MONDAY, July 18, 2022 (HealthDay News) -- For thousands of years, people have used meditation to help diminish their pain – but how the process works has always seemed rather mysterious.
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Cannabidiol (CBD) has gained popularity as a promising complementary remedy for various health issues, including anxiety, epilepsy, and pain management.
CBD is one of several cannabinoids naturally present in the cannabis plant. There is a vast range of CBD products, including oils, tinctures, balms, and candy, all of which may help people experiencing physical pain.
This article discusses how CBD products may help relieve chronic pain. It also provides a list of potentially effective CBD products that have undergone extensive third-party testing for safety.
Is CBD legal?The 2018 Farm Bill removed hemp from the legal definition of marijuana in the Controlled Substances Act. This made some hemp-derived CBD products with less than 0.3 percent THC federally legal. However, CBD products containing more than 0.3 percent THC still fall under the legal definition of marijuana, making them federally illegal but legal under some state laws. Be sure to check state laws, especially when traveling. Also, keep in mind that the FDA has not approved nonprescription CBD products, and some products may be inaccurately labeled.
CBD is one of the many cannabinoids present in the cannabis plant. The term cannabinoid refers to substances within the plant, with CBD and delta-9-tetrahydrocannabinol (THC) being two notable examples. THC is the compound responsible for the “high” that people may associate with cannabis. CBD is a different cannabinoid that, on its own, will not cause a person to feel high.
The human body contains a complex network of neurotransmitters and cannabinoid receptors known as the endocannabinoid receptor system (ECS). Research suggests that cannabinoids, such as CBD, and the ECS may play a role in many bodily processes, such as pain regulation.
There are endogenous and exogenous cannabinoids. Endogenous cannabinoids are naturally occurring lipids that the body produces. Two of the most well-known endogenous cannabinoids are anandamide (AEA) and 2-arachidonoylglycerol.
The body does not produce exogenous cannabinoids — these compounds are part of the cannabis plant. Examples of exogenous cannabinoids include:
Cannabinoids, both endogenous and exogenous, bind to endocannabinoid receptors attached to cells. These include cannabinoid 1 and cannabinoid 2 receptors. This binding action stimulates different cell responses that influence pain signaling pathways.
CBD does not bind very well to endocannabinoid receptors. However, one study on mice found that it may interact with neurological receptors in the spinal cord that suppress chronic inflammatory pain. CBD may also strengthen the effects of AEA, an endogenous cannabinoid that reduces pain.
According to a small 2018 study, researchers evaluated CBD’s pain-relieving effects in seven people who experienced chronic pain after having kidney transplants. Six of the seven participants reported improvements in pain. One of the participants experienced more pain at higher CBD doses but achieved the best pain control at lower CBD doses.
In a 2015 animal study, researchers found that topical CBD reduced arthritis-related joint swelling and pain in mice. According to the authors, effective doses ranged from 6.2 to 62 milligrams (mg) per day.
While more research, such as large-scale, high-quality clinical trials, is still necessary, these preliminary studies suggest CBD may help manage pain. A 2021 study also notes that participants in the research have positive attitudes toward CBD treatment options and report positive outcomes when using the substance for pain-related conditions.
CBD comes in several different forms, including:
CBD gummies and capsules are for oral ingestion. On the other hand, topical CBD products are for external use only. People can apply these products to specific areas of the body, such as sore muscles or aching joints.
CBD oils and tinctures are more versatile than other forms and usually come in tinted glass bottles with a dropper. People can either add a few drops of CBD oil to food or beverages or place a few drops under their tongue, where they can hold the oil for up to 1 minute before swallowing.
Individuals should follow the directions and dosage information on the CBD product label.
This means that the FDA does not regulate commercially-available CBD products. People should look for high-quality products from reputable manufacturers and retailers when shopping for CBD. These companies test every batch of their products via an independent third-party lab for purity, showing that the product does not contain harmful levels of metals or toxins.
