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 o...

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 ...

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 chro...

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 th...

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 pot...

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, ...

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 theor...

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 ...

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 mon...

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 establis...

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. ...