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Surgery won’t fix my chronic back pain, so what will?

<a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> This week’s ABC Four Corners episode <a href="https://www.abc.net.au/news/2024-04-08/pain-factory/103683180">Pain Factory</a> highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain. The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain. <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">One in five</a> Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">A$139 billion a year</a>, including $12 billion in direct health-care costs. The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work? <h2>Opioids and invasive procedures</h2> Treatments offered to people with chronic pain include strong pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/30561481/">opioids</a> and invasive procedures such as <a href="https://pubmed.ncbi.nlm.nih.gov/36878313/">spinal cord stimulators</a> or <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14120">spinal fusion surgery</a>. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm. <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06900-8">Spinal fusion surgery</a> and <a href="https://privatehealthcareaustralia.org.au/consumers-urged-to-be-cautious-about-spinal-cord-stimulators-for-pain/#:%7E:text=Australian%20health%20insurance%20data%20shows,of%20the%20procedure%20is%20%2458%2C377.">spinal cord stimulators</a> are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual. <h2>Addressing the contributors to pain</h2> Recommendations from the latest <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/low-back-pain-clinical-care-standard">Australian</a> and <a href="https://www.who.int/publications/i/item/9789240081789">World Health Organization</a> clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as: <ul> <li>education</li> <li>advice</li> <li>structured exercise programs</li> <li>physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.</li> </ul> Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain. The interventions have minimal side effects and are cost-effective. In the <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">RESOLVE</a> trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move. In the <a href="https://pubmed.ncbi.nlm.nih.gov/37146623/">RESTORE</a> trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it. <h2>Why isn’t everyone with chronic pain getting this care?</h2> While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session <a href="https://www.sira.nsw.gov.au/__data/assets/pdf_file/0005/1122674/Physiotherapy-chiropractic-and-osteopathy-fees-practice-requirements-effective-1-February-2023.pdf">can cost</a> $90–$150. In contrast, <a href="https://www.servicesaustralia.gov.au/chronic-disease-individual-allied-health-services-medicare-items">Medicare</a> provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions. Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs. Access to trained clinicians is another barrier. This problem is particularly evident in <a href="https://www.ruralhealth.org.au/15nrhc/sites/default/files/B2-1_Bennett.pdf">regional and rural Australia</a>, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited. Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/data-file-57-opioid-medicines-dispensing-2016-17-third-atlas-healthcare-variation-2018">rate of opioid use</a>, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas. <h2>So what can we do about it?</h2> We need to reform Australia’s health system, private and <a href="https://www.health.gov.au/sites/default/files/documents/2020/12/taskforce-final-report-pain-management-mbs-items-final-report-on-the-review-of-pain-management-mbs-items.docx">public</a>, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments. Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian <a href="https://pubmed.ncbi.nlm.nih.gov/38461844/">trial</a>, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain. Advocacy and <a href="https://pubmed.ncbi.nlm.nih.gov/37918470/">improving the public’s understanding</a> of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/227450/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, Professor, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/surgery-wont-fix-my-chronic-back-pain-so-what-will-227450">original article</a>.

Body

Why do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?

<a href="https://theconversation.com/profiles/iris-lim-1204657">Iris Lim</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Dealing with chronic urinary tract infections (UTIs) means facing more than the occasional discomfort. It’s like being on a never ending battlefield against an unseen adversary, making simple daily activities a trial. UTIs happen when bacteria sneak into the urinary system, causing pain and frequent trips to the bathroom. Chronic UTIs take this to the next level, coming back repeatedly or never fully going away despite treatment. <a href="https://www.ncbi.nlm.nih.gov/books/NBK557479/">Chronic UTIs</a> are typically diagnosed when a person experiences two or more infections within six months or three or more within a year. They can happen to anyone, but some are more prone due to their <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults">body’s makeup or habits</a>. Women are more likely to get UTIs than men, due to their shorter urethra and hormonal changes during menopause that can decrease the protective lining of the urinary tract. Sexually active people are also at greater risk, as bacteria can be transferred around the area. Up to <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults#Related%20Resources">60% of women</a> will have at least one UTI in their lifetime. While effective treatments exist, <a href="https://www.health.harvard.edu/bladder-and-bowel/when-urinary-tract-infections-keep-coming-back#:%7E:text=Your%20urine%20might%20be%20cloudy,they%20take%20on%20your%20life.">about 25%</a> of women face recurrent infections within six months. Around <a href="https://sciendo.com/article/10.33073/pjm-2019-048?tab=article">20–30%</a> of UTIs don’t respond to standard antibiotic. The challenge of chronic UTIs lies in bacteria’s ability to shield themselves against treatments. <h2>Why are chronic UTIs so hard to treat?</h2> Once thought of as straightforward infections cured by antibiotics, we now know chronic UTIs are complex. The cunning nature of the bacteria responsible for the condition allows them to hide in bladder walls, out of antibiotics’ reach. The bacteria form biofilms, a kind of protective barrier that makes them nearly impervious to standard antibiotic treatments. This ability to evade treatment has led to a troubling <a href="https://theconversation.com/rising-antibiotic-resistance-in-utis-could-cost-australia-1-6-billion-a-year-by-2030-heres-how-to-curb-it-149543">increase in antibiotic resistance</a>, a global health concern that renders some of the conventional treatments ineffective. Antibiotics need to be advanced to keep up with evolving bacteria, in a similar way to the flu vaccine, which is updated annually to combat the latest strains of the flu virus. If we used the same flu vaccine year after year, its effectiveness would wane, just as overused antibiotics lose their power against bacteria that have adapted. But fighting bacteria that resist antibiotics is much tougher than updating the flu vaccine. Bacteria change in ways that are harder to predict, making it more challenging to create new, effective antibiotics. It’s like a never-ending game where the bacteria are always one step ahead. Treating chronic UTIs still relies heavily on antibiotics, but doctors are getting crafty, changing up medications or prescribing low doses over a longer time to outwit the bacteria. Doctors are also placing a greater emphasis on thorough diagnostics to accurately identify chronic UTIs from the outset. By asking detailed questions about the duration and frequency of symptoms, health-care providers can better distinguish between isolated UTI episodes and chronic conditions. The approach to initial treatment can significantly influence the likelihood of a UTI becoming chronic. Early, targeted therapy, based on the specific bacteria causing the infection and its antibiotic sensitivity, may reduce the risk of recurrence. For post-menopausal women, <a href="https://link.springer.com/article/10.1007/s00192-020-04397-z">estrogen therapy</a> has shown promise in reducing the risk of recurrent UTIs. After menopause, the decrease in estrogen levels can lead to changes in the urinary tract that makes it more susceptible to infections. This treatment restores the balance of the vaginal and urinary tract environments, making it less likely for UTIs to occur. Lifestyle changes, such as <a href="https://journals.lww.com/co-nephrolhypertens/FullText/2013/05001/Impact_of_fluid_intake_in_the_prevention_of.1.aspx">drinking more water</a> and practising good hygiene like washing hands with soap after going to the toilet and the recommended front-to-back wiping for women, also play a big role. Some swear by cranberry juice or supplements, though researchers are still figuring out <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001322.pub2/full">how effective these remedies truly are</a>. <h2>What treatments might we see in the future?</h2> Scientists are currently working on new treatments for chronic UTIs. One promising avenue is the development of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10052183/pdf/pathogens-12-00359.pdf">vaccines</a> aimed at preventing UTIs altogether, much like flu shots prepare our immune system to fend off the flu. Another new method being looked at is called <a href="https://link.springer.com/article/10.1007/s12223-019-00750-y">phage therapy</a>. It uses special viruses called bacteriophages that go after and kill only the bad bacteria causing UTIs, while leaving the good bacteria in our body alone. This way, it doesn’t make the bacteria resistant to treatment, which is a big plus. Researchers are also exploring the potential of <a href="https://www.mdpi.com/2079-6382/12/1/167">probiotics</a>. Probiotics introduce beneficial bacteria into the urinary tract to out-compete harmful pathogens. These good bacteria work by occupying space and resources in the urinary tract, making it harder for harmful pathogens to establish themselves. Probiotics can also produce substances that inhibit the growth of harmful bacteria and enhance the body’s immune response. Chronic UTIs represent a stubborn challenge, but with a mix of current treatments and promising research, we’re getting closer to a day when chronic UTIs are a thing of the past.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223008/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/iris-lim-1204657">Iris Lim</a>, Assistant Professor, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-do-i-keep-getting-urinary-tract-infections-and-why-are-chronic-utis-so-hard-to-treat-223008">original article</a>.

