NSAIDS stands for Nonsteroidal Anti-Inflammatory Drugs. As early as 1935, Swedish physiologist Ulf Von Euler isolated a biologically active compound he named "prostaglandin" because he believed it was derived from the prostate gland. It is now known that prostaglandins are made in tisuses throughout the body.

Then in 1971 swedish biochemists determined that aspirin-like drugs could inhibit the synthesis of prostaglandins. Bergstrom, Samuelsson, and Vane, subsequently jointly received the 1982 Nobel prize in Physiology for their research on prostaglandins.

The official Nobel Prize press release made the following comments: 

"Prostaglandins and related substances constitue part of a new biological system. They are formed from unsaturated fatty acids, primarly arachidonic acid. Arachidonic acid is present in the cellular membrane, which also has the enzymatic capacity to form prostaglandins. A release of these compounds takes place when the function of the tissue is perturbed by trauma, disease or stress"

Pheww, thats a mouthful isn’t it? So what does that really mean then?

Well, the last sentence sums it up pretty good, these compounds are released when "the function of the tissue is perturbed by trauma, disease or stress".  Trauma, disease, or stress are easily understood, and understood to cause or result in inflammation and pain.

We can further to conclude that drugs that inhibit the formation of prostaglandins effectively relieve pains provoked by a number of conditions, and because we are a neck pain relief site, then we are taking about relieving neck pain by taking NSAIDS.

 These antiinflammatory compounds such as aspirin act by blocking the formation of prostaglandins and their related substances including thromboxanes.

This represented a really significant finding, because it finally explained how the most frequently used drug all over the world, Aspirin, mode of action, became clarified.  However with the understanding of how NSAIDs work, we then learned about any side effect that may occur, and boy, are there many. Increaesd cardiovascular risks, increase risk for gastrointestinal bleeding and kidney damage, and even an increased risk in Alzheimer’s and dementia. 

 Kidney Disease:  In the New England Journal of Medicine, Dec 22,1994, #25, Vol331:1675-1679 the authors note "people who take analgesic drugs frequently may be at increased risk of end stage renal disease (ESRD), but the risk remains unclear" So they studies 716 patients treated for ESRD adn 361 control subjects. The results showed that a cumulative does of 5000 or more pills containing NSAIDs was associated with an increased risk of ESRD byj 780% compared to the control. These finding should arise a serious concern for people taking large quantities of NSAIDs

Gastrointestinal Bleeding: The New England Journal of Medicine June 17,1999, The authors noted that there was endoscopic proof that aspirin could cause gastric muscosal damage, which has been substantiated by numerous other reports. NSAIDs have more then 70 million prescriptions and more then 30 billion over the counter tablets sold annually in the US.

The authors also note "it has been estimated conservatively that 16,500 NSAID-related deaths occur amoung patients with rheumatoid arthitis or osteoarthrities every year in the United States" They also state " if deaths from gastointestinal toxic side effects of NSAIDs were tabulated separately in the National Vital Statistics report, these effects would constitute the 15th most common cause of death in the US".  Yet these toxic effects remain largely a ‘silent epidemic’, with many physicians and most patients unaware of the magnitude of the problem.

Doses of aspirin as low as 30mg are sufficient to suppress prostaglandin synthesis in the gastric mucosa initiating gastric-duodenal mucosal injury.

Cardiovascular Events: By now, we should all be familiar with the recall of the Cox-2 inhibtor of Vioxx. Well the reason they did this was because of the evidence of unacceptable risk of cardiovascular events. Consequently, other Cox-2 inhibitors were studied for saferty.

In the European Heart Journal July 2006;27(14):1657-63, the authors evaluated the risk of myocardial infarction associated with the use of various NSAIDs in the general population. They concluded that the use of NSAIDs is associated with modest risk off first time Myocardial infarction

Dementia, including Alzheimer’s disease: In the journal Neuorolgy(April 22, 2009)  the Authors studied 2736 dementia free elderly enrollees for up to 12 years to identify dementia and Alzheimer’s disease(AD). These authors concluded "contrary to the hypothesis that NSAIDs protect against AD, pharmacy defined heavy NSAIDs users showed increased incidence of dementia and AD, by 66%"

The standard daily dose of prescription ibuprofen was defined as 1,200mg/day (2- 600mg/day).

 If you’re not scared in the littlest by now, I figured I would put a scary picture up to see if you are breathing. But seriously, If you have alot of pain, have suffered for years, and happened to take NSAIDs on a daily, weekly, or monthly basis, you really need to consider the risks and come up with an Alternative Approach. Here are 2 Alternatives.

