Paisley Park, Chanhassen, MN
Before we dive into the heavier topics, I want to give a Top 5 “honorable mentions” to some complex dance moves Prince performed which I chose not to analyze in depth for this blog series. These dance moves were not likely the cause of the pain for which Prince sought medical care, but they are impressive nonetheless.
#5 - Entrechat quatre - This is a fluttering ballet move where the dancer jumps and beats their legs in front and behind each other while in the air - another nod to his love and respect for ballet dancers.1
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#4 - Stomping - Prince’s shoe designers had to create reinforcing stainless steel shoe braces to hold the high-heels of his shoes in place because Prince danced so intensely, he broke the heels off of his shoes.3 As I mentioned in Prince: Part 2 - The Beautiful Ones, wearing high-heels pushes the talus bone and the ankle forward changing the biomechanical function of the ankle and tension of the surrounding muscles and tendons.4
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#3 - Coffee Grinder/Helicopter -This is a breakdance move where the dancer places their hands on the ground and performs a sweeping circular motion of one leg while lifting the other leg to jump over the sweeping leg, again proving Prince not only crossed genres in music, but in dance as well.6
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#2 - Humping - Let’s face it. This would not be a Prince countdown if I didn’t mention it. No formal explanation here - repetitive hip thrusts to his guitar, his dancers, the floor, the air… really anything that lends itself to the show was fair game!
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Oh, he keeps going! But I’m gonna stop that last video riiiiiiiiiiiight there!
#1 - Kong up/Jumps - Parkour moves on and off of pianos, stages and risers. These are power moves that require fast twitch muscle activation.9 Power and speed. Prince was an athlete through and through. He was a skilled basketball player in middle school and continued playing the game with friends, bandmates and occasionally with other celebrities as infamously reenacted by Dave Chapelle.10 Although not all of Prince’s injuries would have been reported, these types of jumps, in high-heels no less, likely led to multiple ankle sprains, knee pain and even early onset osteoarthritis of the joints in the lower extremities.11,12
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As I go into the subject of pain medication and opiate addiction, I want to make clear my intentions for the sake of all the of Prince’s “fams”, friends and loved ones whose hearts continue to ache from losing his physical presence. Please know that I address this with the utmost respect for this man and his legacy. I have been studying Prince in detail for over an entire year now, first as a doctor and now as a “fam” and an admirer. I know a year doesn’t seem like a lot for those who have followed his career for decades, but what I do bring to this discussion is an objective eye and ear because I don’t have the same longstanding emotional connection to him or his music. It is all still quite new to me. Even more than his music, I admire his transformation and growth as a human being. The evolution of his style and fashion is striking, but the evolution of his Spirit is an example to us all. Prince was a mentor to so many people in his lifetime. I like to think of him as a mentor to me in Spirit over this last year. During an interview with Arsenio Hall, Prince implied that if he had not been such a success in music, he would have liked “to teach in some capacity”.13 Because Prince found joy in teaching us through his life and his music, I believe the Spirit of such a man would also want us to find some REVELATION* through his death.
Few people know the whole story of how Prince was introduced to pain killers; moreover, even fewer people know how he received the medication laced with fentanyl that caused his death. Most of us will never know. As unique of an individual as he was, this story of accidental fentanyl overdosage is anything but unique. Prince’s life was prophetic in many ways. Back when CDs were still the main medium of music consumption, Prince forewarned what the digital age of music would bring.14,15 Before we had the term “gender fluidity” he embodied androgyny, love symbol and all.16 Prince warned us not to let technology control us as we now recognize the effect social media is having on our mental health.17,18 And now we find ourselves in an opioid crisis that was steadily on the rise between 2016 and 2021. Currently, the rate of drug-involved overdose deaths is still higher now than it was in the previous decade.19, 20 According to the National Institute on Drug Abuse in 2021, drug-involved overdoses accounted for over 106,000 deaths in the United States alone.
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Perhaps we should have heeded all of Prince’s warnings with more urgency then. Perhaps we should now.
The next subject we need to address is the lens through which we view drug addiction. I saw a comment from a Prince “fam” that said, “He was not a drug addict, he was a man of God.” What is problematic about this logic is that mutual exclusivity does not hold true in human nature. It can be true that Prince had a drug addiction and was a man of God… at the same time. As highly as we may esteem others in our hearts and in our minds, no one is perfect. We tend to view others as less-perfect versions of ourselves, or occasionally in the case of our heroes, more-perfect versions of ourselves. In other words, we tend to limit another person’s experience based on the understanding we have through our own experiences. Therefore, the number experiences we have had in our own lives dictates the level of complexity with which we are capable of viewing others. Now, how about that logic! Prince even wrote a song about this. You only know what you know!21
In your understanding and opinions of one another, I urge you, proceed with grace or resign yourself to be perpetually disappointed.
