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Study points to physiological pathway responsible for pain perception

A study led by Boston Children’s Hospital and the National Institute of Mental Health (NIMH) may open up new opportunities for treating neuropathic pain, a difficult-to-treat type of chronic pain due to damage to the nervous system that can make the lightest touch intensely painful. In a report today in Nature, scientists led by Zhigang He, PhD, and Clifford Woolf, PhD, of the F.M. Kirby Neurobiology Center at Boston Children’s, demonstrate that neurons that originate in the brain’s cortex influence sensitivity to touch.

The circuit could help explain why mind-body techniques to control pain seem to help many people.

“We know that mental activities of the higher brain — cognition, memory, fear, anxiety — can cause you to feel more or less pain,” says Woolf. “Now we’ve confirmed a physiological pathway that may be responsible for the extent of the pain. We have identified a volume control in the brain for pain — now we need to learn how to switch it off.”

A mind-body pathway

Pain sensation was previously believed to originate with neurons in the spinal cord receiving sensory information from the body and relaying it on to the brain. The new study found that a small group of neurons in the cortex can amplify touch sensation, sending projections to the same parts of the spinal cord that receive tactile sensory information from the body (known as the dorsal horns).

“The anatomy of this circuit has been known for some time, but no one actually looked at its function before,” says He.

“In normal conditions, the touch and pain layers of the spinal cord are strongly separated by inhibitory neurons,” elaborates Alban Latremoliere, PhD, one of four co-first authors on the paper. “After nerve injury, this inhibition is lost, leading to touch information activating pain neurons. When the spinal neurons that are supposed to be pain-only send this information to the brain, we feel pain.”

He, Woolf and colleagues think the cortical neurons they identified could be a potential target for treating the tactile component of neuropathic pain, via drugs or possibly brain electrical stimulation, breaking a feedback loop that introduces and exaggerates the pain response to normally non-painful touch.

When the team severed these neurons or silenced them genetically in a mouse model of neuropathic pain, the mice stopped recoiling from light, innocuous touches, such as stroking with a soft paintbrush or placement of a bit of tape on the bottom of a foot. But the mice retained their sensitivity to truly painful stimuli, reflexively withdrawing their paws when exposed to heat, cold or pinpricks.

Teasing out nerve circuits

The researchers used recently developed technologies to visualize and target specific groups of neurons in the brain and spinal cord. This enabled them to observe the results when different neurons were activated or silenced in a mouse model, and observe which circuits were activated when mice were exposed to noxious or innocuous stimuli.

He notes that some clinicians have tried using brain stimulation as a way of treating neuropathic pain, not always successfully.

“Our findings might help us target the stimulation to particular areas or groups of neurons,” says He. “It might be interesting to look at clinical data and try to replicate the stimulation in animals, and see what kind of stimulation would silence these neurons.”

With functional imaging technologies, investigators could probe what kinds of interventions maximally inhibit this circuit, adds Woolf.

“We now have the ability to silence or activate whole groups of neurons and image their patterns of electrical firing with single-neuron resolution,” he says. “None of this was possible 10 years ago.”

Yuanyuan Liu, Alban Latremoliere and Zicong Zhang (Boston Children’s Hospital) and Xinjian Li (NIMH) were co-first authors on the paper. (Latremoliere is now at Johns Hopkins Medical School.) Kuan Hong Wang (NIMH) was co-senior author together with He and Woolf. The study was supported by the Craig Neilsen Foundation, the Paralyzed Veterans of America Foundation, the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation, the National Institute for Neurological Disorders and Stroke, the NIMH (ZIA MH002897) and the Boston Children’s Hospital IDDRC (NIH P30 HD018655, P30EY012196).


Read this article on ScienceDaily: Boston Children’s Hospital. “Minding the brain to curb pain hypersensitivity: Scientists isolate neurons in the brain that could be targeted to dampen pain from touch.” ScienceDaily. ScienceDaily, 12 September 2018. www.sciencedaily.com/releases/2018/09/180912133437.htm.

