Lyme Disease Support Group

Abnormalities caused by chronic pain improve when patients get relief, study finds

By Robert Preidt

Friday, May 20, 2011

FRIDAY, May 20 (HealthDay News) --

Treating chronic lower back pain can reverse pain-related changes in brain activity and function, according to a new study.

Prior research has shown that people with chronic pain may experience cognitive problems and reduced gray matter in brain areas that play a role in pain processing and the emotional aspects of pain, such as anxiety and depression.

But it wasn't clear if treating chronic pain could reverse those brain changes.

This study included patients who had lower back pain for more than six months and underwent either spinal injections or spinal surgery to treat the pain.

MRI scans of the patients' brains were conducted before and six months after their procedures.

"When they came back in, we wanted to know whether their pain had lessened and whether their daily lives had improved.

We wanted to see if any of the pain-related abnormalities found initially in the brain had at least slowed down or been partially reversed," study senior author Laura S. Stone, of the Alan Edwards Center for Research on Pain at McGill University in Montreal, said in a university news release.

Brain activity and function did show signs of recovery in the patients after treatment, the researchers found.

The study was published May 17 in the Journal of Neuroscience.

"If you can make the pain go away with effective treatment, you can reverse these abnormal changes in the brain," she said.

SOURCE: McGill University, news release, May 17, 2011

HealthDay

Copyright (c) 2011 HealthDay. All rights reserved.

http://www.nlm.nih.gov/medlineplus/news/ fullstory_112315.html

If chronic pain does not respond to more conservative therapies, such as oral medications, physical rehabilitation, injection and infusion therapies and psychosocial interventions, your health care provider may recommend you undergo a trial for a neurostimulation or an implanted drug delivery pump.

Although these implantable pain therapies have certain risks, you can help manage those risks by understanding the type of implantable pain therapy you receive and following your health care provider’s instructions.

by going to below link, you can click on each link of info below this statement ...

Learn more about implantable pain therapies and safety risks:

Implantable Pain Therapies Are a Treatment Option

Neurostimulation Can Be Used Safely

Implanted Drug Delivery Systems Can Be Used Safely

Problems or Complications with Implantable Pain Therapies Can Be Prevented

Recognize and Take Action in an Implantable Pain Therapy Emergency

Frequently Asked Questions about Implantable Pain Therapies

http://www.painfoundation.org/painsafe/person-with-pain/ implantable-pain-therapies/

http://www.nlm.nih.gov/medlineplus/videos/news/ pain_in_neck_061711.html

bg

By Kristina Fiore, Staff Writer, MedPage Today

Published: June 20, 2011

The FDA has approved a short-acting opioid painkiller with abuse-deterrent properties, the drugmaker Pfizer announced Monday.

Oxecta, a new formulation of oxycodone, had previously been under development as Acurox, which included niacin to deter oral abuse. That version received a thumbs down from an FDA advisory panel in 2009.

The new drug uses "Aversion" technology, licensed from Acura Pharmaceuticals -- which is described as a "unique composition of commonly used pharmaceutical ingredients" --

to stop potential abusers from crushing, chewing, snorting, or injecting the opioid. It does not deter oral abuse.

But Pfizer noted in a statement that the potential to abuse the drug via these routes still exists and "there is no evidence that Oxecta has a reduced abuse liability compared to immediate-release oxycodone."

In an earlier interview, Gail Cawkwell, MD, vice president of medical affairs at Pfizer, told MedPage Today that the technology causes the drug to break down into crumbled chunks instead of powder if crushed, and turns it "sudsy" if it is mixed with liquid and drawn into a syringe.

Oxecta is indicated for acute and chronic moderate-to-severe pain and is contraindicated in patients with respiratory depression, paralytic ileus, bronchial asthma or hypercarbia, and in those with a hypersensitivity to the opioid.

Among the most common adverse reactions are nausea, constipation, vomiting, headache, itchiness, trouble sleeping, and dizziness, according to Pfizer.

The new formulation joins a handful of other abuse-deterrent opioids that are on the market or in development.

Purdue Pharmaceuticals, maker of long-acting oxycodone (OxyContin), had a tamper-proof version of its drug approved last year.

Making drugs harder to abuse has been one key strategy for some companies in an attempt to control what the government has deemed an epidemic of prescription painkiller abuse.

Pfizer acquired Oxecta when it merged with King Pharmaceuticals last year, along with an abuse-deterrent formulation of long-acting oxycodone (Remoxy) which is up for FDA approval on June 23.

comments

john mc innis - Jun 20, 2011

From my perspective, this is another attempt at diminishing the supply side of a business refered to as "epidemic drug abuse".

We should all be educated in the sea change taking place led by eminent group of visionary global leaders who authored "Report of the Global Commission on Drug Policy" announced 6/02/11.

To learn more visit www.globalcommissionondrugs.org.

It's incumbent on all in the Healthcare Field especially those truly concerned about "the epidemic of drug abuse" to educate and discuss the major paradigm shift endorsed by this report.

****************

jose morelos - Jun 20, 2011

it is nice to know that an effective narcotic w/ less propensity for abuse is now available.I have often wondered whether pain management w/ opiods is a curse or a blessing.

************

overwhelmed - Jun 21, 2011

I am an American physician working overseas.

I have worked in Europe, Asia and Africa and have not seen anywhere near the level of narcotics used for pain control that exists in the U.S.

The country I am currently working in only has morphine, Tylenol with codeine and Tramadol aside form the usual NSAIDS and Tylenol as oral pain relievers.

I have never run into a case where these were not sufficient.

The government limits morphine use and no one prescribes it for more than a week except in terminal cases.

