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The Missing Pieces to the Chronic Pain Puzzle

The Missing Pieces to the Chronic Pain Puzzle

By Dr. Kevin Wong

PAIN is a significant problem in our society, and the way too many of us deal with it, either by taking medication to temporarily relieve the pain or ignoring the pain altogether, foolishly hoping it will go away, is an even bigger problem, contributing to long-term disability and reduced quality of life. Here are a few important pieces to the puzzle that can help you deal with pain now and prevent future episodes – chronic pain- from ruining your life.

How do you feel at this very moment? You can do a easy self-check just by moving your neck, shoulders, arms and legs around. Do you have any aches and pains anywhere? If your response is, “Don’t most people have pain somewhere in their body?” or “Doesn’t pain come with old age?” keep in mind that while that’s true, it doesn’t mean you have to accept it. And remember, pain isn’t just physical. The emotional stress it creates can be as hard on you as the pain itself. Let’s talk about ways you can find relief from your physical pain, which will undoubtedly lighten your emotional load at the same time.

Pain Defined

Chronic pain puzzle - Copyright – Stock Photo / Register MarkPain is defined as an unpleasant sensation that can range from mild, localized discomfort to sheer agony. Pain has physical and emotional components. The physical part of pain results from nerves being stimulated. Pain may be confined to a specific area, as in an injury, or it can be spread throughout the body. Around the world, millions of people live with pain in some form or another, involving many different body parts, on a daily basis.

One of the most interesting things about pain is how each human being deals with it. Some learn to live with pain. Others can’t stand to feel even an ounce of it. The most common types of pain include arthritis, lower back, bone/joint pain, muscle pain and fibromyalgia (widespread pain, tenderness and fatigue in muscles,tendons and ligaments). Back pain is the most frequent cause of limited activities for people younger than 45 years old.

Acute vs. Chronic Pain

Acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself. This type of pain comes on quickly and can be severe, but it lasts a relatively short period of time. In general, acute pain is in response to an event that happens to the body. It may be a result of surgery or an accident.

Chronic pain is different. Chronic pain tends to stay around or progress over longer periods of time. Pain signals keep firing in the nervous system for weeks, months or even years. Oftentimes, chronic pain is resistant to traditional medical treatments. The emotional component of pain often comes into play in a chronic situation.

The Consequences of Pain

The loss of productivity and daily activity due to pain is substantial. Americans spend at least $50 billion per year on back pain, and that’s just for the more easily identified costs. Pain has a negative impact on an individual’s quality of life. It diminishes one’s ability to concentrate, do their job, exercise, socialize, perform daily tasks and sleep. Over time, this can lead to depression, isolation and loss of self-esteem. Researchers have found that depression is the most frequent psychological reaction to chronic pain.

If you hurt an area of your body and do not restore proper, healthy movement patterns, you will end up with problems later down the road. I can’t tell you how many patients I have seen who got in car accidents and hurt their neck and back, but waited to get treatment and used pain as the indicator for how they feel. Eventually, the pain went down or even away, but they were often left with problems in their bones and joints.

What Your Spine Says About Your Health

What Your Spine Says About Your Health

By Perry Nickelston, DC, FMS, SFMA

You may have heard the saying, “the eyes are the window to the soul.” There is another saying in the world of chiropractic, “your spine is the window to your health.” How can the condition of your spine divulge so much information about overall health? Your spine is the central support column of your body and its primary role is to protect your spinal cord.

Think of it like the foundational frame of a house holding everything together. If the frame becomes dysfunctional many problems will begin to manifest themselves. The house begins to develop cracks, shifts, and structural problems. When your spinal foundation becomes dysfunctional you develop aches, pains, injuries, and other health related issues. The good news is you can do a simple spinal health checklist to determine if you may benefit from the expert intervention of a chiropractor or other healthcare professional. Becoming familiar with simple spinal anatomy, structure and function will help empower you to take control of your health.

