If not opioids, then what, Doc?

That is the Million Dollar question for thousands of people who just want the pain to stop.

As promised in my last blog post, here in one doctor's opinion on the matter:

Dr. Robert H. Smerling, MD, Faculty Editor and a regular contributor to the Harvard Health Publication writes this in his recent entry Here's something completely different for back pain:

"A recent study found that NSAIDs did not work well for back pain. But, new recommendations take that conclusion even further: it may be best to avoid medications altogether — at least at the start.

The American College of Physicians has just come out with new guidelines for the treatment of low back pain based on a review of more than 150 studies. The big news? Medications tend to have only temporary and modest benefits, so it makes sense to try something other than a pill. The specifics depend on the type and duration of back pain.

For new low back pain (lasting less than 12 weeks), try:

• heat
• massage
• acupuncture
• spinal manipulation, as with chiropractic care.

If these don’t work, NSAIDs or a muscle relaxant are reasonable options. But given their potential to cause side effects and their modest benefit, they aren’t the first choice.

For chronic low back pain (lasting 12 weeks or more), try:

• exercise (including stretching, improving balance, and strengthening core muscles)
• physical therapy
• acupuncture
• mindfulness-based programs intended to cope with or reduce stress.

Other approaches, such as tai chi, yoga, or progressive relaxation techniques may also be helpful.

If these don’t work, treatment with NSAIDs, tramadol, or duloxetine is worth consideration. However, opioids should be considered only if other measures have failed and only after a thorough review of potential benefits and risks with your doctor.

It’s important to emphasize these suggestions are for low back pain that might begin after an unusually strenuous workout or shoveling snow. It’s not for serious causes of back pain such as a major injury, cancer, infection, or fractures (see “red flag” symptoms below).

What if the pain continues?

If pain persists despite these non-medication and medication-based treatments, your doctor may want to consider additional tests (such as MRI) or treatments. Remember, each person’s situation is a little different, and even medications that don’t work well on average, may work well for you.

You could see this coming?

It’s been known for years that the vast majority of low back pain goes away on its own, regardless of treatment. So, the challenge has been to find something that safely eases symptoms while waiting for improvement.

How do I know it’s nothing serious?

You don’t. But, you should be reassured that the numbers are with you. Ninety-nine percent or more of people with low back pain do not have a serious cause. But to help make sure your back isn’t in that small sliver of dangerous causes, doctors use the “red flag” questions:

• Have you ever been diagnosed with cancer?
• Have you experienced unexplained or unintentional weight loss?
• Do you have an abnormal immune system (due to disease or medications)?
• Do you use intravenous drugs?
• Have you had a fever recently?
• Have you had significant injury to your back recently?
• Have you had bladder or bowel incontinence?

These questions and a physical examination are intended to identify factors that would increase the chances that your back pain is due to infection, tumor, or other serious cause.

So, what?

These new guidelines endorse an approach to treating a common ailment that only a few years ago would have seemed outrageous. The remedies recommended are not brand new; but discouraging medication use as an initial step is a big departure from prior recommendations. An email alert I received just after these guidelines were published included the headline: “Take two yoga classes and call me next month?” It may not be such a bad idea!

Medical practice rarely changes right away, and these guidelines may have relatively little impact in the short run. But I would not be surprised if non-pharmacological treatment of back pain becomes the norm over time. Many of my patients already seek out these treatments regardless of whether I recommend them. After all, the “usual” medications for low back pain are not all that effective and often cause trouble. It’s time we recognize that there are other, better ways to help."

So there you have it. Some viable and productive options for the treatment of mild to moderate acute onset back pain.  I strongly believe in exhausting all conservative means of pain control prior to taking narcotic pain relievers that simply mask symptoms and potentially create issues greater than the pain itself. 

Remember, as someone much more interesting than I one said "knowledge is power". So load up and take care of YOU.

Until next time, be well and PINPOINT THE POSITIVE!

Christopher B. Renne, D.C.