We just don't have the level of addiction that exists in America.

I don't understand why, unless it is a cultural thing, where Americans expect these types of medications.

The culture of pain is very unique from country to country. I wonder what others think for this difference.

Are Americans wimps and can't handle pain like the rest of the world? I don't think so. What do others think?

**********

tom hennessy - Jun 21, 2011

The definition of the word abuse seems to be up for interpretation. The addiction part of the drug would be an 'abuse' worth worrying about ?

It seems this drug is merely addressing the mode of abuse by drug 'users' as opposed to both the drug abusers and the INCREASED use DUE TO addiction of the drug ?

Opioid based drugs are KNOWN to lead to addiction whereas the NEWEST drugs which DON'T use the opioid pathway are not getting ANY 'press'.

THIS 'contribution' seems to be getting press everywhere and IT obviously addresses only a SEGMENT whereas the venom pain killer technology would address BOTH ? Venom technology.

*************

BJM of Columbus, OH - Jun 21, 2011

And a really heavily addicted person will inject the sudsy stuff anyway, risking an embolism and winding up in an emergency room or a morgue.

************

joseph belshe - Jun 21, 2011

Overwhelmed sees cultures who have yet to experience America's Aging advance into the behavioral changes that include huge alteration of pain perception in general coupled with resources to acquire anything available for mood alteration they might desire.

I spent 20 years in family practice/ general surgery then 40 years in Anesthesiology including a pain clinic.

I suspect much of how one manages personal pain begins with learning how to use your brain to control pain perception.

**************

Dr.Gopinath - Jun 21, 2011

I am an Indian physician working in Saudi Arabia and narcotic analgesics are strictly controlled.

Even minor tranquilizers such as Diazepam are sparingly used.

Renal colic for example, as well as pain of sickling respond very well to injected diclofenac in most patients.

*****************

john fotheringham - Jun 23, 2011

Drug companies should develop a method of internally marking individual tablets of opioid medication. Every patient would have their own bottle at the pharmacy. This would make diversion trackable

http://www.medpagetoday.com/ProductAlert/Prescriptions/ 27157?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=

© 2011 Everyday Health, Inc. All rights reserved

Monday, June 20, 2011

By Eric Schultz

NEW YORK (Reuters Health) -

It may not be surprising, but people who exercise at least one hour per week have a lower risk of troublesome back, neck, and shoulder pain, a new study shows.

The new evidence supports the possibility that obesity and physical inactivity play a role in a person's risk of developing chronic pain in those areas, said study co-author Dr. Paul Mork, of Norwegian University of Science and Technology in an email to Reuters Health.

Mork and colleagues followed more than 30,000 adults who participated in a large Norwegian health study.

They recorded participants' body mass index (BMI) - a measure of weight related to height - at the start of the study, as well as how often they exercised, and then tracked them over the next 11 years.

The authors divided the participants into four categories based on how often they exercised, and four categories based on their BMI.

They also looked at how many people in each category developed chronic neck, shoulder, and lower back pain.

Overall, 1 of every 10 people in the study developed lower back pain, and nearly 2 of every 10 developed shoulder or neck pain.

After taking into account participants' age, BMI, whether or not they smoked, and whether they did manual labor at work,

the research team found that men who were exercising 2 hours or more per week at the start of the study were 25 percent less likely to have lower back pain 11 years later, and 20 percent less like to have neck or shoulder pain, compared men who didn't exercise at all.

And women who exercised at least 2 hours per week were 8 percent less likely to develop lower back pain than women who were inactive, and 9 percent less likely to develop neck and shoulder pain.

Weight, not surprisingly, also affected the risk of chronic pain later on.

Obese men were almost 21 percent more likely to develop chronic lower back pain than men of normal weight, and 22 percent more likely to develop neck or shoulder pain.

Obese women were also 21 percent more likely to develop lower back pain than women of normal weight, and 19 percent more likely to develop neck and shoulder pain.

Based on the results, Mork believes that even moderate physical exercise - just one hour or more per week - "can, to some extent, compensate for the adverse effect of being overweight and obese on future risk of chronic pain."

"Chronic neck and back pain are important to public health due to their substantial influence on quality of life, disability, and health care resources," Dr. Adam Goode from Duke University in Durham, North Carolina told Reuters Health by email.

Goode, a physical therapist, was not involved in the study by Mork's group.

Back in the mid-1990s, a study from the Netherlands estimated that low back pain cost that country nearly 2 percent of its gross national product.

In their new paper Mork and colleagues write that "just a small reduction in the incidence of chronic lower back pain would have a profound economic impact."

Because of the way it was designed, the Norwegian study can't prove that lack of exercise and being overweight actually caused people's chronic pain, or that regular exercise and a more healthy weight prevented it.

It could be that the people who did or didn't have chronic pain are different in ways the study did not measure.

However, given the known benefits of exercise and maintaining a healthy weight, Mork believes that "community based measures aimed at reducing the incidence of chronic pain...should aim at promoting regular physical exercise and the maintenance of normal body weight."

SOURCE: http://bit.ly/jaoix5, online June 11, 2011

Reuters Health

(c) Copyright Thomson Reuters 2011

By Nancy Walsh, Staff Writer, MedPage Today

Published: June 23, 2011

Reviewed by

Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Treatment of chronic pain today remains strikingly inadequate, despite better understanding of the underlying pathology and an ever-widening range of therapeutics, according to an overview of the literature.

For all the treatment modalities surveyed, only about half of treated patients had a response -- and the reduction in pain was only about 30%, reported Dennis C. Turk, MD, and colleagues from the University of Washington in Seattle.

