Research in animals shows brain’s immune system is activated by stress during pregnancy
October 21, 2019
Source: Ohio State University
Chronic stress during pregnancy triggers an immune response in the brain that has potential to alter brain functions in ways that could contribute to postpartum depression, new research in animals suggests.
The study is the first to show evidence of this gestational stress response in the brain, which is unexpected because the immune system in both the body and the brain is suppressed during a normal pregnancy.
The Ohio State University researchers who made the discovery have been studying the brain biology behind postpartum depression for several years, creating depressive symptoms in pregnant rats by exposing them to chronic stress. Chronic stress during pregnancy is a common predictor of postpartum depression, which is characterized by extreme sadness, anxiety and exhaustion that can interfere with a mother’s ability to care for herself or her baby.
Stress is known to lead to inflammation, which prompts an immune response to protect against inflammation’s harmful effects. Based on what they already know about compromised brain signaling in rats stressed during pregnancy, the scientists suspect the immune cells in the brain responding to stress may be involved. If that’s the case, the immune changes may create circumstances in the brain that increase susceptibility to depression.
In unstressed pregnant rats, the normal suppression of the immune system in the body and the brain remained intact throughout pregnancy. In contrast, stressed rats showed evidence of neuroinflammation. The study also showed that the stressed rats’ immune response in the rest of their bodies was not active.
“That suggests there’s this disconnect between what’s happening in the body and what’s happening in the brain,” said Benedetta Leuner, associate professor of psychology at Ohio State and lead author of the study. She speculated that the signaling changes her lab has seen before in the brain and this immune response are happening in parallel, and may be directly related.
Leuner presented the findings Saturday (Oct. 19, 2019) at the Society for Neuroscience meeting in Chicago.
In this work, rats are exposed to unpredictable and varied stressful events throughout their pregnancies, a practice that adds a component of psychological stress but does not harm the health of the mother or her offspring.
In the stressed animals, the researchers found numerous pro-inflammatory compounds that indicated there was an increase in the number and activity levels of the primary immune cells in the brain called microglia. Their findings also suggested the microglia were affecting brain cells in the process.
Leuner’s lab previously determined in rats that chronic stress during pregnancy prevented motherhood-related increases in dendritic spines, which are hair-like growths on brain cells that are used to exchange information with other neurons. These same rats behaved in ways similar to what is seen in human moms with postpartum depression: They had less physical interaction with their babies and showed depressive-like symptoms.
Leuner and colleagues now plan to see whether the brain immune cells activated during gestational stress are responsible for the dendritic spine elimination. They suspect that microglia might be clearing away synaptic material on dendrites.
Leuner has partnered on this research with Kathryn Lenz, assistant professor of psychology at Ohio State, whose work explores the role of the immune system in brain development.
Though pregnancy was known to suppress the body’s immune system, Lenz and Leuner showed in a previous study that the same suppression of the immune system happens in the brain during pregnancy — the number of microglia in the brain decreases.
“By layering gestational stress onto a normal pregnancy, we’re finding this normal immunosuppression that should happen during pregnancy doesn’t occur, and in fact there’s evidence of inflammatory signaling in the brain that could be bad for dendritic spines and synapses,” Lenz said. “But we’ve also found changes in the microglia’s appetite. Every characteristic we’ve looked at in these cells has changed as a result of this stress.”
The researchers are now trying to visualize microglia while they’re performing their cleanup to see if they are eating synaptic material. They are also manipulating inflammatory changes in the brain to see if that reverses postpartum depression-like behavior in rats.
“We’ve seen the depressive-like symptoms and neural changes in terms of dendritic spines and synapses, and now we have neuroimmune changes suggesting that those microglia could be contributing to the neural changes — which we think ultimately underlie the behaviors,” Leuner said.
The research was supported by the National Institutes of Health.
Ohio State current and former students Caitlin Goodpaster, Nicholas Deems and Rachel Gilfarb also worked on the study.
Story Source:
Materials provided by Ohio State University. Original written by Emily Caldwell. Note: Content may be edited for style and length.
Ohio State University. “New way to think about brain’s link to postpartum depression: Research in animals shows brain’s immune system is activated by stress during pregnancy.” ScienceDaily. ScienceDaily, 21 October 2019. <www.sciencedaily.com/releases/2019/10/191021151538.htm>.
We wanted to make you aware of an opportunity to submit public comments to the Food and Drug Administration (FDA). Specifically, the FDA would like the public’s views on two main issues: 1. What criteria the FDA should use to evaluate new opioids to treat pain2. What new incentives are needed to better support and encourage the development of new treatments for pain On Sept. 17 the FDA held a public hearing called “Standards for Future Opioid Analgesic Approvals and Incentives for New Therapeutics to Treat Pain and Addiction.” While the public hearing has passed, the FDA is accepting written comments until Nov. 18. How to submit Written comments are to be submitted to the Division of Docket’s Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852. Electronic comments can be submitted by using the button below.All comments must be identified with the docket number FDA-2019-N-2514. Please keep in mind that all comments submitted to the docket are public. Why advocates should engageWe think it is important for people with pain to let FDA know your thoughts on these issues. A number of people and organizations at the hearing said that they thought no new opioids should be allowed on the market. What’s your opinion about this? People with pain need new options There has long been a lack of new non-opioid medications approved for pain. We encourage you to tell FDA what impact pain has had on your life and how speeding up the development of new drugs in the pipeline could make a difference to your life and the lives of so many others debilitated by chronic pain. People with pain need to make our voices heard. We encourage you to write into the docket.Sincerely, Cindy SteinbergNational Director of Policy & AdvocacyU.S. Pain FoundationSubmit comments here!
Most antidepressants take time to alleviate symptoms, but ketamine reduces symptoms quickly in most patients with major depressive disorder.
Researchers are hailing ketamine as the most significant new development in psychiatry given its high efficacy for treating major depression. Recent evidence has shown that in addition to depression, ketamine may also be a promising treatment for obsessive-compulsive disorder, post-traumatic stress disorder, and a number of other treatment-refractory neuropsychiatric disorders. In a recent paper published in Drug Discovery Today, researchers explore ketamine’s role in revolutionizing new mental health treatments and discuss how this drug’s mechanism of action has led to an influx of new research and studies on depression treatment.
Ketamine was approved by the US Food and Drug Administration (FDA) in 1970 as an anesthetic and safe alternative to phencyclidine. The therapeutic benefits of ketamine as an antidepressant were explored years later because of a stigma on from its widespread recreational use during the late 1960s and 1970s, and this agent was initially only administered intravenously.
In 2000, researchers found that ketamine had strong, fast-acting, and long-term effects in depression. In a randomized, placebo-controlled, crossover design study, patients with depression received 0.5 mg/kg of ketamine or saline on the first day of testing. Treatments were switched 1 week later. Researchers found that the antidepressant effects of ketamine began within 4 hours, peaked at 72 hours, and lasted for 1 to 2 weeks thereafter.1 In a 2006 study, this finding was replicated in an independent group of 18 patients with major depressive disorder who were resistant to other treatments. Compared with participants who received placebo, those who received ketamine showed significant improvement in symptoms within 110 minutes, with 35% maintaining significant response for at least 1 week.2
In subsequent years, results from a number of placebo-controlled studies revealed that ketamine is largely effective and long-acting in treatment of bipolar disorder and treatment-resistant major depressive disorder and produces antisuicidal and anti-anhedonic effects in mood disorders.
Many of today’s depression treatments are monoaminergic-based, including monoamine oxidase inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors. These treatments have been proven effective for a large number of patients. However, a significant subset of patients with major depressive disorder do not respond to these agents.1 When compared with ketamine, these agents have a delayed onset of action that can take up to several weeks — increasing the risk for organ failure and suicide in this subset.
A single dose of ketamine is shown to produce rapid and robust effects within hours to days of administration. This agent is also shown to rapidly reduce suicidal ideation, fatigue, and anhedonia, and improve circadian rhythm and sleep patterns in major depressive disorder.1 Researchers point out that these symptoms are synonymous across several psychiatric disorders but remain inadequately treated by monoaminergic-based agents.
The notable differences between ketamine and standard antidepressants have spurred researchers to develop new ketamine treatments that are less invasive than those involving intravenous administration. In March 2019, the FDA approved an intranasal version of ketamine called esketamine for adults with treatment-resistant depression.
