Acute inflammatory response via neutrophil protects against chronic pain
science.org
science.org
His remedy for elbow tendonitis basically involves a few sessions of doing chin ups until your elbow pain is unbearable. And then keep going. Many low-rep sets over and over. The idea is that this will increase inflammation, causing your body to heal the original injury along with the inflammation.
He claims this healed his own elbow tendonitis and has worked for countless others.
I follow Rip's strength training program. However I can't say I'd ever give this a try and I'm not sure there's any scientific evidence that it works.
Just thought it was pretty interesting, even if it's just bogus. I have no idea!
https://startingstrength.com/training/elbow-tendonitis-how-i... https://en.wikipedia.org/wiki/Pin_firing (an article on his website)
https://www.youtube.com/watch?v=c1frSvu8KyE (he talks about it in this podcast)
Now that I think about it I wonder if it still works if the area is numbed first.
I haven't heard anyone else describe it that way but it makes sense to me. Wonder if this would be better than applying repetitive stress injuries to an existing problem.
But as with a massage, if the cause of the knot in the muscle it not taken away the effect will only be temporarily (couple of days maybe).
+ We are pretty sure acupuncture, done correctly, won't cause any harm
+ It is on par or sometimes slightly exceeds placebo
+ Sometimes "things that seem like acupuncture but are not acupuncture" also give the same kind of results.. even though they shouldn't?
I'd still be pretty skeptical about it, but the risk of trying it seems quite low
People have even been documented to have died from acupuncture https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951167/
The benefits are zero. Potentially living with a chronic disease like Hepatitis C because of a lazy provider that reuses a needle or contaminates it in some way, is a serious risk.
There's also the fact that by engaging in these activities you perpetuate junk science, just like Q anon people, just like climate change deniers, it's all the same insanity.
> We are pretty sure acupuncture, DONE CORRECTLY, won't cause any harm
Yes, if you get stabbed with a dirty needle, you might get a disease. That's true for acupuncture, a tattoo shop, and even a vaccine. Don't get stabbed with dirty needles! I fully suggest not getting stabbed with dirty needles. Bad. Avoid. 0/10.
> The benefits are zero
https://pubmed.ncbi.nlm.nih.gov/3982837/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984198/
It's probably about as effective as placebo? (Maybe?) That isn't zero, that's placebo - and that is an important difference
> you perpetuate junk science,
You're just wrong. This isn't even just a "you might have a different opinion". The absolute best science we have, the entirety of realms of research, is "well, it's probably placebo and maybe it's kind of an expensive placebo". The most scientific answer you can give is "we should do more studies and ask more questions", and it's part of why the medical industry has shifted from "Don't do acupuncture" to "Well, it probably won't do much for you, but sure if you like it, that seems fine".
There's more to science than just asking questions and collecting data though, there's also developing models. Without good models, you can't gain much insight from data, and in fact you'll sometimes gain incorrect understandings. If there's no supported mechanism for how acupuncture works, it's really not a good sign, and it seems dishonest to think it's at all in the same realm of safety as something like vaccines which do have known mechanisms of action.
I think back to how much "data" we had in the 50s that tobacco was harmless. Is it ever a good idea to go for something so invasive to the body as needles without a strong reason, just because the dangers aren't readily apparent? Medicine passes the necessity bar, placebo does not.
The accupuncturist's needles were each individually packed, he washes his hands thoroughly, then puts on gloves as well. Every needle gets thrown away immediately after use.
Not sure how any of that is potentially unhygienic other than the room itself possibly being slightly dirty? (it was clearly well cleaned, but obviously not to surgical standards... why should it?)
Acupuncture works as well as sham acupuncture (inserting needles at non-acupuncture locations). Which suggests to me that acupuncture works on the same basic principle that your doctor giving you sugar pills with a fancy name and strict instructions to take one every four hours with a glass of water works.
> I think back to how much "data" we had in the 50s that tobacco was harmless.
We had pretty good evidence it was bad for you, especially during pregnancy. This is maybe a better example for talking about peer review and conflicts of interest - which is still a real problem.
