Chiropractic + Naturopathic Doctor • July August 2015 • Roundup

Canadians will now be rewarded for good health behaviour through Green Shield Canada’s (GSC) Change4Life health portal, a first in the country, according to the company.

The online health management site not only supports and encourages healthy behaviours – it will reward them. This marks the first time a Canadian health benefits provider will attempt to positively influence Canadian employees’ health behaviour through incentives and rewards.

Founded on behavioural economics (the science of how people make – and don’t make – rational choices), the portal incorporates a points-and-rewards program that nudges Canadian employees to take small, achievable steps towards better health in exchange for points. Those points can then be used to win a variety of rewards including gift cards from major retailers such as Sport Chek and Sobeys.

The Change4Life portal is now available to all of GSC’s plan members, free of charge. They will be encouraged to complete a health risk assessment to produce a personal health score. They will then be directed to online tools, resources and health education tailored to their specific needs. The tools include a step tracker, monitoring of blood pressure and cholesterol, and medication reminders.

The Change4Life health portal is a key part of GSC’s effort to shift the benefits industry’s focus towards addressing one of the biggest issues facing the health of Canadians today – chronic disease. Research has shown that chronic diseases such as hypertension, diabetes and cholesterol can improve significantly when patients improve their health behaviour.

“We have been spending much of our time on rethinking employee health benefit plans in light of the emerging health challenges of Canadians,” said Peter Gove, GSC’s innovation leader for health management. “Our research indicates that our focus should be on engaging plan members in the effective management of their own health. Because the keys to changing behaviours include ease of access to resources and reinforcement of positive change, we know that Change4Life can make a significant contribution.”

Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis and, though still widely misunderstood, is now considered to be a lifelong central nervous system disorder, which is responsible for amplified pain that shoots through the body in those who suffer from it.

Daniel Clauw, a medical doctor and professor of anesthesiology, University of Michigan, analyzed the neurological basis for fibromyalgia in a plenary session address at the recent American Pain Society Annual Scientific Meeting.

“Fibromyalgia can be thought of both as a discreet disease and also as a final common pathway of pain centralization and chronification. Most people with this condition have lifelong histories of chronic pain throughout their bodies,” said Clauw. “The condition can be hard to diagnose if one isn’t familiar with classic symptoms because there isn’t a single cause and no outward signs.”

Clauw explained that fibromyalgia pain comes more from the brain and spinal cord than from areas of the body in which someone may experience peripheral pain. The condition is believed to be associated with disturbances in how the brain processes pain and other sensory information. He said physicians should suspect fibromyalgia in patients with multifocal (mostly musculoskeletal) pain that is not fully explained by injury or inflammation.

“Because pain pathways throughout the body are amplified in fibromyalgia patients, pain can occur anywhere, so chronic headaches, visceral pain and sensory hyper-responsiveness are common in people with this painful condition,” said Clauw.

“This does not imply that peripheral nociceptive input does not contribute to pain experienced by fibromyalgia patients, but they do feel more pain than normally would be expected from the degree of peripheral input. Persons with fibromyalgia and other pain states characterized by sensitization will experience pain from what those without the condition would describe as touch,” Clauw added.

Due to the central nervous system origins of fibromyalgia pain, Clauw said treatments with opioids or other narcotic analgesics usually are not effective because they do not reduce the activity of neurotransmitters in the brain.

“These drugs have never been shown to be effective in fibromyalgia patients, and there is evidence that opioids might even worsen fibromyalgia and other centralized pain states,” he said.

Clauw advises clinicians to integrate pharmacological treatments with nonpharmacological approaches like cognitive behavioral therapy, exercise and stress reduction.

“Sometimes the magnitude of treatment response for simple and inexpensive non-drug therapies exceeds that for pharmaceuticals,” said Clauw. “The greatest benefit is improved function, which should be the main treatment goal for any chronic pain condition. The majority of patients with fibromyalgia can see improvement in their symptoms and lead normal lives with the right medications and extensive use of non-drug therapies.”

Based in Chicago, the American Pain Society is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering.

Ontario’s liberal government will propose legislation this fall to double the fines and enhance prosecution for security breaches involving patients’ medical records.

“The government has an incredibly important role to play in securing and ensuring privacy is upheld,” said Health Minister Er ic Hoskins.”

Hoskins said the new legislation will double fines for violations of patients’ privacy to $50,000 for individuals and $500,000 for the hospital or organization. It would also scrap a rule requiring that prosecutions start within six months of the alleged privacy breach, which Hoskins called “a serious barrier” to prosecuting offenders.

Only three cases of breaching private medical records have ever been referred for prosecution, and there has never been a successful prosecution under the Personal Health Information Protection Act since it was introduced in 2004. One case was unsuccessful and the two others are still under consideration by the Attorney General’s office.

The proposed bill would make it mandatory to report privacy breaches to Ontario’s Information and Privacy Commissioner and to the relevant regulatory colleges that govern health-care professionals. The privacy commissioner can’t launch prosecutions, and can only refer cases to the Attorney General.