Researchers say that ketamine’s mechanism of action in the context of clinical antidepressant efficacy is only partially clear. At present, researchers understand that ketamine’s mechanism of action goes beyond modulating the neurotransmission of glutamate and includes direct and indirect high affinity antagonistic binding properties at the N-methyl-D-aspartate receptor, as well as a-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid throughput modulation.1 Researchers have also noted that ketamine is a weak agonist at the mu, delta, and kappa opioid receptors.1
Other mechanisms that may contribute to ketamine’s efficacy for depression treatment include agonism at the dopamine receptor, antagonism at the M1–3 muscarinic receptors, and inhibition of the reuptake of serotonin, dopamine, and norepinephrine.1
Researchers are continuing to investigate ketamine’s underlying mechanism of action so they can progress with identifying and developing new agents that work similarly and that offer fewer side effects, as well as prolonged therapeutic effects.
Ketamine has influenced researchers to place more focus on the glutamatergic system when developing new therapies, since it is thought that rapid-acting antidepressants may trigger neurobiological events deeply rooted in the rapid reconfiguration of limbic circuitries.1 In addition to intranasal esketamine, other examples of rapid-acting glutamatergic agents that show promising results are nitrous oxide and sarcosine.
Nitrous oxide has been used as an anesthetic for more than 150 years and offers many of the same mechanisms as ketamine. Results from a 2015 study revealed that patients with treatment-resistant depression who received nitrous oxide experienced significant improvement in symptoms at 2 hours and 24 hours compared with placebo. Symptoms that showed the largest changes in improvement were depressed mood, guilt, suicidal ideation, and psychic anxiety.3 Additional trials are being conducted to determine the safety, efficacy, and optimal dosing of nitrous oxide for depression.
Sarcosine is an amino acid that functions as a glycine transporter-1 inhibitor and has co-agonistic properties at the N-methyl-D-aspartate receptor. Results from clinical trials have shown that sarcosine is a promising treatment for major depressive disorder and produces no adverse events. However, compared with ketamine, sarcosine does not produce the same rapid-acting effects within the same amount of time.1 Studies are currently underway to replicate the effects of both nitrous oxide and sarcosine in depression.
Ketamine has been found to enhance the transmission of gamma-aminobutyric acid (GABA) to reduce depression. Shortly after approving intranasal esketamine, the FDA approved an agent called brexanolone that acts as a positive allosteric modulator of GABA receptors. Brexanolone is currently being used to treat postpartum depression since this therapy produces rapid- and long-acting antidepressant effects similar to that produced by ketamine. The exact mechanism of action of brexanolone remains unclear, though researchers theorize that it binds to synaptic and extrasynaptic GABA receptors to increase functionality. Brexanolone is still being tested in clinical trials, since this agent has been associated with serious adverse events including syncope, altered state of consciousness, suicidal ideation, and intentional overdose.1
Buprenorphine, an opioidergic agent currently used to treat opioid use disorder, is also being studied for treatment of depression. Opioidergic agents were once used to treat melancholia during the 1950s before less addictive therapies became available and are shown to have a wide variety of actions in the brain that reduce depression. Studies evaluating the effects of buprenorphine by itself and combined with other agents on depression have produced promising results, though the FDA has stated it needs additional clinical data before this agent can be used to treat major depressive disorder.
Given what studies have since revealed about the efficacy of ketamine in depression, many researchers are reconsidering the potential benefits of banned or scheduled drugs for psychiatric patients.
Psychoactive drugs being reevaluated include lysergic acid diethylamide (LSD), 3,4-methylenedioxy-methamphetamine, and psilocybin. Researchers are determining whether microdosing these substances could produce therapeutic benefits without harmful side effects or abuse. Results from a 2011 study revealed that psilocybin was successful at significantly reducing symptoms of depression for up to 6 months in patients treated for advanced-stage cancer.1 In a 2015 study that examined the effects of LSD in patients with life-threatening diseases who were experiencing anxiety, LSD was safe, well-tolerated, and effective at reducing psychiatric symptoms.1
Researchers say that the recent FDA approval of intranasal ketamine represents a major breakthrough in psychiatry and that advances in ketamine or ketamine-like treatments may greatly improve the quality of life for patients with depression who do not respond to current treatments. Studies conducted on ketamine have paved the way for research evaluating novel approaches for the prevention and treatment of depression.
Disclosure: One author is listed as a co-inventor on a patent for the use of ketamine in major depression and suicidal ideation, among others. Please see original reference for a full list of authors’ disclosures.
300 BC2M High School club members gathered in San Francisco on November 2nd to mark our 4th Annual Student Summit. Thanks to our amazing host, Pinterest, these teens spent an afternoon engaging in mental health conversations, participating in exciting activities, and meeting other students from around the Bay Area. We are so grateful for our keynote speaker, Jen Gotch, CCO and founder of ban.do, in sharing her personal story and path to successfully managing her mental illness. She spent hours engaging in Q&A following her time on stage! After a morning filled with various speakers and an exciting activity fair, our students dispersed into breakout sessions where they chose workshop tracks covering the following topics: Advocacy in High School and Beyond; Mental Health & Interpersonal Relationships; Mental Health in the 21st Century; and Identity and Mental Health. The track system was a hit and our students gave us amazing feedback on this new change we implemented.
The BC2M Summit is one of the biggest highlights of the year for the students and allows them to learn from one another, build a movement of change in their community, deepen their understanding of mental health topics, and make life-long friends. With the inspiration and hope that filled the room, we know that these students will put an end to stigma and create a more empathetic and compassionate world. Special thanks to our sponsors for making the event possible: Pinterest, David & Lucile Packard Foundation, Palo Alto Medical Foundation and Kaiser Permanente.
An Extraordinary Evening Fighting the Stigma
Sydel Curry and Damion Lee, Ben Stiller and Zak Williams, Dave Grohl and Violet Grohl
For the last seven years, Bring Change to Mind has set aside one night each Fall to celebrate Revels & Revelations. This magical night is meant to bring our stories forward; highlight our student advocates; laugh, cry and sing along to wonderful entertainers; and most importantly, fund our efforts to end stigma. October 17th in San Francisco was quite a night and we wish you all could have been with us. 24 BC2M High School club members represented their peers at Revels and shared the work they are doing on their campuses and why mental health advocacy is so important to them. Their stories are courageous and inspirational. Each guest was asked to share why they support BC2M – the students later brought these notes and special intentions to the stage in a very emotional processional.
We were honored to bestow the third Robin Williams Legacy of Laughter Award to Ben Stiller. His heartfelt acceptance speech made for an emotional evening. Performances at Revels included the incredible line up of: Darren Criss, Dave Koz, JB Smoove, Malin Akerman, Margaret Cho, Charles Jones, and the beautiful voice of Violet Grohl, accompanied by her father, Dave Grohl, and Rami Jaffee of the Foo Fighters. Our hearts continue to soar as we think of the generosity of each person in the room that night.
We thank those that attended, have made contributions to support our work or choose to share our work on social media. A special thanks to our Revels partners: American Airlines, VX Capital, St. Regis San Francisco, WindRacer wines, and Ideas Events. Together we will save lives and put an end to stigma.
Take a moment to watch a few highlights from the night!
Support Bring Change to Mind Today
Help support the life-changing work our high school students are accomplishing in their communities and our expansion to bring this program to more schools throughout the country.
Melt the coconut oil in a glass bowl in the microwave for about 30 seconds, and let cool for five minutes. Stir in the sugar and essential oils until combined. Package the peppermint sugar scrub in airtight glass jars, and sprinkle finely crushed candy cane on top; mix the candy cane into the scrub if desired.
To use, gently massage a small amount into clean, dry skin. Rinse thoroughly with lukewarm water, and pat dry. Store the sugar scrub in a cool dry place for up to six months.
Buy jars with hinged lids for a spa look and attach a ribbon and small spoon.
The Danish concept of hygee never gets old. It’s all about slowing down and taking your time, creating space for warmth, coziness, and being in the moment. Although it’s not specific to wintertime, hygee lends itself well to the season. Here are a few ideas on how to infuse hygee into your cozy living this winter.
With films playing a key role in shaping attitudes to mental health, two doctors say Joaquin Phoenix’s troubled supervillain perpetuates damaging stereotypes
As junior doctors who work on acute inpatient psychiatric wards, serious mental illness is our daily reality. We have, therefore, watched the controversies around Todd Phillips’s Joker – in which Joaquin Phoenix plays a troubled loner who turns to violence – with professional interest.
The film’s dominance in the debate about portrayals of mental illness in the movies comes at a curious time. Recently, we’ve witnessed great leaps of awareness about relatively common mental-health issues such as depression and anxiety, and with that awareness, increasing dismissal of the sort of unhelpful prejudices that used to surround them. These are now readily discussed without shame and often represented in the media with a well-informed grasp of the facts, thanks to effective information campaigns.