We can never say "is dangerous" or "is not dangerous". What we can say is X esposure leads to Y harm. Water in sufficient quantities will kill you.
Acupuncture, in a sterile environment, is pretty safe. We also know that skin deep needle penetration is pretty safe given that lots of people get tattoos. It still requires hygiene, but it is a safe activity.
I'm totally sympathetic to "we should be doing health inspections of acupuncture, like we do tattoo shops". I think some areas already do this. It's probably a good idea.
Except that sugar pills don't give anyone HIV or Hep C.
> We can never say "is dangerous" or "is not dangerous". What we can say is X esposure leads to Y harm. Water in sufficient quantities will kill you.
No. Harm is relative to reward. Cancer drugs are extremely harmful. But dying from cancer is worse.
The reward for acupuncture is 0. Just sit and eat a Twix instead. It has the same medicinal benefits. The harm of acupuncture is absolutely real, as I linked above, people have died, people have gotten chronic diseases.
If acupuncture does not beat placebo, lets direct people to homeopathy instead - which basically means drinking water - to get the exact same placebo results. There are less risks associated with drinking water than being stabbed with needles, dirty or not. We could even have those cost fully covered by the state, few millilitres of water won't bankrupt anyone.
Not sure if that's what you meant: In Germany, e.g. acupuncture (and other specific types of homeopathic treatments) are reimbursed by public health insurance, for specific conditions. Exactly because they can induce a significant beneficial placebo effect on average while having less risks, and being cost effective.
BTW, depending a bit on jurisdiction, placebos are routinely given even in hospital care. If you have family/friends who are doctors, do ask them.
On top of that, it puts the state in a weird situation because it has to decide which beliefs are OK (acupuncture fixes fibromyalgy is an OK belief -> reimbursed) and which one aren't (getting a PS5 fixes depression is not and OK belief -> not reimbursed).
People are absolutely entitled to have their own beliefs, but if a treatment hasn't shown any efficacy, we should aim for a close to 0 spending of the public health sector on it.
I feel that creating a state controlled millilitre water bottling company would make some placebo available at virtually no cost, so could be a nice way of offering some effectiveness for free, but acupuncture isn't.
No. That's junk science. There's no different opinion here. It's very clear from many many studies of acupuncture it does nothing. This kind of attitude sells people on something that does not work.
> The most scientific answer you can give is "we should do more studies and ask more questions"
Absolutely not! I am a scientist. That's a total dumpsterfire of an answer. This is how people end up with people taking crazy COVID "treatments", because we "need more study". As a community we have studied this trash extensively now. It is junk. That's it.
If acupuncture was a drug, it would be so widely discredited you couldn't get $1 to do a study. Actually, you couldn't even run a study on it because your local ethics board would think the potential harm for benefit ratio would not be good. The only reason people keep studying this is because dishonest people sell other people on acupuncture as a treatment, so it's a neverending cycle. As long as people keep wanting to engage with this junk, the scientific community needs to keep studying it, we keep finding it's total trash, but then people like you say "Oh look, people are studying it, therefore there is merit". There is no merit.
> and it's part of why the medical industry has shifted from "Don't do acupuncture" to "Well, it probably won't do much for you, but sure if you like it, that seems fine".
The medical industry cannot police snake oil salesmen. This is a well known problem. People get all sorts of insane treatments. From having your back violently adjusted by chiropractors (another junk science where people die) to having the crap beaten out of them with stainless steel rods (something called the "Graston technique"; I have seen the outcome of this, it can be horrific).
A central concept in medicine is that the patient gets to lead the charge. And attitudes like yours are exactly why so many people get caught up in this pseudoscience junk. To immense detriment to their health.
On top of that, opportunity cost is a thing. If you pursue completely ineffective therapy - and spend time figuring out if your local acupuncture parlor uses dirty needles - you waste time and energy that would be spend pursuing worthwhile treatment.
It isn't a helluva drug. It is a bad drug that often simply won't work for you.
Any generalised statement about the effect of placebo/nocebo is difficult, because some portion of the effect is regression to the mean, and relatively little is known about the mechanism of action (e.g. there is some indication about a genetic factor).
