Everyday pain management ideas

Some people say that the massage experience is the ultimate in pampering.  In truth, it can be much more than that.  There is a form of massage known as medical massage. With proper training, any license massage therapist can provide this therapy for any number of conditions, including seizures, fibromyalgia, migraines, nerve pain, joint pain, and many others. Medical massage is a bit different from the spa experience that you might be visualizing right now.  A given patient may go to see his/her therapist weekly, for anywhere from four to sixteen visits.  The number of treatments varies so widely because it is outcome based, so depending on the condition being treated and the goals of therapy.  The therapist will  likely follow up with clients after treatment to ensure that everything is going well and determine whether or not future sessions are necessary. Sadly, health care insurance providers do not always see the benefit of this form of therapy so they do not alwa

A new device in the chronic pain marketplace may be "just what the doctor ordered" in future pain management. Researchers at the University of Texas at Arlington are studying a device that wirelessly sends electrical stimulation to sites deep within the brain to relieve long-term pain. Other stimulation devices currently on the marketplace are designed to send electrical stimulation to a body site where chronic pain originates. The new device is different because it acts at a site deep within the brain--and wireless. It could be used to treat any number of pain conditions and allows the user to go about his/her usual business while it is working! According to the researchers, “There are several other commercial companies making FDA-approved stimulation devices for neurological and psychiatric disorders, such as Parkinson’s disease, depression and dystonia, so many safety issues have already been investigated and addressed,” he said. “We hope to see this move forward

Osteoporosis is very common in older persons. Usually it is the result of aging, but it can also be caused by a medical condition known as hyperparathyroidism . While osteoporosis is not painful, the potential for debilitating or life threatening related conditions is great.  Read below for clarification of this point... Fracture of the hip Here are some facts and figures from The International Osteoporosis Foundation: It is estimated that over 200 million women have osteoporosis. That’s more than the combined populations of the Germany, the United Kingdom and France! In fact, every three seconds a bone will break, somewhere in the world, because of this disease. Many people won’t know they have osteoporosis until their first fracture, which is why it’s called the ‘ silent disease ’. Even after a break, it often goes untreated. Worldwide, one in three women and one in five men over the age of fifty will experience an osteoporotic fracture. Fractures are

What comes first..the chicken, or the egg?  This riddle has been pondered by generations.  And is there really an answer? Maybe...or maybe not.   In the world of pain management, there is a similar question, and that is the basis for today's post. It has long been apparent that living with chronic pain can be disruptive to sleep patterns. This has a negative effect on the quality of life for chronic pain patients.   Have you ever thought about the reverse situation...that is to say, how does a disruptive sleep pattern affect chronic pain? A study of this topic, conducting in the Netherlands, gives us an idea that there is a relationship.  "Emerging adults" (age 19-22) looked at followed subjects over several years; half of those who had sleep problems in the first year of study continued to be plagued with sleep issues in the third year of the study.  The subjects who had sleep problems at the outset were more likely to have chronic pain, and m

As medical research advances, there are many new and interesting findings all the time.  Some of them are revolutionary, result in new and better treatments of health issues. Still others do not help us to find cure or treatment, but instead help us to find connections or to better understand disease process. One most interesting finding of late is that there appears to be a connection between tinnitus (constant ringing of the ears) and chronic pain.  Jose Rauschecker, lead author of a study at Georgetown University reports that these two phenomenon may coexist because of changes that occur in two areas of the brain. According to study findings, two areas in the frontal area of the brain serve as "gatekeepers" of sensory stimuli.  These regions of the brain appear to have less grey matter in persons with chronic pain and/or tinnitus as compared to normal test subjects. This Georgetown study proposes that these areas of the brain tend to filter out signals that a

A recent small scale study conducted by scientists in the US and Australia showed that patients who took opioids for as little as one month demonstrated changes in the gray matter of the brain, confirmed by MRI.  At present, the authors of the study note that it is preliminary to say exactly what these changes mean... Grey Matter of the Human Brain “It’s disturbing to learn that in as little as one month, daily use of opioids can alter brain morphology. And it’s even more disturbing to learn that despite the harm caused to the subjects in the morphine arm, their pain wasn’t any better controlled than the patients receiving placebo,” commented Andrew Kolodny, MD, chief medical officer, Phoenix House; executive director, Physicians for Responsible Opioid Prescribing; and senior scientist, Heller School for Social Policy and Management, Brandeis University, Waltham, Mass. “This is strong evidence that for many patients, the risks of long-term opioids clearly outweigh potenti

News reports out of Sydney, Australia are sharing promising results for patients with osteoarthritis. In a couple of studies going on there, patients with hip or joint osteoarthritis, a new technique involving stem cells is undergoing clinical trials. Human Stem Cells According to reports, patients in these studies first undergo liposuction to harvest the stem cells needed for the procedure.  The stem cells are then processed in a laboratory, and when ready (about four weeks later), they are injected into the same patient's affected joint. This is the first time that a treatment of this type is being tried...and while still incomplete, the early results are quite remarkable. Interestingly, the patients with most severe joint damage seem to be the ones who benefit the most! The results are yet unpublished...but it's exciting to thing that this could revolutionize treatment of osteoarthritis in future.  Maybe joint replacement therapy will become less common, or eve

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