Your spine is composed of 24 bones (vertebrae); 7 in the neck (cervical spine), 12 in the middle back (thoracic spine), 5 in the lower back (lumbar spine) and the base tailbone (sacrum). Your soft spinal cord is encased inside these 24 moveable hard vertebrae to protect it from injury. Your spinal column has three natural curvatures making it much stronger and more resilient than a straight design. There are cervical, thoracic, and lumbar curves designed with precise angles for optimum function. However, these curves are different than the abnormal curves associated with scoliosis and postural distortions. You may remember getting screened in school or your doctor for scoliosis when they had you bend over and touch your toes. This was an early checklist for spinal abnormalities. Through life’s stresses, genetics, trauma, injuries, and neglect the spine can develop dysfunctions in these curvatures and the body must compensate by changing posture as a protective mechanism.

image - Copyright – Stock Photo / Register MarkWhat are some of the compensations your body develops and what can they tell you about spinal health?

Rounded Shoulders: This is a very common postural distortion resulting from more sedentary lifestyles. Hunching over in front of a computer screen hours on end simply feeds this dysfunction. This poor posture pattern adds increased stress to the upper back and neck because the head is improperly positioned relative to the shoulders. Common effects are headaches, shoulder, pain, neck pain and even tingling and numbness in the arms because of nerve compression by tight muscles.

Uneven shoulders: One shoulder higher than the other is indicative of a muscular imbalance or spinal curvature. You probably see this one on most people where one shoulder is migrating up towards the ear. Stand in front of a mirror and you can easily see if this asymmetry is present. You may also notice that one sleeve is longer than the other when you wear a shirt. This asymmetry is a common precursor for shoulder injuries, headaches, neck pain, elbow injuries and even carpal tunnel syndrome (tingling in the hands).

Uneven hips: Hips that are not level are like the foundation of a house that is not level. You begin to develop compensations further up the body so you remain balanced when walking. You develop altered spinal curvatures, shoulder positions, and head tilts. Your body has one primary purpose of maintaining symmetry and balance and it will do it whatever way is necessary. Signs of unbalanced hips may manifest in abnormal shoe wear typically on the outside edges and pants will fit unevenly in the leg length.

When you visit a chiropractor for a spinal evaluation some of the things they will search for during your evaluation are underlying signs of spinal damage that you can’t see. Spinal x-rays are a safe and effective way to get look at your spine for damage or potential problems. Just like a dentist takes an x-ray of your teeth to see if you have cavities or problems with the bones below gum line. If problems are detected, corrective or preventive measures can be implemented to help your body function at optimum.

Degenerative Disc Disease (DDD): This is not a real disease in the terms of how we think of them. DDD is term used to describe degeneration and excessive wear on the soft tissue disc structures between the spinal bones. It may come with age or from biomechanical asymmetries in movement causing excessive wear from overuse. Sort of like uneven treads on a car with imbalanced tires, one may be worse than the other. Although the degeneration cannot be reversed, once discovered there are strategies your chiropractor can implement rebalancing exercises and therapies to help prevent further damage.

Osteoarthritis: The breakdown of the tissue (cartilage) that protects and cushions joints. Arthritis often leads to painful swelling and inflammation from joints rubbing together. The increase in friction causes a protective pain response and excessive swelling where the body attempt to add artificial cushioning via swelling.

Herniated disc: A herniated disc is an abnormal bulge or breaking open of a protective spinal disc or cushioning between spinal bones. Patient’s may or may not experience symptoms with a herniated disc. Disc diagnosis is conformed via a special imaging study called an MRI (\Magnetic Resonance Imaging) which observes soft and hard tissue structures. You cannot see or confirm a suspected disc herniation via normal spinal x-rays.

Spinal stenosis: The narrowing of the spinal canal the open space in the spine that holds the spinal cord. Stenosis is a more severe form of arthritis that typically causes radiating (referred pain down the arms or legs) from an irritated or compressed spinal nerve.