High-quality products undergo third-party testing by laboratories without affiliations to the manufacturer. They test CBD products for:
Products that undergo third-party testing will have a certificate of analysis, a document that contains information about the product’s CBD potency, the presence of THC and other cannabinoids, and safety test results.
A person can also consider the following when buying a CBD product for pain management:
Side effects of CBD include:
More severe side effects include:
Medical News Today chooses products that meet the following criteria:
The following CBD products may be effective in aiding pain management.
CBDfx offers a broad-spectrum CBD cream that contains either 500 mg, 1,000 mg or 3,000 mg of CBD per container.
The cream contains cannabinoids, caffeine, and white willow bark, which reportedly helps ease aches and pain. The company claims it uses pure, organic CBD.
The cream also contains menthol for a cooling effect.
This product is vegan and cruelty-free. The company says it uses clean carbon dioxide (CO2) oil extraction, which means buyers will not find solvent residue in its products.
This CBD-infused ointment contains hemp-extracted, THC-free CBD.
According to the product website, this ointment supports healthy joints by easing joint pain and stiffness.
One tube contains 600 mg of CBD.
This product can be a suitable option for those with arthritis. The manufacturer says it can ease arthritis pain. Aside from peppermint, which can provide a cooling feel, it also contains shea butter, beeswax, and a blend of oils to suit the body.
The essential oils in the product will not be a fit for people with fragrance allergies. Additionally, it is unsuitable for people following vegan lifestyles due to the beeswax.
Use code “HEALTH20” for 20% off.
Charlotte’s Web also manufactures topical CBD products.
This cooling gel contains full-spectrum CBD, menthol, and arnica.
The manufacturer says this gel is free from several major allergens, parabens, and synthetic fragrances. Yet, this product contains a wide variety of fruit extracts, oils, and essential oils. These have fragrance compounds, and fragrance is one of the top allergens, especially for those who find it sensitizing.
However, the company writes that it is gluten-free, cruelty-free, and vegan.
Each 1.7-ounce bottle contains about 510 mg of CBD and comes with an airless pump dispenser.
This THC-free massage oil contains menthol, camphor, and natural oils that may help relieve minor aches and pains.
The manufacturer states it is hypoallergenic and has undergone third-party testing.
A single 103-milliliter bottle contains about 200 mg of hemp-extracted CBD.
The company says this product may help with backache, minor arthritis, strains, bruises, and sprains. However, this product contains essential oils such as frankincense oil, which may irritate the skin in some people.
This relief lotion contains full-spectrum CBD extract, arnica flowers, shea butter, magnesium, and essential oils, such as lavender oil.
According to the product website, it helps relieve muscle pain, inflammation, and tightness while repairing and moisturizing the skin. The hemp and lavender oil aim to reduce tension.
The company states this product is organic, vegan, and comes in biodegradable packaging.
However, lavender may not be suitable for people with sensitive skin.
According to the company, one bottle of relief lotion contains about 155.67 mg of CBD.
PureKana offers waterproof transdermal patches that contain 60 mg of CBD.
People can wear these patches for up to 4 days.
PureKana recommends that individuals place the patch on a flat, dry area, such as the stomach or lower back.
This product might be most suitable for those who wish to apply the product to small areas or target specific muscles.
The company says this product is non-GMO, THC-free, and hypoallergenic.
The table below compares each of the CBD products in this article.
There are various advantages and disadvantages of using CBD products for pain relief.
Manufacturers of CBD products say they may help relieve muscle, joint, and nerve pain. However, there is limited scientific evidence to confirm these claims.
Some alternative treatments for pain include:
People who experience persistent or worsening pain despite trying OTC and at-home treatments may wish to discuss alternative treatment options with a doctor.
A person should see a doctor to understand their pain and get advice on how to manage it.
A doctor can help pinpoint the reason behind the pain and suggest workouts, strengthening exercises, or prescribe medication that can help minimize or eliminate the pain.
While there is supporting research that CBD can help with pain, scientists need more evidence to understand its long-term effects and the appropriate dosages a person should take.
A person should not use CBD products to replace support from a doctor, especially if they have health conditions that cause pain.
