According to a new Swiss study, the longer the period of intense pain in the day following surgery, the greater the likelihood the patient will suffer from chronic pain one year later. This was an observational study meant to evaluate the risks of chronic, post-surgical pain after elected surgery in Europe. 889 patients within 21 hospitals in 11 different countries took part.
Researchers used two metrics to evaluate the post-surgical pain of patients the day after the operation, and during two follow-ups, one six months after the procedure, and one a year later. The chances of moderate chronic pain after surgery were found to be 16%. The risk of severe pain was 2.9% at the six month marker, and 2.2% one year later. Those who did experience moderate pain had a 39.2% chance of it being neuropathic pain or that from nerve damage. Those who had severe pain had a 57.1% chance of it being neuropathic.
Other factors that lead to post-surgical, chronic pain included orthopedic surgery, and pre-operative chronic pain. If the patient felt an increase of 10% in chronic pain the following day after surgery, they had a 30% chance of experiencing chronic pain at the one year mark. Originally, chronic pain post-surgery was not considered a risk factor, according to Ulrike Stamer, MD. He was a co-author on this study. Dr. Stamer is a professor in the Department of Anesthesiology and Pain Therapy at the University of Bern Hospital.
Experts say post-surgical pain is a significant complication. It can seriously impair a patient’s quality of life. But many surgeons and others do not consider it, as other imperatives take precedence at the time just after surgery. If you are experiencing chronic pain after surgery or otherwise, speak to a doctor or specialist, or visit a pain management clinic in your area, and get the help that you need.
An arachnoid is a membrane that covers and helps protect the nerves of the spinal cord. When these membranes becomes inflamed it can lead to pain, burning, tingling, and even neurological problems. Long-term sufferers experience bowel dysfunction, autoimmune disorders, and even lower-extremity paralysis. Until now, there have been no common symptoms used to diagnose this condition. Clinicians did know that it usually affects the nerves of the legs and back. But now a new report finds that many of those suffering from arachnoiditis are often misdiagnosed with mere chronic back pain.
Those who have leg tremors or experience intense pain after standing for too long are now thought to have this condition. Forest Tennant, MD was the lead author in this study. He is a pain specialist from the Veract Intractable Pain Clinic in West Covina, Calif. Dr. Tennant said that those patients who come in complaining of severe back pain, and have an inability to stand for long periods without having to sit or lie on the floor, could have arachnoiditis.
Tennant conducted this study to help better understand and identify the symptoms of this worrisome condition. He recruited 26 patients who were diagnosed with the spinal cord disease via an MRI. Next, he examined what specific symptoms they reported. Patients all talked about tremors in the legs, and having to sit or lie down after standing for too long. Most patients also had difficulty defecating and urinating, felt increased episodes of intense heat and sweating, and occasionally experienced blurred vision. Never before has consistent symptoms for arachnoiditis been isolated like this.
There are many causes to the condition including compressed nerves in the spine, back injury, infection, exposure to certain chemicals, and more. Researchers say though uncommon, the condition very often goes undiagnosed. Spinal manipulations, epidurals, and spinal taps have increased over the last decade, and Dr. Tennant wonders if these are contributing to the increase in arachnoiditis cases. If you suffer from chronic back pain be sure to visit a doctor or specialist. You never know what may be causing it, how serious it is, and to what extent you are in need of medical intervention.
Medical science does not have a full picture of neuropathy. They know it is nerve pain. This is shooting pains, tingling, itching, and burning often in the hands, feet, arms, legs, back, and shoulders. Neuropathy can be phantom limb syndrome, or damaged or dysfunctional nerves that give off pain. Neuropathic pain is caused by a variety of conditions such as: diabetes, HIV, chemotherapy, alcoholism, spinal surgery, M.S., and shingles. In some cases, physicians do not know what is causing it.
For mild cases non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Bayer) or acetaminophen (Tylenol) are effective. Antidepressants or anticonvulsants work with some patients with more intense pain. But in moderate to severe cases, opioid painkillers may be required. Researchers are now searching for better and more effective methods to treat this kind of pain. And they may have found it, in hyaluronic acid (HA).