Alternative Approach #1: Fish Oils:

Fish oils contain omega-3 polyunsaturated fatty acids, including the 20 carbon long oil eicosapentaenoic acid, or EPA. EPA has a therapeutic advantage over NSAIDs in that it inhibits boththe COX and LOX enzymes, which in terms reduces the production of Prostaglandin E2(PGE2) and Leukotriene B4(LTB4) which both lead to the inflammatory cascade that results in pain.

In the journal Surgical Neurology 65(April 2006) 326-331, the paper won first prize in the poster competition at the American Association of Neurologica Surgeons Annual Meeting. The paper was entiled:

Omega-3 Fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain.

The author, Dr Joseph Maroon from the Department of Neurologica Surgery, University of Pittsburgh Medical Center, also wrote a book entitled: Fish Oil, The Natural Anti-Inflammatory.

Dr. Maroon reviews how the use of NSAIDs is associated with occasional extreme complications, including gastric ulcers, bleeding, myocardial infarction, stroke, and even death. With more than 70 million NSAID prescription written each year, and over 30 billion over the counter NSAIDs tablets sold each year, that "Omega-3 EFA fish oil supplements appear to be a safer alternative to NSAIDs for treatment of nonsurgical neck or back pain"

In his study, he showed that after 75 days on high dose fish oil, 59% of patients with chronic spinal pain and who had degenerative spine disease were able to discontinue thier prescription NSAIDs, and 88% stated they were satisfied with their improvements and that they would continue to take fish oil.

 Alternative Approach #2: Spinal Manipulation

In the journal Canadian Family Physician March 2985, Vol. 31,pp 535-540 Dr, Kirkaldy-Willis, a Professor Emeritus of Orthopedics and director of the Low Back Pain Clinic at the University Hospital, Saskatoon, Canada, co-authored:

Spinal Manipulation in The Treatment of Low Back Pain

In this article, Dr Kirkaldy-Willis suggests that the clinica benefit of spinal manipulation is linked to an improved range of motion. This improved range of motion subsequently "closes" the pain gate.

In another journal called Spine July 15, 2003; 28(14):1490-1502, an article entitled:

Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Accupuncture, and Spinal Manipulation, was published.

In this study, Celebrexz or Vioxx was studied, Spinal manipulation was delivered by chiropractors. Patients were assessed for 9 weeks. The highest proportion of early recovery was found in manipulation (27.3%), followed by acupuncture(9.4%) and medication (5%).

The results of this study suggest that spinal manipulation if not contraindicated, may be superior to needle accupuncture or medication for the successful treatment of patients with chronic spinal pain syndrome.

Many people however don’t like spinal manipulation. I understand their fear, but suggest that they don’t throw the baby out with the bath water sort to speak. 

 I urge these people to learn the exercises, postures, and stretches that work to increase spinal ranges of motion, and help postural align of the spine much like a spinal manipulation would try to achieve. I have developed my Lose the Neck Pain System, which I believe is a fantatic alternative to medication,  and can help reduce neck pain.

In Summary, for decades it has been known that taking NSAIDs is associated with undesirable and potentially fatal side effects. Fish Oil as well as spinal manipulation or a rehab program designed to increase spinal flexibility can both be beneficial to individuals suffering from chronic spinal pain syndromes.

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In our 3rd and final installment of Neck Pain and Vertigo, or Dizziness, are they related, we conclude by going over what you can do own your own to help with not only your neck pain, but with your vertigo and dizziness as well.

In part one we asked the question as to whether or not neck pain and vertigo were related.

In part one of my neck pain and vertigo series, I summarized that the part of the brain responsible for vertigo and dizziness, and mentioned the four major sources that sends information to this vertigo center or vestibular nucleus. You can check out my previous post if you didn’t a chance to read that yet.

In part 2,  we talked about the phenomena of:

“Cervical Vertigo” or “Cervicogenic Vertigo” (A fancy way of connecting neck pain and vertigo)

To briefly go over this type of vertigo again, we mentioned that this type of vertigo is caused by  a “disruption of cervical propioceptive input”.

That basically means that the joints in our neck, when they are injured, or more commonly break down because of degenerative changes and wear and tear, they send faulty and conflicting signals to our brains about where our head is in terms of time and space.

Hence neck pain and vertigo are indeed related.

The result is a stimulation of the vestibular nucleus in the brain stem, and a sensation of dizziness and vertigo afterwards.

How to eliminate neck pain and vertigo.

