Dr. Elliot Krane comments on the mysteries of chronic pain

 
 

Elliot Krane at TED University. TED2011. February 28 - March 4, Long Beach, CA. Credit: James Duncan Davidson / TEDToday, The Huffington Post brought Dr. Elliot Krane, director of pain management at Lucile Packard Children’s Hospital at Stanford University, in to emphasize the difference between pain, the purposeful, and the bane of millions of American’s existence, chronic pain, the disease.  (Please click the picture of Dr. Krane with a blow torch for the video since wordpress.com has a distain for embedded html.)  It’s a rare display of the aura of mystery surrounding the condition in the medical community.  I applaud Lucile Packard Children’s Hospital for promoting a holistic approach to chronic pain within the confines of traditional western medicine.

I highly recommend Dr. Krane’s 2011 TED talk in which he elaborates on the mysteries behind chronic pain in fascinating and entertaining detail.

Mission statement change: Compassion and science too

mandalaii

Recent musings have led me to consider the direction of the chronic pain forum.  It’s superficial as is and lacks the compassion I originally sought to emanate.  I still enjoy reporting on the latest issues facing all things chronic pain, but there needs to be a good mix of inspiration here too.  After all, I’ve been sitting here writing all about how beneficial things like holistic treatments, pain psychology, meditation, and the like are; why not implement these things as best I can through the forum?

People need compassion in many forms, and I empathize with that need.  Chronic pain is a private hell to live with, but it doesn’t have to be—it can be shared.  It’s awful to deal with, once all things are considered, but it does provide glimmers of divine truth to those who suffer.

I’ve been doing my research and I don’t think we just need interesting tidbits on things like the latest woes facing big pharma and the opioid manufacturers, or the benefits of medicinal marijuana (although these specific cannabis entries still account for thousands of clicks per day, weeks later even, they are not deep stories or penetrating into the soul of pain).  Pema Chödrön, who I revere, said what I think is one of the best explanations of the purpose of pain, although you can find these sorts of ideas in any number of places, she occupies a special place in my heart.  So, to kick off the new look of the chronic pain forum here is Pema:

Life is glorious, but life is also wretched. It is both. Appreciating the gloriousness inspires us, encourages us, cheers us up, gives us a bigger perspective, energizes us. We feel connected. But if that’s all that’s happening, we get arrogant and start to look down on others, and there is a sense of making ourselves a big deal and being really serious about it, wanting it to be like that forever. The gloriousness becomes tinged by craving and addiction. On the other hand, wretchednesslife’s painful aspect—softens us up considerably. Knowing pain is a very important ingredient of being there for another person. When you are feeling a lot of grief, you can look right into somebody’s eyes because you feel you haven’t got anything to lose—you’re just there. The wretchedness humbles us and softens us, but if we were only wretched, we would all just go down the tubes. We’d be so depressed, discouraged, and hopeless that we wouldn’t have enough energy to eat an apple. Gloriousness and wretchedness need each other. One inspires us, the other softens us. They go together.

Pema Chödrön, Start Where You Are: A Guide to Compassionate Living

I’ve resolved to mix in a little of both science reporting and inspiration from now on, and I pray for your feedback on this change, so I can make a more successful, empathic community for everyone. Thank you for all that you do.

Elissa captures the sickening and emotional response to withdraw that is so difficult to articulate especially when you’re going through the crazies that go along with it. Hang in there!

Chronic Pain Journals

Another week in the process of medication withdrawal.  My body seems to be slowly adapting to my increasingly smaller doses, though night-time is a challenge with the increased pain.  Probably the biggest symptom I am experiencing is that I look really tired because my eyes look dreary.  This isn’t something I find in my internet searches on withdrawal.  It almost feels like when I am having an allergic reaction such as too much time in the grass or after a rare crying outburst. I am surprised that this symptom doesn’t seem to be changing even when I am level in my dose.   Fortunately I can continue with most of my regular activities and I find my ability to concentrate has increased some.  My family believes I might be more sensitive, but not sure I am ready to admit that🙂.  Perhaps the worse I feel the more I want others to understand and…

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I know it’s cliché , but you have got to try to take control of your pain, says the authoritative Nursing Times

managepainNow, I’m not in the business of promoting books or products of any kind on this blog, but this is one to seriously consider taking a look at—not just another “manage your pain” book, okay?  Bear with me.

