Why Is Calcific Tendinitis So Painful?

There are a couple of shoulder conditions that can be extremely painful. One is adhesive capsulitis, better known as frozen shoulder, and the other is calcific tendinitis. Calcific tendinitis is characterised by the formation of calcium deposits in the rotator cuff tendons of the shoulder. A few months ago Hackett et al from the University of New South Wales published the results of a study that could explain why calcific tendinitis is so painful. Their findings are published in The Journal of Bone & Joint Surgery.

They concluded that there was “a significant increase in neovascularization and neoinnervation in calcific tendinitis lesions of the shoulder along with an eightfold increase in mast cells and macrophages. The findings are consistent with the hypothesis that, in calcific tendinitis, the calcific material is inducing a vigorous inflammatory response within the tendon with formation of new blood vessels and nerves”.

Persistent Pain Associated With DNA Changes In Brain And Immune Systems

Renaud Massart et al from McGill University have recently published an article in Scientific Reports on the effects of chronic pain on the body. “Chronic pain” is pain that has lasted for 6 months or more. The study was performed on rats with induced nerve injuries.

The results showed epigenetic changes in the DNA of the prefrontal cortex and in the DNA of T cells. Their findings support the notion that persistent pain affects multiple biological systems. It’s possible that future research will show changes to other systems as well.

Bright Light Effective for Depression

The use of bright light therapy to treat seasonal affective disorder (SAD) is well documented and evidence based but I had never heard of using light therapy to treat nonseasonal major depressive disorder (MDD). Raymond Lam et al, from the Department of Psychiatry at the University of British Columbia, designed an elegant study comparing the effects of light therapy, drug treatment (Fluoxetine), combination therapy (light plus drug) and sham-placebo in adults with nonseasonal depression. Their study was published this month in JAMA Psychiatry.

Treatments were given daily for 8 weeks (the light therapy consisted of a 30 min early morning exposure to a 10,000-lux fluorescent white light box) and depression ratings were taken at baseline and at the 8-week end point. Interestingly, the drug antidepressant did not perform any better than the placebo. Both the light therapy and combination therapy showed significant clinical benefit. The combination therapy had the most consistent effects.

The news that light therapy is effective for both SAD and nonseasonal depression means that there is now a new way of treating depression that has few if any side effects. For more stubborn cases a combination of light and drugs can be used or maybe even a combination of light and cognitive behavioural therapy (CBT).

Tai Chi And CBT Decrease Inflammation

Poor sleep has been linked to increased inflammation. Inflammation is known to cause or exacerbate musculoskeletal disorders as well as more serious diseases such as heart disease, stroke and cancer. Irwin and his colleagues conducted a randomised controlled trial looking into the effects of cognitive behavioural therapy (CBT) and Tai Chi on the inflammatory markers of subjects with insomnia. The participants were offered 2 hour weekly sessions for 4 months.

CBT was found to reduce systemic inflammation whereas Tai Chi reduced cellular inflammatory responses. Both interventions reduced the expression of genes encoding proinflammatory mediators.

High Cholesterol Linked To Tendon Problems

A group of Australian researchers have conducted a systematic review of literature to find articles that looked at the relationship between fat levels in blood and tendon pathology and/or pain. Their results were published in the British Journal of Sports Medicine. They found that people with altered tendon structure or tendon pain had significantly higher total cholesterol, low-density lipoprotein cholesterol (“bad cholesterol”) and triglycerides, as well as lower high-density lipoprotein cholesterol (“good cholesterol”).

The researchers conclude that although a relationship exists between an individual’s lipid profile and tendon health, further longitudinal studies are required to determine whether it is a cause and effect relationship.

Interestingly, the results of the China Study, one of the most comprehensive studies of nutrition ever conducted, found that one of the best predictors of diseases of affluence (heart disease, diabetes, cancer, etc.) was blood cholesterol.

Positive Emotions Improve Health-Related Behaviours

Positive psychological states have been linked to better health and longevity. It’s believed to be partly due to the effect of positive emotions and moods on behaviour. Nancy Sin and her colleagues from the university of Penn State evaluated 5-year associations between positive affect and health behaviours in patients with coronary heart disease.

At baseline, they found that subjects with higher positive emotions and moods tended to have better health behaviours such as: physical activity, sleep quality, non-smoking and medication compliance. However, the baseline measurements of positive affect were not predictive of health behaviours at follow-up. Instead, it was increases in positive affect over the 5 years that were linked to improved physical activity, sleep quality and medication compliance.

The authors conclude that “efforts to sustain or enhance positive affect may be promising for promoting better health behaviours”. Although this may be easier said than done, positive psychology does offer methods and techniques to help achieve this aim.

Bedtime Affects Weight

A group of researchers from Berkeley and Columbia University looked at the relationship between bedtime and weight gain in young people. Their findings have been published in the journal Sleep. They followed over 3000 adolescents between 1994 and 2009. They found that a later bedtime during the workweek was associated with an increase in body mass index (BMI) over time. Even after controlling for sleep duration, screen time and exercise, the relationship was not attenuated. However, fast-food consumption was recognized as a mediator of the relationship. To summarise, if we want to keep off excess pounds we should get to bed earlier and obviously keep away from fast food!

Yoga Helps People With Arthritis

A group of researchers from McGill University looked at the effects of yoga on people with arthritis. Their findings were published in The Journal of Rheumatology. 75 sedentary adults with either rheumatoid arthritis or knee osteoarthritis and with a mean age of 52 years were randomly assigned to a yoga group or a waiting list. The yoga group took part in two 60 min classes and one home practice each week for 8 weeks duration. Yoga poses were modified to suit individual requirements.

Significant improvements were noted in physical, pain, general health, vitality, and mental health scales with most benefits still evident 9 months later. The researchers conclude that this new evidence suggests yoga may help sedentary individuals with arthritis safely increase physical activity, and improve physical and psychological health.

Why Do Statins Sometimes Cause Muscle Problems?

Statins are widely used to lower cholesterol and reduce the risk of cardiovascular disease. Like a lot of drugs, statins come with some side effects. Myopathy, in the form of muscle weakness, pain and cramps is one of the most important adverse effects. A group of researchers from Radboud University Medical Center in the Netherlands may have found out why statins can sometimes cause muscle problems. Their findings are published in this month’s issue of Cell Metabolism.

They found that statins can significantly inhibit mitochondrial (complex III) activity. This effect is primarily from statin lactones rather than the acid forms. These findings could lead to new classes of cholesterol-lowering drugs without the unwanted muscle effects.

Tomatos May Trigger Gout Fare-Ups

Apparently tomatoes are the 4th most mentioned trigger for gout flare-ups after seafood, alcohol and red meat. This is according to a group of researchers from the University of Otago in New Zealand. They have published a new paper in BMC Musculoskeletal Disorders that may have found a biological basis to substantiate the claim. The study revealed a positive association between the consumption of tomatoes and blood urate levels.