Based on this information, we discussed that if we can correct the mechanical function of the neck joints, then the faulty information would not be sent in the first place, and the sensation of dizziness and vertigo would be eliminated. Eliminating neck pain and vertigo

It also stands to reason that if we correct the mechanical function of the neck, we can also eliminate the neck pain as well!

We then ended part 2 of these installment talking about the trying to improve range of motion or restoring normal ranges of motion as one way to restore mechanical function of the neck. Its actually alot easire then you think.

But before we do, we should know what normal ranges of motion even are, and more importantly, what our own motion is, and what motion hurts.

Check out the second installment of my neck pain and vertigo series for the ranges of motion that are considered normal ranges by the AMA guidlines.

The motion that is most likely to be reduced the earliest in life is lateral flexion. This is the one where we bend the ear towards the respected shoulder. AMA guidelines to bend laterally is 40 degrees.

The next ranges of motion that becomes limited is how far we can rotate our head to the right and left, and then finally how far we can look up and down.

At this point, the best question to ask is why do we develop reduced motion in the neck?

If we can address why we are unable to move our neck as far and as pain free as we should, then again, we can restore normal joint function, and ultimately, reduce the cervicogenic vertigo as well.

Past trauma’s to our neck like a motor vehicle accident, a sport or recreational injury, or a repititive stress activity such as working in front of a computer, talking on a phone, or text messaging these days, all lead to a breakdown in our posture. Even the way in which we sleep can adversely affect our posture.

To summarize, any activity that we do repetitively, like our jobs, sleeping, watching television, any traumas that we have had, like an accident or fall, all can lead to postural problems.

These postural problems then lead to range of motion limitations, and pain, which leads to a mechanical breakdown of function in the neck. When the mechanics of the neck breaddown, this leads to stimulation of the vestibular nucleus, which then causes vertigo, phewwwwwwww.

Got it?

So not only restoring proper range of motion in the neck that is important, but also working to correct our posture will go along way to help patients that suffer with neck pain and vertigo.

 Notice in the above posture picture, the middle posture is considered “good posture or balanced posture”. The poor postures are the flat back posture, and the sway back posture.

In both the poor posture pictures, if you disregard whats going on with the back (either flat or sway), the same head position results. That is one in which a forward head position is developed.

This forward head position is the hallmark reason why my lose the neck pain system that I have developed, that addresses this predictable way our bodies begins to break down, is super successful for getting rid of vertigo, dizziness and neck pain.

In this position, with the head protruded forward, muscle fatigue develops, tightness and overcontraction develops, range of motion is compromised, and pain develops, and if you suffer with cervicogenic vertigo, it develops too.

THE SOLUTION TO NECK PAIN AND VERTIGO

The easest thing I can say in summary, is to improve posture, and improve flexibilty in the muscles of the neck. Neck pain relieving exercises, for the cervical spine in which people ”jutt”  their head even further out, as shown in this picture, and then subsequently retracts the chin, is probably the most efficient way at improving posture, and just one of the major movements my system incorporates.

The recommendation for this exercise is to extend the head forward, and then retract the neck backwards. Do this 5x with 5 sets, 5/day, and watch not only your forward head carriage problem improve, but also watch your flexiblity in your neck improve, your neck pain be reduced, and perhaps if you suffer with cervicogenic vertigo and dizziness, watch that disapear as well!

Till next time, watching your back (and neck)

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In part 1 of neck pain, vertigo, and dizziness, I posed the question on whether or not a relationship exists between neck pain and vertigo, and IF SO, we could help both our neck pain and vertigo or dizziness problem by focusing on any associated neck problems that you might have as well.

The importance of the relationship between neck pain and vertigo

The relationship between neck pain and vertigo is extremely important. That’s because if you google drug treatments for vertigo, you will see a host of pharmaceuticals for this condition, and any time we can avoid taking medication for something we can help naturally, then you’ve vastly improved your overall health.

We stated in part 1 of my series of neck pain and vertigo, that the center in the brain(stem) responsible for balance is called the vestibular nucleus.

We also stated that 4 sources of inputing of information to the vestibular nucleus are: 1) Inner ear (Labyrinthine), 2) the cerebellum, 3) the temporomandibular joint (TMJ), and 4) C1-3, and this type of vertigo is called Cervical Vertigo, Cervicogenic Vertigo, or neck pain and vertigo.

NECK PAIN AND VERTIGO AKA CERVICAL VERTIGO:

Clinicians have documented a relationship between cervical spine trauma and the symptoms of vertigo. Dr. Linda Luxon notes in her chapter titled “posttraumatic vertigo” (1) that this type of vertigo can be explained by ‘disruption of cervical proprioceptive input’.

