Monthly Archives: June 2012

Medical device company announces new patents for innovative chronic pain treatment

spinalcordstimThe Wall Street Journal carried a press release today by Nervo Corp., a medical device company, that announced the issuance of two patents related to the company’s Senza™ High-Frequency Spinal Cord Stimulation System.

Unlike traditional systems, Senza delivers pulsed electrical signals to the epidural space of the spinal cord without causing paresthesia, the tingling, buzzing sensation associated with low-frequency spinal cord stimulation.  Needless to say patients often find this unpleasant.

Spinal cord stimulation (SCS) is a high tech procedure involving a surgical implant that uses an electrical current to treat chronic pain in the limbs and back.  A small pulse generator implanted in the back sends electrical pulses to the spinal cord that scramble the nerve impulses that make you feel pain.  What makes Senza different is the lack of side effects associated with paresthesia.  The new technology might make SCS more desirable an option for people suffering from debilitating chronic pain.  It also makes the implant seem like a less extreme compromise.

Does anyone have any experience with SCS?

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Top 5 Foods for Chronic Pain

wildsalmonI’ve wanted to write about foods for chronic pain for a while now, as well as get everyone’s input, so here it is!

The best foods for chronic pain are all anti-inflammatory in nature since pain is either caused by inflammation, or causes inflammation over time.  As a rule of thumb you want to look for food high in antioxidants, fiber, and certain vitamins and minerals.  Over time, a diet like this will give you at least meager pain relief.  And at the very least you will be countering the systemic nature of chronic pain with all of the other health benefits you get from eating healthy.  A wholesome diet helps prevent pain-aggravating weight gain and boosts energy levels and mood so you can have an overall better outlook on things.

  • Wild-Caught Salmon is a great source of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), two very potent omega-3 fatty acids that lower inflammation.  The benefits of omega-3 fatty acids can’t be understated, e.g., they prevents heart disease,  cancer, and reduce some symptoms of autoimmune diseases and psychological disorder, plus all this is backed by myriad scientific studies.  A good substitute to eating salmon a couple of times a week is a good fish oil supplement.

 

  • Blueberries are an  antioxidant powerhouse.  They are high in phytonutrients—certain plant compounds that give you anti-inflammatory protection against a ton of diseases such as cancer and dementia.  Really, any of the berry relatives (especially blackberries, cranberries, strawberries and raspberries) are full of antioxidants and vitamin C.

 

  • Extra Virgin Olive Oil is rich in antioxidant polyphenols, which help lower a common pain-causing mechanism in the body.  It’s low in saturated fat, but can still substitute butter while cooking.  Too much saturated fat has been shown to erode bone density and trigger pain.  ScienceDaily has even reported that a naturally occurring chemical found in extra-virgin olive oil is a non-steroidal anti-inflammatory agent similar to Aspirin.

 

  • Kelp (or any ocean salad) contains fucoidan, a type of complex carbohydrate that is anti-inflammatory, anti-tumor and anti-oxidative.  Recent studies on fucoidan have shown that its brown algae extract can help control liver and lung cancer, as well as promote collagen synthesis—the creation of the primary component in connective tissues, such as tendons and ligaments.  Kelp’s high fiber content also helps induce fullness, slow fat absorption and promote weight loss.  The only problem is it’s not as accessible as some of these other foods, and if you can find it, you have to make sure it’s organic kelp, harvested from unpolluted seas.

 

  • Turmeric is a traditional Asian spice commonly found in pre-mixed curry powder.  It contains a powerful compound called curcumin.  Some studies have shown turmeric’s anti-inflammatory effects are similar to potent drugs such as hydrocortisone and ibuprofen but with none of the side effects.  The University of Maryland Medical Center states that curcumin may also help fight infections, some cancers, and treat digestive problems.

Marijuana mouth spray seeks FDA approval for pain

sativex spaySativex, is a cannabinoid medicine for the treatment of multiple sclerosis (MS) symptoms, cancer pain, and neuropathic pain developed by GW Pharmaceuticals.  Sativex could be approved in the U.S. as a treatment for pain relief in the next few years.

The British pharmaceutical company is currently testing the drug, which is delivered as a mouth spray, in clinical trials.  The company plans to seek FDA approval of the drug for the treatment of cancer pain when the trails conclude in 2014, according to myhealthnewsdaily.  Currently, Sativex is approved in the U.K., Spain, Germany, Denmark, New Zealand and Canada.

Sativex has a low risk for abuse, according to experts, because any “high” that a patient could receive is delayed compared to traditional smoking methods of marijuana ingestion on the street.  Cultural norms that take place in stoner circles may demand the smoking method.  Although some may consider this naive conjecture, the assumption is based on the low abuse rate of similar synthetic cannabinoids that have been on the market in the U.S. for several decades.

