Articles filed under 'CHRONIC PAIN'
According to the Center for Health Statistics, deaths from Methadone nationwide are increasing at a faster rate than other deaths related to drug use. The number of Methadone deaths nationwide rose from 786 in 1999 to 4,462, a nearly six-fold increase. As a comparison, fatal cocaine overdoes rose 63 percent.
Most cocaine users realize they are dealing with a drug with potentially lethal consequences. In contrast, Methadone is not widely perceived as being especially hazardous. Substance abusers are often given Methadone as a heroin substitute, but generally under tight controls. In addition, chronic pain clinics are increasingly prescribing Methadone for pain relief. Because methadone is slow-acting and patients seek immediate relief, they may take a pill or more than the prescribed dose. Methadone does not give a high and is sometimes dangerously combined with other drugs or alcohol.
Some chronic pain patients obtain multiple prescriptions for Methadone from different medical providers. These prescriptions are difficult to track. Other persons get their prescriptions illegally from friends or buy them from individuals. Those who take Methadone without appropriate medical supervision may be unaware of its potential risks. The drug oxycodone, or OxyContin, belongs to the same class of drugs as Methadone. In states such as Vermont, OxyContin is the leading cause of 80 drug-related deaths last year.
For someone with a low tolerance for certain drugs, even low doses of Methadone or OxyContin can be dangerous. While the Northeast is seeing Methadone as the street drug of choice, methamphetamines are the predominant street drugs in other parts of the U.S. Deaths from Methadone are beginning to drop in New England and the Eastern Seaboard where educational campaigns are emphasizing the potential hazards of its use.
Source: San Francisco Chronicle; April 18, 2008; Holly Ramer, A.P.
April 20th, 2008
If you’ve ever experienced chronic pain (lasting more than six months), you were probably depressed. Pain and depression can form a vicious cycle, with one fueling the other. When your quality of life takes a big nosedive, you generally get depressed. If a significant disability is also involved, your chances of depression are even greater.
Most physicians who treat patients with chronic pain also treat the depression that usually accompanies it. Your internist may wish to give you a prescription or refer you to a psychiatrist. Sometimes you may be referred to a licensed “behavioral medicine” specialist. So-called “cognitive therapy” classes may be especially useful in helping you find new ways of thinking and thus reduce your pain levels.
Talk therapy usually takes a back seat to prescription antidepressants these days. In fact, sometimes talking about your pain can actually make it worse because you focus on it more. Antidepressant medications are often a primary treatment for depression, especially when chronic pain syndromes or nerve-related disorders are involved.
The earlier your depression is treated, the better the outcome can be. Early diagnosis and appropriate medications can reduce distress and even prevent suicide, in many cases. Those receiving treatment for depression that takes place while experiencing chronic pain often have an improvement in their overall medical condition.
Antidepressants work by altering certain chemical levels in the brain. It may take a while to find a particular antidepressant with minimal side-effects that works well for you. Every person experiences pain and reacts to medications differently. Among the antidepressants which are commonly prescribed today are the following:
• Celexa
• Prozac
• Zoloft
• Elavil
• Norpramin
• Effexor
• Serzone
• Wellbutrin
• Cymbalta
• Paxil
• Remeron
If you are depressed about a serious, life-changing event or due to severe, unremitting pain and disability, you should consult a physician about treating your depression.
Source: WebMD
March 11th, 2007
Epidural steroid injections to treat chronic back pain and sciatica do little to give lasting relief, according to medical researchers in the field of neurology. Back pain is often accompanied with leg pain along the path of the sciatic nerve. Depending on which vertebral disks are involved, sciatica runs down the back or the side of the leg and can be excruciating.
Based on findings of four studies, a group of neurology professionals is advising against use of epidural injections for long-term back pain relief, improving back function, or avoiding surgery.
Patients who received epidural shots had mild improvement in pain for two to six weeks after their injections. Compared with patients who got epidural shots with no medications (placebo injections), the steroids failed to relieve back pain more than the placebo at 24 hours, three months or six months after the treatments.
The neurologists agreed that some pain relief is positive, but they concluded that the results fell short of expectations and are not “clinically meaningful.” Not only did the shots fail to give significant pain relief, they also did not improve the patients’ average back function or help to avoid back surgery.
