MU: What do you say to people with chronic pain who have given up hope of ever feeling better?

Dr. Giaimo: Don’t give up! Throwing in the towel limits any kind of therapeutic endeavor. First, get engaged. Talk to your healthcare provider about the pain you are having. If the provider feels uncomfortable about addressing the issue, ask for a referral to a pain management specialist. There are a number of physicians with this training, and you want to take advantage of their experience.

MU: What can people do to get the care they need?

Dr. Joseph Giaimo

Dr. Giaimo: Two things come to mind: 1) Prior to the appointment, take time to write down all the information that you want to share with the physician. 2) Complete and print out an online pain survey—there’s one at osteopathic.org. Pain is very subjective, and difficult to describe. The short survey helps people explain their symptoms in more objective terms. Patients who walk into the office with these tools in hand are more able to help the doctor help them.

MU: What’s the most common myth about managing chronic pain?

Dr. Giaimo: Probably the most important and common one that I hear is: “Well, I have pain, and it’s just a normal part of my life.” That’s just not true. It is not normal to have pain.

Many also have concerns, some based on fact and some on myth, about becoming addicted to pain medications. But pain medication is not the only treatment out there. We will consider exercise—certainly an adjunct that we all use and should use more; physical therapy, manipulative therapy, acupuncture, and holistic medicine. There’s a host of alternatives that we can attempt to coordinate.

MU: But addiction to pain pills is a real and present danger, right?

Dr. Giaimo: Certainly, there are many so-called pill-mills—providers who inappropriately prescribe pain medications—and patients who suffer the consequences. And I think that scares away patients and physicians who are trying to do the right thing. Generally, medications used under supervision by a physician are well tolerated. There’s a time, particularly after acute injuries, when people require some pain medication. But then there’s a time when patients need to transition to other, less addictive medications.

Again, patients need to be comfortable with the people who are taking care of them. A holistic approach to alleviating pain is more than reaching for prescribed pain medication. Instead, we develop a coordinated plan to rest or ice an injured area, use pain medications and anti-inflammatories as appropriate, and patiently work toward physical therapy without the drugs.

MU: When should a person get professional help for managing pain?

Dr. Giaimo: Any time the pain is unremitting. Of course, chest pain or severe abdominal pain can be life threatening and require immediate medical attention. But other types of pain in a limb or joint that don’t respond to rest, ice, heat, and over-the-counter pain medicine within two weeks should be evaluated, at least at an initial level. Pain lasting more than six weeks becomes more difficult to deal with because supporting muscles start to weaken, and a greater degree of physical therapy and rehabilitation will be required to help the person recover.

MU: What do you look for during an initial examination?

Dr. Giaimo: The initial priority is to determine whether an acute problem, such as a fracture, is causing pain and needs immediate care. In addition, I perform a physical exam to assess nerve involvement. In someone with back pain, a recent onset of urinary incontinence, bowel problems, or dragging the foot while walking could signal significant nerve entrapment problems that also require emergency attention.

MU: What therapies are utilized for chronic back pain?

Dr. Giaimo: In the absence of acute problems, the most effective therapy for chronic pain includes a systematic plan of bed rest, stretching and strengthening exercises, yoga, and dietary changes to lose weight if indicated. Improving body mechanics and sleep habits are also very helpful. If you’re frequently sitting at a desk—and so many of us do—regularly get up and stretch.

MU: Who can best assess and address a person’s body mechanics?

Dr. Giaimo: Osteopathic physicians are well suited for this type of evaluation because, again, their basic philosophy is that the structure and function of the body are integrated. Certainly, other physicians also have good experience and knowledge of musculoskeletal issues, including primary care physicians, chiropractors, and some acupuncturists.

Managing chronic pain is a team effort. There’s no one individual that can do all of this. But out of the gate, I recommend that people experiencing pain see their physician, who can then call together and coordinate an entire team of pain management specialists as appropriate.

Sometimes I refer patients to an anesthesiologist who will inject a painful area for a few weeks of relief while they start to recover from an injury. Acupuncturists can be helpful. Physical therapists can do wonders, particularly with putting together a training regimen.

