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Device gives Formula Atlantic driver hope after leg amputation, chronic pain brought him down

June 25, 2007

Then again, it’s a long way to the June Sprints from daily doses of morphine and thoughts of suicide.

Meet Michael Roman.

He’s a tattooed and bleached-blond 41-year-old who hops from place to place on his left leg - his only leg - when he’s not seated in his wheelchair or his race car.

He is at the same time proud and repentant, humbled and thankful, inspired and inspiring. He positively glows.

Roman races for himself, yes, but mostly for the people who reside where he has lived, trapped in the cracks of medical science, hopeless, helpless, addicted and bitter.

“I tell the kids all the time, if you dream big, big things happen,” Roman said. “It takes courage to dream but, also, if they come true there’s no better feeling.

“As long as you’re moving toward a goal, you’re successful.”

Roman’s goal is threefold.

For his family, he’d like to make up for 10 years of being a miserable husband, father, son and brother and to pay them back for their inspiration and support.

For himself, he’d like to climb from Formula Atlantic-class club racing to the Indy Pro Series to the Indy 500 by 2009. He has more hope - about racing and about life - than he has had in a dozen years.

And for others like him who have ridden the downward spiral from injury to chronic pain to depression, he’d like to use racing to raise awareness of possible solutions and of sources for help, and he’d like to offer hope.

“If I can get 34 people - two at 17 races - to be a little bit better off than they were when I got there,” Roman said, “deal done.”

The native of Buffalo Grove, Ill., blew out his knee playing basketball, and the resulting surgery left Roman with a staph infection.

Although familiar with the operating room from his job as a surgical assistant at a St. Louis hospital, he could not have imagined 40 visits as a patient. Doctors first amputated Roman’s diseased leg in July 1995, and then “revised” the amputation numerous times all the way to his hip.

Although Roman still felt pain, he was able to race go-karts, as he had as a kid, and to dabble in stock cars before a torn muscle in 2000 increased his dependence on painkillers.
Bottoming out

“It seemed like we had one failure after the other, and hope was a hard thing to come by,” Roman said. “When the doctor said, ‘Go home, medicate yourself and accept your life,’ that took the bottom out.

“I’m a million dollars in debt, I’ve had 40 operations over a decade and (second wife Suzy) has never known me to be healthy, to be consistent, non-medicated or sane.”

Suzy did her best to maintain her husband’s spirits and humor. She also held his morphine at night to keep Roman from doing “something stupid.”

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A couple hundred milligrams of the powerful drug dictated when Roman would wake up, and the pain would determine his mood.

“At first I told my mom, ‘I don’t ever want to see him again,’ ” said Roman’s 14-year-old son, Anthony, who spent Wednesdays and every other weekend at his father’s house.

“Sure, I called him ‘Dad’ but what did he do? He sat and yelled at me because of all of his medication. At the time I knew something was going on.”

On Roman’s umpteenth trip to seek a bump in his medication, his family doctor sent him to a pain management specialist, who suggested an implanted spinal-cord stimulation device.

Even with his medical background, Roman was frightened. He had averaged an operation every three months, and none of them had freed Roman and his family from their hell.

Finally Roman consented and went weeping into surgery in December of 2005. Two weeks later, Roman could cut back his medication, and now he is pain- and morphine-free.

“People get mad when I say ‘miracle,’ but if you’d seen this family 16 months ago, that’s what we were praying for,” Roman said.

“We’d kind of promised each other that if we ever found a solution for this that we’d do whatever we could as patients and a family to get the word out.”

With help from the device’s maker, Advanced Bionics, Roman started a Web site, www.raceagainstpain.com, as an online community for people who suffer from chronic pain and for their families.

It’s not about selling stimulators, Roman said, but about selling hope. Users can share stories, tell each other what relief efforts have or haven’t worked, commiserate and prop one another up. To bring awareness to the site, Roman’s car carries its address.

He speaks to groups of doctors and patients, alike. Upcoming is a trip to Walter Reed Hospital to address injured Iraq war veterans.

“Every doctor has a case that they’re not sure what to do with,” Roman said. “I’ve been begging them to take that one case, that train wreck like I was, and give him some hope.”

