Everyday pain management ideas

The preliminary results of a University of Toledo (Ohio) suggest that emotional abuse in childhood is linked to the development of migraine headaches in adults, particularly in men. All varieties of child abuse (sexual, physical, and emotional) increase the chances of developing migraine later in life, but according to study author Gretchen Tietjen, MD and colleagues, emotional abuse alone increases the risk of developing migraine by a whopping 52%. The authors go on to say that the relationship between emotional abuse, depression, and migraine are worthy of further investigation. Emotional abuse of children is not uncommon...when physical or sexual abuse is added to the mix,the relationship between the abuse and migraine seems to be more strongly connected.  Interestingly, the authors note, when children are emotionally abused, data suggests that it helps to build resilience to a point, but beyond that point the problems begin. The authors go on to suggest their theory as

Most people know about some of the problems with opioid usage: sedation, risk of addiction, impaired motor skills, to name a few.  In truth, there are more problems to add to that list. One of them is the risk of hypotension (low blood pressure)...and perhaps the most deadly side effect of all is the risk of respiratory depression, which can lead to death. CPAP--a common treatment for sleep apnea A review of literature conducted by Frances Chung, MBBS, and her coauthors reports that the overall prevalence of sleep apnea in chronic opioid users is 24%. The rate of sleep disordered breathing in this population is reported as high as 85%;  those who use higher doses (morphine equivalent daily doses of 200 mg or more) show a 92% rate of ataxic periodic breathing. This reiterates the need for primary care and pain management physicians to be aware of this very serious problem.  In this way, the CDC guidelines helps to bring this issue front and center,  and that's exactly

I'm sure after reading parts one and two of this series, chronic pain patients might feel a little anxious...and that is certainly understandable.  Sometimes change is good, but sometimes, it's difficult. Image Source: Wikimedia It's hard to know exactly how these guidelines will affect health care delivery of pain management going forward. First of all, remember that these guidelines are non-binding. No practitioner, regardless of specialty, is being forced to comply. For those patients who are doing well on established regimens, I do not expect much to change. The biggest changes, in my humble opinion, will affect those who are newly diagnosed with chronic pain conditions.  The guidelines emphasize that more conservative measures be the first approach to treatment.  Opioids should reserved for those who fail more conservative treatments, cancer patients, or those who are in palliative or end of life care. There are also provisions in the guidelines for monit

Needless to say, the opioid epidemic has caused a major clash of government agencies, drug companies, pain care advocates and other medical organizations.  Some US states have passed legislation in response to the crisis. In the last few weeks, the CDC--a governmental agency that oversees public health matters--released its own guidelines for pain management.  The guidelines are non-binding but represent a sweeping change to the way pain is addressed in the American medical community.  Some highlights from this policy change include: opioid medications should not be considered "first line therapy" three days or less of opioid medication should be sufficient for most cases, excluding cancer patients, or those under palliative or end of life care dosage and prescribing limitations for prescribers review of dosages and patient goals and outcomes of therapy during patient care visits prescriber monitoring of patient history/pattern of drug usage through established

Even if you don't pay particular attention to the news, stories about the opioid crisis are everywhere. You just can't miss it. Opium has been in use for centuries. According to Wikipedia, opium was in use during the Neolithic Age- (10,200 BC to around 4,500 BC). So, the question is...how did this crisis emerge? Fast forward to the modern century...about fifteen years ago, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) reported that pain was vastly under treated here in the United States. Pain was deemed the "Fifth Vital Sign" and JCAHO stressed that pain assessments be a part of every patient/physician visit.  It was suggested that opioids could safely and effectively be used liberally, without fear of addiction. In the meantime, Purdue Pharmaceuticals launched Oxycontin®, an opioid product that offers continuous pain relief over 12 to 24 hours. As such, this product contained higher amounts of opioid than other immediate rel

Have you seen the infomercials for the "Willow Curve?" It is a low level laser device which is claimed to be useful for temporary pain reduction.  The shape of the device dictates that is can be used on many areas of the body...extremities and neck seem to be the most obvious sites for use. While expensive ( approximately $600), it can be used at home as an alternative or adjunct to other pain management methods. The device is FDA approved. But the million dollar question is--does it work? There are reviews on the official web site, and while two or three folks did not rate it highly...most people claim to be elated with it.  But outside of those reviews, the jury is mixed to put it best.  For instance,  consumer fraud reporting site  has mixed messages about this product.  Amazon.com used to sell the product...then suddenly it disappeared. While it was available there, only 49 reviews were posted...one person referred to it as a $600 heating pad. I neither condone

Today I am sharing a graphic that I found while researching for this blog...it sure is an eye-opener! Source:Paindoctor.com (Originally posted in 2014)

