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Meet BPAT: A New Way To Assess Pain In Nonverbal Patients

Following surgery or during an illness, most patients are asked to rate their pain on a numeric scale. As an alternative, some nurses/health care workers use facial expressions as a gage.  There are pros and cons to these methods, of course.  There are also patients who cannot respond verbally or provide facial cues, even though they may be in severe pain.  The unconscious patient in an ICU is an example of this sort of patient, and perhaps some dementia patients are this sort, too.
A new pain assessment tool known as BPAT (Behavior Pain Assessment Tool) may be the answer to this problem.  This tool evaluates eight behavioral clues, including facial expression, muscle responses, and verbal expressions to determine a patients pain level. While being studied, this new pain tool was used on persons who were able to communicate, then compared to what the patient's rating on a ten point scale.  It was reported to be reliable in two of every three patients studied. Further evaluation w…

Can Body Weight Be A Risk For Migraine Headache?

There are certain things we've known for a long time about migraine headache sufferers:

Migraines are common in women than men.

There are many "triggers" of migraine headache, including foods, MSG, hormonal factors, stress levels, weather conditions, etc.

There are many subtypes of migraine. Here are some examples:  classic migraine, chronic migraine, and menstrual migraine.

Medical research in the field of migraine has made it possible to prevent or reduce migraine occurrence, or abort a migraine shortly after onset!

A new finding, recently published in the journal, Neurology, suggests that there is a relationship between Body Mass Index (BMI)  and the likelihood of migraines.  According to the study that was published, migraine is more likely to occur in individuals whose BMI is above or below the normal range. 

If you are a migraine sufferer and have reason to believe this may be a problem, you can determine if your BMI is in the normal range using the above diagram. You c…

Risk Factors For Autoimmune Diseases

There are several autoimmune diseases (celiac disease, lupus, rheumatoid arthritis, etc) that are responsible for many cases of chronic pain. Since this is the case, it's good to know what the risk factors are, just as you would want to know your risk for heart disease, cancer or anything else.  Here are some things to keep in mind:




1) You already have one autoimmune disease: One in four persons who already has one autoimmune disorder will develop a second autoimmune disorder.

2) Ethnicity: African Americans, Latinos, Native Americans and Asians are at highest risk.

3) Family history: Some types of autoimmune disease run in families. If a close relative has an autoimmune disorder, you have an increased risk simply due to genetic similarities.

4) Gender: A woman's risk of developing an autoimmune disease is generally three times higher than male counterparts. Some autoimmune disorders, such as lupus, are even more prevalent in females.

5) Your spouse has celiac disease: A 201…

Opioid Induced Hyperalgesia

Opioid Induced Hyperalgesia (OIH) is a real condition. It occurs when opioid medications actually cause increased sensitivity to painful stimuli. Yes, it's a paradox but it does occur. It is difficult to diagnose because it is difficult to distinguish from opioid tolerance.  But there are some characteristics unique to OIH:
Pain in more diffuse in naturePain worsens over time even if opioid dosage is increasedPain harder to pinpoint and of lesser quality It is thought that the mechanism of OIH is most likely due to over-excitation of neurons, but at this point the jury is still out. If OIH is suspected, the offending medication is withdrawn slowly. Sometimes, if pain persists it may be possible to reduce the dose of the original medication or switch to another class of drugs for pain management.  There is added difficulty in that a patient might have difficulty understanding how pain levels can actually increase because of their medication!
OIH is poorly understood and more researc…

Novel Pain Treatment Gets The Green Light

As the opioid crisis looms, researchers everywhere are looking into new and novel ways to lessen their usage. One example of this is a story out of the University of Arizona, where researchers studied how exposure to different colors of LED light affected chronic pain in rat populations. After studying several colors of light, it was noted that low intensity green light had the most potent effect. Following the animal study, a small scale human study was conducted.  Study subjects were asked to use the green light in a darkened area of their homes for one or two hours a day.



All the study participants claimed that their moods were improved and pain lessened. The exact mechanism of action is yet to be determined. Larger studies of longer duration are needed to determine the optimum intensity of the light, duration of treatment, ideal frequency of treatments, and so on.  The best news is that no adverse affects were reported during the initial study.

You can read more about this intere…

Herpes As A Helper?

If you've ever had shingles, or known anyone that has experienced it, you probably know that chronic pain can persist following the initial attack (post herpetic neuralgia).  This is because the herpes virus seems to have an affinity for nerve cells.  And while it's not fun to have shingles or post herpetic neuralgia, the herpes virus may be a key in future development of delivery systems for pain management treatments.





Here's the deal--since Herpes simplex has an affinity for nerve cells, researchers are looking a genetically modified, safer version of the virus to deliver genetic material to damaged nerves.  In simple terms, once the genetic material reaches these nerve cells, it will hopefully encode these nerves to ultimately inhibit pain signals.  Animal studies and clinical trials in cancer patients have been encouraging thus far.