If a person reacts to topical CBD products or experiences side effects, they should stop using the product and talk to a medical professional for advice.
Below are answers to the top frequently asked questions about CBD for pain management.
While more research is still necessary to confirm the effectiveness of CBD for pain management, current research suggests it may be a beneficial and suitable option for some individuals.
Many variables, such as the underlying health condition, CBD product, and dosage, can affect how quickly CBD may provide pain relief. For example, the American Arthritis Foundation suggests that a person may feel the effects of a CBD spray or tincture in 15–45 minutes.
The most suitable CBD product will depend on the condition and an individual’s personal preference. As these products are available in many forms, such as oils, creams, gels, and patches, people can try which works best for them. A person can also consider discussing options with their doctor.
Ongoing research is still investigating what conditions CBD can help. Some health issues that CBD may help with include:
While preliminary clinical studies and animal studies suggest CBD may help relieve pain, more research is necessary to evaluate these findings.
CBD is generally safe, but it can lead to side effects, such as tiredness and appetite changes.
People who are currently receiving treatment for pain conditions may wish to discuss the potential benefits and risks of adding CBD to their treatment plan with their doctor.
WILMINGTON, NC (WWAY) — The North Carolina Medical Society is a partner with Our Community Health Initiative (OCHI) software to help Strengthen community health in underserved communities.
The Healthy Opportunities Program is now rolling out its pilot program in the Cape Fear region through the ACTS Movement, founded by Reddgo Long, Jr.
ACTS (A Commitment to Serve) is a Wilmington-based non-profit championing the fight against food insecurity.
It began after Hurricane Florence to aid people from disadvantaged economic, social, and family circumstances.
Long says, “I knew there was a community need related to food insecurity and a lack of resources in certain areas of this city. Since launching this nonprofit, we have become a partner agency with the Food Bank of Central and Eastern North Carolina and many other organizations to reduce food insecurity in our region.”
In its continued growth, The A.C.T.S. Movement has selected OCHI Software to support its mission to foster change and service as a resource for those who need help.
Sylvia E. Long, Ph.D is the Healthy Opportunities Program (HOP) Program Manager. Long says “We are hoping through our partnership with OCHI to champion the advancement of community health particularly in underserved communities in the Cape Fear.”
OCHI was created in collaboration with the North Carolina Medical Society Foundation to serve as a Platform to support Community Integrated Health.
OCHI’s, built atop a certified EHR, core functionality includes the ability to create and manage user specific programs for groups, ingesting biometric data, and designing assessments for completion by health coaches or the participants themselves.
As a program and care management solution, OCHI gives The A.C.T.S. Movement several advantages, not the least of which is a simple solution for interoperability with NC Care 360 and the EHR’s of Providers.
OCHI offers the ability to deliver bidirectional patient data between health system providers and community-based organizations, including YMCAs, who were providing a variety of services including health coaching to patients referred to them.
OCHI’s platform will support The A.C.T.S. Movement, Inc. in its dedication to ensuring underserved communities have access to consistent resources and support, including participation as a Human Service Organization in the Healthy Opportunities Pilot by providing healthy food boxes to approved Medicaid beneficiaries.
MONDAY, July 18, 2022 (HealthDay News) -- For thousands of years, people have used meditation to help diminish their pain – but how the process works has always seemed rather mysterious.
Today, advanced brain scan technology has revealed how this ancient practice alters brain function and provides pain relief to its practitioners.
A first-of-its-kind study used MRI scans to discover that mindfulness meditation can interrupt the communication between brain areas that process pain and the neural network that produces a person's sense of self, researchers recently reported in the journal PAIN.
Essentially, pain signals still move from the body to the brain, but the meditating person feels less ownership over those pain sensations. As a result, their pain and suffering are reduced.
"It's still going to be painful. It's just not going to bother you as much," said senior author Fadel Zeidan, an associate professor of anesthesiology at the University of California San Diego School of Medicine. "The significance of what it means for who you are as a person is being diminished. This is no longer my pain. It just is."