Posted by toshko under Pain Relief News | Comments (0)

Why the cold hurts - research has implications for pain relief

June 21, 2007

Freeing knotted shoelaces with fingers that are frozen stiff is extremely difficult and can even be painful.

The reason that sensitivity and dexterity are poor is that both nerves and muscles perform their tasks reluctantly when they are cold. Nevertheless ice-cold fingers ache and do so all the more in response to the lightest of knocks or squeezing. As unpleasant as this is, it serves as protection against frost lesion. The question of how pain can still be registered despite the otherwise hampered function during cooling has recently been explained by researchers at the Institute of Physiology and Pathophysiology at the University of Erlangen-Nuremberg. Together with scientists from the Anaesthesiology Department at the same University and a group from the University College London, they have demonstrated that the endings of nerves normally involved in signaling pain are equipped with a frost tolerant igniter of nerve impulses. The work has appeared on the 14th of June as a “letter” in the science journal ‘Nature’.

In order to function properly nerve fibres and their endings must generate a small, but explosively rapid, electrical sodium current known as a nerve impulse (action potential). The sluices for this, the sodium channels, open and close more slowly when cooled and also become more likely to be literally ‘frozen’ in a state known as ’slow inactivation’. Pain signaling nerves however possess a rather special sodium channel subtype, the NaV1.8, which also becomes more sluggish with cooling but can resist the entry into slow inactivation and thus the channel is in a position to still generate action potentials at 10?C skin temperature.

The NaV1.8 sodium channel is also renowned for being resistant to blockade by a toxin found in the tasty, albeit for Sushi too expensive, Pacific Fugu fish. The bacterially derived substance from the fish?s entrails known as Tetrodotoxin (TTX) blocks most other sodium channels and in doing so can be fatal to the gourmet even at very low doses. A second feature of NaV1.8 is that it is found exclusively in the nerve endings and cell bodies of pain signaling nerves, called ‘nociceptors’. Nociceptors normally use the TTX-sensitive sodium channels to signal pain. To rescue their function from cold block NaV1.8 channels are recruited so that pain from the extremities can still be registered. Normally, the excitability of these nerve fibres is rather independent of NaV1.8 because its threshold for activation is too high. During cooling however the electrical resistance of the neuronal cell membrane increases. This means that the isolation between the inside and the outside of the cell is better and as such less of the small sodium flow in the nerve ending is lost to a short circuit. In this way, the high threshold of NaV1.8 is reached and its rescue function can be realized.

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The restriction of NaV1.8 to nociceptors that register pain has made this sodium channel an attractive target for the pharmaceutical industry. The hope being that blockade of this channel could selectively block pain without side-effects. This made the disappointment all the more poignant when eight years ago Prof. John Wood?s group (UCL) succeeded in removing the NaV1.8 from the genetic code of mice only to discover that this deficit resulted in hardly any change in sensitivity to various forms of painful stimulation. It was only the response to painful cold that was not tested in these animals and this omission has now been filled in the current work. The experiments this time showed that in the wild such animals would be in danger, since they feel cold but are unable to register cold-induced pain.

Very recently, the American companies Abbott and Icagen reported a possible future medication directed against pain (Jarvis et al., 2007, PNAS) that preferentially blocks NaV1.8. This substance works particularly well in animal experiments against ‘cold allodynia’, a form of over-sensitivity to cold that can occur after damage to peripheral nerves. The research from the Erlangen group explains this action.

This research advance was made possible by the collaborative work of the research group of Professor Peter Reeh at the Institute of Physiology and Pathophysiology together with the anaesthesiologists Dr. Andreas Leffler and Professor Carla Nau, that began as part of the Special Research Program (DFG-SFB 353) “Pathobiology of the origin and processing of pain”. The research in the Anaesthesiology Department at the Erlangen University Clinic is now supported by the German Research Society (Focusgroup KFO130). For the Nature publication, the involvement of the team of Professor John Wood was crucial.