Body

"One step forward, two steps back": Joh Griggs reveals debilitating health battle

Johanna Griggs has revealed how she overcame a debilitating health struggle that threatened to derail her career as a teenager. The former swimming champion won her first medal at the Commonwealth Games in 1990 at 16 years of age, but just one year later, her world changed forever. In a new interview with Prevention magazine, the Better Homes & Gardens host admitted that being diagnosed with chronic fatigue syndrome at the young age of 17 was a blow, but one she ultimately felt “thankful” for. “You learn more about yourself during a tough period than you do during a great one,” she said. “One of the most important things that it taught me was to be able to be by myself and to be comfortable in my own skin.” With her swimming career on pause, Joh shared that the next few years were “one step forward, two steps back”. As a teenager, she learned the power of positive self-belief while learning what was best for her body as she worked her way back to physical and emotional strength. “It’s asking yourself, ‘Can you put your head on the pillow and know in your heart of hearts you’ve done everything within your power that day to get better?’,” she said of that time in her life. “But also, not beating yourself up on it, just working out what was working (and) what wasn’t working.” Over the next two and a half years, Johanna was on a highly restricted diet to combat her health issues, one that was “wheat-free, yeast-free, egg-free, malt-free, sugar-free, dairy-free, herb-free, spice-free, caffeine-free”. Eventually she was able to return to the pool, although she faced further setbacks, including a bout of pleurisy that landed her in hospital. By 1993, she was back at the top of her game, taking out the win for the 50m backstroke at the Australian Swimming Championships. Riding this high, Johanna decided her swimming career was over. “For me, it was a massive milestone to get to say I could be the best, but I also knew when I hit that (pool) wall, I did not want to keep living like that,” she said. “I told my mum I was retiring that night and remember her voice going up a couple of octaves higher than normal.” Image credits: Getty Images / Instagram

Body

King Wally Lewis' devastating diagnosis

Rugby league legend Wally Lewis, known as "The King" for his tough football persona, has made a heartbreaking revelation about his health. In an exclusive interview with 60 Minutes, the 63-year-old Queenslander disclosed that he has been diagnosed with probable chronic traumatic encephalopathy, or CTE. Despite his physical fitness, Lewis is experiencing the distressing effects of this progressive and fatal condition, which can be caused by repeated blows to the head. CTE leads to memory loss, behavioural issues, and a decline in basic cognitive skills. Fans who still follow Lewis' work as a beloved media personality and sports commentator were shocked by this news. “For a lot of the sport guys, I think a lot of us take on this belief that we’ve got to prove how tough we are. How rugged," Lewis said on the program. "And if we put our hands up and seek sympathy, then we're going to be seen as the real cowards of the game. But we’ve got to take it on and admit that the problems are there.” Throughout his illustrious rugby league career spanning three decades, Lewis captained Australia and inspired Queensland, winning a record eight man of the match awards in his State of Origin career. He later transitioned to a successful career in sports commentary. However, in 2006, Lewis suffered an epileptic seizure during a live broadcast, leading to brain surgery in 2007 to control the seizures. The evidence of Lewis' brain deterioration is evident in his scans compared to those of a healthy brain. Leading neurologist Dr. Rowena Mobbs, who has observed an increasing number of former players suffering from CTE, believes Lewis' symptoms align with the condition. "It's devastating," Mobbs said on the program. "It's hard to see these players go through it. The last thing I want to do is diagnose them with dementia." While definitive diagnosis can only occur through a brain autopsy after death, Mobbs is 90% certain about Lewis' condition based on her expertise. Although some former players are contemplating legal action and compensation claims against the NRL and AFL, Lewis has decided against such measures. He remains grateful for the game he loved and the opportunity to have played it. “I loved the game that I played," he said. "I felt privileged to have played it, and to have been given that chance. When you go out there and you’re wearing the representative jerseys, particularly the one for Australia, you feel ten feet tall and bulletproof. Well, you might think you are. But you’re not.” Lewis plans to leave a legacy beyond the football field by donating his brain for research to create awareness of CTE. He emphasises that his intention is not to seek sympathy but rather support for those affected by the disease. In response to Lewis' revelation, Dementia Australia offers support, information, education, and counselling for those dealing with similar challenges. The NRL has taken steps to address head injuries and concussions, implementing comprehensive head-injury policies and procedures in alignment with world's best practices. The league actively invests in the Retired Professional Rugby League Players Brain Health Study to assess and monitor the health of retired players. Wally Lewis' bravery in sharing his story aims to shed light on the impact of CTE on athletes and underscores the importance of advancing research and support for those facing similar health struggles. Images: 60 Minutes.

Mind

90-year-old-with chronic leukaemia skydives for charity

A thrill-seeking 90-year-old has celebrated her birthday - in what some would call an unconventional manner for her age - by skydiving, and raising £5,000 for a homeless charity in the process. Shirley Robinson, from Long Clawson in Leicestershire, jumped out of a plane at 14,000ft for the fundraiser at Skydive Langar in Nottinghamshire. Shirley, who was diagnosed with chronic leukaemia in 2022, raised funds for Crisis, a charity that provides help and support for homeless people. She told BBC News, “It's just wonderful how generous people have been. It's lovely.” Footage of her dive saw Shirley styled in a bright blue jumpsuit as she was cheered on by family and friends before getting on the plane. She smiled and waved at the camera as she was strapped to her skydiving instructor. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/reel/CsZGxykN0PN/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/CsZGxykN0PN/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Skydive Langar (@skydivelangar)</a> </div> </blockquote> After Shirley’s adrenaline packed skydive, she landed safely in a field and can be heard in the video exclaiming, “That was wonderful.” When asked about her favourite part of the experience, she responded, “That was lovely, going through the clouds.” She confessed afterwards that the free fall was a “bit breathtaking” but she “loved it” before thanking her instructor for looking after her. Shirley returned to a hero’s welcome with her beaming friends and family congratulating her. A spokesperson for the charity said, “We want to say an enormous thank you to Shirley for the incredible amount of money she has raised. “Shirley's donation will provide vital support for people experiencing or at risk of homelessness. We're so grateful.” Image credit: Instagram

Retirement Life

Could mobile phones revolutionise chronic wound treatment?

Australian researchers are developing a contactless, thermal imaging system that uses artificial intelligence to help nurses determine the best way to treat leg ulcers without waiting to see if the wound is going to heal properly. It’s estimated that 450,000 thousand Australians currently live with a chronic wound. Being able to predict early on which wounds will become chronic could improve outcomes by enabling nurses to start specialised therapy as soon as possible. But current techniques rely on physically monitoring the wound area over several weeks. New research from RMIT in Melbourne paired thermal imaging with AI. The software was able to accurately identify unhealing ulcers 78% of the time, and healing ulcers 60% of the time, according to the new study <a href="https://www.nature.com/articles/s41598-022-20835-y" target="_blank" rel="noreferrer noopener">published</a> in Scientific Reports. “Our new work that identifies chronic leg wounds during the first visit is a world-first achievement,” says lead researcher Professor Dinesh Kumar, from RMIT’s School of Engineering. “This means specialised treatment for slow-healing leg ulcers can begin up to four weeks earlier than the current gold standard.” How do you normally assess wound healing? The work builds on <a href="https://www.nature.com/articles/s41598-021-92828-2.epdf?sharing_token=7SIEmbOksKOou2TGQ5qPWdRgN0jAjWel9jnR3ZoTv0NntGTf8gfSMhoDjLAz58SefUeGL0aP2A-0mDVnZaiZTcBjNNpA4cvP9FgK6-aoPzyk4oQ0OSbPh83HNS_AwGDQVMg43K4WmG60QDoQohtsdkaRv70YSxfPg4Dn0qa_CUs%3D" target="_blank" rel="noreferrer noopener">previous research</a> by the same team, which found that this method could be used to predict wound healing by week 3 after initial assessment. But they wanted to know whether healing could be predicted from the first wound assessment only, reducing any delay in treatment. If a wound is healing normally it’s area would reduce by 50% within four weeks, but more than 20% of ulcers don’t heal in this expected trajectory and may need specialist interventions. Venous leg ulcers (VLUs) are the <a href="https://treasury.gov.au/sites/default/files/2022-03/258735_wounds_australia.pdf" target="_blank" rel="noreferrer noopener">most common</a> chronic wound seen in Australia and currently, the gold standard for predicting their healing– conventional digital planimetry – requires physical contact. Regular wound photography is also less accurate because there can be variations between images due to lighting, image quality, and differences in camera angle. But a non-contact method like thermal imaging could overcome this. The thermal profile of wounds changes over the healing trajectory, with higher temperatures signalling potential inflammation or infection and lower temperatures indicating a slower healing rate due to decreased oxygen in the region. So, taking thermal images of wounds can provide important information for predicting how they will heal. What did they do? The study collected VLU data from 56 older participants collected over 12 weeks, including thermal images of their wounds at initial assessment and information on their status at the 12th week follow-up. “Our innovation is not sensitive to changes in ambient temperature and light, so it is effective for nurses to use during their regular visits to people’s homes,” says co-author Dr Quoc Cuong Ngo, from RMIT’s School of Engineering. “It is also effective in tropical environments, not just here in Melbourne.” “Clinical care is provided in many different locations, including specialist clinics, general practices and in people’s homes,” says co-author Dr Rajna Ogrin, a Senior Research Fellow at Bolton Clarke Research Institute. “This method provides a quick, objective, non-invasive way to determine the wound-healing potential of chronic leg wounds that can be used by healthcare providers, irrespective of the setting.” So, what’s next? There are a few limitations to this study. First, the number of healed wounds in the dataset was relatively small compared to unhealed wounds, and the study only investigated older people. The authors recommend that “future research should focus on improving the predictive accuracy and customising this method to incorporate this assessment into clinical practice on a wider pool of participants and in a variety of settings.” Kumar says that they are hoping to adapt the method for use with mobile phones. “With the funding we have received from the Medical Research Future Fund, we are now working towards that,” he says. “We are keen to work with prospective partners with different expertise to help us achieve this goal within the next few years.”  <img id="cosmos-post-tracker" style="opacity: 0; height: 1px!important; width: 1px!important; border: 0!important; position: absolute!important; z-index: -1!important;" src="https://syndication.cosmosmagazine.com/?id=222978&title=Could+mobile+phones+revolutionise+chronic+wound+treatment%3F" width="1" height="1" />  <div id="contributors"> <a href="https://cosmosmagazine.com/health/revolutionise-chronic-wounds-treatment/" target="_blank" rel="noopener">This article</a> was originally published on Cosmos Magazine and was written by Imma Perfetto. Image: RMIT University </div>

