Rheumatoid Arthritis Treatment – A link between drug treatments, new FAR infrared and targeting the IL-6 protein.

Last month a news article in The Daily Express, a UK newspaper, appeared referencing a new drug treatment for Rheumatoid Arthritis (RA).  The drug targets the IL-6 protein which is responsible for inflammation.

This stimulated my memory banks for a different study for knee pain which I vaguely remembered made reference to an IL protein … hang on, it’s the IL-6 protein!

Have I just discovered a link to a potential treatment for RA?

Here is the extract from the article and a link, but read on.

Sarilumab

http://www.express.co.uk/news/health/444653/New-breakthrough-jab-to-ease-arthritis-agony-and-slow-disease

Whilst preparing a summary of evidence for new FAR infrared (FIR) elements, I came across a study showing the effects of the FIR treatment on patients who had undergone knee surgery (total knee arthroplasty).  As well as significant pain reduction, reference is also made to IL-6 reduction:

FAR infrared and IL 6 protein

http://www.ncbi.nlm.nih.gov/pubmed/22339105

“This study demonstrated that the FIR can lower the NRS of pain and thus reduce the discomfort experienced by the patient. Findings indicated that effective application of FIR decreased the serum level of Interleukin-6 (IL-6) and Endothelin ET-1, which represent the subjective indicator of pain.”

FAR Infrared TherapyNow, anecdotally we hear countless testimonials from people with arthritis (not specifically RA) reporting significant pain relief from using TherMedic infrared ProWraps, as well as other conditions including low back pain, Frozen Shoulder and more.

Some of these effects may be down to the thermal effects of sustained vasodilation but other studies detail non-thermal effects which may explain other significant properties and benefits of TherMedic FIR for pain relief, see evidence summary.

For some people living with Rheumatoid Arthritis, medication does not always work and can include side-effects.

l220100-heat-pad_jpgThe above paper looking at the application of FIR for knee arthroplasty and reduction of IL-6 protein is not a large double-blind randomised controlled trial.

HOWEVER, in the context of this and other scientific evidence surrounding the re-emergence of FAR infrared, as well as the growing anecdotal evidence, there is surely a case for more detailed investigation into the potential applications of the new localised carbon-fabric infrared modality, TherMedic for the relief of pain caused by Rheumatoid Arthritis.

This question may well be being addressed in Asia where the new carbon fabric infrared element was developed, but to the scientific community in the UK, the new technology is still unknown.  That is changing.

NOTES:

Endothelins are proteins that constrict blood vessels and raise blood pressure. They are normally kept in balance by other mechanisms, but when they are over-expressed, they contribute to high blood pressure (hypertension) and heart disease

Interleukin-6 (IL-6) is an interleukin that acts as both a pro-inflammatory and anti-inflammatory cytokine. Expression of IL-6 is enhanced at the site of inflammation, and blockade of IL-6 and IL-6 signalling is effective at prevention and treatment in models of inflammatory diseases (including arthritis and colitis).  Overall IL-6 is important – indeed, critical under certain conditions – to the development of persistent inflammation.

(C. Gabay Interleukin-6 and chronic inflammation  Arthritis Research & Therapy 2006, 8(Suppl 2):S3 http://arthritis-research.com/content/8/S2/S3

Author: Stephen Small
Director www.steadfastclinics.co.uk

I first came across infrared whilst using it with IDD Therapy spinal decompression.  Initially I saw it as a simple heat modality but it quickly became apparent that there was a lot more to TherMedic than meets the eye.  Steadfast Clinics distribute Thermedic in the UK.

Sciatica or Back Pain? – Google statistics show us what people are actually looking for.

Working with clinics treating herniated discs with IDD Therapy spinal decompression, I am interested to see back pain statistics and trends around the subject of back pain.

Whilst “Back Pain” is the number one musculoskeletal condition people visit their doctor for, is it really back pain they need help with or does Google search traffic data reveal something not factored into the statistics?

Here below you can see the UK monthly search volume for certain keywords.

Google adwords Back Pain Searches

As can be seen, for every “back pain” search in Google, there are over three times as many searches for ‘sciatica’.

What about globally?

Google sciatica search results global

Again we see the same trend.