However, severe mental health conditions, such as psychotic illnesses, remain shrouded in stigma and are consistently misrepresented and misunderstood. Portrayals of mental illness in film can perpetuate unfounded stereotypes and spread misinformation. One of the more toxic ideas that Joker subscribes to is the hackneyed association between serious mental illness and extreme violence. The notion that mental deterioration necessarilyleads to violence against others – implied by the juxtaposition of Phoenix’s character Arthur stopping his medication with his increasingly frequent acts of violence – is not only misinformed but further amplifies stigma and fear.
Studies show this association is exaggerated and people with severe mental illness are more vulnerable to violence from others than the general population. Interesting, then, that Joker’s earnest attempt to create an empathetic character with mental illness – who writes: “The worst part of having a mental illness is people expect you to behave as if you don’t” – contributes to the very prejudice that Arthur longs to evade.
Arthur’s supposed loss of grip on reality is suggested by a peppering of nods to psychotic symptoms: delusional ideas of a grandiose nature (“I am an undiscovered comedic genius”) and hallucinations of his neighbour – which are confirmed by his eventual admission to a psychiatric institution. This restoration of order via Arkham Asylum affirms the overarching inference of
the film: Arthur’s descent into violence and destruction is triggered by his mental deterioration. The result of this is to – disappointingly – remove Arthur’s agency and divert attention from a potentially more stimulating conversation about wealth inequality and its responsibility for societal collapse.
We wouldn’t want to get bogged down in labels, but the psychopathology Arthur inhabits is foggy at best: his apparent lack of disordered thinking means the attempt to illustrate psychosis is half formed. He also displays traits of narcissism and depression. This diagnostic vagueness may create a more relatable character that reflects the pain of any psychiatric illness; but it gives the impression that many disorders have been squashed into a plot device. In the end, it undermines Phoenix’s hypnotic performance and Joker’s sincere attempts to explore the interaction between poverty, inequality and social isolation.
Arthur’s chilling quirk – his bursts of incongruous and uncontrolled laughter – is no laughing matter either. Presumably, he suffers from the neurological condition pseudobulbar affect – also known as “emotional incontinence” – perhaps caused by his childhood head trauma. Joker may make an attempt to unpick the difference between the psychiatric and the neurological – between a mental illness and a medical disorder – but it runs the risk of conflating the two with a haunting, stigmatising and problematic image. Whether intentionally or not, Arthur comes across as a hysterically laughing supervillain, stereotypically “mad” to the untrained eye; a murderous clown laughing alone on a bus.
Cinematic depictions of mental illness – most infamously, One Flew Over the Cuckoo’s Nest– have profound and lasting implications in the real world. It is widely acknowledged within psychiatry that Cuckoo’s Nest led to inappropriate levels of suspicion and misinformation regarding electro-convulsive therapy, and may have meant many people did not receive treatment that is proved and effective. All this due to a single film’s misinformed presentation.
Films have the power to perpetuate stigma and fear, which is why the misrepresentation of severe mental illness in Joker should not be dismissed lightly.
Comments on the Request for Information (RFI) on the Development of a CMS Action Plan to Prevent Opioid Addiction and Enhance Access to Medication-Assisted Treatment
The U.S. Pain Foundation is pleased to respond to CMS’s request for information to inform the development of a CMS Action plan to prevent opioid addiction and improve the treatment of acute and chronic pain. The U.S. Pain Foundation is the largest 501 (c) (3) organization for people who live with chronic pain from a myriad of diseases, conditions and serious injuries. Our mission is to connect, support, educate and advocate for those living with chronic pain, as well as their caregivers and healthcare providers.
Chronic pain is an enormous public health problem. The CDC and NIH have reported that 50 million Americans live with chronic pain and 19.6 million live with high-impact chronic pain that interferes with their ability to
1
There are currently very few highly effective treatments for many pain conditions. Managing pain is a matter of finding the right combination of treatments that allows pain sufferers to function and have some quality of life. We believe people with chronic pain should have access to a wide range of therapies and treatments because pain is very individual – what helps one person living with pain will not necessarily help another. Most people living with chronic pain spend years of trial and error searching for treatments that will help to reduce their pain, while struggling to manage their lives. This is extremely wasteful from a personal standpoint as well as an economic one.
We believe that when it comes to chronic pain, CMS’s goal should be to get beneficiaries effective treatment sooner. Our recommendations for accomplishing this are as follows:
1. Compensate physicians for time spent coordinating complex care
Chronic pain patients require more time from their health care providers, because by its very nature, chronic pain is complex and challenging to treat. Doctors should be able to spend more time conducting a thorough pain assessment and developing a treatment plan at the first visit rather than
1 CDC. Prevalence of Chronic Pain and High Impact Chronic Pain Among Adult – U.S., 2016. MMWR Rep 2018;67:1001-6.
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function on a daily basis. with chronic pain and 5.4 million live with high-impact chronic pain. The Medicare population also includes disabled Americans younger than 65. Since pain is the number one cause of disability in the U.S., we can therefore assume that the number of Medicare beneficiaries living with pain is much higher than those reported numbers. Because many Americans living with high-impact chronic pain are unable to work or can only work part-time, many also depend on Medicaid.
That same study reported that of Americans over the age of 65, 13.5 million live
the fifth visit to the fifth doctor which is the current norm. Furthermore, because the cause, manifestations, and severity of chronic pain can vary so widely from person to person, there is no simple or uniform solution to managing it. Each patient is entirely unique and requires a unique treatment plan.
Individualized, multimodal, integrative care is widely understood to be the best and most effective approach to managing pain. But it requires time and resources to identify and try various modalities and coordinate this care. A traditional 10-minute appointment does not provide sufficient time for a provider to create and implement a multimodal treatment plan, and to continually reassess that plan as the individual’s health and pain change over time.
The lack of reimbursement for coordinating care and managing complex care is perhaps one of the most significant impediments to proper pain care. It has resulted in an overuse of quick fixes—like a reliance on medication alone.
Reimburse for multimodal, multidisciplinary treatmentRehabilitation models of care, which emphasize integrated, multi-modal treatment, have been proven to be the most effective in reducing pain and improving function. Too often, pain management attempts to put a mere band-aid on pain levels, rather than address pain’s effects on function and quality of life. Chronic pain is a biopsychosocial disease, meaning it affects every aspect of an individual’s life, even more so when the individual lives with high-impact chronic pain. Thus, patients need and deserve care that addresses pain at multiple levels. For example, while medication and injections may help control pain, they do not give individuals tools for learning to live within their limitations. Restorative and complementary therapies, like physical therapy, occupational therapy, massage, yoga, and so on, are more suited to improving function and productivity and learning to live day-to-day with painful symptoms. Meanwhile, it is well-known that anxiety, depression, and other mental health conditions are common comorbidities of long-term pain. In fact, recent numbers from the CDC demonstrated that at least 10 percent of suicides in America involve someone living with pain. This vulnerable population needs earlier multimodal intervention that recognizes the full impact of pain on a person’s life. Patients with pain—especially those with high-impact pain—should have access to psychosocial care, including psychological counseling and peer support groups that is tailored to their unique challenges.Unfortunately, we have moved away from a bundled payment approach to this type of care, to the detriment of people with pain. It’s vital we return to reimbursing for multimodal, multidisciplinary treatment..
Incentivize innovative value-based models of care that integrate multimodal treatmentThe cardiac care model, which incorporates exercise, nutrition and other modalities, is one innovative
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approach that has been very successful and cost-effective at reducing the burden of heart disease. This is a model that takes into account that heart disease must be attacked from multiple angles, and that treatments and therapies work best in combination with one another.
This model also has proven that multidisciplinary, multimodal care can be cost-effective care. By investing health care dollars up front in managing heart disease and preventing cardiac events, we have saved millions of dollars in terms of reducing hospitalizations and emergency room visits. Beyond saving on direct healthcare costs, no price tag can account for the enormous reduction in suffering and lives lost.
Chronic pain is just as complex as heart disease. It similarly gets worse—and more expensive to treat– without comprehensive, multimodal early intervention. CMS should encourage and reimburse innovative integrated models of care for chronic pain.