Technology

“The best thing I’ve ever done”: Answering the COPD wake-up call

Brian is a 62-year-old Aussie bloke from Bendigo who once enjoyed a variety of different sports. He had led a very active lifestyle, was a keen fisherman, and loved playing footy. However, all that changed when, at just 47, he was diagnosed with chronic obstructive pulmonary disease (COPD). COPD is a chronic and progressive lung condition, sometimes also diagnosed as emphysema or chronic bronchitis, that can cause your airways to narrow and become obstructed and inflamed, making breathing difficult.1 Unfortunately, there is no cure for COPD but there are management plans available – it’s just a matter of knowing what’s best for you. Which is exactly why Brian is sharing his own experience of the moment he became aware of certain symptoms, and proactively discussing his condition with his doctor to manage his COPD and remain as active as he can. The impact of COPD is staggering, making it the fifth leading cause of death and leading cause of preventable hospitalisations in Australia alone – and the third leading cause of death worldwide.2,3 What’s more, the prevalence of COPD increases with age, mostly occurring in people aged 45 and over.2 When Brian was initially diagnosed, he was interested in learning as much as he could about COPD but was not ready to make specific lifestyle changes at that time. Then in 2015, he was also diagnosed with a heart condition, which shares some of the same risk factors as COPD. For Brian, this major health scare was a wake-up call, and he started to take more notice of his symptoms, particularly his breathing. Brian’s new approach included proactively talking to his doctor to understand his COPD – and in particular to know the difference between his “normal everyday symptoms” and the symptoms he felt when his COPD was worsening, and he was having a flare-up. In this context, a "flare-up" constituted a worsening of COPD symptoms that went beyond the normal day-to-day changes, and which needed additional medication as treatment.1 For Brian, in terms of managing his COPD proactively, this has been the key. “The best thing I’ve ever done is create a plan (with my doctor). Because every time you have a flare-up, it causes more damage to your lungs. If you’ve been diagnosed with COPD, do something about it straight away.” Like Brian, there are countless Australians living with COPD who may not be aware of the difference between normal fluctuations in their symptoms and a COPD flare-up that could impact their overall health, and requires medical intervention.1 Understanding the difference between your “normal everyday symptoms” versus your “signs of a flare-up” can ensure treatment is started as early as possible and may greatly improve the quality of your life. 1 This is why <a href="https://www.beflareaware.com.au/" target="_blank" rel="noopener">www.beflareaware.com.au</a> gives both patients and caregivers free access to an extensive wealth of information. The website provides more information about the disease and how to recognise the symptoms of an exacerbation, or a flare-up, and take action early. The raft of easy-use-tools include interactive videos, quizzes and advice from healthcare professionals. “COPD does creep up on you,” recalls Brian. “Suddenly you are getting puffed out doing everyday activities like walking to the car or along the beach. For me, everything started to become more of a chore, and I was constantly struggling to breathe.” <img src="https://oversixtydev.blob.core.windows.net/media/2022/11/O60_Brian_Evoke-10_1280.jpg" alt="" width="1280" height="720" /> Upon reflection, Brian recalled how COPD had started to impact his relationships with his family and friends too, just as he was coming to terms with the importance of managing his condition. “I have always loved footy,” he says. “My grandson and I used to kick the footy at the local park. He’d be up one end and I on the other. We weren’t even half a dozen kicks in before I was totally out of steam, and I had to sit down. For me, quality time with the grandkids is so important. I told myself, if my grandson wants to kick the footy, then I should be kicking the footy with him to the best of my ability.” Brian started to take a proactive role in his health, including speaking to his doctors about finding a plan to manage his COPD, like taking note of the difference between his “normal everyday symptoms” and when he’s having a flare-up and taking action as soon as he notices one beginning; as well as making important lifestyle changes like quitting smoking and putting a healthy diet and sustainable exercise regime first. “We know our bodies catch up to us as we get older and it’s something many of us find difficult to accept,” he explains. “Knowing the signs and symptoms of issues that aren’t necessarily related to ageing, such as breathing, is critical.” Today, Brian’s lungs are operating at just 37% of normal capacity, which means any form of exertion is difficult. Despite these challenges, Brian has become very flare-aware and actively manages his COPD so that he is able to maintain activities that are important to him. Brian encourages other people living with COPD to take action as early as possible to best manage their condition too. <a href="https://www.beflareaware.com.au/" target="_blank" rel="noopener"><img src="https://oversixtydev.blob.core.windows.net/media/2022/11/O60_BeFlareAware_videoThumb_02_1280.jpg" alt="" width="1280" height="659" /></a> “In everything I do, from taking out the rubbish or going for a walk, I need to pace myself,” he says. “I always say that I could have made more of a difference to how I’m living now if I had taken action earlier and made lifestyle changes straight away.” Brian urges anybody who has been living with COPD to take the diagnosis seriously and <a href="https://www.beflareaware.com.au/" target="_blank" rel="noopener">seek out resources</a> to help you become flare-aware. Early recognition and the ability to manage the disease is important as it can minimise negative impacts of COPD and help prevent future flare-ups.1 If you or someone you care for are feeling overwhelmed by a COPD diagnosis and would like to become more proactive in your management of COPD, <a href="https://www.beflareaware.com.au/" target="_blank" rel="noopener">www.beflareaware.com.au</a> is an excellent resource to educate both patients and caregivers – and also includes useful links and information created by Lung Foundation Australia. Check out the video below to hear more of Brian’s inspiring story, and to find out how you can live better and Be Flare Aware. <a href="https://www.beflareaware.com.au/" target="_blank" rel="noopener"><img src="https://oversixtydev.blob.core.windows.net/media/2022/11/O60_BeFlareAware_videoThumb_1280.jpg" alt="" width="1280" height="644" /></a> References: 1. Lung Foundation Australia. COPD Factsheet. <a href="https://lungfoundation.com.au/resources/copd-fact-sheet/" target="_blank" rel="noopener">https://lungfoundation.com.au/resources/copd-fact-sheet/</a> [Last accessed: September 2022] 2. AIHW. Chronic obstructive pulmonary disease (COPD). Available at: <a href="https://www.aihw.gov.au/reports/chronic-respiratory-conditions/copd/contents/deaths" target="_blank" rel="noopener">https://www.aihw.gov.au/reports/chronic-respiratory-conditions/copd/contents/deaths</a> [Last accessed: September 2022]. 3. Quaderi SA, Hurst JR. The unmet global burden of COPD. Glob Health Epidemiol Genom. 2018; 3: e4. Published 2018 Apr 6. Images: Supplied This is a sponsored article produced in partnership with AstraZeneca’s <a href="https://www.beflareaware.com.au/" target="_blank" rel="noopener">Be Flare Aware</a> campaign.