4111 Atlantic Boulevard

Jacksonville, FL 32207

www.activechirocenter.com

904-398-4860 office

Please don't keep us a secret. Rate us on Yelp!

https://www.yelp.com/biz/active-medical-and-chiropractic-jacksonville

(1) https://www.health.harvard.edu/blog/heres-something-completely-different-for-low-back-pain-2017070611962?utm_source=delivra&utm_medium=email&utm_campaign=BF20170717-BackPain&utm_id=569043&dlv-ga-memberid=11155152&mid=11155152&ml=569043

Why should I care about this so called "opioid crisis" Dr. Chris?

Hello again, friends. Recall, last week we defined what and opioid/narcotic medication was. 
Today, I'd like to expand on why YOU should care in the first place.

"Calls have come from the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA) and the Institute of Medicine (IOM) for a shift away from opioid use toward non-pharmacologic approaches to address chronic pain. 

Overdose deaths involving prescription opioids have quadrupled since 1999, as have sales of these prescription drugs. From 1999 to 2014, more than 165,000 people --- three times the U.S. military deaths during the twenty years of the Vietnam War -- have died in the U.S. from overdoses related to prescription opioids. Today, at least half of all U.S. opioid overdose deaths involve a prescribed opioid. In 2014, more than 14,000 people died from overdoses involving these drugs, with the most commonly overdosed opioids -- Methadone, Oxycodone (such as OxyContin®), and Hydrocodone (such as Vicodin®) -- resulting in death. 

Regrettably, overdose deaths resulting from opioid abuse have risen sharply in every county of every state across the country, reaching a new peak in 2014: 28,647 people, or 78 people per day – more than three people per hour. The newest estimates on the cost of opioid abuse to U.S. employers is estimated at $18 billion in sick days, lost productivity and medical expenses. An important non-pharmacologic approach in helping to solve this crisis is chiropractic care.(my specialty). This discussion offers greater understanding of the scope of the opioid situation, the elements that have contributed to it and an approach that emphasizes non-pharmacologic care. Collectively, we must begin to extricate ourselves from our current ineffective, dangerous and often fatal reality. "

I hope this information finds a place in your consciousness and will help you make wise, informed descisions about the type of care you chose when injured or hurting. I also hope this sparks a hunger to learn more about some of the alternatives to controlled substances that exist in the medical community.

Stay tuned, more to follow....

As always, I am grateful for your thoughtful attention. Please share this with the people you love. Together, I sincerely believe we all can make a difference. And we CAN bring those shocking numbers down. Every life is precious. So take care of yours! 

Yours in health,

Christopher B. Renne, D.C.

4111 Atlantic Boulevard

Jacksonville, FL 32207

904-398-4860

www.activechirocenter.com

Please don't keep us a secret. Rate us on Yelp!

https://www.yelp.com/biz/active-medical-and-chiropractic-jacksonville

What exactly is an Opioid and why should I care, Doc?

Thank you for taking the time to read part 2 in my ongoing series highlighting the growing dangers of prescription and non prescription Opiod (narcotic) medications. Here is a recent description provided by the American Society of Addiction Medicine:

"Opioids are a class of drugs that include the illicit drug heroin as well as the licit (legal) prescription painrelievers, oxycodone, hydrocodone, codeine, morphine, fentanyl and others. Opioids are chemically related and interact with opioid receptors on nerve cells in the brain and nervous system to produce pleasurable effects and relieve pain. Addiction is a primary, chronic and relapsing brain disease characterized by an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Of the 21.5 million Americans age 12 or older that had a substance use disorder in 2014, 1.9 million had a substance abuse disorder involving prescription pain relievers and 586,000 had a substance abuse disorder involving heroin. It is estimated that 23 percent of individuals who use heroin develop opioid addiction."