Study of phantom limb pain leads to more effective treatment

The patient, missing his right arm, can see himself on screen in augmented reality, with a virtual limb. He can control it through the electrodes attached to his skin, which allows the patient to stimulate and reactivate those dormant areas of the brain. Credit: Max Ortiz Catalan - Science Daily

Dr Max Ortiz Catalan of Chalmers University of Technology, Sweden, has developed a new theory for the origin of the mysterious condition, ‘phantom limb pain’. Published in the journal Frontiers in Neurology, his hypothesis builds upon his previous work on a revolutionary treatment for the condition, that uses machine learning and augmented reality.

Phantom limb pain is a poorly understood phenomenon, in which people who have lost a limb can experience severe pain, seemingly located in that missing part of the body. The condition can be seriously debilitating and can drastically reduce the sufferer’s quality of life. But current ideas on its origins cannot explain clinical findings, nor provide a comprehensive theoretical framework for its study and treatment.

Now, Max Ortiz Catalan, Associate Professor at Chalmers University of Technology, has published a paper that offers up a promising new theory — one that he terms ‘stochastic entanglement’.

He proposes that after an amputation, neural circuitry related to the missing limb loses its role and becomes susceptible to entanglement with other neural networks — in this case, the network responsible for pain perception.

“Imagine you lose your hand. That leaves a big chunk of ‘real estate’ in your brain, and in your nervous system as a whole, without a job. It stops processing any sensory input, it stops producing any motor output to move the hand. It goes idle — but not silent,” explains Max Ortiz Catalan.

Neurons are never completely silent. When not processing a particular job, they might fire at random. This may result in coincidental firing of neurons in that part of the sensorimotor network, at the same time as from the network of pain perception. When they fire together, that will create the experience of pain in that part of the body.

“Normally, sporadic synchronised firing wouldn’t be a big deal, because it’s just part of the background noise, and it won’t stand out,” continues Max Ortiz Catalan. “But in patients with a missing limb, such event could stand out when little else is going on at the same time. This can result in a surprising, emotionally charged experience — to feel pain in a part of the body you don’t have. Such a remarkable sensation could reinforce a neural connection, make it stick out, and help establish an undesirable link.”

Through a principle known as ‘Hebb’s Law’ — ‘neurons that fire together, wire together’ — neurons in the sensorimotor and pain perception networks become entangled, resulting in phantom limb pain. The new theory also explains why not all amputees suffer from the condition- the randomness, or stochasticity, means that simultaneous firing may not occur, and become linked, in all patients.

In the new paper, Max Ortiz Catalan goes on to examine how this theory can explain the effectiveness of Phantom Motor Execution (PME), the novel treatment method he previously developed. During PME treatment, electrodes attached to the patient’s residual limb pick up electrical signals intended for the missing limb, which are then translated through AI algorithms, into movements of a virtual limb in real time. The patients see themselves on a screen, with a digitally rendered limb in place of their missing one, and can then control it just as if it were their own biological limb . This allows the patient to stimulate and reactivate those dormant areas of the brain.

“The patients can start reusing those areas of brain that had gone idle. Making use of that circuitry helps to weaken and disconnect the entanglement to the pain network. It’s a kind of ‘inverse Hebb’s law’ — the more those neurons fire apart, the weaker their connection. Or, it can be used preventatively, to protect against the formation of those links in the first place,” he says.

The PME treatment method has been previously shown to help patients for whom other therapies have failed. Understanding exactly how and why it can help is crucial to ensuring it is administered correctly and in the most effective manner. Max Ortiz Catalan’s new theory could help unravel some of the mysteries surrounding phantom limb pain, and offer relief for some of the most affected sufferers.

Read this article on Science Daily: Chalmers University of Technology. “A new theory for phantom limb pain points the way to more effective treatment.” ScienceDaily. ScienceDaily, 6 September 2018. www.sciencedaily.com/releases/2018/09/180906082022.htm.

Dr. Michael Yang On Understanding Pain as We Age – Free Event

Dr. Michael Yang MD will be speaking for a FREE event – Live Your Best Life Now open to the community on Friday October 12th. “Understanding Pain As We Age.” Pain management specialist Michael Yang, MD, will discuss the common misconceptions and myths about pain and aging, and discuss ways to make yourself more comfortable when managing a painful condition. Registration is here: https://vintagehouse.org/events/?eid=4665 Full flyer info below along with registration info.

