PAIN RELIEF MEDICATIONS BLOG

New Study Probes Phantom-Limb Pain Relief

February 28, 2007

Wounded veterans and others facing limb amputations may avoid long-lasting phantom-limb pain through aggressive pain management before and after surgery, according to a study in The Journal of Pain.

Researchers at the University of Washington examined the impact of intense pre-amputation pain and acute pain following amputation as predictors of long- term pain. It was assumed pain before amputation can produce pain ‘memories’ in the nervous system that persist after limb loss. The condition is known as phantom-limb pain. Fifty-seven patients with lower-limb amputations were evaluated. The average age was 44 and 70 percent required amputation from a traumatic injury.

“Publication of this study is very timely, as the VA and other providers are dealing with severe pain in veterans who have lost limbs in combat,” said Mark P. Jensen, PhD, a co-author of the study and an American Pain Society director. “The data clearly show that higher levels of pre-amputation pain predict acute pain, and acute post-amputation pain intensity predicts chronic phantom-limb pain after one year. These findings could help identify patients at greatest risk for chronic pain problems who will need early and aggressive pain interventions,” Jensen explained.

Phantom-limb pain can be excruciating and occurs following amputation as the patient continues to feel sensations from the missing limb. This suggests limb perceptions may be hard wired in the brain and, therefore, contribute to pain sensations that last long after limb loss.

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The authors noted there is some evidence that nerve-block anesthesia before amputation reduced the incidence of chronic phantom-limb pain, but this finding has not been replicated in further studies. Jensen said their results support further investigation to the efficacy of early interventions that can prevent or manage amputation-related pain.

APS President Judith Paice, PhD, RN, said the multidisciplinary organization will continue to promote further research to help control chronic pain problems in injured war veterans. “Our focus as pain care researchers and clinicians is on fostering greater understanding of how to most effectively treat serious pain in combat-wounded and other soldiers returning from Iraq and Afghanistan,” she said.

The Journal of Pain is the monthly peer-review publication of the American Pain Society (APS). Based in Glenview, Ill., APS is a multidisciplinary community of approximately 3,200 members that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering.

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Study Shows Link Between Popular Painkillers, Strokes

February 27, 2007

Regularly taking some of the most popular painkillers on the market is linked to a much greater risk of stroke and heart attack from higher blood pressure, according to American research published yesterday.

Participants in a large American study who took paracetamol, aspirin, or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, six or seven days a week over a two-year period were between a quarter to a third more likely to be diagnosed with highblood pressure.

Those who took 15 pills a week, regardless of type, have almost a 50% risk of higher blood pressure than those who do not.

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More than 5 million Britons with osteoarthritis, migraines, or back pain either buy the drugs over the counter regularly or are prescribed them, though dosages differ.

Those diagnosed with hypertension — high-blood pressure — are at greater risk of stroke, heart attack, heart disease, and kidney failure.

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Do-It-Yourself Spinal Stretch Offers Relief From Lower Back Pain; Portable Therapeutic Belt Uses Body’s Resistance to Strengthen Muscles

February 21, 2007

An estimated nine out of ten people suffer from lower back pain at some point in their lives. It’s the second most common reason for doctor and hospital visits in the U.S., according to Benjamin Jensen, co-founder of BurJen Enterprises, Inc., makers of Disc-Traction, a recently patented therapeutic belt designed to strengthen and traction the lower back. See http://www.Disc-Traction.com.

“Stretching and strengthening the back on a regular basis can be beneficial not only in controlling and preventing back pain, but also for improving mobility, flexibility, posture and alignment,” says Dr. Eduardo Burgueno, inventor of the Disc-Traction belt as an answer to his own chronic back pain.

Based on the simple principle that every action produces an equal and opposite reaction, Disc-Traction provides a do-it-yourself spinal stretch. Its unique handles allow the wearer to apply downward force, producing an opposite effect — the upward pull and stretching of the low and midback.

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By strengthening the core muscles next to the spinal column, the wearer creates strength internally by stabilizing the spine and unloading the disc space and muscles in the lumbar region to provide relief. A series of exercises has been developed to guide the user through a safe and effective exercise regime.