Part of this grace comes from understanding the science of addiction and how opioids affect our neurobiology. Opioid medications bind to receptor sites in the brain and other parts of the body that block signals that perceive pain.22 Please note, I said perceive, not cause. This perception or lack of “feeling” pain gives the patient a false sense that their issue is resolved. However, the mechanism or process that is the root cause of their pain remains unaddressed. This means that the patient will continue to move through life with impaired movement patterns and/or habits that are likely worsening the actual underlying cause of their pain.
A major misconception of addiction is rooted in the stereotype of who an “addict” is or is not. Historically, the stereotype of an “addict” is a person who participates in illicit drug use due to a reckless lifestyle, poor decision-making or questionable character. When in more recent decades, 75% of people abusing opioids reported their initial use of an opioid was prescribed to them by a medical professional. And nearly 80% of heroin users reported using prescription opioids prior to using heroin.23 Fentanyl is the synthetic opioid responsible for Prince’s accidental and fatal overdose.24 It is 50 times stronger than heroin and 100 times stronger than morphine.25 From the toxicology report, 67.8μg/L of fentanyl were found in Prince’s bloodstream.24 To put that into prospective, as little as 20μg/L of fentanyl can be fatal depending on a person’s size.26 At the time of his death, Prince was recorded as being 5’3” and 112lbs.27 From 2019 to 2020, over 82% of all opioid-involved deaths were from synthetic opioids, most commonly fentanyl and its analogs.28 The stereotype and stigma associated with drug addiction may be the reason why people who need help the most, are reluctant about seeking proper care.
It is no wonder that Prince, someone deeply devoted to his spiritual growth, would not want his condition misconstrued as a lack of character or judgment, because, in fact, it is not. Most often people turn to pain medication because it is what is prescribed to them by their doctors and because their pain is excruciating. I believe the truth is that Prince lived much of his life with chronic pain and intense acute flare-ups of pain, likely unexplained and misdiagnosed and incredibly frustrating to him. He also likely began routine usage of opioids initially as prescribed medication. When his recovery was not as expected he likely became more heavily dependent on the only thing that gave him relief.
According to former employee interviews with a Carver County detective investigating his death, Prince did have a chiropractor who would come to Paisley Park or travel to him on occasion.29 But unfortunately by the time he found a drug-free solution to his pain, the neural patterns of addiction would have already been so deeply established in his neural networks they would be incredibly difficult for him to overcome.
Neural networks are connections of neurons in the brain and spinal cord that communicate internal changes of the body. In the case of substance abuse disorder, these changes are caused by chemical stimuli. The stimuli then cause hyperconnectivity in particular areas of the brain and create dysfunction in the brain’s ability to communicate properly with the rest of the body.30 Neural networks can be changed or reversed. New neural networks can even be created. This is the definition of neuroplasticity, but these changes take time, as all sustainable change does.31
*Again, I make this disclaimer: I do not have access to any of Prince’s medical records and I am speaking in a strictly biomechanical analysis. Every patient is different and has other health factors to consider that can contribute to chronic pain. I am also not making any medical suggestions to the audience reading this blog. Please consult a local doctor, chiropractic or medical, for an analysis and diagnosis of any specific symptoms or pains you are experiencing.
I strongly believe much of Prince’s pain could have been avoided or at least significantly reduced with early use of chiropractic care. It would have been best for him to start being adjusting in his teens or early 20s when he started dancing and performing frequently but even in his 30s and 40s much of the accumulation of muscle compensations and misalignments could have been corrected and proper function restored. It is never too late to begin chiropractic care, but when advanced arthritic changes in the spine occur, the effects of chiropractic care can be limited. When the other option for pain relief is addictive medications that do nothing to correct the root cause of an issue, time is truly of the essence.
I tell all my patients, get adjusted regularly to fix little problems as you go about your life. The goal should be to live without pain and take preventative measures instead of waiting until you are in pain and reactive care is required. Our healthcare system in the United States is unfortunately extremely reactionary, when in my opinion the best health practice is prevention.
When I decided to become a Chiropractor, I had many well-meaning, albeit misinformed friends and family members ask me, “Why don’t you become a REAL doctor?” To which I say three things:
1. I am a REAL doctor.
2. I chose my career based on my philosophy of what I believe health should be
3. I want NOTHING to do with pharmaceutical companies.
That is not to say pharmaceuticals do not have their place in healthcare, but their role and influence in our healthcare system is grossly inflated to the detriment of most and the financial gain of few. We have become a society of instant gratification. People want immediate results—a pill for everything. They will put all manner of chemicals in their bodies daily without fully understanding what those chemicals are, the effects they will have in their bodies and without questioning their safety. Yet the idea that multiple chiropractic adjustments are required for retraining and maintaining proper function of your neuromusculoskeletal system is still met with skepticism. And in that mindset, we have settled for a health system that treats symptoms to make people “feel better” rather than treating the root issues to facilitate their “being better”.
