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Why Back Pain Is Difficult to Treat

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Two women come to their doctor with searing lower back pain and a fiery sensation shooting down their legs. Both women have back pain with sciatic-like symptoms, but the source and treatment of their pain are different.

Same Pain, Different Problems

Herniated disk. Helen had a herniated disk. The disk caused inflammation and nerve irritation, which resulted in fiery pain down her leg. Standard treatments for a herniated disk include physical therapy, medications, steroid injections, and time for healing.

Nerve sensitization. Nancy’s pain stemmed from nerve sensitization or nociplastic pain. Nociplastic pain arises from abnormal pain processing in the brain and nerves. Nerves become more sensitive and reactive to stimuli, exaggerating pain signals to the brain.

Nancy’s back and leg pain had slowly worsened over the past year. She developed pain hypersensitivity where simple, everyday movements—like getting up from the couch and walking to the kitchen—had become increasingly uncomfortable. Her symptoms also spread. Instead of pain in a small area of her back, she felt it across her back, down her thighs, and enveloping her leg.

Although an injury may have started Nancy’s pain, it was no longer the factor perpetuating it. Over time, the pain source had shifted from an injury to the nervous system (brain and nerves). Due to nerve sensitization, her brain and nerves kept telling her she was hurt even after the injury had healed.

You Can Have Both Sources of Pain at the Same Time

A mixed pain state is when you have injury pain and sensitization pain simultaneously. For example, you have back pain arising from a herniated disk and sensitization. Sensitization amplifies the pain signal that is already present. The two pain sources overlap into one set of symptoms, making it difficult to discern where the discomfort arises from.

For back pain, three different pain scenarios are possible:

  1. Back pain from an injury with no sensitization, meaning the nerves have not become sensitized; this situation will respond well to standard treatments. This was the case with Helen.
  2. Back pain from an injury and sensitization; in this case, there will be a partial response to standard treatments. This is a “mixed pain state.”
  3. Back pain with predominant sensitization, where most symptoms stem from sensitization; there will be minimal response to standard treatments. This was the case with Nancy.

Understanding the source of back pain is important for selecting the appropriate treatment. Standard treatments like physical therapy, anti-inflammatory medications, and steroid injections don’t work when the pain comes predominantly from sensitization.

The more sensitization drives the symptoms, the less responsive they are to standard treatments because the pain source has shifted to the nervous system.

For example, Helen, with a herniated disc, responded well to treatment with physical therapy and a steroid injection. On the other hand, Nancy did not respond to those interventions. The correct target for her treatment is the nervous system.

You don’t put a cast on a paralyzed arm from a stroke because the cause of the injury isn’t in the arm; it’s in the brain. The problem is deeper in the nervous system. The same is true when treating sensitization.

Credit: webmd.com

Inter thrash Monza 5-1 away with Calhanoglu, Martinez doubles

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Inter Milan thrash Monza

Inter Milan outclassed Monza to chalk up a 5-1 away win in Serie A on Saturday with two goals each from Hakan Calhanoglu and Lautaro Martinez as they moved a provisional five points clear at the top after an exciting game with three penalties.

It was the first Serie A double for the Turkey midfielder who joined Inter in June 2021 after four seasons at AC Milan.

Pessina eventually pulled a goal back for the home side in the 69th with a spot kick but Martinez then made it 4-1 with another penalty after 84 minutes.

The Argentine, who netted twice in the reverse fixture in August, became the fourth player involved in at least 20 goals in each of the last four seasons across the big five European leagues, joining Mohamed Salah, Kylian Mbappe, and Harry Kane.

Martinez has 18 goals and two assists so far this term.

Thuram sealed the win for the visitors two minutes from time after a brilliant cross from Henrikh Mkhitaryan.

Credit: reuters.com

Sancho grab assist on Borussia Dortmund return

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Sancho marks Dortmund return

Jadon Sancho marked his Borussia Dortmund return from Manchester United with an assist to help the German side to a 3-0 win at Darmstadt 98.

On Thursday, the England winger completed a loan move to the club he left for Old Trafford back in 2021.

And he set up Marco Reus to score Dortmund’s second, after Julian Brandt had grabbed the opener.