This throws up some questions which someone probably has the answers to (appreciating that sciatica and back pain are closely related): 

Is back pain more prevalent than sciatica?
Is the pain of ‘sciatica’
less bearable than ‘back’ pain?
Is it the latter which prompts proportionally more people to search for info/help with sciatica than back pain?

What do you think?

Author: Stephen Small, Director Steadfast Clinics Ltd
LinkedIn Profile
www.steadfastfastclinics.co.uk   www.iddtherapy.co.uk
Steadfast Clinics Ltd – Expanding IDD Therapy spinal decompression treatment for intervertebral discs and Thermedic Infrared Therapy Systems for joint pain and soft tissue healing.

Exercise compliance – Insights from using Yoga DVDs at home to instill discipline and motivation in patients.

I leave the clinicians to work out what the best exercises are, my interest is improving compliance.  

Knowing exercises is one thing, doing them is another! 

YogaFor a few years I have had a growing feeling that I need to preserve joint mobility, particularly in my lower back!   So I have toyed with the idea of doing yoga (also for a few years!).

or

At the end of the summer I bought a box set of yoga DVDs and over the last couple of months I have started to use the Yoga videos in the morning, at least twice a week.

They really help and now, I would probably be happy to join a class because I understand that “Cobra” is not a beer brand we have with a curry!

The point is, I did know what a sun salutation was but I never bothered doing them on my own.

With the DVD there is a framework and time structure.  From 30 minutes to 45 minutes.  ie it’s doable and someone is there with you.

Many patients leave a clinic with a set of written or verbal exercises to do. That is not going to work for most.  It DOESN’T work for most people!

I have written about exercise diaries, wall planners etc, my strong recommendation is to find a DVD that you like and sell it to patients for them to do at home (and record when they do it in their exercise diary!)

Then tell them to do the exercises at least 3 times a week or daily or whatever is appropriate.

The APPI do a video for back pain which I believe you can buy at trade prices
http://www.ausphysio.com/product.aspx?productid=344

but there are many others.

IDEA – Why not put on a “back class” at your clinic or elsewhere, get a local videographer to record it and then give that to patients as your own-branded DVD, give complimentary copies to GPs etc etc, then who’s the local daddy?!

COBRA beerIf you do hear yourself saying to patients “do try to do your exercices” you know that most won’t bother. Try the DVD route, it can can only help and you will stand out from the masses.

Now time for some Cobras … I’ll do my yoga in the morning 😉

Author: Stephen Small, Director Steadfast Clinics

Steadfast Clinics is the international distributor of IDD Therapy spinal decompresion, SDS SPINA, Accu SPINA and Thermedic Infrared Therapy Systems. We’re on a pain relief mission !

Leominster Osteopaths, Four Years of IDD Therapy Spinal Decompression for Back Pain, Neck Pain and Sciatica

Leominster Osteopaths was the second clinic in the UK to provide IDD Therapy for their patients.

With some great results and an expanding practice, the clinic is attracting patients from far and wide to get relief from chronic disc-related problems.

Stephen Small and Mark Roughley

Stephen Small of Steadfast Clinics is pictured here with Leominster Osteopaths Clinic  Director Mark Roughley.

For more information about IDD Therapy treatment at Leominster Osteopaths, visit www.leominsterosteopaths.co.uk

Help for Back Pain Sufferers in Croydon with IDD Therapy Treatment

For back pain sufferers living in and around Croydon, help is at hand with advanced targeted treatment at one of the leading clinics in the area.

IDD Therapy Back Pain TreatmentIDD Therapy is a non-invasive spinal decompression treatment which treats targeted segments of the spine to help unresolved conditions, particularly where there is a disc-related condition such as a herniated disc (‘slipped disc’) and sciatica.

The Osteopathic Clinic of Physical Medicine is led by clinic director Paul Morrissey.  Paul has led the way in Surrey by introducing new techniques and treatments such Shock Wave, as well as establishing a fully equipped pilates centre.

Paul is part of a network of UK IDD Therapy providers and says:

“For several years I watched with great interest the developments in IDD Therapy non-surgical spinal decompression.

After experiencing the treatment for myself and hearing the positive experiences of other UK clinicians and their patients, I was keen to introduce the IDD Therapy programme at our clinic.

