Category Archives: Pain Management

Can Pain Be Used to Treat Pain?

Can Pain Be Used to Treat Pain? — Pain News Network – By Jeanne McArdle – Apr 2019

“Can you cure pain with more pain?” was the provocative question posed last month by National Public Radio’s Invisibilia podcast, “The Fifth Vital Sign.”

The show features the story of Devyn, a 16-year old former gymnast living with chronic pain.

Devyn broke the end of her thighbone and required surgery, but the injury never fully healed and her pain was spreading.   Continue reading

Advances in Hormonal Pain Care

3 Advances in Hormonal Pain Care — Pain News NetworkBy Forest Tennant, MD – Mar 2019

There are three new discoveries or innovations in hormonal pain care that I dearly love. I believe they are real trend-setters, but keep in mind that the “next big thing” may not endure.  

Hormone Derivative Treatment

There are two hormonal derivatives that, in my hands, have been extremely beneficial to sub-groups of chronic pain patients.

The first is medroxyprogesterone, which is a derivative of progesterone. In my experience, medroxyprogesterone is far more potent in treating intractable pain patients than is plain progesterone.   Continue reading

Invasive Surgery to Relieve Chronic Pain?

Invasive Surgery: Effective in Relieving Chronic Pain? By Sunali Wadehra, MD – Feb 2019

Invasive surgery may not be any more effective than sham procedures in reducing chronic pain, according to a meta analysis published by Wayne B. Jonas, MD, in Pain Medicine last September.

Dr. Jonas and his team performed a systematic review of 25 randomized controlled trials published between 1959 and 2013, involving 2,000 patients undergoing surgery for chronic pain.

This article explains a concept I haven’t seen elsewhere: chronic pain versus protracted pain. Especially in the case of EDS, this means we can hurt every day, but still not have true “chronic pain”. Continue reading

Too Little, Too Late: Feds Backtrack on Opioid Discontinuation

Too Little, Too Late: US Government Backtracks on Opioid Discontinuation

Thousands of patients have been dispassionately forced into tapering their opioids, often inappropriately, due to fear from regulatory agencies following initiation of the 2016 CDC Guideline on Prescribing Opioids for Chronic Pain.

In addition to unnecessary suffering, this has resulted in opioid withdrawal due to due either rapid or misguided or inexperienced taper regimens.

The sad irony here is that three years later, the FDA is saying exactly what nationally recognized pain experts have been saying all along.   Continue reading

Oral NSAIDs: Duration of Efficacy, Time to Adverse Event

Oral NSAIDs for Knee OA: Duration of Efficacy, Time to Adverse Event Onset Examined – by Da Hee Han, PharmD – Mar 2019

Here’s why people who have pain all the time shouldn’t be using the CDC’s recommendation to use NSAIDs instead of opioids: authors found that traditional NSAIDs were “associated with the least favorable safety profile.

A systematic review and meta-analysis published in Arthritis Care & Research aimed to assess the duration of efficacy, as well as the onset of adverse events, associated with oral nonsteroidal anti-inflammatory drugs (NSAIDS) used in the treatment of knee osteoarthritis (OA).

To investigate these outcomes, researchers conducted a literature search which identified 72 randomized controlled trials where the efficacy and safety of oral NSAIDs was examined in patients with knee OA (N=26,424).    Continue reading

Pain Program Dropouts: Risk Factors Identified

Pain Program Dropouts: Risk Factors Identified – Medscape.com – Fran Lowry – March 13, 2019

Cleveland Clinic’s low back pain program, called Back on TREK, is a 10- to 12-week program that includes psychological and physical therapy sessions.

“Typically, the patient requirement is about 3 to 4 hours a week in two to three sessions in both group and individual sessions. We try to make it easy for patients,” said Mijatovic.

Despite the team’s best efforts, the dropout rate for the 12-week program was 58% of about 200 participants.  

Many patients with EDS have been abused by the Cleveland Clinic, which tends to discount invisible chronic pain, so I’m not at all surprised that more than half drop out. Continue reading

April Fools Day – A National Day of Pain

April Fools Day – A National Day of Pain – National Pain Reportby Richard A. (“Red”) Lawhern, Ph.D – Mar 2019

I wish this effort had started sooner – maybe next year.

.April Fools Day is known around the world as a day for practical and sometimes impractical jokes.

This year, chronic pain patients, their families and their doctors can instead choose to make April 1st a day of change and protest. It can become a National Day of Pain.

The needle on public policy for treatment of pain is beginning to quiver:   Continue reading

Patients’ Experience With Opioid Tapering

Patients’ Experience With Opioid Tapering: A Conceptual Model With Recommendations for Clinicians – free full-text article from Journal of Pain – Feb 2019

I found this an interesting read because it describes different ideas and experiences with tapering. I’m encouraged because it’s only a part of a larger study collecting data on the outcomes of opioid tapers, data we desperately need to hold the CDC accountable for the misery and deaths its guideline caused.

Abstract:

Clinical guidelines discourage prescribing opioids for chronic pain, but give minimal advice about how to discuss opioid tapering with patients.

We conducted focus groups and interviews involving 21 adults with chronic back or neck pain in different stages of opioid tapering.   Continue reading

Study: Opioid cessation and chronic pain

Opioid cessation and chronic pain: perspectives of former opioid users. – PubMed – NCBI – Pain. Jan 2019

From what I can tell, these were voluntary tapers and people were asked why they wanted to stop taking opioids and what they perceived as barriers to that process. I sure wish I had access to the full study…

Current guidelines for addressing opioid cessation in the context of chronic pain management recommend that opioids be discontinued if the risks outweigh the benefits.

However, few studies have focused on understanding opioid cessation from the perspective of individuals with chronic pain.    Continue reading

Increased or improved pain after opioid taper?

Does Opioid Tapering in Chronic Pain Patients Result in Improved Pain or Same Pain vs Increased Pain at Taper Completion? A Structured Evidence-Based Systematic Review – December 2018

This review (based on low-quality evidence) came to the unlikely conclusion that their hypothesis is true: pain doesn’t increase (and sometimes even decreases) when opioids are tapered.

Considering that people are committing suicide due to pain when their opioids are tapered, this study’s findings fly in the face of reality. But people (and our doctors) who read such “research” papers then end up believing this heavily biased nonsense.

Objective

To support or refute the hypothesis that opioid tapering in chronic pain patients (CPPs) improves pain or maintains the same pain level by taper completion but does not increase pain.  

Continue reading