Chiropractic + Naturopathic Doctor • December 2018 • News And Events

Nobody knows why some children’s backs start to curve to one side just as they hit puberty. Most children diagnosed with scoliosis, or curvature of the spine, have no known risk factors.

A new study (Nature Communications DOI: 10.1038/ s41467-018-06705-0) suggests that the body’s inability to fully utilize the essential dietary mineral manganese might be to blame for some cases of severe scoliosis. Researchers at Washington University School of Medicine in St. Louis have found that children with severe scoliosis are twice as likely as children without the disease to carry a gene variant that makes it hard for their cells to take in and use manganese. Manganese is required for growing bones and cartilage.

“Our study links scoliosis to something that’s potentially modifiable in the diet,” said senior author Christina Gurnett, MD, PhD, a professor of neurology, of orthopedic surgery and of pediatrics. “But we don’t want people to go out right now and start manganese supplements, because we already know that too much manganese can be harmful.”

About 3 million new cases of scoliosis are diagnosed every year. Most are mild and require only that doctors keep a watchful eye on the condition. Children who develop a moderate bend to their spine may need to wear a back brace until they finish growing. In rare cases, the curvature is so pronounced that it requires surgery to correct.

Cases of scoliosis tend to cluster in families, but not in a simple way, which suggests that many different genes each play a small role in increasing the risk of the disease. To identify such genes, Gurnett and a research team including Matthew Dobbs, MD, the Dr. Asa C and Mrs. Dorothy W. Jones Professor of Orthopaedic Surgery, and postdoctoral researcher and first author Gabriel Haller, PhD, scanned all the genes in 457 children with severe scoliosis and 987 children without scoliosis.

They found a variant in the gene SLC39A8 in only six per cent of the healthy children but 12 per cent of the children with severe scoliosis. A second analysis in a separate group of 1,095 healthy children and 841 children with moderate to severe scoliosis also found that children with scoliosis were about twice as likely to carry the variant.

The children with the genetic variant did not have manganese deficiency, but they may be unable to use manganese as efficiently as others.

Any manganese supplementation would have to be carefully measured to avoid raising the risk for other serious diseases, the researchers cautioned.

“We’ve started doing these studies in zebrafish by adding manganese to their water,” Gurnett said. “But we still need to do human studies to figure out how much exactly is both safe and effective.”

The following is a comment from the canadianchiropractor.ca article: “B.C. Chiropractors must remove unsupported claims from their websites or face discipline.”

“It’s about time one of our regulatory colleges stepped up to address this issue. Will the CCO show similar leadership in Ontario? And what about the other provinces? Our regulatory colleges are tasked with protecting the public, and antivaccination sentiments within our profession are definitely a public health issue. It’s time for our other regulatory colleges to step up and follow the leadership of the B.C. college. Both public safety and our profession’s credibility are at stake.

I should add that other non-evidence-based treatment recommendations by chiropractors, such as claiming to be able to treat non-MSK disorders (eg. Alzheimer’s, cancer, diabetes), is also a public health and professional credibility issue. I therefore applaud the efforts of the regulatory college in B.C., and again wonder if and when our other provincial colleges will follow suit?”

Smart phone usage has become very prevalent in the recent years across all ages. Unfortunately, many users hold the phone lowered in front, causing “forward head posture” (FHP).

In a recent study, neck muscle fatigue has been shown with FHP while holding the smart phone tilted in a horizontal position (Jung- Hyun Choi et al., 2016). Another study has shown that using your smart phone with FHP (looking down) can start to cause neck muscle fatigue and pain within only 10 minutes, and significant muscle fatigue within 20 minutes (Seong-Yeol Kim, Sung-Ja Koo, 2016). Increase poundage of pressure on your spine as you look down at your phone has also been established (Hansraj, K., 2014). In the study, Hansraj calculated that at zero degrees of tilt, the resting pressure is equal to the weight of the person’s head (10 to 12 pounds). However, at 15 degrees of tilt the pressure increases to 27 pounds; at 30 degrees the pressure is 40 pounds; at 45 degrees, 49 pounds; and at 60 degrees your head adds roughly 60 pounds of force to your spine.

The Simply Align app reminds the user to hold the phone up to avoid muscle fatigue, adjust posture, and create healthy tech habits.

Simply Align was designed by Chiropractor and Physiotherapist, Dr. Nima Pardisnia (along with a programmer) and is available for both Android and Apple devices.

Becoming more sensitive to pain, or pain sensitization, is an important risk factor for developing persistent knee pain in osteoarthritis (OA), according to a new study by researchers from the Université de Montréal (UdeM) School of Rehabilitation and Hôpital Maisonneuve Rosemont Research Centre (CRHMR) in collaboration with researchers at Boston University School of Medicine (BUSM). The findings have been published in the journal Arthritis and Rheumatology.

