Everyday pain management ideas

A new study published in JAMA ( Journal of American Pediatrics) tells us that pregnant women who took Tylenol® (or its active ingredient--acetaminophen)--had an increased risk of delivering a child with hyperactivity issues. This drug is still relatively safe to take...the researchers say that using acetaminophen products during gestation may ward off more significant problems--for example, if it is being used to reduce fever! So the bottom line here is simply this: There's no reason to avoid these products altogether during pregnancy, but it doesn't hurt to err on the side of caution! You can see the ABC news report on this topic by clicking here . Sources: ABCNews; Flickr

The American Eye Institute reports that approximately 3 million Americans suffer from chronic dry eye.  As such, it's a fairly common condition.  The usual treatment for this malady is the use of artificial tears. This is important, because without lubrication the cornea can be damaged, and it can be very uncomfortable as well. New research about chronic dry eye is shedding light on another aspect of the condition.  As reported in the Journal of Pain, some patients with dry eye have a neuropathic pain condition.  Patients reported having higher levels of ocular pain as well as a number of coexisting chronic pain syndromes.  They also reported a higher incidence of depression and a lower quality of life. This research sheds light on the complexities of what we might otherwise think of as a simple everyday problem.  More research is needed to explore more fully the link between dry eyes and chronic pain syndromes, and a more permanent treatment for those affected by this com

After I wrote the post just prior to this one, I took some time to think reflect on the people in my life--most especially those whom I know to have chronic pain.  I can definitely see that there is an emotional component to the problem.  And the study in the prior post seems to confirm that what I am thinking is true. Stated simply, those who have the best coping skills have the best natural ability to deal with chronic pain. Unfortunately, many of us do not have those skills due to any number of reasons. So, the next logical step for people in this group is to learn to improve their coping skills.  I guess I think that's really what my blog is all about.   I do believe the first step in this effort requires an attempt to find a root cause of the pain, and if possible, to correct it.  This is the best hope of staying ahead of the game.  There will always be situations where this is not possible, or that a given condition can be managed but not cured.  For this group, I wo

There's been a lot of discussion in pain management circles about the psychological aspects of chronic pain. Patients with dementia are a hot topic in this area; now more information is coming out about these persons, and those with other cognitive deficits including those with attention deficit and/or impaired executive functions. A study published in January 2014 edition of Brain helps to illustrate how and why this is the case.This study looked at 189 subjects who ranged in age from 18 to 85 years.  Study subjects were all about to undergo knee replacement (for osteoarthritis) or breast cancer surgery. And here's where it becomes interesting--in the knee replacement group, 84% of the patients had "clinically meaningful" pain levels prior to procedure.  Six to twelve months after surgery, 38-39% of these subjects were still reporting significant pain.  In the breast cancer group, none of the subjects complained of significant pain before surgery, but six to

While watching a bit of the Olympics this summer, I gave some thought to all the training and sports medicine...and I couldn't help but think a little bit about all that goes into making each athlete the best he or she can be during competition.  There's a lot more going on there than meets the eye, that's for sure! One example of this came to my mind as I prepared for this post.  Most of us know seasoned Olympic swimmer Michael Phelps and all the gold medals he has earned over the years... It turns out that many of the athletes in Rio, including Mr. Phelps, showed up at the games with circular bruises on various body parts.  It came to be known that these athletes use a form of Chinese medicine known as "cupping." During a cupping section, specialized round cups are heated and placed on the skin to target select muscle groups. The cups create a suction effect and are purported to stimulated blood flow in the target tissues.  It is also said to increase

Sometimes we overlook the simple things. I must apologize--all the time I've been writing this blog, and never thought about the importance of good coping skills.  We all learn to cope with whatever we're dealing with one way or another, but not every coping skill is a positive one.  The good thing is, we can ALL learn positive coping skills that we don't have on board already! So today, I would like you to ask yourself..what are your responses to situations that are not going well?  Whether the situation is a pain filled day or some sad news, our choice of response can make a lot of difference! Here is a list of some NEGATIVE COPING SKILLS . I am not trying to call anyone out--we all do some of these at least some of the time: Avoidance Alcohol Use/Abuse Drugs Sedatives Refusal to address emotions/feelings Self-mutilation The goal here is to be honest with yourself. If you see a little bit of yourself in the list above, look to the list below to fi

