Chronic Pain and Depression

American Chiropractic Association:

Pain serves an important function in our lives. When you suffer an acute injury, pain warns you to stop the activity that is causing the injury and tells you to take care of the affected body part.

Chronic pain, on the other hand, persists for weeks, months, or even years. Some people, often older adults, suffer from chronic pain without any definable past injury or signs of body damage. Common chronic pain can be caused by headaches, the low back, and arthritis. Unfortunately, there is scant objective evidence or physical findings to explain such pain.

Until recently, some doctors who could not find a physical cause for a person’s pain simply suggested that it was imaginary— “all in your head.” This is unfortunate because we know that all pain is real and not imagined, except in the most extreme cases of psychosis. Emerging scientific evidence is demonstrating that the nerves in the spinal cord of patients with chronic pain undergo structural changes.

Psychological and social issues often amplify the effects of chronic pain. For example, people with chronic pain frequently report a wide range of limitations in family and social roles, such as the inability to perform household or workplace chores, take care of children, or engage in leisure activities. In turn, spouses, children, and co-workers often have to take over these responsibilities. Such changes often lead to depression, agitation, resentment, and anger for the pain patient and to stress and strain in family and other social relationships.

How is depression involved with chronic pain?

Depression is the most common emotion associated with chronic pain. It is thought to be 3 to 4 times more common in people with chronic pain than in the general population. In addition, 30 to 80% of people with chronic pain will have some type of depression. The combination of chronic pain and depression is often associated with greater disability than either depression or chronic pain alone.

People with chronic pain and depression suffer dramatic changes in their physical, mental, and social well-being—and in their quality of life. Such people often find it difficult to sleep, are easily agitated, cannot perform their normal activities of daily living, cannot concentrate, and are often unable to perform their duties at work. This constellation of disabilities starts a vicious cycle—pain leads to more depression, which leads to more chronic pain. In some cases, the depression occurs before the pain.

Until recently, we believed that bed rest after an injury was important for recovery. This has likely resulted in many chronic pain syndromes. Avoiding performing activities that a person believes will cause pain only makes his or her condition worse in many cases.

Signs and Symptoms

Some of the common signs and symptoms of chronic pain include:

• Pain beyond 6 months after an injury
• Allodynia—pain from stimuli which are not normally painful and/or pain that occurs other than in the stimulated area
• Hyperpathia—increased pain from stimuli that are normally painful
• Hypersensation—being overly sensitive to pain

Signs of major clinical depression will occur daily for 2 weeks or more, and often include many of the following:

• A predominant feeling of sadness; feeling blue, hopeless, or irritable, often with crying spells
• Changes in appetite or weight (loss or gain) and/or sleep (too much or too little
• Poor concentration or memory
• Feeling restless or fatigued
• Loss of interest or pleasure in usual activities, including sex
• Feeling of worthlessness and/or guilt

What is the treatment for chronic pain and depression?

The first step in coping with chronic pain is to determine its cause, if possible. Addressing the problem will help the pain subside. In other cases, especially when the pain is chronic, you should try to keep the chronic pain from being the entire focus of your life.

• Stay active and do not avoid activities that cause pain simply because they cause pain. The amount and type of activity should be directed by your doctor, so that activities that might actually cause more harm are avoided.
• Relaxation training, hypnosis, biofeedback, and guided imagery, can help you cope with chronic pain. Cognitive therapy can also help patients recognize destructive patterns of emotion and behavior and help them modify or replace such behaviors and thoughts with more reasonable or supportive ones.
• Distraction (redirecting your attention away from chronic pain), imagery (going to your “happy place”), and dissociation (detaching yourself from the chronic pain) can be useful.
• Involving your family with your recovery may be quite helpful, according to recent scientific evidence.
• Drug free Cold Laser Therapy has been found to relieve pain symptoms and offer relief.

Feel free to discuss these or other techniques with your doctor of chiropractic. He or she may suggest some simple techniques that may work for you or may refer you to another health care provider for more in-depth training in these techniques.

For information about Cold Laser Therapy please call 1-866-843-5273 or visit www.theralase.com

Laser-Accelerated INFLAMMATION, PAIN REDUCTION AND HEALING

Low Level Laser Therapy (LLLT) precipitates a complex set of physiological interactions at the cellular level that reduces acute inflammation, reduces pain, and accelerates tissue healing.

by Richard Martin, BS, CLT
Compromised cells and tissues respond more readily than healthy cells or tissues to energy transfers that occur between LLLT-emitted photons and the receptive chromophores found in the various cells and sub-cellular organelles. Cells and tissues that are ischemic and poorly perfused as a result of inflammation, edema and injury have been shown to have a significantly higher response to LLLT irradiation than normal healthy structures. Cell membranes, mitochondria and damaged neurological structures exhibit less than optimal metabolism and stasis conditions. Multiple studies have demonstrated that under these compromised conditions, the introduction of energy transfers and the resultant enhancement of metabolic activity is most pronounced in biologically challenged components. While it may appear that LLLT is thus selectively targeting compromised cells, in reality, these cells exhibit a lowered reaction threshold to the effects of laser light and are more easily triggered to energy transfer responses. The result is that LLLT has a significant effect on damaged cells and tissues while normative biological constituents are appreciably less affected."

