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Showing posts from September, 2014

Genetics play a role in perception of pain

A recent study, supported by Proove Biosciences, sheds an interesting light on perception of pain.
The research project studied 2,721 subjects who suffer chronic pain and divided them into four subgroups based on their genetic makeup--COMT, DRD2,DRD1,OPRK1.  All of the subjects were currently prescribed opioid medications for their respective conditions.

All of the subjects were asked to rate their pain on a scale of zero to 10; those who rated their pain at zero were eliminated from the study.  The results, based on the four groups above, were as follows:





DRD1 gene variant was 33% more prevalent in the low pain group than in the high pain group.
In the moderate group, COMT and OPRK1 gene variants were found 25% and 19% more often respectively, than in the high pain group.
Lastly, the DRD2 variant was 25% more common in the high pain perception category than in the moderate group.




Study author Tobore Onoijighofi , MD says that this finding helps to understand why some individuals ha…

Did you know...

I am sharing this infographic as a public service reminder that September is Pain Awareness month.
Please take a moment to have a look--there's a lot of interesting information here!


Effect of Obesity On The Severity of Fibromyalgia

Back in 2010, a study published in the Journal of Pain suggested that overweight/obese persons with fibromyalgia syndrome had greater pain sensitivity, decreased quality of sleep, and reduced physical strength an flexibility. This might lead some to believe the combination of being overweight and having fibromyalgia is hopeless....









Interestingly enough, the study did not mention whether or not the subjects were overweight prior to their diagnosis, or if coping with the struggles of fibromyalgia led to weight gain.  In either case, weight management has its benefits and it's always a good idea for all of us be cognizant of our weight and our eating habits...

Now, fast forward to 2014.  In a study published in Rheumatology International, Castel et. al concluded that there is no real difference in response to multi modal treatment for fibromyalgia with respect to body weight/body mass index.







This is good news.....multi modal treatment of fibromyalgia seems to be equally effective for al…

Harnessing Herpes: A New Frontier In Pain Management

According to a March 2014 article in Pain Medicine News,  studies are underway to assess use of the Herpes Simplex virus to deliver genetic instructions to the central nervous system to "rewrite" pain signals at their source. After having success in animal models, the studies continue in human clinical trials.  It is entirely possible that this will become a safe and effective approach to chronic pain management in three to five years.

Dr. David Fink, a neurologist at the University of Michigan in Ann Arbor, and Joseph Glorisio, Ph.D. from the University of Pittsburgh, along with their colleagues at Periphagen Holdings are taking the lead in this new and exciting frontier in pain management!


Here is a simple schematic of how this approach might work:




Source: Pain Medicine News; Wikimedia

Spinal Cord Stimulators: Early interventions show high success rate

As a follow up to yesterday's post, I would like to share an example-- how early interventions to treat pain at the source make good sense.





Spinal cord stimulators are medical devices that have been in existence since the late 1960s-early 1970s. When a patient has chronic back pain, a device like this can be surgically implanted ..the actual device sits in the abdomen, while the electrodes are placed in the epidural space of the spine.  Once activated, the device sends electrical impulses that scramble the pain signal, and in doing so, muffle the pain sensation for that patient.  The device is programmable, so that it the signals it emits can be adjusted  after implantation as needed by the patient's health care team.
A recent study at Regina General Hospital in Saskatchewan regarding these devices yielded some interesting results.  Krishna Kumar, MD and his group studied 443 patients who were using these devices.  Seventy five percent of patients who waited 2 years or less f…

September is Pain Awareness Month...

Here's some help from the American Chronic Pain Association:

"Everyone who lives with chronic pain--or cares about someone who does--is different. But at the same time we all have common interests. We are a kind of community and deserve to have our voices heard. The materials and information here can help you reach out to others to help them better understand the social, economic, and personal interests related to pain.  Sometimes, the best way to help yourself is to help someone else."





Here are some resources for those who suffer from chronic pain, and their caregivers:

More about Pain Awareness Month 
Partners for Understanding Pain
Tool Kit for Older Adults




Chronic pain and depression

In light of the suicidal death of Robin Williams, and the news of his problems with depression and Parkinson's Disease, it seems appropriate to revisit the connection between chronic pain and depression. So today, I am sharing a patient guide from Pain Management News about this subject. If you would like to print a copy out for yourself, click here. Click on the image there to obtain a printable copy.