First of all, it fares high praise from the prestigious magazine for nurses in the United Kingdome, NursingTimes.net.  The magazine, and their sister website publish original nursing research and a variety of clinical articles for nurses—and patients on occasion. 

Manage you pain.  Practical and positive ways of adapting to chronic pain by Dr. Michael Nicholas, Dr. Allan Molloy, Lois Tonkin and Lee Beeston was reviewed by Helen Simkins, clinical nurse manager, St. Giles Walsall Hospice.  What’s the book like?  Well you can sample it on Amazon, of course, but Nursing Times deems it a guide “that looks at the causes of chronic pain and provides practical solutions for people to implement into their lives, to help reduce the discomfort that they encounter.”  Now, I’ve heard all this before.

Personally, I’m still not impressed, just based on the rhetoric.  I’ve heard it all before, and took a great deal of it to heart with petty improvement.  But, this silver lining review came from such an authoritative source I had my suspicions in check:

This title allows people who suffer from chronic pain,alternative methods of addressing it. The way the book is set out enables manageable chunks of information to be digested and provides a framework for incorporating practical steps into your everyday life. It provides a message of hope for chronic pain sufferers that they can continue their day-to-day lives and regain the control that they felt they had lost.

The book provides alternative and the many holistic ways of addressing the debilitating pain.  In short, Dr. Michael Nicholas et. al provide some meaningful suggestions for taking control of your chronic pain.  Perhaps even I will check it out.

A great post over at the Bridge about the well known, but little talked about link between mindfulness–and other meditation techniques–and the therapeutic effects on chronic pain and other maladies.

THE BRIDGE

ScienceDaily (July 11, 2012) — Specific types of “mindfulness practices” including Zen meditation have demonstrated benefits for patients with certain physical and mental health problems, according to a report in the July Journal of Psychiatric Practice.

“An extensive review of therapies that include meditation as a key component — referred to as mindfulness-based practices — shows convincing evidence that such interventions are effective in the treatment of psychiatric symptoms and pain, when used in combination with more conventional therapies,” according to Dr William R. Marchand of the George E. Wahlen Veterans Affairs Medical Center and the University of Utah in Salt Lake City.

Mindfulness Techniques Show Health Benefits Dr Marchand reviewed published studies evaluating the health benefits of mindfulness-based practices. Mindfulness has been described as “the practice of learning to focus attention on moment-by-moment experience with an attitude of curiosity, openness, and acceptance.” Put another way, “Practicing mindfulness is simply…

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A great post ov…

A great post over at the Bridge about the well known, but little talked about link between mindfulness–and other meditation techniques–and the therapeutic effects on chronic pain and other maladies.

FDA acts to fight opioid overdose “epidemic”

methadoneiiDrug manufactures that market opioid painkiller medications will be required to train U.S. doctors, nurses and other health care professionals in the ways of safe use of the drugs, which have caused an epidemic of overdose deaths according to the Center for Disease Control (CDC).

The FDA introduced new safety measures for extended-release and long-acting opioid medications, such as oxycodone, hydrocodone, and methadone.  It comes in the form of a mandated blueprint on best practices measures directed at upwards of 20 companies that manufacture opioid analgesics, including how best to educate physicians who prescribe the medications.

New safety measures come from the FDA after the CDC published myriad striking statistics regarding drastically rising opioid overdose deaths.

The Federal requirement handed down from the FDA comes in the wake of a failed U.S. Congressional bill that went to vote several weeks ago.

“Although many Americans don’t realize it, prescription drug abuse is our swiftest growing drug problem. Many of those abuses involve opioids,” said Dr. Margaret Hamburg, commissioner of the Food and Drug Administration. “In 2008, nearly 15,000 Americans died where opioids were involved. In 2009, that number went up to 16,000.”

Medical Marijuana without the high? What a drag

marijuana4An Israeli firm, Tikun Olam, spent three years and millions of dollars developing a marijuana strain that is “highless.”  Seriously, what a drag.

Researchers say this marijuana strain—Avidekel they call it—can be used to ease the symptoms of some illnesses without getting patients high. (Can you imagine the informal trail amongst the growers?  Nope, I ‘m not feeling anything.  Good!)

