Pain Managment ? The Role of Nutrition

Hoping to avoid medications? Try these natural options.

The answer may be in your kitchen pantry, and not in your medicine cabinet

Attributed to : Healthline

Turn to Nature

If you’re suffering from a toothache, backache, or any other type of pain, your first impulse might be to reach for a pill. Many people rely on medications, but they come with the risk of side effects, drug interactions, and the possibility of becoming habit forming. 

You may find the relief you need from a variety of natural painkillers instead.

Many herbs and spices can treat inflammation and other related conditions. These plant-based options fall under a category of medical treatment known as complementary and alternative medicine, which also includes acupuncture, yoga, reiki and other practices. When it comes to pain relief, you may be surprised at what might help you feel better.

Part 2 of 7: Willow Bark

Willow Bark

People have been using willow bark to ease inflammation (the cause of most aches and pains) for centuries. The chemical salicin, which is similar to the main ingredient in aspirin, is found in the bark of the white willow.

Originally, people chewed the bark itself to relieve pain and fevers. Now willow bark is sold as a dried herb that can be brewed like tea. It also comes as a capsule or liquid supplement. It can be used to treat headache, low back pain, osteoarthritis,and many other conditions.

However, willow bark can cause stomach upset, may slow down your kidneys, and can prolong bleeding time, just like aspirin. It should only be used by adults. It could be poisonous to children, just like aspirin can be poisonous when taken in large quantitates.

If you’re sensitive to aspirin, or if you are taking any over the counter anti-inflammatory drugs (e.g., aspirin, ibuprofen, naproxen) you should avoid willow bark. You should also avoid taking it if you are taking warfarin or other anticoagulant treatments, as salicin could increase the risk of bleeding.

Part 3 of 7: Turmeric

Turmeric

Turmeric is a spice that gives curry, an Indian dish, its yellow color and unique flavor. It contains the compound curcumin, an antioxidant that helps protect the body from free radical molecules that can damage cells and tissue.

Turmeric is used for the treatment of many conditions, including indigestion, ulcers, stomach upset, psoriasis, and even cancer. Some people with osteoarthritis turn to turmeric as a natural pain reliever because it helps relieve inflammation.

Part 4 of 7: Cloves

Cloves

Whole cloves are often used to spice up meat and rice dishes. Ground cloves are used in pies and many other foods. As a medicine, cloves can be found in capsule or powder form. Clove oil is also available.

Like other herbal supplements, cloves are used to treat a wide range of conditions. Cloves may help ease nausea and treat colds. They may also help relieve the pain associated with headaches, arthritic inflammation, and toothaches. Cloves can also be used as part of a topical pain reliever.  A study indicated that cloves could be used to treat fungal infections but further research is needed.

The active ingredient is eugenol, which is a natural pain reliever and is also used in some over-the-counter pain rubs. Rubbing a tiny amount of clove oil on your gums may temporarily ease toothache pain until you can get to a dentist. But too much undiluted clove oil may actually hurt your gums, so discuss this approach with your dentist before trying it at home. 

People with bleeding disorders or who are taking blood-thinning medication should be careful when consuming clove products. Clove oil can increase the risk of abnormal bleeding.

Read More: Is Clove a Cure-All?

Part 5 of 7: Acupuncture

Acupuncture

This ancient Chinese medical practice seeks to relieve pain by balancing the body’s natural energy pathways. The flow of energy is known as qi (pronounced CHEE). Acupuncturists place tiny, and very thin needles into your skin. The location of the insertion is related to the source of the pain. But, based on the qi, a needle may be inserted far from the part of the body experiencing pain. Acupuncture may relieve pain by causing the body to release serotonin, a “feel good” chemical that eases pain.

A study published in JAMA Internal Medicine found that acupuncture helped relieve pain associated with osteoarthritis, migraines, and various locations of chronic pain.

Related News: Researchers Find Proof That Acupuncture Blocks Stress

Part 6 of 7: Heat and Ice

Heat and Ice

Among the most common home remedies is applying heat and ice directly to sites of pain. While these may not seem like “surprising” pain relievers, not everyone is clear on exactly when to use ice or heat.