IDD Therapy helps patients suffering with persistent back or neck pain who are not making improvement with manual therapy alone. There is no such thing as a cure-all for back pain, but the IDD Therapy treatment programme offers real opportunities for patients who need something more their pain.”

Whether you have simple back pain or a complex condition, with Paul and his dedicated team, patients can be assured of being in safe hands.  For more details visit www.osteopathclinic.co.uk/idd-therapy or call Croydon 020 8662 1155.

For more information about IDD Therapy treatment in general, visit www.iddtherapy.co.uk .

‘Sarcopenia’, my holiday and insights for back pain patient exercise compliance

muscle mass degenerationSarcopenia is my favourite word.  I heard it a few years ago when I discovered that, like everyone else, I was suffering with it.  The gradual reduction in skeletal muscle mass as we get older (0.5%-1% per year after age 25), the stuff middle aged-crises are made of!

I have always played sports and been active.  As a 42 year old (I count that as young!), I still run, swim and go to the gym once or twice a week.  No major injuries and, touch wood, no back pain issues which is the subject I deal with the most at Steadfast.

I got back from a 2 week holiday in Spain last weekend.

Aside from a little swimming, my activity levels dropped enormously as I tucked into tapas and the odd glass of Rioja!  Now 3 weeks on, I feel a noticeable, alarming reduction in what muscle mass I had before I went away.  Use it or lose it I think is the saying.

However the other thing I notice, which is what got me thinking about back pain patients, is that my will power to return to doing exercise is at rock bottom!

I now have no desire or motivation to go to the gym or do anything.

My principal personal reason for exercising is that my body stagnates when I don’t do anything, so I have to crank things up. Yesterday I did manage to win a herculean mental battle and take myself off for a run but it was painful (run = jog/ run any slower and you’ll be stationary).

It was also depressing because I realised how much pace, strength and stamina I had lost in such a short space of time!

All clinicians prescribe exercises to their patients and patients expect (are resigned) to walk out of a clinic with a list of exercises.

For people who perhaps haven’t had a habit of exercising for a long time, who have pain and particularly those who are overweight, is it any wonder that they find it so difficult to comply with an exercise programme?

And when someone fails to comply with an exercise programme and they remain in pain, doesn’t it reinforce a negative mindset?  Those ‘depressed’ feelings about themselves and what they are (not) capable of are extremely demotivating.

I have written a couple of articles about taking lessons from other industries to improve exercise compliance.

E.g clinicians can use exercise diaries for personal exercise accountability, wall planners as visual reminders and clinicians can link up with personal trainers to create short programmes to help patients with exercise compliance.  There must be other ways too … group classes etc etc.

Given that chronic back pain is the #1 musculoskeletal cost to society, there has to be a case for putting in place more robust systems to help patients and back pain sufferers in particular overcome inertia and progressively develop a habit of activity and exercise.

Otherwise, people will never get off the chronic back pain merry-go-round and, for the reasons outlined here, certain financial inefficiencies will persist as money is spent on treatments when there is limited long term benefit.

PS It’s 8.30 Saturday morning as I write this.  The gym is open for business, there is bacon in the fridge and I feel the battle already in my brain.  Battle won …. I’m getting back on the virtuous circle … though I might I have some bacon when I get back!

Stephen Small linkedinBy Stephen Small
Director Steadfast Clinics Ltd
www.SteadfastClinics.co.uk

Steadfast Clinics is expanding the availability of IDD Therapy spinal decompression for disc-related back pain and Thermedic Infrared Therapy systems for joint pain relief and soft tissue injury rehabilitation.

Physiotherapy Clinic Solihull – IDD Therapy back pain treatment at Broad Oaks Health Clinic

Broad Oaks health Clinic is the longest established physiotherapy clinic in Solihull, West Midlands, UK.

Having been aware of IDD Therapy and the SDS SPINA, clinic director Mark Webb upgraded his old traction unit to offer the advanced IDD Therapy spinal decompression programme. What a difference!

Before …

Traction Bed

After …

SDS SPINA IDD Therapy at Broad Oaks Health Clinic

Broad Oaks Health Clinic IDD Therapy

 

 

 

 

 

 

 

 

 

 

 

For more information about IDD Therapy, back pain treatment and physiotherapy in Solihull, contact Broad Oaks Health Clinic on 0121 705 3509 or visit www.broadoakshealthclinic.co.uk.