“The beauty lies in the simplicity and functionality of the belt’s design,” says Dr. Brett Diaz, D.C., at the Chiropractic Rehabilitation & Therapy Center in Ontario, California.

The portable, home-use devise allows users to traction the lower spine isolating and decompressing the individual lumbar discs in a way previously only possible by means such as a spinal decompression machine or a flexion distraction table.

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Pain Killers That Could Prove Deadly

February 20, 2007

When you think of drug overdoses you may think of cocaine or heroin. But not in Utah. The number one overdose killer is the pain killer methadone.

This is not just a problem in Utah.

Methadone is being investigated as the possible death for Anna Nicole Smith and her son.

And just last week USA Today had a front page article on how methadone tops other prescription drugs for deadly abuse, saying only cocaine kills more by overdose.

But here in Utah methadone tops cocaine, heroin and all others in deadly drug overdoses.

Karen Lasrich still can’t believe what happened to her 41-year-old brother Mike Kennedy.

“This is not right. It’s not right he should be here,� said Karen.

A husband and father who suddenly died from taking a pain killer, prescribed by a doctor, known as methadone.

“I know it is suppose to be a wonderful medication but it can kill you,� Karen said. “That is the bottom line of this medication.�

Another woman, who doesn’t want to be identified, says methadone also killed her son.

“One day he came home after his treatment and laid down and never woke up,� she said.

It too was prescribed by a doctor.

“We trusted him and his actions led to our son’s death.�

And that is why Dr. Lynn Webster, director of the Lifetree Clinical Research and Pain Clinic, is heading up a campaign on methadone.

Dr. Lynn Webster says, “The percentage of overdose deaths in this state is an astounding number.�

“What I’m trying to do is educate physicians about the unique differences with methadone from all the others how we need to prescribe it,� said Dr. Webster.

According to the Utah Health Department, methadone is the number one drug overdose killer in Utah, beating out cocaine and heroine.

Back in 1997 there where 7 deaths related to methadone. In 2005 that number jumped to 113 deaths. That’s almost one person every three days.

And, according to a study done in 2004, half of the methadone deaths came from people who where using the narcotic legally as their own prescription.

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And that’s why Dr. Webster says doctors need to understand the risk and so do patients.

“When you first start taking methadone and you’re taking it to treat pain you may feel pain relief for 4-6 hours and then take another pill for 4-6 hours and then taken another pill,� said Dr. Webster.

“But after 2-3 days the body has not become used to the drug so the respiratory center is not responding properly so you may not wake up,� Dr. Webster said.

Methadone is basically used for two purposes: as a pain killer and as a narcotic to treat heroin addicts.

Like Tenea who started taking heroin at age 14.

“I was really bad,� says Tenea.

But now Tenea says she’s been clean of heroin for 11 years, thanks to methadone.

“I think methadone is a life safer personally,� Tenea said. “It’s helped me get my life together.�

Jerry Costly heads up the Metamorphosis Clinic in Salt Lake City. He says, “Done safely it’s one of the safest medications around.�

Where everyday dozens of people once hooked on heroin come through the doors to take methadone. But costly says he also realizes the dangers of the drug.

“As a street drug, in my opinion it’s one of the most dangerous of street drugs,� says Costly.

And that’s why Costly says they take very serious steps in prescribing the drug.

But as doctors are now realizing you don’t have to buy methadone on the streets to never wake up again.

Karen Lasrich, who lost her brother to Methadone, says, “These doctors’ pharmacies the patients taking it they need to know exactly what they are getting themselves into.�

The Utah Health Department is so concerned about the rise in methadone deaths that it’s now conducting a study to try and figure out why so many people are dying from it, and what can be done to better educate doctors and patients.

That study is expected to be done in the next few months.

No there’s no chance of methadone being banned, but the FDA did issue a warning for methadone use last fall and is looking into possibly changing the way it is prescribed.

But, from what doctors and the health department are telling me, methadone has different effects on everyone, especially when patients are taking other medication.

