How music can help relieve chronic pain

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Don Knox, Glasgow Caledonian University

As the 17th-century English playwright William Congreve said: “Music has charms to soothe a savage breast.” It is known that listening to music can significantly enhance our health and general feelings of well-being.

An important and growing area of research concerns how music helps to mitigate pain and its negative effects. Music has been shown to reduce anxiety, fear, depression, pain-related distress and blood pressure. It has been found to lower pain-intensity levels and reduce the opioid requirements of patients with post-operative pain.

Music has helped children undergoing numerous medical and dental procedures. And it has been demonstrated to work in a variety of other clinical settings such as palliative care, paediatrics, surgery and anaesthesia.

So what makes music so effective at making us feel better? The research has often drawn on theories around how nerve impulses in the central nervous system are affected by our thought processes and emotions. Anything that distracts us from pain may reduce the extent to which we focus on it, and music may be particularly powerful in this regard. The beauty is that once we understand how music relates to pain, we have the potential to treat ourselves.

Music attracts and holds our attention and is emotionally engaging, particularly if our relationship with the piece is strong. Our favourite music is likely to have stronger positive effects than tracks we don’t like or know. Researchers have demonstrated that the music we prefer has greater positive effects on pain tolerance and perception, reduces anxiety and increases feelings of control over pain. In older people with dementia, listening to preferred music has been linked with decreasing agitated behaviour.

Alongside the benefits of listening to what you prefer, the nature of the music has also been shown to be important in enhancing how emotionally engaging it is for patients. Recent research has demonstrated this in relation to dynamics, brightness, arousal levels and other acoustic attributes. Music which is bright, with low intensity and slower tempo has been shown to have the most positive effect on the degree of pain that we experience, for example.

The pain barrier

On the back of all these insights, we are beginning to see music therapy for pain related to a wide variety of medical conditions. Types of therapy include playing musical instruments, singing and listening to music, though mostly in a clinical setting. Yet despite what we have learned and what we are now beginning to practice, there has been little work on chronic pain. This area of growing importance refers to pain either from an ongoing disease or that continues beyond the normal time that a wound usually takes to heal. This affects more than 14m people in England alone – around a quarter of the population.

To ease the burden on health professionals, the government wants sufferers to increasingly manage their pain themselves. Known as self-management in the jargon, this traditionally includes taking medication, stretching, relaxation exercises and so forth. Music has been suggested as an attractive addition to the list, given that it is inexpensive, can be tailored around the everyday activities of the individual and has few of the negative secondary effects associated with many prescription drugs. Beyond the pain itself, it also has the potential to help with persistent parts of the pain cycle such as stress and negative thoughts – particularly in this era of ubiquitous portable playing devices.

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There is also much to study, however. We may know that the music we like can help with the negative symptoms of pain, but key mechanisms are still not fully understood. If being emotionally engaged with music is key to maximising our distraction in this regard, there are myriad factors affecting our emotional relationship with music that we need to understand.

These include the personal meaning and memories that the music conjures for a particular individual, the context the listener is in and factors such as age, gender, occupation and identity. There’s also a lot we don’t know about how people use music to regulate their emotions, such as using it to achieve a psychological high or to suppress negative feelings. Insights into these areas won’t only help in relation to chronic pain, but would certainly bring important benefits in that area.

Most of the research to date has been in laboratories and clinical settings – hence the reason most therapy takes place in the presence of specialists. Particularly if we are to learn how best to apply music to chronic pain, where self-management is so important, we’re going to need more research situated in everyday settings.

I am planning studies myself based around everyday music listening and how this can help support self-management of pain. Undoubtedly music therapy for chronic pain is an area with great potential, so there is every reason to others to press ahead too.

The Conversation

Don Knox, Senior audio lecturer, Glasgow Caledonian University

This article was originally published on The Conversation. Read the original article.

Your smartphone could be good for your mental health

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Joanna Rodriguez, University of Surrey and Nadine Page, University of Surrey

When it comes to mental health, technologies such as smartphones and social media networks are almost always discussed in terms of the dangers they pose. Alongside concerns expressed in the media, some experts believe that technology has a role in the rising rates of mental health problems. However, there is also evidence to suggest your smartphone could actually be good for your mental health.

The brain is a sensitive organ that reacts and adapts to stimulation. Researchers have looked into smartphone usage and the effects on the day-to-day plasticity of the human brain. They found that the finger movements used to control smartphones are enough to alter brain activity.

This ability of technology to change our brains has led to questions over whether screen-based activity is related to rising incidence of such conditions as attention deficit hyperactivity disorder (ADHD) or an increased risk of depression and insomnia. Technology has also been blamed for cyber-bullying, isolation, communication issues and reduced self-esteem, all of which can potentially lead to mental ill health.

