Heat waves steal headlines for their deadly spikes, but, globally, more deaths are caused by the cold than heat. When it comes to heat, our bodies do a pretty good job of regulating our core temperature without any help. But when the temperature drops, even to a mild 60 degrees F, our bodies rely on heaters and extra clothes. This human weakness is especially dangerous in subzero temperatures, where a few minutes in wet clothing or little clothing can cause severe hypothermia or even death if left untreated. Tragically, this past week nine Wisconsinites lost their lives to hypothermia.
Doctors divide hypothermia into three stages: mild, moderate, and severe. But what we call mild hypothermia is a already drop in the body temperature below 95 degrees F (normal body temperature is about 98.6) and not actually very “mild.”
Unlike heat stroke or other problems with high temperature, mild hypothermia has more subtle symptoms. You might just feel off or slow, have some memory loss and confusion, or feel angry and become combative. You also might notice the skin on your belly or inner thigh feeling cooler, and even if you don’t notice this, your brain will detect the low temperature and start sending signals to make heat by shivering.
Shivering jacks up your metabolism 4 to 6 times, so it costs a lot of energy and isn’t a good long-term solution. Your breathing and heart rate speed up to help fuel the shivering and also to make sure the rest of your organs are getting enough oxygen. But once the core body temperature gets below 91.5 degrees F, your brain starts to malfunction. This is known as the “transition zone.” Everything starts to slow down, including your heartbeat and breathing. This is a time when arrhythmias—abnormal heart beating that could lead to death—are likely to occur. It’s a very dangerous emergency that could require intensive care in the hospital.
WATCHING FOR SIGNS AND PREVENTION
If you or someone you know has been outside or in wet clothes and appears confused, is slowing down mentally and physically, and/or is shivering, take a temperature. If the temperature reads 95 degrees F or below, GET EMERGENCY HELP immediately. While you wait for help, or if the temperature is above 95, take off any wet clothing and wrap the person in warm, dry blankets. Prioritize keeping the core warm rather than the arms and legs. Do not take a hot bath as this might actually cause the temperature to drop further (known as the “after drop”). If the person is talkative or interactive, encourage drinking fluids. Do not force any drinks down if the person is losing consciousness.
For older adults, a slight decrease in temperature can be even more problematic because the body’s shivering mechanism is weaker, and the perception of cold may be less sensitive. In addition, older adults are more likely to have other medical problems that are exacerbated by slight fluctuations in temperature.
Here are three non-commercial websites with more information about hypothermia prevention and care.
For all age groups: https://www.cdc.gov/disasters/winter/staysafe/hypothermia.html
For older adults:
TREATING FROST BITE
Frostbite is when the skin or another part of the body temperature reaches 32 degrees F, literally freezing. Unlike hypothermia, frostbite should be rewarmed with warm water (99 to 104 F). Rewarming a frost bitten hand can be very painful as sensation returns to the hand.
HYPOTHERMIA AND CHRONIC PAIN
Some patients with chronic pain sense that things are worse when there is a sudden temperature change. And in the winter they seem to be extra sensitive to cold air. Well, a research team in Australia was interested in looking at this topic and asked the question: do chronic back pain suffers have a lower threshold for pain from cold or heat than other people without low back pain?
Turns out that pain sensitivity from cold stimulation may be worse in those patients with chronic low back pain when compared with patients with no chronic pain. By using a cold stimulus that gradually got colder, a thermometer, and a button, subjects would push when they wanted the pain to stop, researchers measured the difference in cold pain tolerability. When the cold stimulus was on their arm, subjects with chronic back pain asked to stop the cold stimulus at 57 degrees F, on average, while subjects without low back pain averaged at 46 degrees F. And this difference was statistically significant.
The above does not constitute professional medical advice. Please contact your doctor or health care provider for personal medical attention. Seek immediate medical help for anyone with suspected hypothermia or frostbite. Call 911 if you suspect severe hypothermia or notice any change in mental alertness.
Angelie Singh, MD, MPH, MS
,At Spine Pain Diagnostics Associates, we stay current on the latest FDA updates. We want our patients to be as educated as possible, so we often post helpful articles that will keep you up to date. Recently, the FDA announced that it is requiring class-wide changes to drug labeling for opioid medications, including opioid-containing cough suppressants and benzodiazepines, a class of central nervous system (CNS) depressant drugs.