This is one of those developments that makes me believe that there is hope for those in chronic pain. Along with so many other exciting d…

Common Virus Is Possible Trigger Of Celiac Disease

A recent report in Science News shares a study of TL1 reovirus (a very common and usually innocuous virus) and suggests that it could be responsible for the development of celiac disease.  This virus, according to study authors, prompts the immune system to produce an exaggerated inflammatory response. While TL1 reovirus is not deadly, it's very common and most of the time people don't even know they've been infected by it.


Dermody and et. al, who conducted this study at the University of Pittsburgh, found that celiac patients had higher than normal levels of antibodies against TL1 reovirus.  The researchers also believe that other viruses are capable of triggering celiac and other diseases. Future studies will look at this in more detail. If their theory holds true, a vaccine could be developed against  TL1 reovirus or other responsible viruses to halt the development of celiac disease.
For more information about this interesting study, you can read more here
Sources: S…

Posture Treatment: New Hope For An Old Problem?

With the opioid crisis looming over our heads, we need to look for new ways to treat some of the problems that could potentially lead to future opioid use.  One of the most common causes of chronic pain is low back pain that stems from degenerative changes, sciatica, etc. As mentioned in past posts, there is no panacea for any of these conditions, but there are many options out there.



I recently read a story in the New India Express about a new treatment that is offering hope to patients with these types of maladies. According to the article, our body posture can easily end up in misalignment when we try to compromise for things like physical trauma, or develop poor posture habits in the workplace. We often overlook the effects of these postural abnormalities as part of "the big picture."  Using the latest technology, medical science can now detect and treat such abnormalities with great precision. Medical procedures of this sort are non-invasive and are virtually painless…

Strange But True: Burning Mouth Syndrome

Believe it or not, there really is a painful disorder known as "Burning Mouth Syndrome!" While it does not occur commonly, it can affect an individual for weeks, months or years.  This syndrome, as its name implies, causes a burning sensation in the oral cavity.  The primary symptoms is a sensation in the mouth that has been described as burning, scalding, or even tingling. It is difficult to diagnose because there is no visible abnormality for a doctor, dentist, or other health care provider to see upon exam.

Burning Mouth Syndrome is considered "Primary BMS" if no underlying medical condition can be associated with it.  In this case, damage to nerves seems to be the underlying cause of the problem.

"Secondary BMS" can be associated with an existing medical problem such as diabetes, thyroid disorders, allergies, Sjorgren's syndrome, certain medications or nutritional deficiencies, an oral infection or even gastroesophogeal reflux disease GERD).

BMS,…

Shared Reading: A New Approach To Chronic Pain?

One of the traditional strategies in the treatment of chronic pain is cognitive based therapy(CBT)--that is, using the help of a psychologist to help build up coping skills and keep a positive perspective in spite of the hardships. A recent study based in the United Kingdom suggests an alternative approach: shared reading.  Shared reading is an activity in which a small group of individuals gather to read aloud. The study involved reading poetry, short stories, and other literature that helped participants to recall memories and experiences of life, especially those that pertain to childhood, family, work, and other lifetime memories.  The idea for this study stems from the use of this strategy for other chronic conditions such as dementia. It is thought that prompting these memories helps patients to address painful emotions that may contribute to their respective conditions.



While the results of the study are encouraging, the team who conducted the study says a larger scale study w…

New Saliva Test Helps Clinician Monitor Pain Patients

A Denver-based company has developed a test that can help physicians monitor opioid usage in patients--using saliva instead of urine samples.  The test is known as CORE (Comprehensive Oral fluid Rx Evaluation). Cordant Health Solutions, the developer of this test, says that it is more accurate than the widely used urine tests currently in use.  A sample is easily collected simply by swabbing the inside of a patient's mouth. The test can detect if patient is taking the right amount of medication, while urine tests only detect the presence or absence of a drug.  Urine tests also give false results sometimes.  As an example, the decongestant component in common cold remedies can trigger as a positive for amphetamines.



While it has its positives, the company admits that the test is not foolproof. Drug levels found in saliva do not correspond with blood test results about 25 percent of the time. Another drawback is that the result of a saliva test is not available for 48 to 72 hours, wh…

Living With Psoriatic Arthritis

While it might seem overwhelming at first, it is possible to have a somewhat normal life when you are diagnosed with psoriatic arthritis.  If you are new to exercise, it will probably be very challenging in the beginning, but it can be done!  It's important to start low, go slow....you're not training for a marathon when you first start out!




Gentle forms of exercise, such as walking or swimming are great exercises for beginners. It might be necessary to get some help from a physical therapist or a personal trainer to get yourself going! Cycling, yoga and tai chi are other possible activities.  Do not hesitate to talk to your health care team if you are unsure about an activity; it's better to be safe than sorry.

