will not be required as the after-dinner mint.

Avoiding holiday weight gain is not the impossible dream. It’s entirely possible with a little planning and discipline. Besides, no one will really miss all that fruitcake.

coffee-nutrition

Cold Symptoms and Complications

Posted on Posted in Continuing Education, Homestudy, Nutrition, Seminars, Webinars

Couple suffering from cold in bed

Cold symptoms generally emerge between one and three days after a cold virus enters the body and resolve in a week, with or without medication.  One cold in four lasts up to 14 days; this most often occurs in children, the elderly, and people who are in poor health.  Smokers often have more severe, extended cold symptoms than nonsmokers.

Fewer than five percent of colds lead to such complications as bronchitis, middle ear infection, or sinusitis accompanied by a prolonged cough.  But between five and 15 percent of children who have colds develop acute ear infection when bacteria or viruses infiltrate the space behind the eardrum.  A cold can produce wheezing, even in children who do not have asthma. Symptoms of asthma, bronchitis, and emphysema can be exacerbated for many weeks.  Symptoms that persist for more than two weeks or that recur might be more allergy than infection-related.

Post-infectious cough, which usually produces phlegm, may disrupt sleep and persist for weeks or months following a cold. This complication has been associated with asthma-like symptoms and can be treated with asthma medications prescribed by a physician.  Medical attention is indicated if symptoms progress to:

  • sinusitis
  • ear pain
  • high fever
  • a cough that worsens as other symptoms abate
  • a flare-up of asthma or of another chronic lung problem
  • significantly swollen glands
  • strep throat
  • bronchiolitis
  • pneumonia
  • croup

Babies can have between five to seven colds during their first two years of life. This enhanced susceptibility results both from immature immune systems and from exposure to older children who are often careless abut washing their hands or covering coughs and sneezes.  Nasal congestion and runny nose are the most common symptoms of colds in babies.  Treatment consists of breathing moist air and drinking plenty of fluids.  Medical attention is recommended at the first sign of a cold in infants less than three months of age because of a heightened risk for pneumonia, coup, and other complications.

Physician evaluation is also necessary if a baby of any age:

  • has an uncomplicated cold, the symptoms of which last for more than seven days.
  • does not wet a diaper properly.
  • refuses to nurse or accept fluids.
  • coughs up blood-tinged sputum or coughs hard enough to cause vomiting or changes in skin color.
  • has trouble breathing.
  • has bluish-tinted lips or mouth.
  • has a temperature higher than 102°F for one day
  • has a temperature higher than 101°F for more than three days.
  • shows signs of having ear pain.
  • has reddened eyes or yellow-eye discharge.
  • has a cough or thick green nasal discharge for more than a week.
  • has any other symptoms that concern parents and/or caregivers.

PREVENTION

Common sense plays an important part in preventing the common cold.  Absolute avoidance of cold viruses is virtually impossible to achieve, but experts advise keeping a healthy distance from anyone who is ill.  The actions the human body takes to clear infection are the same actions that spread the infection to others.  Sneezing, for example, is a response to irritation of the nose and mouth.  Sneezing as well as a runny nose is the body’s attempt to expel cold viruses before they can invade the nasal passages more deeply. Unfortunately, a sneeze sends infectious particles hurtling through the air at a speed of more than 100 miles an hour.

Simply being in the company of someone who has a cold can contaminate the hands of another person.  Touching one’s eyes, nose, or mouth can transfer the infection.  It is imperative to wash hands thoroughly after touching someone who has a cold or something that has been touched by someone who has a cold.  Playthings touched by a child who has a cold should be washed before being put away. Cleaning surfaces with antiviral disinfectant may help prevent the spread of infection, and increasing interior humidity can reduce susceptibility.

By Ben Hayes, MD, PhD, FAAD

Bookstore-Large-CTA

Managing Holiday Stress

Posted on Posted in Continuing Education, Homestudy, Nutrition, Psychology

They’re coming: Thanksgiving; Hanukkah; Christmas; and New Year. Weeks of potential, nonstop stress are right around the corner. And, all of that is followed by seemingly endless bills, three or four months of miserable weather, and tax season. What could be better? Medically speaking, all of this can lead to a perfect storm of illness. Too much stress and too little sleep can set the stage for everything from colds, flu, and pneumonia, to hypertension, heart disease, and diabetes out of control. The discussion about holiday stress aggravating anxiety and depression could fill a book.