For the study, Zeidan and his colleagues taught meditation to 20 people through four separate 20-minute mindfulness training sessions. Another 20 people listened to a book on tape for the same amount of time, to serve as a control group.
The researchers then placed all participants in an MRI scanner with a plate on the back of their leg that produces painful sensations of heat without causing a burn. Participants received painful heat for 10 episodes -- 12 seconds on, 12 seconds off, Zeidan said.
Participants reported their levels of pain during each brain scanning session, with the people who were taught meditation using the practice to diminish their pain.
People reported a 33% decrease in pain when they used meditation, Zeidan said.
In fact, the people in the control group who didn't know how to meditate experienced a 20% increase in their pain from the beginning to the end of the MRI session, as they became more sensitive to it, Zeidan said.
These results were expected. More interesting is what the MRI scans revealed.
Researchers found that meditation was associated with reduced synchronization between the thalamus -- part of the brain that relays incoming sensory information -- and a group of brain regions known the default mode network.
The default mode network is most active when a person is mind-wandering or processing their own thoughts and feelings. One part of this network is the precuneus, a brain area involved in fundamental features of self-awareness and one of the first regions to go offline when a person loses consciousness.
"The precuneus is super cool," Zeidan said. "It consumes the highest caloric metabolic energy in the brain, and is situated in the brain to integrate all sensory systems into one cohesive stream of self-referential consciousness."
The MRI scans showed that meditation produced greater decoupling between the thalamus and the precuneus, he said.
"We think what happens is that greater pain relief is being driven by the lack of communication between the thalamus and the precuneus," Zeidan said. "The thalamus takes in all this pain-related information from the body, but it stops sending it to the precuneus. That stops the integration of this pain-related sensor information into self, into self-reference."
In other words, he said, the two regions are decoupling the appraisal of what that information means to them. "The more they're able to do that and let go, the better the pain relief," Zeidan said.
The default mode network "has been a very hot subject in neuroscience for the last 10 years, because the more you're involved this self-reference network, the less happy people are, the more depressed or anxious, and the more chronic pain they have," Zeidan said.
"This is the first study to show that this network can play a pain-modulatory role, which is pretty exciting," he said.
If this proves out, meditation could become a common practice taught by doctors or pain certified to help people deal with problems like chronic low back pain, Zeidan said.
"If you think about it, is there anything out there that we can use to reduce someone’s chronic pain immediately, so they can move on with their day?" he said. "I don't know of anything, really. You can take ibuprofen or whatever, but you’ve got to wait 45 minutes, if that works even. Meditation can immediately produce benefits."
Dr. Houman Danesh, director of Integrative Pain Management at the Icahn School of Medicine at Mount Sinai in New York City, reviewed the findings.
This study provides "a good basis to start doing more research into" meditation for pain relief, he said.
"What they're saying with the regions of the brain that are involved and how it decouples, it makes complete sense," Danesh said.
He added that this gets into how complex pain really is.
"We often think of pain that when you touch something hot and you pull your hand back, but it's not that simple," Danesh said. "There are hundreds of thousands of inputs that go up into the brain and hundreds of thousands that come down. And then that overall process is how you experience pain."
Studies like this, which use rigorous science to better understand meditation, could help the practice become as widely accepted as acupuncture -- another ancient art for which the medical evidence has become so compelling that the Centers for Medicare and Medicaid Services now covers its use, Danesh said.
"We all agree that the mind and body are connected, and then when you start trying to delve further into it is when it starts sounding a little bit hokey and a little standoffish," Danesh said. "But in reality, the premise of the mind and body are connected is accepted by almost everybody. And so being able to tap into that can literally transform the way pain is controlled in our society."
The U.S. National Institutes of Health has more about meditation and mindfulness.