That’s why it’s so difficult to pinpoint the reasons for the deaths.

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Small study backs marijuana for pain relief in HIV patients

February 14, 2007

Smoking marijuana eased HIV- related pain in some patients in a small study that nevertheless represented one of the few rigorous attempts to find out if the drug has medicinal benefits.

The Bush administration’s Office of National Drug Control Policy quickly sought to shoot holes in the experiment.

The study, conducted at San Francisco General Hospital from 2003 to 2005 and published in the journal Neurology, involved 50 patients suffering from HIV-related foot pain known as peripheral neuropathy. There are no drugs specifically approved to treat that kind of pain.

Three times daily for nearly a week, the patients smoked marijuana cigarettes machine-rolled at the National Institute of Drug Abuse, the only legal source for the drug recognized by the federal government.

Half the patients received marijuana, while the other 25 received placebo cigarettes that lacked the drug’s active ingredient, tetrahydrocannabinol. Scientists said the study was the first one published that used a comparison group.

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Thirteen patients who received marijuana told doctors their pain eased by at least a third after smoking pot, while only six of those smoking placebos said likewise. The marijuana smokers reported an average pain reduction of 34 per cent, double the drop reported by the placebo smokers as measured with a widely accepted pain scale.

“These results provide evidence that there is measurable medical benefit to smoking cannabis for these patients,'’ said Dr. Donald Abrams, the University of California, San Francisco professor who led the study.

Many critics agree THC has promise as a painkiller, but they argue the smoke itself is harmful.

“People who smoke marijuana are subject to bacterial infections in the lungs,'’ said David Murray, chief scientist at the Office of National Drug Control Policy. “Is this really what a physician who is treating someone with a compromised immune system wants to prescribe?'’

Murray also questioned the statistical relevance of the study with just 50 participants in the test.

California and 10 other states have passed laws legalizing marijuana for medicinal purposes, but the federal government considers it a dangerous drug, like cocaine or heroin.

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Head to head: Right-to-die case

February 13, 2007

A 30-year-old terminally ill woman is to launch a legal battle to force doctors to allow her to die.

Kelly Taylor, from Bristol, who has been given less than a year to live, wants doctors to increase her medication to induce a coma-like state.

Here, two commentators give their views on what could turn out to be a very substantial case.

Dr Tony Calland, British Medical Association

“I agree with the principle of double effect (giving drugs to relieve pain and suffering which may shorten life as a side effect) but that’s not quite the whole story in this case.

“As I understand it, the patient wants the administration of a very significant amount of morphine to make her unconscious.

“And when she is unconscious and therefore has no capacity she has already made an advanced directive which will instruct her medical team not to give her life-sustaining nutrition and hydration.

“So that while she is unconscious she will be allowed to die through lack of nutrition and hydration.

“That is a very different issue because it would be tantamount to the doctors administering the treatment to make her unconscious as a deliberate act, knowing she would die rather than using the double effect principle.

“We have to look at the rights of doctors not to be put in the position that would make them subject to the laws of manslaughter or murder.

“I understand that this is a very sad case but since Hippocrates there has been a tradition of trust between patients and doctors and they will always do their very best to keep their patients alive and make them better.

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“Any move away from that absolute principle will certainly mean considerable amount of more difficulty for doctors trying to do the best for their patients but also do not want to end up being subject to being penalised by the law.”

Deborah Arnotts, chief executive of Dignity in Dying

“The pain relief that Kelly is currently receiving is not adequate to deal with the level of her suffering so she’s asking that doctors increase her level of pain relief.

“She’s doing that on the basis of the principle of double effect which is already very well established as a medical practice.

“One in three deaths are as a result of doctors administering life shortening medication.

“The difference here is she is saying I want to have control over when pain relief medication which will foreshorten my life is given to me. It’s actually about patient choice.

“Doctors already give medication that will foreshorten life and that is perfectly legal under the principle of double effect.

“What Kelly would like most is to have control and choice over the manner of her death.

“Her suffering is unbearable.

“What she is saying is I also have a living will which will take effect should the morphine put me into deep sedation and living wills are legal - we all have the right to refuse treatment.

