Chronic Pain Alters DNA

The team of researchers led by Prof. Laura Stone at McGill University recently found that 6 months after inflicting nerve injuries on mice, the mice still displayed signs of skin hypersensitivity and motor impairment. This was associated with epigenetic changes in the amygdala and prefrontal cortex of the brain. Epigenetics explains how genes can be switched on and off. It’s the study of mechanisms by which the environment controls gene activity. Interestingly, the DNA changes were reversed by placing the mice in a more stimulating environment (three mice per cage, a running wheel mounted on a plastic hut and marbles). Whereas, placing the mice in an impoverished environment (one mouse per cage in the absence of a running wheel, marbles or any other forms of enrichment) didn’t restore normal DNA. DNA changes were found to correlate to hypersensitivity. In other words, placing the mice in a stimulating environment helped decrease their pain.

Long-term Use Of Opioids Lowers Testosterone Levels

A recent study by Rubinstein et al. published in The Clinical Journal of Pain has shown that long-term use of opioid painkillers by men is associated with lower levels of testosterone. This effect is much more prevalent when using long-acting opioids. Low testosterone or hypogonadism, as it’s also known, has been linked with decreases in muscle mass, bone density, cognition, mood, sex drive and general quality of life.

Lighting Up At Night?

A new study led by Samer Hattar at John Hopkins University has found that prolonged exposure to bright light at night affects the brain’s centre for mood, memory and learning. This can result in depression and lower mental function. His advice is to “switch on fewer lamps, and stick to less intense light bulbs”.

Nutritional Supplements For Joint Disorders

Osteoarthritis (OA) is a common source of joint pain, stiffness and swelling. It’s a leading cause of chronic disability and affects about 8 million people in the UK and 27 million in the US. OA leads to the gradual degeneration or wear and tear of joint surfaces and is often the cause of knee and hip replacements. Can nutritional supplements prevent or slow down the process? In my opinion, supplements can be separated into 2 groups: those that decrease inflammation and those that promote the regeneration of joint surfaces. I’d like to focus on the latter.

For quite a while, glucosamine, chondroitin and methylsufonylmethane (MSM) have been used to treat osteoarthritis.

Glucosamine

Glucosamine contains glycosaminoglycans which are a major component of joint cartilage. The glucosamine that is available commercially is derived from the exoskeleton of shellfish. Although inconsistent results have been reported, in 2009, a team at the University of Aberdeen led by C Black reviewed the literature on the clinical effectiveness of glucosamine in slowing or arresting the progression of OA of the knee. Only trials that met stringent criteria were used. They found that there were ‘statistically significant improvements in joint space loss, pain and function for glucosamine sulphate and in 2 studies the need for knee arthroplasty (replacement) was reduced from 14.5% to 6.3% at 8 years follow-up’ . Another study found ‘a 50 % reduction in the incidence of osteoarthritis-related surgery of the lower limbs during a 5-year period’. In 2007 a the WHO Collaborating Center for Public Health Aspect of Osteoarticular Disorders at the University of Liege conducted a review of published studies that concluded that ‘glucosamine sulphate (but not glucosamine hydrochloride) and chondroitin sulphate have small-to-moderate symptomatic efficacy in OA, although this is still debated. With respect to the structure-modifying effect, there is compelling evidence that glucosamine sulphate and chondroitin sulphate may interfere with progression of OA’ . In other words, there is compelling evidence that glucosamine sulphate and chondroitin sulphate prevent joint space narrowing by promoting the regeneration of articular cartilage. Almost all trials have found the safety of glucosamine sulphate and chondroitin sulphate to be equal to placebo.

Chondroitin

Chondroitin is also a glycosaminoglycan and a component of joint cartilage. Commercial chondroitin is derived from the cartilage of cows, pigs, shark, fish or birds. See above for results of research.

MSM

MSM occurs naturally in many primitive plants and in many foods and beverages. The mechanism of its action is uncertain but sulphur is thought to play a part. A literature review of MSM in the treatment of OA by a team at the University of Southampton showed that there was ‘positive but not definitive evidence that MSM is superior to placebo in the treatment of mild to moderate OA of the knee’. Last year an Israeli team led by EM Debbi published a study showing that, after taking MSM for 12 weeks, there was a small improvement in pain and physical function in patients with radiographic confirmed knee OA.

Recently ESM Technologies has funded research on the benefits of eggshell membranes. The eggshell membrane is just underneath the shell and surrounds the egg white. It’s interesting to note that in general, commercially funded trials show larger effects than industry independent trials.

Eggshell Membrane

Eggshell membrane or Natural Eggshell Membrane (NEM) as it is also known contains glucosamine, chondroitin and hyaluronic acid (also a glycosaminoglycan found in joints). In 2009, two papers were published (Journal of Clinical Interventions in Aging and Clinical Rheumatology) on the use of eggshell membrane to treat joint and connective tissue disorders. Both studies were led by Kevin Ruff and sponsored by ESM Technologies. The results were extremely encouraging and showed statistically significant improvements in pain, stiffness and flexibility. The positive results may be due to better bioavailability of joint sustaining compounds from eggshell membranes or possibly to researcher bias due to vested interests. This year, a study by the same author looked into the safety of NEM and concluded that it was safe for human consumption. Hopefully this will lead to independent research to look at the efficacy of NEM supplementation for joint disorders.

