Langford Chiropractic Clinic Newsletter, October, 2004

Pain Medications as the source of Pain

Dr. Heather Karls

You may have recently read about the popular arthritis drug Vioxx, along with Celebrex, increasing the incidence of heart attacks. This correlation was first reported in the Journal of the American Medical Association in 2001. Vioxx is most recently under fire for doubling the risk of heart attacks in persons taking high blood pressure medications.

Equally alarming is a recent study that found a common antibiotic that has been widely prescribed for nearly 50 years, Erythromycin, dramatically increases the risk of cardiac arrest, especially when taken with certain newer, popular drugs.

Unfortunately, the reports of drug related side effects are increasing. New research suggests your pain medication may actually be causing your headaches, neck and/or back pain.

According to a recent 2004 study published in Neurology , daily or near daily use of analgesics such as Advil, Excedrin, and Tylenol are associated with chronic headaches, especially chronic migraines. It is also associated with other chronic pain conditions, such as non-migraine headaches, neck and back pain. In fact, it is thought that approximately 50 percent of all these pain cases can be attributed to medication overuse.

The study was designed to examine the prevalence of chronic headache (more than 15 days/month) associated with analgesic overuse and the association between analgesic overuse and chronic pain (i.e. migraine, non-migraine headache, neck and low back pain). 65,000 adults age 20 and older completed a health survey involving two questionnaires designed to determine whether the person suffered headaches, to determine the frequency of these headaches, and to diagnose migraine according to set criteria.

People who reported headaches for at least 15 days/month in the previous year were classified as “chronic headache sufferers” and divided into two groups: migraine or non-migraine headache. Then the study participants were asked whether they used pain killers (over the counter or prescription) daily or near daily in the previous year. Daily or near daily use of pain medication for 15 days/month constituted “overuse”.

The participants also answered questions concerning the presence of musculoskeletal symptoms, including neck and low back pain. Participants who reported neck or low back pain for at least three of the previous 12 months and for at least 15 days in the past month are classified as chronic pain sufferers.

Armed with this wealth of data the authors determined odd ratios for the likelihood of suffering from chronic pain (migraine, nonmigrainous headache, neck pain, or low back pain) based on analgesic use.

The author's findings were dramatic and their concluding statement is crystal clear:

“The high numbers of individuals with analgesic overuse has important clinical implication, and physicians should be aware of the potential

risk of analgesic overuse among those with chronic pain, especially those with migraines.”

Luckily, there are more natural options to relieve pain including migraine, non-migraine headache, neck and low back pain. Chiropractic care is a prime example because it is safe and effective at reducing pain. Also, chiropractic adjustments will improve function rather than merely masking pain and other symptoms. And unlike drugs, chiropractic adjustments do not have a negative side effect!

Exercise During Pregnancy and the Postpartum Stage

Dr. Laura Dronen

The American College of Obstetricians and Gynecologists recently published new recommendations and guidelines for exercise during pregnancy and the postpartum period.

For the first time the recommendations suggest a possible role for exercise in the prevention and management of gestational diabetes. The recommendations also promote exercise for the sedentary woman and those with medical or obstetric complications, but only after medical evaluation and clearance.

The Centers for Disease Control and Prevention and the American College of Sports Medicine (CDC-ACSM) have recommended the accumulation of 30 minutes or more of moderate intensity physical activity on most days of the week, and preferably all days of the week.

For most healthy adults, moderate intense physical activity is the equivalent to walking briskly at 3-4 mph. More intense exercise performed in 20-60 minute sessions in three to five days a week will result in higher levels of physical fitness.

In addition to aerobic exercise, activities that promote musculoskeletal fitness are part of an overall wellness prescription. Typically, these include resistance training (weight lifting) and flexibility exercises.

Despite the fact that pregnancy is associated with profound anatomical and physiological changes, most otherwise healthy pregnant women may safely follow the same exercise recommendations as non-pregnant women. Of course, it is crucial that each pregnant woman consult her physician before beginning an exercise program.

One factor to consider is that the increased weight in pregnancy may increase stress in joints such as the hips and knees during weight bearing exercise like running. Pregnant women should be aware of this and modify activity if it causes discomfort.

Swimming is a good option during pregnancy because it creates a buoyant condition that is well tolerated by the body. However, activities that increase the risk of falls, such as skiing should include cautions for most pregnant women.