Body

“It’s not easy”: Michael Klim shares health update

Aussie swimmer Michael Klim has opened up about how his life has changed following his diagnosis with a rare autoimmune disease, including the strategy he uses to cope. In 2020, the world champion was diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) - a rare neurological disorder where the fatty myelin sheath protecting nerves is damaged and feeling is lost in the arms and legs. The condition has affected Klim’s physical and mental wellbeing, with the father-of-three struggling to perform everyday tasks such as walking and playing with his kids. But, Klim has adopted a new strategy to help him acknowledge the toll the disease has while not letting it get him down. “My counsellor and I have come up with a strategy where I give myself an hour a day to feel sorry for myself,” he told the <a href="https://www.smh.com.au/sport/swimming/i-am-trying-to-not-let-it-consume-me-the-rare-disease-that-turned-michael-klim-s-world-upside-down-20221027-p5bte5.html" target="_blank" rel="noopener">Sydney Morning Herald</a>. “I can whinge as much as I want and feel down, but after that, then there are still a lot of things I can do and be functional and still have responsibilities as a parent and a coach and as a partner, and I can still do them effectively. “I am trying to not let it consume me completely. But it's hard.” <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/Ci1vISQBbPk/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/Ci1vISQBbPk/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by MICHAEL KLIM (@michaelklim1)</a> </div> </blockquote> Klim said the effect on his body has meant he had to go through a “grieving process”, where he came to grips with the condition and the possibility he may need a wheelchair. “And to a degree the fear is still there. I think I am a bit better, in the sense I have accepted – to a degree – that these are the cards I have been dealt,” he said. “But I am still working through it. When we experience grief, you don't just go one day, 'I am fine, I am better now'. It affects you for much longer, and particularly because it is in my face daily. “There was a fear because I got bad really quickly. I am now in a remission, stable phase. But there is a fear I may go again at the same rate and if I degrade that quickly again, I probably will need assistance with walking and things like that.” Earlier this month, Klim said his mobility has been affected to the point where can no longer leave Bali and make trips to Australia, which he had done several times a year for work and treatment in the past. “I have pulled my focus to the swim academy here in Bali and... we run a bunch of camps and clinics,” he said. “I have sort of simplified my lifestyle just from that point of view. “I mean I did use to do 20 return trips to Australia a year for work and whatever.” “But for now it's just physically... physically actually impossible because (for) myself getting around is not simple.” The 45-year-old revealed he is now facing financial stresses too, after he left his role in sales and marketing at Milk & Co, the skincare company he founded in 2008, due to his inability to travel. “Look it has definitely put a stress on our finances and security because there is a level of investment for me,” Klim told Brett Hawke, the host of the Inside with Brett Hawke podcast, this week. “I stepped back from my role with Milk and Co. because of the demand it had on me physically, flying back and forth and the stress as well. “I was very hands-on doing sales and marketing. (But) unless I could give myself one hundred percent I didn't want to do it.” To make matters worse, Klim’s battle with CIDP has been self-funded because his original health insurance policy doesn’t cover the condition. “Unfortunately unless you have a very good insurance policy, which mine unfortunately didn't cover this disorder, everything is self-funded so it has put a fair bit of stress on everybody I think,” he said. “I have had great support from the family but it's, yeah, it's not easy.” <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/Cf3hl1fhzH6/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/Cf3hl1fhzH6/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by MICHAEL KLIM (@michaelklim1)</a> </div> </blockquote> After first speaking about his condition on The Project in July, including noticing numbness and other symptoms in his legs and feet in 2019, Klim told Hawke that the disorder had worsened in recent months, with the numbness in his feet now in his calf muscles and knees. “I had a big foot drop...my foot is just really floppy and can't control my foot so I'm having to wear special braces called AFO's (ankle-foot orthoses) which keeps my toes up so I don't trip up over myself when I'm using a walking stick or crutches,” he explained. He admitted that he fears losing all of his physical mobility, but still remains determined to fight CIDP and seek treatment from neurological experts in Australia and the US. “I think there is definitely an element of fear in this because it's the fear of the unknown, which we're always scared of, you know,” an emotional Klim said. “So there is 30 percent of patients (that) end up in a wheelchair and it's just to get around. So that's in the back of my mind.” Despite his worsening condition, Klim said he is still able to regularly swim with the assistance of a pool buoy between his legs. “The thing that gives me so much joy at the moment is I can actually still jump in the pool and have a bit of float around,” Klim said. “I like to put the buoy in and punch out a couple of times and, and yeah, it's kind of my happy place at the moment.” Image: @michaelklim1 (Instagram)

Caring

Iron key to heart failure patients’ wellbeing

Patients with chronic heart failure should be made aware of the importance of having their iron levels checked regularly, with research showing half of all heart failure patients have low iron, increasing their risk of hospitalisation, which is often associated with premature death. More than half a million Australians have chronic heart failure, and it is estimated that around 158,000 will require hospitalisation each year. Hospitalisation for heart failure is associated with high rates of readmission, and death, with Australia recording an estimated 61,000 heart failure-related deaths each year. New Australian treatment guidelines recommend intravenous iron treatments rather than oral supplementation for patients with heart failure with reduced heart function who have low iron. This is in a bid to reduce the risk of hospitalisation, as oral iron has been shown to be ineffective in increasing iron levels in these patients. The updated guidelines reflect new research, including a 2020 study that found heart failure patients that received an intravenous iron treatment had a 26 per cent risk reduction in total heart failure hospitalisation, and were 21 per cent less likely to experience cardiovascular death and total heart failure hospitalisation. University Hospital Geelong cardiologist John Amerena, who co-authored the new treatment guidelines, said iron deficiency was easily diagnosed by a blood test, and should be screened for as part of routine management for heart failure patients. “Patients with heart failure with reduced heart function can experience symptoms of tiredness, restlessness, bloating and poor quality of life. These can occur regardless of whether the patient is anaemic or has experienced iron deficiency in the past,” Associate Professor Amerena said. Heart failure prevents the heart from pumping enough blood to organs and tissues and can occur as the result of conditions such as coronary artery disease, high blood pressure, heart valve defects, viral infection, or alcohol misuse. Associate Professor Amerena said heart failure patients’ chances of survival decreased with each subsequent hospitalisation, with research showing a 25 percent chance of death within one year of first hospital admission. He said evidence showed intravenous iron could improve symptoms and patient quality of life, helping to prevent rehospitalisation. Women were more typically at risk of low iron, particularly before menopause, and should have their iron levels measured regularly, particularly if they had a history of heart problems or their family members had experienced heart issues, he said. “Women should be aware that low iron is common in heart failure. Measuring iron levels should be a part of routine blood testing. If their iron stores are low, there is good evidence that the administration of intravenous iron can improve their wellbeing and functional status, as well as reducing the risk for re-hospitalisation” he said. Image: Shutterstock

Body

Veteran runner urges chronic pain sufferers to get moving

A 75-year-old Mosman man, who could barely walk six months ago, has turned back the body clock to finish the gruelling City2Surf run. And in doing so, he’s urged others suffering chronic pain to do the same. Former journalist, author and automotive commentator, John Smailes, suffered from a subchondral insufficiency fracture in his right knee, which left him virtually immobile. According to Mr. Smailes, “Honestly, I went to walk up there to a nearby fitness centre, just a kilometer away, and I couldn’t do it. A simple kilometer, because it really, really hurt.” Mr. Smailes, who has run in dozens of City2Surf events over several decades, thought his running days were over. But then, he made a bet with his physio that he’d not only compete, but finish within a time frame twice that of his much younger rival. He’d been a gym junkie for years but, post-covid, wanted to avoid a sweaty regular gym. His wife urged him to try a nearby Kieser clinic. “I got involved in their way of doing things and the precise means by which they undertake each body movement. I’d never experienced it at any gym where you’re usually judged by how much you can lift. At Kieser, it wasn’t about the amount of weight but the precision and then they introduced me to their physios. Daniel (my physio) was incredible, he wrote me a program and it was nothing short of amazing,” according to Mr. Smailes. Mr. Smailes said, “I competed in the City2Surf several weeks ago. Daniel finished in 55 minutes, and I was under 110 minutes. So, it was a fantastic result. I never thought I could do it after the pain I’d experienced.” “I came off the fourteen kilometers and walked to my daughter who was waiting in a car. I suspect she thought she would pick up a wreck! But now I’m working to get my speed up again.” Mr. Smailes wants other people suffering from back or joint pain to know his story. “You don’t have to go through life suffering pain when there is help out there. I’m already planning my next running event. With the right mindset and the right program, you can change your life.” Images: Supplied