The cellular cascade effect — precipitated by the actions of enzymes and having a significant in the presence of LLLT — has a significant impact on cellular and tissue function. Since a considerable number of the reactive proteins that respond to laser stimulation are enzymes, laser light effects are amplified in the stimulation of beneficial enzymes and depression of deleterious enzymes.

At the cellular level, cytochromes can be defined as electron or proton-transfer proteins that act as energy producers for human biological functions. Both of the cytochrome enzymes, Cytochrome c Oxydase and Nitric Oxide Synthase (NOS) have been found to be particularly reactive to laser photon stimulation. The particular affinity of these and other photoreactive enzymes to accelerate their functions in the presence of LLLT provides critical increases in the molecule ATPand Nitric Oxide (NO) which enhances cellular metabolism, circulatory improvement and nerve function.

Although the various actions of LLLT in regards to inflammation, pain and healing have been separated categorically here for the purpose of process identification, their interactions are not so easily distinguished. In response to LLLT, the reduction in inflammation, pain and healing time all compliment each other and many of the processes are either simultaneous or overlapping.

Acute Inflammation Reduction
Immediately after an acute injury event, the body, in response to the disruption of the integrity of vascular, soft tissue, connective tissue and neurological processes, initiates a series of biological responses. The inflammatory reaction consists of both vascular and cellular events. Injury responsive components such as Mast cells, Bradykinins and Prostaglandins are activated along with the vascular responses and cellular membrane reactions. All of these combined processes and events are represented by the symptoms of edema, inflammation, pain and functional debility. LLLT can be effective in mediating both the symptoms and the underlying inflammatory process by the following actions:

1. Stabilization of cellular membrane — Ca++, Na+ and K+ concentrations as well as the proton gradient over the mitochondria membrane are positively influenced. This is accomplished in part by the production of beneficial Reactive Oxygen Species (ROS) wherein triplet oxygen molecules absorb laser light producing singlet oxygen molecules. These ROSmodulate intracellular Ca++ concentrations and laser therapy improves Ca++ uptake in the mitochondria. 2,3,4
2. ATPproduction and synthesis are significantly enhanced, contributing to cellular repair, reproduction and functional ability. Laser stimulation of Cytochrome c Oxidase, a chromophore found on the mitochondria of cells, plays a major role in this rapid increase in production and synthesis of ATP. 3
3. Vasodilation is stimulated via Histamine, Nitric Oxide (NO) and Serotonin increases, resulting in reduction of ischemia and improved perfusion. Lasermediated vasodilation enhances the transport of nutrients and oxygen to the damaged cells and facilitates repair and removal of cellular debris. 5,6

4. Beneficial acceleration of leukocytic activity results in enhanced removal of non-viable cellular and tissue components, allowing for a more rapid repair and regeneration process.
5. Increased Prostaglandin synthesis, particularly in conversion of the prostaglandins PGG2 and PGH2 periossides into prostaglandin PGI2. PGI2 (Prostacyclin), has a vasodilating and antiinflammatory action with some attributes similar to Cox-I and Cox-II inhibitors. 7
6. Reduction in Interleukin 1(IL-1). Laser irradiation has a reducing effect on this pro-inflammatory cytokine that has been implicated in the pathogenesis of rheumatoid arthritis and other inflammatory conditions. 8
7. Enhanced lymphocyte response. In addition to increasing the number of lymphocytes, laser irradiation mediates the action of both lymphatic helper T-cells and suppressor T-cells in the inflammatory response. Along with laser modification of beta cell activity, the entire lymphatic response is beneficially affected by LLLT. 9
8. Increased angiogenesis. Both blood capillaries and lymphatic capillaries have been clinically documented to undergo significant increase and regeneration in the presence of laser irradiation. The resulting improvement in circulation and perfusion enhances all repair and healing processes. Laser induced increases in NO and the growth factors — in particular cytokine INF-g — are contributory to this process. 10,11
9. Temperature modulation. Areas of inflammation typically demonstrate temperature variations with the inflamed portion having an elevated temperature. Laser therapy has been shown to accelerate temperature normalization, demonstrating its beneficial influence on the inflammatory process.
10. Enhanced superoxide dismutase (SOD) levels. Laser stimulated increases in cytokine SODlevels interact with other anti-inflammatory processes to accelerate the termination of the inflammatory process. Interactions between SODand Reactive Oxygen Species (ROS) production subsequent to LLLT balance free radical activity and allows for the beneficial effects of ROSwhile inhibiting detrimental interactions. 12
11. Decreased C-reactive protein and neopterin levels. Laser therapy has been shown to lower the serum levels of these inflammation markers, particularly in rheumatoid arthritis patients. Decreased marker levels are indicative that the combined effects of all LLLT-induced anti-inflammatory actions are effectively reducing the inflammatory process.
A summary flowchart of the cellular cascade in reducing tissue inflamation is presented in Figure 1. The cumulative effect of these multiple inter-active processes and events is an accelerated inflammatory cycle with diminished symptoms and earlier normalization.
Since LLLT does not exacerbate the inflammatory process but rather condenses the time frame from onset to resolution through acceleration of processes, it can be used immediately post injury. This rapid initiation of therapy in acute inflammation will assist in limiting the scope and duration of the inflammatory event and minimize the pain and severity associated with it.

