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Showing posts from April, 2017

FDA Bans Use Of Codeine AND Tramadol In Children Under 12

"Beware of Giving Kids Codeine or TramadolThe FDA is warning that children younger than 12 shouldn’t take codeine products to treat pain or cough or tramadol to treat pain. The FDA hasn’t approved tramadol for use in children. Kids younger than 18 shouldn’t take tramadol to treat pain after surgery to remove the tonsils (tonsillectomy) or adenoids (adenoidectomy). (Codeine labeling already warns that children should not be treated for post-surgery pain with codeine in these cases.) Youths ages 12 through 18 who are obese or have obstructive sleep apnea (blocked airflow during sleep) or a weakened respiratory system shouldn’t take codeine or tramadol. These risk factors can increase their chances of serious breathing problems. Tramadol is available only for adults and by prescription to treat pain. Codeine products are available by prescription and, in some states, over-the-counter (OTC). Codeine is often combined with acetaminophen in prescription pain medicines and with other cold …

Meet BPAT: A New Way To Assess Pain In Nonverbal Patients

Following surgery or during an illness, most patients are asked to rate their pain on a numeric scale. As an alternative, some nurses/health care workers use facial expressions as a gage.  There are pros and cons to these methods, of course.  There are also patients who cannot respond verbally or provide facial cues, even though they may be in severe pain.  The unconscious patient in an ICU is an example of this sort of patient, and perhaps some dementia patients are this sort, too.
A new pain assessment tool known as BPAT (Behavior Pain Assessment Tool) may be the answer to this problem.  This tool evaluates eight behavioral clues, including facial expression, muscle responses, and verbal expressions to determine a patients pain level. While being studied, this new pain tool was used on persons who were able to communicate, then compared to what the patient's rating on a ten point scale.  It was reported to be reliable in two of every three patients studied. Further evaluation w…

Can Body Weight Be A Risk For Migraine Headache?

There are certain things we've known for a long time about migraine headache sufferers:

Migraines are common in women than men.

There are many "triggers" of migraine headache, including foods, MSG, hormonal factors, stress levels, weather conditions, etc.

There are many subtypes of migraine. Here are some examples:  classic migraine, chronic migraine, and menstrual migraine.

Medical research in the field of migraine has made it possible to prevent or reduce migraine occurrence, or abort a migraine shortly after onset!

A new finding, recently published in the journal, Neurology, suggests that there is a relationship between Body Mass Index (BMI)  and the likelihood of migraines.  According to the study that was published, migraine is more likely to occur in individuals whose BMI is above or below the normal range. 

If you are a migraine sufferer and have reason to believe this may be a problem, you can determine if your BMI is in the normal range using the above diagram. You c…

Risk Factors For Autoimmune Diseases

There are several autoimmune diseases (celiac disease, lupus, rheumatoid arthritis, etc) that are responsible for many cases of chronic pain. Since this is the case, it's good to know what the risk factors are, just as you would want to know your risk for heart disease, cancer or anything else.  Here are some things to keep in mind:

1) You already have one autoimmune disease: One in four persons who already has one autoimmune disorder will develop a second autoimmune disorder.

2) Ethnicity: African Americans, Latinos, Native Americans and Asians are at highest risk.

3) Family history: Some types of autoimmune disease run in families. If a close relative has an autoimmune disorder, you have an increased risk simply due to genetic similarities.

4) Gender: A woman's risk of developing an autoimmune disease is generally three times higher than male counterparts. Some autoimmune disorders, such as lupus, are even more prevalent in females.

5) Your spouse has celiac disease: A 201…

Opioid Induced Hyperalgesia

Opioid Induced Hyperalgesia (OIH) is a real condition. It occurs when opioid medications actually cause increased sensitivity to painful stimuli. Yes, it's a paradox but it does occur. It is difficult to diagnose because it is difficult to distinguish from opioid tolerance.  But there are some characteristics unique to OIH:
Pain in more diffuse in naturePain worsens over time even if opioid dosage is increasedPain harder to pinpoint and of lesser quality It is thought that the mechanism of OIH is most likely due to over-excitation of neurons, but at this point the jury is still out. If OIH is suspected, the offending medication is withdrawn slowly. Sometimes, if pain persists it may be possible to reduce the dose of the original medication or switch to another class of drugs for pain management.  There is added difficulty in that a patient might have difficulty understanding how pain levels can actually increase because of their medication!
OIH is poorly understood and more researc…

Novel Pain Treatment Gets The Green Light

As the opioid crisis looms, researchers everywhere are looking into new and novel ways to lessen their usage. One example of this is a story out of the University of Arizona, where researchers studied how exposure to different colors of LED light affected chronic pain in rat populations. After studying several colors of light, it was noted that low intensity green light had the most potent effect. Following the animal study, a small scale human study was conducted.  Study subjects were asked to use the green light in a darkened area of their homes for one or two hours a day.

All the study participants claimed that their moods were improved and pain lessened. The exact mechanism of action is yet to be determined. Larger studies of longer duration are needed to determine the optimum intensity of the light, duration of treatment, ideal frequency of treatments, and so on.  The best news is that no adverse affects were reported during the initial study.