A strained muscle, tendon, or ligament may feel better after applying an ice pack to reduce swelling and inflammation, shortly after it is injured. Interestingly, once the inflammation has disappeared, heat may help reduce the stiffness that comes with strains and sprains.

A cold pack used briefly on the head may also help take away the pain of a headache.

But, if the painful problem is arthritis, moist heat applied to the affected joint will help more than ice. Moist heat packs that can be warmed in the microwave and used many times, making them easy and effective to use. If you get injured, talk with your doctor or pharmacist about how to use heat or ice to help ease the pain.

Part 7 of 7: Be Careful

Be Careful Managing Pain

The natural painkillers described above may only be effective for specific causes of pain. It’s possible that not all of the suggestions on this list will work for you. However, these natural alternatives to prescription or over-the-counter medications may at least give you some decent options to try before you turn to pharmacological solutions.

Remember, pain is the body’s signal that something is wrong. It may be temporary, such as a strained muscle. But pain can also mean you have a serious health problem that needs a professional medical evaluation. Don’t hesitate to seek out a healthcare provider to diagnose the source of your pain, and then discuss some natural options for treating it.

Cancer, The Emperor of All Maladies

The C word.....is still a feared word, however today there is much hope for many patients with cancers. Cancer is no longer a meaningful generic word .  Compare it to saying you have an infection rather than  saying you have 'ebola'.  The immediate. emotional responses are quite different.

And so it is with many diseases, like HIV and AIDs, still feared but now manageable.  Many live long productive lives with diseases such as HIV.

Are you rich or are you poor ?  Unfortunately it makes a difference .  

This weekend PBS and WETA will be broadcasting a series of events focused on cancer.

Thanks to WETA and PBS as well as Ken Burns (producer)

Watch the Trailer

KEN BURNS

Executive Producer and Series Creative Consultant

Ken Burns has been making documentary films for more than 30 years. Since the Academy Award-nominated Brooklyn Bridge in 1981, he has gone on to direct and produce some of the most acclaimed historical documentaries ever made. The late historian Stephen Ambrose said of Ken’s films, 'More Americans get their history from Ken Burns than any other source.'

Ken Burns brings cancer story telling to a new peak. This series deserves and will receive many accolades from the medical communities and patient advocacy groups, not just for cancer but for many other medical topics as well.

BARAK GOODMAN

Producer and Director

Barak Goodman is co-founder of Ark Media and a principal producer, director, and writer with the company. His films for Ark Media have been nominated for an Academy Award and won multiple Emmys and Writers Guild Awards, the DuPont-Columbia, and Peabody Awards, the RFK Journalism Prize, and twice been official selections at the Sundance Film Festival.

DR. SIDDHARTHA MUKHERJEE

Author, The Emperor of All Maladies: A Biography of Cancer

Dr. Siddhartha Mukherjee’s accomplishments as both a physician and a Pulitzer Prize winning author are compelling and powerful. A cancer specialist, Sid has devoted his life to caring for victims of cancer, a disease that sickens and kills millions of people around the world each year. As a researcher, his laboratory is on the forefront of discovering new cancer drugs using innovative biological methods.

It is important to watch this video with the perspective of a TIMELINE

The series of videos from Cancerfilms.org also gazes into today's research, projecting forward into a world of genomics, personalized treaments, targetted pharmacologic drugs, and as yet unforseen serendipitous discoveries.

Patient-Powered Care Drives New Relationship With Physicians

You fought hard to get that health insurance card, whether it is through the affordable care act, medicare, medicaid or another source..  Perhaps you pay cash or belong to a direct payment model primary care practice.  Or perhaps you are still among those who could not afford health insurance even with the subsidies calculated from the Affordable Care Act's Health.gov website.

Whether your present that card with a zero-dollar copay or zero dollar deductible, you have only just begun your new patient career in the future of medical care.

Even for patients who have had a consistent uniform policy through an employer based or group based coverage most patients find the true story is only known when you present that card to the receptionist or admission clerk.  Many get a surprise when they learn how their 'old policy' has changed, with new rules, copays, deductibles, and other caveats.  Your own physician probably does not know what is in your 'card' let alone your wallet.  The card is swiped, the computer screen blinks several times and the truth will out you. God forbid it says 'declined'....you are relegated to the status of a non-citizen in the digital health sphere.  Go to start, and revert to old fashioned cash. (some are still bogged down or never left that niche)..