This is a FREE event - open to the community. “Understanding Pain As We Age.” Pain management specialist Michael Yang, MD, will discuss the common misconceptions and myths about pain and aging, and discuss ways to make yourself more comfortable when managing a painful condition. Dr. Yang utilizes a multidisciplinary approach to pain management in his private practice in Sonoma and Santa Rosa, using a sophisticated combination of medications, new and minimally invasive interventional procedures, and regenerative treatments. He is a graduate of UCSF School of Medicine and completed his residency in anesthesiology at Cornell University.

CLICK TO DOWNLOAD your personal copy of this flyer.

Dr. Hau and Dr. Yang Selected as among ‘Top Doctors’ for 2018

Summit Pain Alliance’s Dr. John Y. Hau and Michael Yang M.D. Selected as ‘Top Doctors’ of 2017 by Sonoma Magazine.

Sonoma Magazine’s Top Doctor survey is submitted every year to Sonoma County doctors who are asked which medical specialist they would most often recommend to a loved one. More than 300 professionals emerged as top docs in 50 categories of medicine. The research organization tasked with this survey deems that medical professionals are the best judges of other medical professional’s clinical excellence, so the survey was sent to all licensed doctors in Sonoma (including Napa and Marin, as well), asking doctors to nominate three physicians in each category. They were instructed to take into account such factors as education, hospital appointment, board certifications and bedside manner and they could not nominate themselves. Dr. Hau and Dr. Yang rose to the top of the survey and were highlighted for their work in Pain Medicine.

About Dr. John Hau, M.D.

Dr. John Y. Hau Top Doctor 2017Dr. John Hau is a Board Certified Anesthesiologist and Board Certified Pain Management Physician. Dr. John Hau completed his undergraduate studies in Molecular and Cell Biology at the University of California, Berkeley, after which he went on to complete his medical school training at Temple University School of Medicine in Philadelphia.

Following medical school, Pain Doctor John Hau completed residency training in anesthesiology at Rush University Medical Center in Chicago, where he was elected chief resident by his peers and faculty during his final year of residency. Dr. John Hau then went on to complete fellowship training in interventional pain management at the University of California, Los Angeles, which is ranked as one of the best hospitals in California and the nation. During his training at UCLA, he learned advanced and cutting edge interventional pain management techniques used in the treatment of many painful conditions. Dr. Hau is proud to join the Petaluma and Santa Rosa community. He currently serves as the Medical Director of Summit Pain Alliance, Petaluma.

About Dr. Michael Yang, M.D.

Dr. Michael Yang M.D. Top Doctor 2017Dr. Michael Yang grew up in Southern California and completed his undergraduate degree with Phi Beta Kappa and Psy Chi honors from Johns Hopkins University with dual majors in Biology and Psychology. He then returned to the west coast where he conducted neurosurgery research at UCLA. Pain Doctor Yang attended UCSF, one of the top five medical schools in the nation, to complete his medical degree. Throughout his medical education, he continued to be interested in the connection between the physical body and the mind. This led him to graduate with honors in psychology and anesthesiology rotations.

After medical school, Dr. Yang moved to New York City where he completed his residency in anesthesiology at Cornell University. After residency, Dr. Yang completed ACGME-accredited fellowship training in the field of pain management from a multidisciplinary approach, working in three of the top hospitals in the nation: Memorial Sloan-Kettering Cancer Center, Hospital for Special Surgery and New York Presbyterian Hospital. From his fellowship and his experience in private practice in Santa Rosa, Dr. Yang treats patients with cancer pain, acute and chronic orthopedic injuries, and various chronic back and nerve pains.

In his free time, Dr. Yang enjoys fishing, tennis, hiking, travel and snowboarding. He looks forward to becoming an integral part of the medical community in Santa Rosa, providing the latest of techniques and innovations to treating his patients.

At Summit Pain Alliance, we believe in improving your quality of life by getting you back to doing the things that you enjoy. Our double board-certified physicians use state-of-the-art diagnostic and therapeutic techniques that exceed standards in safety and efficacy. We will be your partner on this journey. To schedule an appointment call (707) 623-9803.

