12/04/2019

Can the weather really worsen arthritis pain

Pediatricians and child behavior specialists who work with teens know that adolescence is an incredibly important time for social growth. Yet these years can be fraught with anxiety for the parents of teens. How will you know if your moody teen is hanging out with the right people? Which friends might be a bad influence? How can you help your son or daughter develop healthy relationships?

Recent research has addressed some aspects of these questions. One study entitled “Spreading of healthy mood in adolescent social networks,” published this year in the Proceedings of the Royal Society of London, investigated whether a teen whose friends have a healthy mood is less likely to be depressed. It also looked at how emotionally healthy friends affected a teen’s recovery from depression. Basically, the researchers wanted to find out: is a good mood contagious?

The study involved roughly 3,000 teens. Each study volunteer completed two surveys, six months apart, in which he or she listed up to five male and five female friends. Each teen was then followed over time, to see how his or her mood changed.

One of the interesting things about this study is that these researchers defined depression as a behavior, not necessarily as a disease that someone could get. This allowed them to do their statistical analysis a little differently from previous studies looking at the same subject matter, and it uncovered the potential power of positively minded friends.

The investigators found that having a social network made up of friends with a healthy mood cut a teenager’s probability of developing depression in half over a 6- to 12-month period. It also significantly improved the chances of recovering from depression for teens who already suffered from it. While the data don’t show a direct cause and effect, this study does suggest that having friends with a healthy mood may reduce the risk of depression and make it a little easier to recover from depression should it occur.
Surprising findings on from social networking research

This study is a nice example of a recent trend in epidemiology — using data about an individual’s social network to learn things about that person. This type of research has led to numerous interesting findings, and has really shaped an entire new area of inquiry. A study published in 2007 in The New England Journal of Medicine was one of the first of this kind. It showed that people who had obese friends and family were themselves more likely to be obese. Since then, additional research has looked at how social networks influence an individual’s risk of developing (or sidestepping) specific health conditions, such as obesity, smoking, and depression.

Results of these studies have been, at times, surprising, thus giving the medical community valuable new information. For example, I myself led a study in 2011 called “The influence of social networks on patients’ attitudes toward type II diabetes.” When I started this research, I supposed that patients would be less concerned about having diabetes if more of their friends and family members had diabetes. I had guessed that these patients might have become so used to the idea of diabetes that the disease would seem common and almost normal. But in fact, my team found the opposite! Patients with a higher prevalence of diabetes within their social networks expressed greater concern about their illness. This unexpected result gave me information that helped me to better take care of my patients.
Using social network data to improve your teen’s mental health

This type of research is not only helpful to doctors, but it also provides important information for anyone trying to improve his or her own health, or the health of one’s family. The study on positive mood in teens’ social networks suggests that parents may be able to reduce their teen’s chances of developing depression — or improve her or his mood if she does have depression — simply by promoting and supporting friendships with emotionally healthy peers. With much controversy about using antidepressants in teens, results such as these can give parents a simple way to promote emotional health and well-being in their adolescent children — with no medications involved. Soon after his shootout with police in 2013, one of the suspected Boston Marathon bombers was taken to an area hospital with serious injuries. A reporter covering the story described how, despite the heinous crimes of which he’d been accused, doctors would work hard to save his life because they’d taken an oath to do so. I knew she was referring to the Hippocratic Oath. But I also knew she was wrong.

There was a good chance that these doctors had never taken the Hippocratic Oath, but even if they had, there’s nothing in the oath that specifically obligates them to provide care for suspected criminals.

Perhaps it should, but it doesn’t.

In fact, the modern-day Hippocratic Oath covers only a few issues relevant to the ethical practice of medicine. It does cover some important stuff. Some of that stuff is controversial, and has been liberally revised. But plenty is simply left out from the original.
What is the Hippocratic Oath?

The Hippocratic Oath is named after the ancient Greek physician Hippocrates. He is widely considered to be its author, although its true origins are uncertain; it may have been written by one of his students or by more than one person. It represents a time-honored guideline for physicians and other healthcare professionals as they begin or end their training. By swearing to follow the principles spelled out in the oath, healthcare professionals promise to behave honestly and ethically.

Those taking the “original” Hippocratic Oath promise to:

    respect and support their teachers
    share medical knowledge with others who are interested
    use their knowledge of medicine and diet to help patients
    avoid harming patients, including providing no “deadly medicine” even if requested to do so
    not provide a “remedy” that causes an abortion
    seek help from other physicians (such as a surgeon) when necessary
    avoid “mischief,” “injustice,” and “sexual relations” during visits to patients’ homes
    keep patient information confidential.