I think now is a good time to provide an important disclaimer. My office is proud to feature both medical and chiropractic solutions to pain related syndromes. We have no axe to grind against allopathic (1) medicine and we are proud to work with traditional medical providers to find the very best solutions for our patients.  Many times, these treatment plans include prescription medications.
The overall purpose of this series is to provide education to the public regarding what is happening and future posts will provide alternatives for consideration that do not include potentially dangerous opioid medications. As a father of three growing boys that like to hurt themselves, this series is very personal to me as I have seen first hand what irresponsible dispensing of these potentially harmful drugs can do.

So please read, absorb and empower yourself to make safe choices for you and those you love.

As always, Pinpoint the Positive and be well!

Yours in health,

Christopher B. Renne, D.C.

4111 Atlantic Boulevard

Jacksonville, FL 32207

www.activechirocenter.com

904-398-4860 office

Please don't keep us a secret. Rate us on Yelp!

https://www.yelp.com/biz/active-medical-and-chiropractic-jacksonville

(1) Allopathic: a system of medical practice that aims to combat disease by use of remedies (as drugs or surgery) producing effects different from or incompatible with those produced by the disease being treated—compare homeopathy.

Emergency! Please read and share

Tallahassee, Fl – In an unprecedented action, Governor Scott, Wednesday declared an opioid epidemic threatening the State of Florida with an emergency.  In his Executive Order No. 17-146, Governor Scott recognized the 33,000 nationwide deaths per year and 3,900 Florida deaths due to opioids.

The Order allows for federal grant funds to provide for services to Florida communities instead of waiting until the start of the next fiscal year, July 1, 2017. The HHS grant of $27M over two years, provides funds to the Department of Children and Families, to provide prevention, treatment, and recovery support services to address this epidemic.  

The Order also directs DCF, DOH, and FDLE to meet with communities and hold workshops to identify additional strategies to fight the rising opioid usage cases in Florida. (1) 

Thank you for reading and sharing this. There will be more to follow on the very hot topic. Stay tuned and stay well!

Respectfully yours,

Christopher B. Renne, D.C.

4111 Atlantic Boulevard

Jacksonville, FL 32207

www.activechirocenter.com

904-398-4860 office

Please don't keep us a secret. Rate us on Yelp!

https://www.yelp.com/biz/active-medical-and-chiropractic-jacksonville

(1) Source: Paul Lambert, J.D. Florida Chiropractic Association General Council

Pillow talk, anyone?

Hey Jacksonville, time for a little pillow talk!

Sorry for the pun, but I couldn’t resist. But here is a serious question for you: when was the last time you thought about the pillow you lay your head on at night? You should, because it can impact you more than you might think!

First of all, a comfortable pillow can make it that much easier to get a good night’s sleep. But even more importantly, it can help protect pain in your head, you neck, your shoulders, your hips and other problem areas. If you suffer from chronic pain in your joints, I recommend that you take a good hard look at that soft pillow!

Generally speaking, a good pillow should provide support to your muscles with support and keep your upper body in alignment. Your head should be aligned with the spine and curved forward slightly, just as it would be in a healthy resting position if you were awake. If your pillow is too high or too flat it keeps your neck out of alignment while you are sleeping. This causes muscle strain through your shoulders and cervical spine. Studies show that good pillows support the head at about 4-6” off the bed (this means you’ll want to change your pillow regularly, as pillows flatten out over time).

There isn’t one perfect pillow. Everybody will find different pillows that work best for them. Choosing the right pillow depends on a lot of factors. Your personal comfort level is the first! But another big factor is what position you sleep in.

Side sleepers

When you are lying on your side, your pillow should support your head so that your spinal column is a straight horizontal line. Because your head is heavy, you will want a firm pillow that gives it lots of support. Studies show that you should probably avoid feather pillows, since they compress the most. Use a soft pillow and you will feel it in your cervical spine the next day!

I want to note that if you are a side-sleeper, it’s important that you also put a pillow between your legs. This will keep your hips from rotating while you sleep, pulling your spine out of alignment.

Back sleepers

The spine is naturally curved, so if you sleep in this position it is key to support your head and neck! When you’re standing with a correct, neutral posture, your neck has a curve and your head is slightly forward. You want a pillow that maintains this same posture when you are sleeping. Back sleepers don’t need as firm pillows as side sleepers do.