"A general conclusion about the treatment of chronic noncancer pain is that the results presented are sobering," the researchers wrote in the June 25 Lancet.

Action Points

■Explain that a review of treatments for chronic noncancer pain found little good news; opioids were most commonly prescribed with disappointing results.

■Note that the authors were unable to provide a summary table due to heterogeneity among studies reviewed.

Worldwide, one in five people report chronic pain, according to World Health Organization estimates.

Many factors influence patients' experience of pain, including cognitive and emotional elements, history, and pathology -- all of which need to be addressed for successful pain control.

To review the empirical evidence for common approaches to chronic pain, the researchers surveyed the literature for systematic reviews, meta-analyses, and guidelines on osteoarthritis, neuropathic pain, fibromyalgia, and low-back pain.

They found that opioids were the most commonly prescribed drugs, with sales that increased by more than 175% between 1997 and 2006 -- yet these agents were associated with only small improvements in pain and function.

In general, opioids were not recommended as first-line therapy for osteoarthritis and fibromyalgia, though they could be considered during specific clinical situations such as exacerbations of neuropathic pain.

Side effects such as constipation and drowsiness can be significant with opioids, and a small number of patients taking these drugs long term develop hyperalgesia.

Opioids also are widely misused, with studies suggesting that almost half of long-term users may be misusing the drugs and placing themselves at risk for overdose and death.

Other options include nonsteroidal anti-inflammatory drugs (NSAIDs), which can help in osteoarthritis and rheumatoid arthritis, although less is known about potential benefits for fibromyalgia or neuropathic pain.

Acetaminophen is widely used for analgesia as an alternative to NSAIDs, which can cause serious gastrointestinal adverse effects, but concern has been growing about toxicity and hepatic failure with acetaminophen and warnings have been added to the drug's labeling.

Antidepressant drugs, particularly the tricyclics, have various effects that could contribute to pain relief, such as interfering with the reuptake of noradrenaline and serotonin -- but these drugs can cause hypotension and arrhythmias.

Nonetheless, a recent systematic review determined that evidence for efficacy exists for the use of tricyclic antidepressants in several pain syndromes, including fibromyalgia and neuropathic pain.

The newer selective serotonin and noradrenaline reuptake inhibitors duloxetine (Cymbalta) and milnacipran (Savella) have been found effective in fibromyalgia and neuropathic pain, but more studies are needed to assess their effects in other conditions, according to Turk and colleagues.

Anticonvulsants also exert a number of actions that can interfere with pain, such as binding to a calcium-channel protein in the brain and spine, and inhibiting neurotransmitter release.

Studies have shown that gabapentin and pregabalin (Lyrica) are beneficial for neuropathic pain and fibromyalgia, although troublesome side effects include fatigue and weight gain.

Aside from pharmacotherapy, the researchers also reviewed several interventional approaches such as

injections and surgery, finding some evidence for the use of epidural steroid injections in patients with radiculopathy associated with prolapsed lumbar discs.

SEROID INJECTIONS NO NO FOR LYME PATIENTS; THEY SUPPRESS IMMUNE SYSTEM...BETTYG NOTE!

A recent systematic review found some benefit for lumbar fusion for back pain, but many patients report worsening over time after the surgery.

"High complication rates and repeat procedures are realities of spinal surgery as well," the researchers observed.

Psychological techniques such as cognitive-behavioral therapy can have "modest benefits," they found, but long-term outcomes are uncertain, and individual patients may respond better to different types of psychological therapies.

Evidence also varies for complementary approaches, being "promising" for acupuncture in fibromyalgia.

Turk and colleagues noted that they would have liked to include a table summarizing their conclusions and comparing the various modalities, but were unable to do so because of the wide variety across studies in diagnostic criteria, outcome measures, and health systems.

They concluded that none of the widely used treatments are adequate for eliminating pain and improving function in most chronic pain patients.

They recommended that combinations of various types of treatment be evaluated, and also advised that helping patients maintain realistic expectations is vital.

In addition, they called for more clinical exploration into chronic pain.

"A great need exists for research that goes beyond asking the questions of whether a particular treatment is effective, to addressing what treatment is effective for which patients, on what outcomes, under what circumstances, and at what cost," they stated.

Turk has received grants from the National Institutes of Health, as well as from Endo Pharmaceuticals and Ortho-McNeil Janssen.

He also has been on advisory boards and consulted for Eli Lilly and Pfizer, and is a special government employee of the FDA.

One co-author also has received a grant from Ortho-McNeil Janssen.

Primary source: The Lancet

Source reference:

Turk D, et al "Treatment of chronic non-cancer pain" Lancet 2011; 377: 2226-2235.

http://www.medpagetoday.com/PainManagement/PainManagement/ 27248?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=

comments ... uffda!

jean-lansing,mi - Jun 24, 2011

This is also very special..The tx of low back pain is now in a phase of regression..

BCBS is now denying claims for phenol rhizotomies which they have pd for in the past yrs, also harder to get payment for facet blocks ,this is at pain centers.

this is not forwarding the cause for pain control for those that are suffering.

medicare no longer pays for the phenol rhizotomy using sedation but pays for a procedure which can only be done while the pt. is awake and is painful and is required to guide the physican as to where the pain is at.

It is a radio frequency tx of sorts ,I only know it is painful and I am fearful.

These changes in tx of chronic pain are turning things into a whirlwind.

When calling BCBS,you cant get the same person twice and you get a different answer every time.

When you have a procedure done , you often find out up to a year later that the procedure isnt covered and is very, very costly, when all along you think your ins. is covering you, well surprise!!!!!

