New Hope for Chronic Pain Sufferers

A new study by a University of Reading researcher has found that painful areas on our body can be controlled through the power of positive thinking.

In a study led by Dr Tim Salomons, healthy participants were given five minute spells of cognitive behavioural therapy (CBT) prior to having eight, hour-long sessions of heat applied to their forearm to evoke pain. This created areas of secondary hyperalgesia – a measure of pain sensitivity in the area surrounding injuries such as burns.

By managing their negative thoughts the group managed to reduce the physical symptoms of secondary hyperalgesia by nearly 40%. Secondary hyperalgesia is an example of central sensitisation, where pain sensitivity is enhanced by the central nervous system.

Although not a replacement for other forms of treatment the results are good news for those who suffer from chronic pain condition like lower back pain and fibromyalgia, as central sensitisation has been observed in chronic pain disorders.

CBT focuses on examining negative beliefs and changing thoughts that are distorted and unhelpful.  Used widely to treat mental health issues and ’emotional’ pain, this research showed that CBT can actually alter the body’s physical responses to pain after injury.

 

Men, Opiods, and Low Testosterone Levels

As a man, with chronic pain, and taking long-acting pain meds, I found this article interesting and yet disturbing at the same time. What are we to do? We take pain meds to get through the day and then have to add a testosterone supplement later in life? I by no means think that life is fair, but can’t we catch a break? Just an itsy-bitsy one?

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Men Taking Long-Acting Chronic Pain Meds Five Times More Likely to Have Low Testosterone Levels

Jan. 31, 2013 — Low testosterone levels occur five times more often among men who take long-acting instead of short-acting opioids for chronic pain, according to a new Kaiser Permanente study published in The Clinical Journal of Pain.

While it has been known that opioids cause low testosterone in men, this study is the first to show a significant difference in risk between short-acting (immediate release) and long-acting opioids.

The 81 men in the retrospective study were between 26 and 79 years old (median age 51) and were seen in the chronic-pain clinic at Kaiser Permanente’s Santa Rosa Medical Center (Calif.) between January 2009 and June 2010. All of the participants had been on a stable dose of an opioid for at least three months, and none had a previous diagnosis of low testosterone. A larger retrospective study of more than 1,500 male pain patients is currently under way.

“There’s a large gap in the evidence base with regard to opioids,” said Andrea Rubinstein, MD, of the Departments of Chronic Pain and Anesthesiology, Kaiser Permanente Santa Rosa Medical Center. “More safety and efficacy studies are needed. We need to know how we can prescribe these very useful medications in a way that brings the greatest benefits to our patients, without introducing additional risks.”

Once prescribed primarily to cancer patients, the use of opioid-based medications such as oxycodone (Oxycontin) and hydrocodone (Vicodin) for treating chronic, non-cancer pain has increased dramatically in recent decades. An estimated 4.3 million Americans use opioids on a daily basis for pain.

 

I have wanted to post the same type of entry for a while now. Someone of course has already said it better, and to that I say, “Thank you!”

 

 

New Procedure for Chronic Pain Sufferers

Reposted from Timesofmalta.com

People suffering from chronic pain will be able to undergo a new procedure called dorsal column stimulation which was launched this morning by Health Minister Joseph Cassar.

So far two patients have undergone this procedure. A third operation is planned for April. Each intervention costs €35,000, Dr Cassar said during a press conference at Mater Dei Hospital – where the procedure is offered.

Dr Marilyn Casha, from the hospital’s pain clinic, explained that the procedure was being offered to patients suffering from two conditions: complex regional pain syndrome and failed back surgery syndrome.

It involves inserting a “wire pipe”, containing eight electrodes, into the spinal cord. The wire emits electrical pulses that correct the pain-generating pulses emitted by the spinal cord. The patient can control the pulses generated by the device through a remote control, depending on the level of pain.

Karl Attard, 23, was the second person to have underdone this surgery. He shared his experience this morning. The young chef had hurt himself about five years ago when he slipped at work, injuring his leg. But instead of getting better, the pain spread throughout his body causing an “invisible disability” that stopped him from working. Now that he had undergone the procedure and intends to start working again.

 

Should People with Severe Chronic Pain be Allowed Assisted Suicide?