More likely the computer screen  will display what insurance is in effect, deductibles, copays, prior authorization requirements and much more.  The clinic EHR system is most likely connected directly to multiple insurance companies, billing agencies, hospitals and now to a nationwide health data exchange to increase transparency, and improve efficiency (when and if it is working).

Doctors, go back to your patient rooms, this stuff is not for the faint of heart and you will need all of your energy, commitment and discipline to do what you know best for your patients. Cardiac arrests, CPR, seizures, gunshot wounds are all trivial in the face of a 17% carve out of the U.S. GDP for health costs. Should you want to know more about the business of medicine you would have to have been in medical practice for at least 20 years, and have had several near misses at practice insolvency and you will need to get an MBA. 

It used to be that having an M.D. degree was the end all. Not so anymore. Many young physicians in training or early practice are enrolling in an MBA program,  perhaps on one of those MOOCs , through Coursera  or taking evening courses at the local college.  Some have learned by OJT working through the ranks of managing their clinic departments or managing their own practice in years gone by.



For more about Paient Powered Care:

Rx: A Quiet Revolution
An Interview With Cardiologist Turned Documentary Producer Jennifer Mieres
Bob Harrington interviews Jennifer Mieres about the PBS documentaries Rx: The Quiet Revolution and Rx: Doctors of Tomorrow, on innovative models for practicing and teaching patient-centered care.

PBS Documentary Champions Patient-Centered Care
Airing on April 2, 'Rx: A Quiet Revolution' turns aside from the usual discontents of medicine to show how reviving the physician-patient relationship can help Americans cope with chronic illness. 

Expert Reviews
Primary Care Models: Not One Size Fits All
A Perspective From Reid Blackwelder, MD, Board Chair, AAFP

Healthcare As It Is, or As We Want It to Be?
Professor of medicine Mark Williams reflects on the meaning of healthcare models shown in the PBS short film.

A PCMH Model That Works
Brad Fox, MD, a practicing family physician, reflects on the success of the PCMH depicted in an Alaskan practice described in the PBS film.

Transforming Primary Care, One House Call at a Time
Kenneth Lin, MD, discusses how a new documentary demonstrates the value of house calls in primary care, and why they should be reimbursed for that value.

Diabetes in the Delta: Helping Patients Meet Goals
Dr Dace Trence reviews an upcoming PBS documentary that addresses a Mississippi program for diabetes patients.

Rx: The Quiet Revolution: Heart and Soul Meet Modern Medicine
After so many doom-and-gloom healthcare documentaries, Seth Bilazarian is pleasantly surprised to find Rx: The Quiet Revolution to be both representative of his experience and insightful.

Healthcare Is a Team Sport; Nurses Are Key Players
Ken Miller, president of the American Association of Nurse Practitioners, explains how healthcare has also become a team effort, as highlighted by the PBS documentary.

Transforming Medical Education
Emotional Education in PBS's Rx: Doctors of Tomorrow
Medical student Alexa Mieses reviews the PBS documentary Rx: Doctors of Tomorrow. The program focuses on an innovative medical school that highly values empathy and emotional experience

Providers must be aware that illness can severely impair patient judgment and the ability to be self empowered during acute and some chronic illnesses.   Patient advocacy will become even more important as  providers and hospitals may fail to discharge their duties toward patients. It's all in the small print.

So let's not abdicate our position of leadership in caring for patients and monitoring just how well or not our 'allied' staff performs.

THIS IS NOT AN APRIL FOOL DAY JOKE.