*****************

Bruce Bennett blog dot com - Jun 24, 2011

I know of a substance that is cheap, works, relieves depression, reduces chronic pain to a manageable level and quality of life goes up in every way.

Let me say I am a Nurse Anesthetist with 40 years experience and work with people who worked in a pain clinic.

Some of the people who worked there were pain patients and I have seen this work on them.

Fibromyalgia, back pain after extensive surgery gone, osteo arthritis reduced 95%, plantar fascitis gone.

The pain clinic did not put them on this substance. I told them about it.

Vitamin D is a great anti inflammatory in doses of 1,000 iu per 25lbs. Titrate to a blood level of 70 to 100 ng/ml.

The closer you get to 100 ng/ml the more pain relief. It takes three months of steady dosing before the vitamin ( a pro hormone) levels out.

Toxicity occurs at above 200 ng/ml. Amazing, cheap, non addicting, and it works!

******************

Westxndoc - Jun 24, 2011

My practice sees these chronic pain patients and we have success in treating them with Specific Upper Cervical chiropractic, herbals, and other adjuncts. Fribromyalgia patients always seem to respond very well.

You've got to stimulate the body to release it's own pain killing hormones, break the pain pathways, and give the body exceptional nutrition in order to heal. More drugs just result in more addicts.

-------------------

dave rickmers - Jun 24, 2011

"Only 30%"? That can make a big difference in quality of life to the end user.

And whether big Pharma likes it or not, smoked marijuana and an aspirin tablet allow me to stand and walk, faster than any of the fancy drugs listed above. Cox inhibitor NSAIDS make my glucose go high.

You're not supposed to use them on an ongoing basis due to bleeding and cardiovascular complications. I am allocated 4 [ea] NORCO 5/325 per day.

I take them while I'm awake and "withdraw" when I sleep. I do not get drowsy and am never constipated.

I tend to get locked into a sitting position and when I stand up there is a huge rush of pain and endorphins.

That's when the urge to scream hits me. This is when the hydrocodone comes in handy.

Hard to keep a job if you scream every time you get up.

In situations where my back goes acute (have had lumbar microsurgery), where I used to go to a clinic for epidural, I have found a blue jelly ice pack in the right spot works nearly as well.

I am 62 and my somewhat abused liver takes longer to clear certain substances from my system.

The NORCO half life may be longer in me, so I know I should be extra careful.

I have seen people nodding at the pain clinic, they are probably overmedicating.

----------------

Joy E. Dill, RN (Retired) - Jun 24, 2011

After 10 years os severe PHN (Post Herpetic Neuralgia) I will tell you, nothing helps!

Acupuncture, epidurals, Neurontin, Lyrica, narcotics,tri-cyclics, Blue Emu Cream, Fentanyl cream, Capsaisin, TENS, Lidoderm Patches,Gardenia Oil.

Some helped for a little while, some not at all. Side effects made many impossible (Lyrica caused Alzheimer like behavior).

I considered the implanted nerve root stimulator but decided that, with my luck,I would be the one with only 30% relief.

It didn't seem worth the cost. Currently , I go nowhere and try to move as little as possible.

Still in a LOT of pain but I don't cause anyone else to be uncomfortable with it.

Good luck in your search for chronic pain control. Do let me know if you have any luck!

****************************

Ken Wolski, RN - Jun 24, 2011

Why was there no mention of cannabis/marijuana therapy in chronic pain control? Medical marijuana is now legal in 16 states and the District of Columbia (or for about 90 million people in the U.S.) and another dozen states are considering similar laws.

Doctors recommend marijuana most frequently in these states for chronic pain control.

Most patients who use marijuana for neuropathic pain say nothing provides the type of relief that marijuana does.

The article ignores the safest and most effective method of chronic pain control and then complains that there is little progress in treating chronic pain. Open your eyes.

*****************

Peter Reynolds - Jun 24, 2011

The least toxic and most effective treatment for chronic pain is medicinal cannabis. It is also cheap.

Perhaps its failure to contribute to Big Pharma's profits is the reason it is not even mentioned in this study. By any normal standards its omission is a grave error.

What are we interested in here - relieving chronic pain or staying politically correct?

*******************************

Brian McDonagh, MD, Chicago - Jun 24, 2011

I agree that mainstream medicine has little to offer chronic pain sufferers, but if you "look outside the nine dots" you will find that Prolotherapy has been successful for many decades.

Great results are common in treating chronic pain from Prolotherapy (developed in the 1930s by George Hackett MD) and especially it's latest version, neural prolotherapy, developed over the past 2 years by Dr. John Lyftogt, using solutions of Dextrose because it is a powerful TRPV1 antagonist.

I have found Neural Prolotherapy to be excellent (and quick) at relieving chronic low back pain, advanced OA of the knees and other joint pains.

"Prolo" regenerates the articular cartilage and re-stabilizes the joint ligaments.

And Vit D3 cream at a concentration of 40,000 IUs/gm, applied QID, is a powerful and simple remedy for Fibromyalgia, Plantar Fasciitis, post herpetic neuralgia and the pain of Rheumatoid hands.*************************************

Travis - Jun 24, 2011

Since this was a review of medical literature, I assume cannabis was excluded by default.

There is no standardized dosage, no recognized quality control measures, no standardized delivery form, and it's still considered illegal by the FDA.

In my state, physicians don't actually prescribe cannabis anyhow, they only sign off that the patient has a condition that might warrant it's use.

It's rather hard to say physicians should prescribe cannabis when really they can't.

In the pain clinic I rotated through they required all patients to stop using cannabis if the patient was to receive narcotics from them.