OA is a common cause of pain and altered joint function, affecting 302 million adults worldwide. It can lead to chronic disability frequently in the knee joint. Past research suggests that a number of different factors outside of structural pathology may contribute to pain experienced in patients with OA.

“Understanding the factors that contribute to the development of persistent pain is critical in improving our ability to prevent its onset and the transition to more persistent pain’, said Lisa Carlesso BSc.PT. PhD, assistant professor School of Rehabilitation (UdeM) and scientist at CRHMR.

Researchers analyzed data from a multicenter OA study that followed 852 adults (ages 50- 79) with, or at risk of knee OA, but who were free of persistent knee pain at the beginning of the study. Sociodemographic data, pain sensitization measurements, as well as risk factors traditionally associated with knee pain – such as psychological factors, widespread pain and poor sleep were collected on the participants who then were followed for development of persistent knee pain over two years.

The researchers used the above risk factors and pain sensitization data to identify four distinct subgroups called pain susceptibility phenotypes (PSPs). The authors found these PSPs were primarily characterized by varying degrees of pain sensitization. The PSP with the highest degree of sensitization had the highest risk of developing persistent knee pain. Female gender, non-Caucasian race and age 65+ were significant sociodemographic predictors of being a member of the PSP with the highest degree of sensitization.

The researchers believe identifying these PSPs is an important step in understanding the complex pathology of knee osteoarthritis. “Our findings suggest that therapy aimed at prevention or improvement of pain sensitization may be a novel approach to preventing persistent knee pain,” explained author Tuhina Neogi, MD, PhD, professor of medicine and epidemiology at BUSM and BU School of Public Health. “Preventing pain is crucial to improving quality of life and function in patients who suffer from OA.”

Last month, researchers at the University of Maryland Medical Center became the first team in the US to treat neuropathic pain using noninvasive focused ultrasound therapy. Led by Dheeraj Gandhi, MD, the early-stage, pilot trial aims to establish the safety of destroying a small target in the brain to treat chronic neuropathic pain using Insightec’s Exablate Neuro device.

“If we can interrupt or carefully destroy the nucleus in the brain responsible for processing and amplifying pain signals, then we can disrupt this network and stop the neuropathic pain,” says Gandhi, professor of diagnostic radiology and nuclear medicine at the University of Maryland School of Medicine and director of neurointerventional radiology at the University of Maryland Medical Center.

Neuropathic pain is a type of chronic pain caused by nerve damage or a malfunctioning nervous system. It can be a result of a number of things, including injury, infection, metabolic disease, or a traumatic event to the peripheral nerves or the brain. It can cause significant disability, depression, and sleep problems.

Currently, the study is limited to ten patients with certain causes of neuropathic pain: radiculopathy (sciatica), spinal cord injury, and phantom limb pain. It is being funded by the Focused Ultrasound Foundation.

“Pain is a global health problem for millions of patients, so this trial aligns with the Foundation’s mission to support research that will make a large impact,” said Foundation Chairman Neal F. Kassell, MD. “Treating neuropathic pain using focused ultrasound was pioneered by Dr. Daniel Jeanmonod in Switzerland, and I am confident the University of Maryland team will build upon this work to relieve pain in many more patients.”

If this pilot trial is a success, Dr. Gandhi plans to hold a larger trial and expand to other types of neuropathic pain that are widespread, such as diabetic neuropathy pain.

If you thought that proactively offering help to your co-workers was a good thing, think again. New workplace research from Michigan State University found that when it comes to offering your expertise, it’s better to keep to yourself or wait until you’re asked.

Building upon previous findings that showed how helping colleagues slows one’s success, management professor Russell Johnson looked more closely at the different kinds of help in which people engage in at work – and how that help was received.

In looking at the ways people help one another in the workplace, Johnson explained that there are two basic kinds of help one can offer – proactive and reactive help – which are differentiated by whether or not assistance was requested.

If you are the go-getter and actively offer to help others, you’re proactively helping. If a co-worker approaches you and asks for assistance that you then give, you’re reactively helping, Johnson explained.

“What we found was that on the helper side, when people engage in proactive help, they often don’t have a clear understanding of recipients’ problems and issues, thus they receive less gratitude for it,” Johnson said. “On the recipient side, if people are constantly coming up to me at work and asking if I want their help, it could have an impact on my esteem and become frustrating. I’m not going to feel inclined to thank the person who tried to help me because I didn’t ask for it.”

Johnson surveyed 54 employees between the ages of 21 and 60 who worked full-time jobs across a variety of industries, including manufacturing, government, health care and education. He collected data over 10 days for a collective 232 daily observations to assess daily helping, receipt of gratitude, perceived positive social impact and work engagement.