They say that suicide is a permanent solution to a temporary problem. However, what if it’s not that easy? We allow patients with terminal cancer seek a humane way out. So, why can’t those with debilitating chronic pain seek the same relief? I’ve thought about this some over the years and still can’t come up with a good answer to that one. I’ve thought about suicide as a way to end the pain, but I would never do it. I personally struggle with a chronic condition that isn’t even on the same magnitude as the woman mentioned in the article below. How can we, as a self-labeled compassionate race even begin to comprehend what some chronic pain sufferers go though and how can we judge them? This woman is not a 16 year old boy or girl with depression and social issues that feel that death would be preferable to their emotional pain. This is a 44 year old woman who has lived life and determined that the pain just isn’t manageable anymore. If nothing else, this article shows us that the problem of chronic pain isn’t just silent. Doctor’s need to listen more, and help.

I would like some feedback on this. What do you think? Would you ever consider suicide to end the pain? If so, why? What magnitude of pain do you think warrants this extreme action? Are there moral or ethical complications that you can think of? Let’s start a conversation about this.

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Chronic-pain patients at high risk of suicide

January 29, 2013 by Marni Jameson in Psychology & Psychiatry

Two months ago, Gary Rager’s girlfriend asked him to do the unthinkable. The 44-year-old woman, who has suffered disabling pain for the past three years, asked Rager if he would help her end her life.

“I don’t want to kill her, and I don’t want to go to prison. But I don’t want to see her suffer anymore either,” said Rager, a 59-year-old Sanford, Fla., sculptor whose work appears at area theme parks and public spaces throughout Orlando, Fla.

Such are the desperate measures that many afflicted with chronic disabling conditions – and those who love them – contemplate.

Some do more than think about it.

Like many patients in chronic pain, Karen Brooks has seen dozens of doctors over the past few years.

All take tests and discuss her physical health, but few have inquired about her mental health, said her sister, Michelle Brooks, of Maitland, Fla., who takes her sister to her doctors’ appointments.

Given the high correlation between chronic illness or pain and depression – even suicide – more providers need to bring up the dark subject, health experts say.

Large-scale studies show that at least 10 percent of suicides – and possibly as many as 70 percent – are linked to chronic illness or unrelenting pain.

Authors of a 2011 British study that looked at the link concluded that patients with such conditions “should be considered a high-risk group for suicide … and much greater attention should be given to providing better … psychological support.”

 

Finally an Agreement on Acupuncture?

I would be interested in knowing if this has helped anyone NOT involved in a study. I know a few people that have tried acupuncture with no relief whatsoever. I suppose that it is cheap enough to try and see if it works. I also wonder whether one session is enough to know whether it works. If I actually go, I will be sure to post a full review with maybe even a video of the experience!

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Study Finds ‘Firm Evidence’ Acupuncture Relieves Chronic Pain
by RICHARD LENTI on OCTOBER 22, 2012

As many as 3 million Americans receive acupuncture treatments, most often for relief of chronic pain. While there appears to be little consensus in the scientific community to its value, a new study in the Archives of Internal Medicine suggests that relief offered by acupuncture is very real and should be considered as a viable option by the medical community.

Focusing on patients who reported chronic back and neck pain, osteoarthritis, chronic headache and shoulder pain, researchers from Memorial Sloan-Kettering Cancer Center in New York conducted a six year, meta-analysis of data from 29 prior studies involving nearly 18,000 adults.

Study participants were randomly assigned treatment with acupuncture, standard treatments such as drugs and physical therapy, or “fake” acupuncture in which needles were inserted at points other than the traditional meridians.

Using a scale from zero to 100, the average participant’s pain measured 60. Conventional methods brought the pain down to 43, fake acupuncture brought it down to 35, and the actual acupuncture dropped pain to 30.

According to Dr. Andrew J. Vickers, attending research methodologist at Memorial Sloan-Kettering Cancer Center and the lead author of the study, that means about half of the patients who got acupuncture had improvement in pain, compared with 30% who didn’t get acupuncture and 42.5% who had fake acupuncture.

“This has been a controversial subject for a long time,” Vickers told the New York Times “But when you try to answer the question the right way, as we did, you get very clear answers. We think there’s firm evidence supporting acupuncture for the treatment of chronic pain.”