The reason being is that both can impair judgement and cognitive behavior.

Once cannabis has been studied, found to be effective, a standardized dosage form created, and legal status given, then I might consider prescribing it, but not sooner.

Evidence based medicine should be at play here as well.

****************

Freda - Jun 24, 2011

When pain is localized nerve stimulators work.

I've avoided a second hip replacement by using one. Why do I never see them included in studies?

************************************

steven brenner, md - Jun 24, 2011

Most pain management studies are comparing substances against placebos rather than opioids such as morphine which do have substantial effect, so even though some agent is found to have effect, when compared to placebo, in actual practice, there is probably not much clinical applicability.

Perhaps enhancing the placebo effect though practices such as hypnosis might actually have more potential for real clinical effectiveness than the medicines which are found to be better than placebos.

****************

Peter Reynolds - Jun 24, 2011

"There is no standardized dosage, no recognized quality control measures, no standardized delivery form" Travis, that is a Big Pharma myth.

Any decent dispensary can provide just that precision. Here in Europe, Bedrocan, the Dutch government's official producer provides precise dosage and quality control.

Smoking, vaporising or ingesting in food or as tea are very controllable and accurate means of delivery.

*******************

Jason - Jun 24, 2011

We experience pain for a reason. The body is trying to tell us something.

A lot of the time the underlying cause is misalignment and a chiropractor visit or drugs will not address the cause.

Read "Pain Free" by Pete Egoscue. It's only $15-20.

I had chronic rhomboid pain (in my upper back) and low back pain. These exercises, you can do at home, really work.

******************

Paulette Shalhoub - Jun 24, 2011

The best explanation I have found for why cannabis works for chronic pain, whereas opioids are virtually useless (and far more dangerous long-term)can be found in the cover story of the November 2009 issue of Scientific American.

In short, opioids target only pain neurons, which are involved in acute pain, but cannabis targets the glia cells (helpers to pain neurons), which are literally covered with cannabis receptors.

Cannabis is far safer for chronic pain than any medication.

Opioid receptors -- but not cannabis receptors -- are contained in the brain stem, where breathing is controlled.

Therefore, while you may die from suppressed breathing due to opioids, cannabis cannot and never has had such an effect.

As a person who has suffered chronic pain for 40 years, I would appreciate it greatly if the medical community would honor and listen to those of us who choose not to put synthetics into our bodies.

I do not eat synthetic food, nor do I take synthetic drugs.

I have found that anything a drug can do, a natural (but not profitable to the medical industry) substance can do at least as well, and with far fewer side effects. Thank you for your consideration.

***************************

Jason - Jun 24, 2011

I believe cannabis works for many people but lets not suggest it cures all chronic pain.

"Safer for chronic pain than ANY medication" and "anything a drug can do, a natural substance can do at least as well"? I disagree Paulette.

Many times you don't need anything but proper e-cises, for real.

I'm against the wide use of opioids and cannabis.

I also favor legalization of marijuana and other drugs.

BUT lets get EDUCATED and not be blind to the side effects and unintended consequences of long term marijuana usage.

It's currently under debate but use your intuitive mind.

For the long term, NO DRUG is the best drug whether it's synthetic or natural.

*********************************

Ken Wolski, RN - Jun 24, 2011

The Endocannabinoid System is, in part, a series of receptors in every organ of the human body for cannabinoids, components of marijuana.

The discovery of this system has established the scientific basis for marijuana's remarkable ability to affect so many symptoms, diseases and conditions.

The science is there, if you choose to learn it.

Thankfully, there are many physicians who are compassionate enough to recommend this therapy, despite the fierce opposition of the federal government.

An estimated one million Americans now have recommendations from their doctors for medical marijuana.

Chronic pain is the most common complaint among these patients.

© 2011 Everyday Health, Inc. All rights reserved.

MANY OF YOU MIGHT NOT READ ABOVE, sohere yougo!

jean-lansing,mi - Jun 24, 2011

This is also very special..The tx of low back pain is now in a phase of regression..

BCBS is now denying claims for phenol rhizotomies which they have pd for in the past yrs, also harder to get payment for facet blocks ,this is at pain centers.

this is not forwarding the cause for pain control for those that are suffering.

medicare no longer pays for the phenol rhizotomy using sedation but pays for a procedure which can only be done while the pt. is awake and is painful and is required to guide the physican as to where the pain is at.

It is a radio frequency tx of sorts ,I only know it is painful and I am fearful.

These changes in tx of chronic pain are turning things into a whirlwind.

When calling BCBS,you cant get the same person twice and you get a different answer every time.

When you have a procedure done , you often find out up to a year later that the procedure isnt covered and is very, very costly, when all along you think your ins. is covering you, well surprise!!!!!

*****************

Bruce Bennett blog dot com - Jun 24, 2011

I know of a substance that is cheap, works, relieves depression, reduces chronic pain to a manageable level and quality of life goes up in every way.

Let me say I am a Nurse Anesthetist with 40 years experience and work with people who worked in a pain clinic.

Some of the people who worked there were pain patients and I have seen this work on them.

Fibromyalgia, back pain after extensive surgery gone, osteo arthritis reduced 95%, plantar fascitis gone.

The pain clinic did not put them on this substance. I told them about it.

Vitamin D is a great anti inflammatory in doses of 1,000 iu per 25lbs. Titrate to a blood level of 70 to 100 ng/ml.

The closer you get to 100 ng/ml the more pain relief. It takes three months of steady dosing before the vitamin ( a pro hormone) levels out.

Toxicity occurs at above 200 ng/ml. Amazing, cheap, non addicting, and it works!