Remove access barriers to evidence-based non-opioid drugs and medical devicesCMS should require that at least two medications in each class of non-opioid medications commonly used for pain—such as antidepressants (SSRIs, SNRIs, or tricyclics), anticonvulsants, corticosteroids, NSAIDs, muscle relaxers, triptans, calcium channel blockers, topicals and so on)—are in the lowest-cost tier in every Part D plan formulary.It is vital to recognize that, again, each individual is unique, and what works for one person may not work for another. Patients must have access to various options to determine what reduces their pain levels. Unfortunately, many patients cannot afford the high copays on these medications, creating enormous and unnecessary barriers to safer, non-opioid medications. If CMS is committed to reducing opioid use, it must make alternative medications more affordable.In addition, an increasing number of evidence-based medical devices for pain management are available, with more coming to market each year. These devices represent an important category of treatment, especially in that they often provide sustained relief and generally come with less side effects than many other interventions. CMS must work to improve access to these types of devices by reducing out-of-pocket costs and removing overburdensome prior authorization requirements. In particular, CMS should remove the requirement for a psychological evaluation prior to obtaining spinal cord stimulation devices. There is no such requirement for surgery, which is much riskier, or for other treatments for pain.
Partner with NIH/NCCIH to continue to build the evidence base for complimentary treatments like acupuncture for chronic low back pain (ie. therapeutic massage, yoga, tai chi, aquatherapy) This is an area where data collection is essential to determining the value of these modalities for pain control. There is much anecdotal evidence that many complimentary techniques, especially gentle
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exercise and mobility programs, are helpful in the ongoing management of chronic pain. These interventions can also be cost-effective, especially those that train patients on a program they can then practice at home. Exercise and mobility programs also do a lot to restore function, in addition to general pain reduction. But there is a lack of funding to do the randomized control trials that are necessary to prove their value. If we are truly committed to reducing opioid use, we must investigate and make available evidence-based alternatives for pain relief.
Reimburse for promising treatments in specific conditions as evidence becomes available.The approach that CMS is using for chronic low back pain and acupuncture is an excellent model. In this instance, CMS is focusing on a narrow pain condition with one modality and a large subject population. This approach correctly recognizes that different modalities work differently for different types of pain—and must be studied accordingly. In particular, we commend CMS for covering treatment costs as part of this study. This reflects an understanding that cost is an enormous barrier to care, especially for the Medicare and Medicaid populations, who typically have limited ability to work. We would recommend using this approach simultaneously for other specific conditions.
Encourage states to make more complementary and integrative care available through MedicaidA number of states have granted Medicaid waivers to cover complementary treatment for specific pain conditions and then studied the effect of these modalities on patients’ pain levels and function. One such example we are aware of is a waiver in Colorado to cover complementary treatments for spinal cord injury. We urge CMS to support more states in offering this type of Medicaid coverage.
Incentivize participation in pain management group programs, similar to Medicare Silver Sneaker Program for fitness club membership & Medicare’s Diabetes Prevention Program These programs have proven track records of helping patients more effectively cope with and manage chronic illness. Educating patients about ways to engage in self-management of their condition, and then incentivizing such self-care, could have a similarly positive impact on the pain population. If patients were reimbursed for the cost of membership in these programs, it would help them maintain wellness and function.
Reimburse for participation in chronic pain-specific patient education self-management and support group programs Similar to above, patient education on self-management and coping skills are key to living successfully with a chronic condition. These programs can be taught via support group models and provide essential information on topics such as: cognitive behavioral therapy; stress reduction techniques, like meditation; strategies for activity restriction and modification; and much more.Isolation, stigma, and a sense of helplessness are enormous problems faced by the pain population,and create significant barriers to care. As mentioned before, people with chronic pain have
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significantly higher incidences of mental health comorbidities, and are at greater risk of suicide. It is well-known that mood disorders and stress can increase pain levels, and vice versa, creating a vicious cycle. CMS has a vested interest in providing more comprehensive care, that treats the whole patient—mind and body. Creating opportunities for connection, community, and education is vitally important.
10. Begin a serious effort to code for, collect, and analyze data on chronic pain in the Medicare and Medicaid population
CMS does not collect nor analyze epidemiologic data on chronic pain in its beneficiaries. We do not know the incidence of chronic pain in general, the prevalence of various pain conditions, trends over time, subpopulations at risk, nor the health consequences of pain in terms of morbidity, mortality and disability. It is critical to have this data to understand the scope of the problem. It is also vital in order to assess whether the improvements in care and interventions CMS undertakes in the Action Plan are effective in reducing the enormous burden of chronic pain.
In Section 6032 of the SUPPORT Act, Congress has called on CMS to use its authority to improve access to care for the millions of Americans whose lives have been devastated by the dual public health crises of opioid use disorder and pain. We are hopeful that CMS will give serious consideration to the recommendations we and others, such as the HHS Pain Management Best Practices Task Force have proposed. Now is the time for CMS to take bold and innovative action to ameliorate the enormous burden of chronic pain in America.
Sincerely,
Cindy Steinberg National Director of Policy & Advocacy U.S. Pain Foundation 781-652-0146 cindy@uspainfoundation.org
Interim CEO Nicole Hemmenway was one of three keynote speakers at the closing session of the American Massage Therapy Association (AMTA) national convention last weekend in Indianapolis, IN.
In her talk, “Massage for Chronic Pain: What our community wants you to know,” Hemmenway shared her personal journey with complex regional pain syndrome and why she’s dedicated herself to helping others with pain through the U.S. Pain Foundation. She gave attendees a glimpse into the programs and services U.S. Pain offers, and provided insight into the scope of the chronic pain health crisis in America.
The emphasis of Hemmenway’s remarks was on the barriers to multidisciplinary care, particularly massage, and how massage therapists can best help people with pain.
“It truly was a privilege to be invited by the AMTA to speak at their annual convention,” Hemmenway says. “There is a greater need, maybe now more than ever, for affordable access to multidisciplinary care, such as massage therapy. I was so impressed with the therapists I spoke to who are genuinely invested in patient’s overall wellness. But like the pain community, they also feel discouraged by the lack of access. That is why it is so important for us to use our voices to fight for better coverage of options like massage.”
Hemmenway shared feedback from the pain community about what they wanted massage therapists to know, including:
People with pain have bodies that are very sensitive and complex. Pain continually evolves and changes, which means communication is vital to ensure that the massage is beneficial and to avoid making the pain worse.
Maintaining a baseline can be just as important as achieving improvement (sometimes improvement isn’t possible); setting realistic goals is necessary.
Massage therapy can be an important treatment option, but barriers exist, namely cost and transportation. Massage therapists should take into consideration things like providing more flexible pricing packages, offering in-home massages for those who are homebound, etc.
To learn more about U.S. Pain’s recent efforts related to complementary therapies, click here.
One of my friends tells her story of growing up with a mother with “issues” rather matter-of-factly, but the details are pretty grim to listen to. “She would stop talking to me for no reason, for days at a time, and put a gift on my bed when she decided she was done being mad at me. We never talked about why she was angry, and most of the time I didn’t know. I just knew not to talk to her until she left something on my bed, and then I’d hold my breath until the next time she got upset about something.”
My friend’s mother sometimes disappeared for lengths of time without anyone knowing where she went or when (or if) she would return. When she fought with my friend’s father, she frequently brought my friend into the arguments as a mediator, despite her being a child. “Everything was about her,” my friend says. “Even as an adult, forty years later, everything is still about her.”
Whether we are born into families with difficult people, or enter into relationships with them as friends, coworkers, partners, etcetera, it can be challenge to know how to best respond to someone who is emotionally unwell. In order to do so effectively, it is paramount that we understand that the behaviors that are being presented are not our fault, develop firm and clear boundaries about what we will and will not tolerate, and practice asserting ourselves confidently and consistently.
IT’S NOT YOU, IT’S THEM. NO, REALLY.
More times than I can count, I’ve had clients sitting across from me in the therapy room, blaming themselves for the erratic and unacceptable behavior of someone else, and puzzling over what they might have done differently. It sometimes seems as though difficult people have special powers that enable them to sniff out the highly sensitive and empathic among us, and attach themselves to them. Inevitably, those sensitive individuals become sponges for all the negative emotions of their difficult friend, and seek support from a clinician like me, wondering why they just can’t do better.
The answer is (and trust me, this took ages for me to learn personally, too): You cannot fix a problem that does not belong to you. It’s just not possible. As much as you would like to, as much as you might be a stronger person, or better emotionally equipped, or have supernatural empathic healing powers – if someone does not want to do the work on themselves, then the work simply cannot be done. We cannot work on anybody but ourselves. When we start with the assumption that we are unable to do anything to change the behaviors of those around us, then we create space to make plans to care for ourselves. These plans often begin with identifying our boundaries.
BOUNDARIES, BOUNDARIES, BOUNDARIES.