Body

Paul Green’s brain donated to science

Paul Green’s brain has been donated to the Australian Sports Brain Bank to help with science. The legendary coach and former player Paul Green was just 49 when he <a href="https://oversixty.com.au/news/news/rugby-league-icon-dead-at-49" target="_blank" rel="noopener">was found dead</a> at his home in Brisbane on August 11. It is confirmed that the father-of-two died from suicide. His family has now confirmed that his brain will be donated to the <a href="https://www.mycause.com.au/page/290298/in-memory-of-paul-green" target="_blank" rel="noopener">Australian Sports Brain Bank</a> to help aid research into concussion-related condition chronic traumatic encephalopathy (CTE) - a common injury amongst NRL players due to the nature of the game. "In memory of our beloved Paul, we ask that you support the pioneering work of the Australian Sports Brain Bank,” their post read. "Paul was known for always looking out for others. We are proud that part of his legacy will be looking out for the brain health of all others involved in the game that he loved. "Amanda, Emerson and Jed." They are hoping to raise $150,000 to help with the research. Michael Buckland, the director of the Australian Sports Brain Bank, thanked Green’s family for their donation. "This is an incredibly generous donation and will be an invaluable part of our research into the long-term effects of repetitive head impacts in sport and elsewhere," he said. "We at the Australian Sports Brain Bank are blown away by the fact that in their time of grief, Amanda and the rest of the family thought of how they could help others." Green had an incredible NRL career, playing 162 first grade matches between 1994-2004 and winning the prestigious Rothmans Medal in 1995 as the game's best and fairest. He played for several different clubs including Cronulla-Sutherland Sharks, North Queensland Cowboys, Sydney Roosters, Parramatta Eels and the Brisbane Broncos. Green eventually swapped his playing boots to coaching ones as he took on the North Queensland Cowboys from 2014-2020. If you would like to donate to the research, click <a href="https://www.mycause.com.au/page/290298/in-memory-of-paul-green" target="_blank" rel="noopener">here</a>. If you are experiencing a personal crisis or thinking about suicide, you can call Lifeline 131 114 or beyondblue 1300 224 636 or visit <a href="https://www.lifeline.org.au/">lifeline.org.au</a> or <a href="https://www.beyondblue.org.au/">beyondblue.org.au</a>. Image: Australian Sports Brain Bank

Body

Triple M radio host passes away after lengthy health battle

Radio presenter Bob Peters has died following a long battle with polycystic kidney disease. Bob was only 45 years old when he was diagnosed with the chronic illness which saw his kidneys fail. The former announcer on 107.7 Triple M on the Central Coast of NSW was receiving ongoing dialysis every second day in hospital to help keep him alive. Unfortunately the side effects of the chronic illness led to other things such as golden staph infection, to preventative brain surgery due to an aneurysm. He was placed on the organ donor list to receive functioning kidneys and after 10 years a match was made. Tragically, it was only five years later in January 2021 that doctors discovered that Bob had in fact terminal cancer. This prompted Bob to quit his job and fulfil his dream of touring around Australia in an RV. His funeral is being held on Friday, June 24 at Mackay Family Funerals in Ourimbah, followed by a wake at Tall Timbers Hotel. Bob was also known for his work at the Nine Network and ARN, as well as his voice-overs for Channel 10 and Fox Sports. Images: Triple M

Caring

Stroke, cancer and other chronic diseases more likely for those with poor mental health

<a href="https://www.aihw.gov.au/reports-statistics/health-welfare-services/mental-health-services/overview">Four million Australians</a>, including our friends, family members, co-workers and neighbours, are living with mental health conditions, including anxiety and depression. A <a href="https://www.vu.edu.au/australian-health-policy-collaboration/publications#chronic-diseases">new report out today</a> from the <a href="https://www.vu.edu.au/australian-health-policy-collaboration">Australian Health Policy Collaboration</a> has found these four million Australians are at much greater risk of chronic physical disease and much greater risk of early death. Having a mental health condition increases the risk of every major chronic disease. Heart disease, high blood pressure, arthritis, back pain, diabetes, asthma, bronchitis, emphysema and cancer are all much more likely to occur among people with anxiety and depression. More than 2.4 million people have both a mental and at least one physical health condition. For the first time in Australia, this report quantifies the extent of this problem. For example, people with mental health conditions are more likely to have a circulatory system disease (that is, heart disease, high blood pressure and stroke). The likelihood increases by 52% for men, and 41% for women. More than a million people are affected by both a circulatory system disease and a mental health condition. These diseases are Australia’s biggest killers. For painful, debilitating conditions such as arthritis and back pain, the numbers are even higher. Arthritis is 66% more likely for men with mental health conditions, and 46% more likely for women, with 959,000 people affected. Back pain is 74% more likely for men with mental health conditions, and 68% more likely for women, with more than a million affected. The gender differences are significant. Women with mental health conditions are much more likely to have asthma than women across Australia as a whole (70% more likely), while men are 49% more likely to have asthma with a mental health condition. The biggest gender difference is cancer. Men with mental health conditions are 84% more likely to have cancer than the general population, and for women the figure is 20%. As more women live with mental health conditions than men, overall, women are 23% more likely to be living with both a mental and physical health condition than men. The report shows having a co-existing mental health condition and chronic physical disease generally results in worse quality of life, greater functional decline, needing to use more health care and higher healthcare costs. These people require more treatment, use more medications, and have to spend more time, energy and money managing their health. People with a mental health condition are also <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60240-2/abstract">more likely to be poorer</a>, less likely to work, less likely to receive health screening and, sadly, <a href="https://www.rethink.org/media/810988/Rethink%20Mental%20Illness%20-%20Lethal%20Discrimination.pdf">more likely to receive substandard care</a> for their physical diseases. On average, people with mental health conditions die younger than the general population, and mostly from preventable conditions. We know from <a href="https://www.bmj.com/content/346/bmj.f2539">earlier research</a>that people with severe mental illnesses die much earlier than the rest of the population. Our report shows even common mental health conditions such as anxiety and depression contribute to more chronic disease, leading to higher rates of early death. <h2>Why?</h2> We don’t know exactly why people with mental health conditions have poorer physical health. The <a href="https://acmedsci.ac.uk/policy/policy-projects/multimorbidity">Academy of Medical Sciences</a> has identified that poor mental health and psychosocial risk factors such as feeling dissatisfied with life, not feeling calm, having sleep problems that affect work, and financial concerns can predict physical disease. Other factors, such as <a href="https://theconversation.com/low-income-earners-are-more-likely-to-die-early-from-preventable-diseases-87676">low socioeconomic status</a>, poor social networks, living in rural areas and smoking are associated with both poor mental health and poor physical health. We do know people with mental health conditions often don’t receive advice about healthy lifestyles, don’t get common tests for disease, and are less likely to receive treatment for disease. Some of this is due to <a href="https://www.ncbi.nlm.nih.gov/pubmed/21379357">stigma and discrimination</a>, and sometimes it’s neglect. People with mental health conditions can <a href="https://www.ranzcp.org/Files/Publications/RANZCP-Serious-Mental-Illness.aspx">fall through the gaps between disjointed physical and mental health systems</a>. <h2>What can we do about it?</h2> There is <a href="https://www.ranzcp.org/Files/Publications/RANZCP-Keeping-body-and-mind-together.aspx">momentum for change</a> among the mental health sector, with dozens of organisations signing up to the <a href="https://equallywell.org.au/">Equally Well</a> consensus statement. This aims to improve the quality of life of people living with mental illness by providing equal access to quality health care. There’s some great work being done around the country, including in the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/inm.12459">Hunter region</a>, where people with mental health conditions can access tailored help with physical health risk factors such as smoking and diet. People using mental health services should have their physical health regularly assessed, and any problems addressed as early as possible. Better coordination of care would preserve healthcare resources and improve quality of life. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/stroke-cancer-and-other-chronic-diseases-more-likely-for-those-with-poor-mental-health-100955" target="_blank" rel="noopener">The Conversation</a>.

Mind

Midlife chronic conditions associated with higher dementia risk as we age

Middle-aged people with multiple chronic conditions may have a higher risk of developing dementia later in life according to a new study. French researchers <a href="https://www.scimex.org/newsfeed/midlife-chronic-conditions-linked-to-increased-dementia-risk-later-in-life" target="_blank" rel="noopener">found</a> that middle aged people with at least two chronic conditions - including diabetes, high blood pressure, coronary heart disease and chronic lung disease (COPD) - have a higher risk of dementia than those who develop these conditions when they are older. While studies have shown that having two or more chronic conditions - known as multimorbidity - is common, especially among older people and those with dementia, little is known about how multimorbidity affects one’s risk of dementia. The new study, published in the <a href="https://doi.org/10.1136/bmj-2021-068005" target="_blank" rel="noopener">BMJ</a>, saw the team use data collected from over 10,000 British men and women involved in the Whitehall II Study, which looks at the association between social, behavioural and biological factors and long-term health. Of the 10,095 participants in the study, about 600 people (6.6 percent) had multimorbidity at 55, while 3200 people (32 percent) did by 70. When participants first joined the study between the ages of 35 and 55, they were free of dementia. Over a median follow-up period of 32 years, the team identified 639 people with dementia. The researchers then found that, considering factors such as age, sex, diet and lifestyle, people with multimorbidity at 55 had a 2.4-times higher risk of dementia compared to those without any of the 13 chronic conditions they looked at. They also found that this association weakened as the age that people were diagnosed with multiple chronic conditions increased. Though the team did find an association between age, multimorbidity and dementia risk, they stressed it was an observational study that can’t establish cause and effect. They also noted some limitations to their study, such as the misclassification of some dementia cases, and that the study participants were likely to be healthier than the general population. Despite these limitations, the researchers said their findings could be promising for finding ways of preventing dementia. “Given the lack of effective treatment and its personal and societal implications, finding targets for prevention of dementia is imperative,” they write. “These findings highlight the role of prevention and management of chronic diseases over the course of adulthood to mitigate adverse outcomes in old age.” Image: Getty Images