“We are proposing in this legislation changes that will require mandatory reporting from a health-care custodian in a hospital, for example, if any human resource action takes place as a result of a breach,” said Hoskins.

Potential privacy breaches increase with the growing use of electronic medical records, although security protocols are much more stringent than under the old paper files, added Hoskins, who said it’s not just a hospital problem.

“I think that is part of the advantage of mandatory reporting of all breaches, is we are going to have a better understanding where these breaches occur,” he said.

The Progressive Conservatives said the proposed legislation should make it mandatory to report serious breaches of patients’ privacy to police.

“The government is finally taking steps to better protect the privacy of the people, though it comes only after months of headlines exposing breaches of patient information and does not guarantee police involvement for serious cases,” said PC attorney general critic Sylvia Jones.

A report released in june by the Canadian Centre for Policy Alternatives (CCPA) takes an in-depth look at a sample of WorksafeBC (WCB) claimants with chronic pain and raises the alarm about serious flaws in how the B.C. workers’ compensation board deals with injured workers who develop chronic pain.

“I’ve been working in this area for 25 years, and I’m extremely concerned about what I’m seeing,” said Dr. Cecil Hershler, the report’s lead author and a specialist who has worked with thousands of patients with chronic pain, many of whom have had workplace injuries.

“Financial hardship, severe physical pain, and deep emotional suffering, including suicidal thoughts – these are some of the consequences for my patients who are dealing with the WCB system.”

After seeing a troubling pattern among patients dealing with WCB, Hershler decided to take an in-depth look at the impacts on a sample of these patients. He and co-author Kia Salomons interviewed nine patients with chronic pain resulting from workplace injuries. The authors identified seven key issues facing chronic pain sufferers, including long periods of time with on-and-off payment of compensation or no compensation at all; lack of income and depletion of financial resources; disbelief on the part of employers and WCB; and undue pressure to engage in job search, even when their injuries should have ruled this out.

According to the report, four out of the nine patients Hershler interviewed for the study had contemplated suicide, while two of the nine had attempted taking their own lives.

These findings are reflective of WCB’s own statistics on suicide, according to the CCPA. An internal document available on the agency’s website shows a startling and steady increase in “threats of suicide,” from only a handful in the early 2000s to almost 200 in 2010.

In his recommendations for change, Hershler offers concrete ideas for improving patient care and reducing physical and emotional suffering. These include ensuring economic stability during the claims process (including appeals, which can take many years to resolve), not sending patients with serious chronic pain back to work too soon, and ending inappropriate work searches.

One of Hershler’s biggest concerns is that claimants must rely on doctors and rehab specialists employed or contracted by WCB for their treatment.

“The priority should be helping the worker recover as much as they possibly can, and this requires collaboration with the patient’s own family doctor and pain specialists. The patient should be able to rely primarily on their own providers, whose familiarity and expertise are essential to their recovery, and those providers should play more of a role in WCB’s decision- making process about the patient’s claim and entitlement to benefits, including pensions,” Hershler said.

A new clinical decision rule for determining patients with higher risk of developing chronic low-back pain has been developed by researchers at the University of California San Francisco, University of Georgia and Kaiser Permanente.

Researchers said the new clinical decision rule may help primary care providers predict which patients with acute low-back pain will progress to chronic low-back pain, according to an article posted on the U.S. National Center for Complementary and Integrative Health (NCCIH) website.

The study, funded in part by the NCCIH, was published in the March 14, 2015 issue of The Spine Journal.

The study involved an initial survey of 605 adults with acute low-back pain, followed by 521 adults surveyed at six months, and 443 at two years.

For purposes of the study, acute low-back pain was defined as back pain between the rib cage and buttocks of less than one month that was severe enough to seek medical care and was not preceded by any other episodes of low-back pain in the past year. The questionnaire assessed the history of prior pain episodes, duration of current episodes, pain intensity, number of days on sick leave and of reduced daily activities, perceived stress, and other parameters, the study explained.

The researchers identified optimal score cutoffs for creating low-risk, medium-risk and high-risk categories for the likelihood of developing chronic pain. At six months, 47 per cent of participants were categorized as low-risk, 38 per cent as medium-risk and 15 per cent as high-risk. At two years, these numbers were 49 per cent, 36 per cent and 15 per cent, respectively. At two years, 10 per cent of those categorized as low-risk had chronic low-back pain, while 20 per cent of those who were medium-risk and 42 per cent of those who were high-risk had chronic low-back pain.

Patients at high-risk of developing chronic low-back pain may warrant more intensive interventions, the researchers noted. “Those in the medium-risk group may need closer oversight by their primary care providers than the low-risk group, but it may be justified to suggest waiting a little longer before prescribing more intense and expensive treatment options.”

In the study, the researchers remarked there is an urgent need for a clinical decision tool for low-back pain, which is one of the most common and expensive conditions in primary care. They also noted that this rule should be validated in a separate study population.