Most of the beneficial effects seen from LLLT in the treatment of acute inflammatory events will also have medical efficacy as LLLT is initiated inmore chronic

inflammatory conditions. While the treatment regimen and course of therapy may be modified in chronic situations, the physiological responses and interactions remain consistent. Chronic conditions may require longer treatment times and results will vary with the patient, condition and length of the chronic condition.
Pain Reduction
The unique pain reduction abilities of LLLT have been extensively researched and documented in numerous clinical studies and medical papers. While there remains much to learn in respect to the various processes through which LLLT achieves its pain reduction characteristics, there is a wealth of knowledge currently available to demonstrate the effectiveness of laser therapy in this regard.
Because the pain amelioration capabilities of LLLT are accomplished via the combination of local and systemic actions — utilizing enzymatic, chemical and physical interventions — the process is very complex. However, there is a preponderance of medical evidence that justifies a conclusion that effective pain reductions can be achieved via LLLT. Following are processes and events that are promoted by LLLT therapy:
1. Increase in b-Endorphins. the localized and systemic increase of this endogenous peptide after LLLT irradiation has been clinically reported in multiple studies with subsequent pain reductions.
2. Blocked depolarization of C-fiber afferent nerves. The pain blocking effect of LLLT can be pronounced, particularly in low velocity neural pathways, such as non-mylenated afferent axons from nociceptors. Laser irradiation suppresses the excitation of these fibers in the afferent sensory pathway. 13,14

3. Increased nitric oxide production. NO has both a direct and indirect impact on pain sensation.

As a neurotransmitter it is essential for normal nerve cell action potential in impulse transmission activity and, indirectly, the vasodilation effect of NOcan enhance nerve cell perfusion and oxygenation.

4. Increased nerve cell action potential.Healthy nerve cells tend to operate at about -70 mV and fire at about -20 mV. Compromised cells membrane potential approximates -20 mV thereby resulting in pain stimulus. LLLT can help restore the action potential closer to the normal -70 mV range. Both compound muscle action potential (CMAP) values and nerve latency values have shown improvement with laser therapy. 15
5. Axonal sprouting and nerve cell regeneration. Several studies have documented the ability of LLLT to induce axonal sprouting and some nerve regeneration in damaged nerve tissues. Where pain sensation is being magnified due to nerve structure damage, cell regeneration and sprouting may assist in pain decrease. 16,17
6. Decreased Bradykinin levels. Since Bradykinins elicit pain by stimulating nociceptive afferents in the skin and viscera, mitigation of elevated levels through LLLT can result in pain reduction. Laser-induced decrease in plasma kallikrein, increase in Kininase II, and increase in NOare considered the contributors to this Bradykinin decrease.
7. Increased release of acetylcholine.By increasing the available acetylcholine, LLLT helps in normalizing nerve signal transmission in the autonomic, somatic and sensory neural pathways.
8. Ion channel normalization.LLLT promotes normalization in Ca++, NA+ and K+ concentrations resulting in beneficial pain reduction results from these ion concentration shifts. Figure 2 presents a simplified representation of the effects of LLLT on pain improvement at the cellular level.
Tissue Healing
One of the truly unique characteristics of LLLT is that it has the ability to actually promote and enhance healing, not just treat symptoms. The irradiation by low-level laser light accelerates and enhances healing activities carried out by the body. Several of the unique characteristics of LLLT that work to alleviate pain and inflammation also play an important role in accelerating the healing process; the LLLT-mediated reduction in inflammation and pain frees the body’s natural ability to repair and heal itself.
As wound healing progresses through the stages of inflammation, proliferation, remodeling and maturation, laser therapy presents the opportunity to impact each of these phases in positive and beneficial ways. LLLT can provide the following beneficial impacts in both open surface wounds and closed connective or soft tissue injuries as follows:
1. Enhanced leukocyte infiltration. LLLT stimulates activity involving neutrophils, monocytes and lymphocytes.
2. Increased macrophage activity. LLLT accelerates macrophage activity in phagocytosis, growth factor secretion and stimulation of collagen synthesis.
3. Increased neovascularization. The significant angiogenesis that occurs with laser therapy promotes revascularization with subsequent improvement in perfusion and oxygenation. Endothelial cell regeneration is accelerated. 18
4. Increased fibroblast proliferation. LLLTstimulation increases fibroblast numbers and fibroblast-mediated collagen production. 19
5. Keratinocyte proliferation.The beneficial synthesis activities and growth factor ability of keratinocytes are enhanced by proliferation secondary to LLLT. 20
6. Early epithelialization. Laser-stimulated acceleration of epithelial cell regeneration speeds up wound healing, minimizes scarring, and reduces infection opportunities.
7. Growth factor increases. Two to five fold increases in growth-phase-specific DNAsynthesis in normal fibroblasts, muscle cells, osteoblasts and mucosal epithelial cells irradiated with IR light are reported. Increases in vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF-2) secondary to IR light irradiation have also been reported.
8. Enhanced cell proliferation and differentiation.Laser-induced increases in NO, ATPand other compounds that stimulate higher activity in cell proliferation and differentiation into mature cells. Increased numbers of myofibroblasts, myofibrils, myotubes etc., as well as bone cell proliferation, have been clinically documented after LLLT. Satellite cells, the precursor cells in the process of muscle regeneration, show significant increase in proliferation when irradiated with LLLT. 21,22,23
9. Greater healed wound tensile strength.In both soft tissue and connective tissue injuries, LLLT can increase the final tensile strength of the healed tissue. By increasing the amount of collagen production/synthesis and by increasing the intra and inter-molecular hydrogen bonding in the collagen molecules, laser therapy contributes to improved tensile strength. 24,25,26,27 The preceding effects combine to achieve an accelerated healing rate (see Figure 3). The time from onset of injury to mature healed wound is reduced. 28
Conclusion
The FDAhas recently cleared multiple laser and LEDdevices for treatment of a variety of medical conditions including carpal tunnel syndrome, cervical neck pain, low back pain, joint pain, generalized muscle pain and acceleration of wound healing. Governmental agencies such as NASAare currently using technical light therapy for medical conditions in space applications. The U.S. Olympic training facilities have just released statements of endorsement for laser therapy for athletes. All of these events validate the growing acceptance in mainstream medicine for the medical efficacy of laser therapy as a viable, often superior therapeutic treatment modality.
With over 200 clinical studies — many of which are double-blind, placebo-controlled — and in excess of 2000 published articles on LLLT, this innovative new technology has a well-documented research and application history. Having grown far beyond its distant Institutional Review Board (IRB) and experimental treatment status, LLLT is now being considered a therapy of choice for many difficult pain management challenges such as fibromyalgia and myofascial pain. New and ongoing clinical investigations offer growing potential for even more widespread applications of this truly unique light therapy.

