Everyday pain management ideas

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!

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 mid

As the heroin epidemic continues, and the struggle with taming the opioid crisis goes on, the marketplace has become full of many new devices to help those who deal with chronic pain. So today, let's look at some of the new devices that have come out in the past year.  I am surely hoping that someday, someone will read this--or one of my many other posts--and find a reason for hope, and a way to make each and every day brighter.  So, without further ado, here are a few of the devices that came out this year, along with a link and brief description. 1) PainShield ®--  This novel device is actually an ultrasound device that is applied to the body via a topical patch.  It is very portable--and battery operated-- so it can be used anywhere, anytime. The manufacturer says it is indicated for pain and soft tissue injuries . Most of the reviews on the product website claim that it is helpful for trigeminal neuralgia that has failed to respond to other therapies. 2) iovera ®--An

I really like to crochet...and one day when I was showing someone a few pictures of my work, I was told that persons who are under treatment for PTSD are shown how to knit or crochet for therapeutic reasons.  Hmmm...I thought--I am going to do a little research on that topic! One of the things I found was this story from CNN that illustrates this point exactly.  According to the article, crafting can help anyone with anxiety, PTSD, chronic pain, and/or depression.  While no specific research has been done on crafting, studies have shown that the same cognitive skills used to complete crossword puzzles may be used when a person is crafting. I can tell you from experience that I have a little anxiety and have a history of some chronic pain disorders. When I have my yarn and hook working away, I could care less about any of those issues. I just get lost in my project and loose all sense of reality. And before you know it, I have produced a blanket, a scarf or a hat...made with lo

At the moment, there is much debate about whether or not pain levels should be considered "the fifth vital sign."  This idea came about some years ago when pain control became one of the quality measures in hospital care. The hospitals, in turn, relied mostly on medication to score well on those quality measures.  Who does this idea really benefit in the end...the hospital, who may benefit from higher insurance or Medicare reimbursements due to higher scores...or the patient? I am interested in what you might think about this topic; feel free to comment if you like.  My own personal opinion is that pain is NOT a vital sign because it's not a measure of life and death.  But I also believe that it is important to help people manage their pain levels as much as possible.  It means that those who are suffering should learn self-management from the earliest point possible, and showing them all the options that are possible, and where to find those options. In the p

Rheumatoid arthritis (RA) can really affect the quality of a person's life. Just ask anyone who has been diagnosed as such, or one of their family members or friends.  More than likely, they will have a lot of information to share with you. In a prior post, "Rheumatoid Arthritis IS A Deadly Disease"  you will find a list of some things that cause an RA patient to suffer above and beyond the usual.  You will see that there are some things on the list that these patients can control...and that's what today's post is about. Himalayan Pink Salt Some of these things are lifestyle changes--and while they are not easy, they can happen. One of those things is modification of salt intake.  The American diet is pretty high in sodium as is. Opting for reduced sodium food products and using salt substitutes such as "Mrs. Dash" or pink himalayan salt can be a good place to start.  While himalayan salt does contain sodium, it has slightly less sodium than ta

You may (or may not) realize it--but there are antacid products on the US pharmaceutical market that contain "salicylates"--which are a form of aspirin.  One example it Pepto-Bismol®: just look at the active ingredients and you'll see the term "bismuth subsalicylate". Herein lies the problem..as salicylates are a form of aspirin, they carry all the risks of aspirin and all the other NSAID drugs.  Recently the FDA has been monitoring reports of increased bleed risk with use of these drugs.  Many people take a daily dose of aspirin to reduce the risk of stroke or heart attack. Who would think that taking a product for an upset stomach on top of this could be such a serious problem? My advice to you...ALWAYS read labels carefully when you purchase over the counter products. Just because a product is available over-the-counter does not mean it's risk free.  Make sure you understand exactly what you are taking and why you are taking it!  Check with your