If you experience spinal pain, tingling, numbness, weakness, muscles spasms or swelling near your spine or arms and legs consult a healthcare professional. These are all warning signal signs from your body that something is wrong and needs your attention. Pain is how your body communicates its function with you. A car has dashboard warning lights that tell you when the car has a problem. If you chose to ignore the signals bad things are going to happen. Your body has its own warning light system. Start checking for the warning lights. Ignore them at your own risk. See your chiropractor for a proper assessment and any concerns.

Perry Nickelston, DC, is clinical director of the Pain Laser Center in Ramsey, N.J., where he focuses on performance enhancement, corrective exercise and metabolic fitness nutrition To learn more about Dr. Nickelston, visit

Ditch the Drugs for Low Back Pain

Ditch the Drugs for Low Back Pain

By Editorial Staff

Ask someone with low back pain what they do to manage the pain, and you’ll usually get one of several responses: endure the pain or take over-the-counter pain medications. And in some cases, their doctor may have prescribed even stronger pain meds such as opioids, which have been in the news lately for all the wrong reasons.

Of course, if they’ve been to a doctor of chiropractic before, they know what not enough people know: Chiropractic is a first-line treatment option for low back pain, while OTC and other pain medications provide only short-term relief, don’t address the root cause of the pain, and have side effects that range from mild to life threatening.

Fortunately, research is proving the benefits of non-drug treatment options for LBP and emphasizing the relative lack of effectiveness / side effects of commonly used pain medications. For example, a recently updated guideline from the American College of Physicians recommends chiropractic and other nondrug options (acupuncture, massage, exercise, tai chi, heat therapy, etc.) for acute (lasting less than four weeks), subacute (lasting four to 12 weeks) and chronic (lasting longer than 12 weeks) low back pain before turning to medication. Only if these options prove ineffective should doctors consider recommending medication, according to the guideline.

low back pain - Copyright – Stock Photo / Register MarkA recent study underscores the ineffectiveness of medication for low back pain and other forms of spinal pain, concluding that nonsteroidal anti-inflammatory drugs (NSAIDs, such as aspirin and ibuprofen) are no more effective than placebo for combating spinal pain. In other words, drugs worked no better than doing nothing! (A placebo is an inactive treatment patients think is active; in this case, a nondrug pill they thought was actual medication.)

What’s more, the study noted that 5-6 patients would need to take medication in order for just one to achieve a meaningful benefit. Let’s hope if you do take pain meds, you’re the one who does benefit, particularly considering “all NSAIDs have been associated with cardiovascular and gastrointestinal risks,” according to the study, whose researchers also found that NSAID use elevated the risk of adverse GI effects in the first two weeks of use. If you’re the majority who don’t benefit from the medication, why are you taking them in the first place when natural pain-relief options are preferred and recommended first?

The bottom line: If you’re already seeing a chiropractor for your low back pain, great job! If you’re not, what are you waiting for? Physician guidelines and research are pointing you in the right direction.

Back Pain: Bad for Your Mental Health

Back Pain: Bad for Your Mental Health

By Editorial Staff

If you’re not already utilizing chiropractic care to resolve your back pain and reduce the likelihood it will return – not to mention improving your overall health and wellness – that means one of two things: you haven’t suffered back pain (yet) or you’ve decided to temporarily suppress the pain with over-the-counter or prescription medications. The latter is, as mentioned, a temporary solution that doesn’t address the root causes of the pain, while the former is also likely temporary, since an estimated 80 percent of adults will suffer back pain at some point in their lifetime.