Sativex is the first marijuana-based drug to be made by extracting the compounds from the plant, rather than synthesizing them, which is the case in two other drugs, Marinol and Cesamet that were approved by the FDA in the 1980s.  These two drugs have had low rates of abuse in the past.

Patients can adjust the dose of Sativex to prevent it from entering the blood steam too rapidly, allowing them to experience symptom relief without the high, says GW Pharmaceuticals.  Furthermore, the drug is made up mostly of two ingredients: THC and another cannabinoid called CBD, the latter of which is known to meliorate some of the side effects of THC, such as the high that marijuana users feel.

Opioids and Alternatives according to Dr. Torregiani

Dr. Seth Torregiani wrote a somewhat useful essay today about the state of opioid treatments in the medical marketplace and their viable alternatives.  He argues that while pain pills have a place in treating chronic pain, their usage has ballooned, screening other treatments that could be even more effective.

The original purpose of opioid medicines was for the treatment of pain related to cancer, or for the short-term treatment of moderate to severe pain from injury or following a medical procedure. They have since become the “go-to” medication for pain of all kinds, including chronic pain.

In my opinion, opioids, while they may have a role in chronic pain treatment and may be necessary at times, are not a great choice for the long-term treatment of pain.

…I think it has become incumbent upon the medical community, patients and their advocates as well as insurers and the government to seriously rethink the approach we have adopted as a society to the treatment of pain.

 

 

vicoOpioids have become the most prescribed class of drugs in the U.S. despite being potentially dangerous and very easily abused.  Recent studies have shed new light on the dangerous qualities of these drugs.

However, it’s one thing to claim what we all know to be the case—that the potential for overdose and abuse has skyrocketed—but it’s quite another to claim there are treatments out there that are as effective as opioids.  I remain skeptical, especially for cases involving chronic neuropathic pain.  Dr. Torregiani lays out the “wide variety of techniques and therapies that are now available”:

  • “Don’t take a percocet when acetimenophen (Tylenol) will do.”  Tylenol and NSAIDs (non-steroidal anti-inflammatory drugs) like Advil and Aspirin work very well with lower doses of opioid drugs and can reduce the need for higher or more frequent doses of opioids, he argues.  Do people really have opioids stashed away in the medicine cabinet reserved for headaches and minor aches and pain?  I find this bit of advice useless, and somewhat irrational.
  • “Don’t be stoic.”  Really?  Dr. Torregiani encourages patients to not “tough it out” and to always have their pain meds in their system.  I find this to be a useless point.  Usually people suffering from chronic pain want nothing more than to have relief, right?
  • “Honesty is the best policy.”  He makes the superfluous argument that people suffering from chronic pain shouldn’t see the complete eradication of pain as an ultimate goal.  I agree, but would like to add that after many years of suffering from chronic pain, most people wouldn’t be so delusional. “…[A] long-term strategy to manage pain, one that involves the patient, family and friends, employers as well as caregivers, is often the best approach, if a complete cure is unlikely.”  This just seems obvious to me, and unhelpful.
  • “Consider bodywork.”  Now this is some useful advice, and actually relates to the topic of alternative treatment that he originally set out to write about.  The idea is that chronic pain, whether it’s musculoskeletal related or neuropathic, causes additional somatic symptoms such as trigger points and muscle spasms that can be alleviated with some types of manual bodywork.  He specifically cites massage, myofascial release (vigorous massage), Rolfing, chiropractic manipulation, osteopathic manipulation, craniosacral therapy.
  • “Keep moving.”  This is also good advice.  Research suggests that activity is good for chronic pain.  Exercise increases endorphin release, improves blood flow, decreases muscle tension, improves moods, etc.. “I regularly advise my patients to keep moving — whether walking, tai chi, yoga, gardening, stretching.”

Overall, I found Dr. Torregiani’s advice to be well intentioned and out of touch.  I guess perhaps I could be the one who’s out of touch, but I’d be willing to bet that he’s never suffered from chronic pain, nor spent more than a few minutes at a time with his patients.  I think this is an all too common problem in the medical profession based on personal experience as well as a reading of How Doctors Think by Dr. Jerome Groopman.  This book is excellent and makes the case that communication needs to be restored between doctors and their patients in order to optimize care.  Any way, what do you folks think of Dr. Torrengiani’s column?  Could I have overlooked something?

CDC: Prescription painkiller overdoses skyrocket

viOverdoses due to prescription painkiller abuse or misuse is up these past few years.  Way up.  According to a CDC report published late last year, prescription painkiller overdoses killed nearly 15,000 people in the U.S. in 2008, more than 3 times the 4,000 deaths reported in 1999.