A new study out of Brigham and Women's Hospital puts a new twist on the adage, "You are what you eat."  In this instance, researchers were looking at the "gut brain" and how it plays a role in inflammation of the human brain. Human Fetal Astrocyte The researchers found that bacteria in the gut produce molecules known as astrocytes . These molecules are derived from tryptophan, which is an amino acid found in high protein foods such as chicken, turkey, fish, and nuts.  These astrocytes, once formed, reside in the brain and spinal cord and serve to limit inflammatory activity there. During this study, it was found that multiple sclerosis patients had low levels of these tryptophan -derived molecules. Tryptophan is also essential in the production of serotonin, a neurotransmitter that regulates mood and mental activity.  According to the study author, "Deficits in the gut flora, deficits in the diet, or deficits in the ability to uptake these prod

For this last day of Fibromyalgia Week, I have two things for you, my readers. First, I have a quiz...just to see how much you know, or have learned, about fibromyalgia this week.  Click the link below if you want to try it out! How much do you know about Fibromyalgia? » online quizzes Secondly, and very importantly...I have found something that some of readers may find quite useful.  There are lots of "apps" for smartphones out there, and some for fibromyalgia. Today I am sharing a link for "FibroMapp", which is available for Android and Kindle.  Sadly, there is not an Apple platform for this app but we can only hope that some day....  There are other apps like this available, but this one seems to have lots of good reviews.  Here is a link if you would like to check it out. Click here FibroMapp App http://www.fibromapp.com/ repost from 2014  

On this day 4 of fibromyalgia week, I am going to focus my writing on treatments for this mysterious condition.  As discussed in earlier posts, this condition tends to be chronic --and while it is debilitating, it is not life threatening.  There is no inflammatory process involved either. Pharmacotherapy for fibromyalgia  Drug treatment for fibromyalgia is still sort of in the trial and error phase.  There has been good response to some of the SSRI and tricyclic antidepressants to date.  Other drugs that have some use in fibromyalgia are NSAIDs (ibuprofen for example), COX 2 inhibitors (a specific category of NSAID such as celecoxib) and antiepileptics (eg Gabapentin). There have been some trials of naltrexone and also Immune Globulin . To date, these last two studies look promising but at this point they are not conventional therapy.  At one time, guaifenesin was thought to be promising but there is no clinical or scientific data to support its use as a treatment for fibro

Today, I am sharing some thoughts about what causes fibromyalgia.  Current understanding of this debilitating disorder suggests that central pain processing in fibromyalgia patients is altered.  Somehow, the central nervous system (CNS)  has some faulty wiring problems, resulting in an amplified physical pain. In the adult population, it seems that more women are affected by fibromyalgia than are men.  In children and adolescents the gender ratio is 1:1. There are a few theories out there as to the root cause of fibromyalgia.  Some ideas: 1) Genetic Basis -- it seems that fibromyalgia "runs in families", suggesting that there is a specific gene  that may be involved in the perception of pain. 2) Biochemical Imbalances --Some findings in fibromyalgia show that these patients have very low levels of serotonin,which has been linked to problems with sleep,pain perception,headaches, and mood disorders. Other studies have shown that people with fibromyalgia have eleva

Tender points...click caption for WebMD animation Tender points are a unique feature of fibromaylgia.  There are 18 such points on the human body (9 pairs as shown).  Using special technique by hand or a dolorimeter, a fibromyalgia patient will experience pain in at least 11 points, and there will be at least one painful tender point in each quadrant of the body! One study found that up to 96% of fibromyalgia patients suffer from sleep disorders. It is believed that this is responsible for a deprivation of delta sleep, during which human growth hormone is produced. This hormone is essential to tissue repair. Other common problems in fibromyalgia are fatigue, concentration/memory ("fibro fog"), and depression.  There is no doubt in my mind that just enabling the patient to sleep well on a regular basis would be of great benefit! It is not uncommon for fibromyalgia patients to have coexisting conditions--some of these are lupus, disease, irritable bowel syndrome, l