Richard Martin, BS, CLT is a photobiologist specializing in laser therapy and holds the position of Director of Science at MicroLightLaser, a subsidiary of Innovative Medical Group Corporation in Santa Monica, CA. He has taught laser physics and photodynamics for eight years. He has served as manager for several biomedical design and service facilities and participated as lead researcher for biomedical devices involved in emergency cardiac care, warmed intravenous fluid therapy and laser therapy. Richard has participated in medical clinical trials for 15 years as a clinical trial analyst and contributing clinician.
References
1. Almeida-Lopes L. Human gingival fibroblast proliferation enhanced by LLLT. Analysis in vitro of the cellular proliferation of human gingival fibroblasts with low level laser. Dissertation at Universidade do Vale do Paraíba, São Paulo, Brazil. 1999.
2. Lubart R, Friedman H, and Lavie R. Photobiostimulation as a function of different wavelengths. bone regeneration. The Journal of Laser Therapy. Vol 12. World Association of Laser Therapy. 2000.
3. Karu T. et al. Changes in absorbance on monolayer of living cells induced by laser irradiation. IEEE Journal of Selected Topics in Quantum Electronics. IEEE Lasers and Electro-Optical Society. December 2001. 7(6):982.
4. De Castro E Silva Jr. O, et al. Laser enhancement in hepatic regeneration for partially hepatectomized rats. Lasers in Surgery and Medicine. 2001. 29(1):73-77
5. Silveira LB, et al. In vivo study on mast cells behaviour following low-intensity visible and near infrared laser radiation. Laser Surg Med. Abstract issue. Abstract 304. 2002.
6. Trelles MA, et al. LLLT in vivo effects on mast cells. Department of Tissue Pathology, University Hospital, Tarragona, Spain. Abstract from the 7th International Congress of European Medical Laser Association, Dubrovnik, Croatia, June 2000.
7. Tam G. Action of 904 nm diode laser in orthopedics and traumatology. Laser Center, Tolmezzo, Italy. Meridian Co, Ltd. Website:http://www.meridian.co.kr/ product1_8.htm. Last visited 10/27/03.
8. Bjordal JM, and Couppe C. What is optimal dose, power density and timing for low level laser therapy in tendon injuries?A review of in vitro and in vivo trials. Department of Physiotherapy Science, University of Bergen, Norway. Abstract from the 7th International Congress of European Medical Laser Association, Dubrovnik, Croatia, June 2000.
9. Stadler I, et al. In vitro effects of low level laser irradiation at 660 nm on peripheral blood lymphocytes. Lasers Surg Med. 2000. 27(3):255-61
10. Kubota J. Laser and sports medicine in plastic and reconstructive surgery. Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan. Abstract from II Congress of the Internat. Assn for Laser and Sports Medicine, Rosario, Argentina, March 10-12, 2000.
11. Lievens P and Van der Veen PH. Wound healing process: influence of LLLT on the proliferation of fibroblasts and on the lymphatic regeneration. Department of Rehabilitation research, Vrije University, Brussels, Belgium. Abstract from the 7th International Congress of European Medical Laser Association, Dubrovnik, Croatia, June 2000.
12. Karu TI. Mechanisms of low-power laser light action on cellular level. In Lasers in Medicine and Dentistry. Ed. by Z.Simunovic. Rijeka. Vitgraph. 2000. pp. 97-125.
13. Ohno T. Pain suppressive effect of low power laser irradiation. A quantitative analysis of substance P in the rat spinal dorsal root ganglion. J Nippon Med Sch. 1997. 64 (5):395-400.
14. Tsuchiya K et al. Diode laser irradiation selectively diminishes slow component of axonal volleys to dorsal roots from the saphenous nerve. Neuroscience Letters. 1993. 161:65-68.
15. Rochkind S, et al. Laser therapy as a new modality in the treatment of incomplete peripheral nerve injuries: Prospective Clinical Double-Blind PlaceboControlled Randomized Study. Department of Neurosurgery, Rehabilitation and Physiotherapy, Tel Aviv Sourasky Medical Center, Israel. Abstract from the 7th International Congress of European Medical Laser Association, Dubrovnik, Croatia, June 2000.
16. Byrnes KR, et al. Cellular invasion following spinal cord lesion and low power laser irradiation. Lasers Surg Med. 2002. S14:11.
17. Rochkind S, Shahar A, and Nevo Z. An innovative approach to induce regeneration and the repair of spinal cord injury. Laser Therapy. 1997; 9 (4):151.
18. Schindler A, et al. Increased dermal neovascularization after low dose laser therapy. 2nd Congress, World Association for Laser Therapy. Kansas City. 1998.
19. Almeida-Lopes L, et al. Comparison of the low level laser therapy effects on cultured human gingival fibroblasts proliferation using different irradiance and same fluence. Lasers in Surgery and Medicine. 2001. 29(2):179-184.
20. Samoilova KA, et al. Enhancement of the blood growth promoting activity after exposure of volunteers to visible and infrared polarized light. Part I: stimulation of human keratinocyte proliferation in vitro. Advance Article of 2004 Photochemical & Photobiological Sciences. Published on the web at http://www.rsc.org/is/journals/current/PPS/ppAdvArts.htm. Sept 1, 2003.
21. Barber A, et al. Advances in laser therapy for bone repair. The Journal of Laser Therapy. Vol.13. World Association of Laser Therapy. 2000.
22. Antonio L, et al. Biomodulatory effects of LLLT on bone regeneration. The Journal of Laser Therapy. Vol. 13. World Association of Laser Therapy. 2000.
23. Shefer G, et al. Low energy laser irradiation promotes the survival and cell cycle entry of skeletal muscle satellite cells. Journal of Cell Science. 2002. 115:1461-1469.
24. Enwemeka CS and Reddy GK. The biological effects of laser therapy and other modalities on connective tissue repair processes. The Journal of Laser Therapy. Vol. 12. World Association of Laser Therapy. 2000.
25. Reddy GK, Stehno-Bittel L, and Enwemeka CS. Laser photo stimulation accelerates wound healing in diabetic rats. Wound Repair and Regeneration. 2001. 9:248-255.
26. Stadler I, et al. 830 nm irradiation increases the wound tensile strength in diabetic murine model. Lasers in Surgery and Medicine. 2001. 28 (3):220226.
27. Parizotto N, et al. Structural analysis of collagen fibrils after He-Ne laser photostimulation. 2nd Congress, World Association for Laser Therapy. Kansas City. 1998.
28. Simunovic Z, et al. Low level laser therapy of soft tissue injuries upon sport activities and traffic accidents: a multicenter, double-blind, placebo-controlled clinical study on 132 patients. Pain Center-Laser Center, Locarno, Switzerland. Abstract from II Congress of the Internat. Assn for Laser and Sports Medicine, Rosario, Argentina. March 10-12, 2000. 