The reality is difficult to deny. During this wonderful but weird time, millions of people will go places they really don’t want to go. They will do things they really don’t want to do. And, in many cases, they will visit people they don’t even like. This is not necessary. Too many activities, too much chaos, noise, and stress, not to mention too many calories and too little sleep, combine to create a physiologic disaster. Before the madness begins, a few principles of prevention may help:

  • Minimize caffeine and alcohol. Alcohol is loaded with empty calories and will disrupt normal sleep architecture.
  • Avoid holiday exhaustion. It’s okay to decline invitations. Try not to go out two nights in a row and schedule some quiet time instead.
  • Make time for exercise. It will help dissipate stress, boost energy, and facilitate better sleep.
  • Avoid unrealistic expectations. Don’t try to recreate a Norman Rockwell scene. It puts too much pressure on everyone.
  •  Aim for a few lovely memories—not a credit card extravaganza. Overspending is a major contributor to holiday stress.
  • Be prepared to overlook a lot. Everyone has annoying relatives. We can’t control what they say or do, but we can control our response to it. Don’t let a thoughtless remark ruin the day for everyone.

In short, managing holiday stress involves a healthy dose of common sense. Don’t overeat, overindulge, overreact, or overspend. Do try to have a healthy routine with a little less food, a lot less chaos, and for more rest. That’s a good plan for any time of the year.webinarsSeminars-CTA

 

Binge Eating Disorder

Posted on Posted in Brain Science, Continuing Education, Nutrition, Seminars, Webinars

binge-eatingBinge eating disorder is an illness that resembles bulimia nervosa. Like bulimia, the disorder is characterized by episodes of uncontrolled eating or binging—occurring, on average, at least once a week for three months, according to DSM-5 (“Diagnostic and Statistical Manual, ” version 5).  However, binge eating disorder differs from bulimia because its sufferers do not purge their bodies of excess food.

Individuals with binge eating disorder feel that they lose control of themselves when eating. While they commonly eat fewer meals than people without eating disorders, when they do eat, they eat rapidly, consuming large quantities of food.  They do not stop until they are uncomfortably full. When binging, they typically do so alone because of feeling embarrassed by how much they are eating.  They tend to feel disgusted with themselves, depressed, or very guilty afterward. Usually, they have more difficulty losing weight and keeping it off than do people with other serious weight problems. Most people with the disorder are obese and have a history of weight fluctuations.

Binge eating disorder is found in about two percent of the general population—more often in women than men. Recent research shows that binge eating disorder occurs in about 30 percent of people participating in medically-supervised, weight-control programs.

Because people with binge eating disorder are usually overweight, they are prone to the serious medical problems associated with obesity, such as high cholesterol, high blood pressure, and diabetes. Obese individuals also have a higher risk for gallbladder disease, heart disease, and some types of cancer. Research at the National Institutes of Health and elsewhere has shown that individuals with binge eating disorder have high rates of co-occurring psychiatric illnesses, especially depression.

Cognitive behavioral therapy and interpersonal therapy are the treatments found to produce the greatest degree of remission in patients with binge eating disorder.  These therapies result in improvements in specific eating disorder psychopathology and associated psychiatric problems, such as depression and psychosocial functioning (Wilson, 2011).

Epidemiology of Eating Disorders

 Estimates of the incidence or prevalence of eating disorders vary depending on the sampling and assessment methods.