SOURCES: Fadel Zeidan, PhD, associate professor, anesthesiology, University of California San Diego School of Medicine; Houman Danesh, MD, director, Integrative Pain Management, Icahn School of Medicine at Mount Sinai, New York City; PAIN, July 7, 2022
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The past two years have brought their trials across industries, as well as in our lives, but few sectors were hit like the medical industry. We spoke with Zelda van Staden, National Sales Manager for Sub-Saharan Africa Blood Division of SSEM Mthembu Medical (Pty) Ltd; one of the top distributors of medical equipment across Southern Africa. SSEM stands apart for two reasons – the way the company is structured, and the incredible passion that seems to run through the veins of its culture and employees. We spoke with Zelda about the work that the company does to save lives, both in the context of Covid and across medicine’s wider demands and how the company and its teams have coped under the incredible added pressure of juggling these needs with a pandemic response.
Throughout Southern Africa, SSEM Mthembu Medical is a top distributor when it comes to electro-medical devices and medical consumables. Short for Specialised Systems Electro Medical, SSEM was founded in 1987. At the time, the business was focused primarily on the electrophysiology and respiratory markets, the latter of which has been highly relevant of late. Since then, SSEM has since expanded into 14 divisions and six self-sufficient national branches, located in Johannesburg (Head Office), Cape Town, Durban, Gqeberha, East London & Bloemfontein.
Its full range of products is extremely vast, ranging across medical disciplines such as blood management, neurology, ventilation, MRI, radiology and surgical equipment, to name less than half of the categories covered by these many departments. Whilst all of these branches are based in South Africa, the company supplies equipment throughout the whole of Southern Africa. Within this market, the company caters to four types of clients: hospitals (whether government-run, academic or private), blood transfusion services, the homecare sector and independent medical practitioners.
We asked Zelda what she thought set SSEM apart from its rivals, and her answer came right back to what we see as the real brilliance of SSEM: “SSEM has a unique business strategy, where every division is run as a separate business within the company. Each division is managed by highly qualified Product Managers who have a passion for the business and their product range.”
This structure allows SSEM to cover an extremely broad spectrum of needs without watering down expertise. For Zelda, her passion lay in the blood department:
“I started as a Critical Care Representative in 2011, working mostly in Theatre, which I absolutely loved. I was entrusted to take on another division (the Blood Division) in 2013. I worked in both divisions for a year. This was very taxing on me, and I had to choose which division I would like to continue with. I chose Blood Division as I get to save lives on a daily basis.” Sticking on her chosen path, Zelda was appointed as National Product Manager for Blood Division in 2019 and National Sales Manager Africa in 2020.
We asked Zelda whether she had any stand-out examples of the difference she has seen the Blood Division’s equipment making in the lives of others, and her response was as immediate as it was heartfelt:
“So many. My absolute favourite example is when we treat Alcohol Foetal Syndrome: they’ll take blood out of the baby’s umbilical cord, a couple of millilitres at a time, and the blood will be almost black. Then, they’ll put healthy blood into the umbilical cord, and they continue this process until the blood they extract on the one side is bright red. It’s amazing to watch, and it’s that baby’s best chance in life. They would usually suffer from brain damage because there’s not enough oxygen in their blood, and just to watch that whole process is incredible.”
SSEM’s method of structuring itself means that each division is able to live and breathe the area they work in, acutely aware of the good that they do and the needs of the countries and people around them. “We’ve got non-executive directors who recently attended our three-day strategy meeting and at the end of those three days, one of them, was in tears: she said she couldn’t believe the absolute passion every Divisional manager has for their products and division. It’s true passion that’s driving the company; it’s absolutely what makes us work.”
This sort of passion is exactly the motivation needed when facing a period such as the past two years – and for SSEM, the work is far from over. The company has distributed ventilators for many years, as well as producing ventilator filters in-house. In response to Covid-19, the company turned its small in-house manufacturing operation towards other consumables, such as swabs for Covid tests and, for a time, face masks. For the Blood Division, the period has been particularly critical because of the vaccine rollout: the same refrigeration technology used to store and transport blood can be used for vaccines, and it was this front line that Zelda’s division has been operating on.
“It’s going well. We supply WHO pre-approved vaccine carriers as well as vaccine fridges. South Africa has always been good for vaccine fridges, but not the vaccine carriers that much, because we never had mobile vaccine sites before. You would go to the pharmacy, which had a vaccine fridge and the freezer, and you would get vaccinated there. Now, with this massive vaccine rollout, we’re using sites like coffee shops that closed down during Covid – empty premises. So, that’s where we had to supply our WHO approved vaccine products.”