You may find that putting a second pillow under your knees helps alleviate back pain while you are sleeping in this position.

Front sleepers

As a chiropractor, I really wish that no one slept on their front side! Unfortunately, some of us are accustomed to it. When you sleep like this, you have to turn your face to the side in order to breathe. This means your head and neck are twisted way out of alignment the whole night through, forcing your muscles to compensate.

If you are going to sleep like this, you want a very flat pillow under your head. You might even just sleep flat on the mattress. Placing a pillow underneath your pelvis can help your lower back. But to be honest, if it is even remotely possible, I recommend trying to switch to a side or back sleeping position. Sure, you’ll have a few sleepless nights. But you might just save yourself some major back and neck pain down the road!

Can’t decide

Do you switch it up during the night? Don’t worry, there are pillows for you too! You can find pillows that have higher areas for side sleeping and lower areas for back sleeping. Give it a shot!

Types of pillows

There are so many pillows out there these days! Orthopedic pillows offer extra head support and are contoured to fit the curve of your neck. If you have cervical neck problems and are a back sleeper, this is a great solution. Some side-sleepers enjoy using body pillows, as one pillow can support their head and fit between their legs.

Your standard pillow is still an excellent choice, too. Standard pillows come with a number of different fillings to choose from including:

·         Down or down-alternative

·         Latex

·         Memory foam

·         Water

·         Buckwheat hulls

The last option, Buckwheat hulls, is becoming popular among those with degenerative disc diseases and other severe spine problems.

But only you can decide what pillow feels truly comfortable and supportive. I’d recommend trying a few different types of pillows. You never know, you may come across something that gives that old pillow you’ve been using for years a run for its money! Wouldn’t it be worth it for a good night’s sleep?

At Active Medical and Chiropractic we have a selection of specialized pillows that you might find helpful if your current pillow isn’t giving you the support you need. Ask us about it on your next visit!

Yours in health,

Christopher B. Renne, D.C.

4111 Atlantic Boulevard

Jacksonville, FL 32207

www.activechirocenter.com

904-398-4860

Easy to Implement Tips for Better Sleep

From the Desk of Christopher B. Renne, DC

Hey there, Jacksonville! Let’s talk about sleep. Are you getting enough? Too many people are not!

And that’s a problem, because lack of sleep has been linked to everything from mood swings to pimple breakouts to weight gain to poor memory to a weakened immune system, and even to vision problems. The fact is, our bodies need sleep to function in a normal, healthful manner.

But sometimes you might have trouble sleeping. It could be due to stress, or chronic pain, or some other issue.  Maybe you toss and turn but just can’t fall asleep. Maybe you wake up at 4 AM and find yourself just lying there until the alarm goes off. Maybe you sleep through the night but you’re still waking up exhausted.

Whatever the case may be, here are some tips to help you get those forty winks.

1. Give yourself a chance to wind down before bed

What are you doing right before you switch off the lights? Checking work emails? Watching TV? Playing video games?

These are all fine activities on their own, but they stimulate your brain rather than sedate it. If you are doing these kinds of things right before bedtime, experts strongly recommend that you take a break. Give yourself an hour before bed to start winding down - and you should probably make sure that hour is electronics free.

Many people find that establishing a relaxing bedtime ritual also promotes sleep. See what works for you. Bedtime is an excellent chance to spend time with a good book!

2. Don’t stay in bed if you aren’t sleeping

This one is as simple as it sounds: if you can’t sleep after lying there for 20-30 minutes, get out of bed.

Lying there worrying that you can’t get to sleep will probably not help you get to sleep! Get up and engage in some calm activity that won’t overstimulate you (don’t turn on that TV!). Have a cup of non-caffeinated tea or a glass of warm milk. Read some more of that book. When you feel gravity dragging your head toward your pillow it’s time to fall back into bed, hopefully this time to sleep.