Pain is an unfortunate consequence of psoriatic arthritis.  Medications are necessary to combat pain and also the inflammation caused by this condition.  Most likely prescription NSAIDs or biologics such as Humira® will be a component of your treatment.  Some pati…

Psoriatic Arthritis: Complementary Therapies

While the mainstay of therapy for psoriatic arthritis is the medical management of inflammation, there are a number of things that complement the efforts of their health care team.  First and foremost, diet and nutrition play a big role in this regard.




Their are several facets to consider in this effort:

--Anti-inflammatory foods help to reduce the inflammation caused by psoriatic arthritis and psoriasis.
   See my earlier post: The Painful Truth About Psoriasis: Dietary Considerations
--A heart-healthy diet, including elimination of alcohol, processed foods, and fatty foods and instead opting for lean meats, fish, fresh fruits and vegetables, and healthy oils.
--Inclusion of omega-3 oils in the diet through supplements, nuts, fish oil, eggs and other foods
--Up to 25 percent of those who have psoriasis have gluten sensitivity, so a gluten-free diet is worth considering.

--Weight loss is important, especially since obesity is a risk factor for psoriasis and the other risks a psoriasi…

Psoriatic Arthritis: Are You At Risk?

Psoriasis is a chronic disorder, and those who suffer from it are at higher risk than most for other disorders.



One such problem is psoriatic arthritis.  About 10 to 20 percent of all psoriasis patients will go on to develop psoriatic arthritis.  Symptoms include joint pain, stiffness, and swelling are the hallmarks of psoriatic arthritis. Any part of the body can be affected by it, and the symptoms can range in intensity from mild to severe.  There is no cure for this disorder, so the focus of treatment is on managing inflammation to prevent joint pain and disability.

That being said, psoriasis is not the only risk factor for psoriatic arthritis; as a matter of fact some people develop psoriatic arthritis even though they do not have psoriasis! Knowing these risk factors and doing your best to control the controllable are the keys to prevention.

So, here is a list of these risk factors.

1) As already mentioned, having psoriasis is a big risk factor for development of psoriatic arthr…

The Painful Truth About Psoriasis--Dietary Considerations

Just as with many other chronic health conditions, diet plays a role in disease management.  Here is a quick overview of dietary considerations for people with psoriasis:

First off, if you are a psoriasis patient you may notice that some foods tend to trigger flare-ups more than other foods.  To this point, it's good to be observant and do what your body tells you to do. As long as you follow a healthy diet, this is good!
It has been suggested that people with celiac disease may be at higher risk for psoriasis than other persons. A gluten free-diet is the mainstay of treatment for celiac disease,and it may help keep psoriasis flares at bay as well. But the relationship between gluten intolerance, yeast exposure and psoriasis is not well understood at this point in time. You can try eliminating gluten or yeast if you suspect it to be a problem and see what happens.
Fatty red meats are known to increase heart health risks...and people with psoriasis have an increased risk of heart …

The Painful Truth About Psoriasis--Traditional Medical Treatments

As previously posted, psoriasis is a chronic immune mediated disorder that causes raised red scaly patches to appear on the skin.  You might not think of it as a chronic pain disorder, but it's not exactly comfortable to be living with this condition all the time. If left untreated, psoriasis can develop into psoriatic arthritis. Other possible complications include eye issues, type 2 diabetes, obesity, hypertension, heart disease and more.  So it makes sense to manage and treat it, because it certainly is much more than a simple skin condition.

There are several methods that are used to manage psoriasis in traditional medical practice. Here are some examples:

Biologics--usually administered via IV infusion, these drugs are usually used for more severe cases or cases in which other treatments have been ineffective.

Systemics--these are for moderate to severe cases of psoriasis.  Some are injectable and some are oral medications. They include drugs such as cyclosporine and methotrex…

The Painful Truth About Psoriasis--In A Nutshell

The National Psoriasis Foundation defines psoriasis as "an immune-mediated disease that causes raised, red scaly patches to appear on the skin." The exact cause of this disorder in not known, but genetics and the immune system play a big role in its development. Men and women are affected equally, but Caucasians are more susceptible than African Americans. Most people are initially diagnosed somewhere between 10 and 15 years of age. Psoriasis is not a contagious disease!

There are five basic types of psoriasis:

Plaque psoriasis is the most common form of psoriasis. It appears as raised red patches with a silver to white buildup of dead skin cells on top.  It looks something like this:



Guttate psoriasis appears as small dot like lesions on the skin.  This form usually starts in childhood, and is the second most common form of the disorder.  Here is an example:



Very red patches that appear in body folds, such as armpits, back of the knee, or groin might be a form of psoriasis k…

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