Proprioception comes from the latin word proprius, meaning “one’s own” and perception-is one of the human senses. Thus one’s own human sense, functions to sense orientation of ones limbs in space.

In the case of the neck or cervical spine, we have proprioceptors throughout the anatomy of the neck that sense stretch or quick movements, and ultimately tell our brain where we are in space and time.

The information of where our head is space gets relayed or sent to the vestibular nulcei, with the major signals being sent from the joints and capsules in the neck.

The major implication of these findings is that problems in the upper cervical spine joints (or neck in general) is that they can alter the signals being sent to the vertigo centers in the brain, and result in VERTIGO! Better yet, neck pain and vertigo are definitely related.

The Relationship Between Neck Pain and Vertigo Always Us to Try And Fix Both:

Now that we know that a relationship between neck pain and vertigo certainly exist, treatment would be to improve the mechanical function of these joints, and not just focusing on taking medication to control the symptoms of both neck pain and vertigo.

So, the question becomes, why don’t you know about this? That is, why aren’t you told that that accident you had, that one that you injured your neck, also caused you to have vertigo.

That is, if you would have focused on fixing your neck pain, you could have improved your vertigo, because a definite relationship exist between neck pain and vertigo.

So why don’t you know about this relationship?

Not to get too political, but, the drug industry is a Multi Billion dollar industry, and they have a stake at promoting their products. Unfortunately, as well, in general, society is looking for a magic pill. One that we go to bed at night with, and wake up in the morning with whatever we took the pill for fixing the problem.

That is the “should be world” and unfortunately, we live in the “is world” .

The is world when it comes to vertigo, dizziness and neck pain, IS to improve the “mechanical function of thes joints”, fix the faulty signals being sent to the vertigo centers in the brain, and fix the vertigo, dizziness, and neck problems.

I know that If I where you, I would be asking right about now “What the heck is mechanical function of the neck joints???”. and more importantly, “how do I fix the mechanical function of the neck joints”????

Well great question, funny you should ask. I try to explain things in a simple and easy analogies to understand things that we may not be familiar with. So, think about our joints in the neck like a door hinge.

Now I know that this analogy is abit crude, but, we all understand how a hinge joint works. With a door, the way the hinge joint was designed allows the door to swinge open and swinge closed.

All we have to do is push the door and viola, it swings open. Two joints in the body that are called hinge joints are the elbow and knee.

These joints can swinge open and closed, or flex and extend in one direction, like a hinge joint of a door (more or less). But think about when that hinge joint becomes faulty.

Perhaps it is rusty, or not lubricated properly, the joint stops working properly. When that happens, the door may not open up as much, the joint my grind, and then it really becomes difficult to get through the doorway.

If we force the door too much, where the hinge is mounted to the framework, that may begin to loosen  up as well. Now you have an even bigger problem.

Well the neck joints are similar  in the way they breakdown. The joints in the spine or called facet joints (see above diagram for an illustration). In the case of the facet joints in the neck, when we bend our neck to look downwards, the joints open up or seperate.

When we look up to the sky, the joints bear down on each other and come together. We also have the ability to turn left and right, and laterally flex each ear to the respected shoulder. This is what we call “normal joint mechanics” or mechanical function of the neck joints.

So how do we fix this mechanical function in the neck? Well, techniques to improve range of motion, in all directions is the first suggestion. In order to do that, we have to first determine what ranges of motion or what direction we are limited in.

As a quick reference, AMA guidlines for spinal motion are as follows

Flexion= 60 degrees

Extension= 75 degrees

Cervical Right Lateral Flexion= 40 degrees

Cervical Left Lateral Flexion= 40 degrees

Cervical Right Rotation = 80 degrees

Cervical Left Rotation = 80 degrees

How to fix your neck pain and vertigo.

So step 1. would be to evaluate your own range of motion with the “eyeball method” and determine if you have a) full ranges in all direction b) painfree movement b) symmetry between left and right motions (that is, left motion is as good as right motion and vice versa).

Once you have determined any “dysfunctions with your range of motion, you are ready to go on to step 2.

So keep posted for my 3rd and final installment of Neck Pain and Vertigo, or Dizziness, are they related? where I continue to give you valuable information to help to improve your mechanical function of your neck and get rid of your vertigo once and for all.

For Part 3 of Neck Pain and Vertigo or Dizziness, click here.

Till next time, watching your back (and neck).

Reference:

Luxon L. “Posttraumatic Vertigo” in Disorder of the Vestibular System, edited by Robert W. Baloh and G. Michael Halmagyi, Oxford University Press, 1996

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