Positive potential

However, focusing only on the negative experiences of some people ignores technology’s potential as both a tool for treating mental health issues and for improving the quality of people’s lives and promoting emotional well-being. For example, there are programmes for depression and phobias, designed to help lift people’s moods, get them active and help them to overcome their difficulties. The programmes use guided self help-based cognitive behavioural principles and have proven to be very effective.

Computer games have been used to provide therapy for adolescents. Because computer games are fun and can be used anonymously, they offer an alternative to traditional therapy. For example, a fantasy-themed role-playing game called SPARX has been found to be as effective as face-to-face therapy in clinical trials.

Researcher David Haniff has created apps aimed at lifting the mood of people suffering from depression by showing them pleasing pictures, video and audio, for example of their families. He has also developed a computer game that helps a person examine the triggers of their depression. Meanwhile, smartphone apps that play subliminal relaxing music in order to distract from the noise and worries of everyday living have been proven to be beneficial in reducing stress and anxiety.

Doctor on call Shutterstock

Technology can also provide greater access to mental health professionals through email, online chats or video calls. This enables individuals to work remotely and at their own pace, which can be particularly useful for those who are unable to regularly meet with a healthcare professional. Such an experience can be both empowering and enabling, encouraging the individual to take responsibility for their own mental well-being.

This kind of “telemedicine” has already found a role in child and adolescent mental health services in the form of online chats in family therapy, that can help to ensure each person has a chance to have their turn in the session. From our own practice experience, we have found young people who struggle to communicate during face-to-face sessions can be encouraged to text their therapist as an alternative way of expressing themselves, without the pressure of sitting opposite someone and making eye contact.

Conditions such as social anxiety can stop people seeking treatment in the first place. The use of telemedicine in this instance means people can begin combating their illness from the safety of their own home. It is also a good way to remind people about their appointments, thus improving attendance and reducing drop-out rates.

New routes to treatment

The internet in general can provide a gateway to asking for help, particularly for those who feel that stigma is attached to mental illness. Accessing information and watching videos about people with mental health issues, including high-profile personalities, helps to normalise conditions that are not otherwise talked about.

People can use technology to self-educate and improve access to low-intensity mental health services by providing chat rooms, blogs and information about mental health conditions. This can help to combat long waiting times by providing support earlier and improving the effectiveness of treatment.

More generally, access to the internet and use of media devices can also be a lifeline to the outside world. They allow people to connect in ways that were not previously possible, encouraging communication. With improved social networks, people may be less likely to need professional help, thus reducing the burden on over stretched services.

Research into the potential dangers of technology and its affect on the brain is important for understanding the causes of modern mental health issues. But technology also creates an opportunity for innovative ways to promote engagement and well-being for those with mental health problems. Let’s embrace that.

The Conversation

Joanna Rodriguez is Senior tutor at University of Surrey and Nadine Page is Teaching Fellow (Integrated Care) at University of Surrey

This article was originally published on The Conversation. Read the original article.

Women's magazines could play a role in promoting natural births

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Kate Young, Monash University and Yvette Miller, Queensland University of Technology

Reading just one magazine article promoting childbirth without medical intervention makes women want a more natural birth. This is the finding of research we recently published in the peer-reviewed journal Women and Health. Our research suggests the media could play a role in reducing rates of unnecessary medical intervention in childbirth.

Such intervention is associated with preventable maternal and infant ill health, and it places an extra burden on the health-care system.

Epidural, for instance, is associated with increased risk of the mother having very low blood pressure and fever, as well as the use of forceps and vacuum extraction. And caesarean section in low-risk births is associated with increased risk of babies needing intensive care.

Intervening too much

Several things contribute to the over-use of medical intervention in birth. Whether the hospital is publicly funded or a private one makes a difference, as do hospital policies that restrict birth options for certain women, such as those who’ve had a previous caesarean section.

Maternity care providers, such as midwives and obstetricians, also contribute to these rates. One study found a large proportion of women were not informed about the risks and benefits of the medical procedures being recommended to them.

Selective communication by care providers and directive communication that’s biased towards particular options inhibits women’s ability to make informed decisions about their care.

While maternity care providers have the primary responsibility for talking to women about birthing, other sources of information also influence their understanding of the risks of birth and the need for medical intervention. Our work shows that even brief exposure to alternative information and perspectives in a single magazine article can have an impact.

Essentially, long before women are directly receiving maternity care, any information about birthing they’re exposed to influences their preferences for and expectations about the amount of medical intervention they will be comfortable with.