With less gratitude for the helper and lower esteem for the person receiving help, Johnson explained that the respondents’ answers proved that proactive help has negative bearings on both sides – but for different reasons.

In some ways, Johnson said that his research suggests workers mind their own business and not go looking for problems to solve. Ultimately, he said, help is good – but just wait to be asked for it.

“As someone who wants to help, just sit back and do your own work. That’s when you’ll get the most bang for your buck,” he said. “As the person receiving help, you should at a minimum express gratitude – and the sooner the better. If you wait a few days, it won’t have a positive impact on the helper.”

The siren call of addictive drugs can be hard to resist, and returning to the environment where drugs were previously taken can make resistance that much harder. However, addicts who exercise appear to be less vulnerable to the impact of these environmental cues. Now, research with mice suggests that exercise might strengthen a drug user’s resolve by altering the production of peptides in the brain, according to a study in the journal ACS Omega.

Re-exposure to drug-related cues, such as the location where drugs were taken, the people with whom they were taken, or drug paraphernalia, can cause even recovered drug abusers to relapse. Prior studies have shown that exercise can reduce craving and relapse in addicts, as well as mice. Although the mechanism was unknown, exercise was thought to alter the learned association between drug-related cues and the rewarding sensations of taking a drug, possibly by changing the levels of peptides in the brain. Jonathan Sweedler, Justin Rhodes and colleagues at University of Illinois at Urbana-Champaign decided to explore this theory by quantifying these peptide changes in mice.

Mice were given cocaine injections over four days in special chambers with a distinctive floor texture to produce a drug association with that environment. The animals were then housed for 30 days in cages, some of which included a running wheel. The researchers found that mice that exercised on these wheels had lower levels of brain peptides related to myelin, a substance that is thought to help fix memories in place. Re-exposure to the cocaine-associated environment affected running and sedentary mice differently: Compared with sedentary mice, the animals with running wheels showed a reduced preference for the cocaine-associated environment. In addition, the brains of re-exposed runners contained higher levels of hemoglobin- derived peptides, some of which are involved in cell signaling in the brain. Meanwhile, peptides derived from actin decreased in the brains of re-exposed sedentary mice. Actin is involved in learning and memory and is implicated in drug seeking. The researchers say these findings related to peptide changes will help to identify biomarkers for drug dependence and relapse.

Expect a shot to hurt and it probably will, even if the needle poke isn’t really so painful. Brace for a second shot and you’ll likely flinch again, even though the second time around you should know better.

That’s the takeaway of a new brain imaging study by University of Colorado at Boulder neuroscientists, who found that expectations about pain intensity can become self-fulfilling prophecies.

“We discovered that there is a positive feedback loop between expectation and pain,” said psychology and neuroscience professor Tor Wager, senior author of the paper. “The more pain you expect, the stronger your brain responds to the pain. The stronger your brain responds to the pain, the more you expect.”

The new study is the first to unpack the vicious cycle between increased pain expectations and increased pain and elucidate the neural mechanisms underlying it.

Marieke Jepma, then a postdoctoral researcher in Wager’s lab, launched the research after noticing that even when test subjects were shown time and again that something wouldn’t hurt badly, some still expected it to. Jepma is the lead author of the study and now a researcher at the University of Amsterdam.

The researchers recruited 34 subjects and taught them to associate one symbol with low heat and another with high, painful heat. Then, the subjects were placed in a functional magnetic resonance imaging (fMRI) machine. For 60 minutes, subjects were shown low or high pain cues (the symbols, the words Low or High, or the letters L and W), then asked to rate how much pain they expected.

Then, varying degrees of painful but non-damaging heat were applied to their forearm or leg, with the hottest reaching “about what it feels like to hold a hot cup of coffee,” then were asked to rate their pain.

Unbeknownst to the subjects, heat intensity was not actually related to the preceding cue. The study found that when subjects expected more heat, brain regions involved in threat and fear were more activated as they waited. Regions involved in the generation of pain were more active when they received the stimulus. Participants reported more pain with high-pain cues, regardless of how much heat they actually got.

“This suggests that expectations had a rather deep effect, influencing how the brain processes pain,” said Jepma.

Surprisingly, their expectations also highly influenced their ability to learn from experience. Many subjects demonstrated high “confirmation bias” – the tendency to learn from things that reinforce our beliefs and discount those that don’t. For instance, if they expected high pain and got it, they might expect even more pain the next time. But if they expected high pain and didn’t get it, nothing changed.

This phenomenon could have tangible impacts on recovery from painful conditions, suggests Jepma.

“Our results suggest that negative expectations about pain or treatment outcomes may in some situations interfere with optimal recovery, both by enhancing perceived pain and by preventing people from noticing that they are getting better,” she said. “Positive expectations, on the other hand, could have the opposite effects.”