Researchers from McMaster University in Hamilton, Ont., may have uncovered the body’s secret to physically aging well and keeping muscle strength in tact.

Through the recent discovery of a key protein required to maintain muscle mass and strength as people age, researchers at McMaster may help provide some understanding about what causes people to lose muscle strength as they age and how exercise can prevent it from happening.

This important finding means new and existing drugs targeting the protein may potentially be used to preserve muscle function during aging, a release from McMaster University stated.

“We found that the body’s fuel gauge, AMP-activated protein kinase (AMPK), is vital to slow muscle wasting with aging,” said Gregory Steinberg, the study’s senior author and professor of medicine at the Michael G. DeGroote School of Medicine. He is also co-director of MAC-Obesity, the Metabolism and Childhood Obesity Research Program at McMaster.

“Mice lacking AMPK in their muscle developed much greater muscle weakness than we would have expected to see in a middle-aged mouse,” said Steinberg. “Instead these mice, which were the equivalent of being just 50 years old, had muscles like that of an inactive 100-year-old.”

The research was published Tuesday, June 2nd, in Cell Metabolism and involved members of the MAC-Obesity research team. The lead author is Adam Bujak, a PhD student of McMaster’s Medical Sciences Graduate Program.

“It is known that AMPK activity in muscle is ‘dialed down’ with aging in humans, so this may be an important cause of muscle loss during aging,” Steinberg said.

Previous research by Steinberg’s team has shown that this “metabolic switch” is turned on with exercise as well as commonly used medications including metformin and salicylate (the active ingredient in Aspirin).

Despite the importance of maintaining muscle function and strength as people age, there is currently no treatment besides exercise. With an aging population, age-related muscle wasting and loss of muscle strength is a growing issue that shortens lives and creates a significant financial burden on the Canadian health-care system, McMaster said.

“We know we can turn on the AMPK pathway with intense exercise and commonly used Type 2 diabetes medications,” said Steinberg. “By knowing that AMPK is vital for maintaining muscle mass with aging, we can now try to adapt exercise regimes and existing drugs to switch on AMPK in muscle more effectively. The development of new selective activators of the AMPK pathway in muscle may also be effective to prevent muscle loss with aging.”

This study was conducted over four years and was supported by the Natural Sciences Engineering Research Council, Canadian Institutes of Health Research, Canadian Foundation for Innovation, Australian National Health and Medical Research Council, and the MAC-Obesity Research Program.

A consumer research study by the British Chiropractic Association (BCA), determined that the average age when men feel the strain of back and neck pains is 37. The study surveyed 2,127 U.K. adults of which 908 were men between the ages of 16 and 55+.

The study found that four in five men in the U.K. say they currently live with neck or back pain or have suffered in the past compared to 75 per cent just a year ago.

Moving heavy objects is the top trigger for nearly half of men, but 41 per cent admit they don’t do anything to proactively look after their backs, while 28 per cent opt to self-treat with over-the-counter medicine.

Some men are putting the strain down to their size; 14 per cent think having a big belly has the most negative impact on their back health compared to just six per cent of women, but according to the experts, this is not necessarily the case.

BCA chiropractor Rishi Loatey said: “The modern man is certainly feeling the strain as we constantly juggle busy lives – working longer hours, tackling DIY and looking after the kids – it all takes its toll, but worryingly we’re seeing younger men coming through our doors who aren’t looking after themselves.

“There is however, no real correlation between weight and back pain, rather the link is between poor muscle tone and back pain – people who are overweight do tend to have poor muscle tone so it’s important they focus on strengthening the muscles in their back.”

Ontario has launched a plan that will give patients and their caregivers greater flexibility in choosing a provider, and how and when that provider delivers services.

This new provision is part of the provincial government’s program, Patients First: A Roadmap to Strengthen Home and Community Care. This initiative aims to improve and expand home and community care for Ontarians over the next three years.

“Our new plan puts patients and their caregivers first by improving access and expanding services,” said Minister of Health Dr. Eric Hoskins.

“We know that people who receive care in their homes – where they want to be – tend to heal faster because they are happier and more comfortable in a familiar setting. Our new plan outlines the path we will follow together with patients, caregivers and providers to improve the care people receive no matter where they live across the province.”

Funding for an additional 80,000 hours of nursing care is part of the 2015 Budget commitment to increase investment in home and community care by more than $750 million over the next three years. These extra hours of care will make it possible for individuals with complex conditions to receive care where they want to be – in their home and community, instead of in a hospital or in long-term care.

The new plan outlines how the government will transform delivery of care at home and in the community.

• Giving clients and caregivers greater say in choosing a provider, and how and when that provider delivers services

• Clear and consistent levels of home and community care services, no matter where in the province a patient lives

Helping more people access better health care faster and closer to home is part of the government’s plan to build a better Ontario through its Patients First: Action Plan for Health Care. This program aims to provide patients with faster access to the right care, better home and community care, the information they need to stay healthy and a health care system that’s sustainable for generations to come, according to the Ontario health ministry.