Image source: PainMedicineNews

Sleep Issues and Fibromyalgia: Partners in Crime

For people with fibromyalgia, sleep issues can be a big problem. Even though these individuals may have the ability to sleep at night, it is the lack of restorative sleep that seems to be a big factor. The body needs restorative sleep to repair and refresh itself; but for those who are plagued by insufficiency a whole night's sleep does little good. This is not insomnia, but a lack of sufficient sleep quality. Unfortunately, this seems to be both a cause and a consequence of the condition.
Research suggests that this sleep problem stems from a dysfunction of the autonomic nervous system. A 2009 study suggests that one factor at play is heart rate variability-a measure of ANS function--is abnormal in people with fibromyalgia.  The sympathetic (fight or flight) branch of the ANS seems to be stuck in an "on" position,  causing them to be on guard even when asleep.  As a result, sleep quality is impaired and a lack of restorative sleep is the result. This can become a vicio…

Addiction...it can happen to anyone

It recently came to my attention that people who use opioid medications for pain management might not understand the difference between drug abuse and addiction. It is possible for an individual to become addicted to a drug even when it's prescribed for a legitimate medical condition and is taken as directed. 

Consider the definitions of these words:

Addiction:
Habitual psychological and physiological dependence on a substance or practice beyond one's physical control.

Drug Abuse:
Habitual use of drugs to alter one's mood, emotion, or state of consciousness.








As you can see from the definitions above, addiction and abuse are not the same thing.  







That is the slippery slope when patients use opioids for pain management.  This is not to say that opioid medications have no place in pain management; it is simply a fact that when the opioid pain medications are used routinely over time, addiction will happen.  It does not matter if the user is abusing the medication or not, it's ju…

Some thoughts on quantifying pain.......

No human being on earth is exempt from experiencing pain...it is as much a part of the human condition as eating or breathing.  But pain is a weird thing...for example the neuropathy experienced by a diabetic is not at all like post-operative pain, or childbirth.  Modern medicine seeks to quantify pain using one of several different pain scales in an attempt to determine severity and appropriate treatment.
But is this the right approach?

Some examples will help to illustrate my point here...


The most basic method used to measure pain is to ask the patient to rate their pain on a scale of 1-10.  Zero or one indicates little to no pain; a score of ten is really off the charts!  Many medical practices use this method for their patients.The FACES scale is similar to the above, except that there are faces over the numbers to help those who might have a little trouble assigning a number to the intensity of their pain.  This is especially helpful when working with children or mentally impair…

NonDrug Pain Management Ideas: Pet Therapy

In this short video, Sandy Sentivany-Collins, RN, and Carly, a Golden Retriever working with our pediatric pain management service, are highlighted for their work at Lucile Packard Children's Hospital at Stanford. Carly is an official member of the Packard staff and understands a number of languages. Sandy and Carly's work provides extraordinary support to the kids and families at this hospital.




Pet therapy is good for all age groups. In November 2009 Science Daily reported on a study of using pet therapy for adults undergoing joint replacement therapy.  According to the study, those who used pet therapy in their treatment required 50 percent less medication that those who did not.  You can read the article in its entirety by clicking here.

If you don't have your own dog or cat, perhaps you know someone who would share with you. Animals love unconditionally and their is much to be gained from their companionship besides pain management. This is one of the most reward…

Non Drug Pain Management Ideas: Alpha-Stim

The alpha-stim is an FDA cleared medical device that has been available since 1981. It has been approved for use in anxiety, depression, insomnia, and chronic or post-operative pain.
There are two basic models: The Alpha- Stim M and the Alpha-Stim AID.  The difference between the two models is that the M model is more suited for those with pain issues, while the AID model is applicable to anxiety and depression.

This device has been said to be more cost-effective than medication over time. After the initial expense of purchasing such a device, there are a few parts and accessories that may be needed for routine use and maintenance, but they are not expensive to buy. Here are some graphics from the Alpha Stim website that illustrate my point:






























This device came to my attention when I saw an article online that mentioned that the US government is making this device available to its service members who suffer from PTSD.
Some insurance companies will offer coverage for these devices; check w…