More modern revisions have avoided any mention of abortion and, as in a popular 1964 revision (by Dr. Louis Lasagna, a physician at Johns Hopkins University), treated euthanasia with more nuance:

“…it may…be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.”

In addition, Dr. Lasagna encouraged a holistic and preventive approach to care:

“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure.”
What’s missing?

Today’s doctors face a number of important ethical issues that are not included in the Hippocratic Oath. For example, it makes no mention of:

    honoring patients’ preferences
    sharing medical information with patients
    avoiding conflicts of interest, such as profiting by ordering unnecessary tests or treatments
    protecting patients who enroll in research studies
    treating all patients equally, regardless of ability to pay, social class, education, race, or suspicion of criminality
    avoiding the practice of medicine while impaired (due to physical or psychological disease).

Who takes the oath?

According to a 1989 survey, barely half of U.S. medical schools used any form of the Hippocratic Oath and only 2% used the original. In a 2011 study published in the Archives of Internal Medicine, about 80% of practicing physicians reported participating in an oath ceremony, but only a quarter felt that the oath significantly affected how they practiced.
Beyond the Hippocratic Oath

In the United States, when newly matriculating medical students are draped in their freshly starched white coats, an oath of some kind is often read as part of the ceremony. But there is far more for these new trainees to learn and understand than a passage as brief or as ancient as the Hippocratic Oath could capture. Today, health professionals routinely encounter ethical challenges in modern clinical practice. Rather than rely on well-intentioned but outdated principles, they must call upon their experience and training, widely-accepted modern guidelines, the advice of mentors, and their personal sense of right and wrong to figure out what to do. Fortunately, there are many useful resources beyond the Hippocratic Oath to help guide them in the right direction. In the 1890s, a Shakespearean actor named Frederick Matthias Alexander set out to discover why he often lost his voice when he performed. (Imagine yourself as a Shakespearean actor, completely dependent on your voice to pay your bills, finding yourself without a voice just when you needed to perform!) Needless to say, Alexander had to figure out why this was happening.

He began by observing himself in multiple mirrors while he prepared to perform. Indeed, he did discover that something changed prior to his speaking: He was contracting the muscles in his upper body, especially his neck, so strongly that his entire posture changed. He theorized that his voice loss could be a result of his disrupted posture.

Fortunately, his guess turned out to be correct. When he was able to release the tension in his muscles with a variety of movements, not only did his voice loss resolve, but he was able to change the habit he had developed of contracting his neck. As he continued to refine and improve his methods, Alexander realized they could help others improve their health and well-being. His discoveries, which have since been codified into the Alexander Technique (AT), are still in use today.
How is the Alexander Technique used today?

Today, AT is considered a mental discipline that teaches individuals how to let go of tension in the body and how to enable the body to move with ease and minimal effort. AT is used to treat a variety of conditions, from musculoskeletal pain and repetitive strain injuries to breathing problems, voice loss, and sleep disorders. Many artists, musicians, dancers, singers, and actors use AT to help enhance their performance. The purpose of AT, ultimately, is to enable individuals to methodically unlearn maladaptive (negative) habits — which can show up in the way we stand, sit, eat, walk, or talk — and instead learn how to return the body to a relaxed, balanced state of alignment and poise.
Is AT for you?

But you don’t have to be a musician or dancer to benefit from AT. Here’s just one example: You, like most of us living in today’s world, spend much of your time on a computer or checking your smartphone for emails and texts. This means you spend much of your time looking down, rather than straight ahead, the way your vertebrae were designed to support your head. Keeping your head bent down for long periods puts continual strain on the large neck muscles, which are meant to normally be lax. In contrast, the small neck muscles (which are meant to hold up your neck vertebrae) are not being used and are therefore lax. The result is that your vertebrae lose their support, so that you end up not only with neck stiffness or pain, but possibly some degeneration in your cervical spine, too.

AT can address this habitual contraction of the neck and teach you how hold your phone, how to position your head, and ultimately, how to re-establish better posture and ease in your body.
Is there science to support AT?

A recent randomized controlled study published in the Annals of Internal Medicine found that Alexander Technique lessons led to significant reductions in neck pain over 12 months, compared with usual care. (Interestingly, the study also found that acupuncture reduced pain as well, compared with usual care.)