The FDA is requiring boxed warnings—its strongest warning—and Medication Guides for 389 separate prescription opioid analgesics, opioid-containing cough medications, and benzodiazepines, which must include information about the serious risks associated with using these medications together, including extreme sleepiness, respiratory depression, coma, and death.
The FDA reviewed data about the use of these products and found that physicians have been increasingly prescribing opioids and benzodiazepines together, which has proven to be a lethal combination. In addition, from 2004 to 2011, the rate of emergency department visits involving nonmedical use of both drug classes increased significantly, with overdose deaths nearly tripling.
The labeling changes will affect both branded and generic products, according to FDA Commissioner Robert Califf, MD.
This action is one of several steps the FDA is taking as part of the agency’s Opioids Action Plan, which focuses on policies aimed at reversing the U.S. prescription opioid abuse epidemic, while still providing patients in pain access to appropriate pain treatments.
Opioid analgesics are powerful pain-reducing medications that include prescription oxycodone, hydrocodone and morphine, among other drugs. Certain other opioid medications are also approved to treat coughs.
Benzodiazepines are drugs typically prescribed for the treatment of neurologic and/or psychological conditions, including anxiety, insomnia, and seizure disorders. Both classes of drugs depress the central nervous system and, each has unique pharmacology, safety risks, and labeling information related to its use.
The FDA’s actions are consistent with the clinical guidelines released by the Centers for Disease Control and Prevention, and existing label warnings for prescribers regarding prescribing opioids and benzodiazepines to avoid potential serious health outcomes.
Adapted from: Pain Medicine News, FDA Requires Strong Warnings for Opioids and Benzodiazepines, Marie Rosenthal and Martin Leung. September 1, 2016. <http://www.painmedicinenews.com/Web-Only/Article/09-16/FDA-Requires-Strong-Warnings-for-Opioids-and-Benzodiazepines/37809>
Other articles and information you may find helpful.
Although there is no universal standard definition of a super food, super seed or superfruit, they are often described as providing a number of nutrients and health benefits all in one package. Linda Milo Ohr writes about six seeds and superfruits that fit the bill for consumers' desire for natural, minimally processed foods. Here are six super foods that will help you feel more like a superhero when added correctly to your diet.
1. Chia Seeds: Chia seeds are often used in yogurt, homemade trail mixes, baked goods, commercial nutrition bars, beverages and snacks. They are high in omega-3 fatty acids, calcium, phytonutrients, vitamins, minerals and antioxidants.
2. Flaxseeds: Flaxseeds are a good source of protein, fiber, antioxidants, and phytoestrogens in the form of lignans and omega-3 fatty acids. A study has also linked eating ground whole flaxseed to lowering blood cholesterol (Health Canada, 2014).
3. Sunflower Seeds: Often considered a traditional ballpark snack, sunflower seeds provide monounsaturated and polyunsaturated fats, protein, fiber, vitamin E, and phytochemicals like choline, lignan, phenolic acids and betaine (Phillips, 2005).
4. Tart Cherries: Tart cherries are high in anthocyanin and have high antioxidant activity. Reported benefits include enhanced sleep, anti-inflammation in arthritis and gout, and sports recovery.
5. Avocados: More than just the main ingredient in guacamole, avocados have beneficial effects on cardio-metabolic risk factors that extend beyond their heart-healthy fatty acid profile (Wang, 2015). In a study of 45 overweight or obese subjects who ate a moderate-fat diet including an avocado daily had lower bad cholesterol than those on a similar diet without the avocado or those on a lower-fat diet (American Heart Association, 2015).
6. Cranberries: Cranberries have long been associated with benefiting urinary tract health but have also shown to benefit heart health, cancer prevention, oral health, and glycemic response (Cranberry Institute, 2014).
Do these superfoods prevent pain? Not necessarily, but a healthy strong body can help us avoid injury, heal more quickly if we are injured and help us deal more effectively with the pain we may have. Try adding some superfoods in your diet. If you feel we might be able to help you manage your pain, we invite you to request an appointment.
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Watch the Pain Free TV Episode on Compression Fractures
Click below and scroll to the bottom episode. ( You can watch the others too.)
