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.

---

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.”

 

Marijuana, Obesity, and Pain: A link?

This was definitely a fun read!

---

‘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>

---

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?

---

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.

 

The Soft Link Between Smoking and Pain

So, if you’re like me, you’ve used smoking to cope with your pain from time to time. Or rather, you’ve justified smoking because it seems like a great coping mechanism. I have sat around and chain smoked before when my pain has been the worst. Do I think that it helps? Of course not! I do think however that it helps to act as a distraction at times. A recent “study” has been published that states that we are better off quitting then coping using this method. See below for the full article.

---

Interventional Pain Medicine
ISSUE: JULY 2012 | VOLUME: 10:07
Smoking Cigarettes a Poor Coping Strategy For Chronic Pain

by George Ochoa

Among patients with chronic pain, smokers who reported using cigarettes to cope had worse pain-related outcomes than either nonsmokers or smokers who denied using smoking to manage their pain, according to a new study in the Journal of Pain (2012;13:285-292).

“These findings may be contrary to expectations for some people,” two study authors, Alexander Patterson, PsyD, affiliated with the National Center for Telehealth and Technology, Tacoma, Wash., and Benjamin Morasco, PhD, staff psychologist, Mental Health and Clinical Neurosciences Division, Portland VA Medical Center, and assistant professor, Department of Psychiatry, Oregon Health & Science University, Portland, said in an email. “There are a number of patients who, in the context of routine clinical care, mention that smoking cigarettes can be helpful for providing distraction and reducing the severity of pain. The results from this study suggest that this coping strategy is associated with poorer pain-related outcomes.”

In this cross-sectional study, Drs. Patterson and Morasco recruited 151 veterans from a VA medical center. Most were male (92.1%), white (74.8%) and middle-aged (median, 54.2 years). Current smoking status was assessed through a single self-report question (yes/no), and smoking to cope with pain was assessed through a yes/no response to the question, “Have you ever smoked cigarettes to help cope with pain?” Of current smokers (n=79), 40 denied using cigarettes to cope with pain and 39 reported using cigarettes to cope with pain; the remaining 72 patients were nonsmokers. All had pain diagnoses, most commonly chronic neck or joint pain, chronic low back pain and rheumatism/arthritis.

 

This Opens Some Questions for the 21st Century

So is was something that I experienced a few doctors visits ago. My doctor was slightly uncomfortable at the end of our session and then asked me if I would mind taking a urine test. He decided that he was going to start screening his patients that were on pain meds for illicit substances. I readily agreed of course because I didn’t have anything in my system to hide. The problem that comes from this is because I live in a state that has passed a medical marijuana law allowing it for conditions such as chronic pain. So here is my main question: what if I had legally bought and used medical marijuana? Does that mean that he would stop my entire pain regiment due to this? At what point does getting help from one source preclude you from another? I would love to hear your opinions on this in the comments!

---

Fairbanks Daily News-Miner – TVC starts new medical marijuana procedure

FAIRBANKS — Tanana Valley Clinic has instituted a new policy requiring some patients taking certain pain-killing medications to be marijuana-free.

The clinic started handing out prepared statements to all chronic pain patients Monday, said Corinne Leistikow, assistant medical director for family practice at TVC.

The statement reads, in part, “We will no longer prescribe controlled substances, such as opiates and benzodiazepines, to patients who are using marijuana (THC). These drugs are psychoactive substances and it is not safe for you to take them together. Your urine will be tested for marijuana. If you test positive you will have two months to get it out of your system. You will be retested in two months. If you still have THC in your urine, we will no longer prescribe controlled substances for you.”

 

More “Experts” Frown on Using Opiods to Treat Chronic Pain

Yet another reason why those without chronic pain should stay out of our business. I truly understand that we have a problem in America with abuse of prescription pain medication which is why I am all for more follow ups with your PCP. However, if the only thing that works for your pain is Opiods, the government and the experts need to back off a little. Soon, it will become impossible for those in need such as ourselves to get the care we need because of the opinions of those on the outside looking in.