  • An estimated five million Americans suffer from eating disorders at any given time, including approximately five percent of women and less than one percent of men.  The disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder.
  • Estimates of the male-female prevalence ratio range from 1:5 to 1:1 (although 19 to 30 percent of younger patient populations with anorexia nervosa are male).
  • The reported lifetime prevalence of anorexia nervosa among women has ranged from 0.5 percent for narrowly defined cases to four percent for more broadly defined cases of anorexia nervosa.
  • Estimates of the lifetime prevalence of bulimia nervosa among women have ranged from 1.1 to 4.2 percent. Some studies suggest that the prevalence of bulimia nervosa in the United States may have decreased slightly in recent years.
  • An estimated 85 percent of eating disorders have their onset during adolescence.
  • Approximately 5 to 1.0 percent of adolescents suffer from anorexia nervosa and one to five percent suffer from bulimia nervosa. Female college students are at highest risk of the latter.
  • The prevalence of anorexia nervosa and bulimia nervosa in children and younger adolescents is unknown.
  • While eating disorders have generally been recognized as affecting a narrow population of Caucasian adolescent or adult young women from developed Western countries, in recent years, data are steadily accumulating to document that:
  1. eating disorders have become more common in pre-pubertal children and women in middle and late adulthood in such countries.
  2. ethnic and racial minority groups in these countries are vulnerable to eating disorders.
  3. there is nothing uniquely “Western” about eating disorders, which are a global health problem (Pike et al, 2013).

Bookstore-Large-CTA-2

History of Meditation

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology

face-1279636_640

The earliest roots of meditation go back too far to trace with full confidence. We do know, however, that the practice of meditation was refined in the temples, caves, and monasteries of the East and Near East.  Meditation has found its way to the West in the past century. In slightly different form, meditation also appears in the Judeo-Christian tradition.

Meditation dates back to our earliest ancestors, who stared in wonder at the sky as they waited for hours to hunt for prey.  Perhaps these ancestors waited while communal fires burned. Our ancestors had plenty of time on their hands.  Because meditation entails a shift from thinking and doing to just “being,” these ancestors were probably able to meditate during the course of many of their days.

Long before the arrival of Buddha in the East, or the great Indian yogis, shamans — people with alleged access to what is good and evil — living in hunter-gatherer cultures all over the world used meditative techniques to enter altered states of consciousness known as trances. Focusing their minds using simple rhythms and chants, and sometimes employing hallucinogenic substances, these shamans traveled to the “spirit world” and returned with wisdom, healing abilities, magic abilities, and spirit blessings to bestow on their people.

Cave paintings dating back at least 15,000 years show figures lying on the ground in poses of meditative absorption. Scholars have determined that these were shamans in a trance state asking the spirits for a successful hunt. Other cave pictures showed shamans transformed into animals and taking on the animals’ magical powers.

Although shamanism has declined considerably, there are still world cultures that utilize shamans as healers, guides for the dead, and intermediaries between humans and spirits. Recent years have shown an upsurge of interest in shamanism, due in some part to the writings of Carlos Castaneda, Michael Harner, and Joseph Campbell.

But perhaps meditation’s deepest roots can be traced to India, where sadhus (traveling holy men and women) and yogis have practiced meditation in one form or another for more than 5,000 years. It was in India that meditation first flourished, and it is from India that meditation later traveled and spread to distant parts of the globe.

The earliest Indian scriptures, the Vedas, don’t have a word for meditation but described what are now known to be meditative rituals requiring great concentration. Over time, these practices evolved into a type of prayerful meditation that entailed the use of breath control with devotional focus on the Divine. From these earliest roots, three of India’s best-known meditative traditions blossomed:  yoga; Buddhism; and tantra (a range of religious traditions).

By Barbara Sternberg, Ph.D.

homestudy

Seasonal Affective Disorder

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

woman-1388879_640

Seasonal affective disorder (SAD), also known as winter depression and winter blues, is a type of mood disorder that is typically caused by low light levels. SAD generally begins in the fall and worsens during the winter months.  The rarer, reverse seasonal affective disorder (summer blues, summer depression) begins in the spring and worsens in the in the summer.

SAD is generally found more frequently in people who live in latitudes far north or south of the equator (for example, one percent in Florida; four percent in Washington, D.C.; 10 percent in Alaska).  Some patients experience a serious mood change when the seasons change. They may sleep too much, have little energy, and crave sweets and starchy foods. They may also feel depressed. Although symptoms may be severe, they generally resolve over several months.

SAD can be a serious disorder that may require hospitalization. There is a potential risk of suicide among some individuals experiencing SAD. The symptoms of SAD mimic those of clinical depression or dysthymia. The prevalence of SAD in the adult American population has been estimated at between 1.5 percent in Florida and about nine percent in the northern US.  Overall, 6.1 percent of the US population is affected by SAD. Subsyndromal seasonal affective disorder is a milder form of SAD estimated to affect 14.3 percent of the American population.