Once we’ve let go of the notion that we can change or fix the person in question, we can go ahead and set some boundaries. The beauty of this is that there is no right or wrong to setting boundaries – they are truly based on whatever we individually want and need. Do you need to set limits about the frequency and length of visits to a relative? Perfect. Do you need to allow yourself to walk away from conversations that become shaming and/or emotionally abusive? Awesome. Do you need to only see a certain person if you have a support person with you? Go for it. There are a billion ways to design your boundaries, and you can create them based on what your insides are telling you feels safe and right.
Remember to watch out for “shoulds” here. The “shoulds” get in the way by dictating to us what we “should” be able to do in any given situation, and making us feel bad about it. Some classic “shoulds” include: “You really should be able to deal with this behavior for a few days over the holidays;” “You shouldn’t be so sensitive to that language – they were only joking;” “You should spend time with this person because they are older/related to you/a person in authority.” The problem with the “shoulds” is that they are typically culturally dictated and have little to do with what might be right or wrong for us as individuals. By ignoring our gut instincts and doing what the “shoulds” tell us to, we betray ourselves, and sometimes cause ourselves unnecessary suffering and harm.
Be kind and stay true to yourself. Don’t let anyone but you dictate your boundaries.
CONSISTENT AND CONFIDENT SELF-ASSERTION.
For many of us, self-assertion is difficult to put into practice. Once we’ve identified our personal boundaries, we have to go about implementing them by saying them to a difficult person, out loud. This can be incredibly challenging. We might be much more comfortable avoiding the subject (forever), or allowing our feelings to build up until we explode. Truly, self-assertion is a hero’s mission, and we must be gentle with ourselves as we attempt to master this very difficult and hard-won skill.
I’ve found that seeking support from a good therapist (or a very unbiased friend) can be helpful when beginning to practice self-assertion. It is useful to have an objective party translate one’s boundaries into language that is level, direct, and un-muddied by emotion. Another reasonable option is to begin setting small boundaries, which help us gain traction and build trust and confidence in ourselves. Not ready to call off a visit on Thanksgiving? Set a smaller boundary to stay home for a lower-stakes holiday, and assess how it feels. Baby steps lead to big steps.
Conclusion
To wrap it all up, let’s acknowledge again that this is hard work, and requires patience, practice and time. Many of us have spent a lifetime walking on eggshells around difficult folks, and the idea of suddenly unleashing a confident boundary seems as likely as running a marathon with no training – anxiety is to be expected. Be patient and compassionate with yourself, and implement your new skills at a pace that feels comfortable to you. As you do, you may notice a greater sense of peace and self-empowerment when dealing with the challenging people in your life. 11022
Dana Belletiere
I am a licensed therapist serving clients in New Hampshire, Pennsylvania, and Massachusetts. In my practice, I focus on helping clients to shape their own narratives, accept and value all parts of themselves, and empower themselves to cultivate an authentic and meaningful life. Learn more about me and my practice on my website: http://www.danalicsw.com.
Gluten-Freedom by Alessio Fasano, MD with Susie Flaherty
Ingredients:
1 1/2 to 2 pounds salmon (wild-caught preferred with skin on)
Juice from 2-3 limes
Olive Oil
Sesame Seeds
Preheat oven to 350 degrees. Line baking sheet with parchment paper and coat very lightly with olive oil. Place salmon, skin side down, on parchment paper in the pan.
Squees the juice of 2-3 limes into a bowl. Use a pastry brush to coat salmon with lime juice. Coat the top of the salmon with sesame seeds. Bake for 15-20 minutes. Fish is done when it flakes easily with a fork. Be careful to not overcook.
Dear pain warriors, Each November, U.S. Pain Foundation organizes a month-long educational campaign for the pain community. Recognizing that art and writing can help kids and adults cope with and/or express chronic pain and its effects on their lives, this year’s KNOWvember campaign will focus on creativity. During the month, titled “Art through Pain: How Creativity Helps Us Cope,” U.S. Pain will be:hosting three virtual events, soliciting visual art submissions to showcase at a later date,and highlighting information about art and pain on social media (#ArtThroughPain).If you’d like to submit your artwork, you have the option of sharing it with us privately or allowing us to use it in a future project (such as in a blog post on Remedy or an INvisible Project magazine) through the link below.
For healthcare to work, we the patient, need to be heard. Find out what I am doing to give the medical community a better understanding of what is important to us.
Heat a large skillet or frying pan. Add sausages and cover halfway with water. Cook over medium heat until sausages are halfway cooked (15-20 minutes). During the process, prick the sausage with a fork to release the juices from the sausage.
While sausages are cooking, place sweet peppers in a colander and rinse off the water. Add the peppers and tomato paste to the sausages. Cook for another 10-15 minutes, stirring occasionally until the sauce thickens.
Cut sausages in 2-inch pieces, making sure that they are cooked all the way through.
Use funnel to pour jojoba oil into dropper bottle. Add the tea tree essential oil and lavender essential oil to the bottle. Place lid on the bottle and gently shake to combine.
TO USE:
Apply 1 teaspoon of the dandruff relief oil to your scalp prior to hopping into the shower. Massage the oil into your scalp and let it sit for five minutes before washing hair.
Combine the sugar, coconut oil, and apple cider vinegar in a small dish. Mash with fork until a scrub-like consistency forms. Add the honey and rosemary essential oil. Blend into scrub with a fork.
TO USE:
Apply a generous amount of scrub to wet hair. Using fingertips, avoiding your fingernails, gently massage the scrub into your scalp in a circular motion.
Allow scrub to sit for several minutes. Rinse and cleanse with shampoo, and apply conditioner as normal.
Five years ago I began a friendship with my friend H.Dale who was incarcerated because of a psychotic episode. We began exchanging letters. Since that time I have come to know him as a brilliant young man who like many of us got blind sided by a serious mental illness. Unless you’re the one who […]
In post https://lookingforthelight.blog/2019/07/22/agoraphobia-is-not-logical/ , I forgot to mention the nightmares that have haunted me and I believe reinforce my agoraphobia. Every dream is based on not being able to get out or leave where I am. Examples, can’t find keys, don’t know what exit to take from store, cars covered in snow, not sure which one is mine.
I also dream I’m flying, which I have for a long time, new to my dreams are not being able to see or only seeing a small amount. I’m not real deep into dream interpretation but from what I’ve read the deffinitions could fit. Flying is generally a good sign however it could mean you are fleeing something. Being blind is not wanting to see or face what is before you.
I can’t help but think these dreams are aggrevating my agroraphobia and anxiety. Saturday I woke up and during the dream I could not find my car because it was snowed under, then I was flying in a part of town that is an hour away from where I live yet I was trying to get home. Next in the dream I’m in an expensive business suit and enter an auditorium, I’m nervious someone will think I have money and try to rob me so I’m shoving my purse into my breifcase. Then I find and pay phone and fumble for change and someone is standing in my way and won’t move from the phone. They try to take my top off and I woke myself up screeming. These dreams are very disturbing and are so vivid, it like they last forever.
My therapist believes the agoraphobia is trauma releted and EMDR Therapy may help. EMDR Therapy it stands for Eye Movement Desensitization and Reproccessing.
Eye Movement Desensitization and Reprocessing (EMDR Therapy) is a therapeutic technique developed by Francine Shapiro, Ph.D. in 1987. The method was originated by Dr. Shapiro when she noted that disturbing thoughts suddenly disappeared after engaging in a particular type of eye movement. As she deliberately retrieved the disturbing thoughts, they were no longer upsetting to her. This positive effect prompted her to retrieve other disturbing images, engage in the eye movements, and note the result. Upon discovering that a variety of disturbing thoughts and images were no longer upsetting to her, Dr. Shapiro, began a study to note the effects with others.
Since 1987 this methodology has evolved into a multifaceted approach to treat a variety of different problems with a wide number of populations. EMDR is frequently used in the treatment of painful experiences and the disturbing feelings and thoughts that accompany high impact events. Additional uses include resolution of grief, anxiety, panic, phobias, relief from chronic pain, performance enhancement and dealing with any unpleasant memory.
The procedure of EMDR treatment involves the client focusing on a disturbing image while the trained therapist facilitates a type of eye movement by having the client follow the movement of the therapist’s fingers or a row of lights across the field of vision.
Upsetting images are physiologically and neurologically arousing and this can interfere with the processing of the information in the brain. Consequently, the experience gets misplaced or frozen in our nervous system. The effect of high impact events on the brain is like having a traffic police officer in your brain which gets very tired and sends the distressing signal to an unauthorized parking zone where it gets stored in the wrong area. EMDR retrieves the signal and parks it in the authorized zone.