Brain region associated with mindfulness also linked with lower pain experience

Ever wonder why some people seem to feel less pain than others? A study conducted at Wake Forest School of Medicine may have found one of the answers — mindfulness. “Mindfulness is related to being aware of the present moment without too much emotional reaction or judgment,” said the study’s lead author, Fadel Zeidan, Ph.D., assistant professor of neurobiology and anatomy at the medical school, part of Wake Forest Baptist Medical Center. “We now know that some people are more mindful than others, and those people seemingly feel less pain.”

The study is an article in press, published ahead-of-print in the journal PAIN.

The researchers analyzed data obtained from a study published in 2015 that compared mindfulness meditation to placebo analgesia. In this follow-up study, Zeidan sought to determine if dispositional mindfulness, an individual’s innate or natural level of mindfulness, was associated with lower pain sensitivity, and to identify what brain mechanisms were involved.

In the study, 76 healthy volunteers who had never meditated first completed the Freiburg Mindfulness Inventory, a reliable clinical measurement of mindfulness, to determine their baseline levels. Then, while undergoing functional magnetic resonance imaging, they were administered painful heat stimulation (120°F).

Whole brain analyses revealed that higher dispositional mindfulness during painful heat was associated with greater deactivation of a brain region called the posterior cingulate cortex, a central neural node of the default mode network. Further, in those that reported higher pain, there was greater activation of this critically important brain region.

The default mode network extends from the posterior cingulate cortex to the medial prefrontal cortex of the brain. These two brain regions continuously feed information back and forth. This network is associated with processing feelings of self and mind wandering, Zeidan said.

“As soon as you start performing a task, the connection between these two brain regions in the default mode network disengages and the brain allocates information and processes to other neural areas,” he said.

“Default mode deactivates whenever you are performing any kind of task, such as reading or writing. Default mode network is reactivated whenever the individual stops performing a task and reverts to self-related thoughts, feelings and emotions. The results from our study showed that mindful individuals are seemingly less caught up in the experience of pain, which was associated with lower pain reports.”

The study provided novel neurobiological information that showed people with higher mindfulness ratings had less activation in the central nodes (posterior cingulate cortex) of the default network and experienced less pain. Those with lower mindfulness ratings had greater activation of this part of the brain and also felt more pain, Zeidan said.

“Now we have some new ammunition to target this brain region in the development of effective pain therapies. Importantly this work shows that we should consider one’s level of mindfulness when calculating why and how one feels less or more pain,” Zeidan said. “Based on our earlier research, we know we can increase mindfulness through relatively short periods of mindfulness meditation training, so this may prove to be an effective way to provide pain relief for the millions of people suffering from chronic pain.”


Read this article on Science Daily: Wake Forest Baptist Medical Center. “‘Mindful people’ feel less pain; MRI imaging pinpoints supporting brain activity.” ScienceDaily. ScienceDaily, 7 September 2018. www.sciencedaily.com/releases/2018/09/180907110425.htm.


At Summit Pain Alliance we provide individualized pain management for a pain-free life. For more information and to schedule an appointment call (707) 623-9803.

Scientists search for a safe, non-addictive pain killer

Scientists working to find a safe, non-addictive pain killer to help fight the current opioid crisis in this country.

With the support of the National Institute on Drug Abuse, scientists at Wake Forest School of Medicine have been working to find a safe, non-addictive pain killer to help fight the current opioid crisis in this country. And they may have done just that, though in an animal model. Known as AT-121, the new chemical compound has dual therapeutic action that suppressed the addictive effects of opioids and produced morphine-like analgesic effects in non-human primates.

“In our study, we found AT-121 to be safe and non-addictive, as well as an effective pain medication,” said Mei-Chuan Ko, Ph.D., professor of physiology and pharmacology at the School of Medicine, part of Wake Forest Baptist Medical Center. “In addition, this compound also was effective at blocking abuse potential of prescription opioids, much like buprenorphine does for heroin, so we hope it could be used to treat pain and opioid abuse.”

The findings are published in the Aug. 29 issue of the journal Science Translational Medicine. The main objective of this study was to design and test a chemical compound that would work on both the mu opioid receptor, the main component in the most effective prescription pain killers, and the nociceptin receptor, which opposes or blocks the abuse and dependence-related side effects of mu-targeted opioids. Current opioid pain drugs, such as fentanyl and oxycodone, work only on the mu opioid receptor, which also produces unwanted side effects — respiratory depression, abuse potential, increased sensitivity to pain and physical dependence.