Study results were recently published in a news release from the American Academy of Neurology. The report indicates that the team of neurologists did not have enough data to evaluate the use of epidural steroid shots for neck pain. Researchers call for more studies of these types of injections for neck and back pain.
Source: WebMD
March 8th, 2007
Researchers in Germany have used a technique called diffusion tensor imaging (DTI) in a study that examined brains of healthy volunteers and those with chronic back pain. They discovered that the brain in patients with chronic back pain had a more complex, active microstructure in regions associated with pain-processing, emotion and stress response.
The study findings were presented at the annual meeting of the Radiological Society of North America, held in Chicago recently. Researchers indicated that DTI demonstrates chronic pain is real and could help treatment research. Patients who suffer back pain sometimes have difficulty convincing their physicians, relatives, and insurance carriers of their genuine distress. Spinal MRI images do not always clearly demonstrate the source of pain.
According to the lead researcher, a radiologist in Munich, Germany, the objective and reproducible correlates in brain imaging should change the way chronic pain is perceived. It need no longer be a subjective experience. For pain diagnosis and treatment, the consequences could be huge. As a result, clinicians may direct therapeutic attention from the spine to the brain.
What is unclear is whether the brain in certain individuals is predisposed to developing chronic pain, whether ongoing pain causes hyperactivity and change in the brain’s organization or a combination of both.
Physicians who treat patients with chronic back pain have long known that chronic pain can begin with a serious injury. Even after healing has occurred, the brain continues to send pain signals for these individuals. The new imaging technology DTI will be able to validate their theory that the nervous system has been “rewired.”
This study adds to the growing body of research showing that chronic pain is associated with physical changes in the brain. Chronic is defined as lasting more than six months.
In some cases, back pain plagues individuals for many years after their initial injuries.
This study helps the medical community to understand how the central nervous system is involved in back pain. More research is needed to determine what the brain’s physical changes mean and how to most effectively treat the pain.
Source: BBC News
February 20th, 2007
Low back pain sufferers can look forward to a potential cure for their damaged disks and resulting pain. A research team at the University of Manchester, England, hopes that the new, patented treatment can be available within three years.
The therapy, developed by Dr. Stephen Richardson, would use injected adult stem cells taken from the patient’s own bone marrow. These mesenchymal stem cells (MSCs) have the ability to differentiate into many different cell types. The extracted stem cells are then embedded in a gel-like material where they are grown in a culture. The gel-like substance is similar to natural collagen already used to treat cartilage defects.
Dr. Richardson has been successful in turning MSCs into cells that make up the nucleus pulposus (NP) to provide cushioning between vertebrae. Because the stem cells are harvested from the patient’s own body, there is no chance of rejection by the immune system.
The British medical team reintroduces the cultured material into the damaged spinal disks through a tiny incision and using an arthroscope. The patient should be able to return home the same day after the procedure or the following day.
With treatments currently available to treat debilitating low back pain, success may be limited, and the cause of the pain is not completely addressed. This new procedure is expected to correct the root cause of the pain and give welcome relief from symptoms.
Pre-clinical trials will begin next year, after which full patient trials will take place. Although still in the early stages of development, the treatment appears very promising based on initial results.
Source: BBC News
December 2nd, 2006
The Center for Disease Control voted in October to make vaccination with the FDA-approved Zostavax shingles vaccine routine for all Americans 60 and older.
The older generation did not have the benefit of the chicken pox vaccine, now available to children and teens or older persons who never had the viral disease. Chicken pox was once a common disease of childhood.
Shingles will afflict about 20% of people who had chicken pox. For those who live to be 85, their chance of getting shingles rises to 50%.
A major clinical trial indicated that Merck’s Zostavax vaccine is more than 60% effective in minimizing shingles symptoms. It reduces painful PHN by 60% or more.
Shingles is caused by a herpes-type virus that remains dormant in the nerves until the individual’s immune system is suppressed due to aging, disease or immunity-suppressing drugs. An outbreak appears as clusters of red blisters above an underlying nerve path. It can vary considerably in size, severity, and length of time before it heals.
In about 30% of cases, shingles turns into an excruciatingly painful disease called postherpetic neuralgia (PHN). A smaller number get a painful disease called ophthalmic zoster which can cause blindness in one or both eyes. The worst part is not going blind, but the accompanying all-consuming pain experienced every moment without relief for years.
The patient’s and family’s lives are profoundly affected by this horrible affliction.