Posted by toshko under Pain Relief News | Comments (0)

Nobility Homes Q2 Profit Declines On Lower Revenues - Update [NOBH]

June 13, 2007

6/7/2007 9:36:06 AM Thursday, Nobility Homes Inc. (NOBH), a builder of homes, revealed its second quarter financial results reporting earnings that declined from last year on lower revenues.

The Ocala, Florida-based company reported second quarter net income, after taxes, of $1.07 million or $0.26 per share, compared to $1.92 million or $0.46 per share in the earlier year quarter.

Quarterly operating income was $1.14 million, in comparison with $2.51 million in the same quarter last year. Sales for the quarter were $10.3 million, down from $16.69 million in the previous year quarter.

Terry Trexler, President stated, “Second quarter sales and operations for fiscal 2007 were adversely impacted by the reduced manufactured housing shipments in Florida plus the overall decline in Florida and the nation’s housing market.”

The company noted that its second quarter financial position remains very strong with cash and cash equivalents, short and long-term investments of $23.0 million and no outstanding debt.

For six-month period, the company reported net income, after taxes, of $1.8 million or $0.44 per share, in comparison with $3.4 million or $0.82 per share in the corresponding period last year.

The company reported operating income for six-month period of $1.79 million, down from $4.47 million in the earlier year quarter. Sales for the period decreased to $19.13 million from $30.34 million in the year ago period.

In October, the Special Committee of the Board had retained Savvian Advisors, an investment banking firm, to assist in the exploration of strategic alternatives. Following receipt of a report from Savvian Advisors, the Special Committee has determined that Nobility Homes should remain an independent, public company for the immediate future.

The company did not purchase any shares of its common stock during the first six months of fiscal 2007 due to the exploration of strategic alternatives. Nobility plans to reactivate its stock repurchase program during the third quarter of fiscal 2007.

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NOBH closed Wednesday’s trading session at $20.90 million.

Merck Migraine Drug Under Development Gives Pain Relief - Update [MRK]

6/7/2007 9:29:05 AM Merck & Co. Inc. (MRK), a global research-driven pharmaceutical company, on Thursday said that its drug MK-0974, which is under development, in the Phase II trial gave pain relief to migraine suffers after two hours of medication and the pain relief continued for 24 hours.

MK-0974 is now in Phase III clinical development for the treatment of migraine in adults.

“Larger clinical trials, such as those now underway, will provide more insight into the efficacy and safety profile of MK-0974,” said Tony Ho, senior director of Clinical Neuroscience, Merck Research Laboratories.

The company stated that the treatment with MK-0974 was generally well tolerated with no reports of serious adverse events. The most common adverse experiences occurring in patients treated with MK-0974 were nausea, dizziness and somnolence.

The Whitehouse Station, New Jersey-based Merck stated that it still expects to file New Drug Application for MK-0974 with the U.S. Food and Drug Administration in 2009.

If the drug is approved, the company said, it may be the first in a new class of migraine treatment since the approval of the first triptan drug in 1991.

MRK lost $0.28 or 0.55% in the pre-market trading at $50.48 on a volume of 100 shares.

Posted by toshko under Pain Relief News | Comments (0)

Back Pain Relief Without Surgery

June 6, 2007

Is back pain slowing you down?

A non-surgical option could help you find relief.

90% of adults will have back pain at least once in their life and the last thing many people want to have is surgery.

Now there is an option that has many people finding relief without going under the knife.

Last year, Rick Terrana hurt his back and could not walk or sit in a chair without being in pain.

Rick’s back is better now, in fact, he recently ran his first half marathon.

This is the DRX 9,000.

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It is a machine that literally pulls the spine apart, relieving pressure on the disc.

The technology is so precise; doctors can pinpoint the exact problem area.

Luis Crespo, M.D., pain management specialist, said, “By changing the level and the angle of the pull, we can target the specific disc that’s affected instead of just pulling the entire spine.”

This treatment is for patients with any disc related problem.

Studies show nine out of ten patients significantly reduce their back pain after 20 treatments and there are no side effects.

The cost of treatment is about $35-hundred and not all insurance companies will cover the cost

Posted by toshko under Pain Relief News | Comments (0)

Chronic Pain or Drug Addiction?