---

Opioids for chronic noncancer pain discouraged
Published on July 12, 2012 at 5:15 PM
By Caroline Price

US experts have called for more selective and cautious opioid prescribing for chronic noncancer pain, because of concerns over misuse of the drugs and continued uncertainty over when and for how long they should be prescribed.

In a collection of related articles in the current Annals of Family Medicine, they highlight concerns surrounding opioid use and misuse among primary care patients, and the lack of clear guidance on safe use of the drugs in this setting.

Family physicians Roger Rosenblatt and Mary Catlin, from the University of Washington in Seattle, write: “Entering into chronic opioid therapy requires a long-term commitment by clinicians and patient alike to use this powerful, precious, and dangerous medication with care and diligence.”

 

False Drug Shortage Due to Discrimination of Chronic Pain Sufferers

As I was scouring the net late at night I found the article before that had me sitting there wondering… WTF? It is hard enough to go through life with not only chronic pain, but also the stigma that comes when trying to order the medication necessary for relief. I’ve personally experienced it nearly every time I’ve been to the pharmacy. The pharmacist (or rather the person working behind the counter) is always friendly UNTIL they see the script. Their eyes lower to the floor and you can tell that they are trying to treat me as if I am some sort of delicate situation. However, the script always gets filled. Now, I’m in no way “pharmacy shopping” but since I do not have prescription insurance, I sometimes go elsewhere where my meds are cheaper. The article below takes this to a whole new level. Flat out lying to patients is never acceptable. For someone to flat out lie and deny you medication based on their personal beliefs is an atrocity. Please read the article below and share your comments.

---

Drug shortage ups suffering for legitimate pain patients
By Marni Jameson, Orlando Sentinel
7:46 p.m. EST, July 10, 2012

Last week, former TV anchor Carole Nelson watched the clock, knowing that in just a few hours she would face the agony of drug withdrawal made worse by paralyzing pain.

Her last oxycodone pill would wear off in 24 hours. She needed more.

However, during the prior 10 days, Nelson had been to 15 pharmacies trying to fill her prescription for the pain medication she has taken steadily for three years. Oxycodone, an often-abused narcotic, is the only treatment of many Nelson has tried that manages her chronic lower-back pain, the result of a seriously damaged and deteriorating spine.

No pharmacy would fill it.

“They all said they didn’t have any and didn’t know when they would get it,” said the 74-year-old professor, who lives in Volusia County.

It’s a line pain patients are hearing all over Central Florida as the crackdown on the state’s pill mills has begun to restrict the flow of pain medications to legitimate patients.

“When these medications aren’t available, it undermines the whole basis of pain management — which is about stabilizing pain,” said Dr. Peter Preganz, who treats chronic-pain patients, including Nelson, at his Lake Mary office.

 

5 Pain Management Experts Respond to CMS’ Cancelled TENS Reimbursement [Rebuttal]

In continuing to follow the nonsense concerning Medicare and TENS, here is an interesting article:

5 Pain Management Experts Respond to CMS’ Cancelled TENS Reimbursement
Written by Taryn Tawoda | June 13, 2012

The Centers for Medicare and Medicaid Services last week announced that most uses of transcutaneous electrical nerve stimulation will no longer be reimbursed as treatment for chronic low back pain. In a memo released Friday, CMS officials wrote that reimbursement for TENS will be available only when patients are participating in a randomized, controlled trial to gauge the clinical effectiveness of the treatment.

Medicare previously paid for FDA-approved TENS equipment and supplies when prescribed by a physician for chronic pain and reimbursed physicians and physical therapists for evaluating patients’ suitability for the treatment.

Five pain management experts weigh in on the CMS decision.

Pamela D’Amato, MD, Pain Management Specialist, Advanced Interventional Pain Management (Clifton, N.J.): I feel that the CMS ceasing reimbursement for TENS treatment is surprising. In the climate of pain management, with the over prescription of opioid medications, it is always nice to have a non-medication and non-interventional alternative, in my arsenal of treatment options. Unfortunately, we now run the risk of the private insurance companies following the CMS’s stance. It limits the concept of a multi-modal approach to patients with chronic low back pain. A TENS unit can be beneficial for a patient, they can utilize it on their own and often with little adverse side effects.