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December 2, 2014

Jonathan Tobin: Defending the Right to a Jewish State

Heather Hale: Compliment your kids without giving them big heads

Megan Shauri: 10 ways you are ruining your own happiness

Carolyn Bigda: 8 Best Dividend Stocks for 2015

Kiplinger's Personal Finance editors: 7 Things You Didn't Know About Paying Off Student Loans

Samantha Olson: The Crucial Mistake 55% Of Parents Are Making At Their Baby's Bedtime

Densie Well, Ph.D., R.D. Open your eyes to yellow vegetables

The Kosher Gourmet by Megan Gordon With its colorful cache of purples and oranges and reds, COLLARD GREEN SLAW is a marvelous mood booster --- not to mention just downright delish
April 18, 2014

Rabbi Yonason Goldson: Clarifying one of the greatest philosophical conundrums in theology

Caroline B. Glick: The disappearance of US will

Megan Wallgren: 10 things I've learned from my teenagers

Lizette Borreli: Green Tea Boosts Brain Power, May Help Treat Dementia

John Ericson: Trying hard to be 'positive' but never succeeding? Blame Your Brain

The Kosher Gourmet by Julie Rothman Almondy, flourless torta del re (Italian king's cake), has royal roots, is simple to make, . . . but devour it because it's simply delicious

April 14, 2014

Rabbi Dr Naftali Brawer: Passover frees us from the tyranny of time

Greg Crosby: Passing Over Religion

Eric Schulzke: First degree: How America really recovered from a murder epidemic

Georgia Lee: When love is not enough: Teaching your kids about the realities of adult relationships

Cameron Huddleston: Freebies for Your Lawn and Garden

Gordon Pape: How you can tell if your financial adviser is setting you up for potential ruin

Dana Dovey: Up to 500,000 people die each year from hepatitis C-related liver disease. New Treatment Has Over 90% Success Rate

Justin Caba: Eating Watermelon Can Help Control High Blood Pressure

The Kosher Gourmet by Joshua E. London and Lou Marmon Don't dare pass over these Pesach picks for Manischewitz!

April 11, 2014

Rabbi Hillel Goldberg: Silence is much more than golden

Caroline B. Glick: Forgetting freedom at Passover

Susan Swann: How to value a child for who he is, not just what he does

Cameron Huddleston: 7 Financial Tasks You Should Tackle Right Now

Sandra Block and Lisa Gerstner: How to Profit From Your Passion

Susan Scutti: A Simple Blood Test Might Soon Diagnose Cancer

Chris Weller: Have A Slow Metabolism? Let Science Speed It Up For You

The Kosher Gourmet by Diane Rossen Worthington Whitefish Terrine: A French take on gefilte fish

April 9, 2014

Jonathan Tobin: Why Did Kerry Lie About Israeli Blame?

Samuel G. Freedman: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Jessica Ivins: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Kim Giles: Asking for help is not weakness

Kathy Kristof and Barbara Hoch Marcus: 7 Great Growth Israeli Stocks

Matthew Mientka: How Beans, Peas, And Chickpeas Cleanse Bad Cholesterol and Lowers Risk of Heart Disease

Sabrina Bachai: 5 At-Home Treatments For Headaches

The Kosher Gourmet by Daniel Neman Have yourself a matzo ball: The secrets bubby never told you and recipes she could have never imagined

April 8, 2014

Lori Nawyn: At Your Wit's End and Back: Finding Peace

Susan B. Garland and Rachel L. Sheedy: Strategies Married Couples Can Use to Boost Benefits

David Muhlbaum: Smart Tax Deductions Non-Itemizers Can Claim

Jill Weisenberger, M.S., R.D.N., C.D.E : Before You Lose Your Mental Edge

Dana Dovey: Coffee Drinkers Rejoice! Your Cup Of Joe Can Prevent Death From Liver Disease

Chris Weller: Electric 'Thinking Cap' Puts Your Brain Power Into High Gear

The Kosher Gourmet by Marlene Parrish A gift of hazelnuts keeps giving --- for a variety of nutty recipes: Entree, side, soup, dessert

April 4, 2014

Rabbi David Gutterman: The Word for Nothing Means Everything

Charles Krauthammer: Kerry's folly, Chapter 3

Amy Peterson: A life of love: How to build lasting relationships with your children

John Ericson: Older Women: Save Your Heart, Prevent Stroke Don't Drink Diet

John Ericson: Why 50 million Americans will still have spring allergies after taking meds

Cameron Huddleston: Best and Worst Buys of April 2014

Stacy Rapacon: Great Mutual Funds for Young Investors

Sarah Boesveld: Teacher keeps promise to mail thousands of former students letters written by their past selves

The Kosher Gourmet by Sharon Thompson Anyone can make a salad, you say. But can they make a great salad? (SECRETS, TESTED TECHNIQUES + 4 RECIPES, INCLUDING DRESSINGS)

April 2, 2014

Paul Greenberg: Death and joy in the spring

Dan Barry: Should South Carolina Jews be forced to maintain this chimney built by Germans serving the Nazis?