“Overdoses involving prescription painkillers—a class of drugs that includes hydrocodone, methadone, oxycodone, and oxymorphone—are a public health epidemic,” says the report.

A few more scary statistics:  In 2010 one in 20 people in the U.S., ages 12 and older, used prescription painkillers for recreational use or without a prescription; also in 2010, about 12 million Americans reported nonmedical use of prescription painkillers the past year; nearly half a million emergency department visits in 2009 were due to people abusing prescription painkillers; finally, nonmedical use of prescription painkillers costs health insurers upwards of $72.5 billion annually.

Now, I feel deep sympathy for those who get hooked on pain pills because they were prescribed to them for long-term treatment.  Through no fault of their own they get desensitized  to their prescription and they have eventually have to “abuse” the medication.  In this case the “abuser” is blameless, and unfortunate.  I think it’s unfair to pass judgement on these people.  However, I really don’t like the idea of people getting this stuff just for recreational use.  It’s very discouraging that kids and adults who don’t have pain problems have perpetuated a growing demand for these drugs.  People with painful conditions need these medications, and these recreational users take advantage of that need.  The idea of unscrupulous doctors running pill mills, e.g., the recent case of two CVS Pharmacies in Florida that each sold 20 times more oxycodone pills (about 3 million each) than the national store average due to morally reprehensible medical practices is even more disturbing and maddening.  I can’t quite put my finger on the reason why.  Any thoughts?

Lower back pain? Artificial Spinal Discs not far off

timthumbAre you afflicted with lower back pain?  If you are, you’re not alone.  Millions of Americans report having the condition every year.  The good news is there may be a viable solution available in the not so distant future.

The BYU newspaper reported today that mechanical engineering professors have developed an artificial spinal disc that they believe could cure chronic lower back pain for many people.  They describe the disc as using flexible pieces of titanium to move naturally with the spin, thus mimicking a normal disc.

One of the most common reasons for a doctor visit these days is low back pain.  In fact, up to 80 percent of people will experience back pain sometime during their lifetime.

Currently, the silver bullet for the chronic condition is spinal fusion surgery.  This treatment involves removing the degenerative disc then fusing the gap together with bone fragments.  Although more than 300,000 operations like this are performed each year, about half of these patients are unsatisfied with their result.

The Mormon biomedical engineering department at BYU believe they have the answer.  The artificial disc is currently being developed by Crocker Spinal Technologies based in Salt Lake City.  It will first be available overseas (due to strict FDA regulations here in the U.S.) but will be accessible to Americans—pending favorable study results—very soon.

Is Marijuana an effective treatment for Fibromyalgia?

weedAnyone who suffers from fibromyalgia syndrome knows that it’s painfully frustrating to treat.  Many of these folks resort to alternative therapy and some find medicinal marijuana to be a very effective way to ease many of the most persistent and virulent symptoms.

The June 21 edition of the journal Arthritis Care & Research includes a study that states about 10 percent of fibromyalgia patients use marijuana to relieve symptoms such as pain, fatigue and insomnia.  The article noted that traditional drug treatments for fibromyalgia have a low or partial efficacy which leads some patients to self medicate with marijuana, either legally or illegally depending on the state of residence.

I know the issue of medical marijuana is vast and complex due to its controversial nature, so I don’t wish to get into the politics here.  I am interested in determining whether people think it works or not.  And if so, what might be the risks and side effects.

The findings of the journal article raise several questions for me.  For example, the study revealed that marijuana use was associated with mental illness, opioid drug seeking behavior, and unemployment.  Now, having myself exhibited some of these things at one time or another during my lifetime, I believe any of these factors can cause any of the others.  The simplest case-in-point would be that chronic pain frequently causes clinical depression and vice versa.  Furthermore, depression can cause unemployment or drug seeking behavior and so on.  What do you think about this issue?

The study concluded by cautioning against the use of “illicit” drugs until more research is done (would this include medicinal marijuana or not since it it legal in 12 states or so?):  “While self-medicating with cannabinoids may provide some pain relief to fibromyalgia patients, we caution against general use of illicit drugs until health and psychosocial issues risks are confirmed.”  Clearly these are sophisticated experts but the researchers have probably never suffered from chronic pain, i.e., the complex relationship between depression and chronic pain is not noted or elaborated on.  Judging from their recommendations they seem to view these symptoms as compartmentalized factors albeit somewhat related.

In general, I would argue that marijuana does not cause mental illness simply because these test subjects would probably have not begun using had they not been seeking relief from chronic pain.  I believe that the depression they noted in subjects was caused by the chronic pain.  But that’s just conjecture based on personal experience coming from me.  What do you think?