Not disagreeing with you that it may not work for you, but it may work quite well for some people. Acupuncture being a prime example.
Meaning enough with the bullshit remedies that don't work.
Most Psychiatry drugs are on my hit list.
I can't believe these $450 a visit fancy boys are allowed to prescribe 90% of their bread and butter drugs. I'm not just picking on shrinks either, but they are an easy target.
I am beyond disillusioned that our FDA has approved drugs that are harmfully and actually don't work.
(Former Chiropractic student who walked out after hearing, "We have over 15 upper cervical techniques--and they all work Equally well.")
Enough is enough.
The only way known to distinguish one variety of depression from at least a half-dozen others is to see which medication relieves it. So, any RCT of a depression treatment necessarily throws together people with a half-dozen or more independent conditions, some of which might be relieved by the treatment, others worsened.
Repeat after me: RCT results depend absolutely on precise and correct diagnosis. If you cannot diagnose, you cannot design a valid RCT. Invalid RCTs are easy, though; people run those all the time. The RCTs that seem to prove psychiatric drugs are ineffectual are exactly those.
We are in the condition of people getting arm and leg fractures, but we can't tell where. Splinting is seen to help; doctors who put splints on various places usually hit on a place where it manifestly helps. But our RCTs of splints placed on left shinbones seem to help only a precious few of our patients. Some people swear up and down, loudly and repeatedly, that they are dead certain this means splints are useless and a big scam.
i'm told he strictly used it literally as a placebo ONLY when he knew the cause of the "problem" was not physical or something wrong because of infection or something. I'm told he would treat patients with depression by counseling without telling them (usually family members) and prescribing this "white medicine" to keep up appearances.
i'm told he never treated anyone outside of this usecase because well, there are medicines for that purpose.
remind you this is from 50 years ago when my town had 3 hospitals in total and there was no "medical equipment" like we have currently or that were available in major cities. Call it the neck of the woods so its not like there was modern medical care available but patients didn't seek it. He was the physician of his time and pretty successful at that.
That's in comparison to a sham acupuncture placebo. And the placebo effect is already pretty powerful. Even in the "no benefit" studies, that's usually in comparison to a sham acupuncture placebo that has a real effect compared to waiting. In terms of pain treatment, I'd say even a safe non-addictive placebo treatment is pretty good, better than getting hooked on opioids at least.
I wouldn't get acupuncture hoping for a cure to cancer. But it's not exactly a stretch to think that manipulating nerves with needles will help with pain.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365227/figure/...
It's difficult to imagine how you would blind the acupuncturists performing the treatment. I suppose you could have one acupuncturist mark the needle location and another blinded one stick the needle in. But a skilled acupuncturist would probably be unblinded by their own knowledge of where it makes sense for the needle to go. So there is definitely risk of performance bias, but they're sticking needles into patients at predefined points - I don't think it's a very large risk.
Transcutaneous electrical nerve stimulation (TENS or TNS) : https://en.m.wikipedia.org/wiki/Transcutaneous_electrical_ne...
Fibromyalgia (FM) : https://en.m.wikipedia.org/wiki/Fibromyalgia
Perturbations.
Life isn't a double blind randomised placebo controlled study, mostly on rats / students / in a clinical setting / lab, and therefore there's a strong case to be made that we shouldn't necessarily use that model to model our behaviour.
Back to perturbations, I mean in the astronomical sense: deviation of a celestial body from a regular orbit about its primary, caused by the presence of one or more other bodies that act upon the celestial body.
You go to a one or more acupuncture sessions and your life is, in a very literal sense, changed.
It's not just a placebo, you actually went and did something you otherwise wouldn't have, with the intention of seeking improvement, thereby setting your life on a divergent path to what it otherwise would have been.
Over time, the divergence can be drastic.
This a very under appreciate power of our ability.
But placebo or not, I’ll also say that the physical impact was genuinely calming. And while the setting and circumstances might account for most of that—soothing music, dark room, being still for about an hour with no interruption—I also found different needle placements had noticeably different effectiveness.