Research shows a large proportion of women are not informed about the risks and benefits of the medical procedures being recommended to them. Sarah Zucca/Flickr, CC BY-SA

But research shows popular media, including reality television shows and women’s magazines, are also biased towards promoting the benefits of medical intervention, such as induction of labour, epidurals and caesarean births, even when there’s little medical necessity for mother and baby.

A little test

Given women’s magazines are a popular source of information on birth, we wanted to test whether they could be used to communicate evidence-based information about the benefits of avoiding medical intervention.

We randomly exposed 180 childless women of childbearing age (18 to 35 years) to one of three different magazine articles. Two of the test articles – one featuring celebrities and one with “real life” people – included information on the benefits of birth without medical intervention.

The articles presented birth as a natural physiological event rather than a high-risk medical condition, which is how it’s often portrayed in the popular media. And they gave examples of non-medical interventions that women report as useful for managing labour and birth, such as changing positions and using a pool to labour or birth in.

They also highlighted how different maternity care providers are appropriate for different types of pregnancies. We know that midwifery care, for instance, is associated with the best health outcomes for women and babies with no substantial medical complications.

The third article was a control piece on organic eating. We included this to test whether just reading an article endorsing “natural” health-related approaches was responsible for any observable effects.

The way forward

We found reading an article about the benefits of giving birth without medical intervention reduced women’s willingness to accept such intervention. Profiling the experience of celebrities didn’t appear to affect impact, but explanations of the risk involved in birth and associated medical interventions did.

Of course, a single magazine article is unlikely to counteract the current collective bias toward overuse of medical intervention in birth information. But a change in the media’s approach could address women’s exaggerated perceptions of the risk of birth and provide balanced information about the benefits of natural birthing.

Still, it’s important to be mindful of the fact that some women may want and benefit from interventions that are not based on medical necessity. Any attempt to reduce medically unnecessary intervention in birth should not focus on restricting access to available options. Rather, maternity care stakeholders should seek to level the current bias and inaccuracy in the information we provide to the media so women can make the best decisions for themselves.

Our findings suggest this may simultaneously combat the increasing use of medical intervention and avoidable associated health-care costs.

The Conversation

Kate Young is PhD candidate at Monash University and Yvette Miller is Associate Professor in Public Health at Queensland University of Technology

This article was originally published on The Conversation. Read the original article.

Lyme disease - Integrative Treatment Approach Part One

Lyme disease, or Lyme Borreliosis, is caused by a species of bacteria called Borrelia. It is transmitted to humans by ticks. Some ticks carry Borrelia, and when they attach and suck blood, they can regurgitate the bacteria into their host. The most common strain is Borrelia burgdorferi. This is the cause of most cases of Lyme disease in America. In Europe, the main strains are B. garinii and B. afzelii.

 

What are the symptoms of Lyme disease?

Borrelia bacteria are slow growing. Symptoms may take days or months to appear. In some cases, the disease may lie dormant for years, and surface after a stressful event such as illness, surgery, or physical or emotional trauma. One of the earliest and most defining signs of Lyme disease is a rash that spreads out from the site of the tick bite. The rash resembles a bulls-eye. At this early stage you may feel like you have the flu- fatigue, fever, headaches, muscle and joint aches and pains, and swollen lymph nodes are common.

The later stages of Lyme disease can take months or years to develop, and can cause problems in the joints, heart, and nervous system, and may affect mood and cognition.

 

Lyme disease in Australia, why the controversy?

The question of whether Australian ticks carry the bacteria that causes Lyme disease is controversial. The Australian government denies that Australian ticks carry the Borrelia bacteria, and suggests that people with Lyme disease must have contracted it while overseas. However, switched-on health practitioners are finding that not all patients with Lyme disease have been outside of Australia.

So why is there so much disagreement on Lyme disease in Australia? In 1994 a study by Russell and Doggett set out to answer the question of whether Australian ticks carry Borrelia bacteria. They collected 12 000 common Australian ticks and did not isolate any Borrelia DNA, concluding that Australian ticks do not carry the bacteria that causes Lyme disease. However, there were a number of issues in this study. Of the 12 000 ticks, only 1038 were actually tested for Borrelia. Russell and Doggett also worked on the assumption that only the burgdorferi strain of Borrelia causes Lyme disease, yet European studies have found that B.garinii and B.afzelii can also cause Borreliosis.