For further information, please call 1-866-843-5273 or visit www.theralase.com

Nova Scotia Tightens Rules on OxyContin

Anna Mehler Paperny

Globe and Mail Update

Published Monday, Feb. 20, 2012 10:04PM EST

Last updated Tuesday, Feb. 21, 2012 11:02AM EST

Nova Scotia has become the latest province to clamp down on OxyContin prescriptions, with Health Minister Maureen MacDonald announcing the province will only pay for the potent painkiller’s replacement in extenuating circumstances – for cancer-related pain or palliative care.
Nova Scotia’s move comes days after Ontario, with the highest rates of prescription-opioid addiction in the country, announced it is tightening rules for the painkiller. Physicians called the move a step forward, but warned that changing publicly funded drug plans won’t be nearly enough to stem abuse from the prescription drug.
“There is a lot more that needs to be done,” said David Juurlink, a drug-safety specialist at Sunnybrook Hospital in Toronto. “These drugs should be harder to obtain, harder to prescribe – and certainly at high doses.”
Provinces’ intention to restrict long-acting oxycodone prescriptions only apply to people covered by public drug plans – and they’re in the minority.
Fifty-five per cent of the cash spent on Canadians’ prescription drugs comes from private insurance plans or individuals paying out of pocket. That makes for a total of $14.3-billion spent privately on drugs in 2010 – $350-million on narcotics alone, according to Mike Sullivan, head of Cubic Health, a Toronto-based company that advises insurance plans.
And tightening the rules on drugs paid for privately is far trickier.
“I don’t know of a single plan out there that has restrictions out there for coverage of narcotics,” Mr. Sullivan said. “I absolutely think they should.”
About 80 per cent of the employers his company deals with Canada-wide have had instances of inappropriate narcotics use among their plans’ beneficiaries.
Mr. Sullivan is hoping employers put dollar thresholds on the narcotics they pay for, with anything above requiring special authorization, and a doctor’s note.
Helen Stevenson has been on both sides of the quandary: Formerly executive officer of Ontario’s public drug programs, she now runs Reformulary, which is designing its own formulary for insurers and their clients. The company inked a deal with Sun Life Financial in December.
Ms. Stevenson wouldn’t say what its rules will be for narcotics like OxyNEO, but says she’s looking at the same criteria facing Ontario and other provinces.
In the meantime, provinces are aiming to be proactive after being accused of inaction in the face of rising addiction rates and thousands of opioid-related deaths.
“We recognize the need to impose stronger restrictions on potentially addictive prescription drugs,” Nova Scotia’s Ms. MacDonald said in an interview. “We have particular pockets in the province where we’ve had difficulties.”
The Annapolis Valley and Cape Breton are among them – areas rocked by spikes in prescription-opioid addiction, attendant crime and overdose deaths. The crisis prompted a rethink of the province’s addiction treatment: Now, Ms. MacDonald said, they’re focused on licensing methadone doctors to cover a broader, decentralized area.
Manitoba restricted the kinds of OxyContin prescriptions it pays for two years ago. It was the only study that saw an ever-so-slight drop in oxycodone use in 2010, notes University of Manitoba pharmacist Shawn Budgen. But he admits success is tough to measure.
“We know the use went down a little bit, but we’re not really sure if it was steering people away from abusing this product,” he said.
“It’s a very complex problem. We feel [the new regulation] has helped encourage rational use. And that’s at least part of the solution.”

Pain Relief and Healing at the Speed of Light for Companion Animals and Horses

Just what is laser therapy? Many people know this kind of treatment as “Low Level Laser Therapy” or “Cold Laser Therapy”. Most people think of surgical lasers or Star Wars and think the treatments will hurt. Actually, it is a very safe, painless, and effective way of treating injuries, pain and many medical conditions.