It’s not for everyone. I wouldn’t dream of suggesting anyone try it who wasn’t already open to it. But it did really help me, regardless of the science. And I’m grateful for it.
And needles placed at random do seem to have significant placebo effect for some conditions and people.
We don't have poison ivy in Australia, but apparently this works for things like rashes, mosquito bites, etc. I'd never heard of it before.
I can't wait to get a rash or something so I can try this. Thanks!
I experienced elbow pain after doing a lot of deadlifts and I assume my tendons couldn't bear the weight, since they take longer to strengthen than muscle tissue.
Fixed it after ~2 weeks of use. Highly recommend.
amazon.com/TheraBand-Tendonitis-Resistance-Tendinitis-Intermediate/dp/B00066D6K4/ref=asc_df_B00066D6K4/?tag=hyprod-20&linkCode=df0&hvadid=198109692418&hvpos=&hvnetw=g&hvrand=6240534091611235770&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9031499&hvtargid=pla-404191336687&th=1
Conversely, my wife's debilitating ankle injury was going nowhere with physical therapy and after a single trip to a local acupuncturist she could walk pain free.
A couple of years ago, I got golfer's elbow from doing high volume chin-ups (supinated pull-ups). I'm at an age where this kind of thing is common (I've heard of it referred to as "middle age pull-up syndrome").
I tried to ignore it and work through it, but it got worse, and I eventually went to therapy where they recommended the Flex bar. It took more than a few weeks, but eventually it completely resolved the pain. For me at least, it did the job, and it's a lot cheaper than a single visit to the therapist (even if you end up buying multiple "levels" of it).
Nowadays I do my pull-ups on gymnast rings, so these creaky old elbow joints can move freely rather than being stressed by a fixed hand position.
Hot PokerStars potentially kill infection. Heat is a well known means to help kill infection.
Exercise increases the rate at which lymph is returned to the circulatory system from the tissues. That's how the body takes out the trash.
Inflammation is poorly understood and I don't like these hand wavy hypotheses.
"The concept of creating irritation or injury to stimulate healing has been recorded as early as Roman times when hot needles were poked into the shoulders of injured gladiators"
Nowadays they (thankfully!) use a mix of Lidocaine/Dextrose but the key is to NOT take ANY anti-inflammatories to allow the body to react & repair itself.
I had a similar surgery 14 years ago (part of the heel bone was sawed off and the tendon was "scarred"), followed by 2 weeks on crutches. I was coming from more than 2 years of terrible pain in my right Achilles. Three months after the surgery, performed arthroscopically, I ran a 10K. I never had any problems or pain after surgery.
Intriguingly, being an eternal explorer of alternative methods, I had tried using a number of remedies/procedures to heal my Achilles (acupuncture, "shock waves," electrostimulation). I was an athlete and it was all under medical supervision. Virtually nothing worked except cortisone injections, which only mask the pain for a few weeks. But what did work, albeit for a few hours, was Alpha-stim ("an electrotherapy device that relieves post-traumatic, acute and chronic pain through painless electrical stimulation"). I applied the microcurrents with the stick and pads provided (Alpha-stim is mostly used transcranially) and I remember the pain that was torturing me disappeared for a few hours. I went out for a run and felt nothing, it felt miraculous. I feel that electro-medicine has been understudied and under applied.
The long-term solution was to change some basic behaviors (never wear a backback while bicycling, use saddlebags instead, and always warmup before exercise), and I also started a very slow recovery program (i.e. about a year-long very steady-and-slow increase in exercise levels). I'm pretty sure a key component was the use of supplements for connective tissue development (glucosamine, chondroitin, MSM, vitamin C) and bone development (calcium-hydroxyapatite and magnesium sources). However, thinking back, I also quit the NSAIDs (which were unnecessary as I always backed off the exercise whenever I felt the slightest twinge during the recovery period).
Nowadays, I just do continual light resistance training for back strength (basically frequent hiking with a well-balanced backpack), some relatively light gym workouts, and I've felt zero back pain for several years, and the tendonitis has also vanished, and I almost never take any NSAIDs (which I used to eat rather like candy). I still take that supplement mix (and I've tried going off it for a few months and had a notable increase in sore joints etc.) but now I wonder if quitting the ibuprofen was equally important.
