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Showing posts with the label Pain Management

Pain and Pregnancy, Part Two

Fibromyalgia was not recognized as a clinical disorder until sometime in the 1990s, but it has probably existed for a lot longer than that.  People of almost any age can be affected by fibromyalgia, but many people are first diagnosed in their twenties. According to the National Fibromyalgia and Chronic Pain Association, 75-90% of persons affected by fibromyalgia are women. For these reasons, it's important to share a few thoughts about the management of fibromyalgia in women during the childbearing years.

There are medications for fibromyalgia, but at the present time, these drugs are not recommended for use during pregnancy.  Therefore, alternative methods of fibromyalgia management are very important. These methods include exercise, yoga, meditation,  massage and rest.  Exercise is key, because it keeps you fit and improves mood due to an increase in serotonin levels. Serotonin seems to be a key player in helping one to manage stress, in calming anxiety, and improving mood. An…

Ten Remedies for Restless Leg Syndrome Relief

Web MD has a great slide presentation about home remedies for Restless Leg Syndrome--they're all simple things most anyone can do to help manage this condition.

Here is a quick list of ten of the suggestions they present~~

keep a regular bedtime--helps combat fatigue and keeps symptoms in checkstretch before you sleep~leg stretches may help just before bed or following prolonged sittingeliminate caffeine~may worsen symptoms for some RLS suffererswarm bath before sleep~a classic way to wind down and relax before sleepexercise habit~one study found that exercise resulted in reduced leg movement/deeper sleepexercise your brain~crossword puzzles, knitting, etc. are good distraction techniquesleg massage~calf massage can help one to fall asleep more quicklyyoga~stretching, breathing and relaxation of can relieve mild RLS symptomsavoid alcohol and cigarettes~nicotine and alcohol can exaggerate RLS symptomsmedication review~some cold and allergy medicines and antidepressants can worsen y…

Complementary, Alternative, Or Integrative Medicine: What's The Difference???

After my last post, I realized that the terms complementary, alternative, or integrative medicine may seem to confusing to some readers. It is my hope that after reading today's post these terms will be better understood. So, without further ado, here is my attempt to explain--

Alternative medicine  refers to practices outside the scope of traditional medicine. Yoga practice, meditation, chiropractic medicine,  and nutritional supplements or herbal medicines are some examples of these practices.  The term "alternative medicine" implies that one ore more of these non-traditional methods is being used in place of traditional medicine for a given condition.

Complementary medicine  refers to using a combination of traditional and alternative medicine to treat a given condition. As an example, a migraine sufferer finds that attending yoga classes regularly helps to reduce the frequency of migraine headaches. But this same individual is also under care of a physician who has pr…

The Tsunami Effect of Opioid Dependence

In one of the first studies of its kind, the FAIR Health group released some very interesting information last fall.  This group used claims data from privately insured persons to illustrate some obvious, but very shocking conclusions about privately insured persons who are regular opioid users.
The data from this study looked at (non-identifying) data from insurers who cover upwards of 150 million patients. They noticed the following observations:
From 2007-2014, medical services for people with opioid dependence diagnoses skyrocketed more than 3,000%
Much of the increase in opioid dependence occurred since 2011, even though this period was marked by increased attention to the problem and a growing concern amongst advocates as they called on doctors to reduce the number of opioid prescriptions.
Younger patients (19-35 years) were most likely to be diagnosed as “opioid dependent” relative to other age groups. (Dependence is defined by symptoms such as increased tolerance, withdrawal or un…

Quantifying Pain: The Oswestry Disability Index

There are many ways by which pain can be evaluated.  For instance, there are a couple of scales I discussed in an earlier post (Some Thoughts On Quantifying Pain). In this post I specifically discussed the 1-10 scale that is commonly used when people are able to verbally relate their pain to a caregiver or health care provider.  I also provided an example of the FACES scale, by which a nurse or other caregiver can assess pain by the expression on a person's face.  FLACC is the third example I shared in this post, which is primarily used when a patient is unresponsive but thought to be in pain.

The above examples are all useful in assessing acute pain--following an injury, during an acute illness, surgery, etc.  But they do not really apply to chronic pain patients because chronic pain can come and go or feel better or worse on any given day.  For chronic pain it's more appropriate for a health care team to use their own questionnaire to assess the kind of pain a patient has, …

Alcoholism Can Contribute To Chronic Pain--And Other Health Issues,Too!

It's not surprising to hear...or to be... someone who drinks, or drank as a minor. Those crazy teenage and college years are what memories are what made of, right?  In these early years of life we don't always take the time to think about the long term consequences of our choices; instead we focus on having a good time our friends and forgetting about our troubles for a while.

