Everyday pain management ideas

In the modern era of pain management, it has become of utmost importance to pinpoint the source of pain. This really offers someone who is experiencing pain the best hope of a speedy, permanent resolution to their discomfort.  If pain medications are ordered, they may be effective, but will only cover up the pain instead of fixing it. This process can be very frustrating. It's not unusual for someone to have pain but no source can be identified. But it's really better to be relentless in the search.  Here's a story that sort of illustrates my point: Mrs. A. is a healthy woman in her later 50s. She lives in the country and raises chickens...she always has fresh eggs on hand!  She has never smoked and does not really consume alcohol too often.  She is a regular exerciser and loves to garden. She has been happily married for almost forty years. One day Mrs. A. notices some shoulder pain so she visits her local ER. The physician there tells her that she probably pulle

In the wake of opioid and heroin addiction, you may be hearing more about patient/provider agreements when it's determined that opioid therapy is in the patient's best interest.  Today's post will provide you with a brief overview of what a patient/provider agreement is, and what you might see in one if opioid therapy is in your future A patient/provider agreement is simply a contract that these two parties make with each other at the onset of treatment.  This type of contract spells out in detail all of the responsibilities of the health care provider as well as those of the patient.  The contract also spells out what will happen if the terms of the contract are violated by either party. What are some of the things you might see in a patient/provider agreement? Each provider may be a little bit different, but in general you can expect to see at least some of the following: Patient Responsibilities: Patient agrees to take medication only as prescribed. Patie

My message for today is simple but very important.  My message today is that a positive attitude about ANY situation--chronic pain being a prime example--is the most important weapon you can have.  Case in point: Barby Ingle.  Click here for a link to a column she wrote for her the Pain News Network.  Her story is not unusual; her attitude is priceless! Sources: Flickr; Pain News Network

One of the most baffling pain conditions women experience is chronic pelvic pain. This unfortunate problem is not only uncomfortable, but can be a cause of infertility in women. Some of the usual causes are fibroids, endometriosis and pelvic adhesions. Typically, these problems are addressed by standard modalities--surgery, medications, psychotherapy, and physical therapy among them. Recently, I came across a newer idea for treatment of pelvic pain caused by adhesions.  It's known as the Wurn Technique, and it's really a quite interesting approach.  Similar to a deep tissue massage, this method can be used to break the adhesions in the pelvic area.  This helps to reduce the pelvic pain and can even restore fertility in some cases!  The best part is that it's all drug free! For more information about the Wurn Technique, you can click here to reach the ClearPassages website. This site explains in more detail about how the technique is used and also the story of how

Piercing is a form of self expression these days, along with tattoos of every shape and size. I try not to judge--and here is one good reason why. Have you ever seen someone with a piercing like the one above?  This is known as Daith piercing .  It is not just someone trying to be stylish! This is actually an acupuncture practice that has been in existence for thousands of years.  There is no scientific evidence to support this practice, but many migraine sufferers who have this piercing report a reduced frequency in migraine attacks. Migraine headaches are a complex neurological event. More than 3 million persons in the US experience a migraine attack every year. The pain can be so severe as to cause nausea and vomiting, and can incapacitate a person for hours to days.  If you experience severe headache, typically a throbbing on one side of the head, accompanied by sensitivity to light and/or nausea/vomiting, it just might be a migraine.  There are many pharmacological and no

My thoughts exactly! Sources: Flickr.com

Do you know anyone who is extremely flexible--in the physical sense?  As it turns out, a small number of these individuals actually have a connective tissue disorder.  Known as Ehlers-Danlos syndrome, this inherited disorder of connective tissue results in overly flexible joints and stretchy, fragile skin.  A more severe version of this disorder also affects the walls of the blood vessels. How does one know this might be a problem? Firstly, the joints are much more flexible than the average person because the connective tissue that holds the joints together is very loose.  Secondly, the skin of affected individuals is very "stretchy...it can be pulled away from the body more than normal, but goes right back into place when released.  The skin is also very fragile, to the point where wounds do not heal well. Those who have the vascular form of this disorder have distinctive facial features( thin nose and upper lip, small earlobes, and prominent eyes), and the heart can be aff

Back in March 2015 I wrote a post about pain catastrophizing .  You can read that post by clicking this link , but I will try to explain it to you briefly: Pain catastrophizing simply means that physical pain that is amplified by negative emotions that coincide with the physical pain.  Many people might think that this is just part of a personality, that it cannot be changed, etc. etc. But today I am here to share some good news--that is to say, that some of that factors associated with pain catastrophizing CAN be controlled.  In the next paragraph or two, you'll get my drift. First, let me tell you about an article I read about this topic that was completed at Emory University. The study authors investigated 300 chronic pain patients at clinics in rural Alabama. The study revealed that a very key factor common to pain catastrophe is low health literacy. These patients simply did not understand much about health and/or medicine, so they had very poor understanding of thei

A new study published in JAMA ( Journal of American Pediatrics) tells us that pregnant women who took Tylenol® (or its active ingredient--acetaminophen)--had an increased risk of delivering a child with hyperactivity issues. This drug is still relatively safe to take...the researchers say that using acetaminophen products during gestation may ward off more significant problems--for example, if it is being used to reduce fever! So the bottom line here is simply this: There's no reason to avoid these products altogether during pregnancy, but it doesn't hurt to err on the side of caution! You can see the ABC news report on this topic by clicking here . Sources: ABCNews; Flickr