“We developed AT-121 that combines both activities in an appropriate balance in one single molecule, which we think is a better pharmaceutical strategy than to have two drugs to be used in combination,” Ko said. In the study, the researchers observed that AT-121 showed the same level of pain relief as an opioid, but at a 100-times lower dose than morphine. At that dose, it also blunted the addictive effects of oxycodone, a commonly abused prescription drug. The bifunctional profile of AT-121 not only gave effective pain relief without abuse potential, it also lacked other opioid side-effects that patients typically struggle with, such as itch, respiratory depression, tolerance and dependence.

“Our data shows that targeting the nociceptin opioid receptor not only dialed down the addictive and other side-effects, it provided effective pain relief,” Ko said. “The fact that this data was in nonhuman primates, a closely related species to humans, was also significant because it showed that compounds, such as AT-121, have the translational potential to be a viable opioid alternative or replacement for prescription opioids.” Next steps include conducting additional preclinical studies to collect more safety data, and then if all goes well, applying to the Food and Drug Administration for approval to begin clinical trials in people, Ko said. AT-121 was developed by Nurulain T. Zaveri, Ph.D., a member of the research team at Astraea Therapeutics.

The work was supported by grants from the National Institutes of Health, National Institute on Drug Abuse R01DA032568, R01DA027811, R44DA042465, R21DA040104, and R21DA044775, and the U.S. Department of Defense W81XWH-13-2-0045.

Read this article on ScienceDaily: Wake Forest Baptist Medical Center. “Scientists take big step toward finding non-addictive painkiller.” ScienceDaily. ScienceDaily, 29 August 2018. www.sciencedaily.com/releases/2018/08/180829143821.htm.

Chronic pain conditions exacerbated by arguments with spouse

A fight with a spouse may end in hurt feelings, but for those with chronic conditions like arthritis or diabetes, those arguments may have physical repercussions as well, according to researchers.

They found that in two groups of older individuals — one group with arthritis and one with diabetes — the patients who felt more tension with their spouse also reported worse symptoms on those days.

“It was exciting that we were able to see this association in two different data sets — two groups of people with two different diseases,” said Lynn Martire, professor of human development and family studies, Penn State Center for Healthy Aging. “The findings gave us insight into how marriage might affect health, which is important for people dealing with chronic conditions like arthritis or diabetes.”

Martire said it’s important to learn more about how and why symptoms of chronic disease worsen. People with osteoarthritis in their knees who experience greater pain become disabled quicker, and people with diabetes that isn’t controlled have a greater risk for developing complications.

The researchers said that while previous research has shown a connection between satisfying marriages and better health, both physically and psychologically, there’s been a lack of research into how day-to-day experiences impact those with chronic illness.

“We study chronic illnesses, which usually involve daily symptoms or fluctuations in symptoms,” Martire said. “Other studies have looked at the quality of someone’s marriage right now. But we wanted to drill down and examine how positive or negative interactions with your spouse affect your health from day to day.”

Data from two groups of participants were used for the study. One group was comprised of 145 patients with osteoarthritis in the knee and their spouses. The other included 129 patients with type 2 diabetes and their spouses.

Participants in both groups kept daily diaries about their mood, how severe their symptoms were, and whether their interactions with their spouse were positive or negative. The participants in the arthritis and diabetes groups kept their diaries for 22 and 24 days, respectively.

The researchers found that within both groups of participants, patients were in a worse mood on days when they felt more tension than usual with their spouse, which in turn led to greater pain or severity of symptoms.

Additionally, the researchers found that within the group with arthritis, the severity of the patient’s pain also had an effect on tensions with their spouse the following day. When they had greater pain, they were in a worse mood and had greater tension with their partner the next day.

“This almost starts to suggest a cycle where your marital interactions are more tense, you feel like your symptoms are more severe, and the next day you have more marital tension again,” Martire said. “We didn’t find this effect in the participants with diabetes, which may just be due to differences in the two diseases.”