Body

Coffee may prevent chronic liver disease

<div class="copy"> Drinking coffee – whichever way you take it – may reduce the risk of liver disease, according to a new <a rel="noreferrer noopener" href="https://doi.org/10.1186/s12889-021-10991-7" target="_blank">study</a> published in the journal BMC Public Health. A team of researchers, from the universities of Southampton and Edinburgh in the UK, analysed <a rel="noreferrer noopener" href="https://www.ukbiobank.ac.uk/" target="_blank">UK Biobank</a> data on 495,585 participants, followed over roughly 11 years, to monitor the development of chronic liver disease and its relationship to coffee consumption. Coffee drinkers had a 21% reduced risk of chronic liver disease and a 49% reduced risk of death from liver disease, according to the study. The maximum benefit was found among those who drank ground coffee, which contains high levels of the ingredients kahweol and cafestol – which have been <a rel="noreferrer noopener" href="https://pubmed.ncbi.nlm.nih.gov/17590492/" target="_blank">shown</a> to be beneficial against liver disease in animal trials. But even instant coffee, which has low levels of these two key ingredients, had a marked benefit in reducing risk of liver disease, suggesting other ingredients or combinations are also beneficial. The find is important because chronic liver disease is a <a rel="noreferrer noopener" href="https://www.ncbi.nlm.nih.gov/books/NBK554597/" target="_blank">growing cause</a> of morbidity and mortality worldwide. “Coffee is widely accessible and the benefits we see from our study may mean it could offer a potential preventative treatment for chronic liver disease,” says lead author Oliver Kennedy, of the University of Southampton. “This would be especially valuable in countries with lower income and worse access to healthcare and where the burden of chronic liver disease is highest.” Coffee has <a rel="noreferrer noopener" href="https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/coffee-and-health/faq-20058339" target="_blank">often had a bad rap</a>, with early studies suggesting negative health impacts and a <a rel="noreferrer noopener" href="https://hellogiggles.com/lifestyle/health-fitness/health-benefits-caffeine-free/" target="_blank">bevy</a> of health gurus and online blogs espousing the benefits of abandoning the drink. But in recent years, a number of studies have demonstrated the potential benefits of coffee against a range of illnesses, including <a rel="noreferrer noopener" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125458/" target="_blank">Parkinson’s disease</a>, <a rel="noreferrer noopener" href="https://care.diabetesjournals.org/content/29/2/398" target="_blank">type 2 diabetes</a>, and <a rel="noreferrer noopener" href="https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.119.006799" target="_blank">heart failure</a>. The authors conducted their research based on the “biological plausibility” of coffee as a preventive factor in liver disease. Caffeine is a non-selective antagonist of the A2aA receptor. When activated, the A2aA receptor stimulates collagen production by hepatic stellate cells, which mitigate against liver fibrosis. Other active ingredients including kahweol, cafestol and chlorogenic acid have also been shown to protect against fibrosis in animal studies. The authors note that coffee consumption was only reported at initial enrolment into the study, so long-term changes in consumption are not accounted for. The participants in the study were also predominantly white and from higher socio-economic backgrounds, skewing the results towards particular physiologies and lifestyle factors, highlighting the need for further research. Image credits: Getty Images </div> <div id="contributors"> This article was originally published on <a href="https://cosmosmagazine.com/health/coffee-may-prevent-chronic-liver-disease/">cosmosmagazine.com</a> and was written by Amalyah Hart. </div>

Body

Physical symptoms linked to genetic risk of depression

People who experience physical symptoms such as chronic pain, fatigue and migraines are also more likely to have a higher genetic risk of clinical depression, according to a new study. Researchers from the University of Queensland collaborated with the QIMR Berghofer Medical Research Institute at the Royal Brisbane and Women’s Hospital to conduct a new study published in <a rel="noopener" href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2783096" target="_blank">JAMA Psychiatry</a>. They analysed data from over 15,000 volunteers, who provided information about their mental health history, depression symptoms, and a DNA sample. The team found that participants who had a higher genetic risk of developing clinical depression were more likely to experience additional physical symptoms. Dr Enda Byrne, a senior research fellow in psychiatric genetics and one of the researchers involved, said the study aimed to improve understanding of the genetic risks of depression and how other symptoms can be used to aid diagnosis. <img style="width: 500px; height:281.25px;" src="https://oversixtydev.blob.core.windows.net/media/7845012/depression1.jpg" alt="" data-udi="umb://media/e08ca3fc9f134a3c8fb3556dde363b83" /> Dr Enda Byrnes, the senior author of the latest study on depression and genetic risk. Image: The University of Queensland “A large proportion of people with clinically-diagnosed depression present initially to doctors with physical symptoms that cause distress and can severely impact on people’s quality of life,” <a rel="noopener" href="https://www.scimex.org/newsfeed/genetic-risk-for-clinical-depression-linked-to-physical-symptoms" target="_blank">he said</a>. “Our research aimed to better understand the biological basis of depression and found that assessing a broad range of symptoms was important. “We wanted to see how genetic risk factors based on clinical definitions of depression differed - from those based on a single question to those based on a doctor’s consultation about mental health problems.” Genetic risks of depression, explained Many different factors can contribute to the onset of depression, and there is strong evidence to suggest that genetics can affect the likelihood of developing the mental illness. Individuals can be predisposed to developing depression if someone in their family has been diagnosed. If a person’s biological parent has been diagnosed with clinical depression, their genetic risk of developing the illness sits at <a rel="noopener" href="https://www.blackdoginstitute.org.au/wp-content/uploads/2020/04/1-causesofdepression.pdf" target="_blank">about 40 percent</a>, with the other 60 percent coming from factors in their environment such as stress and age. Previous studies have also examined the role genetics plays in depression, but Dr Byrne said it can be difficult to find genetic risk factors that are specific to clinical depression. “Previous genetic studies have included participants who report having seen a doctor for worries or tension - but who may not meet the ‘official’ criteria for a diagnosis of depression,” he said. The researchers also stressed the importance of using a large number of samples in order to identify the risk factors for clinical depression but not for other definitions of depression. “It is also linked to higher rates of somatic symptoms - that is, physical symptoms that cause distress and can severely impact on people’s quality of life,” Dr Byrne said. “Our results highlight the need for larger studies investigating the broad range of symptoms experienced by people with depression.” Image: Getty Images

Mind

Pain and the brain: Closing the gap between modern pain science and clinical practice