Is your waiting room reading an after-thought? What last year’s gossip magazines say about you.

Mens healthTwo contrasting clinic visits last week.  One, bright, newly painted and the other, tired and dull.

One, nice selection of current magazines, the other; copies of last year’s celebrity gossip magazines.

Like a restaurant where the experience is not just about the food, in a clinic patients are looking at the details.

It is not that the choice of reading material affects the treatment, but poor reading material detracts from the experience and reflects badly on the clinic.

For £25 a year why not get a subscription to a magazine, like Mens Health.  Or, use a service like http://www.dltmagazines.co.uk where you can get 8 magazines delivered every month at 50% cover price.

I also notice the type of soap in the toilet, for an extra 50p or £1, give patients something a little luxurious!  It all reinforces the impression a patient gets from you.

Regarding the two clinics – guess which one was busier … no surprises!

How much sugar is in your bottle of lemonade? See the shocking picture here!

Do you like lemonade, then the picture below shows you how much sugar is in a typical bottle.

Yesterday I popped out with my youngest daughter.  She bought a bottle of a well known-brand of lemonade.  I made a small remark that since it was a sugary drink, we’d be thirsty again in no time (not a complaint, it was very hot yesterday!).

So I asked her how much sugar it said was on the label.  Good news, 30% less than normal.  OK, what does that mean?

Well the label says there are 16.5g of sugar per 250ml.  OK, but isn’t this a 500ml bottle?!  So what’s that?  oh, 33g of sugar.

So I asked my daughter, what does that amount of sugar look like?  Neither of us had a clue.

So, we decided to (well, I was on a roll so I said we were going to!) measure out 33g of sugar.

Here is what it looks like.

Sprite sugar content

With our teaspoon it was just over 7 spoons of sugar!

If a child put 7 spoons of sugar in a cup of tea, we’d be flipping out, but somewhere in the interest of “staying hydrated” children are being pumped with sugar!

Children are at least half the size of adults (though clearly not the ones who drink fizzy drinks all day).  Proportionately, putting 7 spoons of sugar into an adult is like putting 14+spoons of sugar into a child.  And we wonder why kids go hyper after fizzy drinks!

I looked at the bottle of cola in my fridge.  Whilst this lemonade has just over 6g of sugar per 100ml, the well known brand of cola in my fridge has over 10g! To my maths that’s more than 50% more!

To wean children off sugary drinks, experts recommend progressively diluting fruit juice with water, or better still, h2o – way to go!  

Author: Stephen Small
Director, Steadfast Clinics Ltd www.steadfastclinics.co.uk

International Distributor of IDD Therapy, SDS SPINA, Accu SPINA, Thermedic Infrared Therapy Systems and HydroMassage dry hydrotherapy.

Spinal injections for back pain relief – Is there a disconnection from rehabilitation?

injectionsI recently gave a talk to a group of about 40 physiotherapists, osteopaths and chiropractors where I posed this question and asked for a show of hands.

There was universal agreement that there was a significant disconnect.

Looking at how to improve back pain treatment outcomes for both patients and over stretched healthcare budgets, there appears to be a significant opportunity to improve outcomes from spinal injections by making spinal rehabilitation an integral part of the post-injection treatment plan.

Patient pathways

There is a lot of debate about the merits of spinal injections.  The Cochrane Review (1) concludes “There is insufficient evidence to support the use of injection therapy in subacute and chronic low-back pain”.

Yet many clinicians report that patients do benefit which is backed up by the same Cochrane Review “it cannot be ruled out that specific subgroups of patients may respond to a specific type of injection therapy.”

As with many back pain treatments, it is difficult to get a black and white answer since there are so many variables in play.

The typical pathway for a patient who develops chronic low back pain (or neck pain) looks something like this:

Self-prescribed pain medication
GP visit, pain medication and advice to remain active
GP visit
Manual therapy and exercise (physiotherapy)
GP visit
Consultant referral
Spinal injection
Consultant referral
Injection, possible surgery,
self-management (aka get on with it because we have no more options for you)

Self-pay patients typically bypass their GP and go straight to a physiotherapist, osteopath or chiropractor.  Private patients who are referred to a consultant often receive a spinal injection without first having a course of rehabilitation.

