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.

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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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Celebrex: nothing to celebrate: how Pfizer defrauded millions and made billions

Jeffrey Kindler, left, chairman and chief of PfizerThe popular nonsteroidal anti-inflammatory drug (NSAID) used for the treatment of arthritis pain, Celebrex, has undergone intense scrutiny in a marathon securities fraud case against the manufacturer, Pfizer.  This week, The New York Times reported that thousands of internal documents were unsealed by a federal judge, and that they proved to be riddled with deliberate fraud and deception regarding not only safety concerns about the drug, but claims about the benefits as well.

In 2004, Celebrex and other COX-2-inhibitors—a class of NSAIDs thought to reduce pain and inflammation without the gastrointestinal side effects of other NSAIDs—underwent sharp examination after a similar drug, Viox, was withdrawn from the market after studies uncovered that the drug doubled the risk of heart attack and stroke.  Leading up to the release of internal documents, Pfizer has dealt with a wave of lawsuits from more than 3,000 patients who claim that Celebrex caused heart attacks and strokes.

The New York Times reported this week that blatant and unabashed deception about Pfizer’s research was detected in the documents unsealed by a federal judge.  “They swallowed our story, hook, line and sinker,” wrote a research director.  Not only was Celebrex not easier on the stomach than other NSAIDs like aspirin, but the dangers of stroke and heart attack were masked.  The only reason it appeared that the drug was safer on the stomach was because Pfizer and it’s partner, Pharmacia, cherry picked their research results by only presenting the first six months of a yearlong study.

To top off the conspiratorial nature of this case, it turns out that Pfizer stole the research that led to the discovery of Celebrex in the first place.  Last month, Pfizer settled with Brigham Young University for $450 million. A chemistry professor, Daniel L. Simmons, discovered the genetic workings of the drug in the early 1990s and the university had a research agreement for royalties with Monsanto Company which was later acquired by Pfizer.  The original agreement not honored by Pfizer was 15 percent royalty on sales of Celebrex, or about $9.7 billion.  Rather than risk losing everything in a trial by jury, BYU settled for just $450 million.

I’ll leave you to draw your own conclusions about some of the eccentricities of big pharma from this bit.

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?

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?