Laser Therapy is a method of treatment where laser light is applied to tissues with a low light intensity so that heating is negligible and a therapeutic influence is produced. The effect achieved is produced by the light creating a photobiostimulation in the tissues at a cellular level – modulating cellular function.
The minimal heat produced by the laser light is a negligible contribution to the therapeutic effect. This is quite different from surgical lasers where a strong laser light is used and the subsequent heat produced creates a cutting, evaporating or coagulating effect. The benefits in low level laser therapy are seen in improved healing time, pain relief, reduced swelling, increased circulation and increased range of motion. Numerous studies have been conducted in human medicine lending support to its use as a therapeutic medical device to improve healing time, decrease inflammation and relieve pain.


The Main Biological Effects of Laser Light:

• Pain relief
• Reduced inflammation
• Increased blood flow to injured tissues
• Accelerated tissue repair and cell growth
• Accelerated wound healing
• Reduced formation of scar tissue
• Improved nerve function
Laser therapy is gaining in popularity in human rehabilitation medicine as well as in veterinary medicine. It is particularly attractive for the treatment of athletes–human, canine, and equine– due to the potential of a shortened recovery time and the effectiveness of lasers in treating musculoskeletal disorders. But while laser therapy is very useful for injuries, it is far from limited to sports medicine. It has proven to be effective in decreasing the amount of time needed for wound and fracture healing


Conditions treatable with Laser Therapy include:


• Arthritis
• Neck and back pain
• Joint pain
• Muscle strain or injury
• Tendon injuries
• Ligament Sprains
• Hoof pain
• Post-surgical pain and healing
• Fracture healing
• Edema (swelling)
• Wound Healing
• Burns
• Neurologic conditions
• Rehabilitation


How does it work?

The laser light interacts with tissues at the cellular level by increasing metabolic activity. This leads to an increase in the production of ATP (cellular fuel) and thereby a cascade of events leading to increased cellular reproduction, function and health.
On a systemic level, the laser energy increases circulation by inciting vasodilation (increasing the diameter of blood vessels leading to increased blood flow to the tissues). This serves to increase the transportation of specific healing enzymes, oxygen and nutrition to damaged tissues while increasing the removal of cellular debris and toxins. As a result, all cells and thereby all tissues, are repaired faster. In addition, the laser light increases the formation of new capillaries in damaged tissue (angiogenesis) and fibrous tissue; contributing to the speeding up of healing as well as reducing the formation of scar tissue. The laser light also activates lymphatic drainage helping to reduce inflammation.
Damaged nerve cells are particularly slow to heal and this can lead to neurologic deficits such as numbness and impaired function. Laser light can help speed up the cellular regeneration of the nerve axons and help improve recovery time. It also seems to be helpful in slowing down the progression of some degenerative nerve diseases – possibly by increasing the amplitude of action potentials to optimize muscle action.
Perhaps most importantly, laser therapy has an analgesic effect by attacking pain on different levels. The laser light has an effect on nerve cells by blocking pain transmitted by these cells to the brain and decreasing nerve sensitivity. The laser therapy decreases inflammation – this also helps decrease the pain being caused by the edema. At the same time, the laser light stimulates the central nervous system to signal the brain to release pain blocking chemicals such as endorphins, enkephalins, and opioids. In addition to the analgesic effect, these chemicals have a relaxing, sedative effect on the patient. If done correctly, there is little or no sensation during laser therapy.