Youssoufa Moukoko struck in added time to seal the visitors’ first win in five Bundesliga games.

Sancho returned to Germany having not played for Manchester United since 26 August after falling out with manager Erik ten Hag.

“Ever since I’ve come back I have felt like at home and felt great to be on the pitch again,” said the 23-year-old, who came off the bench in the 55th minute.

“To be happy again, to be back on the pitch and help the team – getting them back into the top three and the Champions League of course. We take it game by game. We will fight every game.”

Credit: bbc.com

Harry Kane scores again as Bayern beat Hoffenheim

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Harry Kane scores again

Harry Kane scored his 22nd Bundesliga goal of the season as Bayern Munich beat Hoffenheim on an emotional night of tributes paid to Germany great Franz Beckenbauer at Allianz Arena.

Bayern wore shirts with ‘danke Franz’ written across the front in their first game since former player and manager Beckenbauer’s death aged 78 on Sunday.

Jamal Musiala scored either side of half-time before Kane lashed in a late third for the hosts.

Bayern stay second in the table.

The Bavarians, who have lost just one of their 16 league matches so far, are one point behind leaders Bayer Leverkusen.

Bayern struggled for rhythm throughout following an emotionally charged build-up to the game, with numerous tributes to Beckenbauer, who made 582 appearances for the club and later went on to manage them.

The home team warmed up wearing the former World Cup winner’s iconic number five shirt and walked out to ‘Gute Freunde’, a song recorded by Beckenbauer in the 1960s, before kick-off.

It had been a quiet night for ex-Tottenham forward Kane prior to his late fierce strike into the top corner, heading wide when well placed and then blazing over the bar after Hoffenheim had been reduced to 10 men following Grischa Promel’s sending off for two bookings.

Credit: bbc.com

Chelsea chalk narrow win over London rivals Fulham

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Cole Palmer has scored five penalties this season,

Cole Palmer’s first-half penalty gave Chelsea a narrow win over West London rivals Fulham at Stamford Bridge in the Premier League.

Palmer’s reverse pass set up Raheem Sterling, who was caught by Issa Diop inside the penalty area.

Palmer dispatched the spot-kick, sending Fulham keeper Bernd Leno the wrong way to net his ninth goal since joining the Blues in August.

Conor Gallagher almost added a late second when his sweetly struck effort using the outside of his boot cannoned off the far post.

Chelsea kept Fulham at arm’s length and held on for their third consecutive victory to jump to eighth in the table.

The visitors stay in 13th and have lost four of their past five matches. It was not a classic but Chelsea did enough to come away with three points.

Victory meant Mauricio Pochettino’s side won a fourth home league match on the bounce for the first time since July 2020.

Credit: bbc.com

City secure late win over Newcastle in a breathless encounter

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Kevin de Bruyne's goal was his first of the season

Oscar Bobb scored a stoppage-time winner as Manchester City moved within two points of Liverpool at the top of the Premier League with victory over Newcastle in a breathless encounter at St James’ Park.

The Norwegian, 20, latched on to a superb lofted pass from fellow substitute Kevin de Bruyne and showed superb footwork to take the ball pass Martin Dubravka and tap into the empty net.

It rounded off a brilliant game that saw both sides dominate periods, but City controlled the second half and showed the fight and quality to seal what could be a huge win come the end of the season.

While Bobb enjoyed his first Premier League goal, the success was sparked by De Bruyne.

Just four minutes and 35 seconds after he came off the bench, the Belgian found space in between the home defence and midfield before sweeping a finish into the far corner.

Bernardo Silva had put the Premier League champions ahead in the 26th minute, meeting Kyle Walker’s right-wing cross with an audacious backheel, before two goals in three minutes put Newcastle in charge.

First, Alexander Isak collected a sweeping Bruno Guimaraes pass before curling past City’s reserve keeper Stefan Ortega – who had replaced the injured Ederson – and into the top corner for his fourth goal in four games.

Then, Anthony Gordon was released down the left and he took advantage of Walker backing off to spectacularly curl into the bottom corner and send the home fans into raptures.