The research also may shed light on why, for some, chronic pain can linger long after damaged tissues have healed.

Whether in the context of pain or mental health, the authors suggest that it may do us good to be aware of our inherent eagerness to confirm our expectations.—University of Colorado at Boulder

People who experience migraine with visual aura may have an increased risk of an irregular heartbeat called atrial fibrillation (AF), according to a study published in an online issue of Neurology.

Migraine with visual aura is when disturbances in vision occur right before head pain begins. Those disturbances may include seeing wavy lines or flashes of light, or having blurry vision or blind spots.

With AF, a form of arrhythmia, the heart’s normal rhythm is out of sync. As a result, blood may pool in the heart, possibly forming clots that may go to the brain, causing a stroke.

“Since atrial fibrillation is a common source of strokes caused by blood clots, and previous research has shown a link between migraine with aura and stroke, we wanted to see if people who have migraine with aura also have a higher rate of atrial fibrillation,” said study author Souvik Sen of the University of South Carolina in Columbia.

For the study, 11,939 people with an average age of 60 without prior AF or stroke were evaluated for headache. Of those 9,405 did not have headache and 1,516 had migraine. Of those who had migraine, 426 had migraine with visual aura. The participants were followed for up to 20 years.

During the study, 1,623 people without headache, or 17 percent, developed AF while 80 of 440 people with migraine with aura, or 18 percent, developed the condition and 152 of 1,105 people with migraine without aura, or 14 percent.

After adjusting for age, sex, blood pressure, smoking and other factors that could affect risk of AF, people with migraine with aura were found to be 30 percent more likely to develop the condition than people who did not have headaches and 40 percent more likely to develop atrial fibrillation than people with migraine with no aura.

The results translate to an estimated nine out of 1,000 people with migraine with aura having atrial fibrillation compared to seven out of 1,000 people with migraine without aura. Researchers also found that the rate of stroke in the migraine with aura group was four out of 1,000 people annually compared to two out of 1,000 people annually in those with migraine without aura, and three of 1,000 people annually in those with no headache.

“Our research suggests that atrial fibrillation may play a role in stroke in those with migraine with visual aura,” said Sen. “It is important to note that people with migraine with aura may be at a higher risk of atrial fibrillation due to problems with the autonomic nervous system, which helps control the heart and blood vessels. More research is needed to determine if people with migraine with visual aura should be screened for atrial fibrillation.”

Can’t exercise? A hot bath may help improve inflammation, metabolism, study suggests

Hot water treatment may help improve inflammation and blood sugar (glucose) levels in people who are unable to exercise, according to a new study. The findings are published ahead of print in the Journal of Applied Physiology.

Physical stress such as exercise can cause the short-term elevation of inflammatory markers. After exercise, the level of an inflammatory chemical (IL-6) rises. In a process called the inflammatory response, this activates the release of anti-inflammatory substances to combat unhealthily high levels of inflammation, known as chronic low-grade inflammation. Recent research has shown that raising body temperature augments the inflammatory response and provides a rationale for identifying exercise alternatives that reduce low-grade inflammation in the body. Previous studies have also found a connection between a spike in body temperature and nitric oxide production, a substance that aids blood flow and helps carry glucose throughout the body.

Researchers studied markers of inflammation and blood sugar and insulin levels in a group of sedentary, overweight men. The volunteers participated in both hot-water immersion and ambient room temperature (control) trials separated by at least three days. The researchers took blood samples before and after the participants rested in an 80-degree F room for 15 minutes. After the rest period, the participants either remained seated in the room or entered a hot-water bath for 60 minutes. In the hot water trial, the volunteers sat immersed up to their necks in 102-degree F water. The research team measured the men’s heart rate, blood pressure and body temperature every 15 minutes throughout both the control and immersion conditions. Blood samples were taken again two hours after each session.

The researchers found that a single hot-water immersion session causes the elevation of Il-6 levels in the blood and increased nitric oxide production, but did not change the expression of heat shock protein 72 – another protein suggested to be important for health. However, a two-week treatment period in which the men participated in daily hot-water baths showed a reduction of fasting blood sugar and insulin levels as well as improved lowgrade inflammation at rest.

The men reported a level of discomfort during the hot water immersion trial, which could be due to the high temperature of the water or the length of time they were required to remain immersed. The researchers acknowledge that these conditions may make it difficult for people to commit to this type of alternative treatment. However, the positive results of decreased inflammation and improved insulin sensitivity suggest that hot-water immersion may “improve aspects of the inflammatory profile and enhance glucose metabolism in sedentary, overweight males and might have implications for improving metabolic health in populations unable to meet the current physical activity recommendations,” the researchers wrote.