Most patients seem to genuinely enjoy their treatments and no patient sedation or restraint is needed.

Laser light can also be used to stimulate acupuncture points. This non-invasive technique is especially useful for animals that do not take to being needled. This can be used for all the same syndromes as acupuncture but is especially effective for muscle trigger points and providing musculoskeletal pain relief.


How is treatment done?

Treatment time varies depending on the size of the area being treated, the size and thickness of the animal being treated, the type of tissue being targeted, and the type of machine being utilized. Typically, treatment time is 3 to 8 minutes.
Initially, treatment for some acute conditions may be performed daily. More chronic conditions should initially be treated 2-3 times a week. This will be tapered down as improvement occurs – usually to once or twice a week.
Some conditions, may display immediate improvement and only require 1-2 total treatments while others may require 6-12 treatments. Treatments are cumulative when done over a short time period and in some cases, it may take 3-4 sessions before a change is notable in the condition. Some chronic conditions may require ongoing treatment or a maintenance program in which treatment occurs periodically as needed.
Treatment programs and plans need to be tailored to the individual animal and that animal’s issue. It is critical to have a correct veterinary diagnosis and treatment plan to avoid inhibiting healing.


Take home message

The use of therapeutic lasers in small and large veterinary practices is becoming more and more popular as veterinarians recognize its use as a painless and effective means of reducing pain and improving healing. The simple means of application and safety in use allow for a tool to treat many types of injuries and medical conditions. This is useful as an adjunct to traditional medicine or when medication may not be ideal. Many animals resist taking medication, their owners are not comfortable in delivering medication, or the animal is fractious and resistant to rehabilitative treatment. In addition, there are many patients for whom analgesic (pain) medication is ineffective or who may not be able to take analgesic medications. Laser Therapy is an easy and effective alternative.
Laser Therapy is a non-invasive and extremely gentle form of treatment with virtually no side-effects. However, the use of a laser as a medical device should be done by veterinary medical practitioners to ensure that an adequate diagnosis has been obtained prior to treatment so that the use of the laser does not inhibit healing and more effective medical treatment is not being overlooked.
Depending on the initial condition, effects from laser therapy may be seen immediately. Some cases even resolve after one or two treatments while other chronic conditions, such as arthritis, continue to be seen on a regular basis to maintain the animal’s comfort.


For further information, please call 1-866-843-5273 or visit www.theralase.com

Chronic Pain: 1 in 3 Suffer, Study Says

By Delthia Ricks

Newsday

Persistent pain that lasts weeks to years is an overlooked medical problem that affects more than 116 million people nationwide and needs to be the focus of a public health campaign, doctors said this week.
Physicians reporting in the New England Journal of Medicine cited a long list of concerns, including lack of access to pain-management specialists and inadequate consumer education about pain treatment, that they believe is causing people to suffer needlessly.
Authors of the report are calling on the medical community to educate more doctors capable of treating people experiencing long-term, intractable pain.
“That’s like 1 in 3 Americans in pain and that estimate is not far off the mark, based on what I am seeing,” said Dr. Brian Durkin, director of the Center for Pain Management at Stony Brook (N.Y.) University Medical Center.
“It’s a little shocking when you think about 1 out of 3 people being in pain. But I am getting calls every day,” added Durkin. “People are not looking for narcotics; they’re looking for pain relief.”
Dr. Philip Pizzo, dean of Stanford University’s medical school, wrote the report, which is based on research he led last year as chairman of an Institute of Medicine panel. The institute is the health division of the National Academy of Sciences and is chartered by Congress to investigate health concerns.
Pizzo said round-the-clock acute and chronic pain affects adults and children, and that there is misunderstanding and insensitivity about persistent pain by physicians and the public.
With fewer than 4,000 pain specialists nationwide, Pizzo said it’s time for primary care physicians to step up and help address what he calls a nationwide epidemic.
Durkin said about 50 million people undergo surgery annually in the United States, and many of those patients account for those in acute pain.
The vast number of people who make up the millions in long-term discomfort generally suffer from persistent headaches, and neck and lower-back pain, he said.
“So 116 million is not that crazy a number,” Durkin said. “Our population is getting older, and people are having problems.”
Dr. Lewis Nelson, an emergency medicine specialist and clinical toxicologist at New York University Medical Center in Manhattan said he doesn’t buy the estimate that nearly 1 in 3 Americans are in pain. He also doesn’t think there’s a shortage of pain management specialists.
“If there is so much pain, why are we just now finding out about it? Why weren’t people in pain 25 years ago?” Nelson asked.
Nelson said the estimate of millions of people in chronic pain is not only overblown, it overlooks the epidemic of prescription painkiller abuse. He said the pain epidemic can be plotted along a graph that also shows a rise in the worldwide proliferation of narcotic pain pills.
Nelson said he too often sees the flip side of pain treatment: people who have overdosed on prescription pain medication.
“To say that people in pain are not being treated overlooks those who are being overmedicated — and dying,” he said.