I'll second this anecdata for back pain/tendonitis. NSAIDs become unnecessary, or even as the parent suggests, harmful. My broccoli and fruit intake obviated calcium and vitamin C supplements respectively, and I never heard about the necessity of MSM.
Regular light exercise is the only thing kind of working for me right now, but every now and then the pain gets bad and I fall out or exercise.
https://www.healthline.com/health/fitness/superman-exercise
https://m.youtube.com/watch?v=CfiJ4qfaUbM
And get a foam roller for a easy low back massage.
I used to have low back pain for a long time from too much desk work. Although I do a lot of different exercises now, I think those 3 things are the easiest and most impactful way you can keep yourself pain free. They're simple, 5 or 10 min a day will really help.
I use a foam roller regularly! Less so on my back and hips, more on my legs and upper back. I use a lacrosse ball for my hips and lower back, which feels like it gets a little deeper.
It's quite surprising to me just how weak my back can get at times if I'm not doing regular strength exercises for it.
I also second the lacrosse ball. It's a life saver for long car and plane trips!
I have a sacralized L5-S1, and doctors have discouraged surgery because they’re not confident it’ll help. I’ve had years of PT and several rounds of epidurals, all of which helped a bit but not completely. At this point it’s more about learning to manage the pain. I’ve kind of given up hope of full recovery.
The source of my issue is mechanical, reducing my back's thresholds for stress and inflammation and greatly extending the required time for recovery if exceeded. I do a range of stretches and strength training exercises that don't give immediate relief but can definitely be felt if I slack off for a week, and I use some implements to promote lordosis when I have to sit. It's not solved, but I'm sleeping all night and have reduced incidents of disabling pain.
The duloxetine showed me that I had multiple types of pain that were related but not the same, allowing me to address each one individually. Eventually I'll go off it, but that's probably another year or two away.
One of the interesting topics was that during recovery from exercise or an acute injury, your body's natural response to repair is through inflammation (not surprisingly). But that reducing or trying to block inflammation inhibits your body's ability to repair and build itself, leading to much slower recovery.
All in all, it seems there is a balance between reducing inflammation to prevent it from either killing you or causing pain vs reducing it to the point that it prevents your body's natural build and repair processes.
I've done so in this case.
HN's long-standing policy in the case of clickbaity or vague article titles is to replace them with one from the text itself if possible. See:
https://news.ycombinator.com/item?id=9695092
The last sentence of the abstract here seems to offer a couple of options.
In my own submissions, I'll note where I'm making such substitutions and why. Usually for length:
https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...
Stay off your sugar and do a bit of intermittent fasting. Herbert Shelton might have been onto something you know.
https://en.wikipedia.org/wiki/Neutrophil#Structure "In 1973, Sanchez et al. found that the capacity of neutrophils to engulf bacteria is reduced when simple sugars like glucose, fructose as well as sucrose, honey and orange juice were ingested, while the ingestion of starches had no effect. Fasting, on the other hand, strengthened the neutrophils' phagocytic capacity to engulf bacteria. It was concluded that the function, and not the number, of phagocytes in engulfing bacteria was altered by the ingestion of sugars."
Could someone kindly translate this to layman's terms?
Neutrophils are white blood cells. The rest is gibberish to me.
Edit: To be clear, I am trying to understand this piece of the statement:
Transient neutrophil-driven up-regulation of inflammatory responses...
Edit: I'm wondering if that means "Temporary white blood cell driven increase in inflammation was protective..."
[0] https://physoc.onlinelibrary.wiley.com/doi/10.1113/JP278996
Ice to numb things, sure. ICE to reduce inflammation by inhibiting blood flow … ?
We know lots of supplements and food that seems to be universally considered healthy to have anti-inflammatory effects: olive oil, boswellia, pretty much all fruit and especially vegetables (and an infinite amount of other substance(s) (classes)). Is too much or even just a bit of those bad in some cases?
Or are only the "heavy hitters" NSAID and corticosteroids bad? If so, why? Are they so much stronger?