Another interesting study published in the medical journal BMJ in 2008 tested a variety of treatments for back pain. A total of 579 patients with chronic or recurrent low back pain were randomly divided into four groups. The first group were given “normal care” (that is, they were the control group). The second group received massages. The third took six Alexander Technique lessons. The fourth group took 24 Alexander Technique lessons. Half of each group also received a prescription for exercise (primarily walking) from a doctor, plus behavioral counseling from a nurse. The results showed that the patients who had AT lessons along with an exercise plan improved the most. In addition, this combined intervention was also the most cost-effective (in particular, taking six lessons combined with an exercise plan).
What does this mean for you?

Proponents of the Alexander Technique would tell you to start paying attention. Pay attention to your posture — the way you walk, talk, sit, stand, or generally do anything, even lifting a forkful of food to your mouth. If you are like most people, your body is likely stuck in tense muscle patterns that may be causing you myriad problems, from back pain to headaches to possibly even anxiety. It may behoove you to unlearn these stuck patterns so you can move through your life with more ease — and much, much less pain.

If you’re interested in Alexander Technique lessons, the American Society for the Alexander Technique can help you find an instructor. If you have arthritis, you may have noticed that the weather affects your symptoms. I hear it from my patients all the time.

If it’s true that the weather can worsen arthritis pain, how does that work? Is there any scientific evidence to explain it? People have been asking these questions for many years without finding good answers. But that’s not keeping researchers from trying to understand it better.
What we (think we) know

Past studies examining the effect of rain, humidity, and other weather-related factors on symptoms of arthritis have been inconclusive, and in some cases, contradictory. Some suggest that the key variable is rising barometric pressure. Other studies found just the opposite — that falling pressure could provoke joint pain or stiffness. There have even been attempts to artificially vary environmental conditions to mimic weather changes, such as placing arthritis sufferers in barometric chambers and varying the pressure up and down.

Despite this, we still don’t know whether it is one particular feature of the weather or a combination of features that matters. There are many potential factors — humidity, temperature, precipitation, and barometric pressure among them. Even if we could precisely identify what about weather affects arthritis pain and stiffness, we’re still not sure why — biologically speaking — weather should have any impact on joint symptoms.

Having reviewed the studies, I find myself not knowing how to answer my patients who ask me why their symptoms reliably worsen when the weather is damp or rain is coming, or when some other weather event happens. I usually tell them that, first, I believe there is a connection between weather and joint symptoms, and second, researchers have been unable to figure out just what matters most about the weather and arthritis symptoms or why there should be a connection.
The newest studies

In just the past year or so, two new studies have weighed in on the question of whether weather has an impact on arthritis symptoms. And both found that yes, indeed, weather matters!

In the first study, Dutch researchers enrolled 222 people with osteoarthritis of the hip — the most common, “wear-and-tear” type of arthritis — and compared their reported symptoms with a variety of weather variables. They found that over a two-year period, pain and stiffness were slightly worse with rising barometric pressure and humidity, although the overall average impact was small. The second study included more than 800 adults living in one of six European countries and who had osteoarthritis of the hip, knee, or hands. Although changes in weather did not seem to affect symptoms, higher humidity was linked with increasing pain and stiffness, especially in colder weather. So, while these studies varied in the specifics, we now have a bit more evidence linking weather to joint symptoms.
So what?

It’s a fair question. After all, even if we could prove a clear and powerful impact of weather on symptoms of arthritis, how is that helpful to know? It’s not as if doctors are likely to suggest that a patient move to a more arthritis-friendly climate. It’s even less likely that patients would follow such a recommendation. Until we can control the weather or our internal environments with precision, these new studies probably have little impact for the individual arthritis sufferer.

However, identifying a link between a particular type of weather and joint symptoms might help us understand the causes and mechanisms of arthritis symptoms. And that might lead to better treatments or even preventive strategies. In addition, figuring out why some people seem to feel worse in certain circumstances while others notice no change (or even feel better) in those same environments could help us understand subtle differences between types of arthritis or the ways individuals respond to them.
“Everyone keeps talking about the weather…

…but no one is doing anything about it.” That’s an old line but, of course, there’s truth to it. But even if weather does affect the symptoms of arthritis and there’s nothing that can be done about the weather, that doesn’t mean there’s nothing to be done about the arthritis! There are more treatment options than ever before, with and without the use of medications. If you have significant and persistent joint pain, stiffness, or swelling, see your doctor — rain or shine.

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