It's really too bad that the human brain works this way.  A new study about long term consequences of alcohol consumption during the adolescent and early adult years gives us insight as to how alcohol abuse in the early years can contribute to health issues several decades later. The study was conducted by interviewing middle aged to older persons about their drinking habits during their earlier years and their current health status.  The main conclusion was that drinking heavily or excessively in the earlier years was strongly correlated with more health problems in the later years. The study menti…

The Role of Genetics in Pain Mangement

Pain management is a complicated field.  For one thing, there is an objective goal--that is to say, to determine what is causing pain in the first place, and what to do about it. But we also have to consider subjective aspect of pain management.  One of the tenets of pain management is this: If a person says they are in pain, we cannot deny that the pain exists.  But sometimes it's hard to determine why that person is experiencing this discomfort, or why it seems to be as severe as they claim.

In recent years the genetic aspect of pain management is under closer study.  One example of this is a group from Touro College of Pharmacy in New York City.  Dr. Priyank Kumar and his associates are looking at a specific human gene--namely, 118G. They are finding that variations in this particular gene help to predict a patient's response to opioids, and also the risk of respiratory depression, opioid misuse and even addiction.

Genetic testing of this sort may become commonplace in pai…

New Non-Pharmaceutical Technique Shows Promise In Controlling Post-Operative Pain

The opioid crisis came about largely because of routine use of opioids for chronic pain conditions. Opioids are used to control post operative (acute) pain as well; and even though short term use of these drugs generally does not lead to addiction, more and more advances are being made to reduce or eliminate their usage save for very rare circumstances.

Here are a couple of examples--

1) There is a product line known as On-Q® can click the link to see specifics about this if you wish.  These products are drug delivery systems that can be used in some types of surgery, such as knee replacements to reduce or eliminate the need for opioids. On-Q® devices can be filled with a local anesthetic. The device has tubing with a catheter like tip that is placed in the operative site, allowing the anesthetic to be delivered directly to the affected area via the On-Q® pump.  These have been around for several years, and the results are dramatic!

2) A new technique devised by Dr. Brian Ilfie…


Have you ever heard of HCAHPS? It's an acronym for Hospital Consumer Assessment of Healthcare Providers and Systems. A creation of the US Department of Health and Human Services, this is website where you can look up patient satisfaction scores for specific doctors, hospitals, and such.  The data provided on this site is generated from surveys sent randomly to patients following hospital admissions, medical visits, etc.

Under the Affordable Care Act, this data is also used to determine reimbursement rates for these same providers.  To put it simply, better scores mean better rates of reimbursement for health care providers. So it's natural to assume that providers want to perform well, because that means more income for them!

One of the sections of these surveys pertains to pain management.  And since pain was considered the "fifth vital sign" until very recently, pain control is/was very important part of patient satisfaction. Now that we are in the midst of an &qu…

Are NSAIDS safe to take...or not?

Some new thoughts on the dangers of long term use of popular NSAID drugs are emerging from a study out of UC Davis.  According to study author Aldrin Gomes, PhD. , we already knew that prolonged use of these medications could lead to increased risk of heart disease and stroke...but now we are beginning to understand why.

The study examined the use of prolonged administration of NSAIDs in mice, and discovered the following:

a reduced ability of cardiac cells to produce energygeneration of a stress-inducing reactive oxygen speciesinterference with production of proteasome ...all of which leads to a toxic buildup and eventual cell death.
Another finding of note--the study compared naproxen, which is available over the counter, with a more potent prescription product, meclonfenamate sodium.  It appears that the prescription drug was more likely to have detrimental effects than its OTC counterpart.  In addition, the authors note that vitamin C, an antioxidant, along with NSAIDs my help to …

What do you believe?

"If you can imagine it, you can achieve it. If you can dream it, you can become it."                             William Arthur Ward

This is what I'd like to reflect on in today's post.  I am not talking about the latest breakthrough in pain management research. I am simply asking you to think about some of the non-drug pain management ideas we've explored on this blog in the past--such as dietary changes, weight loss, smoking cessation, and exercise.  It's not easy to find the motivation to make these changes for many of us. These lifestyle changes begin as every journey does--by taking the first step.  But what is the first step?  Is it heading for the gym tomorrow, or starting a  new diet tomorrow?  It is not.
What is the first step, then, you ask? And so I will tell you. The first step requires time to think about what you really need to do.  It requires accepting the challenges you will face when you make that very first step.  In order to accomplish this…

What is an auto-immune disease--and why is it painful?

In all the time this blog has been in existence, we have discussed a number of auto-immune diseases that can cause chronic pain.  Some examples are rheumatoid arthritis, systemic lupus(SLE), and celiac disease.  But I have never explained the cause of these types of diseases. Once you understand the root cause, you will understand why the people who have these problems are often the victims of chronic pain.

When a person suffers from an auto-immune disease, it is because somewhere along the way their immune system began to see normal body tissue as a foreign body.  Normally, when a foreign body is detected in the human body, a whole chain of biochemical reactions takes place in an effort to destroy that foreign body. In the case of auto-immune disease normal human tissue is perceived as a foreign body, the immune system produces antibodies that seek to find and destroy the invader.

If you find that confusing, think of it like this:  A pedestrian is walking down a busy street. A hit m…

By the numbers: Some facts about chronic pain

Here are some random facts about Chronic Pain in America.  Interesting?  Well, I think so!