A little anecdote in regards to chronic pain: A combination of high dosage Loratadine (3x10mg) and Ambroxol (2x75mg) a day helped the chronic nerve pain in my face a lot, when NSAID didn't.
What does that mean for the therapy of humans? How can we administer neutrophils in humans to fight chronic pain?
https://www.cancertherapyadvisor.com/home/news/conference-co...
CAR T-cell therapy is for refractory or relapsed lymphomas. One of its side-effects is cytokine release syndrome (CRS), an inflammatory response which, in its most severe grade, is fatal. Anakinra, used for rheumatoid arthritis among other things, greatly reduces the severity of CRS in poor yahoos like me receiving CAR T-cell therapy, turning what could be a rocketship ride to Hell into what will more likely be a rather uncomfortable United flight to Newark.
> in its most severe grade
I will hazard a guess that most inflammation is not severe but our tolerance for it has diminished due, in part, to the prevalence of anti-inflammatory drugs.
If you go to the supermarket and get yourself some cbd topical solution for like sore muscles.. you are just getting generic sore muscle lotion that basically treats inflammation, and it has had cbd waved near it for an upcharge.
The only potential like thing here are high cbd transdermal patches but the dose is high and the efficacy is still pretty low.
Not always. They sell ibuprofen in a tube so you can rub it on muscles. If you are in the US, you probably don't see it on your pharmacy shelves, though. The pharmacy I worked at didn't sell it (and it was a large chain), but all of the pharmacies I've seen in Norway have it.
The labeled one had a measuring/dosage card attached which was really weird to me.
> CBD does seem to have an effect on inflammation.
Yes but it doesn't penetrate the skin very well. That's why I sort of hinted at large dose transdermals as being a possibility, but the small bit of research that has been done is both early and mixed. I think the transdermal is a pretty critical part here and I don't know of any approved transdermal CBD products, just lotions that are useless.
If your pain is in fact chronic, then ... you might wish to revisit. Your specific instance and circumstances will, of course, vary from others. And I'm well aware that those suffering from chronic conditions face all manner of denial and unhelpful contributions from others, both healthcare professionals and not. (I'm of the latter class.)
Having been through some serious injuries myself, I can attest that 1) short-term relief, over days and weeks, from quite powerful anti-inflammetories was immense, and 2) that the long-term issue would likely best be treated by other means, particular to my circumstances.
TL;DR: shor-term and long-term benefits may in fact be in opposite directions. As any alcoholic or junkie is aware.
I've experienced it all.
If you care to discuss: anything in particular that did/does seem to help or hurt especially?
Activity, strength stuff, not to excess, but consistent. (Weightlifting, swimming, running, cycling, etc.)
Low weight. My injuries were to knees and pelvis, so the more I weigh the more problems I have.
Decades of NSAIDs, and a year of Oxy turned me to cannabis, which works in small amounts while CBD alone does not. CBD loosens up my muscles too much, and my adductors are a major issue when not influenced already. Outright weed keeps things on the level, which makes no sense when I run a mountain marathon the next morning.
What? Inflammation happens for a number of reasons. Some nebulous "balance" that your body is "out of" isn't it.
No, it really isn't. If you cut your finger, you are going to have inflammation around the wound. This is completely normal and desirable: It helps the wound close and heal. Same if you get injured: swelling near a broken elbow means you are less likely to move the joint for a few days, at least (pain will keep me from moving it afterwards). These are all temporary maladies and no amount of getting your nutrients checked is going to fix these.
And steroids certainly won't help you in those situations. Steroids can make healing slower, depending on what is wrong. Not to mention that they aren't safe for everyone and can have serious side effects. slow healing, bad sleep, brittle bones, and so on.
I'm not saying steroids are never the answer. I have MS and have had high dose steroids to help with nerve inflammation (hopefully to minimize damage). High dose meaning... it was administered through an IV and I hallucinated every few hours for 3 days. And I've had steriods for an allergic reaction that simply wasn't calming down.
But the situations aren't in your favor: Steroids aren't a cure-all for inflammation, which isn't always bad.