Like the rest of the world, Africa was left guessing when it came to the emergence of Covid: at the beginning, no one knew the details of the virus, how it worked or how to respond. In fact, as Zelda explained it to us, the African continent had an even stranger time than a lot of us:
“We were one of the last countries that Covid hit. It happened all around us, and we couldn’t believe that Africa had no cases at all. So, we’re thinking; ‘Now what? Should we prepare for it? Is it not going to come here?’ We thought that maybe it was because it was too hot here, or because of our TB vaccination, which everyone here has as babies. We had a lot of speculation. Then, eventually, cases appeared in Botswana.”
We asked how SSEM prepared for what was to come, in such an uncertain period: “We have been proactive in our markets. We have our strategic meetings. We brainstorm. We have a lot of highly intelligent people in the room, and we take everybody’s input into account. But it’s a guessing game – nothing’s set in stone. For example, we thought our death rates would extremely high because of the amount of HIV cases in Africa and South Africa and these patients are they already immunocompromised. However, it turns out that the antiretroviral treatment (ART’s) actually help to protect against the virus to a certain degree.”
The biggest thing SSEM could do in response was to make sure that, whilst responding to the calls of Covid, it didn’t let this period as any other. “We do crisis management because we are currently in a worldwide crisis. But we didn’t drop the one ball to juggle the other one. As a company, we committed ourselves to giving our full support to our current market to ensure every medical need during these times will be met. We are proud to say that we maintained smooth product supply in a high demand period, regardless of the many obstacles during this period. Phenomenally enough, we are even still on track with our 5-year plan.”
Some of the biggest challenges that SSEM faced were in shipping: delays on and off throughout the pandemic meant that 4-week lead times for products to arrive became more like 15 weeks. In order to remain a reliable distributor, SSEM responded to this by ordering 5 to 6 months’ worth of stock, keeping its usual buffer in their normal warehouses whilst keeping the surplus in extra warehouse space that they leased. The extra stock holding, and leased space was an additional investment, but the result avoided not only a loss of business and reputation for them, but it also avoided crisis for the medical practises that rely on them to deliver.
As for Zelda’s division, South Africa faces an ongoing shortage in blood donations, with less than 1% of the country habitually giving blood. This means that when it comes to collecting, distributing and using this precious medical resource, it is important that every stage is well supplied for and carried out with care, and this is where Zelda’s area of SSEM can help. “SSEM is able to supply blood products for any need in modern blood transfusion practice. We have the expertise to assist blood banks with all their blood bag and equipment requirements, and as well as consumables, we supply blood processing devices, platelet Incubators and agitators, blood collection devices and various instruments used to seal and strip blood tubing.”
SSEM’s blood division’s total presence extends to South Africa, Angola, Rwanda, Swaziland, Lesotho, Namibia, Botswana, Mozambique, Zambia, Uganda, Malawi, Mauritius, Zimbabwe, Seychelles, St Helena Island and Tanzania, including the supply of blood bags and other products to the National Blood Services and in each country. As such, it is the region’s trusted contact for many leading medical brands. As Zelda told us:
“SSEM is the appointed distributor for JMS Singapore, Conroy Sweden, Vacucare & Qualimed India for ranges such as blood bags, blood banking equipment, blood sealers and blood management machines, which are of superior quality and have a long and laudable reputation in Sub Sahara Africa. We currently have 1/3 of the blood bag supply to SANBS and supply various blood collection tubes nationally.” (SANBS has a risk policy that requires them to have more than one provider for critical items, meaning that no one company can exclusively supply them products.)
“During the hard lockdown in South Africa, blood donations and usage dropped significantly because there were no elective surgeries and little to no road accidents. However, collections and usage started increasing towards August 2020 and have now completely normalised.”