As we can see, there are several nutritional supplements that can aid the regeneration of joints. Here are the recommended daily dosages:

• Glucosamine Sulphate 1500 mg/day
• Chondroitin Sulphate 1200 mg/day
• NEM 500 mg/day

Exercise And Testosterone Help Nerves Heal

A study by Arthur English and Nancy Thompson has found that exercise can promote the regeneration of peripheral nerve injuries. In both males and females, the effect requires the assistance of androgens such as testosterone.

Acupuncture Helps Nerves Regenerate

Several experiments have been conducted on animals to study the effects of acupuncture or electroacupuncture on nerve injuries. Here are some of the results and conclusions:

• acupuncture increases the survival of damaged neurons
• electroacupuncture increases the number of nerve fibres
• electroacupuncture increases axon density and blood vessel area
• electroacupuncture improves nerve conduction speed
• electroacupuncture improves the function of de-innervated muscle tissue

So those are the effects on rats, rabbits and frogs…but what about humans? Well, a study conducted in Germany at the Heildelberg School of Chinese Medicine and published in the European Journal of Neurology showed some promising results. Forty seven patients with peripheral neuropathies of unknown cause were assigned to either an acupuncture group or a control group (the control group received the best medical care but no specific treatment for peripheral neuropathy). The patients were evaluated over a year by nerve conduction studies.

Over three-quarters of the acupuncture group improved. These results are even more impressive when we realise that the natural progression of the neuropathies, as shown by the control group, was one of gradual deterioration.

The overwhelming data suggests that acupuncture can help promote nerve regeneration and this remains true whether the nerve problem results from injury or some undefined cause.

Chronic Pain And Emotion

Professor Apkarian has studied chronic pain for over 20 years. In a recent study looking into people with recent back pain, he was able to predict with 85% accuracy those that would go on to develop chronic back pain! How? By noticing an increased level of cross-talk between two specific parts of the brain…suggesting that the more emotionally the brain reacts to the injury…the greater the likelihood of developing chronic pain. The researchers also found that the subjects that developed chronic back pain lost grey matter density…this is in accord with earlier studies that have measured brain atrophy in people with chronic pain. These changes can be compared to those that occur with aging.

10-20-30 Training

Jens Bangsbo and Thomas Gunnarsson from the University of Copenhagen have published the results (Journal of Applied Physiology) of a fascinating study comparing the effects of interval training to regular endurance training. A group of moderately trained runners was split into 2 groups: over a 7-week period the control group continued their normal runs and the interval group replaced their usual runs with the 10-20-30 protocol.

The 10-20-30 protocol consisted of a 1km warm-up followed by 3-4 5 min blocks of interval training. Each block was followed by 2 min of recovery. The interval training was made of low, moderate and high-speed running (<30%, <60% and >90% of maximal intensity) for 30, 20 and 10 sec respectively.

Although the total training volume in the interval group was less than half that of the control group (14 km/week vs 30 km/week), it produced some amazing results. At the end of the study, the 10-20-30 group increased their VO2 max (maximal oxygen consumption) by 4% and improved their 1500 m and 5 km runs by 21 sec and 48 sec respectively. In addition to this, they significantly decreased their systolic blood pressure, total cholesterol and LDL cholesterol levels.

So despite a 50% reduction in training volume, 10-20-30 interval training improves the performance and health of trained runners.

Pain: how much is in the mind?

A study by Luis Buenaver and colleagues published in the June edition of Pain has shown some fascinating links between pain, thinking and sleep. It’s already known that about 80% of people with chronic pain experience troubled sleep and that poor sleep increases pain sensitivity. It is also known that pain catastrophizing is a contributor to chronic pain. Catastrophizing is a combination of rumination and negative thinking. What Buenaver and his colleagues discovered was a direct link between pain catastrophizing, poor sleep and worsening pain…a vicious cycle…the more often you think negatively about your pain experience…the more your sleep is disrupted…the worse your pain becomes…which in turn adversely affects your thoughts, etc.

Another piece of research published in this month’s Current Biology by Christian Sprenger et al. demonstrates that mental distraction techniques can decrease pain sensations by inhibiting incoming pain signals in the spinal cord. The effect was found to be partly mediated by endorphins.

In essence, people with chronic pain can improve their sleep and comfort by choosing to focus on pleasant activities or goals rather than brood gloomily over their pain.

To change the way we feel we must change the way we think!

Acupuncture May Prevent Muscle Wasting

A study by Akiko Onda et al. published in Biochemical and Biophysical Research Communications has concluded that “acupuncture can partially prevent skeletal muscle atrophy”. It helps recover skeletal muscle mass and cross-sectional area possibly by increasing protein synthesis and decreasing protein degradation. Although the experiment was performed on mice, it was hypothesised that acupuncture could be used to prevent muscle wasting in the elderly and in patients with “severe conditions”.