Blog Archives

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.

Advertisements

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.

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.

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?