With blood collection and use back to normal rates, the vaccine rollout in full swing and Covid still in effect, SSEM’s Blood Division, like its other divisions, has too much work to do for rest. As the work requires trained-up, technical knowledge, Zelda explained that they cannot simply bring in casual workers to boost their numbers during this time, and sourcing and training staff that they would then need to let go after Covid isn’t fair or feasible. Therefore, the team of 220 staff that exists has been working extremely hard. As Zelda told us, that passion has driven them forwards, but even passion can burn out if people don’t receive the right support. Knowing this, SSEM has taken good care of its staff, providing regular, in-depth counselling and coaching sessions to allow people to touch base, share their experiences, receive help and know that they aren’t alone.
“It was phenomenally helpful. We’d have 5 or 6 people in a meeting, all online, and for an hour and a half, we’d have a coaching session. Some meetings, I’d just cry for the full hour and a half because I felt so exhausted, but hearing that the other managers were going through the exact same thing made me feel better about it. Just to have someone listen, and say ‘I hear you.’”
“I have been privileged to be with SSEM Mthembu Medical for 10 years. I get up in the morning and I think “I’ve got to work. I’ve got a job, and I love what I’m doing”. When you have that passion for your job, it honestly never feels like I’m working, although I’m tired and I work hard. It just feels like I’m living my passion. You get to do what you love every day.
If you look after yourself, you are then in a healthy position to look after others. Whilst making sure that they supported their customers and kept Southern Africa reliably supplied with the medical equipment it needed, the team at SSEM’s blood division has made sure to look after each other. “As a company, we have grown together and the support between employees is heart-warming. We really stand together as a family.” From that strong position, the team is then ready to help others, whether through visits to labs to maintain their tech and advise in their operations, or simply through the reliable delivery of their essential stock. SSEM’s staff have been rushed off their feet, but it’s work that contributes to saving lives. “It’s exhausting, but I wouldn’t change it for anything else in the world.”
Approximately 4.5 million South Africans have type 2 diabetes—a condition characterized by high levels of sugar in the blood. It can be treated with drugs and managed through healthy eating and exercise. But if it's not managed well, it can be life-threatening. Diabetes is one of the leading causes of death in South Africa.
Blood sugar levels rise to dangerous levels when the pancreas does not produce enough insulin, a hormone that regulates the movement of sugar in the body.
As diabetes progresses, insulin injections become the only treatment option. But the transition from oral medication to injectable insulin is often a bumpy one. Managing a patient on insulin requires patients to inject at least once a day and to measure their blood sugar levels at least twice a day. In addition, health care workers must have the knowledge, skills and time required to monitor patients and adjust the insulin dose when necessary.
To address this problem, we developed an intervention called the Tshwane Insulin Project. Our intervention combines various elements. One is a digital tool, the Vula app, which health professionals can use to communicate with each other.
Another aspect of the intervention involves community health workers in the care of people with diabetes. We also train health care professionals at primary care level to manage people living with diabetes, including those who need insulin.
Our intervention is a more efficient way of managing people with diabetes because health care providers share the tasks of patient education, insulin initiation and follow-up. The intervention also reduces the number of referrals from clinics to hospitals because of unavailability of doctors or lack of skills to manage patients on insulin.
When a person's blood sugar is not controlled with two drugs, they get the correct information about insulin and why it is necessary. If the patient agrees to go on insulin, the doctor prescribes it and the primary care nurse informs the patient.
The mobile app is very useful in primary health care settings because the doctor can send a prescription remotely using the app. Patients don't have to wait for doctors to visit the facility. The nurse can check if the patient meets the criteria for insulin therapy and the doctor can confirm that, remotely, based on the information provided by the nurse.
Once the patient is initiated on insulin, the nurse contacts the community health worker team assigned to the clinic to inform them about the new patient.
Community health care workers are a very important part of this intervention.
Before the intervention, patients were sent home with a huge amount of information to digest by themselves. They would have to remember how, where and when to inject their insulin; how to draw the appropriate dose; how to measure their sugar levels; how to identify when their sugar levels are low (hypoglycaemia); and what to do at that moment.