Medicare to cut Physician Reimbursement by over 20 % Today

21 percent cut to Medicare now in effect As of midnight last night, the current sustainable growth rate (SGR) patch expired, meaning the 21 percent cut in Medicare payments is in effect. Every day that the U.S. Senate does not act causes disruptions to physician practices and puts more patients at risk of not getting the care they deserve. Last week, the U.S. House of Representatives overwhelmingly passed bipartisan legislation that would permanently repeal the SGR formula, but the Senate failed to act before leaving on a two-week recess. While Senate leadership has indicated they will take up the bill upon return on April 13, the clock is ticking. The administration can only hold claims until April 15, leaving a very narrow window of time for the Senate to act before Medicare claims are paid at the drastically reduced rate. We need you to keep the pressure on during the recess! Please contact your senators today to remind them that they have unfinished business here in Washington, D.C., and urge them to support H.R. 2 immediately when they return! Call your senators district offices using the AMA's toll-free Grassroots Hotline: (888) 434-6200. Send an urgent email to your senators reinforcing the need for SGR repeal now. Contact key senators still undecided on this most critical issue directly through their own social media channels and share with your own Facebook friends and Twitter followers as well. For help scheduling a district meeting or to find a list of district town halls this recess, email grassroots@ama-assn.org and we can assist you with office hours and locations. This is urgent! The current SGR patch has expired; physicians are being hit with a 21 percent cut to Medicare - your voice is needed now, more than ever! For more information read the bill summary (PDF) and be sure to check out fixmedicarenow.org for all the latest. The Senate  went on recess prior to approving the House approval of the SGR Revocation Bill. Not unusual, and the type of action that promotes apathy about our government taking meaningful action in a timely fashion... Another reason why your healthcare should not be competing with other congressional responsibilities, such as defense, terrorism and federal emergencies....

For more information, please visit:  AMA Physicians' Grassroots Network   AMPAC   Click here to unsubscribe from this mailing list.

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Change From the Inside Out: Health Care Leaders Taking the Helm

Even as politicians and pundits continue to debate the merits of the Affordable Care Act (ACA), it is time to look beyond it to the next phase of US health care reform. Although many physicians contributed to the development and implementation of the ACA, the forces that have steered it so far have been primarily governmental.

The ACA has set the stage. The law has 2 major thematic aspects. The first, and by far the most visible in public discourse, extends health care coverage through a combination of Medicaid expansion and subsidies on newly established private insurance marketplaces. The second aspect of the ACA, far less often discussed in the public arena, is not about coverage; it is about changing the way in which health care is delivered and experienced. The mechanisms the ACA offers are numerous and the potential is profound. The response to this second theme, changing care, has been substantial, accelerating the adoption of new care structures in both the public and private sectors

Continued reliance on the ACA alone is wholly insufficient to accelerate delivery system reform to the level needed.

Leaders from within health care should now more firmly take the tiller. To borrow a phrase contributed by Splaine and colleagues.   it is time to move from change forced from the “outside in” to change led from the “inside out.”

Today’s polarized politics too often prevent authentic dialogue and exploration in the public arena that are essential in designing a better system of care. For example, the toxic and ill-informed “death panel” rhetoric in Washington stalled meaningful policies to improve the care of those with advanced illness

Needed, and now forming under the aegis of the Institute for Healthcare Improvement, is a Leadership Alliance of major health care organizations that commit publicly to partnering with their patients, and
their communities.

The current ongoing discussions about repeal of the ACA are moot, and assembling a littany of complaints  skirts the real issues.

The Supreme Court is currently reviewing the ACA

Oral Arguments for King V. Burwell

The arguments have little to do with health care and paient welfare, and much to do with the balance of powers in the three powers of government,  constitutional law, and self-interest groups.

Author commentary:

Local communities of providers, hospitals and organizations now should come to the table, and mold what little is left to adapt to practical, viable and credible trustworthy solution to another miscarriage of congressional law.  ..  Nancy Pelosi...you passed it, we read it, and now will fix what you were paid to legislate.  It can be done.........IOM, AHRQ, and other lofty non clincal health leaders please move to the back of the bus....now.

We should not expect national government to fix our own local health issues.