Prince along with hundreds of thousands of others in our country have suffered in silence for years for any number of reasons. It has been 7 years since Prince passed. In our mourning, we may have missed the immediate lesson he had to teach us, so let us now revisit this lesson and take it to heart. It is time for REAL solutions to this opioid problem.
Changing our minds about how we view addiction, eliminating the stereotype of who can or cannot be an addict and understanding why people fall into addiction are the first steps to healing our society of this opioid epidemic. Let love and compassion be the lens through which we view this issue. After all, it is our brothers and sisters, children and parents, friends, coworkers, partners and even our heroes and our icons who need our help.
REFERENCES
*Revelation https://youtu.be/ZDJWekf0xqk
Ballet Terminology: https://www.abt.org/explore/learn/ballet-dictionary/
Partyman music video: https://youtu.be/4zqaTU5bGx8
Baby I’m a Star music video: https://youtu.be/9Lgf2VU_M70
Little Red Corvette Music video: https://youtu.be/v0KpfrJE4zw
Plotkin, D. L., Roberts, M. D., Haun, C. T., & Schoenfeld, B. J. (2021). Muscle Fiber Type Transitions with Exercise Training: Shifting Perspectives. Sports (Basel, Switzerland), 9(9), 127. https://doi.org/10.3390/sports9090127. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473039/pdf/sports-09-00127.pdf
Dave Chapelle skit: https://youtu.be/ff8LEx9Mw54
Lytle JB, Parikh KB, Tarakemeh A, Vopat BG, Mulcahey MK. Epidemiology of Foot and Ankle Injuries in NCAA Jumping Athletes in the United States During 2009-2014. Orthop J Sports Med. 2021 Apr 16;9(4):2325967121998052. doi: 10.1177/2325967121998052. PMID: 33948444; PMCID: PMC8053761. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053761/
Amoako, A. O., & Pujalte, G. G. (2014). Osteoarthritis in young, active, and athletic individuals. Clinical medicine insights. Arthritis and musculoskeletal disorders, 7, 27–32. https://doi.org/10.4137/CMAMD.S14386. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039183/
Arsenio Hall Interview: https://youtu.be/EDUhHwTLZpE
Prince speech on the digital era of music: https://youtu.be/HQYPZDeOzGc
Prince on record companies: https://youtu.be/jXawTbQFGjQ
Interview with Chris Rock: https://youtu.be/_6k13ZDRl7g
Computer (Social Media) Warning: https://youtu.be/Iy7i9ru7HB8
Karim F, Oyewande AA, Abdalla LF, Chaudhry Ehsanullah R, Khan S. Social Media Use and Its Connection to Mental Health: A Systematic Review. Cureus. 2020 Jun 15;12(6):e8627. doi: 10.7759/cureus.8627. PMID: 32685296; PMCID: PMC7364393. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364393/pdf/cureus-0012-00000008627.pdf
https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates Overall, drug overdose deaths rose, overdose deaths reported in 2021
The Same December music video: https://youtu.be/9_tIrT2sKPg
NIDA. 2021, June 1. Prescription Opioids DrugFacts. Retrieved from https://nida.nih.gov/publications/drugfacts/prescription-opioids on 2023, April 19. https://nida.nih.gov/download/37633/prescription-opioids-drugfacts.pdf?v=7e5209dd2a0356d596862911eb963a2b
NIDA. 2015, October 1. Prescription opioid use is a risk factor for heroin use. Retrieved from https://nida.nih.gov/publications/research-reports/prescription-opioids-heroin/prescription-opioid-use-risk-factor-heroin-use on 2023, April 19. https://nida.nih.gov/download/19774/prescription-opioids-heroin-research-report.pdf?v=fc86d9fdda38d0f275b23cd969da1a1f
Carver County Sheriff’s Reports: https://youtu.be/_5z9shGdzTo
Medical examiner’s report: Medical Examiner Report: https://www.anokacountymn.gov/DocumentCenter/View/10066/Press-Release-June-2-2016?bidId=
Former Prince Employee Interviews: https://youtu.be/p9AZn8_qom8 ; https://youtu.be/DtUd8_6FdFA
Tolomeo S, Yu R. Brain network dysfunctions in addiction: a meta-analysis of resting-state functional connectivity. Transl Psychiatry. 2022 Jan 28;12(1):41. doi: 10.1038/s41398-022-01792-6. PMID: 35091540; PMCID: PMC8799706. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8799706/pdf/41398_2022_Article_1792.pdf
Puderbaugh M, Emmady PD. Neuroplasticity. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557811/?report=classic. https://www.ncbi.nlm.nih.gov/books/NBK557811/#_NBK557811_pubdet_