Pain during and after severe body damage

Pain is NOT “just a feeling” – it’s our body’s initial indication that something is seriously wrong.

Then, if left untreated too long, ongoing pain itself “sickens” the whole nervous system and leads to central sensitization.

Study Finds Correlation Between Pre-treatment Pain and Prognosis for Survival

Writing in The Journal of Pain, researchers at M.D. Anderson Cancer Center report that pre-treatment pain intensity is an independent survival predictor for patients with head and neck cancer.
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Pain Reducing Effect of Opioids is Reliable

Is the Pain Reducing Effect of Opioid Medication Reliable? A Psychophysical Study of Morphine and Pentazocine Analgesia – Pain. 2013 Mar – Free full-text PMC article

A number of laboratory studies have confirmed the efficacy of opioid medication in reducing pain generated by a number of psychophysical modalities

However, one implicit assumption of clinical and experimental pain testing of analgesics is that the analgesic response is stable and will be comparable across repeated administrations

In the current study, the repeatability of opioid analgesia was assessed in a randomized, double-blinded study,   Continue reading

Brain imaging of pain: state of the art

Brain imaging of pain: state of the art – J Pain Res. 2016 Sep – free full-text PMC article

Advances made in neuroimaging have bridged the gap between brain activity and the subjective experience of pain and allowed us to better understand the changes in the brain that are associated with both acute and chronic pain.

Additionally, cognitive influences on pain such as attention, anticipation, and fear can now be directly observed, allowing for the interpretation of the neural basis of the psychological modulation of pain.

The use of functional brain imaging to measure changes in endogenous neurochemistry has increased our understanding of how states of increased resilience and vulnerability to pain are maintained.   Continue reading

Gabapentin (Neurontin) vs Pregabalin (Lyrica)

How Gabapentin Differs From Pregabalin By Jeffrey Fudin – Sept 2015

More than 85% of patients with neuropathic pain caused by peripheral neuropathy will require pharmacotherapy.

Pregabalin (Lyrica) and gabapentin (Neurontin) are often considered first-line treatments for various neuropathic pain syndromes, generally irrespective of cause.

Because the products are so variable, this article compares the pharmacokinetics (PK) and pharmacodynamics (PD) of pregabalin with various gabapentin formulations, and also covers conversion regimens.   Continue reading

A Better Opioid/Pain Contract

Breaking the pain contract: A better controlled-substance agreement for patients on chronic opioid therapy | Cleveland Clinic Journal of Medicine. 2016 November

ABSTRACT: “Pain contracts” for patients receiving long-term opioid therapy, though well-intentioned, often stigmatize the patient and erode trust between patient and physician. This article discusses how to improve these agreements to promote adherence, safety, trust, and shared decision-making.

Regulatory bodies and professional societies have encouraged or mandated written pain treatment agreements for over a decade as a way to establish informed consent, improve adherence, and mitigate risk.

Unfortunately, the content of these agreements varies, their efficacy is uncertain, and some are stigmatizing or coercive and jeopardize trust.

See The Tyranny of Pain Management Contracts   Continue reading

Inhibition of Nociceptors: Interpret Results With Caution

DREADD Inhibition of Nociceptors: Interpret Results With Caution Nov 2016

Chemogenetic technique to produce analgesia in mice also disrupts endogenous signaling

The designer receptors exclusively activated by designer drugs (DREADD) system can be used to suppress nociceptors

But thanks to a set of careful control experiments, researchers led by Brian Davis and Michael Gold, University of Pittsburgh, US, also find an important caveat: DREADD expression alters endogenous channel activity and signaling pathways in sensory neurons independent of the ligand used to activate the receptor.   Continue reading

Medicare May Adopt Flawed CDC Guidelines

Medicare Takes Big Brother Approach to Opioid Abuse — Pain News Network

Just the thought of this makes my stomach lurch.

Politicians, bureaucrats, and financial interests are determined to control how much pain we must suffer by restricting access to the most effective relief.

Various industries which stand to gain from opioid restrictions (addiction-rehab, pharmaceutical, medical device, drug-testing) are colluding with political powers to pass legislation restricting opioid dosages to arbitrary limits.

Investigations of abuse or inappropriate prescribing would be shared with insurers enrolled in the giant Medicare/Medicaid system, even if the allegations are never proven.  Continue reading

The Benefits of Controlled Breathing

Breathe. Exhale. Repeat: The Benefits of Controlled Breathing – The New York Times

Take a deep breath, expanding your belly. Pause. Exhale slowly to the count of five. Repeat four times.

Congratulations. You’ve just calmed your nervous system.

Controlled breathing, like what you just practiced, has been shown to reduce stress, increase alertness and boost your immune system. For centuries yogis have used breath control, or pranayama, to promote concentration and improve vitality

Science is just beginning to provide evidence that the benefits of this ancient practice are real.   Continue reading

Ignoring pain levels in studies on opioids

Here is an article promoted by “Pain Week”, spreading biased views of opioid pain management instead of advocating for pain patients.

Study Finds Worse Outcomes for Patients on Long-term Opioid Therapy – June 2016

Results of a small study of patients with sickle cell disease suggest that long-term opioid therapy may be contraindicated for treatment of their chronic pain.

The study, conducted by researchers from Johns Hopkins found that patients who were prescribed long-term opioid therapy tended to score worse on measures of pain, fatigue, and activity levels than did those who were not on opioids.

This is crazy: they attribute our pain to the medicine we take to relieve our pain!   Continue reading

Link Between Breathing and Anxiety

The breathing conundrum – interoceptive sensitivity and anxiety  2013 Oct – free full-text PMC article

This review focuses on the relationship between breathing and anxiety.

Several anxiety disorders have been associated with

  • altered breathing,
  • perception of breathing and
  • response to manipulations of breathing.

Both clinical and experimental research studies are reviewed that relate breathing dysfunctions to anxiety.   Continue reading