ARTICLE INFORMATION

Published Online: March 26, 2015. doi:10.1001/jama.2015.2830.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

REFERENCES

1. Splaine M, Batalden P, Nelson E, Plume SK, Wasson JH. Looking at care from the inside out: a conceptual approach to geriatric care.J Ambul Care Manage. 1998;21(3):1-9. 
2. Leavitt Partners. Growth and dispersion of accountable care organizations: June 2014 update. http://leavittpartners.com/2014/06/growth -dispersion-accountable-care-organizations -june-2014-update/. Accessed March 12, 2015. 
3. National Committee for Quality Assurance. Patient-centered medical homes. http://www.ncqa .org/Portals/0/Newsroom/2013/pcmh%202011 %20fact%20sheet.pdf. Accessed March 12, 2015. 
4. Berwick DM, Nolan TW, Whittington J. The Triple Aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759-769. 
5. Gerhardt G, Yemane A, Hickman P, Oelschlaeger A, Rollins E, Brennan N. Medicare readmission rates showed meaningful decline in 2012. Medicare Medicaid Res Rev. 2013;3(2). 
6. US Department of Health and Human Services. New HHS data shows major strides made in patient safety, leading to improved care and savings. http://innovation.cms.gov/Files/reports /patient-safety-results.pdf. Accessed March 12, 2015. 
7. Centers for Medicare & Medicaid Services. Projections of national health expenditures: methodology and model specification. http://www.cms.gov/Research-Statistics-Data -and-Systems/Statistics-Trends-and-Reports /NationalHealthExpendData/Downloads /ProjectionsMethodology.pdf. Accessed March 12,

United Health Care, Network Squeezes, Henry Ford System, End of California Children Health Insurance Program , Reid will never give up, SGR Fix, 100 Most Influential People in Healthcare

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Editorial: The SGR fix helps the value-based care evolution

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Doctors Needing Assistance Transferring from Fee for Service to Quality of Care Reimbursement

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Featured from   Best Doctors®           Best Doctors in the Financial Services Industry The Rising Health Care Costs Beware the Quickie Second Opinion

Doctors face tremendous hurdles attempting to convert a volume based, procedural fee system to the        proposed method of quality and outcome based reimbursement.  Physicians and consultants alike have long      recognized the inflationary component of the old fee for service methods.  What is not apparent in the            new proposal is that it does not discard billing for procedures, but adds on a new algorithm which                  modifies the fee based upon other measures, currently in development.  Much of the algorithm is still in          development. The calculus depends upon big data analytics measuring outcomes and some vague          measures of quality. 

Some have been proposed, such as hospital readmission rates, length of stay measures and others. CMS' meaningful use criteria will play a role as a built in component of certified electronic health records.  Some of these tools will not be available until 2018.  The initial metrics proposed for healthcare are new and arbitrary, and have not  yet been proven scientifically.  There are agencies such as AHRQ who have formulated guidelines, long before changes in reimbursement methodology were proposed.  Quaity issues must be a thing unto itself, unbound from payment methodology. Basing payment on quality of care remains a new algorithm.

Kaiser ordered to pay woman more than $28 million

Founded in 1945, Kaiser Permanente is one of the nation’s largest not-for-profit health plans, serving approximately 9.6 million members It serves as one HMO model in the U.S.   They promote themselves with the   "THRIVE" icon in their marketing campaigns for the impact of wellness promotion in lowering health care costs while at the same time improving quality of life.

Fast Facts about Kaiser Permanente

Much of their financial stability can be assigned to a highly disciplined and organized approach to  accessibility to expensive testing.   These methods are monitored by utilization review departments. Kaiser is a   ''super HMO' and as such has scaled many operations to higher levels of practice administration far above the  'grass roots' of practicing clinicians.  In fact Kaiser clinicians (like so many other group practice clinicians) have preferred practice guidelines to which they must conform or face sanctions, and even dismissal if they disregard the guidelines.

At times these guidelines, do not serve quality of care well at all.  They may save money for an organization in the short and/or long term,  however many patients complain about restrictive guidelines interferring with their care.  Sometimes it is minor annoyance, however cases such as this occur more than rarely.  In this case the sanction was medico-legal to the tune of $ 28 million dollars.....paid for by a malpractice insurance carrier.  This is another hidden cost of health  care and is not accounted for in health finance analysis.

The story is carried in today's edition of the Los Angeles Times and the San Francisco Chronicle.

Kaiser Permanente is also under scrutiny for it's mental health program and is being accused of  'patient dumping into public health  programs, with a class action lawsuit filed on behalf of their psychiatric patients.