By now, most of us know one person or another who has had a knee or hip replacement.  What you might not know, is, as these procedures become more common, the frontier of joint replacement has expanded to include shoulder replacements.  And even more recently, ankle joint replacements have become available. Up until this point, ankle fusion, or ankle arthrodesis has been the surgery of choice for those who suffer from debilitating ankle pain due to arthritis or prior ankle injury. The downfall of this procedure has been that the bones of the ankle are fused using metal plates and screws.  The end product is a joint that is less flexible than the normal ankle.  In turn, this puts pressure on other joints of the foot, leading to the possibility that arthritis will develop in those joints. Ankle replacement joints were approved by the FDA in 2012.  The advantage to using them is that the post operative ankle function is more like a normal ankle, allowing the patient improved fu

As previously mentioned, one of the most painful consequences of type II diabetes is a condition known as peripheral neuropathy . This condition is essentially nerve damage caused by elevated blood sugar levels over extended periods of time. There are also other forms of peripheral neuropathy--due to nerve damage from other causes. According to Peter Carney, MD, there are approximately 23 million persons in America who suffer from this problem.  Dr. Carney is the lead author of a study that offers a novel approach to treatment of this condition...and perhaps the answer to a prayer for sufferers. Dr. Carney's study involves using a technique known as Combined Electrochemical Therapy (CET). This technique uses a combination of local anesthetic and electrical current. Forty-one patients with peripheral neuropathy were studied. After twice weekly treatments (up to 24 total treatments per patient), 73% showed regrowth of nerves. Reduction in pain (as per visual analog scale)

Mindfulness is defined as "the quality or state of being conscious or aware of something." This concept has become a hot topic in the past couple of decades. The roots of this idea are ancient—martial arts, yoga, meditation and Buddhism are all closely related to it. Mindfulness is a very powerful tool. There are reports that Buddhist monks who sleep in freezing conditions in the mountains of Tibet are able to control their body temperature using this technique!  You have to ask yourself...what things could be possible in your own life if you were able to master this practice? Four hundred participants in a study at Brown University recently gave us a hint at what is possible.  Using the Mindful Attention Awareness Scale (MAAS), researchers found a significant association between dispositional mindfulness and glucose control. After evaluating their findings, the authors hypothesize that being aware of the present moment can lead to reduced likelihood of

The marketplace for pain management products is changing...and many devices have come onto the market for this purpose.  The early generation products, such as spinal cord stimulators and TENS units are still in use today..but more and more new devices have entered the scene. X-ray of knee replacement One such device is undergoing clinical trials right now.  It's called i overa® and it's  already FDA approved for breakthrough pain.  The current trials are focused on post-surgical management of pain in knee replacement patients. There is a lot of interest in this product--according to Myoscience , the California based product developer, enrollment for the study filled up ahead of schedule! This device is a little different from some of the earlier devices because of its use f or breakthrough pain.  The earlier products I am most familiar with deliver a constant baseline level of pain relief--if breakthrough pain should occur while using these earlier products, it i

Okay, so sometimes pain management with opioids fails for one reason or another.  Maybe the side effects are just too much for an individual...or maybe an individual becomes addicted and wants to find and alternative way to manage pain going forward.  If that sounds like you, or someone you know...there is hope. Research findings presented at this year's American Academy of Pain Management describe a study of this very thing.  A study of patients at the Chronic Pain and Recovery Center in New Canaan, Connecticut followed 154 patients who came to the center due to opioid failure/addiction.  Following a 28 day residential treatment program, these patients learned self management techniques,and participated in group therapy, physical therapy,substance abuse and nutrition counseling, 63 percent of these folks were no longer on opioids and still reported a reduction in their pain scores! These findings are preliminary, but they are indeed good news! You can read the origina

A very traditional part of medicine follows the logic that medication is the first resort for pretty much every medical condition known to man.  This was a widely accepted practice for many years. For patients, it became pretty much expected that a visit to the doctor entailed a brief exam to evaluate the patient's complaint, followed by a prescription for some medication to treat said medical condition. In more recent years, the medical community has learned from the flaws in this logic.  For example, after treating patient after patient with antibiotics for minor infection, we have fallen victim to "super bugs"--strains of bacteria that are resistant to most, if not all, antibiotics.  We have learned that it's better to find other approaches to the more minor infections, allowing the body to heal itself and develop a stronger immune system. In that same vein, chronic pain conditions fell into the same logic process.  Long acting opioid products used ove