<div> <div class="copy"> Statistics show that chronic pain affects 3.4 million Australians – that’s almost 14% of the population. But while pain science discoveries have enormous consequences on chronic pain treatment, the medical community knows little about them. Pain scientists have been urging clinicians for decades to ditch the traditional biomedical approach and adopt a multidisciplinary and multimodal methodology to chronic pain treatment. This latter approach considers the biological, psychological and social factors that affect the patient’s perception of danger. Evidence-based treatment includes a <a rel="noreferrer noopener" href="https://www.sciencedirect.com/science/article/pii/S0004951414601690?via%3Dihub" target="_blank">combination</a> of pharmacological and non-pharmacological techniques, including pain education, physiotherapy management and mental health support. “We have developed a four-steps process that brings together all these ideas (drawn from modern pain science),” says Professor Benedict Wand, a pain scientist at the University of Notre Dame. The first, fundamental step of this process, he says, is modern pain neurobiology education, which helps people gain a less threatening understanding of pain. The second step is helping the person feel safe to move, while the third step includes an active progressive rehabilitation that gradually loads the body so that movement continues to feel safe. Lastly, the focus shifts towards making the body stronger. Read more: <a rel="noreferrer noopener" href="https://cosmosmagazine.com/health/medicine/chronic-pain-in-women-could-be-genetic/" target="_blank">Chronic pain in women could be genetic</a> The biomedical model in which most health professionals in Australia have been trained describes pain as a direct consequence of tissue damage – the more severe an injury, the stronger the pain. In this model, pain provides an accurate measure of the state of the tissues, and it can be ‘fixed’ by providing pain relief. “We originally thought that pain was a simple readout of noxious information from the body,” says Wand. “But that is certainly not the process that underpins complex and long-standing pain experiences.” Decades of <a rel="noreferrer noopener" href="http://www.cor-kinetic.com/wp-content/uploads/2014/04/reconceptualizing-pain.pdf" target="_blank">research</a> in pain science have led scientists to believe that the level of pain is not an indication of the level of tissue damage. Instead, scientists have discovered that pain is a vital mechanism that happens in the brain (and not in the tissues) to protect us from more severe injuries. When we get hurt, pain receptors send a ‘possible threat’ signal to the brain, which then evaluates the danger of the threat by drawing information from current and past experiences and the state of the mind. If the brain does not perceive the circumstance as dangerous, it will not cause pain. If we are anxious or frightened, our brain might perceive the situation as dangerous and produce pain to protect us. “An interaction between incoming information from the world around you and held information – things that you already think and feel and believe – gives rise to an experience of pain when you judge your body to be under threat or needing protection,” says Wand. In one <a rel="noreferrer noopener" href="https://journals.lww.com/pain/Fulltext/2007/12150/The_context_of_a_noxious_stimulus_affects_the_pain.9.aspx" target="_blank">study</a>, scientists placed an ice-cold rod on the back of volunteers’ hands while showing them either a red or blue light. The rod was at the same temperature each time, but those who were shown the red light, which in our imagery represents danger, reported more intense pain than those who saw the blue light. In another <a rel="noreferrer noopener" href="https://journals.lww.com/pain/Fulltext/1998/01000/The_role_of_prior_pain_experience_and_expectancy.24.aspx" target="_blank">experiment</a>, volunteers put their heads inside what they thought was a ‘head stimulator’. In front of them, researchers manoeuvred an ‘intensity knob’. The volunteers reported levels of pain that correlated with the intensity on the knob, although the stimulator was doing nothing at all. These studies suggest that pain is not a response to real danger or physical damage but to perceived danger, says Professor Lorimer Moseley, a pain scientist at the University of South Australia. Consequently, psychosocial factors that alter our perception of threat play a crucial role in the level of pain we experience. When pain becomes chronic, it is less about physical damage and more about a pain system that has become excessively protective. A physical cause of the pain might never be found in scans, yet the pain people feel is real, says Moseley. <h2>Go the distance for pain science</h2> While lack of access to multidisciplinary pain services is a countrywide issue, rural and regional areas are severely underserved. Pain Revolution is <a rel="noreferrer noopener" href="https://www.painrevolution.org/" target="_blank">an organisation</a> set up to close the gap between modern pain science and clinical practice in rural and regional communities. The organisation has established a Local Pain Educator Program that trains rural and regional GPs and health professionals in modern pain science and management. In turn, they support their communities by providing pain education to the public. With another project called the Local Pain Collectives, Pain Revolution helps rural and regional health professionals establish community-based, interdisciplinary networks to build their skills in contemporary pain education and management. “Two essential ingredients for recovery from persistent pain are learning and movement,” says Moseley, who is also CEO of Pain Revolution. “There is very strong evidence that movement is medicine. Our muscles, bones, ligaments, skin, tendons – you name it – love movement.” To support its work, Pain Revolution has launched a virtual challenge to raise funds called Go the Distance. “Go the Distance is challenging everyone to learn a bit more about pain and get moving, and walking, running and cycling are three easy ways to do it,” says Moseley. The initiative has replaced the annual Rural Outreach Tour, which had previously been the major Pain Revolution fundraiser. “Like many events in 2021, COVID has meant that we had to find an alternative to the tour,” says Moseley. The initiative will be held in October, and it challenges participants to walk, run or ride as far as possible to support people who suffer from chronic pain and often don’t receive medical care that is based on the latest scientific evidence. If you want to help, support our science writer Manuela Callari, who has taken the challenge, by donating <a rel="noreferrer noopener" href="https://painrevolution.raisely.com/manuela-callari" target="_blank">here</a>. If you want to sign up as an individual, or join a team, go to <a rel="noreferrer noopener" href="http://painrevolution.raisely.com/" target="_blank">painrevolution.raisely.com</a>. Image credit: Shutterstock This article was originally published by <a rel="noopener" href="https://cosmosmagazine.com/health/pain-and-the-brain-closing-the-gap-between-modern-pain-science-and-clinical-practice/" target="_blank">cosmosmagazine.com</a> and was written by Dr Manuela Callari. </div> </div>

Body

Learn about our fastest-growing chronic disease with Dr Michael Mosley

Renowned doctor and trusted medical journalist Dr. Michael Mosley is back on our televisions screens to tackle Australia’s fastest growing chronic disease, type 2 diabetes. Called Australia's Health Revolution with Dr. Michael Mosley, this new TV show premieres soon on Wednesday 13 October at 7.30pm on SBS and SBS On Demand. In the show, Dr Mosley tackles some of our misconceptions about just how healthy Australians are and he embarks on a confronting journey alongside eight brave Australians. Eating his way into, and out of, ill health Working with proud Gomeroi man and exercise physiologist Ray Kelly, Dr Mosley puts his own body on the line to demonstrate the latest science and he shows us just how fast you can eat your way into, and out of, ill health. <iframe width="560" height="315" src="https://www.youtube.com/embed/SciXE-e1mXo" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen=""></iframe> To demonstrate this, Dr. Mosley follows an average Australian diet and in just two weeks, his blood sugar levels become pre-diabetic and he pushes his blood pressure worryingly high - highlighting the root of Australia’s obesity and type 2 diabetes epidemic, at a time where almost 200 Australians are diagnosed with type 2 diabetes every day. Dr Mosley isn’t on this journey alone. He and Ray meet with eight brave Australians diagnosed with type 2 diabetes or pre-diabetes who dream of getting their health back and turning their lives around. Together with Ray, Dr Mosley guides the participants through drastic diet and lifestyle adjustments rather than medicine, in an attempt to reverse the effects of pre-diabetes and type 2 diabetes. Can they kick start a ‘Health Revolution’ and empower a nation to take ownership of its health? Dr Michael Mosley has said we’ve become too complacent about the dramatic surge in rates of type 2 diabetes, driven by weight gain: “If we’re going to tackle our obesity epidemic, then we need to understand how our bodies work so we can reverse the damage we are doing,” he adds. “I was really shocked by how quickly my weight, blood pressure and blood sugar levels rose when I started eating far more ultra-processed foods, the sort of diet many Australians follow. I want to show people simple ways we can all improve our health, and that every bit counts. “I hope people are surprised and perhaps alarmed when they watch this show – I want it to challenge what you think you know about food and health, and I hope it illustrates just how deadly increased blood sugars can be. But also, how we can beat it,” he said. Now is an important time to be healthy Celia Tait, Executive Producer Artemis Media said of the show: “There has never been a more important time to be healthy. Now, as we grapple with the complexity of living amidst a pandemic, it’s all the more important to share the latest science around type 2 diabetes reversal. “We take heart and inspiration from Dr Michael Mosley, Ray Kelly and the participants whose stories we follow and who show us how to live a healthier life,” she added. <img style="width: 0px; height: 0px;" src="/nothing.jpg" alt="" data-udi="umb://media/bf113418f44947df97b023103ec2efa6" />Supportive programming from NITV In addition to the SBS broadcast, NITV will air a suite of supportive programming which explores the type 2 diabetes epidemic in Aboriginal and Torres Strait Islander communities. At 8:35pm on Wednesday 13 October on Living Black, Karla Grant speaks with Dr Michael Mosley about what fired his passion to take the fight against type 2 diabetes globally and gets the answers on why the disease is so prolific in Indigenous communities. Australia's Health Revolution with Dr. Michael Mosley will be available to stream on <a href="https://www.sbs.com.au/ondemand/">SBS On Demand,</a> with subtitled versions available in Arabic, Simplified Chinese, Traditional Chinese, Vietnamese and Korean. The TV show is an Artemis Media production for SBS with principal production investment from Screen Australia in association with SBS. You can join the conversation at #AusHealthRevolution Image and video: SBS TV