California again slams Kaiser for delays in mental health treatment

For the second time in two years, California regulators slammed HMO giant Kaiser Permanente for causing mental health patients, including some who were severely depressed or suicidal, to endure long delays for treatment.

The medical-malpractice option remains at times the only option for regulating and maintaining true quality of care issues outside the imaginary realm of algorithms and CMS edicts.

Senate Delays SGR Repeal Vote Until Mid-April

It seemed so simple as recently as one week ago  when the U.S.  House of Representatives passed a bill to revoked the 17 year old never used SGR bill of 1995.

Now here comes (or perhaps didn't come) the U.S.Senate.

Once again, the Medicare reimbursement crisis has turned into an exercise in brinkmanship that physicians would rather do without. However, they may yet escape a dreaded 21% Medicare pay cut next month.

Yesterday, in a rare display of bipartisanship, the House overwhelmingly approved a bill that repeals Medicare's sustainable growth rate (SGR) formula for physician pay and moves the program eventually from fee-for-service to pay-for-performance. That bill, which President Barack Obama said he is eager to sign, would avert a SGR-triggered pay cut of 21% for physicians that is set for Wednesday, April 1. It also would extend funding for the Children's Health Insurance Program for 2 more years.

Earlier today, however, Senate Majority Leader Mitch McConnell (R-KY) said the Senate will not vote on the SGR repeal bill until after it returns from an Easter-Passover break on Monday, April 13. McConnell said the Senate would make the legislation its first order of business.

"I think there's every reason to believe it's going to pass the Senate by a very large majority," Reutersquoted McConnell as saying.

The decision to schedule a vote in April, which organized medicine had anticipated as a possibility, allows the 21% pay cut technically to take effect on April 1. It will apply to claims for all services rendered after March 31. However, physicians will not experience this big axe if the Senate approves the repeal bill and the president signs it by April 14. This new deadline arises from how the Centers for Medicare & Medicaid Services (CMS) pays Medicare claims.

By law, CMS and its claims processing contractors cannot pay clean electronic claims any sooner than 14 calendar days after receipt (29 days for hard copy claims). Accordingly, the Senate has until April 14 to approve the SGR repeal bill before CMS begins applying the 21% rate reduction to claims for services rendered on April 1 and beyond. In a best-case scenario, the Senate beats its deadline and all those April claims get paid at the rates in effect before April 1. Under the bill, Medicare rates would be frozen at their current levels until July 1, when they would bump up 0.5% for the remainder of 2015, with annual 0.5% increases from 2016 through 2019.

McConnell said he is counting on this 14-day claims processing window to spare physicians the ill effects of the 21% cut, according to Reuters.

Moans of Frustration From Organized Medicine

Congress has postponed SGR-triggered pay cuts for physicians 17 times since 2003, usually at the last minute. McConnell's decision to let the 21% cut kick in and then undo it retroactively in mid-April set off moans of frustration in organized medicine.

The American College of Physicians said it was "greatly disappointed."

"By not passing the bill, the Senate failed to join the House in enacting legislation to achieve historic reforms in physician payment while making other needed healthcare improvements," American College of Physicians President David Fleming, MD, said today in a news release.

Robert Wergin, MD, president of the American Academy of Family Physicians, told Medscape Medical News he was "disappointed, but not discouraged."

"The House vote (392 to 37) showed strong support — stronger than we anticipated — for a bill that ensures healthcare access for the elderly, the disabled, and children," said Dr Wergin. "It's got the right mix for a bipartisan agreement [in the Senate]."

Democrats and Republicans alike in the Senate generally agree that Medicare's SGR formula, designed to curb spending, should be replaced. However, some Senate Democrats would like to extend the life of the Children's Health Insurance Program for 4 years, instead of 2, and to remove language in the bill that restricts the use of federal funds for abortions. In addition, in a recent opinion-editorial piece published in Politico, Sen. Ben Sasse (R-NE) objected to how the legislation would increase the federal deficit by $141 billion, and other fiscally conservative Senate Republicans may rally around that position as well.

It was not clear to this reader why the Senate could not deal with this in a timely manner. 

No one in medicine is surprised, and can wait another two weeks. After all we have waited 15 years, and hell has still not frozen over.