In 1959 Mackerras isolated Borrelia from Australian kangaroos, wallabies and bandicoots. Russell and Doggett did not mention this study in their own work. In 1962 Carley and Pope discovered an Australian strain of Borrelia, called Borrelia Queenslandica. Again, Russell and Doggett made no mention of this in their study. In 1995 Barry, Wills and Hudson isolated and grew Borrelia bacteria from Australian ticks. They also tested people with symptoms of Lyme disease, and 20% were positive for B.garinii, B.afzelii or B.burgdorferi.

Given that three out of four studies isolated Borrelia species from Australian fauna, a review of the government position on Lyme disease in Australia would be wise. We need more research to fully understand Lyme disease in Australia, and more public awareness of Lyme disease, to ensure people receive the correct diagnosis and best treatment.

 

Why is Lyme disease so difficult to diagnose?

Aside from the clear roadblocks that the controversy of Lyme disease in Australia causes for diagnosis, a number of other issues make diagnosis difficult. Firstly, less than 30% of patients with Lyme disease can recall getting a tick bite. Secondly, the bulls-eye rash that is a defining feature of Lyme disease occurs in less than 30% of cases.

And the list of reasons goes on: Borrelia can live inside cells and inside the central nervous system, and so may not come up in blood tests, especially in chronic cases. The tests currently used are very poor at detecting Borrelia, and results may come back falsely negative. None of the tests, either in Australia or overseas, test for strains of Borrelia specific to Australia, like Borrelia Queenslandica.

Because Lyme is difficult to diagnose, and awareness of Lyme disease in Australia is poor, patients are being misdiagnosed. People with Lyme disease have been misdiagnosed with fibromyalgia, motor neurone disease, Parkinson’s disease, Alzheimer’s disease, and chronic fatigue syndrome.

 

The complexities of Lyme disease

Lyme disease is not your average bacterial infection. Ticks often carry other organisms, including Babesia, Anaplasma, Ehrlichia, and Bartonella. These can be transmitted to humans at the same time as the Borrelia bacteria, causing co-infection. It is incredibly important to test and treat these co-infections as well. Animal and human studies show that these co-infections can cause more severe and treatment-resistant Lyme disease.

Borrelia is also capable of creating a biofilm. A biofilm is a slippery, glue-like coating that some bacteria create to act as a protective shield. The plaque on your teeth is a type of biofilm produced by Treponema denticola, which causes gum disease. To create the biofilm, the bacteria clump together and build a complex matrix around themselves. They can do this on a range of surfaces including our soft tissues. Other organisms, including the co-infections common in Lyme disease, can live inside the biofilm. The biofilm protects the bacteria from attacks from the immune system and antibiotics.  The Borrelia biofilm is one of the reasons Lyme disease and its co-infections are so difficult to treat.

 

Diagnostic considerations for Lyme disease

At The Health Lodge, we understand that the diagnosis and treatment of Lyme disease is complex. Therefore, we suggest a comprehensive diagnostic work-up to gather information relating to your health, including:

  • Screening for Borrelia
  • Screening for co-infections
  • Testing for nutrient deficiencies. Practitioners have found vitamin B12 and magnesium deficiency are common in patients with Lyme disease
  • We may test levels of stress and thyroid hormones. Thyroid and adrenal function is often impaired in Lyme disease
  • Screening for markers of inflammation, as chronic inflammation is an issue in Lyme disease
  • Assessing the health of your detoxification organs. Lyme disease and its co-infections can release toxins that attack the body, especially the nervous system. It is very important that the liver, kidneys, and digestive system are working well to get rid of these toxins. Unfortunately, in many patients with Lyme disease, these detoxification organs are under-functioning.
  • Heavy metal screening. Heavy metals can be incorporated into the bacterial biofilm, and affect the body’s ability to detoxify.

 

Treatment considerations for Lyme disease

Treatment of Lyme disease can be a long and difficult journey. Many people with Lyme disease do not get the treatment they need due to misdiagnosis.  Lyme disease is incredibly complex, and best treated by a team of health practitioners. At The Health Lodge, our treatment plan for patients with Lyme disease may include:

  • Supporting detoxification
  • Breaking down the biofilm
  • Treating Borrelia and co-infections
  • Decreasing inflammation
  • Supporting affected organs and systems
  • Heavy metal chelation
  • Correcting nutrient imbalances
  • Psychological support

 

Your integrative team of health care specialists

We believe that a multidisciplinary team of health care professionals is essential in managing all the aspects of Lyme disease. The multidisciplinary team may include general practitioners, psychologists, dietitians or nutritionists, naturopaths, osteopaths, and acupuncturists. This comprehensive and holistic approach is designed to support the patient’s physical, mental, and emotional well being.

For enquiries call The Health Lodge on 02 6685 6445