Back pain can be a problem for a variety of reasons beyond the pain, whether it’s limiting your daily function, forcing you to take time off work, or otherwise impacting your life. But there’s another reason suggested by recent research that should vault “getting rid of back pain” to the top of your priority list: Back pain could increase your risk of suffering mental health problems.

back pain - Copyright – Stock Photo / Register MarkThe study used data from the World Health Organization’s World Health Survey 2002-2004 and involved more than 200,000 study subjects ages 18 and older from 43 countries. Data analysis revealed that compared to people without back pain, those with pain were more than twice as likely to suffer from one of five mental health conditions: anxiety, depression, psychosis, stress and sleep deprivation. Subjects with chronic back pain were particularly at risk for a depressive episode (more than three times more likely) or psychosis (2.6 times more likely) compared to pain-free subjects.

Think you’ve got your back pain handled? Nice try. Do something about the pain – and the potential mental health consequences – with regular visits to your doctor of chiropractic.

TV and Eating: A Bad Combination

TV and Eating: A Bad Combination

By Editorial Staff

It’s become commonplace: sitting down to your favorite meal with the television on. Perhaps it’s the time crunch people feel that makes them want to digest their food with as much information (news, etc.) as possible.

Or perhaps it’s the comfort that comes from watching your favorite show in the rare moments you have to actually sit down and relax. But regardless of the reason, eating and watching TV may be a dangerous combination.

Here’s why: Families that eat dinner in front of the television tend to eat less healthy food than when the TV is off, suggests research. These findings held up even when they weren’t actually watching TV, but merely had it on in the background to generate “white noise.”

This is the latest study to link what has been called “distracted eating” to unhealthy eating. In fact, research connects distracted eating to overeating, and “mindful eating” (as opposed to rushed / distracted eating) to the opposite. What’s more, excessive television viewing has its own drawbacks beyond its impact on eating habits: At the most extreme, watching three or more hours of TV a day may increase your risk of early death compared to people who watch less daily television. Taken collectively, the evidence suggests we keep that TV off whenever possible and find healthier ways to enjoy our free time.

Wide Awake in the Electronic Age: Our Kids’ Sleep Habits Are Suffering



Wide Awake in the Electronic Age: Our Kids’ Sleep Habits Are Suffering

By Editorial Staff

Smartphones, tablets and everything in between – chances are high that if your child’s over the age of 6 (and in some cases, even younger these days), they’re spending a considerable (read: unhealthy) amount of time engaged with portable electronic devices. At the same time, we’re finding that kids are suffering from sleep deprivation in terms of time spent asleep and quality of sleep enjoyed. Is there a connection? Yes, say researchers who reviewed various studies on the topic – and the news is even worse than you might imagine.

After reviewing 20 studies, researchers found that kids who used portable electronic devices near bedtime had more difficulty falling or staying asleep, and experienced poor daytime function because of sleepiness. Device use also contributed to lack of sleep compared to non-use: less than 10 hours per night for children and less than nine hours for teens.

But here’s the kicker: Even kids who didn’t use the devices, but had access to them, still experienced shorter sleep times. Children with bedtime access to devices close to bedtime three or more times a week also experienced less sleep and lower quality of sleep compared to children with less or no device access. Researchers speculate that access, even without use, can exert an influence on sleep because children are thinking about different aspects of the device, such as text messaging (e.g., “Has someone responded to that message I sent earlier?”).

Ready to limit your children’s (or your own) screen time? Click here for three ways to get started. For more information on another potential negative health consequence of excessive smartphone / tablet use, click here.

Five Things You Can Do To Boost Your Mood

Five Things You Can Do To Boost Your Mood

By Julie T. Chen, MD

Your mood is something that affects many aspects of your health from your heart to your thyroid to your sleep cycle to your menstrual cycle. So, as the daylight hours start to wane this winter season, how can you keep your mood elevated?

I always tell my patients in my integrative medicine clinic in San Jose, CA that mood is affected by many things. So, in order to address your mood concerns, you have to be willing to optimize many aspects of your life. But if you can do so, not only will your mood improve but also your overall health.