MU: You are a D.O. What distinguishes you from a Medical Doctor (M.D.), specifically as it relates to chronic pain management?

Dr. Giaimo: M.D.s and D.O.s go to four years in college followed by four years in medical school. An allopathic school for M.D.s focuses on treating a disease state while the emphasis at an osteopathic school is on the form and function of the entire individual. Osteopathic physicians are uniquely positioned for managing chronic pain because it is rarely isolated. More often, something happens in one part of the body that affects other areas. Our approach to pain involves looking at the entire structure of the person rather than the physical pain and discomfort of one region.

MU: Do M.D.s and D.O.s often collaborate?

Dr. Giaimo: They’re very complementary. There was a time when there was a very distinct line drawn between those two entities. But in today’s age of the Internet and electronic medicine, we can and do cooperate. My particular specialty is pulmonary and critical care medicine and our practice has osteopathic and allopathic physicians on staff.

Managing Chronic Pain The Saturday Evening Post

Here are some digital freebies to stop smoking, protect your skin, and live well with diabetes:

Clear the Air: Are you ready to quit smoking and willing to share the good, the bad, and the ugly about your experience? If so, the National Cancer Institute invites you to Smokefree Women, an interactive community for women who want to get (and stay) smokefree.

Skin Savers: Look up your UV Index online, download My UV Check to your Mac or PC, or get the Sun Alert Lite iTunes app.

Diabetes On the Go: Track and send glucose readings, medication records, and food intake to your health care provider with Diabetes Log for iPhones and OnTrack Diabetes for Droid. The American Diabetes Association and websites like dlife offer videos, message boards, news, and tips on food and fitness.

Tell us your favorite apps and website to keep you looking—and feeling—good!

Free Tech Tools for Health The Saturday Evening Post

Smoke Alarms: A Sound You Can Live With

Smoke alarms, the focus of NFSA’s Fire Prevention Week 2010 (October 3-9), save lives by ensuring that everyone has time to safely escape a home fire.

Too often, however, missing or broken alarms lead to tragic consequences. Data show that nearly two-thirds of home fire deaths occur in homes with no smoke alarms at all, or with ones that don’t work.

Basic smoke alarms come in two types: ionization units that are generally more responsive to flaming fires (such as a pan fire), and photoelectric devices designed to detect fires that begin by smoldering for a long time (such as a lighted cigarette dropped on a sofa). While each is effective, NFSA experts say that installing both versions offers more comprehensive home fire protection. Newer alarms that incorporate both technologies are also available.

NFPA Safety Tips: Test your smoke alarms at least once a month. Smoke alarms should be in every bedroom, outside sleeping areas, and on every level of the home, including the basement. Interconnected smoke alarms offer the best protection; when one sounds, they all do. Practice an escape plan with two ways out from every location.

Prevention Basics

Many home fires are preventable. Act now to stop fires before they start.

1. Cooking is the #1 cause of home fires and injuries. U.S. fire departments respond to an average of 150,200 fires involving cooking equipment per year.

NFPA Safety Tips: Stay in the kitchen while frying, grilling, or broiling food. Turn off the stove if you leave the kitchen, even for a short time. When simmering, baking, roasting, or boiling food, check it often and remain in the home until cooking is complete. Use a timer to remind you of food on the stove.

2. Smoking is the leading cause of fire deaths. In 2007, there were about 140,700 smoking-material fires in the U.S.

NFPA Safety tips: If you smoke, smoke outside. Douse butts and ashes in water or sand.

3. Heating is the second leading cause of home fires, fire deaths and fire injuries. Space heaters alone account for 32% of home heating fires.

NFPA Safety Tips: Keep anything that can burn at least three feet away from heating equipment. Only use heating equipment that has the label of a recognized testing laboratory. Never use your oven for heating.

4. Electrical failures or malfunctions contribute to roughly 50,000 reported fires each year.

NFPA Safety tips: Replace or repair loose or frayed cords on electrical devices. Avoid running extension cords across doorways or under carpets. Cover unused wall sockets with plastic safety covers.