******************

Westxndoc - Jun 24, 2011

My practice sees these chronic pain patients and we have success in treating them with Specific Upper Cervical chiropractic, herbals, and other adjuncts. Fribromyalgia patients always seem to respond very well.

You've got to stimulate the body to release it's own pain killing hormones, break the pain pathways, and give the body exceptional nutrition in order to heal. More drugs just result in more addicts.

-------------------

dave rickmers - Jun 24, 2011

"Only 30%"? That can make a big difference in quality of life to the end user.

And whether big Pharma likes it or not, smoked marijuana and an aspirin tablet allow me to stand and walk, faster than any of the fancy drugs listed above. Cox inhibitor NSAIDS make my glucose go high.

You're not supposed to use them on an ongoing basis due to bleeding and cardiovascular complications. I am allocated 4 [ea] NORCO 5/325 per day.

I take them while I'm awake and "withdraw" when I sleep. I do not get drowsy and am never constipated.

I tend to get locked into a sitting position and when I stand up there is a huge rush of pain and endorphins.

That's when the urge to scream hits me. This is when the hydrocodone comes in handy.

Hard to keep a job if you scream every time you get up.

In situations where my back goes acute (have had lumbar microsurgery), where I used to go to a clinic for epidural, I have found a blue jelly ice pack in the right spot works nearly as well.

I am 62 and my somewhat abused liver takes longer to clear certain substances from my system.

The NORCO half life may be longer in me, so I know I should be extra careful.

I have seen people nodding at the pain clinic, they are probably overmedicating.

----------------

Joy E. Dill, RN (Retired) - Jun 24, 2011

After 10 years os severe PHN (Post Herpetic Neuralgia) I will tell you, nothing helps!

Acupuncture, epidurals, Neurontin, Lyrica, narcotics,tri-cyclics, Blue Emu Cream, Fentanyl cream, Capsaisin, TENS, Lidoderm Patches,Gardenia Oil.

Some helped for a little while, some not at all. Side effects made many impossible (Lyrica caused Alzheimer like behavior).

I considered the implanted nerve root stimulator but decided that, with my luck,I would be the one with only 30% relief.

It didn't seem worth the cost. Currently , I go nowhere and try to move as little as possible.

Still in a LOT of pain but I don't cause anyone else to be uncomfortable with it.

Good luck in your search for chronic pain control. Do let me know if you have any luck!

****************************

Ken Wolski, RN - Jun 24, 2011

Why was there no mention of cannabis/marijuana therapy in chronic pain control? Medical marijuana is now legal in 16 states and the District of Columbia (or for about 90 million people in the U.S.) and another dozen states are considering similar laws.

Doctors recommend marijuana most frequently in these states for chronic pain control.

Most patients who use marijuana for neuropathic pain say nothing provides the type of relief that marijuana does.

The article ignores the safest and most effective method of chronic pain control and then complains that there is little progress in treating chronic pain. Open your eyes.

*****************

Peter Reynolds - Jun 24, 2011

The least toxic and most effective treatment for chronic pain is medicinal cannabis. It is also cheap.

Perhaps its failure to contribute to Big Pharma's profits is the reason it is not even mentioned in this study. By any normal standards its omission is a grave error.

What are we interested in here - relieving chronic pain or staying politically correct?

*******************************

Brian McDonagh, MD, Chicago - Jun 24, 2011

I agree that mainstream medicine has little to offer chronic pain sufferers, but if you "look outside the nine dots" you will find that Prolotherapy has been successful for many decades.

Great results are common in treating chronic pain from Prolotherapy (developed in the 1930s by George Hackett MD) and especially it's latest version, neural prolotherapy, developed over the past 2 years by Dr. John Lyftogt, using solutions of Dextrose because it is a powerful TRPV1 antagonist.

I have found Neural Prolotherapy to be excellent (and quick) at relieving chronic low back pain, advanced OA of the knees and other joint pains.

"Prolo" regenerates the articular cartilage and re-stabilizes the joint ligaments.

And Vit D3 cream at a concentration of 40,000 IUs/gm, applied QID, is a powerful and simple remedy for Fibromyalgia, Plantar Fasciitis, post herpetic neuralgia and the pain of Rheumatoid hands.*************************************

Travis - Jun 24, 2011

Since this was a review of medical literature, I assume cannabis was excluded by default.

There is no standardized dosage, no recognized quality control measures, no standardized delivery form, and it's still considered illegal by the FDA.

In my state, physicians don't actually prescribe cannabis anyhow, they only sign off that the patient has a condition that might warrant it's use.

It's rather hard to say physicians should prescribe cannabis when really they can't.

In the pain clinic I rotated through they required all patients to stop using cannabis if the patient was to receive narcotics from them.

The reason being is that both can impair judgement and cognitive behavior.

Once cannabis has been studied, found to be effective, a standardized dosage form created, and legal status given, then I might consider prescribing it, but not sooner.

Evidence based medicine should be at play here as well.

****************

Freda - Jun 24, 2011

When pain is localized nerve stimulators work.

I've avoided a second hip replacement by using one. Why do I never see them included in studies?

************************************

steven brenner, md - Jun 24, 2011

Most pain management studies are comparing substances against placebos rather than opioids such as morphine which do have substantial effect, so even though some agent is found to have effect, when compared to placebo, in actual practice, there is probably not much clinical applicability.

Perhaps enhancing the placebo effect though practices such as hypnosis might actually have more potential for real clinical effectiveness than the medicines which are found to be better than placebos.