“What Kelly is saying is it’s not down to doctors to make these decisions, it should be down to the patient.”

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Alternative Medicine: Tuina: Ancient pain relief meets modern life

February 8, 2007

Tuina (pronounced “twee-naa”) has been used widely in traditional medicine clinics and hospitals in China as well as in Hong Kong, Singapore, Thailand and Taiwan for thousands of years. The knowledge and skill has been accumulated and improved throughout its very long history. Tuina is a form of Chinese manual medicine. It is commonly used to prevent and treat disease by removing obstructions and increasing vital energy, called Qi (”chee”), through manual methods, herbal remedies, heat pads, cupping and moxibustion.

Tuina practitioners are trained in five-year educational programs in traditional medicine colleges in China. After graduation, they serve additional apprenticeships under close supervision of experienced Tuina practitioners. Retired Tuina doctors often come to teach and pass their experience to other doctors and discuss difficult cases.

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Tuina medicine is increasingly used to promote circulation, reset the relationship between bones and their surrounding tissues, increase joint flexibility, heal soft tissue and sport injuries, and balance Yin-Yang function of internal organs.

Tuina is a unique and independent medicine used for preventive as well as therapeutic purposes for both chronic and acute diseases. Diseases and conditions addressed in the U.S. by Tuina practitioners include back pain, sciatic pain, headache, muscle tightness, frozen shoulder, neck pain, tennis elbow, insomnia, fatigue, constipation, diarrhea, stroke recovery, joint dislocation, poor childhood appetite and even the common cold.

To find a qualified and well-rounded Tuina expert, look for an experienced traditional Chinese medicine practitioner who is well versed in traditional Chinese herbs and also has the LAc credential, which stands for “Licensed Acupuncturist.”

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Supplemental therapy can ease pain for people suffering from common jaw disorder

February 5, 2007

A new supplemental therapy that teaches pain coping and biofeedback skills can reduce pain, the potential for chronic pain and health-care costs for millions of Americans suffering from a common jaw disorder, UT Southwestern Medical Center researchers have found.

The therapy certainly did the trick for Harriet Velevis, a Dallas pre-kindergarten teacher.

Her jaw used to throb with intense pain that made it hard to eat or do her job, and dental care provided little relief. But after participating in a UT Southwestern trial of the supplemental therapy, called early biopsychosocial intervention, she learned to self manage the pain. The intervention teaches a combination of coping techniques and tips on controlling stress-related bodily functions.

“Eventually I had no pain symptoms thanks to these techniques. I still use them today,” Mrs. Velevis said. “For instance, I have a picture of a countryside scene in my classroom and I focus on it if I begin to grit my teeth or clench my jaw. Focusing on something that makes you happy helps your body relax.”

UT Southwestern’s trial evaluated early biopsychosocial intervention, which aims to help people at risk of developing chronic pain due to temporomandibular disorder, or TMD. The condition, which is associated with jaw or facial pain, affects more than 10 percent of Americans, making it the second-most common pain-causing muscular and skeletal condition, behind low-back pain.

Trial participants – 20 men and 81 women who ranged in age from 18 to 70 – were divided into two groups. One group got an intervention and standard dental care and the other received standard care alone.

The results, described in a study appearing online today in the Journal of the American Dental Association and in another study published in the journal’s March 2006 issue, show that those who received the intervention had significantly lower levels of pain and fewer doctor visits.

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Study participants in the intervention group also spent less money on treatment than those with no intervention, said Dr. Anna Stowell, assistant professor of psychiatry and anesthesiology and pain management at UT Southwestern and co-author of the studies. Standard care for TMD, such as medication, physical therapy and surgery, can be expensive.

“The early intervention can reduce TMD-related pain levels, stave off chronic pain and save people money on costly treatments,” Dr. Stowell said.

In search of a low-cost supplement, researchers in this study combined two separately effective teaching techniques – pain-coping and biofeedback skills – into early biopsychosocial intervention.