Memphis residents take control of chronic pain with a holistic approach to pain management

GoldFlwr3I wanted to share this article from June 4 by a Memphis newspaper because it introduces a completely different paradigm of pain management than traditional western models, and seems to be having a lot of success.  There are so many great quotations in the article that I encourage everyone to take a look if you have a moment.

To summarize, this piece takes the angle of Debbie Nichols who suffers from chronic arthritis pain and had little luck when she sought medical treatment.  She gave yoga a try, then her yoga instructor urged her to incorporate massage therapy into her treatment plan.  She had tremendous success with the two treatments working in tandem.

“I am in no way pain free, but when I have pain, now I know what to do with it.  Now I know that when I’m not doing well, I know what I’m doing wrong and I can stop doing that and do something more productive.”

Yoga instructor, Leah Bray Nichols, and licensed massage therapist and massage instructor, Lorrie Garcia, began sharing clients and had so much positive feedback that they collaborated to create a free panel discussion on pain management.  The panel added a meditation teacher and an art therapist.

“We were getting clients who had had every test under the sun, seen all kinds of doctors and specialists, and couldn’t find a solution to what was causing their pain. We would start to work with these clients, helping them become more aware of where their pain was, their postural holding patterns and the emotional ties it has, so that they were able to undo the patterns themselves,” said Garcia.  “We were getting feedback that they had never heard about the kind of work we were doing and that they never knew it was possible to do the work themselves.”

I don’t know about you but I can definitely relate to having “every test under the sun” and seeing “all kinds of specialists” only to come up with nothing very concrete.  Sometimes this is one of the most frustrating things about chronic pain.  We’re programmed to think that everything has a cause, especially within the paradigm of western medicine, but sometimes pain is just pain.

This multifaceted holistic approach sound very promising.  I think the most important work being done here is allowing the patient to take charge of their pain.

“You have to treat the whole person. It’s about the full picture–mind, body and spirit.  A lot of times you are dealing with emotional pain, which physical pain can result from. And physical injury can cause depression and anxiety. The things we hold in our bodies, like stress, can cause a tremendous amount of pain.”

I think every community should have a program like this.  Has anyone ever heard of one of these or tried something similar?

Exercise may reduce chronic nerve pain

ratswum

Regular low impact exercise is a common recommendation by physicians for easing chronic pain, but so far research has been mixed about whether this is the case for neuropathic pain.  Men’s Health wrote a short piece on this today.

An experimental study published in the June issue of Anesthesia & Analgesia, the official journal of the International Anesthesia Research Society (IARS), suggests that exercise helps to alleviate pain related to nerve damage.

Neuropathic pain is often very difficult to treat—manifested as nerve damage associated with trauma, diabetic distal neuropathy, phantom limb pain, and many other conditions—but exercise could potentially be an effective nondrug option.

Scientists examined the effects of exercise on neuropathic pain induced by sciatic nerve injury in rats.  The group of injured rats that performed progressive exercise such as swimming or treadmill running exhibited fewer observable pain behaviors over the course of a few weeks.  These rats also had less inflammation-promoting substances called cytokines in their sciatic nerve tissue.

The exercising rats also had an increased expression of a protein called heat shock protein-27, which may have contributed to reductions in cytokine expression.

Typically the burning pain and numbness associated with nerve damage doesn’t respond to conventional pain meds. Antidepressant and antiepileptic drugs are often helpful but have significant side effects. Exercise could prove to be an effective nondrug treatment.

I have begun swimming per recommendation of my pain doctor, but it is difficult to tell if I’m having less pain.  Perhaps it’s too early to tell.  Has anyone had any good results from exercise?

Pain Management: the doldrums of modern medicine

 

mandala 01If you’ve ever been through pain management with a physician, then you might know what I’m talking about.  After a complete workup by your specialist or primary care provider it’s finally determined that your pain is not caused by anything serious so it’s off to the pain management doctor.  It may also be your experience that the cause is known, but nothing else can be done as far as treatment is concerned. 

There is something rather heartbreaking to know there’s nothing wrong with you.  Don’t get me wrong; I know it should feel great that there’s no insidious reason for your pain, but there is something deeply unsatisfying to know that there is nothing that can be fixed.  Whether it’s a dubious diagnosis of “nerve pain,” “nerve damage,” fibromyalgia syndrome, or even something much more concrete like osteo arthritis, it’s off to pain management.

It represents a shift from treatment of the malady to the management of it.  You know that with painful finality that treatment of the cause of your chronic pain shuts like a book and the only thing left to do is “manage.”  It’s demoralizing at first to say the least.  I know it’s difficult to accept that nothing else can be done.  I wonder if anyone ever really does get over this.  Perhaps you have.  I would imagine that it is liberating to finally accept that this nagging pain is going to be with you for the rest of your life and put yourself full tilt into having a positive outlook and working with your pain management doctor.

Has anyone else had an experience like this?