Martire said the results — recently published in the journal Annals of Behavioral Medicine — could potentially help create interventions targeted at helping couples with chronic diseases.

“We usually focus on illness-specific communications, but looking at tension in a marriage isn’t tied to the disease, it’s not a symptom of the disease itself,” Martire said. “It’s a measure you can get from any couple. It suggests to me that looking beyond the illness, to improve the overall quality of the relationship might have some impact on health.”


Read this article on Science Daily: “Love hurts: Spats with spouse may worsen chronic pain, other symptoms.” ScienceDaily. ScienceDaily, 15 May 2018. www.sciencedaily.com/releases/2018/05/180515131553.htm.


At Summit Pain Alliance we provide individualized pain management for a pain-free life. For more information and to schedule an appointment call (707) 623-9803.

Clinical Research Department; exciting news for this month


AUGUST 2018 – NEWSLETTER – Summit Pain Alliance

This month is full with exciting new projects. Sadly we have to say good bye to one of our providers but we won’t let this slow us down in our efforts of keep offering our patients with the latest technology and advances in pain management. Here at Summit Pain Alliance, we are honored to participate in the development of the most innovative treatments and practices to better serve our patients.

Current studies status:

  • Flowonix-Prometra: Active but not enrolling, we have 4 participants remaining in this study.
  • Saluda- Evoke: active but not enrolling, we have 4 participants in this study.
  • Nevro-Tap10: active and open for enrollment, we recently submitted an abstract for the North American
    Neuromodulation Society ( NANS) annual meeting with the preliminary data of our first 5 patients.
  • Enso: active with enrollment on hold.

Hormones may be responsible for migraines in women

Research published today reveals a potential mechanism for migraine causation which could explain why women get more migraines than men. The study, in Frontiers in Molecular Biosciences, suggests that sex hormones affect cells around the trigeminal nerve and connected blood vessels in the head, with estrogens — at their highest levels in women of reproductive age — being particularly important for sensitizing these cells to migraine triggers. The finding provides scientists with a promising new route to personalized treatments for migraine patients.

“We can observe significant differences in our experimental migraine model between males and females and are trying to understand the molecular correlates responsible for these differences,” explains Professor Antonio Ferrer-Montiel from the Universitas Miguel Hernández, Spain. “Although this is a complex process, we believe that modulation of the trigeminovascular system by sex hormones plays an important role that has not been properly addressed.”

Ferrer-Montiel and his team reviewed decades of literature on sex hormones, migraine sensitivity and cells’ responses to migraine triggers to identify the role of specific hormones. Some (like testosterone) seem to protect against migraines, while others (like prolactin) appear to make migraines worse. They do this by making the cells’ ion channels, which control the cells’ reactions to outside stimuli, more or less vulnerable to migraine triggers.

Some hormones need much more research to determine their role. However, estrogen stands out as a key candidate for understanding migraine occurrence. It was first identified as a factor by the greater prevalence of migraine in menstruating women and the association of some types of migraine with period-related changes in hormone levels. The research team’s evidence now suggests that estrogen and changes in estrogen levels sensitize cells around the trigeminal nerve to stimuli. That makes it easier to trigger a migraine attack.

However, Ferrer-Montiel cautions that their work is preliminary. The role of estrogen and other hormones in migraine is complex and much more research is needed to understand it. The authors emphasize the need for longitudinal studies focusing on the relationship between menstrual hormones and migraines. Their current work relies on in vitro and animal models, which aren’t easy to translate to human migraine sufferers.

Nonetheless, Ferrer-Montiel and his colleagues see a promising future for migraine medication in their current findings. They intend to continue their research using pre-clinical, human-based models which better reflect real patients.

“If successful, we will contribute to better personalized medicine for migraine therapy,” he says.

The research is part of a special article collection on cell membrane proteins as targets for drugs.

Read this article on Science Daily:  “Why do women get more migraines? Estrogen and other sex hormones may be responsible for the higher prevalence of migraine in women.” ScienceDaily. ScienceDaily, 14 August 2018. <www.sciencedaily.com/releases/2018/08/180814075932.htm>.


At Summit Pain Alliance we provide individualized pain management for a pain-free life. For more information and to schedule an appointment call (707) 623-9803.