This topic is important...and has not yet been addressed in this blog, so today is the day! Modern medications are a true marvel.  There are more drugs for more indications on the market now than we ever could have imagined even a decade ago.  As the science of drug development evolves, the newer drugs seem to be more effective than their predecessors. At the same time, more is known about drug metabolism and the interactions drugs have with foods and other drugs. This has made medicinal therapy become increasingly more complex as the years pass. At the same time, there are occasions when therapy with medication fails.  Chemotherapy for cancer is one example; while much progress has been made, there are still many treatment failures.  This is also the case in the realm of pain management.  There are many medications out there--some new and some old standbys. But not every drug or drug combination for pain is successful 100% of the time in 100% of patients. For t

One of the best defenses we have against chronic pain, or any illness for that matter--is to know what the risk factors are and to do our best to eliminate as many risks as possible. There are some risk factors we really can't control--such as genetics. The good news is, there are many risk factors that can be controlled or eliminated. Type II diabetes is one example of the health conditions I am talking about here.  While diabetes is not a painful condition in and of itself, it can lead to the development of diabetic neuropathy . This condition leads to nerve damage due to elevated blood glucose levels over extended periods. There is a period of time prior to development of type II diabetes that is known as pre-diabetes. During the pre-diabetes period, timely management of risk factors such as hypertension, weight management, dietary modifications, etc. can halt the further development of this form of diabetes. For that reason, today I am sharing a link to a q

One subject we have not broached too much in this blog is spirituality...it is one of the elements of holistic health care...but does not always get the "air time" that it deserves. Spirituality is defined as " being concerned with religion or religious matters; of or relating to a person's spirit."  One approach to spirituality is the practice of organized religion, but spirituality is actually more encompassing than that... Organized religion is certainly a great way to address a person's spiritual needs.  Most religions have a system of beliefs that set them apart from other religious practices. Those who embrace these practices can find much solace in their respective system of belief. Beyond Christianity, Judaism, Islam and other practices, spirituality also encompasses a sort of "sixth sense." Each person's idea of spirituality is as unique as a fingerprint.  As previously stated, this may be firmly rooted in organized religion

Holistic medicine is defined as medical practice that seeks to treat an individual as a whole--body, mind, emotions, and spirit--as opposed to treatment that is focused on a specific malady.  The holistic approach to medicine emerged in the 1970s. Traditional western medicine scoffed at what we now know as complementary or alternative practices; since that time these practices have become more widely accepted and integrated into modern medical practice. The principles of holistic medicine embrace a team approach to patient care. Holistic practitioners believe that every individual possesses an innate ability to heal themselves. They see the patient as a person rather than a disease state. In an attempt to treat the patient, holistic practitioners are members of a team that strives to correct the underlying cause of the patients condition as opposed to simply alleviating symptoms. There are many types of treatments that come under the auspices of holistic medicine.

Fibromyalgia is still a poorly understood disorder..but fear not, the push is on to learn more about it so it can be better managed and treated. Ask anyone who has this disorder--it's certainly no walk in the park, and the need for remediation is obvious. Microglia (green) and neurons in a rat brain culture One of the more recent discoveries in this effort is the existence of microglia.   Unique to the central nervous system, these tiny cells travel about to areas of injury or infection. Once there, they send out an SOS to other parts of the immune system. Microglia also attempt to begin the healing process. Inflammation is part of this process. While this is a normal part of the healing process, chronic inflammation is problematic. It's thought that microglial activation is part of the problem experienced by patients with fibromyalgia...perhaps with respect to brain fog and issues with hyperalgesia (pain amplification) and mechanical allodynia (pain expe

In recent news, it's been reported that women with fibromyalgia commonly suffer from pelvic pain.... An Oregon Health & Science University is looking to expand a preliminary study of 177 females average age approximately 52 years who responded to three different questionnaires regarding these topics: Fibromyalgia Impact Questionnaire (FIQ), Pelvic Floor Distress Inventory 20 (PFDI-20) , and the Pelvic Pain Urgency, and Frequency Questionnaire (PUF) .  When the results were analyzed, a positive correlation between fibromyalgia and the other two conditions was found. At this point in time, study authors recommend that patients with fibromyalgia be routinely offered all three of these questionnaires to screen for these conditions.  Sources:HCPLive; Pixabay

Given that fibromyalgia is such a painful condition, it may seem logical to think that treatment should include chronic opioids. After all, the "tender points" that are the hallmark for diagnosing this condition are so excruciatingly painful to the slightest touch . That leads us to question why the practice of prescribing Oxycontin and similar products for round the clock relief...right? If the truth be told, the American College of Rheumatology treatment guidelines for fibromyalgia  specifically state the following in this regard: "Doctors do not recommend opioid narcotics for treating fibromyalgia. The reason for this is that research evidence suggests these drugs are not of great benefit to most people with fibromyalgia. In fact, they may cause greater pain sensitivity or make pain persist." There are currently three drugs on the market that have FDA approval for chronic treatment of fibromyalgia--and all three of them are antidepressants.  Whethe