Researchers do not know why (EMDR Therapy) Eye Movement Desensitization and Reprocessing works. The similarities of the eye movement patterns and Rapid Eye Movement (REM) sleep have contributed to theorizing a connection between the two. Information is processed when dreaming occurs. Dreaming occurs in the stage of sleep known as REM sleep. When the client accesses the disturbing image and thought that accompanies the image while moving their eyes back and forth, the information seems to be processing at an accelerated rate.
With EMDR (Eye Movement Desensitization and Reprocessing), feelings of tension are usually significantly reduced, the image seems to change by fading or becoming more distant, and the power of the negative thoughts are often diminished.
Eye Movement Desensitization and Reprocessing makes the following assumptions about healing:
1. EMDR therapy uncovers hidden aspects of problems. 2. EMDR therapy gets you unstuck and allows a natural movement toward healing. 3. EMDR therapy generates a new perspective of your problem. 4. EMDR therapy allows you to go directly to you healing destination and eliminate incorrect pathways. 5. EMDR therapy creates new pathways beyond the limitations of your previous route. 6. EMDR therapy accesses the natural healing abilities of your deeper self. 7. EMDR therapy enables your ability to let go. 8. EMDR therapy installs positive behaviors and allows you to connect to useful resources within yourself.
The research on EMDR therapy has indicated that the effects remain stable over time. Research on Eye Movement Desensitization and Reprocessing has also reported the following positive therapeutic results:
Combat veterans who were not able to be free of symptoms no longer experience flashbacks, or nightmares.
People with phobias revealed a rapid reduction of fear and symptoms.
People with panic disorder reported recovering at a more rapid rate when compared to other treatment methods.
Crime survivors and police officers were no longer disturbed by the after effects of violent assaults.
People have been relieved of excessive grief due to the loss of a loved one.
Children have been symptom free from the effects of assault or natural disaster.
Sexual assault survivors were able to lead normal lives and have intimate relationships.
Accident and burn survivors who were debilitated are now able to resume productive lives.
Those with sexual dysfunction are now able to maintain healthy sexual relationships.
Clients with chemical dependency have decreased tendency to relapse and show signs of stable recovery.
Clients with a wide variety of overwhelming events experienced relief from their symptoms with EMDR.
I am in the prosses of getting on my refferrals schedule and look forward to seeing if EMDR Therapy can help with my agoraphobia and anxiety.
Have you had an EMDR experience you would like to share or comments you can leave. I would really appreciate any feedback.
1/2 pound Mozzarella di Bufala di Campania (soft mozzarella cheese)
1 tablespoon extra virgin olive oil
Using a bread knife, slice tomatoes thickly in 1/2 inch slices. Select soft mozzarella cheese packaged in water so it remains moist and flavorful (don’t use hard packed mozzarella used for pizza topping.)
Carefully slice the mozzarella cheese 1/2 inch pieces. Place the mozzarellla on top of the tomato and add a sprig of freshly washed basil on top.
At this point, you can drizzle with 1/2 teaspoon of olive oil and serve. Or if preparing ahead of time, refrigerate on individual plates and drizzle olive oil on top just before serving.
Is CBD a cure-all — or snake oil? Jeffrey Chen, executive director of the UCLA Cannabis Research Initiative, explains the science behind the cannabis product.
CBD gummies. CBD shots in your latte. CBD dog biscuits. From spas to drug stores, supermarkets to cafes, wherever you go in the US today, you’re likely to see products infused with CBD. There are cosmetics, vape pens, pills and, of course, the extract itself; there are even CBD-containing sexual lubricants for women which aim to reduce pelvic pain or enhance sensation. CBD has been hailed by some users as having cured their pain, anxiety, insomnia, depression or seizures, and it’s been touted by advertisers as a supplement that can treat all of the above and combat aging and chronic disease.
As Executive Director of the UCLA Cannabis Research Initiative, I’m dedicated to unearthing the scientific truth — the good and the bad — behind cannabis and CBD. My interest was sparked in 2014 when I was a medical student at UCLA, and I discovered a parent successfully treating her child’s severe epilepsy with CBD. I was surprised and intrigued. Despite California legalizing medical cannabis in 1996, we weren’t taught anything about cannabis or CBD in med school. I did research and found other families and children like Charlotte Figi reporting success with CBD, and I knew it was something that needed to be investigated. I established Cannabis Research Initiative in the fall of 2017, and today we have more than 40 faculty members across 18 departments and 8 schools at UCLA working on cannabis research, education and patient-care projects.
So what exactly is CBD and where does it come from? CBD is short for cannabidiol, one of the compounds in the cannabinoid family which, in nature, is found only in the cannabis plant (its official scientific name is Cannabis sativa l.). THC — short for tetrahydrocannabinoid — is the other highly abundant cannabinoid present in cannabis that’s used today. THC and CBD exert their effects in part by mimicking or boosting levels of endocannabinoids, chemical compounds that are naturally produced by humans and found throughout our bodies. Endocannabinoids play an important role in regulating mood, memory, appetite, stress, sleep, metabolism, immune function, pain sensation, and reproduction.
Despite the fact that they’re both cannabinoids found only in the cannabis plant, THC and CBD are polar opposites in many ways. THC is intoxicatingand responsible for the “high” of cannabis, but CBD has no such effect. THC is addictive; CBD is not addictive and even appears to have some anti-addictive effects against compounds like opioids. While THC stimulates the human appetite, CBD does not. There are areas where they overlap — in preliminary animal studies, THC and CBD exhibit some similar effects, including pain-relieving and anti-inflammatory properties and anti-oxidant and neuroprotective effects. In some early research, they’ve even shown the ability to inhibit the growth of cancer cells, but years of rigorous studies need to be conducted before we’ll know whether they have the same impact on humans.
Even though humans have been using cannabis for thousands of years, the products available today are not the cannabis that has traditionally been consumed. After cannabis was prohibited at the federal level in 1970 by the US Controlled Substances Act, illicit growers were incentivized to breed strains that had higher amounts of THC, so they could increase their profits without needing larger growing spaces. What they didn’t know was that by driving up THC content, they were dramatically reducing the CBD content. In 1995, after decades of surreptitious breeding, the ratio of THC to CBD was ~15:1, and by 2014 the ratio had jumped to ~80:1 as CBD content further plummeted.
Due to decades of research restrictions in the US and growers’ focus on THC, there are very few human studies that look at CBD and its effects. The strongest evidence we have is that CBD can reduce the frequency of seizures in certain rare pediatric disorders — so much that a CBD-based drug called Epidiolex was FDA-approved in 2018 for this purpose. There is also preliminary human data from small clinical trials with dozens of subjects that suggests CBD may have the potential to be used for conditions like anxiety, schizophrenia, opioid addiction, and Parkinson’s disease. But please note that the participants in these studies generally received several hundreds of milligrams of CBD a day, meaning the 5mg to 25mg of CBD per serving in popular CBD products may likely be inadequate. And even if you took dozens of servings to reach the dosage used in these clinical trials, there is still no guarantee of benefit because of how preliminary these findings are.
But while there is a lack of concrete and conclusive evidence about CBD’s effects, there is considerable hope. Recent legislative changes around hemp and CBD in the US and across the world have enabled numerous human clinical trials to begin, investigating the use of CBD for conditions such as autism, chronic pain, mood disorders, alcohol use disorder, Crohn’s disease, graft-versus-host-disease, arthritis and cancer- and cancer-treatment-related side effects such as nausea, vomiting and pain. The results of these studies should become available over the next five years.
Furthermore, in an effort to protect consumers, the FDA has announced that it will soon issue and enforce regulations on all CBD products. Buyers should beware because the products being sold today may contain contaminants or have inaccurately labelled CBD content — due to the deluge of CBD products on the market, government agencies haven’t been able to react quickly enough so there is currently no regulation in the US whatsoever on CBD products.
While CBD appears to be generally safe, it still has side effects. In children suffering from severe epilepsy, high doses of CBD have caused reactions such as sleepiness, vomiting and diarrhea. However, we don’t know if this necessarily applies to adults using CBD because these children were very sick and on many medications, and the equivalent dose for an average 154-pound adult would be a whopping 1400 mg/day. And while CBD use in the short term (from weeks to months) has been shown to be safe, we have no data on what side effects might be present with chronic use (from months to years).
Right now, the most significant side effect of CBD we’ve seen is its interaction with other drugs. CBD impacts how the human liver breaks down other drugs, which means it can elevate the blood levels of other prescription medications that people are taking — and thus increase the risk of experiencing their side effects. And women who are pregnant or who are expecting to be should be aware of this: We don’t know if CBD is safe for the fetus during pregnancy.