One limitation of the study noted by authors was that since comparisons between acupuncture and no acupuncture could not be blinded, both performance and response bias were possible.

In an accompanying editorial, Dr. Andrew Avins of the University of California, San Francisco pointed out that the study’s authors left themselves open to criticism by relying on fixed-effects models “that are less conservative than random-effects models and more likely to yield statistical significance.”

For him, a greater concern was the potential for skepticism generated by the study’s assertions that acupuncture works only slightly better than a placebo in treating pain. Avins worries that colleagues who don’t seriously consider acupuncture as a treatment option will continue dismiss it as nothing more than a placebo.

“At the end of the day,” says Avins, “our patients seek our help to feel better and lead longer and more enjoyable lives, Perhaps a more productive strategy at this point would be to provide whatever benefits we can for our patients, while we continue to explore more carefully all mechanisms of healing.”

Acupuncture is the insertion and stimulation of needles at specific points on the body to facilitate recovery of health. Originally developed as part of traditional Chinese medicine, some contemporary acupuncturists approach it in modern physiologic terms, helping make it one of the most widely practiced forms of alternative medicine in the country.

 

Marijuana, Obesity, and Pain: A link?

This was definitely a fun read!

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‘Cannabis’ receptor discovery may help understanding of obesity and pain

(Phys.org)—Researchers have discovered that a genetic difference in a ‘switch’, which causes over-activity in parts of the brain, may explain why some people could be more susceptible to conditions such as obesity and addiction, and may play a role in chronic pain and psychosis.

Aberdeen scientists believe that the findings—published in the Journal of Biological Chemistry—might help our understanding of these conditions and also be a step towards the development of personalised therapies to help treat them. The team from the University’s Kosterlitz Centre for Therapeutics studied genetic differences around the gene CNR1. This gene produces what are known as cannabinoid receptors, which are found in the brain, and which activate parts of the brain involved in memory, mood, appetite and pain. Cannabinoid receptors activate these areas of the brain when they are triggered by chemicals produced naturally in our bodies called endocannabinoids. Chemicals found in the drug cannabis mimic the action of these endocannabinoids and there is growing evidence that cannabis has pain relieving and anti-inflammatory properties which can help treat diseases such as multiple sclerosis and arthritis.  However, developing drugs from cannabis to treat these conditions is hampered by the fact that such drugs will have psychoactive side effects, and smoked cannabis can cause addiction and psychosis in up to 12% of users. In order to understand more about these side effects and the genetic factors which determine how people respond, the scientists studied genetic differences around the CNR1 gene. Dr Alasdair MacKenzie, who helped lead the team, said: “We chose to look at one specific genetic difference in CNR1 because we know it is linked to obesity and addiction. What we found was a mutation that caused a change in the genetic switch for the gene itself—a switch that is very ancient and has remained relatively unchanged in overthree hundred million years of evolution, since before the time of the dinosaurs. “These genetic ‘switches’ regulate the gene itself, ensuring that it is turned on or off in the right place at the right time and in the right amount. “It is normally thought that mutations cause disease by reducing the function of the gene, or the switch that controls it. “In this case however, the mutation actually increased the activity of the switch in parts of the brain that control appetite and pain, and also—and most especially—in the part of the brain called the hippocampus, which is affected in psychosis. Dr Scott Davidson, who played a key role in the discovery of this genetic difference in the switch added: “Further analysis of this mutation will help us to understand many of the side effects which are associated with cannabis use such as addiction and psychosis.” Professor Ruth Ross, Head of the Kosterlitz Centre and an internationally recognised expert in cannabis pharmacology, added: “Previously in drug research, attempts to detect the causes of adverse drug reactions have focused on the genes themselves. “Our study is one of the first to explore the possibility that changes in gene switches are involved in causing side effects to drugs. We believe this approach will be crucially important in the future development of more effective personalised medicine, with fewer side effects.” One question that is intriguing the research team is why this overactive genetic switch evolved in the first place. Dr MacKenzie explains: “We know that this overactive switch is relatively rare in Europeans, but is quite common in African populations. But we were all once African, so something must have decreased it in our early ancestors who left Africa and migrated through Central Asia towards Europe and the north. “One possibility we are keen to explore is that once in Central Asia these early migrants came into contact with the cannabis plant, which we know was endemic across that area at that time. it is possible that the side effects of taking cannabis were such that people with the mutation were not so effective in producing and raising children. Therefore, over the generations the numbers of people with the mutation decreased. “This work is at a very early stage however, and there are likely to be more exciting discoveries—not only on how these differences came about, but also about the role of this genetic switch in health and disease.”