This is a naturally occurring sugar that resides in different areas of the body, the middle layer of the skin for example, and as lubrication for joints. It has also been made popular for cosmetic enhancement in injectable, wrinkle-reducing products such as Juvederm. But a recent study conducted by neurologist John A. Campa III, MD is showing promise. Dr. Campa hails from the Neuropathic Pain Center for Clinical Research and Treatment in Albuquerque, New Mexico. This was an off-label use of the substance, as the FDA has only approved HA to address moderate to severe skin folds and wrinkles. 15 neuropathy patients participated. Each was injected with RA at the points causing pain or related to it.
Patients had been suffering this type of pain for 66 months on average. After the injections, they felt significant relief, at an average of 1.5 out of 10 on the Visual Analog Scale of Pain (VAS). Most patients began to feel relief within 24 hours. It lasted on average for 7.7 months. No side effects were reported. An additional study must be performed to verify these results. But they are very promising. Those who believe they are experiencing neuropathic pain should talk to their doctor or a pain specialist so that they can find relief, and learn how to manage their condition properly.
Dr. David Nagel is a pain management, physical medicine, and rehabilitation specialist out of Concord, New Hampshire. He has 28 years’ experience and is putting it to good use. Dr. Nagel has authored a book that is more than a monograph. It is a call to action. The book is entitled, Needless Suffering: How We Fail To Manage Chronic Pain. It is set to be released sometime in 2016.
Dr. Nagel is calling for a complete overhaul in how we treat chronic pain. In an interview with National Pain Report, he called the current state of pain management “dismal.” But things are changing. Pain experts recently came together, Dr. Nagel included to voice concern over how these patients are sometimes treated, and to call for new ways to interact with them and help them find relief. The most important thing is a doctor or specialist who takes a patient’s pain seriously. Though many physicians out there today are professional, others wave away patient’s pain as psychological, or that they are making it worse than it actually is.
Another suggestion by the doctor, more time has to be allotted for such patients. For those suffering chronic pain, a ten minute office visit is insufficient to grasp fully the scope of the problem. Dr. Nagel also addresses the stigma that comes with chronic pain. He says that we need to “de-stigmatize the stigmatized.” Another important proposed change, more training for doctors so that they can deal sufficiently with pain-related conditions. In four years, doctors generally get less than seven hours of training in dealing with chronic pain. He also wants to remind doctors and patients that the goal is not a cure, but managing the condition as best as possible.
A paradigm shift is occurring in how we view chronic pain in our society. If you are living with pain, see a doctor, or better yet a specialist to address your condition. Do not wait. It usually gets worse over time, and harder to treat. But be sure to find a physician that has the right outlook, and gives you the time and care you need to address your condition properly.
Digestive problems seem to be more common nowadays, or at least identifying them is. The problem is Crohn’s disease, irritable bowel syndrome, and inflammatory bowel disease all have similar symptoms. The overuse of laxatives, or having trouble digesting sorbitol or fructose are other considerations. Symptoms include bloating, abdominal pains, gas, and diarrhea. Lactose is a protein found in milk and other dairy products such as butter, cheese, ice cream, and yogurt.
When the body stops producing the enzyme to break it down, or does not produce enough to break down the protein in sufficient quantities, indigestion can occur. Many people try to hunt down what exactly it is that they ate, and attempt to identify whether it may be dairy that is effecting them, or something else. Though this is helpful, relevant information that should be brought to a clinician’s attention, only your doctor can tell what it is for sure.
Many patients are ambivalent when they are first diagnosed. At once they are relieved that the source of their pain and discomfort has been isolated. On the other hand, they are upset because they have to follow strict dietary guidelines, and inquire when approaching a buffet, party, or some other place where a spread is laid out. Inquiries need to be made as to what has dairy in it, and what does not. There are pills one can purchase to eliminate lactose from what one has ingested. They are sold over the counter in most pharmacies.
One must be sure to follow the directions carefully however, and take enough, or else they may not be sufficient to avoid symptoms. It can be hard to determine for instance how many glasses of milk are in an ice cream Sunday, or two slices of pizza. Take too little of the pills and suffer the consequences. One glass of milk no matter the variety contains about 10 g of lactose. This is about how much most people with this condition can digest on their own. Other dairy products have varying amounts. Some with lactose intolerance can eat yogurt as the active cultures aid the digestive process. But not all can. There are ice cream and milk products on the market that do not contain lactose, and alternative varieties containing no dairy too. But the first step is confirming with a doctor whether or not you have this condition, or something else.
Baby boomers are known to be a particularly youthful and active generation. They subscribe to a forever young mentality, and do not want pain and other conditions slowing them down. This may be one of the reasons why more and younger Americans are having knee replacement surgery today. That is according to a study conducted by the CDC’s National Center for Health Statistics (NCHS).