So where does this leave us? Unfortunately, outside of certain rare pediatric seizure disorders, we scientists do not have solid data on whether CBD can truly help the conditions that consumers are flocking to it for — conditions like insomnia, depression and pain. And even if it did, we still need to figure out the right dose and delivery form. Plus, CBD is not without side effects. Here’s the advice that I give to my friends and family: If you’re using CBD (or thinking about using it), please research products and talk to your doctor so they can monitor you for side effects and interactions with any other drugs you take.
So is CBD a panacea or a placebo? The answer is: Neither. CBD is an under-investigated compound that has the potential to benefit many conditions. While it does have side effects, it appears as if it could be a safer alternative to highly addictive drugs such as opioids or benzodiazepines. And thanks to a recent surge in research, we’ll be learning a lot more about its capabilities and limits in the next five years.
Watch his TEDxPershingSq talk now:
ABOUT THE AUTHOR
Jeffrey Chen, MD , is the founder and Executive Director of the UCLA Cannabis Research Initiative where he leads an interdisciplinary group of 40+ UCLA faculty conducting cannabis related research, education and patient care. You can follow him @drjeffchen or visit his website http://www.drjeffchen.com.
New research suggests that PTSD is a normal response to common life events.
According to the National Institute of Mental Health, 7.7 million adults suffer from Post-Traumatic Stress Disorder (PTSD). Along with a surge of awareness regarding PTSD, there are also many misconceptions. For example, some believe it is only associated with war veterans, events such as 9/11, or natural disasters.
Although this diagnosis has historically been associated with military veterans who undergo multiple deployments, there are many other events that can trigger symptoms of PTSD. For example, prolonged exposure to emotional and psychological abuse (e.g., verbally abusive relationships, alcoholism, or stressful childhoods) are risk factors for developing symptoms. Some of these lingering misconceptions may be due to the fact that development and recognition of the disorder is relatively recent and has really only blossomed in the last three decades.
History
In 1980, the American Psychiatric Association (APA) formally recognized PTSD as an actual mental health diagnosis. Historically, it had been formally recognized as “shell shock” and was thought only to occur in military war veterans. Further, PTSD had historically been thought of as something that someone “gets over” over time. This may be true for some, but it isn’t for others.
Researchers continue to discover risk factors that can cause PTSD symptoms. This includes emerging research on the study of what happens in childhood and how it affects adults in their lifetime (van Der Kolk, 2014). For example, some of my clients may have grown up with “tough love” and were disciplined with physical violence by a family member or a teacher. As adults, they may suffer from trauma-related symptoms but not realize the origin of their suffering.
Many who suffer from PTSD symptoms may have behavioral consequences such as binge eating, or they may self-medicate with alcohol, drugs, gambling, or other compulsive behaviors. Equally as important as identifying PTSD symptoms is understanding that they are a natural response to overwhelming events.
PTSD symptoms are an injury. Source: Pexels
PTSD is a Mental Injury, Not a Mental Illness
Researchers argue that it is important to view PTSD symptoms as a mental injury, versus a mental illness or something pathological (Zimbardo et al., 2012). This is because PTSD symptoms are a natural reaction to a distressing event where one may have felt overwhelmed, afraid, or helpless. Historically, mental illness is pathologized as something that is “wrong” with the person, versus simply a manifestation of how most people would respond.
For example. if a person falls and cuts their leg, that would be an injury. Bleeding could occur, which would be a symptom of the injury; the amount of bleeding would be based on the severity of the wound, previous injuries, etc. Similarly, PTSD symptoms may manifest into problems with concentration, angry outbursts, sleep disturbance, sadness, anxiety, and even nightmares. These are natural responses to overwhelming circumstances, whether they are obviously traumatic to most (war, natural disasters) or less obvious to most people.
Obvious vs. Less Obvious Trauma
Researchers state that forms of trauma can be categorized into obvious and less obvious trauma. Obvious traumas include war, childhood abuse and neglect, sexual assault, rape, and natural disasters such as hurricanes. However, there are also less obvious forms of trauma that include:
Invasive medical procedures; higher risk if performed on children who may have been restrained or had chronic issues.
Falls and accidents, particularly in children or the elderly
Natural disasters like hurricanes, fires, or earthquakes
Being left alone as infants or children
Automobile accidents or whiplash
A mental health professional can formally diagnose and treat PTSD. However, some people have symptoms but do not meet the full criteria.
It may be irrelevant whether a person meets the full criteria—what matters is if symptoms are causing problems in their life. Symptoms include feelings of irritability, angry outbursts, issues with concentration and sleep, feelings of detachment from others, and nightmares of the event.
A mental health professional can formally diagnose and treat PTSD. However, some people have symptoms but do not meet the full criteria.
It may be irrelevant whether a person meets the full criteria—what matters is if symptoms are causing problems in their life. Symptoms include feelings of irritability, angry outbursts, issues with concentration and sleep, feelings of detachment from others, and nightmares of the event.
‘There is an increasing number of books on evolutionary psychology that are available on the market focused on outcomes rather than ticking off boxes. When it comes to PTSD there is no doubt that while all survivors don’t fit into the same boxes, what really matters is that they can be helped back to a place of health from where they can move forward.’
There are several treatment recommendations for PTSD, including Eye Movement Desensitization and Reprocessing (EMDR). This is a highly effective treatment used by the U.S. Department of Defense to help veterans with PTSD.
Some victims of workplace sexual harassment are reluctant to report what happened because they fear the effect on their career. For those who leave their job after experiencing harassment or assault, it can be hard to know how to approach a new job search, application, or interview process.
“It’s a challenging issue. It’s a difficult scenario that more and more people are being placed in. The main thing is to remember you’re not to blame and this situation doesn’t define you,” says Pete Church, a member of RAINN’s National Leadership Council and Chief Human Resources Officer at Avangrid, a leading sustainable energy company that operates in 24 states.
What to do during your search
“If your goal is to assess how a potential employer understands and addresses harassment in the work environment, then there’s a lot of helpful research you can do before you’re in an interview,” Church suggests. He also recommends going on Glassdoor and reading reviews of the company. Even if you don’t see specific mentions of sexual harassment in the reviews, you can learn about the company culture.
It can also be helpful to find past employees of a company you’re interested in on LinkedIn. You can reach out for a networking phone call to ask about what their experience was like, about the company culture, and if you feel comfortable doing so, why they left the organization. Approach the situation optimistically and know that most companies promote a harassment-free environment.
How to navigate the interview process
Once you’re in an interview process and asking about the company, you can ask questions that are a little more benign, but still bring you into the core of what you really want to know. These can be things like:
Tell me a little bit about the company culture?
Why might someone not feel like a good fit at your company?
Does your company do an employee survey?
How does your company show it cares about employees?
If you feel comfortable doing so during the interview process, Church suggests asking questions that avoid being personal but are still focused on sexual harassment, such as: “Unfortunately we see way too many headlines in the newspapers today about workplace violence and workplace harassment. I’m curious about what your company has in place to protect employees?”
What to say about why you left
The goal is to explain your employment story in a truthful and respectful way that doesn’t raise any red flags for a future employer. Give enough of an explanation so that they aren’t left wondering what happened. But remember, your story is yours. You’re never obligated to tell anyone more than you’re comfortable with. If you signed a non-disclosure agreement with your previous employer, you also need to be careful not to share anything that violates the agreement.
At some point in this process you’re going to be asked why you left. Practice how you want to answer this question ahead of time, either by yourself or with someone you trust, so that you don’t leave any questions or concerns in the mind of the interviewer—but in a way that doesn’t bring back too many difficult memories.
Your answer may be different if you are still employed and are looking for a new job so you can leave versus if you already left your job and are currently unemployed. Either way, it’s important that you rehearse the answer and know exactly what you’re willing and not willing to say during the interview.
“If you’re still employed, it’s best to frame your interest in the job as an opportunity you’re excited about. If you’ve already left your last job, you’ll need to explain the gap on your resume and you should never lie about this,” says Church. Instead, he suggests giving an answer that addresses any questions or concerns the interviewer may have, while not revealing anything personal about what happened. You could say something like, “It was a really difficult decision to leave the company after having been there for x number of years.” However, Church suggests focusing on what excites you about the organization where you are interviewing and how the position aligns with your interests, skills, and career goals.
How much to disclose to a possible employer
The interviewer wants to hear about how your current skills will add value to their organization. A negative experience with a previous employer doesn’t necessarily provide insight into who you are as an employee and the potential you have to add value to a new company. Negative comments about your previous employer, even when warranted, are risky. They may lead some interviewers to think think you are likely to say negative things about your new employer in the future. The safest approach is to avoid saying negative things about your previous employer.