Read more at: http://phys.org/news/2012-08-cannabis-receptor-discovery-obesity-pain.html#jCp

 

Wisconsin Doctors to Start Prescribing “Tough Love”?!

I HATE articles like this. I believe that true chronic pain sufferers have enough to deal with in their care to be worrying about things like this. Doctors realize that chronic pain is a real condition needing real therapy. However, until a good one is found, some of us are left to fend with pain meds instead. I bet that I can ask any others like me and they would say the same thing, “find me something that works and I’ll flush these pills in an instant.” People don’t seem to realize that we DON’T want to take pills. We want to feel better. We want to be able to do the things in life that “normal” people do. Like I said previously, it’s hard enough without drug abusers getting in the way.

I have a better idea! How about doctors prescribe a visit to a therapist WITH the prescription? That way, we can get the meds that we need while also getting the much needed counseling in order to deal with the feelings and emotions that come from a debilitating life condition? That way you leave labeling an addict to a psychological professional and not your opinion. I’m sure that a counselor can see between the lines to determine whether you legitimately need pain meds or not. I feel that we need chronic pain sufferers making these rules (or at least previewing them) instead of doctors or politicians that are slave to their personal views and not what’s always best for those that need help. </rant>

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Area ER Doctors To Limit Who Gets Prescription Pain Meds

As prescription pain medication abuse continues to rise, area emergency rooms will likely go Oxy Free in the next few months, meaning patients might get a little more tough love.

By Denise Lockwood
July 27, 2012

Fed up with patients that don’t have legitimate reasons for taking prescription pain medications, emergency room physicians in southeastern Wisconsin will soon be giving large doses of tough love to patients who are doctor shopping.

Nationally, narcotic prescription medication abuse, including abuse of oxycodone and oxycontin, is on the rise. So within the next few months hospitals in Milwaukee County are going “Oxy-free” and a Racine-based emergency department is also looking into doing the same. The information-sharing group includes officials from Froedtert Hospital, Wheaton Franciscan, Columbia-St. Mary’s, and Aurora Health Care.

Dr. Gary Swart, medical director for the emergency departments at Wheaton Franciscan’s Elmbrook Memorial, St. Joseph and The Wisconsin Heart Hospital campuses, said he’s part of a network of emergency department administrators that will be implementing tighter restrictions on how prescription pain medications are used and they want their patients to know about their policies prior to registering.

 

Chronic Pain in Another Part of the World

I would really like to know if this statistic is true and how it came to be… 1 in 10 adult Australians suffer from chronic pain? That seems a little high. Furthermore, if it is true that it is underreported, how many really suffer from it? I can now understand why many aren’t getting the help that they need. At least there is awareness on the topic unlike here in America where either you’re considered to be “faking it” or are just “looking for a fix”.

One of the most interesting things about this article is the possibility of defining chronic pain as a “disease”. I wonder what this would mean for those afflicted with it. I am not sure of what the disability laws are like in Australia, and would love for someone to fill me in on this. How would redefining chronic pain influence the sufferer? What do you think?

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Chronic pain takes a big toll

Cathy O’Leary Medical Editor,

The West Australian

Updated July 26, 2012, 2:10 am

Health experts are warning that chronic pain is taking a huge personal and economic toll on Australians, affecting one in five people and costing more than $34 billion a year.

As part of National Pain Week, they say pain clinics around the country have long waiting lists and less than 10 per cent of patients with chronic pain have access to effective treatment.

It comes as new figures from the Australian Bureau of Statistics based on a household survey show one in 10 Australian adults experienced severe or very severe pain in the previous month and they were much more likely to report high levels of psychological distress than those without pain.

Experts argue chronic pain, which is pain that lasts longer than three months, should now be seen as a disease in its own right.