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Mayo Clinic Health Letter: Highlights from the May Issue.

ROCHESTER, Minn. -- Here are highlights from the May issue of Mayo Clinic Health Letter. You may cite this publication as often as you wish. Reprinting is allowed for a fee. Mayo Clinic Health Letter attribution is required. Include the following subscription information as your editorial policies permit: Visit www.HealthLetter.MayoClinic.com or call toll-free for subscription information, 1-800-333-9037, extension 9771.

Comprehensive Approach can Break the Chronic Pain Cycle

ROCHESTER, Minn. -- Chronic pain -- whether from headaches, back pain or conditions such as fibromyalgia -- can interfere with work, day-to-day activities and relationships. All too often, pain relief treatments are ineffective and can lead to a downward spiral of frustration, decreased functioning, stress, isolation -- and worsening pain.

The May issue of Mayo Clinic Health Letter covers comprehensive pain rehabilitation and how this approach can help patients break the cycle of worsening pain.

Pain rehabilitation centers and programs vary widely in scope and focus. Offerings may include a series of classes that last a few days to a few weeks. Some programs are residential; others are day programs. A common denominator across programs is a team approach, including physician specialists, psychologists, nurses, physical and occupational therapists and, in many cases, dietitians, social workers and chaplains. The team works to develop an individualized plan to address the many far-reaching effects that chronic pain has on the patient and family members.

Pain rehabilitation programs often include:

* A thorough up-front evaluation -- A review of physical and psychological conditions, medications, work status and relationships is used to develop a pain management approach.

* Medication management -- Many patients with chronic pain end up on opioids which, over the long term, may worsen pain, decrease pain tolerance or cause other side effects. Reducing or eliminating some medications often is beneficial.

* Physical therapy -- Physical deconditioning, including weight gain and loss of strength and stamina, often occur with chronic pain, making daily activities difficult. Physical therapists can assist with several approaches to manage pain, including safely improving fitness levels, improving posture and determining ways to move the body more efficiently.

* Stress management -- Relaxation methods such as meditation might be taught. Another option is biofeedback, where a computerized instrument displays a patient's physical response to stress. Through the feedback, patients can learn to better control physical responses to stress. Psychological care, lifestyle management, group therapy, family counseling, acupuncture or hypnosis may be offered, too.

While a pain rehabilitation plan usually can't eliminate the pain, care from a team of pain management specialists can help patients change their focus from living with pain to living a more fulfilling life.

Cholesterol Levels: A Telling Indicator of Diet and Exercise

ROCHESTER, Minn. -- Diet and lifestyle choices aren't only evident on the bathroom scale. The effect of these choices is also reflected with relative accuracy in cholesterol numbers.

The May issue of Mayo Clinic Health Letter looks at how an individual's lifestyle choices can affect "good" and "bad" cholesterol levels as well as levels of triglycerides, another blood fat.

Cholesterol isn't inherently bad. It's essential to normal body functions and is found in every cell of the body. Cholesterol helps with digestion and hormone production. But too much puts blood vessels at risk. Cholesterol and triglycerides travel through the bloodstream, attached to proteins called lipoproteins. Deposits of excess low-density lipoprotein, the "bad" cholesterol, in the blood vessel walls result in narrowing. As blood flow is restricted, the risk of heart attack, stroke or sudden death increases.

Two factors affecting total cholesterol, age and heredity, can't be controlled. But many can.

For elevated LDL ("bad") cholesterol: The leading contributor to elevated LDL cholesterol is a diet high in saturated and trans fats. To reduce LDL levels, limit saturated fats, trans fats and high-cholesterol foods. To improve your cholesterol, use cholesterol-lowering foods made with plant sterols, for example, the margarine-like spreads. Another strategy is to eat more foods high in soluble fiber, such as oatmeal, apples and kidney beans.

For low HDL ("good") cholesterol: A sedentary lifestyle and lack of exercise are major causes of low HDL levels. To make a difference, significantly increase the frequency and intensity of exercise. Also beneficial is boosting HDL-friendly omega-3 fatty acid intake by eating fatty fish (salmon, mackerel) or taking fish oil supplements.

For high triglycerides: Contributors to high triglyceride levels are being overweight, a high intake of sugary food and excess alcohol consumption. To lower triglyceride levels, cut back on calories, limit sugar and alcohol, and get regular exercise. Other strategies include losing excess weight, eating more whole grains and taking fish oil supplements.

Sometimes, diet and lifestyle choices alone aren't enough to manage total cholesterol levels. Yet, diet and exercise are important management strategies even when cholesterol-lowering medications are indicated.

Tick-Borne Illness: Watch for Symptoms, Seek Care Promptly

ROCHESTER, Minn. -- It's tick season, and the May issue of Mayo Clinic Health Letter covers signs and symptoms associated with tick-related diseases.

Although most tick bites are harmless, ticks can pass on infectious organisms that cause serious illnesses. As a general rule, it's important to seek prompt medical attention when symptoms occur after a tick bite. Symptoms may include rash, fever, muscle aches, joint pain, swollen lymph nodes or flulike symptoms.

Lyme disease: This illness is transmitted by deer ticks, which are brown and smaller than wood ticks. They are found throughout the United States, especially on the East and West coasts and in Wisconsin and Minnesota. Only a minority of deer ticks carry the infectious agent, but the longer the tick is attached to the skin, the greater the risk of infection.

Signs of infection may appear several days to a few weeks after the bite. A red, circular-shaped rash may develop around the bite, followed by flulike symptoms.

When the infection is caught early, treatment is oral antibiotics. Without treatment, Lyme disease can lead to arthritis, facial paralysis (Bell's palsy), heart problems and neurological symptoms.

Rocky Mountain spotted fever: This illness is transmitted by several types of ticks, including the wood tick and American dog tick. The illness occurs in patients throughout the country but is most common in the eastern United States.

Flulike symptoms may be the first indicator of the illness. During the first week, a red rash may appear on the wrist and ankles and eventually spread up the arms and legs to the chest. When treated promptly with antibiotics, mild cases of the infection typically cause few problems. Untreated, Rocky Mountain spotted fever may cause heart, lung or kidney failure or encephalitis, a brain infection that can lead to coma.

Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today's health and medical news. To subscribe, please call 1-800-333-9037 (toll-free), extension 9771, or visit www.HealthLetter.MayoClinic.com.
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