The American Eye Institute reports that approximately 3 million Americans suffer from chronic dry eye.  As such, it's a fairly common condition.  The usual treatment for this malady is the use of artificial tears. This is important, because without lubrication the cornea can be damaged, and it can be very uncomfortable as well. New research about chronic dry eye is shedding light on another aspect of the condition.  As reported in the Journal of Pain, some patients with dry eye have a neuropathic pain condition.  Patients reported having higher levels of ocular pain as well as a number of coexisting chronic pain syndromes.  They also reported a higher incidence of depression and a lower quality of life. This research sheds light on the complexities of what we might otherwise think of as a simple everyday problem.  More research is needed to explore more fully the link between dry eyes and chronic pain syndromes, and a more permanent treatment for those affected by this com

After I wrote the post just prior to this one, I took some time to think reflect on the people in my life--most especially those whom I know to have chronic pain.  I can definitely see that there is an emotional component to the problem.  And the study in the prior post seems to confirm that what I am thinking is true. Stated simply, those who have the best coping skills have the best natural ability to deal with chronic pain. Unfortunately, many of us do not have those skills due to any number of reasons. So, the next logical step for people in this group is to learn to improve their coping skills.  I guess I think that's really what my blog is all about.   I do believe the first step in this effort requires an attempt to find a root cause of the pain, and if possible, to correct it.  This is the best hope of staying ahead of the game.  There will always be situations where this is not possible, or that a given condition can be managed but not cured.  For this group, I wo

There's been a lot of discussion in pain management circles about the psychological aspects of chronic pain. Patients with dementia are a hot topic in this area; now more information is coming out about these persons, and those with other cognitive deficits including those with attention deficit and/or impaired executive functions. A study published in January 2014 edition of Brain helps to illustrate how and why this is the case.This study looked at 189 subjects who ranged in age from 18 to 85 years.  Study subjects were all about to undergo knee replacement (for osteoarthritis) or breast cancer surgery. And here's where it becomes interesting--in the knee replacement group, 84% of the patients had "clinically meaningful" pain levels prior to procedure.  Six to twelve months after surgery, 38-39% of these subjects were still reporting significant pain.  In the breast cancer group, none of the subjects complained of significant pain before surgery, but six to

While watching a bit of the Olympics this summer, I gave some thought to all the training and sports medicine...and I couldn't help but think a little bit about all that goes into making each athlete the best he or she can be during competition.  There's a lot more going on there than meets the eye, that's for sure! One example of this came to my mind as I prepared for this post.  Most of us know seasoned Olympic swimmer Michael Phelps and all the gold medals he has earned over the years... It turns out that many of the athletes in Rio, including Mr. Phelps, showed up at the games with circular bruises on various body parts.  It came to be known that these athletes use a form of Chinese medicine known as "cupping." During a cupping section, specialized round cups are heated and placed on the skin to target select muscle groups. The cups create a suction effect and are purported to stimulated blood flow in the target tissues.  It is also said to increase

Sometimes we overlook the simple things. I must apologize--all the time I've been writing this blog, and never thought about the importance of good coping skills.  We all learn to cope with whatever we're dealing with one way or another, but not every coping skill is a positive one.  The good thing is, we can ALL learn positive coping skills that we don't have on board already! So today, I would like you to ask yourself..what are your responses to situations that are not going well?  Whether the situation is a pain filled day or some sad news, our choice of response can make a lot of difference! Here is a list of some NEGATIVE COPING SKILLS . I am not trying to call anyone out--we all do some of these at least some of the time: Avoidance Alcohol Use/Abuse Drugs Sedatives Refusal to address emotions/feelings Self-mutilation The goal here is to be honest with yourself. If you see a little bit of yourself in the list above, look to the list below to fi

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!

Are you a chronic pain patient who has been on opioids for a long time?  Or maybe a physician who has patients like this?  As you might know, there is no magic formula for "getting off" of an opioid regimen.  The risks of long term use of opioids is quite clear. In addition, after a period of use, the effectiveness of an opioid regimen seems to diminish. One thing is for certain.  If a patient has been on an opioid regimen for an extended period of time, an abrupt discontinuation can lead to withdrawal symptoms. That is certainly not a good plan of action! So, how can a patient find their way off of one of these treatment regimens in a healthy way? Here are some suggestions based on a lecture at the World Congress of the World Institute of Pain in May 2016: 1) For patients on multiple opioid regimens, decrease long acting opioids first . This way the patient still has the shorter acting opioids available if necessary. 2) Go slowly .  Reduce dosage of remaini

Serotonin  is an important chemical in the human body.  In a nutshell, it's a neurotransmitter that's involved in many body processes.  The current thinking on depression and anxiety (which often accompany chronic pain syndromes) is that there is an imbalance in the central nervous system mainly due to low levels of serotonin.  Many of the medications we use to treat depression belong to a class of drugs known as SSRIs, or  S elective S erotonin R e-uptake I nhibitors. These drugs help the body to make the most use of the serotonin a person has in their body by keeping it "active" as much as possible. But this is not the only way serotonin levels can be boosted.  There are many natural phenomenon that help fulfill this purpose.  It's good to know that these practices can help to accomplish the same goals that these medications do.  If you are a person who does not wish to take these medications, I would like to share these ideas with you today! So, wit