What can be done?

Benefits of Laser Therapy

Efficacy rates up to 90% with no side effects 
• Non-toxic
• Decrease/eliminate pain
• Reduce inflammation
• Promote new blood vessels and tissue growth
• Promote nerve axon growth
• Faster wound healing and closure
• Virtually painless
• Non-invasive
• Highly effective for patient (>90% efficacy) No side effects
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• Superior alternative to analgesics, NSAID's,
  other medications and other modalities
• Virtually no contraindications

For more information please call 1-866-843-5273 or visit www.theralase.com

Read more here: http://www.miamiherald.com/2012/02/07/2628037/chronic-pain-1-in-3-suffer-study.html#storylink=cpy#storylink=cpy

Cold Lasers For an Aging Population:Geriatric Conditions

Cold Lasers For an Aging Population:Geriatric Conditions

Join us for a Webinar on February 29 Space is limited. Reserve your Webinar seat now at: https://www2.gotomeeting.com/register/868051730 Below are a few items that will be covered in the Webinar: Understand the benefits of treating seniors with cold laser. Review common geriatric conditions that can be treated with laser. Learn How to Optimize Your Laser Treatments for these Conditions. Title: Cold Lasers For an Aging Population:Geriatric Conditions Date: Wednesday, February 29, 2012 Time: 1:00 PM - 2:00 PM EST After registering you will receive a confirmation email containing information about joining the Webinar. System Requirements PC-based attendees Required: Windows® 7, Vista, XP or 2003 Server Macintosh®-based attendees Required: Mac OS® X 10.5 or newer

How do I know which laser I should buy?

1. "Laser instruments" have been sold which do not even contain a laser, but LEDs and sometimes even ordinary light bulbs. These instruments have been sold for between US $3,000 - $10,000. Ask for proof that the instrument really does contain a laser.
2. In a number of products, laser diodes have been combined with LED's. This is often not mentioned. Check that all light sources in the apparatus (except guide lights and warning lights) are real lasers.
3. For oral work and wound healing HeNe and GaAIAs are the most common types and GaAIAs as the most versatile. Sterilizable probes are normally only available for GaAIAs lasers. For injuries to joints, vertebrae, the back, and muscles, that is, for the treatment of more deep-lying problems, the GAAs laser is the best documented. For veterinary work, laser designed so that the light can pass through the coat, and penetrate to the desired depth is best. For superficial tendon and muscle attachments, the required depth can be reached with the GaAIAs laser. Many companies have only one type of laser, such as a GaAIAs, and the salesman will naturally tell you that it is the best model for everything, and that it is irrelevant which type of laser is used. However, research tells quite a different story.
4. Size, colour, shape, appearance and price vary a great deal from manufacturer to manufacturer. Because a piece of equipment is large, it does not necessarily follow that its medical efficacy is high, or vice versa. The most important factor is the dosage that enters the tissue. Make sure the laser you buy is designed so that the light actually enters the tissue. Ask the salesman: How is the dosage measured? What kind of dosage is too high, and what is too low?
5. Many companies which import lasers have deficient knowledge in terms of medicine, laser physics, and technology. In fact, there are many examples of companies that have gone bankrupt. If a piece of equipment is faulty, it may have to be sent to the country of manufacture for repair. How long would you be without your equipment in such a case, and what would it cost to repair? Can the importer document his expertise? Who can you speak to who has used the apparatus in question for a long period of time? Is there a well-known professional who uses this make? What does it cost to change the laser diode or laser tube, for example, after the guarantee has expired? Can you get written confirmation of this? Try to get a list of references.
6. The difference between a colourful brochure and reality is often considerable. There are examples of brochures which describe the output ten times that which the equipment actually provides. How can you find out the real performance of the equipment (e.g. its output)? Are the measurement results from an independent authority? Is it possible to borrow an apparatus in order to measure its performance? Is there an intensity meter on the apparatus which can measure what is emitted and show it in figures? It is not enough simply to have a light indicator.
7. Some dealers know that their products are sub-standard. This can often be seen by the fact that they are anxious to get the customer to sign a contract. If a product is good, the dealer will have no doubts about selling it on sale-or-return basis, with written confirmation of this. What happens if the medical effects are not as promised? Is it possible to get a written guarantee of sale-or-return? In most countries, therapy lasers must be approved. The approval certificate shows the laser type and the class to which the instrument belongs, e.g. laser class 3B. There is also a certificate number. A laser which is not approved is either not a laser, or is being sold illegally.
8. Many companies organize courses and "training" events of markedly varying quality. A serious importer or manufacturer takes pains to ensure that his equipment is used in a qualified way, and makes sure that the customer receives some training in its use. What are the instructor's background and qualifications? Has he or she published anything? Is there a course description? What does the training material cost? Is a training course included in the cost of the equipment? Is the training material included? Is it possible to buy the training material only?
9. Development is going on at a fast pace. Suddenly, you have out-of-date laser equipment and a new and perhaps more efficient type of laser comes onto the market. What happens if your laser becomes outmoded? Do you have to buy a new laser, or can your equipment be updated with future components lasers?

For further information call 1-866-843-5273 or visit www.theralase.com 

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