Credit: bbc.com

Nigeria, Equatorial Guinea game end in a stalemate

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Victor Osimhen got off the mark with a goal

Victor Osimhen scored a first half equaliser but wasteful Nigeria were held to a 1-1 draw in their Africa Cup of Nations Group A opener with Equatorial Guinea in Abidjan, unable to turn their pressure into three points.

Iban Salvador netted a surprise opener for Equatorial Guinea against the run of play with a well-worked goal, but the lead lasted only two minutes before Napoli forward Osimhen headed Nigeria level.

The West African side dominated the chances after that but found Equatorial Guinea goalkeeper Jesus Owono in fine form as he made several outstanding saves, to go with some poor finishing.

The match was a slow burner, but burst into life with two goals in as many minutes towards the end of the first half.

Nigeria’s Zaidu missed an open goal at the back post when a cross from the right eluded everyone and fell kindly to him, but he skewed his shot high and wide with the goal gaping.

Equatorial Guinea took the lead on 36 minutes with a fine finish from Salvador.

Some hesitant defending saw Nigeria fail to clear the ball and when Salvador was teed up by Jose Machin 18 yards from goal, he side-footed a shot into the bottom corner with a clinical finish.

But the lead lasted only two minutes as Nigeria hit back almost immediately.

Winger Ademola Lookman hung up a cross from the left to the back post and Osimhen had the simplest of headed finishes to score his 21st international goal.

Moses Simon then forced a good low save from Equatorial Guinea goalkeeper Jesus Owono when his shot looked destined for the bottom corner as the teams went to the break at 1-1.

It will be viewed as two points dropped for the Super Eagles, who have faced recent stinging criticism after 1-1 draws with tiny Lesotho and Zimbabwe in the World Cup qualifiers in November.

Credit: espn.com

Afcon 2023 kick-starts with spectacular opening ceremony

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The 2023 Africa Cup of Nations opening ceremony lived up to the hype following the display of spectacular cultural performances and delivery of musical acts.

The fans were treated to a raucous opening ceremony, a riot of colour and noise which featured a rendition of the tournament’s official song by popular Ivorian group Magic System.

Performances from local dance troupes and top music artists such as Dadju and Tay C, as well as Yemi Alade, left the stadium in full excitement.

Opening ceremony

There were also displays of masquerades and a rich showcase of Ivorian culture through their colours and fireworks.

Meanwhile, the President of the country delivered a message of peace and solidarity and was delighted to welcome Africa to Abidjan.

There were also speeches by FIFA President Gianni Infantino and African football boss Patrice Motsepe.

Credit: sportsbrief.com

Ivory Coast record emphatic win over Guinea-Bissau

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Winning start for Ivory Coast

Hosts Ivory Coast opened their 2023 Africa Cup of Nations campaign with a 2-0 victory over Guinea-Bissau.

Seko Fofana gave the Elephants the perfect start in the Group A clash in Abidjan when he blasted home from just inside the area in the fourth minute.

He almost doubled the lead before half-time but another powerful effort was tipped on to the bar by Ouparine Djoco.

Jean-Philippe Krasso hooked in the second after the break after some smart control under pressure in the box.

The 2023 Afcon finals have been pushed back by six months – into early 2024 – to avoid the rainy season in West Africa, but the delay helped Ivory Coast finalise their preparations, with the total cost of hosting more than $1bn.

The Elephants, looking for their third continental triumph after wins in 1992 and 2015, had to begin their bid for glory without first-choice striker Sebastien Haller because of injury.

But midfielder Fofana broke the deadlock early on after being fed by Franck Kessie, skipping past a couple of defenders and sending his powerful right-footed strike inside the right-hand upright.

Mama Balde spurned Guinea-Bissau’s best chance in the first half, scuffing his effort when played into the box, and only a smart save by Djoco kept the score at 1-0 after the impressive Fofana latched on to a cut-back from the right.

Krasso doubled the lead after showing great skill to juggle the ball and then swivelling and hooking in a left-footed shot from eight yards out in the 58th minute.

Substitute Franculino fired straight at Ivorian keeper Yahia Fofana in the final 20 minutes but the Djurtus, who have qualified for a fourth consecutive Afcon, could not score and are still awaiting their first win at the finals.