Some may ask, “Why spend millions of dollars developing something that’s already a proven therapy?”  Tikun Olam’s head of development Zack Klein says, “Sometimes the high is not always what they [patients] need.  Sometimes it is an unwanted side effect.  For some of the people it’s not even pleasant.”  Personally, I can relate to this argument—some medicinal strains are very potent and can leave me disoriented for hours when I’d rather be able to function normally or focus on work but still get some pain relief.

The “highless” marijuana strain is able to work it’s magic—or lack-thereof—because it contains very low amounts of Tetrahydrocannabinol (THC), the main psychoactive substance in cannabis.  Conversely, it has very high levels of Cannabidiol (CBD), a cannabinoid that is believed to give marijuana many of its palliative properties.  Klein said their marijuana strain contains 15.8 percent CBD and only traces of THC—possibly lower than one percent.

In Israel, medicinal use of marijuana was first permitted in 1993, and today it is used to treat more than 9,000 people suffering from diseases such as cancer, Parkinson’s, multiple sclerosis, Crohn’s disease and post traumatic stress disorder, according to Israel’s health ministry.

Other drug companies have recently shown interest in marketing cannabis as a medicine.  In the U.K., GW Pharmaceuticals recently began selling a marijuana mouth spray, and is currently seeking FDA approval so in can enter the U.S. market.

Honestly, I’m on the fence about this.  It’s a plus that the main stream medical marketplace is starting to become more accepting of cannabis treatments, but I can imagine the consumers would bear the brunt of the cost of Big Pharma’s expensive R&D and marketing.  What do you guys think?

Methadone: Public Enemy No. 1

The opioid class painkiller, methadone, is the cause of one in 3 prescription painkiller overdose deaths, despite accounting for only 2 percent of painkiller prescriptions written, reports Kristina Fiore for MedPage Today.

Methadone took center stage in a recent CDC report.  Approximately 5,000 patients died from methadone overdose in 2009, about six times more than 10 years ago.

“Methadone is riskier than other prescription painkillers … and we don’t think it has a role in the treatment of acute pain,” said Thomas Frieden, director of the CDC.

Frieden explained that the proportion of methadone to other painkiller prescriptions is on the rise because insurers have increasingly made it a top-tier drug for chronic pain since it has such a low cost.  Evidence suggests that the increase in methadone overdoses is directly related to the increased use of methadone to treat chronic pain.

It’s  “penny wise and pound foolish …with higher societal costs in terms of death and other problems that can be avoided” Frieden said adding that there are other, safer opiates that should be used for pain.

Frieden cautioned that there’s limited evidence for the efficacy of opiates on chronic pain that is not related to cancer.

I suppose this is simply another example of insurance companies using a cost/benefit analysis on human life.

Scientists show chronic pain is “all in the head”

brainA new study published by Nature Neuroscience this week suggests that chronic pain is all in your head, although not in the way you might think.

According to the report, brain regions related to emotional and motivational behavior communicate more in people who develop chronic pain, suggesting that the state of mind one is in after an injury determines whether or not chronic pain will develop.

“For the first time, we can explain why people who may have the exact same initial pain either go on to recover or develop chronic pain,” said Prof. Vania Apakarian, from Northwestern University, Chicago.

“The injury by itself is not enough to explain the ongoing pain,” Apkarian added. “It has to do with the injury combined with the state of the brain.”

The authors looked at brain images of 40 people with recent onset of back pain and found they could predict with 85 percent accuracy who would develop chronic pain.  The variable was the level of communication between the frontal cortex (cognition) and the nucleus accumbens (emotions and motivation).

Most people suffering from chronic pain are acutely aware of the correlation between pain and emotions, but this study sheds light on the details surrounding the inception of chronic pain.  The emotional reaction to an injury is directly proportional to the persistence of pain.  Prof. Apkarian explains:

“It may be that these sections of the brain are more excited to begin with in certain individuals, or there may be genetic and environmental influences that predispose these brain regions to interact at an excitable level.  Now we hope to develop new therapies for treatment based on this finding.”

The study demonstrated a definite association between levels of communication in the brain and chronic pain; however, it didn’t show causality, leaving the results open to further interpretation.  The unique brain activity associated with chronic pain may very well be a result of a unique type of injury, or perhaps a result of a person’s pain tolerance.  Despite all of this, the study has proved to be a landmark case.

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