It was published in NCHS Data Brief. Researchers took their data from National Hospital Discharge Survey, and examined knee replacement occurring between 2000 and 2010. Over 5.2 million procedures were performed during this time period. Investigators were shocked that by 2010, knee replacement became the leading inpatient operation undergone by patients 45 and older. The procedure has almost doubled in the decade covered by the study, for both men and women. People are no longer putting off the procedure. And the average age a person gets this surgery has dropped also. In 2000 the average age was 69. By 2010 it was 66.
Those who have pain in their knees should see a doctor right away. A full examination will take place, and the healthy knee will be compared to the painful one. The blood vessels and nerves in the area are also to be evaluated for damage. The knee will first be inspected. At this time, the physical will examine it for swelling, tenderness, warmth or coolness, and more. Next, your physician will test its range of motion and listen for any clicking, grinding, or popping sounds.
The ligaments which hold the knee together will be tested as well. Generally, this will include a series of movements to check for pain and your range of motion. Each movement or exercise tests a different aspect of your knee. An orthometric test may be required. This is where two sensors are hooked up to the knee. A special handle allows the doctor to apply pressure to see how the knee reacts. A full physical exam will be given whether the problem has lasted a short while or is a chronic complaint. A mild anesthetic may be administered for those who find the exam much too painful. Talk to your doctor if you are experiencing knee pain. The sooner it is located and treated, the better your options and outcomes will be.
A large swath of Americans experience chronic pain. It is a $650 billion industry. We are an instant relief society, and believe that popping a pill is the best way to do it. Unfortunately, opioid painkillers while affective for acute or temporary pain, may not be the best for chronic or long-term pain. What’s more, opioids come with the risk of overdose or addiction, if taken in ways other than as instructed. Surgery is another option if nothing else works. But for many, surgery is a last resort.
Luckily today, there are new and exciting pain management treatment options available that do not include opioids. One such method is laser therapy. Once relegated to the realm of cosmetic procedures and dental surgery, lasers are now being used to help patients with soft tissue injuries, orthopedic problems, and even autoimmune diseases, find relief. Known as actinotherapy, this technique is non-invasive, reduces inflammation, and helps promote healing on the cellular level. It lasts about 30 minutes, and many feel the difference after their first session.
Another technique is physiatry. A physiatrist treats pain associated with movement, usually to do with the bones, muscles, and nerves. The goals here are to increase functionality while decreasing pain. These include trigger point non-steroidal injections, range of motion exercises, and more. This is the realms of physical and occupational therapy. Those with degenerative osteoarthritis may in particular find relief from this kind of medicine. Another interesting technique is interventional pain medicine. Here digital imaging is used to pinpoint the exact place the pain is emanating from. Then a small injection is given at the exact location or to nearby pathways.
The last is stem cell therapy. Scientists have hardly scratched the surface for what stems cells can do. In terms of pain management, they can initiate healing in areas that radiate pain. For instance, those suffering from debilitating back pain may feel much better and regain some functionality after an injection of stem cells. These techniques may not help every patient. But alternative methods are a good choice previous to surgery. Contact your doctor or a pain management specialist if you believe one of these is right for you.
There are few options that medical science has for treating chronic pain. And lots of the therapies out there do not necessarily work for a large number of patients. Opioid painkillers are effective. On the other hand they come with all kinds of concerns. There is the worry of accidental overdose, or of addiction. For many over time, they build up a tolerance, which means they need more and more just to find relief. Non-opioid related treatments are sorely sought after, to give treatment-resistant sufferers the relief they need, without adding to the opioid addiction epidemic.
Surgically implanted spinal cord stimulators (SCS) are another option. These intercept the pain sensation by disrupting the signals sent from the site of pain to the brain via the spine. But this has side effects, and the procedure to implant it is invasive. Giuseppe Marineo is aware of this problem and thinks he has found an answer. He is a bio-engineer and professor at Tor Vergata University in Rome. Marineo is also the inventor of the recently FDA approved Calmare Pain Therapy Treatment, also known as scrambler therapy.
This is a free standing device. It does not require any drugs, is not invasive, and has no side effects. The sensation of chronic pain develops over time. It is like learning a skill. The more a person works at it the better he or she gets. But unfortunately with pain, the longer the body feels it, the deeper it becomes and carries more impact. When an injury occurs, the brain ramps up its response. But once the area is healed, the brain switches off the pain sensation and other operations associated with healing. Sometimes however the pain switch gets stuck in the on mode.