For more fire facts, safety tips, and kid’s games and activities featuring Sparky the Fire Dog, visit http://www.nfpa.org

Do You Have Enough Smoke Alarms? The Saturday Evening Post

To mark the occasion, Grand Slam tennis champ and TV broadcaster Mary Joe Fernandez is serving up advice to help parents and kids with asthma learn all they can about the chronic disease that inflames and narrows airways, making it hard to breathe.

More than 16 million adults and 7 million children in the U.S. have asthma.

Diagnosed with asthma at the age of 20 and mother to son Nicholas who also has asthma, Mary Joe is doing a live video web chat on September 13 from 1:00 to 2:00 pm EDT.

Topics will include how she overcame the challenges of asthma to achieve a successful tennis career as well as tips for parents to get the best care for their kids who have the persistent breathing problem.

To register for the live video webcast and submit your question, visit EveryoneBreathe.com http://www.everyonebreathe.com/, a website sponsored by pharmaceutical company Sepracor Inc. that features downloadable tools for parents such as a Back-to-School checklist, Asthma Action Plan, and Trigger Tracker.

The live chat with Mary Joe Fernandez will also appear on the website in October and be available for about one year.

Take a Swing at Asthma The Saturday Evening Post

AF occurs when the heart’s two upper chambers (the atria) quiver instead of beating effectively. In paroxysmal AF, the abnormal heart rhythm starts and stops on its own.

When drugs to control erratic heartbeats don’t work, doctors may use electric shock or thread catheters through blood vessels to zap cardiac cells with heat, a therapy called radiofrequency ablation.

The innovative therapy reported at the American College of Cardiology (ACC) 2010 Scientific Sessions utilizes freezing technology, or cryoablation, instead.

“Cryoablation could offer a straightforward and significantly simplified treatment for patients with very symptomatic and obnoxious atrial fibrillation,” says Dr. Douglas Packer, professor of Medicine at the Mayo Clinic in Rochester, Minnesota, and principal investigator of the Stop AF (Sustained Treatment of Paroxysmal Atrial Fibrillation) study.

In the pivotal trial, the Arctic Front Cardiac CryoAblation Catheter System from Medtronic kept nearly 70 percent of AF sufferers symptom-free for one year, compared to 7.3 percent of those given the usual drug therapy.

“There are 150,000 to 200,000 new cases of AF in the U.S. every year, Dr. Packer explained to Post editors. “Some will be asymptomatic and treated with blood thinners to prevent strokes. Others might be treated with anti-arrhythmic drugs. But the target population for ablation is people who don’t respond to drug therapy—and there are a lot of them.”

To date, more than 9,000 patients have been treated worldwide with the Arctic Front Cryocatheter. The treatment is not yet approved in the U.S., however.

“Seeking FDA approval for the system is the next step,” says Dr. Packer. “Data from Europe support the approach, but the FDA requires a large U.S. trial to demonstrate the device’s effectiveness and safety,” he explains. “This is the hallmark clinical trial in the U.S.”

Other ACC News on Atrial Fibrillation

Ablation therapy: Dr. Packer also reports that the CABANA pilot study of 60 patients with persistent or long-standing AF and underlying cardiovascular disease found that catheter ablation more effectively prevented recurrent AF than drug therapy. But the NIH-funded study is just getting started.

“The 4 to 5 year Cabana trial will consider longer-term issues of ablation: Does it reduce mortality, does it prevent strokes, and how much does it cost,” notes Packer.

Drug therapy: Analysis of pooled data from the EURIDIS and ADONIS trials suggest that it’s safe for doctors to prescribe dronedarone (brand name: Multaq) for their patients with atrial fibrillation within two days after discontinuing treatment with the drug amiodarone (brand name: Cordarone).

“Many doctors want to switch their AF patients from amiodarone to dronedarone,” says Dr. Peter Kowey, lead investigator and chief of the division of cardiovascular diseases at the Main Line Health System in Wynnewood, Pennsylvania. “These data will give some guidance until a randomized trial is completed.”

Atrial Fibrillation The Saturday Evening Post