June 5, 2007

It was Sunday morning on my weekend off and I was stalked by a narcotic seeker. She conned the hospital operator twice into paging me to get around my partner who was on-call. Then she made eight phone calls to my home throughout the day. Thanks to caller ID, I was able to avoid them.

Multiple calls to my house outside of office hours for pain meds is a red flag for a patient with a drug problem. So is using extraordinary measures to work around my on-call partner. I’ve seen both of these warning signs before.

Doctors are often accused of not adequately treating pain and being insensitive to patients’ needs. But they also have found themselves prosecuted or disciplined by licensing boards for prescribing too much pain medication. Trying to find a balance can be tricky.

The quandary has intensified in recent years, with an increase in abuse of narcotic painkillers. Because of the potential for patient addiction and the resulting liability risk, some physicians would like to avoid treating patients with pain medications all together.
DOCTOR’S OFFICE FORUM

[Forum]
When should doctors draw the line on prescription painkillers? Share your thoughts with Dr. Brewer in an online forum. Readers are urged to post here, rather than send email, as Dr. Brewer may not be able to respond to all mail.

I don’t want to go that far. There certainly are patients that have lifelong pain and have permanent pain medication needs. I write prescriptions for strong medications — narcotic medications that could become addictive — without worrying too much about it.

I have a lady with clogged arteries in her legs who is on 60 mg of Oxycontin daily and has been for years. Such patients may require a lot of medication to get relief, but their needs and their medication dosages seem to be stable. They often require gradual dosage increases, but most don’t really “want” the increase due to side effects.

On the other hand the addict patients want higher doses more often and they quickly go through anything I might give them. When I prescribe long-term narcotics for a patient I think to myself, “could I defend this to doctors on the licensing board? Are this patient’s needs potentially worth the scrutiny I might get?” I admit that the headlines of doctors being prosecuted for prescribing pain medications have made me gun shy.

Some patients are outright fakers looking for a fix. I found out that the nice married guy with three kids I’d been treating with the common anti-anxiety medication Xanax was dealing cocaine out of his house. The cocaine was evidently causing his anxiety. He fooled me initially, but not for long, as the small-town family doctor has a broad network of sources.

Sometimes what patients really need is a drug-treatment program rather than a steady supplier for their Vicodin scripts. They doctor shop, and often come from a distance when every doctor in their own community and their local E.R. has wised up to their activities.

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We’re supposed to sort out the good (true chronic pain) from the bad (drug addiction without an underlying health malady), but often it’s not easy. The toughest are the patients with an appropriate diagnosis for chronic pain medication but who also have addictive tendencies.

Patients with prescription-drug addiction seek narcotics by feigning or magnifying common ailments like chronic daily headaches, a bad back or chronic abdominal pain. They complain of pain from disorders that often can’t be objectively verified, and they often ask for their drug of choice by name. They claim to be allergic to essentially any pain medication that can’t give them a mind-altering buzz. Drug seekers tend to tell lies about their past evaluations and activities.

Having the old records is the key to the real story. A review of one patient’s records showed she had requested a refill of her medication after “her cat knocked it over in the sink.” She had told the same story to three different doctors over the span of five years.

Such patients take medication more frequently than they should, then call with a really good story and emotional plea for an early refill. Running a little short one time is believable, but for drug addicts this is a chronic problem that escalates.

Patients who call the office after a few days claiming intolerance to a drug I just prescribed are often looking to get an extra script of a similar drug. It worked the first time, but now I’m wise to the ploy.

Clinics have sprung up to help patients with chronic pain, and sometimes they do help. But I’ve also seen from several clinics a preference for doing profitable procedures on people followed by physical therapy until the insurance benefit runs out. Then the patients are dumped right back in my lap with the same issues and medication challenges they started with.

Taking care of patients with tough pain problems and sometimes hidden agendas is negotiating a liability mine field. Two patients that I turned down for pain medications later overdosed on another doctor’s prescription. One of them complained bitterly to her HMO that I wouldn’t meet her demands for the type of pain medications she eventually overdosed on.

My weekend caller will be getting some help with her drug problems or she will be getting another doctor.

Posted by toshko under Pain Relief News | Comments (0)