Seasonal affective disorder is more common in women than men and in people between the ages of 15 and 55 years. The risk of developing SAD for the first time decreases with age. People who have a close relative with SAD are also at greater risk.

CAUSES

There is strong evidence that SAD is caused by a lack of available sunlight. Decreased exposure to sunlight may have an effect on the body’s biological clock, which regulates mood, sleep, and hormone production. Exposure to light may reset the biological clock. Melatonin and serotonin synthesis may be altered in individuals with SAD. Exposure to light appears to correct both neurotransmitter deficits and changes in the biological clock.

SYMPTOMS

Symptoms of SAD include difficulty waking up in the morning, a tendency to oversleep, to overeat, and to crave carbohydrate-rich foods, often leading to weight gain. Other symptoms include a lack of energy, difficulty concentrating on completing tasks, and withdrawal from friends, family, and social activities. Individuals with SAD are characterized by depression, pessimism, and a lack of pleasure in usual activities. Symptoms of SAD can include heightened anxiety as well as depression. For most people with SAD, symptoms start in September or October and end in April or May  and tend to occur at the same time every year.

TREATMENT

There are several treatment options for classic SAD. Bright-light treatment uses a specially designed lamp (or light box) — with an intense “full spectrum” or blue light at doses of 2,500 to 10,000 lux. The patient sits at a prescribed distance, usually 30 to 60 cm, in front of the box with eyes open but not staring at the light source for 30 to 60 minutes. Many individuals use the light box in the morning, and there is evidence that morning light is superior to evening light  although people may respond to evening light as well. One study found that up to 69 percent of patients find the treatment inconvenient, and as many as 19 percent stop use because of this.

There is evidence that dawn simulation is effective as well. In some studies, this has been found to be 83 percent more effective than other bright-light therapies. Most studies have found light therapies to work well — for several weeks — as seasonal treatment until greater amounts of natural light are available.

By Nikita Katz, MD, PhD

INR-Bookstore-CTA

A Brief History of Pain

Posted on Posted in Continuing Education, Homestudy, Pain, Seminars, Webinars

first-aid-908591_640Early humans explained the mystery of pain by associating it with evil, magic, and demons. Relief was the responsibility of sorcerers, shamans, priests, and priestesses, who treated their clients with herbs and rituals.

On stone tablets, ancient civilizations recorded accounts of pain and the treatments used, including pressure, heat, water, and sun. The Greeks and Romans were the first to advance a theory of sensation, the idea that the brain and nervous system were involved in the perception of pain. During the Middle Ages and into the Renaissance, evidence began to accumulate supporting these theories. Leonardo da Vinci and his contemporaries came to see the brain as the central organ responsible for sensation, with the spinal cord transmitting sensations to the brain.

In the 19th century, pain came to dwell under a new domain—science—which paved the way for advances in pain therapy. Physician-scientists discovered that opium, morphine, codeine, and cocaine could be used to treat pain. In the late 1800s, research led to the development of aspirin, to this day the most commonly-used pain reliever. Before long, anesthesia—both general and regional—was refined and applied during surgery.

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. There are two basic categories of pain, acute and chronic, and they differ greatly.

Acute pain usually results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly—for example, after trauma or surgery—and may be accompanied by anxiety or emotional distress. The cause of acute pain can generally be diagnosed and treated, and the pain is self-limiting—confined to a given period of time and severity. In some instances, it can become chronic.

Chronic pain is widely believed to represent a disease in and of itself. It persists over a longer period of time than acute pain and is resistant to most medical treatments. Chronic pain often persists longer than three months, or longer than expected for normal healing. It can be made much worse by environmental and psychological factors. It can—and often does—cause severe problems for patients, as pain signals keep firing in the nervous system for weeks, months, or years. There may have been an initial mishap such as a sprained back or serious infection, or there may be an ongoing cause of pain such as arthritis, cancer, or infection. However, some people suffer chronic pain in the absence of any past injury or evidence of illness.

INR-Bookstore-CTA