Mayra Bitsko: Save me! An alien took over my child's personality

Frank Clayton: Get happy: 20 scientifically proven happiness activities

Susan Scutti: It's Genetic! Obesity and the 'Carb Breakdown' Gene

Lecia Bushak: Why Hand Sanitizer May Actually Harm Your Health

Stacy Rapacon: Great Funds You Can Own for $500 or Less

Cameron Huddleston: 7 Ways to Save on Home Decor

The Kosher Gourmet by Steve Petusevsky Exploring ingredients as edible-stuffed containers (TWO RECIPES + TIPS & TECHINQUES)

Jewish World Review

Mayo Clinic Medical Edge: What you need to know about implanted pain relief devices

By Halena M. Gazelka, M.D.



JewishWorldReview.com | DEAR MAYO CLINIC: Eighteen months ago, I had surgery on my back to relieve the nerve pain that radiates down my leg. It didn't help as much as I'd hoped, and my doctor says additional surgery isn't likely to help. I have tried pain meds, steroid injections, chiropractic, and physical therapy, but I'm still in a lot of pain. What exactly are implanted pain relief devices, and would I be a candidate for one? If so, how effective are they?

ANSWER: The pain you're describing is called radiculopathy, and it is a type of nerve pain. There are several devices for pain relief from varied types of chronic nerve pain. Some rely on stimulating nerves with a mild electrical current. Other implanted devices deliver pain-relieving medication directly into the spinal canal. These devices are typically implanted by physicians specializing in pain management. Both types are usually considered only after more conservative options have failed, and they seldom provide complete pain relief. However, when they are effective, they can change debilitating pain into tolerable, manageable pain that allows you to function and regain your life.

Nerve stimulation devices work by blocking pain signals as they travel from the nerves to the spinal cord. In doing so, they send electrical impulses from the spinal cord out along affected nerves. These electrical impulses may produce a pleasant "tingling" sensation that can be directed to the area where you feel pain. The two main forms include:

1. Spinal cord stimulators. With these, a wire electrode is implanted in the epidural space within the spinal canal. It provides electrical stimulation on an area of the spinal column called the dorsal columns, which is where sensory nerves from the spinal cord are located.

Spinal cord stimulators are FDA approved for conditions that involve pain generated from damaged or dysfunctional nerves of the trunk, legs or arms. This includes problems such as radiculopathy, pain that persists after spine surgery, peripheral neuropathy, post herpetic neuralgia, and a condition called complex regional pain syndrome, which usually results in leg or arm pain.


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2. Peripheral nerve stimulators. Placed along nerves that branch off from the spinal cord, these may be used for pain arising from numerous peripheral nerve problems, including remaining leg pain after back surgery, post-herpetic neuralgia and some types of headaches.

Peripheral nerve stimulators are more targeted to a specific nerve or group of nerves than are spinal cord stimulators. Occasionally, spinal cord and peripheral nerve stimulators are used in combination to achieve better pain relief.

Determining if one or both nerve stimulation devices are right for you depends on many factors, including the cause of your pain, its location, your overall health and your ability to care for an implanted device. If your doctor thinks you may be a candidate, you'll likely undergo a stimulation test with a temporarily placed electrode to find out how well you respond to the therapy. If the device had a beneficial effect, the wire electrode and the electrical generator (or battery pack) can be fully implanted under the skin during a separate surgical procedure.

MEDICATION PUMPS
Technically called intrathecal drug delivery systems, these deliver pain medication directly into the fluid that surrounds the spinal cord. They're most often used to relieve pain from cancer or to relieve chronic back pain that's unresponsive to more conservative therapies. They also may be used as a "last resort" option for certain types of severe chronic pain. They may be considered if a nerve stimulator fails to provide relief, or rarely, in conjunction with a nerve stimulator.

Medication pumps consist of a small flexible catheter that's placed in the spinal fluid. The catheter is connected to a drug infusion pump that's implanted into your lower abdominal wall. The pump is programmed to dispense the drug it contains -- often opioid pain medications (such as morphine) or other medications to treat nerve pain -- at a set rate and can be refilled with an injection through your skin and into a sealed port on the device.

A key limitation of medication pumps is the eventual development of tolerance to the drugs. Dosages of pain medication can be increased as tolerance rises, but there are limits. That's why this therapy is generally used for people with limited life expectancy or those in extreme circumstances. One main advantage of this type of device is that the medication is delivered directly to the site of action (spinal cord), and the effective dose can be reduced by 100 fold from the equivalent dose by mouth. This greatly reduces the risk of side effects from the medications.

Surgery to implant any pain device carries some risk of complications, such as infection, bleeding, or even the potential for spinal cord or nerve damage. Fortunately, the risks are quite low.

Nerve stimulators and medication pumps can work exceedingly well in the right situations. When effective, a reasonable goal with these devices is to reduce pain by at least 50 percent. The main objective is to reduce pain to a manageable level, allowing improved function and quality of life. -- Halena M. Gazelka, M.D., Pain Medicine-Anesthesiology, Mayo Clinic, Rochester, Minn.

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