Using small electrodes such as those associated with an EKG, the scrambler device overrides the pain message, telling the brain instead that in fact, there is no pain. Patients undergo 10-20 daily treatments which last 30-60 minutes each. Patients will all kinds of pain-related conditions have shown remarkable results. Their pain drops significantly over time. Talk to your doctor or a specialist if you suffer from chronic pain. And see if scrambler therapy may be right for you. (http://nationalpainreport.com/scrambler-therapy-%E2%88%92-a-new-way-to-treat-chronic-pain-without-drugs-or-invasive-devices-8827467.html).
A new study found that over a third of patients with chronic pain also have attention deficit disorder (ADD). A researcher and physician at the Intractable Pain Management clinic in West Covina, California conducted study, Forest Tennant, MD. Dr. Tennant said these findings may have doctors start to evaluate whether or not their non-adherent patients suffer from ADD, in addition to their pain-related condition. He presented these findings during PAINWeek 2015, a convention of pain management professionals.
Tennant said of the study, “I think this is a nice new little advance in how to take care of people with pain.” This is just the latest in a trend, evaluating the whole patient and what other disorders may be influencing their pain-related condition. 45 participants were recruited from a pain treatment clinic. Each filled out a 16 question survey asking them about their attention, concentration, temper, impulsivity, distractibility, short-term memory, and reading retention. If patients answered five or more questions affirmatively it meant that they had ADD. The pain specialist found that 37.8% of respondents tested positive for the disorder.
Dr. Tennant said that those suffering from chronic pain often have a deficiency in catecholamine, a substance that helps relieve pain in the body. This deficiency causes hyper-arousal in the autonomic nervous system. That in turn causes changes in the sympathetic nervous system. This pain depletes the body of dopamine. It also puts the brain into a hyperactive state, causing ADD. Dr. Tennant believes this is why some pain patients have difficulty completing daily activities. The researcher said he had noticed for years that pain patients would exhibit the same symptoms associated with ADD. They would quit reading, and taking part in certain daily activities. Yet, they would not tell their physician. This lack of attention crosses over into treatment, however.
These patients are given careful instructions but fail to adhere to them. Tennant said that once they start taking ADD medication their condition improves, and they are better able to adhere to their pain associated regimen. If you suffer from chronic pain, be sure to address the issue with a doctor or pain management specialist. Those who believe their pain is affecting their ability to concentrate should talk it over with a specialist.
The CDC has just released new guidelines referring to the treatment of acute and chronic pain, and opioid painkillers are playing far less of a role than in years past. What’s more, jurisdictional wrangling has arisen between the CDC and FDA as to who has the power to set regulations regarding prescription medication. A recent webinar hosted by the CDC covered these new guidelines, including foremost a push toward “non-pharmacological therapy” over opioid painkillers.
This is to stem addiction and overdose. Drug testing patients before prescribing opioids and during use is also being considered. Anti-depressants would not be prescribed simultaneously, as many pain patients also suffer from depression, which causes the sensation to become worse. For acute pain, prescriptions would only last for up to three days. The agency plans to finalize its guidelines by November. Those would be submitted to the Department of Health and Human Services, to be put into place by January of next year. Though these changes are meant to help curb the prescription drug addiction epidemic and avoid overdoses, many patients are worried they will also severely curtail their access to one of the few treatments that successfully treats their pain. There are many questions left up in the air. But the agency is not releasing the webinar nor the guidelines to the public.
Here are some of the changes. Opioids should only be prescribed after non-pharmacological options are considered insufficient, and if the benefits outweigh the risks. Physicians should outline specific treatment goals to patients before starting opioid therapy, such as less pain and better mobility. The risks and benefits should be discussed at length with the patient. Short acting varieties should be prescribed over long-acting varieties. The lowest possible effective dose should be prescribed at the outset.
A patient’s substance abuse record should be reviewed, and the patient carefully monitored and reevaluated periodically, including submitting to drug tests. For pain patients already receiving treatment, be aware of these proposed changes. Those who are not, and who suffer from chronic pain should seek out a physician or specialist. There are many different kinds of treatments available today to give you relief and let you reclaim your life. Let an expert help find the right option for you, pharmacological or otherwise.