Some recognizable examples of Nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (Advil, Motrin), diclofenac, and  naproxen (Aleve).  They are frequently used as the first line of defence to reduce pain and inflammation.  Most NSAID medications are available without a prescription and are widely used to reduce fever and pain related to long- and short-term medical conditions such as headaches, arthritis, menstrual cramps, and flu symptoms. However, just because they are available without a prescription does not mean that they are 100% safe. New labeling requirements have raised awareness of potential risks for the estimated 30 million Americans taking nonsteroidal anti-inflammatory drugs each year.

The Food and Drug Administration has recently strengthened its warning on NSAIDs due to recent studies that shows even small amounts of NSAIDs present a risk of heart attack, heart failure, or stroke. The updated warning is a result of a growing body of research into these widely used over the counter (OTC) drugs. While it was always presented as a risk, the new strengthened warning clarifies that NSAIDs may increase the risk of heart attack or stroke in all patients, with or without heart disease or risk factors for heart disease as previously thought.  Those with risk factors of heart disease should be particularly cautious because they are already at a higher baseline for such complications. The FDA will require new labels to reflect this developing research.

Should you worry? Not if you are using these medications as directed. There seems to be a consensus from the medical community that more studies are needed before we empty out our medicine cabinets. Bruce Lambert, director of the Center for Communication and Health at Northwestern University, who specializes in drug safety communication shared his comments with the New York Times, “One of the underlying messages for this warning has to be there are no completely safe pain relievers, period.” Another article for NPR highlights the general rule of using caution with any medication.

Although the FDA’ s  new warnings need not cause alarm, the announcement is an important reminder to the millions of people that use NSAIDs on a daily basis that misuse or overuse of OTC drugs could result in severe health consequences. Patients that rely on these OTC painkillers long term should talk to their health care providers about reasonable alternatives.


We always imagine medicine racing forward, but what if a look back into our evolutionary biology could give us answers to some of the health problems we face today?

Lower back pain is one of the most frequent complaints worldwide, and the World Health Organization has recognized it as a leading cause of disability. Scientists in Scotland, Canada and Iceland have published a study which found that people with lower back pain and other problems are more likely to have a spine shaped similarly to our ape ancestors.

Prof Mark Collard, from the University of Aberdeen and Simon Fraser University in Canada noted in an article for the BBC:

“Our findings show that the vertebrae of humans with disc problems are closer in shape to those of our closest ape relatives, the chimpanzee, than are the vertebrae of humans without disc problems.”

This study compared human, chimpanzee, and orangutan vertebrae to examine links between shape, movement and disc herniation of the spine. Because humans have evolved into a bipedal species (i.e. walking on two legs) the shape of our spine has changed to adapt to our lifestyle as the demand on the vertebrae changed. Researchers noted that humans with lower back pathologies might have a spine that is “less adapted for walking upright.”

The researchers note that the findings of this study have diagnostic and preventative value as practitioners would able predict who is at risk for certain spine injuries or back pain.


Today we are happily sharing another whiteboard video by Dr. Mike Evans, Toronto based professor, doctor and health educator extraordinaire.

Dr. Evans outlines some very practical aspects of preparing for joint surgery which encourage the patient to be at the centre of the process. The key message: all of the surgeons, nurses and practitioners that participate in your care before and after your joint surgery will be doing everything they can to support you with their skill and expertise, but ultimately you will play the instrumental role in the healing and long term functionality of your new joint.

The video points out that, in Ontario, patients are generally in and out of hospital after 4 days… sometimes sooner. This gives us bit of perspective on this major procedure. The actual surgery is a the shortest event in the whole process. It is what you do before and after your time in the hospital that will influence your outcome dramatically.

Dr. Evans introduces the idea of the new normal: Your joint has been causing you pain and therefore limiting your activity. After surgery it might be difficult to imagine doing things you had avoided to prevent pain leading up to the replacement. However, it is important to develop the physical  and mental strength before  your procedure and keep up this momentum and attitude in the days and months after surgery. More specifically, simple tasks done in advance (organizing your home for your return and having a contact list of people to call on for help) can allow you to focus on your rehabilitation as soon as you leave the hospital.

We see a lot of people at Allevio who are considering joint replacement or are working with our specialists post-operatively.  We are in the process of developing a Total Knee Program and we currently offer several therapies that address pain following joint replacement surgery. If you are a patient considering or having a joint replacement, please take time to research the conditions and treatments below, or feel free to ask your clinical team about these options. It is always important to do homework and understand what treatments may be available, and what independent reserach has shown for any treatment you may consider.

Some potential treatments may include:

Pulse Radio Frequency

Platelet Rich Plasma (see previous post)

Osteopathy (see previous post)

Chiropractic strategies including various modalities

Custom designed support bracing and orthotics, available through certified and trained experts such as Chiropractors for bracing and Chiropractors or Chiropodists for orthotics.


In a recent article in  Chatelaine, an assistant editor tested out osteopathy for her joint pain. Like many first time patients of osteopaths (also known as DOs or Doctors of Osteopathic Medicine) she was surprised by just how much information could be determined by observation and touch alone. The final verdict: not only was the physician able to aleve some of her discomfort, but she was also able to tell her about her digestive and respiratory problems after one session of hands-on therapy.

So what is osteopathy exactly?

In short, an osteopath is trained to treat the whole person instead of the symptoms or disease. The intricacy of all of the body’s systems (musculoskeletal, respiratory, cardiovascular, digestive, reproductive, or nervous system) are considered when trying to determine the source of imbalance causing sickness or discomfort. The overall idea is to restore function so the body can find its way toward healing itself naturally.

What sets osteopaths apart is their holistic approach, the osteopathic medicine structure influences function, and osteopaths are trained to touch and observe the body to determine the state of tissues, muscles, fluids, and bones.

There have been several studies which demonstrate that osteopathy is particularly effective in treating chronic pain. The holistic approach of an osteopath takes into account the patient’s full life situation (for example; stress, mental health, living conditions) and uses a combination of treatments to restore balance and function to all systems. As pain is a complex experience, many patients benefit from the the comprehensive approach of osteopathic techniques.

While Allevio Pain Management offers Osteopathy services as part of its integrated care model, Allevio always suggests patients find a provider that they are comfortable with, who can communicate and collaborate with their existing team for care, and of course who is a member in good standing with their local college or governing body.


More than managing headaches and chronic pain, Allevio is here to help you get your life back. Our services are completely geared to offering you the best relief available.

Our Flagship Location

240 Duncan Mill Road Main Floor Suite 101 Toronto, Ontario M3B3S6

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