Research shows that this can be overwhelming for patients. Some are illiterate, with limited medical knowledge. With the involvement of community health workers in the intervention, patients are no longer alone. Patients are visited at home every week. The community health workers remind patients of key education messages, injection sites and techniques.
The community health workers are also important in the adjustment of insulin doses. Before the intervention, most patients would have their insulin doses adjusted during clinic visits—which happened once a month at best—because they could not do it themselves. Insulin is always started at a low dose for safety reasons and to help the patient adjust. Then the dose is progressively increased until the optimal dose is reached. That optimal dose varies from one patient to another. When the dose is adjusted only once a month it takes too long to reach the ultimate dose. Many patients never reach that dose and remain with high glucose levels despite injecting.
With our intervention, during the weekly home visit, the community health workers communicate the blood sugar levels to the doctor via the mobile app. The doctor assesses the sugar levels and indicates whether the insulin dose should be increased, decreased, or maintained. With weekly dose adjustments, the patient reaches the optimal insulin dose faster and the condition is controlled sooner. The ability to adjust a patient's insulin dose as often as weekly thanks to the team doing a home visit is a game changer.
The insulin project intervention was tested with a limited number of patients at ten clinics in the Tshwane district in South Africa. The results of this trial are promising. There was no report of low blood sugar, which meant that the intervention was safe. Patients who completed the 14-week follow-up with home and clinic visits recorded a reduction of their glycated hemoglobin or HbA1c by 2.2%, meaning that their blood sugar was better controlled after the intervention.
We are currently conducting a large-scale evaluation of the intervention.
There is a lot of misinformation around insulin. As a result, some people with type 2 diabetes perceive the progression from oral medication to insulin as a sign of failure. Even worse, some believe insulin means that death is near.
We've also found high rates of insulin refusal by patients—as high as 50% in some areas. Many patients are not meeting their treatment targets. They remain on oral therapy with high blood sugar levels which leave them exposed to serious complications.
In addition, many health care professionals, especially those working at primary care clinics, are not equipped to manage patients who need insulin. Their lack of skills and knowledge may contribute to patients' fears. And community health workers are in short supply. The number of community health workers is estimated at 55,000 for the whole country which is not enough considering the population needs. The Medical Research Council estimated that South Africa needs 41,000 more to bring the total to 96,000.
Despite all of these challenges, we are confident that interventions like ours can Strengthen the management of people living with diabetes. The support of health authorities and health care workers is crucial for a successful implementation.
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Lane Regional Medical Center is one of the first hospitals in the region to adopt Iovera technology, a clinically proven, nonopioid, pain management solution for relief of chronic and acute knee pain, a news release said.
Iovera is an outpatient treatment that can be performed prior to knee surgery to help reduce pain during the critical weeks after surgery, or as a treatment for chronic pain due to osteoarthritis of the knee. Pain relief is immediate and can last up to 90 days, the release said.
Certified nurse anesthetists skilled in this new technique are able to deliver precise, controlled doses of cold through a portable, handheld device. This minimally invasive treatment is safe and causes no damage to surrounding tissues, the release said.
Because Iovera provides relief right at the pain site, there are no systemic side effects that are typically experienced with NSAIDs, narcotics, or other medications.
“Traditionally, opioid pain medications have been the first line of defense against chronic knee pain, both before and immediately after surgery, despite causing side effects that can detract from a patient's recovery experience,” said Lori Carruth, director of Surgical Services. “The Iovera system allows us to provide patients with an improved recovery after surgery by offering the latest, unique advances in pain management.
It is important to note that Iovera does not treat the underlying cause of pain, the release said. The Iovera system is FDA-cleared to provide immediate and long-lasting relief of chronic and acute knee pain. It has been studied in clinical trials of patients prior to total knee replacement surgery and to treat the pain and symptoms of knee osteoarthritis. Only mild localized side effects have been observed, such as bruising, swelling, inflammation, redness or tenderness.
For information, schedule an appointment with Dr. David Rabalais or Dr. Adam Whatley at BR Orthopedic Clinic in Zachary, (225) 658-1808.