****************

Peter Reynolds - Jun 24, 2011

"There is no standardized dosage, no recognized quality control measures, no standardized delivery form" Travis, that is a Big Pharma myth.

Any decent dispensary can provide just that precision. Here in Europe, Bedrocan, the Dutch government's official producer provides precise dosage and quality control.

Smoking, vaporising or ingesting in food or as tea are very controllable and accurate means of delivery.

*******************

Jason - Jun 24, 2011

We experience pain for a reason. The body is trying to tell us something.

A lot of the time the underlying cause is misalignment and a chiropractor visit or drugs will not address the cause.

Read "Pain Free" by Pete Egoscue. It's only $15-20.

I had chronic rhomboid pain (in my upper back) and low back pain. These exercises, you can do at home, really work.

******************

Paulette Shalhoub - Jun 24, 2011

The best explanation I have found for why cannabis works for chronic pain, whereas opioids are virtually useless (and far more dangerous long-term)can be found in the cover story of the November 2009 issue of Scientific American.

In short, opioids target only pain neurons, which are involved in acute pain, but cannabis targets the glia cells (helpers to pain neurons), which are literally covered with cannabis receptors.

Cannabis is far safer for chronic pain than any medication.

Opioid receptors -- but not cannabis receptors -- are contained in the brain stem, where breathing is controlled.

Therefore, while you may die from suppressed breathing due to opioids, cannabis cannot and never has had such an effect.

As a person who has suffered chronic pain for 40 years, I would appreciate it greatly if the medical community would honor and listen to those of us who choose not to put synthetics into our bodies.

I do not eat synthetic food, nor do I take synthetic drugs.

I have found that anything a drug can do, a natural (but not profitable to the medical industry) substance can do at least as well, and with far fewer side effects. Thank you for your consideration.

***************************

Jason - Jun 24, 2011

I believe cannabis works for many people but lets not suggest it cures all chronic pain.

"Safer for chronic pain than ANY medication" and "anything a drug can do, a natural substance can do at least as well"? I disagree Paulette.

Many times you don't need anything but proper e-cises, for real.

I'm against the wide use of opioids and cannabis.

I also favor legalization of marijuana and other drugs.

BUT lets get EDUCATED and not be blind to the side effects and unintended consequences of long term marijuana usage.

It's currently under debate but use your intuitive mind.

For the long term, NO DRUG is the best drug whether it's synthetic or natural.

*********************************

Ken Wolski, RN - Jun 24, 2011

The Endocannabinoid System is, in part, a series of receptors in every organ of the human body for cannabinoids, components of marijuana.

The discovery of this system has established the scientific basis for marijuana's remarkable ability to affect so many symptoms, diseases and conditions.

The science is there, if you choose to learn it.

Thankfully, there are many physicians who are compassionate enough to recommend this therapy, despite the fierce opposition of the federal government.

An estimated one million Americans now have recommendations from their doctors for medical marijuana.

Chronic pain is the most common complaint among these patients.

© 2011 Everyday Health, Inc. All rights reserved.

By Charles Bankhead, Staff Writer, MedPage Today

Published: June 27, 2011

Reviewed by

Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Action Points

■Explain that the integration of analgesic strategies into palliative care has created the potential to minimize pain and suffering for cancer patients.

■Point out that although opioid-based analgesia remains the cornerstone of treatment for cancer pain, other strategies include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), adjuvant analgesic drugs (such as glucocorticoids, antidepressants, and anticonvulsants), and nonpharmacologic treatment involving behavioral modification and psychotherapy.

Integration of analgesic strategies into palliative care has created the potential to minimize pain and suffering for cancer patients, the author of a review concluded.

Opioid-based analgesia remains the cornerstone of treatment for cancer pain.

However, innovative pain-management strategies have evolved from the integration of nonsteroidal anti-inflammatory drugs (NSAIDs), adjuvant analgesic drugs (such as glucocorticoids, antidepressants, and anticonvulsants), and nonpharmacologic treatment involving behavioral modification and psychotherapy, Russell K. Portenoy, MD, wrote in an article in the June 25 issue of The Lancet.

"The advances of recent decades suggest a future that includes increased evidence-based targeting of specific analgesic interventions within an individualized plan of care that is appropriate through the course of illness," wrote Portenoy, of the Beth Israel Medical Center in New York.

The new treatments and strategies have little supporting evidence, he added, and research to generate comparative and long-term data remains a pressing need.

Among patients with solid tumors, estimates of chronic pain prevalence range from 15% to 75%. Though multiple clinical guidelines have been developed for pain management, scant evidence proves that adherence to the guidelines improves pain control, Portenoy wrote in his introduction.

Moreover, barriers to effective treatment further complicate efforts to optimize pain control for cancer patients. One recent review indicated that more than 40% of cancer patients receive inappropriate care for pain (Ann Oncol 2008;19:1985-1991).

The emerging framework of palliative care affords an opportunity to integrate pain management into a continuum of comprehensive care that addresses the physical, psychological, social, and spiritual needs of patients with life-threatening illnesses and their families, according to Portenoy.

Evidence has begun to accumulate in support of the effectiveness of palliative care.

As an example, a recent randomized trial showed that providing lung cancer patients and their families with access to a specialized palliative care team was associated with less depression, improved quality of life, and a three-month survival advantage compared with usual care.

Survival improved even though the patients in the palliative care arm received less aggressive treatment at the end of life.