I have been watching the statistics on this blog since I started it, and I could not help but notice that some of the most popular posts pertained to fibromyalgia.  So, I thought,  why not devote a whole week to the subject?  So, without further ado, on this first day of Fibromyalgia Week, I shall begin with an overview. The American Medical Association  gave official recognition to fibromyalgia back in 1987. Before that time, this disorder was considered a "wastebasket" diagnosis, but in more recent years it is being recognized as a true illness. Here are some interesting facts about fibromyalgia: The characteristic feature of fibromyalgia is chronic, widespread musculoskeletal pain, associated wit symptoms of fatigue, insomnia, and other symptoms such as stiffness, headache, and chest pain. An interesting and unique feature of fibromyalgia is "tender points"--which are specific targeted areas where people with this disorder feel an amplified pain

I just reviewed a very interesting article regarding scientific reasoning with respect to weather and various chronic pain conditions.  Many who suffer from afflictions such as osteoarthritis, rheumatoid arthritis, fibromyalgia, and migraines seem to feel that the weather honestly affects how they feel on any given day.  But in the world of science, the jury is still out. A peer-review of many studies on this topic revealed conflicting information.  Some studies demonstrated that certain weather changes affected pain levels for some pain conditions, while others seem to find no evidence for this.  The authors of the article conclude the following possibilities: One study method, known as the crossover method, seems to mitigate the time invariant factors in this type of study...leading to confounding results. Studies regarding pain level versus changes in barometric pressure are sometimes poorly designed, or don't really have enough subjects in the study to really com

Did you know... 18 percent of all Americans suffer from migraines. In other words, it's a very common disorder! 2-3 percent of migraine sufferers will progress from episodic migraines (occasional) to chronic migraines (suffering migraine several days of the week, every week). Risk factors for developing chronic migraine include:   increasing frequency of migraine attacks   nausea   allodynia (experiencing pain from something that does not usually cause pain)   risk is increased for persons who also have comorbid disorders such as depression, anxiety, obesity, asthma, stress, sleep apnea, other pain disorders, or neck issues   failed relief after using rescue medications can also lead to risk from episodic to chronic migraine, especially i f those medications contain barbiturates or opioids The risk of progression from episodic migraine to chronic migraine can also be reduced by the following measures: learn what your migraine triggers are (keepin

Thinking about osteoporosis, I think about those who have the highest number of these risk factors-- small frame female Caucasian or Asian post-menopausal or post-hysterectomy family history Osteoporosis in and of itself is not painful, but it increases the risk of fracture. If a fracture does occur, it can be disabling or perhaps even fatal.  In the last few years I have seen a few women with known osteoporosis suffer fractures that laid them up for months on end. And it never seems to be the same after the fact, even after the bones have healed, and many physical therapy sessions have been attended. With that in mind, we must also keep in mind that other persons can suffer from osteoporosis as well. Men, for example, can develop this condition, and it's sometimes overlooked because the focus is on women with known risk factors.  Sadly, this group can suffer the same risk of fracture, and when it happens, they can be laid up for months on just like their fema

While we await a final autopsy findings on Prince's cause of death, People   magazine reports that he was being treated for addiction just prior to his demise.  Sadly, bad things happen to good people..and whether or not Prince's death is related to this issue, it brings the topic of addiction front and center. The Washington Post recently reported that there were 52 deaths per day in 2014 due to opioids.  If you do the math, that amounts to almost 190,000 deaths per year!  The federal government has recently shown some movement in response to this issue...last month, the CDC released its recommendations for prescribers with respect to opioid usage and prescribing.  In the last couple of weeks, the FDA has chimed in. An FDA advisory panel has voted in favor of mandatory opioid prescribing training for physicians. It's about time something is done. This problem has been ongoing for the last twenty years. There have been many deaths that could have been prevented.