3. Keep a regular sleep schedule

If you’re like many people, you stay very busy on weekdays and so on the weekends you sleep in as much as possible. Or perhaps you simply find yourself going to bed at different times every night. Both of these patterns can lead to poor sleep. Going to bed at roughly the same time every night and waking up at a normal hour, even on weekends, can help you get more consistent restful sleep.

That doesn’t mean you have to get up at 7 AM on Saturday. But sleeping half the day away can wreak havoc on your sleep schedule and leave you feeling tired and drained come Monday morning.

4. Exercise daily

If you’ve been sitting in an office all day, your body may still have pent-up energy to burn come bedtime. That could make getting to sleep difficult. A vigorous workout - not too close to bedtime - can exhaust your body and your mind and help you get those badly needed Z’s.

5. Consider your sleep environment

There may be simple changes you can make in your bedroom that will help you get a good night’s sleep. Here are some ideas to consider:

·         Blackout curtains on the window can block out external light sources which keep you awake.

·         A white noise machine helps lull some people to sleep.

·         Make sure your bedroom is nice and cool. Too warm and you may have trouble staying asleep.

·         Is your pet waking you up at 2 AM every night? Your little fluff ball may need to sleep somewhere other than your bedroom.

·         Make sure your pillows are comfortable. Replace them regularly.

·         Make sure your mattress is doing the job. Most mattresses need to be replaced once every ten years or so.

Believe it or not, Active Chiropractic and Medical has a number of ways to help people with pain sleep at night. Perhaps there is a special pillow or mattress that might make you more comfortable. Or maybe you just need help with pain. If aches and pains are keeping you awake, come in and see us!

Here is wishing you a good night’s sleep, Jacksonville!

Yours in health,

Christopher B. Renne, D.C.

4111 Atlantic Boulevard

Jacksonville, FL 32207

904-398-4860

www.activechirocenter.com

What do I do if I'm in an accident?

Hello, friends and patients,

Here is something to think about: When was the last time you were in a car accident?

Car industry studies show that on average a driver is in an auto collision once every 17.9 years. So if you've had a clean driving record for a couple of decades, watch out - you're overdue!

Almost everyone who gets behind the wheel of an automobile will, sooner or later, be in an accident. Even if you are a terrific driver! When it does happen, you may be shaken up and not sure what to do next. So it really pays to plan ahead! Here are a few steps to take after you've been in an accident:

1. Pull over and call 911

This is always a good idea and should really be the first thing you do. Sometimes the other driver in the accident may try to talk you out of calling the authorities. Don't let them! 911 can dispatch medical help if required. They will also send a police officer to the scene. That officer can assess the whether everyone is safe, what was damaged, and make a determination of who was at fault.

2. Exchange information

If you are able to, try to collect critical information from everyone that was involved in the accident. That means names, driver's licenses, insurance information, and license plates. Don't forget that if you carry a smart phone, like most people do these days, you can use the camera on it to snap pictures of license plates other documents.

3. Document the scene

Still have that smartphone handy? Great, because it's a good idea to snap some pictures of the scene itself. Then, when the police arrive, make sure to ask if they will be filing a report. After that, it is time to call your insurance company and let them know you have been in a fender bender. Your pictures, phone call, and the police report help establish what happened for your auto insurance and any personal injury claims. Without it, it is your word against the other driver.

4. Consult a medical professional

Obviously if you are hurt you need immediate transportation to the hospital. If the collision was severe, you may even want to wait to move until paramedics arrive and evaluate you for spinal injuries. But even if you walk away from the accident feeling fine, you should consult a medical professional as soon as possible. Some injuries can take days to show up. This is especially true of back and neck injuries resulting from auto collisions. Don't assume that you're fine! The sooner you get checked out, the better.

So many of the folks that come through my door have pain and injuries resulting from a car accident. If you have been in an accident, I highly recommend you don't wait or take any chances. Call and make an appointment to see us today!

Yours in health,

Christopher B. Renne, D.C.

4111 Atlantic Blvd

Jacksonville, FL 32207

www.activechirocenter.com

904-398-4860