In reviewing the progress toward an integrated approach to pain management, Portenoy emphasized several points:

•Pain assessment should characterize and clarify the pain, including the status of the underlying disease, the cause and nature of the pain, and factors contributing to disease burden

•Pain often can be addressed with primary disease-modifying treatment, such as radiotherapy

•Opioids continue to be the mainstay of drug therapy for pain, and clinicians should strive to optimize the benefits of the agents and minimize the risks

•Effective opioid therapy includes use of the right drug and route of administration, individualized dosing, rescue dosing for breakthrough pain, and management of side effects

•Adding NSAIDs to opioids can be helpful, but the drugs' risks must be considered on a case-by-case basis

•Clinicians should familiarize themselves with adjuvant analgesics, which have many uses when opioids are not sufficient

•Nonpharmacologic treatments can improve pain control, coping, adaptation, and self-efficacy

•Interventions, such as neural blockade and implanted therapies, have a small but key role in managing refractory pain

"With analgesic strategies integrated into a palliative plan of care, there is increasing hope that patients can experience cancer with a minimum of suffering," Portenoy wrote in conclusion.

Portenoy disclosed relationships with CNSBio, Covidien Mallinckrodt, Grupo Ferrer, King Pharmaceuticals, ProStrakan Pharmaceuticals, Purdue Pharma, Abbott Laboratories, Ameritox, Archimedes Pharmaceuticals, Cephalon, Endo Pharmaceuticals,

Forest Laboratories, GW Pharma, King Pharmaceuticals, Meda Pharmaceuticals, Ortho-McNeil Janssen, Otsuka Pharma, and Tempur-Pedic.

Primary source: The Lancet

Source reference:

Portenoy RK "Treatment of cancer pain" Lancet 2011;377:2236-2247.

comment

Steven A. King, M.D. - Jun 28, 2011

I'm confused about the use of the word "New" in your title.

As far as I can discern there is no treatment modality mentioned in the article which we were unaware of ten or even twenty years ago.

The reason why so many patients receive inadequate management of their pain is because of the poor education in the subject that so many physicians receives.

Perhaps your use of "New" reflects the level of your knowledge about pain treatment.

It is beyond me why drugs such as the antidepressants and anticonvulsants are so frequently still referred to as adjuvants.

This term is left over from when it was thought any pain relief provided by these drugs was either due to their bolstering the analgesic effects of the opioids and NSAIDs or effect on comorbid conditions.

As we now know they have direct analgesic effects, it is foolish to continue to falsely differentiate them other analgesic medications.

http://www.medpagetoday.com/PainManagement/PainManagement/ 27292?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=

© 2011 Everyday Health, Inc. All rights reserved.

The Power of Pain Foundation provides community-based support services that address the immediate need of chronic pain patients with neuropathy conditions such as

RSD (Reflex Sympathetic Dystrophy)...

Post Cancer Pain and

Diabetic Neuropathy

Accordingly, beneficiaries include patients who are economically and socially affected by these invisible diseases.

Whether you have neuropathy pain or are a caregiver, family member or friend of some diagnosed, we'll help you face the challenges and life changes of chronic nerve pain, head on.

- Power of Pain Foundation (www.powerofpain.org)

PROHEALTH Note:

This site offers information about 16 chronic conditions involving nerve pain, from fibromyalgia to multiple sclerosis, plus resources such as links to doctors, pain groups, and clinical trial information.

You can contribute to a number of surveys they're running to create informative databases (and review statistics based on surveys completed to date).

ProHealth.com

June 25, 2011

Mutations in the SCN9A gene (found in a third of ‘unexplained’ neuropathic pain patients) cause nerve cells to be hyper-excitable, thus leading to degeneration of the nerve fibers.

Roughly 20 million people in the US suffer from peripheral neuropathy, marked by the degeneration of nerves and in some cases severe chronic pain.

There is no good treatment for the disorder and no apparent cause for the destruction in a third of cases.

But now an international team of scientists headed by researchers from Yale University and the Veterans Affairs Medical Center in New Haven, Connecticut, and the University Maastricht in the Netherlands have linked mutations of a single gene to 30% of cases of unexplained neuropathy.

The findings, published online June 22 in the Annals of Neurology, could lead to desperately needed pain treatments for many victims of this debilitating disorder.

"For millions of people, the origin of this intense pain has been a frustrating mystery," says Yale neurologist Stephen Waxman, MD, a co-author of the study.

"All of us were surprised to find that these mutations occur in so many patients with neuropathy with unknown cause."

The study focused on mutations of a single gene - SCNA9 - which is expressed in sensory nerve fibers.

• Waxman's group had discovered that mutations in this gene's product - the protein sodium channel Nav1.7 - cause a rare disorder called "Man on Fire Syndrome," characterized by excruciating and unrelenting pain.

• Colleagues in the Netherlands carefully scrutinized neuropathy patients to rule out all known causes of the neuropathy, such as diabetes, alcoholism, metabolic disorders and exposure to toxins.

• Researchers then did a genetic analysis of 28 patients with neuropathy with no known cause. They found that:

- 30% of these subjects had mutations in the SCN9A gene.

- And the mutations cause nerve cells to become hyperactive, a change they believe eventually leads to degeneration of nerve fibers.

"These findings will help us as clinicians to a better understanding of our patients with small fiber neuropathy and could ideally have implications for the development of future specific therapies," says University Maastrict co-author Catharina G. Faber, MD, PhD.

The research was funded by the Department of Veterans Affairs, The Erythromelalgia Association (USA), and the Profileringsfonds of University of Maastricht, The Netherlands.

Source: Yale University news release, Jun 22, 2011

http://www.prohealth.com/library/showArticle.cfm? libid=16352&B1=EG062911&utm_source=EG062911&utm_medium=em&utm_campaign=Wellness&slvor=10655.1041322.0.1.0.9938&eid=

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