Severe cases of PHN pain can cause some to commit suicide to escape the unremitting pain.
Everyone 60 and over should welcome the opportunity to get the vaccination.
Medicare and Medicaid Part D are expected to cover the cost of the vaccination.
Source: WebMD
November 1st, 2006
Until recently it was thought that Alzheimer’s patients could not feel pain. Now it is understood that they feel pain as powerfully as others, maybe more so, but are unable to verbalize their feelings. This may be so especially for those in the later stages of the mind-robbing disease. Because they have lost communication skills, their pain may be under-treated by physicians and caregivers.
An Australian study using MRI real-time brain scans to check the brain’s major pain channels gave clear evidence that pain may still be intensely felt in the Alzheimer’s patient. The study compared Alzheimer’s patients who could still describe their pain to other study participants who were volunteers without the disease.
In this study appearing in an online edition of the journal Brain, study authors concluded that dealing with pain became problematic because diseased patients were unable to divert their attention from it, as healthy volunteers were able to do. If patients in the study who could still communicate found pain to be bewildering, it might be even more so for those with Alzheimer’s.
When words can no longer adequately express pain, doctors and other caregivers can look for facial expressions and body movements that show discomfort. Often, the Alzheimer’s patient’s caregiver has a greater capacity to understand these signals of pain than even their physicians. They look for signs of agitation, altered eye contact, grimacing, or other indications.
It is generally impossible to totally eliminate pain in Alzheimer’s patients or in other persons with chronic pain. The goal for those with Alzheimer’s Disease or other dementias should be to find greater levels of comfort and pain management.
Source: Web MD
October 1st, 2006
As leading music therapists have known for years, music was found to relieve chronic pain in adults taking part recently in a one-week study. Sixty adults in their late 40s or early 50s who lived in Ohio were recruited from pain clinics and a chiropractic office.
The majority of study participants reported feeling chronic pain in multiple areas, including lower back, legs, knee joints and feet. Half had never gotten a pain-related diagnosis, but osteoarthritis was the most common reason for symptoms of those who knew the source of their pain. All had pain for at least six months, and some suffered from pain for years.
Researchers split the adults into three groups, with one group selecting their own music or relaxing sounds of nature. The second group listened to instrumental music supplied by the researchers. In the third group (control group), patients did not listen to music. Both music groups were given tape players and headsets to use while relaxing for one hour during each day.
Results were startling when patients rated their pain, depression, disability and feelings of empowerment. Comparing each category before and after the study, average scores improved for both music groups, but not for the comparison group.
• Average pain ratings fell 20%
• Average scores on depression fell up to 25%
• Self-rated disability ratings dropped up to 18%
• Feelings of ability to change their lives rose by up to 8%
Researchers discovered that a variety of different musical selections and styles were effective for both groups listening to music. The conclusion reached was that music can help patients deal with chronic, nonmalignant pain. The rest that patients got while listening to music could have added to the beneficial result.
Source: WebMD
June 6th, 2006
A study of 1,583 patients with arthritis in the knees showed no positive effect from the two best-selling dietary supplements glucosamine and chondroitin. Three of the five patient groups involved in the study took glucosamine or chondroitin separately or a combination of both. Two other study groups took a placebo (fake) pill or Celebrex (celecoxib).
Only those taking Celebrex demonstrated statistically significant improvement in their symptoms. This recent study, published in the New England Journal of Medicine, was designed to answer perplexing questions about whether the supplements are effective.
Physicians have held out hope for their patients with arthritis that this most important and rigorous study ever conducted on the supplements would prove them to be beneficial. “It’s a null study,” said Dr. Devid Felson, a rheumatologist (arthritis specialist) at Boston University. “It doesn’t work any better than placebo.”
In 2004, Americans spent about $734 million on glucosamine and chondroitin, among the most widely used dietary supplements in the nation. More than 20 million in this country suffer from osteoarthritis, a degenerative joint disease and the most common form of arthritis.
Glucosamine and chondroitin are found naturally in joints. Many medical experts believed it might be found helpful for arthritis patients by assisting in the repair of cartilage. Their hopes were dashed in this large and comprehensive study. Previous studies were small, with no more than 100 patients, and they looked at only short-term effectiveness.
Source: New York Times, 2/23/06, Gina Kolata reporter; San Francisco Chronicle
March 21st, 2006