As time goes on, we're starting to see some very nasty consequences of long term opioid usage. There's always the risk of addiction. To me, a person is addicted if abstaining from said drug results in withdrawal symptoms.  This can happen whether a person is using these medications for legitimate or recreational purposes. Beyond that, we are now seeing some of this patient population resort to heroin usage because it's much easier and much less expensive to obtain. As if that's not argument enough, there is now some preliminary scientific evidence to support more conservative opioid prescribing. Animal studies at the University of Colorado performed an experiment in which laboratory rats underwent surgery to induce sciatica like pain.  Ten days after surgery, one group of rats was given a five day course of morphine treatment, while the other group was given saline. The saline group demonstrated signs of recovery in about four weeks, while those who received mo

The FDA recently approved a new approach to treat (and hopefully, eliminate) chronic low back pain in the last several weeks.  Known as INTRACEPT®, this new therapy uses minimally invasive surgery to deliver radio frequency to select portions of the lower spine.  The goal of this treatment is ablation of the basivertebral nerve. As such, it is said to be the first treatment of its kind for those who have failed conservative treatment of   > 6 months duration  You can read more about this newly approved treatment by clicking here. Relievant Systems, the innovators of the INTRACEPT system, have provided a video via YouTube which shows a simulation of the procedure using this device.  You can view the video here: As of the time of this writing , Relievant Systems has not yet updated their website to indicate where or when this product will be available in the US.  For future reference, you can access that site by clicking here . Sources: Painweek; Relievant.com;YouTube;PRNews

Recently, I posted a piece about using genetics to predict who would most benefit from opioid prescribing and who would be most prone to addiction.  As if that isn't interesting enough, I came across another study...a study that looked back at opioid usage to find out if there was a relationship between pain levels and Opioid Usage Disorder (OUD). Interestingly, this study (Olfson et. al.) does indicate that there is a relationship between these two things.  This study authors found that the risk of OUD was higher in those persons who reported higher pain levels.  Those who reported elevated pain levels and OUD were also more likely to have recent substance abuse disorders, family history of alcohol abuse, and/or anxiety and mood disorders Their was also an increased risk of OUD in males and young adults. The study authors caution that under-treating pain can lead to addiction; they do not advise against opioid prescribing but advise exercising caution. You can read

Another new way to treat chronic pain is on the horizon...and while we are in the midst of an opioid crisis, these developments can't come soon enough. A study of  a group of addicted veterans in treatment compared this emerging therapy to a more conventional one...and the results are promising! Known as ImPAT (Improving Pain During Addiction Treatment), this new strategy combines cognitive behavioral therapy(CBT) and acceptance and commitment therapy.  These two (ACT) psychological treatments are not usually available as a combined therapy, but when utilized together in this study : the intensity of their pain decreased their ability to function increased alcohol consumption decreased One of the best things about this type of therapy include the fact that it's very inexpensive and as such, it's cost effective. In addition, those who participated in weekly sessions for 10 weeks experienced the benefits of therapy for up to a year. All I can say is... wow!

Are you a chronic pain patient who has been on opioids for a long time?  Or maybe a physician who has patients like this?  As you might know, there is no magic formula for "getting off" of an opioid regimen.  The risks of long term use of opioids is quite clear. In addition, after a period of use, the effectiveness of an opioid regimen seems to diminish. One thing is for certain.  If a patient has been on an opioid regimen for an extended period of time, an abrupt discontinuation can lead to withdrawal symptoms. That is certainly not a good plan of action! So, how can a patient find their way off of one of these treatment regimens in a healthy way? Here are some suggestions based on a lecture at the World Congress of the World Institute of Pain in May 2016: 1) For patients on multiple opioid regimens, decrease long acting opioids first . This way the patient still has the shorter acting opioids available if necessary. 2) Go slowly .  Reduce dosage of remaini

Serotonin  is an important chemical in the human body.  In a nutshell, it's a neurotransmitter that's involved in many body processes.  The current thinking on depression and anxiety (which often accompany chronic pain syndromes) is that there is an imbalance in the central nervous system mainly due to low levels of serotonin.  Many of the medications we use to treat depression belong to a class of drugs known as SSRIs, or  S elective S erotonin R e-uptake I nhibitors. These drugs help the body to make the most use of the serotonin a person has in their body by keeping it "active" as much as possible. But this is not the only way serotonin levels can be boosted.  There are many natural phenomenon that help fulfill this purpose.  It's good to know that these practices can help to accomplish the same goals that these medications do.  If you are a person who does not wish to take these medications, I would like to share these ideas with you today! So, wit