Postpartum:

Many of the physiological changes of pregnancy persist for up to six weeks post delivery. Thus, pre-pregnancy exercise routines should be resumed gradually after pregnancy.

Nursing women should consider feeding their infants before exercise to avoid the discomfort of engorged breasts. In addition, nursing before exercise avoids the potential problems associated with increased acidity of breast milk due to build up of lactic acid.

Finally, a return to physical activity after pregnancy has been associated with decreased rates of postpartum depression.

Omega 3 Fatty acids: Health Benefits

Dr. Anne Langford

Maternal and infant health: Fish oil omega-3 fatty acids are essential for healthy fetal and infant development. During pregnancy, the developing baby obtains omega-3 fatty acids from the mother. After birth, the infant must obtain them from breast milk or formula supplemented with essential fatty acids. In early human development, fish oil omega-3 fatty acids are beneficial for:

Healthy infant visual function. The photoreceptor cell in the retina of the eye have large amounts of DHA, which is involved in visual function. Infants whose diets contain fish oil omega-3 fatty aids have improved visual acuity when compared with infants not receiving them.

Improved infant neurodevelopment. Several tests of motor skills, learning behavior, language development, and mental function in infants and children consuming fish oil omega-3 fatty aids from breast milk or supplemented formula have higher developmental measures than those not receiving them. In several studies, infants consuming omega-3s exhibited a more mature type of neurodevelopment then those of the same age who did not have omega-3 fatty acids. It is not certain whether the findings in infancy carry over into childhood and adulthood.

Risk of premature and underweight births. Consuming omega-3s-particularly DHA– in pregnancy, especially in the last trimester, reduces the risk of premature and underweight babies. Studies have shown that babies of mothers who consumed DHA in the last trimester were heavier than those of mothers not fed DHA. Gestation time is also prolonged, reducing the risk of a premature baby.

Important in pregnancy: In the last three months of pregnancy, the baby avidly takes up omega-3 fatty acids from the mother's circulation. These fatty acids are incorporated into brain, eye and other tissues. Because the mother's diet and body stores are the only source of these essential nutrients, women are wise to consume fatty fish regularly.

Important in lactation: In the first six months of life, infants depend on breast milk or infant formula for all or most of their nutrition. Nursing woman can ensure their infants receive essential fatty acids by eating fatty fish regularly, at least once a week. These dietary omega-3s are transferred to breast milk, so the infant will obtain them. However, due to the mercury content in most fish today, it is not recommended that pregnant or nursing woman consume more than one serving per week. Therefore , it is essential to supplement your diet with omega-3s.

Low birth weight and premature infants: Underweight and “preemie” babies are at increase risk of receiving too little omega-3 fatty acids during gestation. When a baby is born early, it has less time to acquire these vital fatty acids from its mother. Thus, it is especially important for these infants to receive all essential fatty acids, including omega-3 fatty acids, to ensure healthy development. Human milk and fatty acid supplemented formula will supply the necessary omega-3s.

Omega-3's are good for EVERYONE: These essential fats are important for your body at all times, not just during pregnancy. Some benefits of taking a fish oil supplement include:

Decreasing blood pressure
Protecting heart by reducing “bad” cholesterol (LDL) and increasing “good” cholesterol (HDL)
Supporting brain and nerve tissue
Improving skin (i.e. helps eczema, psoriasis)

Reducing overall inflammation, therefore can reduce pain and increase overall health.

Clinic News

Congratulations to Dr. Dronen on the birth of her baby girl, Alexis, on August 14. Everyone is well. Dr. Dronen will be on maternity leave until November. When she returns, her new hours will be Monday, Tuesday and Thursday 9am-6pm. Dr Dronen has entrusted your chiropractic care to Kate Hansen and Drs. Langford and Karls. Kate has been with us since April.

Welcome Katie Scholzen, our new chiropractic assistant. Katie is from Andover and is getting married in January.

Michelle and her new husband, Craig, just purchased a new home. Congratulations!

Welcome Ashley Tessier, our new intern. She is a T9 chiropractic student at Northwestern Health Sciences University. Ashley loves animals, especially her American Eskimo dog “Killian”. Ashley will be moving to San Diego in January where she will complete her last internship and attempt to master surfing.

Teresa Thommes was promoted to Assistant Office Manager. Congratulations Teresa!

Langford Chiropractic is happy to announce that we will be offering a buy five, get one free offer on massages. Ask the front office staff for more details. Get your punch card today!