Category Archives: pain management

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.

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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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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.

Exposure to media coverage of terrorist attacks increases pain levels in those suffering from chronic pain

israelmissileattackThis was an odd little story reported by ScienceDaily today.  Professors at Ben-Gurion University of the Negev (BGU), a university in Israel, recorded the levels of depression, anxiety, and chronic pain as well as exposure to media coverage in 55 patients before and after a three-week long missile attack in Israel’s Negev Region.  The experiment showed that exposure to the attacks through the media predicted an increase in pain levels but did not predict depression or anxiety.

So, terrorism effects more than just the public psyche, apparently.  Prof. Golan Shahar accounted for the psychosomatic-like symptoms by suggesting patients with chronic pain are already under a great deal of stress even before stressful events unfold, and thus their ability to cope manifests in predictable symptoms of pain.

THE BRIDGE

surgery procedure1 Surgery isnt Always the Answer

I love this article by Dr. Don Nixfdorf and thought it was well worth a share.

By Dr. Don Nixdorf, Chiropractor

Studies suggest that at least 80% of people will suffer from some type of spine problem at some point in their lifetime.  Many of these people will be referred to a surgeon to correct the issue and in some cases, surgery is in fact the correct choice.  As my colleague Dr. Rich Hunter mentioned in a previous Empowered Health episode, surgery can be life saving.  It can remove pathology such as tumours and repair deformities.  But surgery isn’t always the best answer for everyone.  While some patients may find significant improvement with surgery, many do not.  In fact, recent studies suggest that one out of every two patients who goes under the knife for back or neck pain ends up the same or worse than before the surgery…

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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?

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?