There are five easy ways to keep your mood elevated this winter season:

  1. Stay in touch with your loved ones
  2. Keep touching your furry friends
  3. Light therapy isn’t a thing of the past
  4. Keep your kitchen stocked full of vegetables and avoid sugars
  5. Keep your body moving throughout the winter season

Social support is something that is important in managing our mood. When we are surrounded by friends and loved ones, we manage our stressors and mood triggers better. Try to focus your time and energy on your friends and loved ones who are positive. If you are not in the best mood, don’t spend more time with people who are negative in your life. When you are feeling down, that is the time to find people who lift you up…not bring you down. I know that during the holiday season, there are a lot of social obligations, but just remember that you are the most important obligation and if you are already feeling low, find those who are uplifting to spend time with until your mood is better. You deserve to feel loved and cherished, so find those who make you feel this way to spend time with for the time being.

exercise - Copyright – Stock Photo / Register MarkPets and animals seem to cheer people up and so if you are an animal person, you should spend time with your pet or spend time with your friends who have pets. Studies suggest that pets bring joy and those with pets feel happier.

I know that many of you have heard of light therapy during the winter season for seasonal affective disorder. If you have that, you should check with your doctor for support and potentially discuss the option for counseling. But if your main issue is the lack of light during winter time, you should look into investing in light therapy at home. If you have a healthcare account, ask your doctor to see if you can use that to get reimbursed for the machine to use at home.

What we eat can trigger our brain to secrete different chemicals. So, if you eat a diet high in antioxidants, minerals and vitamins in the form of vegetables and avoid sugars, your mood will likely be more stable. Many of my patients find that a diet rich in vegetables and low in processed foods and sugars help their mood quite a bit. But if you are depressed, the safest thing is to first see your doctor about it but in the interim, eating clean and healthy will only help.

Finally, exercise is always helpful for mood because when you exercise, you release more endorphins and helps to trigger better mood. If you are stressed and busy, exercise doesn’t mean you have to go to the gym. You can even go on walks and hikes with your buddies…this way you can combine tip number one and five together and you can spend time with loved ones while exercising.

At the end of the day, the most important thing is to find support and ask for help when you need it. Your doctor cares about you…let him/her help you find some way for you to feel better because sometimes you need stronger options to help with low mood, so make sure to see your doctor to make sure you’re OK. But in the interim, these five tips should help you keep your mood up throughout these winter months.

Dr. Julie T. Chen is board-certified in internal medicine and fellowship-trained and board-certified in integrative medicine. She has her own medical practice in San Jose, Calif. She is the medical director of corporation wellness at several Silicon Valley-based corporations, is on several medical expert panels of Web sites and nonprofit organizations, is a recurring monthly columnist for several national magazines, and has been featured in radio, newspaper, and magazine interviews. She incorporates various healing modalities into her practice including, but is not limited to, medical acupuncture, Chinese scalp acupuncture, clinical hypnotherapy, strain-counterstrain osteopathic manipulations, and biofeedback. To learn more, visit

Stick to the Program: How to Make This the Healthy Holidays

Stick to the Program: How to Make This the Healthy Holidays

By Editorial Staff

Yes, it’s that time of year again: the holiday season. And with it comes the annual battle many of us have to maintain our health, fitness and sanity. You’ve worked so hard the past 10 months; why throw it all away now? Unfortunately, that’s what too many people do – eating right, working out, keeping stress low and optimizing their health and wellness from January to October, only to regress once November hits.

But that’s not your immediate future, because you’ve invested to much in yourself. And, as luck would have it, it’s also that time of year when we offer great ideas to survive what we like to call the “unhealthy holidays.” Take these tips to heart and stick to the program these holidays. After all, you’re worth it.

    • Less Is More: In general, the holiday season is all about excess; or at least the opportunity (read: temptation) of excess. That’s particularly true when it comes to food, which can turn ugly and sabotage your health efforts if you don’t rein it in. Moderation is the key, and the way to achieve moderation is to go to every holiday party / meal with a plan: less is more. Less piling on means more satisfaction; less helpings means more waking up on the right side of the bed, feeling great about yourself, not overstuffed and unmotivated.