How to deal with reference checks and retaliation
Many people who have experienced harassment or assault in the workplace wonder how this will impact future reference checks. “Though most companies are only required to verify dates of employment and title, if you’re worried about retaliation or malicious behavior, it’s best to proactively provide a list of references you’ve chosen who would be appropriate for a potential employer to call,” says Church.
If you feel that everyone at your previous company could be a liability as a reference, then you don’t have to list them. You can give a list of references including past mentors, organizations you’ve volunteered with, etc. If asked why you cannot give your previous employer as a reference, you can say something like: “I left voluntarily because it was not a great culture fit. I loved the work I was doing, but my experience there was not ideal and I’m not confident that they would give the best summary of my job performance.”
A company’s culture is defined not by moments of the worst thing that happened, but by how the company responds once they know about it. Learn more about the work RAINN’s consulting services team does every day to help companies and organizations improve their prevention and response practices.
Essential oils can be used to soothe and help heal many ailments, and they are a great resource for relieving pain. Specific oils treat certain types of pain naturally without causing uncomfortable side effects that sometimes come with medications. Here we’ve broken down which oils are best to use when targeting each type of pain. Make sure to properly dilute the essential oil with a carrier oil before applying to skin.
TMJ
Wen dealing with jaw point pain, combine wintergreen and lavender essential oils to utilize the analgesic effects and help ease muscle tension.
NECK AND SHOULDER
This pain often stems from strain or prolonged sitting. Try using chamomile, lavender, and frankincense essential oils for their anti-inflammatory benefits.
NERVE
To help ease nerve pain, it’s best to use essential oils with anti-inflammatory properties to reduce swelling, such as eucalyptus essential oil.
BACK
This type of pain can stem from various causes like inflammation or menstral cramps and it’s ideal to use ginger, wintergreen, thyme, or lavender essential oils for relief.
HIP
To naturally reduce inflammation and increase blood flow, apply a combination of lavender, frankincense, and wintergreen essential oils.
LEG
Weather growing pains or extended use fatigue, try rosemary essential oil to reduce swelling and wintergreen essential oil to increase blood flow.
KNEE
Rosemary, wintergreen, ginger, and frankincense essential oils are best for treating swollen knee joints.
*DON’T FORGET TO USE A CARRIER OIL TO PROPERLY DILUTE
Mix together the sea salt and the grapeseed oil in a bowl or jar. Add essential oils, and mix well. Transfer to a jar for storing or gifting. As you use the scrub, the oil and salt may separate: give a quick stir before using it. To use, gently massage a bit of the salt scrub onto wet skin using a circular motion. Rinse with warm water.
Notes:
Citrus essential oils can cause possible skin sensitivity, particularly in sunlight.
If you’re pregnant or taking prescription medications, please consult your physician before using essential oils.
When I ask a group of participants to think of all the words associated with someone who has mental illness here’s what I get: crazy, looney, nuts, attention seeking, dangerous, violent, etc. Then I ask the question what are words you hear about a cancer survivor. Those words are: hero, warrior, brave, strong, etc. Then […]
Keep speaking out. My personal path into patient advocacy began with speaking at conferences about my struggle with complex regional pain syndrome, and, then, writing a book about it. But I know first-hand that speaking up isn’t easy–it can leave you feeling vulnerable and exposed, and it requires your already-limited energy and time. That’s why I’m so grateful to each pain warrior who has participated in our #LetsTalkAboutPain campaign. Whether commenting on a Daily Challenge post on social media, sharing a video as part of our Storyathon, attending an online event, or participating in any other way — your efforts make a difference. There’s one week left for Pain Awareness Month. Let’s make it count!
There are a number of things that can block your recovery from Lyme disease. If you have been on antibiotics for six to nine months and you are not getting better, there are additional steps to take. In Treatment Stuck? Try These Steps at Six Months and Beyond I describe how to move your treatment forward.
In my Seattle practice, I discovered ways to move the treatments forward of my patients. In Treatment Stuck? Try These Steps at Six Months and Beyond I describe my formula. Read and watch this article to see if effective treatments are right for you.
In Health,
Marty Ross MD Read or Watch NowSpread the Word! ShareTweetForwardQuality Matters. You can find the various supplements I use effectively in my Seattle practice at Marty Ross MD Supplements. Look Now
This is a repost from 2014 discussing a Gluten-Free diet. The information is an overview and may help if you’ve been told to start your Gluten-Free journey.
I hope this answers some of your questions and starts you on your way to less inflammation in your life.
Have a great day and always thank you for reading, I appreciate you. I love reading your comments so keep them coming.
Melinda
This week I want to give a brief overview on Gluten Free Diet and Epstein Barr Virus. Both where the top searches in last weeks post. I hope the information is helpful. The CDC is a great place to get up to date information. Have a great weekend. :) M
Gluten Free What does it mean?
My doctor follows The Mayo Clinic, Gluten-free diet: What’s allowed, what’s not. All information taken from The Mayo Clinic outline.
A gluten-free diet is a diet that excludes the protein gluten. Gluten is found in grains such as wheat, barley, rye and triticale (a cross between wheat and rye). Gluten causes inflammation in the small intestines. Switching to a gluten-free diet is a big change at first, it takes some getting used to. Many specialty grocery stores sell gluten-free foods. We shop at Whole Foods and have found a large selection of gluten-free products, including brownies. Here are some surprises I discovered. My husband eats many gluten-free products but not exclusively. The Mayo Clinic strongly warns to watch for cross contamination. An example is if one is eating gluten-free bread and the other is not, the toaster could cause cross contamination. Another contamination point is using the same utensils to cook gluten-free and non gluten-free. Yes, it is that detailed. Be careful with grains such as oats which can get contaminated with wheat during the growing and processing. I treated myself to ham lunch meat and cheese last week. Wrong, no processed meats. You have to look for vitamins and medicine that use gluten as a binding agent. Remembering all this information is why I have started eating only items marked gluten-free. I don’t want to work that hard. A gluten-free diet helps people with Lyme Disease to reduce inflammation in the body.
Epstein Barr Virus
The information is from The Center for Disease Control. Epstein-Barr virus (EBV), also known as human herpesvirus 4, is a member of the herpes virus family. It is one of the most common human viruses. EBV is found all over the world. Most people get infected with EBV at some point in their lives. EBV spreads most commonly through bodily fluids, primarily saliva. EBV can cause infectious mononucleosis, also called mono, and other illnesses. After you get an EBV infection, the virus becomes latent (inactive) in your body. In some cases, the virus may reactivate. This does not always cause symptoms, but people with compromised immune systems are more likely to develop symptoms if EBV reactivates.
EBV is spread by saliva through: Using the same eating utensils, toothbrushes, sharing drinks and food, kissing and having contact with toys children have drooled on
The first time you get infected with EBV (primary EBV infection) you can spread the virus for weeks and even before you have symptoms. Once the virus is in your body, it stays there in a latent (inactive) state. If the virus reactivates, you can potentially spread EBV to others no matter how much time has passed since the initial infection.
General challenges:
The neuropathy in legs and hands is like getting stabbed with big needles. My hands and legs go to sleep very quickly while sitting down.
The fatigue has taken its toll the past four days. I have spent more time sleeping than awake. Today is the first time I’ve felt good in a week.
I have revolted against the supplements this week. With my sleep schedule it wasn’t worth trying to keep up..
The blinding headaches are a daily occurrence, the pain meds help, not crazy about taking pain pills. I will get well and don’t want a drug habit to break. After starting antibiotic treatment in a couple of weeks, may change my mind.
The edema causes my ankle bone to disappear and legs tight up to shin. Anything I bump into leaves a huge bruise.
The lab work did show Chronic Lyme Disease which means I’ve had Lyme for a year or more. I have to wait until 9/17/14 to get the complete run down.
I still have several test to complete for the Cardiologist. Didn’t do well on the pulmonary part of stress test. One breathing exercise only scored 55%.
From Mary Frances McFadden, Jackson Township, New Jersey
Basic Salad Dressing
Ingredients:
1/2 cup water
1/4 cup apple cider vinegar or white vinegar
1 teaspoon white sugar
1/4 teaspoon salt
Pinch of black pepper
1 teaspoon celery seed
Fresh herbs of your choice (parsley, rosemary, thyme, dill or other)
Cucumber Salad
Peel one or two cucumbers and slice into rounds. Use English cucumbers or peel if skin is tough. Place in bowl. Throughly mix or shake ingredients for dressing and pour over cucumbers. Chill well in refrigerator before serving.
Cole Slaw
Peel and grate two carrots and one half green cabbage and place in bowl. Pour dressing over bowl and refrigerate.
Looking for the Light 