Chronic pain could be changing your brain

The way we feel - whether it’s happiness, irritation or any other emotion - has been found to be a balancing act between two chemical messengers in our brains. But, for the more than 3 million Australians who experience chronic pain, new research has found the likelihood of experiencing negative emotions more often than positive ones is higher. The new study, which used advanced imaging techniques to scan the brains of volunteers with and without a history of chronic pain, saw that those affected by chronic pain tend to be more anxious and depressed due to disruptions in the communication between cells. “Chronic pain is more than an awful sensation,” <a rel="noopener" href="https://newsroom.unsw.edu.au/news/science-tech/chronic-pain-might-impact-how-brain-processes-emotions" target="_blank">says</a> Associate Professor Sylvia Gustin, the senior author of the new study and a neuroscientist and psychologist at the University of New South Wales and NeuRA. “It can affect our feelings, beliefs and the way we are.” What happens in the brain Emotions are processed by many different areas in the brain, which work together as a network. These regions include the amygdala (responsible for handling positive and negative information), and the prefrontal cortex (which helps us regulate our emotions). For example, when something frightening is happening, the amygdala sends that information to the prefrontal cortex, which decides whether to communicate with other areas of the brain so you can run away or react in other ways. This communication requires the help of chemical ‘messengers’ called neurotransmitters, which both help in sending messages between cells and regulating everything from mood to appetite.. One neurotransmitter called gamma-aminobutyric acid (GABA) can stop neurons from becoming over excited to limit communication between the amygdala and the prefrontal cortex. A second, called glutamate, can excite them. These neurotransmitters work together to regulate mood, so that our feelings help motivate us to take action when we need to, without feeling overwhelmed or overly anxious. <img style="width: 500px; height: 499.99999999999994px;" src="https://oversixtydev.blob.core.windows.net/media/7842887/gettyimages-1030518600.jpg" alt="" data-udi="umb://media/47371b7ecc6f445b94f92f194fa15a0c" /> Image: Getty Images In previous studies on animal models, scientists found that subjects in pain experience varying levels of glutamate. Similarly, a <a rel="noopener" href="https://pubmed.ncbi.nlm.nih.gov/31849800/" target="_blank">decrease in glutamate</a> has also been seen in humans experiencing chronic pain, matching a decline in their emotional regulation. However, changes in the amount of GABA in subjects experiencing pain has only been seen in mice, which is where this new study comes in. The study By scanning the brains of 48 participants with and without chronic pain, the scientists were able to determine whether the levels of GABA differed when someone was in pain and not in pain. Though the sample size isn’t large, the study does show enough evidence to support the view that being in pain for a long period of time changes how the brain processes emotions. “We have discovered, for the first time, that ongoing pain is associated with a decrease in GABA, an inhibitive neurotransmitter in the medial prefrontal cortex. In other words, there’s an actual pathological change going on,” Gustin says. <blockquote style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" class="instagram-media" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/CR3BpqlK9kg/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="13"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"></div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"></div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"></div> </div> </div> <div style="padding: 19% 0;"></div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"></div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" rel="noopener" href="https://www.instagram.com/p/CR3BpqlK9kg/?utm_source=ig_embed&utm_campaign=loading" target="_blank">A post shared by NeuRA (@neuraustralia)</a> </div> </blockquote> With lower levels of GABA, it can become harder to dampen the thought processes which deal with our emotional responses and reasoned-out thoughts and actions. Why it matters Understanding how pain affects our emotions in the long term can help researchers develop ways to manage its effects, including poorer sleep, additional stress, and feelings of guilt. “It’s important to remember it’s not you - there’s actually something physically happening to your brain,” says Gustin. “The brain can’t dampen down these feelings on its own, but it is plastic - and we can learn to change it.” This research was published in the <a rel="noopener" href="https://onlinelibrary.wiley.com/doi/10.1002/ejp.1838" target="_blank">European Journal of Pain</a>.

Mind

Ways to ease chronic pain

Around 1.6 million Australians aged 45 or over have been living with persistent pain, according to newly released data from the Australian Institute of Health and Welfare. The figures, which cover 2016-17, reveal that GP consultations for chronic pain increased by 67% in the preceding decade. The number of visits for lower back pain increased by 400,000. Dealing with chronic pain also means you are likely to face longer hospital stays, much poorer mental health and are three times more likely than normal to be taking painkillers regularly. About 105,000 people were hospitalised with chronic pain in 2017-18, with a typical hospital stay three times longer than average. Behind those figures lies the human cost. As a clinical specialist in pain medicine, I see the jobs lost, the mortgage defaults, the superannuation withdrawals, and the family roles given up because of debilitating pain. Lower back pain, migraine and pain following trauma are among the top 10 causes of years lost to disability worldwide, and this has <a href="http://www.healthdata.org/gbd">barely changed over the past 20 years</a>. Because chronic pain can happen at any stage of life, many people have to live with it for decades. A <a href="https://www.painaustralia.org.au/static/uploads/files/the-cost-of-pain-in-australia-final-report-12mar-wfxbrfyboams.pdf">2019 Deloitte Access Economics report</a> commissioned by advocacy group <a href="https://www.painaustralia.org.au/">Painaustralia</a> estimated the annual cost to Australia’s economy at A$139.3 billion per year, more than A$20 billion of which comes directly out of the pockets of pain patients. A fresh approach The most expensive and inefficient way to manage this national crisis is pretty much the way we are currently doing it. Chronic pain care <a href="https://www.painaustralia.org.au/static/uploads/files/the-cost-of-pain-in-australia-final-report-12mar-wfxbrfyboams.pdf">is too fragmented</a> and too often delivered by those without the most up-to-date training. Yet most of the really effective treatments can be delivered at a relatively low cost and with low-tech means. Here are some potential solutions that pain doctors and researchers are confident will work. <ul> <li> Medications need to be carefully chosen and ruthlessly abandoned if they are not helping. The <a href="http://www.pbs.gov.au/statistics/expenditure-prescriptions/2018-2019/PBS_Expenditure_and_Prescriptions_Report_1-July-2018_to_30-June-2019.pdf">Pharmaceutical Benefits Scheme</a> (PBS) currently spends more than A$170m a year on drugs such as sustained-release opioids and pregabalin. This could be reduced if more doctors prescribed them in accordance with <a href="https://www.nps.org.au/professionals/opioids-chronic-pain">best practice</a> knowledge. This would help patients and taxpayers alike. </li> <li> Skilled interventions such as inpatient infusions of medications like ketamine, or invasive procedures such as <a href="https://www.mayoclinic.org/tests-procedures/radiofrequency-neurotomy/about/pac-20394931">radiofrequency neurotomy</a>, need to be provided according to <a href="http://fpm.anzca.edu.au/documents/fpm-procedures-in-pain-medicine-ccs-v1-0-20191003.pdf">appropriate quality standards</a> so resources are not wasted and patients are not put at risk. </li> <li> PBS funding should be extended to cover effective treatments for specific conditions such as <a href="https://link.springer.com/article/10.1007/s11916-019-0768-y">migraines</a>. </li> <li> Proven treatments such as group pain programs and individual therapy sessions with credentialed allied health specialists need to be supported by Medicare. These are essential for building the self-management skills needed to reduce patients’ reliance on pain medication. </li> <li> We need a massive investment in training and service redesign for agencies that deal with chronic pain as a result of work or transport injuries. </li> <li> High-quality pain care should be viewed not as a luxury for hospitals, but an essential part of the health-care ecosystem. Pain care should be integrated throughout the public health system, in both acute and subacute care, where it can shorten inpatient stays and improve rehabilitation. </li> <li> We should restrict access to low-value treatments like repeated surgery or medications that have not been working. </li> </ul> In the void created by the huge unmet need and the limited availability of expert pain care, an industry of highly dubious usefulness has been allowed to flourish. Social media is full of false hope. Supplements such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/27477804">glucosamine</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/28470851">curcumin</a> and <a href="https://journals.lww.com/jclinrheum/fulltext/2017/09000/omega_3_fatty_acids_in_rheumatic_diseases__a.6.aspx">fish oil</a> are not supported by credible studies, yet they are still promoted commercially as effective. Dodgy arthritis “cures” and devices that claim to relieve pain using magnets or electricity are everywhere. Despite <a href="https://www.tga.gov.au/publication/guidance-use-medicinal-cannabis-treatment-chronic-non-cancer-pain-australia">dismal supporting evidence</a>, the medical cannabis industry continues to sell itself to chronic pain patients. While the COVID-19 pandemic continues, it can be hard to focus on other health issues. But Australia already has a path to improving life for many thousands of chronic pain sufferers. The federal government has developed a <a href="https://www.painaustralia.org.au/static/uploads/files/national-action-plan-11-06-2019-wftmzrzushlj.pdf">strategic plan for pain management</a> that offers a blueprint for future action. The plan calls for upskilling of all primary care health professionals to help them recognise the early stages of a chronic pain problem and nip it in the bud. If implemented, it will bring the dream of timely access to well-resourced expert interdisciplinary pain teams in the regions and outer suburbs closer to reality. Most importantly, we need a community-wide effort to destigmatise persistent pain and those who suffer from it. After all, the chances are you either have it or you live or work with someone who does.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/137891/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michael-vagg-1771">Michael Vagg</a>, Conjoint Clinical Associate Professor, Deakin University School of Medicine and Specialist Pain Medicine Physician, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/1-in-5-aussies-over-45-live-with-chronic-pain-but-there-are-ways-to-ease-the-suffering-137891">original article</a>.

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Surgery won’t fix my chronic back pain, so what will?

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