The six-week intervention teaches patients about the mind-body relationship, the body’s reaction to stress and relaxation training in everyday settings. Instruction also is given on biofeedback (the use of monitoring equipment attached to the body to record changes in muscle tension, respiration and temperature) to teach a person to control those functions generally considered involuntary.

About 50 of the study participants received the intervention and a year later reported reduced levels of pain. They also displayed improved coping abilities and better moods and emotions, Dr. Stowell said. The other half of the participants, who did not undergo intervention, made many more trips to a doctor to seek pain treatment. They also reported more general anxiety and other disorders.

“The intervention really helps people become more capable of managing pain,” said Dr. Stowell, who works at the Eugene McDermott Center for Pain Management.

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New Clues for Sciatica Pain Relief

February 2, 2007

ISLAMABAD: For years, damaged discs in the lower back or spinal nerve problems have taken the blame as the most common cause of sciatica, a painful condition in which the sciatic nerve in the back of the leg is pinched and pain radiates down the leg.

But a new study suggests the cause of sciatica pain may actually be piriformis syndrome, a condition in which a muscle in the buttocks called the piriformis compresses or irritates the sciatic nerve.

The study appears in the February issue of the Journal of Neurosurgery: Spine.

The findings may help many patients finally get relief from their pain, said study author Dr. Aaron Filler, a neurosurgeon at Cedars-Sinai Institute of Spinal Disorders in Los Angeles. “Doctors often recommend spinal fusion surgery for spinal problems [associated with sciatica],” he said, “when the real problem is piriformis syndrome.”

In the study, Filler and his colleagues evaluated 239 patients whose symptoms of sciatica had not improved after diagnosis or treatment for a damaged disc. They performed the usual X-rays and MRI scans, and found seven of the patients had torn disc-related conditions that could be treated successfully with spine surgery.

The other 232 patients underwent MR neurography, a new technique that generates detailed images of nerves. The researchers report that 69 percent had piriformis syndrome, while the other 31 percent had some other nerve, joint or muscle condition.

To treat piriformis syndrome, Filler’s team injected a long-acting anesthetic into the spine, muscle or nerve areas. About 85 percent of the patients got some relief from the injections, which helps relax muscle spasm. However, relief was not long-lasting and 62 patients needed surgery to correct the syndrome. Of those, 82 percent had a good or excellent result during the six-year follow-up.

The findings may help legions of Americans suffering from sciatica, Filler said. “More than 1.5 million Americans have experienced sciatica severe enough to be sent for lumbar MRI scanning each year,” Filler said. “About 300,000 lumbar disc surgeries are done each year for sciatica. Of those, about one-third fail.”

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In some cases, those surgeries may fail because disc damage is not the underlying problem, Filler said. Instead, the real culprit could be other conditions, such as piriformis syndrome.

The nerve scan used in the study is relatively new, Filler said, being first used in humans in 1993. His group reported on the first groups of patients who underwent the technique in 1996. “Since 1996, we have imaged several thousand patients,” he said. The technique is available now at major universities and hospitals, Filler said, and is expected to become more widespread in the next year or so.

While the study provides new clues to sciatica, experts say its results need to be duplicated. When patients complain of sciatica, “we typically focus on spinal nerves,” explained Dr. Scott M. Fishman, president-elect of the American Academy of Pain Medicine.

“This study helps clarify that pain that radiates down the back of the leg is often of sciatic origin,” Fishman said, and doctors should consider the possibility that the pain may be due to entrapment of the sciatic nerve by the piriformis muscle.

“Piriformis syndrome is pooh-poohed [as a diagnosis] by orthopedic surgeons and neurosurgeons,” added Dr. Peter Slabaugh, a spokesman for the American Academy of Orthopaedic Surgeons. But the new findings, he said, “might have some merit,” although he said more studies with similar results are crucial before firm recommendations can be made.

Those with sciatica should also know that the pain typically comes and goes, Slabaugh said. Unless symptoms are very severe, waiting three months after the pain starts before undergoing serious treatments such as surgery is usually sound advice, he added.If the pain doesn’t subside after three months, patients would be wise to then consider imaging studies of the spine and nerves, he added.

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