Nigeria face Equatorial Guinea at 14:00 GMT on Sunday in the second Group A match, while 2021 runners-up Egypt and four-time champions Ghana will also be in action later in the day as Group B commences.

Credit: bbc.com

Akufo-Addo on private life: I Go To Shows With My Family

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President Akufo-Addo with 1st Lady Mrs Rebecca Akufo-Addo

Regardless of the packed schedule of his professional life, the President, Nana Addo Dankwa Akufo-Addo, manages to spend time with his family.

The President made this known on Wednesday, January 10, 2024 at Jubilee House, when some Immersive Field Courses (IFC) students of the Harvard Business School visited him.

President Akufo-Addo was bombarded with questions from the students, one of which was to know how he strikes a balance between his personal and professional lives.

The president, in answering the question, admitted it was a difficult one, but told the students that it was important not to get consumed by the workload of his office.

He said the First Lady, Rebecca Akufo-Addo, has been bearing the brunt of the pressures associated with the office, but he tries “as much as possible to” strike the balance.

“The challenges, that’s a difficult one. Personal and public, yeah, it is a sort of question that other people should be here to be able to answer, [like] my wife, who has been the one to bear the brunt of the pressures of this office,” he said to the amusement of the students.

He continued, “But it is very important to try and strike the balance so that you don’t get consumed by the work you do in this office.

“That, you give yourself an opportunity still to do some things. I mean, go to shows, go to restaurants, have time to be with your family, and all of those. It is important that those continue. I have been a workaholic, but nevertheless, it is important that those balances are struck. I try as much as possible to do so.”

QUESTION

Dyllan Muller, one of the Harvard Business School IFC students from Australia, posed that question to President Akufo-Addo.

He said that as students, they love to keep themselves busy, but sometimes it is hard to find the balance between their personal and professional lives.

“As president, I can’t think of anyone that has more packed schedule than yourself. So how have you managed to navigate the challenges that come between balancing your personal and professional life as president, to not only be a good president but also a good friend and family member?” Muller asked.

He was one of eight students who asked President Akufo-Addo questions. Other questions were about the International Monetary Fund (IMF), international relations and its politics, with regards to Ghana.

Taking his turn, Ian Irungu, a Kenyan, asked the President about Ghana’s leadership in regional integration and initiatives to mirror the success of the East African community.

Another question was asked about what sectors the president would have paid much attention to, if he had another term.

RESPONSES

In his response, President Akufo-Addo was quick to point out his flagship policy, One District, One Factory, but also added agriculture.

Advising his successor on hindsight, he said they should recognise that the period in office is much shorter than it may seem.

He said, therefore, that the urgency to implement programmes in the initial days should “be re-doubled. That’s the lesson that I have learned. If you don’t act quickly, you are less likely to get the results that you anticipate. So, on hindsight, that will be my advice to my successor. Get going as quickly as possible and you have a better chance of succeeding and being able to leave a positive imprint on the future,” he said.

On the issue of international relations and politics, President Akufo-Addo said that Ghana deals with every country on merit.

He explained that, whatever feud there may be between the developed countries, for instance China and America, Ghana is not a party to it and the same should not affect the nation’s individual trade relations with those countries.

President Akufo-Addo would like a situation where the IMF serves as an interface between private and public funds.

He explained that the Bretton Woods Institution holds in trust the taxes of American citizens, but if it had access to private funds, it would be in a better position to lend more to developing countries.

He remarked that the private sector holds more funds than the public sector, which could make huge funds available to the IMF, than what it is getting from American taxpayers.

Meanwhile, President Akufo-Addo told the students that Africa was working towards leveraging the continental trade agreement to boost intra-African trade.

The Minister for Communication and Digitalisation, Ursula Owusu-Ekuful, briefed the students about the STEM and Digitalisation drive of Ghana, through its education system.

VISIT

Prof. Hakem Belo-Osagie of Harvard Business School, who led the students, told the president that they had come to learn from his leadership skills.

According to him, the school had resolved to allow students to experience leadership practically, in other parts of the world, and had developed courses on that.

The students that visited Jubilee House were Immersive Field Courses (IFC) students-Ghana. But there is IFC in other countries where other students, some of whom are Ghanaians, are also doing their fieldwork.

The Ghanaian Chronicle