Ladies, that pain in your neck may not be from stress at work or home like you think it is. According to a study from Loyola University Health System in Chicago, women are 1.38 times more likely than men to report neck pain due to cervical degenerative disc disease.
The study was presented at an annual meeting of the American Academy of Pain Medicine in Palm Springs, California.
The findings add to the growing body of research on the differences in which men and women experience pain. Previous studies have found that females are more likely to be treated at pain clinics for chronic pain and that certain painful conditions, such as migraine headaches and fibromyalgia, are more common in women. Various explanations have been proposed, including hormonal differences and the belief that men may be less willing to report pain.
Cervical degenerative disc disease is a common cause of neck pain. Symptoms include stiff or inflexible neck, burning, tingling, and numbness. Pain is most prevalent when the patient is upright or moving the head.
If you are having neck pain that it is persistent, you may want to contact our office to request an appointment for evaluation.
Loyola University Health System. “Women suffer more from neck pain than men.” Science Daily. ScienceDaily, 8 March 2016. <www.sciencedaily.com/releases/2016/03/160308133051.htm>.
Like these articles and interested in reading more? Click an article below or browse our website.
Watch the Pain Free TV Episode on Osteoporosis.
According to a study from the Journal of the American Medical Association, both exercise alone, and exercise and education may reduce the risk of low back pain.
The authors of the study used 23 published reports to determine these findings.
The authors report that moderate-quality evidence suggests exercise combined with education reduces the risk of an episode of low back pain. Low to very low quality evidence suggests that exercise alone may reduce the risk of both low back pain and the use of sick leave. Other interventions, including education alone, back belts, and shoe inserts do not appear to be associated with the prevention of low back pain.
Evidence suggests that exercise alone reduced the risk for a low back pain episode by 35% and reduced the need for sick leave by 78%. Additionally, exercise combined with education reduced the risk of an episode of low back pain by 45%.
While these findings are merely suggestive, it is just another reason for people of all ages to engage in exercise or moderate physical activity to maintain optimal health and potentially prevent back pain.
The JAMA Network Journals. "Exercise associated with prevention of low back pain."
Click here for a slide show of exercises for lower back pain recommended by Mayo Clinic.
More You May be Interested in from our Clinic...
When conservative treatment options have been exhausted and a patient is still suffering from pain, an interventional pain physician may consider a spinal cord stimulator for neurostimulation.
Spinal cord stimulators consist of an implantable pulse generator (IPG), which is approximately the size of a stop watch, and one or more leads (special medical wires) that deliver an electrical signal to the epidural space near your spinal cord. This signal provides pain relief by modifying (modulating) pain messages before they reach the brain.
Spinal cord stimulators are an attractive option for most patients due to the fact that the process first involves a trial period to allow the patient to test the stimulator without undergoing implantation of the device. If the patient experiences relief during the trial period, the stimulator is implanted beneath the skin. Because of the relatively small size of the device there is little concern for aesthetic consequences.
Neurostimulation can be effective for a number of conditions including radiculopathy, failed back surgery syndrome, peripheral neuropathy, complex regional pain syndrome (CRPS), pelvic pain, bladder pain, abdominal pain, leg pain, and headaches.
For years, doctors have been stating that smoking increases the risks for heart disease, lung diseases, and cancer, and have advised smokers to quit. Now, there is a new reason why putting out your cigarette is a good idea: smokers are three times more
likely than nonsmokers to develop chronic back pain.
According to a new study from Northwestern University’s School of Medicine, smoking changes the way the brain responds to pain, making smokers more susceptible to pain.
A smoker who experiences new, acute back pain is less likely to recover from that pain than a nonsmoker, and that pain is much more likely to develop into a chronic pain problem.
In addition, statistics consistently show that smokers report feeling more intense pain and anxiety than nonsmokers and have far more difficulty getting around, being alert, and getting a good night’s sleep than nonsmokers.
If you suffer from pain, whether acute or chronic, and you use cigarettes to help you cope with your pain or stress, put them away. There are better and healthier ways to manage your pain than smoking. One of the best ways is to take a walk or engage in some other kind of exercise. Exercise releases endorphins in your brain, which block pain in the same way as morphine.
If you would like to quit smoking, talk to your doctor. He or she can help you achieve your goals, and your back will thank you!
Click here to learn more about pain and smoking from WebMD
Angelie Singh, MD, MPH, MS