You can read more about this intere…

Herpes As A Helper?

If you've ever had shingles, or known anyone that has experienced it, you probably know that chronic pain can persist following the initial attack (post herpetic neuralgia).  This is because the herpes virus seems to have an affinity for nerve cells.  And while it's not fun to have shingles or post herpetic neuralgia, the herpes virus may be a key in future development of delivery systems for pain management treatments.

Here's the deal--since Herpes simplex has an affinity for nerve cells, researchers are looking a genetically modified, safer version of the virus to deliver genetic material to damaged nerves.  In simple terms, once the genetic material reaches these nerve cells, it will hopefully encode these nerves to ultimately inhibit pain signals.  Animal studies and clinical trials in cancer patients have been encouraging thus far.

This is one of those developments that makes me believe that there is hope for those in chronic pain. Along with so many other exciting d…

Common Virus Is Possible Trigger Of Celiac Disease

A recent report in Science News shares a study of TL1 reovirus (a very common and usually innocuous virus) and suggests that it could be responsible for the development of celiac disease.  This virus, according to study authors, prompts the immune system to produce an exaggerated inflammatory response. While TL1 reovirus is not deadly, it's very common and most of the time people don't even know they've been infected by it.

Dermody and et. al, who conducted this study at the University of Pittsburgh, found that celiac patients had higher than normal levels of antibodies against TL1 reovirus.  The researchers also believe that other viruses are capable of triggering celiac and other diseases. Future studies will look at this in more detail. If their theory holds true, a vaccine could be developed against  TL1 reovirus or other responsible viruses to halt the development of celiac disease.
For more information about this interesting study, you can read more here
Sources: S…

Posture Treatment: New Hope For An Old Problem?

With the opioid crisis looming over our heads, we need to look for new ways to treat some of the problems that could potentially lead to future opioid use.  One of the most common causes of chronic pain is low back pain that stems from degenerative changes, sciatica, etc. As mentioned in past posts, there is no panacea for any of these conditions, but there are many options out there.

I recently read a story in the New India Express about a new treatment that is offering hope to patients with these types of maladies. According to the article, our body posture can easily end up in misalignment when we try to compromise for things like physical trauma, or develop poor posture habits in the workplace. We often overlook the effects of these postural abnormalities as part of "the big picture."  Using the latest technology, medical science can now detect and treat such abnormalities with great precision. Medical procedures of this sort are non-invasive and are virtually painless…

Strange But True: Burning Mouth Syndrome

Believe it or not, there really is a painful disorder known as "Burning Mouth Syndrome!" While it does not occur commonly, it can affect an individual for weeks, months or years.  This syndrome, as its name implies, causes a burning sensation in the oral cavity.  The primary symptoms is a sensation in the mouth that has been described as burning, scalding, or even tingling. It is difficult to diagnose because there is no visible abnormality for a doctor, dentist, or other health care provider to see upon exam.

Burning Mouth Syndrome is considered "Primary BMS" if no underlying medical condition can be associated with it.  In this case, damage to nerves seems to be the underlying cause of the problem.

"Secondary BMS" can be associated with an existing medical problem such as diabetes, thyroid disorders, allergies, Sjorgren's syndrome, certain medications or nutritional deficiencies, an oral infection or even gastroesophogeal reflux disease GERD).


Shared Reading: A New Approach To Chronic Pain?

One of the traditional strategies in the treatment of chronic pain is cognitive based therapy(CBT)--that is, using the help of a psychologist to help build up coping skills and keep a positive perspective in spite of the hardships. A recent study based in the United Kingdom suggests an alternative approach: shared reading.  Shared reading is an activity in which a small group of individuals gather to read aloud. The study involved reading poetry, short stories, and other literature that helped participants to recall memories and experiences of life, especially those that pertain to childhood, family, work, and other lifetime memories.  The idea for this study stems from the use of this strategy for other chronic conditions such as dementia. It is thought that prompting these memories helps patients to address painful emotions that may contribute to their respective conditions.

While the results of the study are encouraging, the team who conducted the study says a larger scale study w…

New Saliva Test Helps Clinician Monitor Pain Patients

A Denver-based company has developed a test that can help physicians monitor opioid usage in patients--using saliva instead of urine samples.  The test is known as CORE (Comprehensive Oral fluid Rx Evaluation). Cordant Health Solutions, the developer of this test, says that it is more accurate than the widely used urine tests currently in use.  A sample is easily collected simply by swabbing the inside of a patient's mouth. The test can detect if patient is taking the right amount of medication, while urine tests only detect the presence or absence of a drug.  Urine tests also give false results sometimes.  As an example, the decongestant component in common cold remedies can trigger as a positive for amphetamines.

While it has its positives, the company admits that the test is not foolproof. Drug levels found in saliva do not correspond with blood test results about 25 percent of the time. Another drawback is that the result of a saliva test is not available for 48 to 72 hours, wh…