More Americans suffer from chronic pain than many other chronic illnesses?  It is estimated that about 100 million citizens are afflicted by chronic pain.  Compare that to 25.8 million Americans who have diabetes, 16.3 million with heart disease, 7 million stroke victims, and 11.9 who have cancer! The cost of health care related to chronic pain, including medical costs and lost wages is somewhere between $560 and $635 billions dollars per year (expressed in 2010 dollars). This is approximately $2000 per person including all persons in the US.Lifestyle adjustments that are made to deal with chronic pain include taking disability leave from work, change of career, obtaining assistance with activities of daily living, and moving to a home that is easier to maintain.Overall, workers who were surveyed in one study lost an average of 4.6 work hours per week due to a pain condition.Approximately 20% of…

Stem Cell Transplantation: A Future Treatment for Degenerative Disc Disease?

At the 2014 American Academy of Pain Management meeting, the Mayo Clinic shared some very positive findings during a poster session.  This is interesting..maybe someday it will lead to a new way to treat degenerative disc disease, a common and painful condition that is all too common.  
The poster explained a study that was conducted using stem cell transplants to treat degenerative disc disease in animals.  Over the study period, the discs in the spines of the animals treated with stem cells actually showed signs of regeneration!

Current treatment of degenerative disc disease via medication: acetaminophen and NSAID drugs are commonly employed for this purpose.  We all know long term or excessive use of these medications is unwise; it is good to know that new ways of addressing this problem may be on the horizon. What's more exciting is that a stem cell infusion is a lot easier to endure than some other forms of treatment, such as surgery.  
Let's hope that this research leads…

The Role of Animal-Human Bonding in Pain Management

A Loyola University study reveals that animal assisted therapy reduced the need for oral pain medication following total joint replacement therapy. The study retrospectively compared a group of subjects who were given AAT as part of treatment vs. a group that did not benefit from such therapy.
In conclusion, those who were given animal therapy had a reduced need for medication-- 28 percent less, to be exact! The two groups were similar in composition with respect to age, ethnicity, etc..the only difference was that the AAT group had daily visits with specially trained dogs, for a duration of somewhere between 5 and 15 minutes per visit. The study was published in the August/September issue of Anthrozoos, the official journal of Anthrozoology.

Once again, we see that health, healing, and relief from chronic pain can be enhanced by forces aside from traditional medical treatment.  The bond between humans and animals is powerful, and can be of great benefit to all who are willing to emb…

From the Cleveland Clinic: How to Manage Pain Without Medications

I always like sharing information from the Cleveland Clinic with my readers--they are highly regarded in the world of medicine, and have much to offer persons will all sorts of illnesses and disabilities.  Today I would like to share what they have to say about managing pain without medications.  You can read the article in its entirety here.

For those of you who simply prefer an overview of this piece, here is an overview:

Many people suffer from pain due to illness or injury.  All too often the first treatment of choice is medication.  Unfortunately, medications can have troubling side effects, and some of them are potentially addicting.  Therefore, it is wise to look at some alternative forms of treatment and incorporate them into a treatment plan.One of these alternatives is Osteopathic Manipulation Therapy, which involves re-alignment bones/joints in an effort to ease pain. This is the hallmark of Osteopathic medicine. Chiropractic medicine and acupuncture are similar to OMT.Exer…

HowStuffWorks "Mysterious Pain Quiz"

How much do you know about painful medical conditions?  This link is VERY informative!
HowStuffWorks "Mysterious Pain Quiz"

Sources:How Stuff Works; 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…

Hot & Cold Therapy

We've all heard of applying heat or an ice pack to an injury. Recently I came across a different twist on these ideas.  I kind of put it on the back burner, until a friend was telling me that she used it for a foot injury and that it worked really well.  So without, further ado I am passing the idea on to those who never heard of it before!

The idea is known as "Contrast Hydrotherapy."  Basically it involves immersing an injured body part into ice water or using cold packs for five or so minutes--immediately followed by application of heat or immersion into a warm water bath. The exercise can be repeated multiple times.  The theory is that the warm application causes the blood vessels to dilate...the cold causes them to constrict.  As this occurs, the lymphatic system follows suit.  The blood vessels have a central pump (the heart!) but the lymphatic system does not.  The hot/cold treatment essentially provides the pumping action for the lymph nodes to pump stagnant flu…

Some thoughts about dementia and chronic pain

Nearly 5 million people in the USA are affected by dementia; if you are reading this you probably know of at least one person who has or is affected by this condition.  The signs of dementia are varied,and can include problems with memory( loss of orientation to person,place, and time) and difficulty with expression (not being able to find the right words to say things, forgetting "the right word', etc.) Eventually this disorder can can cause a person to forget how to care for themselves, and they can no longer care for themselves.

In this post, I am going to concentrate on the loss of ability to express...because that is where the difficulty comes in when a person with dementia suffers from chronic pain.  It is not uncommon for older persons to have multiple health issues; arthritis is one very common example.  When dementia is added to the list of comorbidities, things become much more complicated.  The ability to say "I have pain in my lower back" or "My le…