Category Archives: Chronic Pain

Reducing the global burden of chronic pain

Reducing the global burden of chronic pain – Beth D. Darnall, Clinical Professor, Stanford University School of Medicine

The profound global burden of chronic pain is increasing as the world population ages, and particularly so for low and middle income countries.

Reducing the global burden of pain requires

  • national policy and investment to develop coordinated local, national and international efforts to improve professional and public pain education;
  • promotion of the biopsychosocial model of evidence-based pain care;

However, the biopsychosocial model is based on poor or biased evidence. Many pain patients ultimately respond only to the effectiveness of opioid therapy.  Continue reading

Opioids Proven Necessary for Sickle Cell Disease

University of Minnesota Researchers Study Effect of Chronic Opioid Therapy on Pain and Survival in Sickle Cell Disease | Medical School – University of MinnesotaAuthor: Krystle Barbour – April 2, 2019

New UMN research recently published in Blood Advances, Kalpna Gupta, PhD, Professor of Medicine, University of Minnesota Medical School, demonstrates the impact of opioids on the survival of humanized mouse models with sickle cell disease, compared to normal mice.

Sickle Cell Disease (SCD) affects millions of people throughout the world. The genetic disease worsens over time and can cause lifelong pain.

Given the often severe nature of the pain associated with SCD opioid use is a rule not an exception for treatment.

Unfortunately, I’ve read several accounts of patients with documented SCD not being allowed opioids, even when in a crisis.  Continue reading

What About Pain Patients Who Don’t Get Better?

What About Pain Patients Who Don’t Get Better? – By Roger Chriss – Mar 2019

In this excellent article, Mr. Chriss points out that chronic pain means life-long opioid medication, and the anti-opioid crusaders don’t like that.

The standard narrative of the opioid crisis focuses on pain management run amok.

“Looking back it’s clear that using opioids to treat chronic pain — backaches, bum knees and the like — might well be considered the worst medical mistake of our era,” wrote Haider Warraich, MD, in a recent opinion piece in The New York Times.   Continue reading

Treating chronic pain can restore normal brain function

Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function | Journal of Neuroscience – Free full-text article – May 2011

Though also not new, this study is a follow up on an earlier post: Brain abnormalities are Consequence Not Cause of pain (2009). The article below contains dozens of links to further information.

Abstract:

Chronic pain is associated with reduced brain gray matter and impaired cognitive ability.

In this longitudinal study, we assessed whether neuroanatomical and functional abnormalities were reversible and dependent on treatment outcomes.     Continue reading

Brain abnormalities are Consequence Not Cause of pain

Brain Gray Matter Decrease in Chronic Pain Is the Consequence and Not the Cause of Pain | Journal of Neuroscience Nov 2009

If you can reverse brain “damage” by effectively treating the patient’s chronic pain, it seems pretty clear that the chronic pain was the cause.

This means we don’t have to accept the idea that abnormalities in our brains are what’s causing our pain (which some have hinted at).

Recently, local morphologic alterations of the brain in areas ascribable to the transmission of pain were reported in patients suffering from chronic pain.

Although some authors discussed these findings as damage or loss of brain gray matter, one of the key questions is whether these structural alterations in the cerebral pain-transmitting network precede or succeed the chronicity of pain.   Continue reading

Complex Chronic Pain Disorders

Complex Chronic Pain Disorders By Don L. Goldenberg, MD – Feb 2019

The pathophysiology of and approaches to 3 commonly seen pain conditions: CRPS, EDS, and SFN.

  • Complex regional pain syndrome (CRPS),
  • Ehlers-Danlos syndrome (EDS), and
  • small fiber neuropathy (SFN)

are three important and complex chronic pain disorders.   Continue reading

The Involvement of Epigenetics in Chronic Pain

Chronic Pain: Emerging Evidence for the Involvement of Epigenetics – free full-text /PMC3996727/ – Apr 2013

Abstract

Epigenetic processes, such as histone modifications and DNA methylation, have been associated with many neural functions including synaptic plasticity, learning, and memory.

Here, we critically examine emerging evidence linking epigenetic mechanisms to the development or maintenance of chronic pain states.

Although in its infancy, research in this area potentially unifies several pathophysiological processes underpinning abnormal pain processing and opens up a different avenue for the development of novel analgesics.   Continue reading

Pain patients suffer from efforts to reduce addiction

Chronic-pain patients suffer as agencies try to regulate addiction – by Wendy Sinclair – Jan 2019

I’m encouraged to see our side of the opioid story published in the mainstream media like this. We must expose more of the public to the nightmare experienced by pain patients, one they are only one accident or misfortune away from landing in themselves.

Opioid. For many, the word elicits images of addiction, but that’s only one side of the story.

This is our side, the one that’s no longer socially acceptable, that shatters bias and stigma. It’s the side of the story that I live — that of the chronic pain patient (CPP), not the addict.   Continue reading

Problems with Neuroimaging for Chronic Pain

Neuroimaging for Chronic Pain: IASP Consensus Statement – by 

health and disability insurance companies seek methods to confirm the pain status of beneficiaries to corroborate self-report, which is the current gold standard for pain assessment in clinical and research settings.

All parts of our health system (and its interface to the legal and financial systems) have difficulties with self-reported symptoms because they are all based on numerical values that are independently verifiable.

A blood test or x-ray taken by your doctor will not yield significant differences from the ones taken by your insurance company or lawyer, so these are seen as “factual evidence”.   Continue reading