As a former member of the Society of Back Pain Research Committee said on stage at their annual meeting a few years ago, “I have a clinical intuition that they (spinal injections) are effective … and patients ask for them”.

Working with so many different clinicians, the problem appears to be that once a patient sees a consultant and is given an injection, many are simply sent home with little more than a recommendation to remain active, to do exercises and to possibly see a physiotherapist.

Given the costs of injections and clinical time, is this an efficient use of resources?

Manual therapists often dismiss injections because they do nothing to address the underlying condition believing them to be a band aid at best”.  Yet the purpose of the injection is not to cure the problem: it is to relieve pain to help the patient get on with their life.

If a patient can then be more active then the body has a chance to heal itself.

However, in the many cases where patients remain in pain it is perhaps in part because there is no proper rehabilitation.  Then the issue we have is what kind of rehabilitation will they get? 

If it is in the NHS, then the sort of rehabilitation a patient might access is exactly the same physiotherapy treatment which failed to address the problem in the first place.

Einstein’s definition of insanity is over quoted but to keep doing the same rehabilitation and expect a different outcome is surely insane … and an inefficient use of valuable resources.

Many spinal injections are given in the private sector.  One neurosurgeon I know sees approximately 1,500 patients a year.  He operates on 3% and gives an injection to around 20%, i.e. around 300 patients.

If a patient has an injection they leave hospital and then if they need follow up, they return to their consultant.  In some circumstances patients will receive a further injection.  If the injection hasn’t worked then the patient is more likely to become a candidate for surgery.

After all, conservative methods failed to resolve the problem.  Yet, I can’t help but feel that many of the spinal rehab programmes for patients who reach a stage of requiring (wanting) injections are simply not intensive enough.

Working with and talking to many clinicians, I often hear that if a patient is not better within four to six visits, then it’s time to look at other options.  It has become accepted dogma.

When IDD Therapy spinal decompression was originally developed, the clinicians who looked at back pain suggested in part that if they could work one on one with patients for eight hours a day, they would get much better results.

When people seriously embark on a diet to lose weight or train for a sporting event, they approach their goal with a level of commitment and intensity that is quite different to an approach to back pain rehabilitation.

Perhaps those involved in spinal rehabilitation should examine intensive programmes of spinal rehabilitation which are an agreed condition if a patient wishes to have an injection.

IDD Therapy spinal decompression programme offers such a programme for patients with disc related issues.  It is one method and undoubtedly not the only method.  A case study recently received from one provider detailed a 33 year old male office worker with a six month history of neck pain and headaches.

The patient received two injections during this time and felt no change.

He then embarked on a twice weekly course of cervical IDD Therapy.  After three weeks and six treatments, the headaches were gone and VAS pain was down to 1/10.  A further two weeks saw VAS pain at zero and no headaches.

That is a total of 10 treatments over a six week period.

All clinicians will have an opinion on the efficacy of injections.  The author believes that some people benefit from injections whilst for others there is no benefit, particularly without rehab.  However as with all back pain treatments, the difficulty is being able to predetermine who will benefit and who won’t!

There are significant costs to providing injections for back pain.  However as the British Pain Society point out, the unintended consequence of discontinuing pain interventions may be that more patients then access more costly interventions such as spinal surgery.

In the meantime, it would seem to make sense to reconnect spinal injections to a more intensive programme of spinal rehabilitation to help some patients return to a more active lifestyle.  If you have a comment, do share for others.

Staal JBde Bie RAde Vet HCHildebrandt JNelemans P. Injection therapy for subacute and chronic low back pain: an updated Cochrane review.Spine (Phila Pa 1976). 2009 Jan 1;34(1):49-59.
http://www.ncbi.nlm.nih.gov/pubmed/19127161

Author: Stephen Small
Director Steadfast Clinics Ltd
http://www.SteadfastClinics.co.uk

Steadfast Clinics is the international distributor of IDD Therapy spinal decompression, SDS SPINA, Accu SPINA devices, Thermedic FAR infrared therapy systems and HydroMassage machines.