    • healthy holidays - Copyright – Stock Photo / Register MarkMore Is Less: In the hustle and bustle of the holiday season, stress can overwhelm even the best of us. And when we’re stressed, we’re prone to comfort activities, which can lead to poor eating and discontinuance of our fitness routine. In this case, more is less: The more you stay true to your gym visits, nutrition plan, etc., the less stress you’ll feel, breaking the vicious cycle of stress, unhealthy habits, more stress.


    • Strength in Numbers: Chances are you haven’t succeeded the past 10 months entirely on your own, and now’s not the time to start. Sit down with your workout buddy, friends and loved ones who’ve helped you along the way and pledge to stick to the program through the holiday season. A little motivation can go a long way.


  • Movement Is Life: The more you move this holiday season, even if it’s not technically your standard exercise routine, is better than nothing at all. In fact, the holiday season often offers many unique opportunities for physical activity – taking a hike with holiday guests, playing a little family-against-family touch football game, etc. – that just aren’t available during the year.

For Low Back Pain, Look to Chiropractic

For Low Back Pain, Look to Chiropractic

It’s estimated that eight out of 10 people suffer from back pain at some point in their lives. A recent study on the prevalence of musculoskeletal disorders in the U.S. estimated that 40 million Americans aged 20-64 will experience “frequent” low back pain (LBP), with 15% suffering from LBP lasting up to two weeks at a time!

There’s no clear-cut way to resolve back pain, but chiropractic offers the most promise.

Witness the results of a recent study comparing one-month outcomes for 93 chiropractic patients and 45 medical patients with chronic, recurrent LBP. Chiropractic care included spinal manipulation and various forms of physiotherapy, averaging four patient visits. Medical care averaged one visit and frequently included the prescription of anti-inflammatory drugs.

Patients treated by chiropractors showed better overall improvement and satisfaction after one month than patients treated by family physicians. Chiropractic patients showed substantial decreases in pain severity, functional disability, and pain quality, while medical patients showed only minimal improvements with regard to the first two measures, and deterioration in the third.

If you’re suffering from low back pain, the road to recovery may not be an easy one, but it begins with chiropractic! Schedule a consultation with a chiropractor today, and for more information on back pain, visit


Nyiendo J, Haas M, Goodwin P. Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medical physicians: a practice-based feasibility study. Journal of Manipulative and Physiological Therapeutics, May 2000: Vol. 23, No. 4, pp239-45.

Obesity and Cancer: Only a Matter of Time?

Obesity and Cancer: Only a Matter of Time?

By Editorial Staff

An estimated 36 percent of women are now considered obese. The importance of this statistic has nothing to do with image, beauty or perception, none of which should be influenced by a woman’s weight; it’s concerning from a pure health perspective, because obesity has been associated with numerous negative health consequences including diabetes, cardiovascular disease and yes, even cancer.

The obesity problem becomes even more concerning when it’s persistent, meaning one suffers from it for a prolonged period of time. For example, research suggests a decade of obesity elevates the risk of developing several types of cancer. Here are the female-specific increases in cancer risk for every 10 years a woman is obese, based on a 12-year analysis of nearly 75,000 U.S. women:

  • Any type of cancer: 7 percent increased risk
  • Postmenopausal breast cancer: 5 percent increased risk
  • Endometrial cancer: 17 percent increased risk

stop cancer - Copyright – Stock Photo / Register MarkConsidering breast cancer is the most common cancer in women worldwide and endometrial cancer is the fourth most common cancer in U.S. women, understanding the risk factors – and then doing something to mitigate them – is a key step in reducing the cancer burden and, quite frankly, saving more lives. For the more than one in three women classified as obese, achieving a healthier weight could be the first – and most important – step.

Talk to your doctor for more information on the dangers of obesity and to develop a strategy to lose weight, improve your health and reduce your cancer risk.

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