Dr. Yang Interview Excerpt – Focus on Inflammation

The word inflammation comes from the Latin word inflammationem, which means “a setting on fire.” Certainly anyone who has experienced the feelings of heat, redness, swelling, pain and burning that makes the origin of this word an accurate description. But what exactly is inflammation and how can it hurt—as well as help—your body?

At its most basic definition, inflammation is the body’s natural reaction to an injury or infection—its attempt to heal itself. So, while we generally have negative connotations to the word, we are nevertheless fortunate that the body has this built-in immune system in place to recognize damaged cells, irritants and pathogens to heal an injury or fight an infection. Though inflammation may be uncomfortable, it is the body’s biological response to remove a harmful affect on the body. Without it, infections, wounds, and other damage to tissue couldn’t heal.

“Inflammation overall is an immune response,” says Kim Kulp, registered dietician at Santa Rosa Memorial Hospital. “It’s your body’s way of trying to fix any foreign invader, or some damage to the body,” adds Kulp, who is also the owner of her own private practice, Health Tastes Great, seeing patients in both Novato and Mill Valley.

Generally, once the injury or infection is healed, the inflammation should stop. This normal process is usually identified as acute inflammation. However, when inflammation does not dissipate, but lingers in the body long term it becomes chronic inflammation and can lead to a variety of other diseases.

“Acute and chronic [inflammation] is just a descriptor of the chronicity, or the time, that the inflammation has taken place in your body,” says Michael Yang, M.D., Santa Rosa-based Summit Pain Alliance, a leader in pain management in Northern California, which provides cutting edge technologies, pain management therapies, and advancements in pain relief, both acute and chronic. “Generally, in the field of pain management, we demarcate that at about six months. It’s not an exact science, but we have to draw the line somewhere, so it’s generally accepted that anything beyond six months is considered chronic pain. Inflammation is exactly that. So, if you’ve had an inflammatory response in a certain body part and if it’s been there longer than six months, it’s considered chronic.”

A silent precursor to disease

Unfortunately, chronic inflammation is not only uncomfortable or painful, but more and more research shows a link to a variety of diseases. According to Harvard Medical School, “…research on inflammation has created a shift in medical thinking. For two millennia, it has been viewed mainly as a necessary, even beneficial, response to illness or injury. But now both observational studies and laboratory research are indicating that inflammation can be more of a bane than boon, the common, causative factor in many diseases.” Research now shows inflammation may be a common underlying cause of many major degenerative diseases, including coronary artery disease, diabetes, cancer and Alzheimer’s.

“Inflammation itself can be harmful to the body, even though it’s the body’s way of bringing in the healing factors,” says Yang. “If it’s chronic and it’s constantly bringing in these inflammatory cytokines that cause swelling and redness and pain, all of that is just the body trying to heal itself. But if it’s there on a chronic basis, that in itself can also cause deterioration. In medical terms, anything with –itis at the end of it means inflammation of whatever is in that base word. So, arthritis is inflammation of the joints, appendicitis is inflammation of the appendix, and bronchitis is inflammation of the bronchials. But of course, chronic bronchitis is terrible for you and arthritis—as it gets worse—causes giant swollen joints, which can cause terrible deformities. Chronic inflammation can cause a lot of damage to your body.”

Alarmingly, some inflammation that occurs deep inside the body, such as in an internal organ where there may not be any sensory nerve endings, may not have any visible or noticeable signs that make it immediately obvious what is happening in the body.

“Eventually something will go wrong,” warns Kulp. “You’re not going to be feeling well, or there will be more fatigue, or you might have some symptoms of these diseases. There isn’t just one sign of inflammation.”

Other symptoms that may eventually become present include abdominal or chest pain, fever, joint pain, or a rash, but some of these indicators can seem mild enough to not necessarily seek medical attention. However, today there are certain blood tests that show if an inflammatory process is going on.

“There are parts of the body that have little sensation,” says Yang. “You can have inflammation that is just circulating in the blood stream. You can have inflammation of your bowels, like irritable bowel syndrome and chronic ulcerative colitis—those are bowel inflammations that can wreak havoc on the body, but you don’t feel it until you have a stomach cramp. But the inflammation is there all the time.”

Read entire article on Northbay Biz

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