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Get control of chronic back pain with a full spectrum of therapy options, experts say

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The Dose24:29How can I manage chronic back pain?

Millions of people around the world suffer from chronic back pain everyday, often not knowing if they’ll ever recover. Pain specialist Dr. Brenda Lau offers advice on how you can manage chronic back pain, as well as some of the newer treatment options that can offer relief.

Ann Marie Gaudon was at the gym when she injured her back. After bending down to lift something off the ground, she experienced a ripping feeling rush through her body.

“The air was sucked out of my lungs,” said Gaudon, an Ontario psychotherapist and social worker. “I couldn’t breathe, I couldn’t stand up. I didn’t know what was going on, but I knew it was serious.”

Gaudon spent years speaking with chiropractors, massage therapists and pain experts, finally finding a specialist who helped her recover.

Ann Marie Gaudon is a psychotherapist who has been living with chronic back pain since 2017. (Submitted by Ann Marie Gaudon)

But she was pain-free for a only a few years before her back pain returned. Gaudon says she has less pain now than she did when she first hurt her back in 2017, but still deals with discomfort on a daily basis.

What is chronic back pain?

Gaudon is one of the nearly eight million Canadians who live with chronic pain, and one of the hundreds of millions of people around the world with chronic back pain.

According to pain specialist Dr. Brenda Lau, co-founder and medical director of the CHANGEPain clinic in Burnaby, B.C., pain can be acute — caused by injuries, stress or disease — or chronic. Pain is typically classified as chronic after three to six months.

The persistent discomfort associated with chronic back pain affects men and women relatively equally, with most people experiencing chronic back pain between the ages of 25 and 55.

A group of four people — three men and one woman — stand together while smiling a the camera. The men are dressed in medical scrubs.
Dr. Brenda Lau, right, poses with team mambers at the CHANGEPain clinic in British Columbia. Lau is a pain specialist and co-founder and medical director of the clinic. (Submitted by Brenda Lau)

“Typically, it’s someone who’s actually been doing a lot of sitting around,” Lau told The Dose host Dr. Brian Goldman.

Smoking, poor eating habits and poor sleep habits also contribute to chronic back pain, Lau added.

What causes chronic back pain?

When Gaudon first hurt herself, medical imaging revealed a herniated disc, a disc bulge and three areas with pinched nerves.

While Gaudon had physically traumatized her back, Lau says many people living with chronic back pain often have nothing physically wrong with their bodies.

“We also know the imaging, MRI, CT scans, X-rays, whatever you see there, they don’t correlate to the intensity,” Lau told The Dose host Dr. Brian Goldman.

 

The science on lower back pain

Most Canadians will likely deal with lower back pain at some point in their lives. Now there’s some scientific consensus on the most effective way to get relief.

Instead, Lau says, medical images done on people with back pain can look a lot like images of people without.

The term non-specific low back pain can often be applied in circumstances where there is back discomfort, but the reason isn’t clear.

“It becomes very hard to say that the structural abnormalities that you see on an X-ray or an MRI, or that you find in a physical examination are, in fact, the cause of somebody’s back pain,” said Dr. Ted Findlay, a pain physician with the Calgary Chronic Pain Centre.

“That’s what we mean by non-specific low back pain. It’s getting away from saying we have to do imaging to identify a particular tissue or structural abnormality in order to develop a treatment plan.”

How can we treat chronic back pain?

Typically when a person is injured, the body’s neurochemical processes kick in to help with recovery, according to Lau.

“There’s an inflammatory soup, if you will,” Lau said. “All types of host defences call into action when injury of any tissue occurs.”

In the event of chronic pain, however, the pain persists even after the body is done healing.

A man smiles outside in the wilderness.
Dr. Ted Findlay is a pain physician with the Calgary Chronic Pain Centre. (Submitted by Ted Findlay)

“It changes the nerve system itself so that now [the pain is] no longer the area where there’s some sort of inflammatory response,” Lau said. “It’s more like the nerve system’s been ramped up.”

Treating chronic back pain therefore requires a “biopsychosocial model,” according to Findlay, referring to a model of care that links biology, psychology and social factors.

Referencing World Health Organization guidelines published in late 2023, Findlay said treating chronic back pain requires a combination of education and rehabilitation.

“The more recent guidelines suggest there can be benefits from spinal manipulation,” he said.

Spinal manipulation is a process by which specialists use their hands or small instruments to apply pressure to a patient’s spine, to help relieve pain or discomfort.

Taking painkillers to treat inflammation could lead to chronic pain, research suggests

 

New research suggests treating acute pain with anti-inflammatory drugs, such as ibuprofen, could have an unintended effect: increasing the chances of developing chronic pain.

Lau agrees that treating chronic back pain requires a full-spectrum approach.

“What we need to do is rehabilitate, retrain, the way those muscles are working,” she said.

“Physiotherapists, chiropractors, exercise physiologists, [and] dedicated trainers can get people back on their feet.”

Tools like pain reprocessing therapy — which use common psychological techniques to encourage patients to reframe their thinking around the pain they experience —  can also be “very effective” in aiding patient recovery, Lau says.

“Pain reprocessing therapy is all about utilizing a combination of active ways of thinking that is going to inspire you to move the body, to eat well, to reduce the fears around the pain itself,” Lau said.

“You’ve already received the diagnosis.… Now is the time to start reinterpreting [the] pain signals to the extent that you can alter them.”

Can medication help?

People living with chronic back pain might be tempted to rely on medication to alleviate their discomfort, but Lau and Findlay recommend being careful about overusing anti-inflammatory drugs like naproxen.

“We know that the long-term side effects of those do, in fact, cause more harm,” Lau said. “Kidney damage, gastric issues [are] two of the main things.”

That said, Findlay says you don’t need to avoid over-the-counter medications entirely.

“If you’re a weekend warrior and you’ve been playing hockey and you’ve got back pain, then why not take an anti-inflammatory or acetaminophen,” he said.

“But for the long-term, they probably have very little effect.”

Can chronic back pain ever go away?

Lau says she’s witnessed patients recover from their discomfort over time.

However, Findlay says there are numerous instances where patients continue to experience pain, even while taking steps to improve their overall health and well-being.

A recent meta-analysis published by the CMAJ showed that patients with pain that persisted between less than six weeks and 12 weeks, “had substantial improvements in levels of pain and disability within the first six weeks.”

Patients with pain that lasted between 12 and 52 weeks continued to experience “high levels of pain and disability with minimal improvements over time,” the analysis added.

 

The Current24:11How reframing chronic back pain could bring relief

Many Canadians suffer from debilitating chronic back pain, affecting their work, relationships and even mental health. We hear from researchers about a treatment called pain reprocessing therapy, which could offer some sweet relief by reframing that pain in our minds.

While this might not seem like great news for people living with persistent chronic back pain, the analysis suggests that diagnosing and treating back pain early could “reduce the likelihood” of it becoming persistent low back pain.

“Pain is a call to action that most people can’t ignore,” said Lau.

“We hope that at that call to action, that you will empower yourself to say, ‘Yes, there are things that I’ve got to personally change, but I also have to link to providers who can help guide my way.'”

At the same time, Lau encourages people living with chronic back pain to seek out new approaches if relief remains out of reach.

Gaudon echoes Lau’s sentiments.

“If you truly don’t know what’s going on and you go to alternative practitioners and you’re still in pain, why would you keep doing that?” Gaudon said.

But, she added, it’s important to stick with it to find a solution.

“You’re not helping yourself if you’re still in pain.”

 

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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