Category Archives: Pain Management

Fentanyl: Potent and Deadly in Illicit Form

The Fentanyl Story – The Journal of Pain – Dec 2014 – free full-text article

Here’s everything you ever wanted to know about fentanyl, the ultra-strong opioid first synthesized in 1960 for IV medical use.

This article explains the history and the rationale for using this particular opioid medically in transdermal patches (continuous dose) and sublingual wafers (immediately effective).

Unfortunately, even in 2014, it seems the scientific community was unaware that fentanyl was and is being illicitly manufactured for sale on the black market. It is this illicit fentanyl that’s causing so many overdoses due to its extreme potency and poorly controlled careless handling.   Continue reading

Role of Stress Gene in Chronic Pain

Researchers Elucidate Role of Stress Gene in Chronic Pain – from NIH – Posted on  by 

For most people, pain eventually fades away as an injury heals. But for others, the pain persists beyond the initial healing and becomes chronic, hanging on for weeks, months, or even years.

Now, we may have uncovered an answer to help explain why: subtle differences in a gene that controls how the body responds to stress.

In a recent study of more than 1,600 people injured in traffic accidents, researchers discovered that individuals with a certain variant in a stress-controlling gene, called FKBP5, were more likely to develop chronic pain than those with other variants.   Continue reading

Tapentadol: for acute and chronic pain

Here are excerpts from 5 PubMed studies on tapentadol (an atypical opioid):

Tapentadol Prolonged Release for Chronic Pain: A Review of Clinical Trials and 5 Years of Routine Clinical Practice Data. – PubMed – NCBI – Pain Pract. June 2017

Tapentadol prolonged release (PR) for the treatment of moderate to severe chronic pain combines 2 modes of action.

These are μ-opioid receptor agonism and noradrenaline reuptake inhibition in a single molecule that allow higher analgesic potency through modulation of different pharmacological targets within the pain-transmitting systems.   Continue reading

Overcoming Neck Pain with Exercises

Overcoming Chronic Neck Pain: Postural Causes and A Unique Exercise Fix | Home –

I’ve learned that some of my pain of musculoskeletal origin can be ameliorated by strengthening weaker muscles and aligning my spine better.

For years, I had a severe problem with recurring cervicogenic headaches, which were probably caused by a pinch somewhere in my hypermobile cervical spine. But after doing Isometric exercises with my neck my vertebrae realign properly and I don’t get the headaches anymore.

This author, Rochelle Cocco has created a whole website describing exactly what she learned and did to surmount her own crippling neck pain. Continue reading

Pain Patients Must ‘Deserve’ Treatment

Why Must Pain Patients Be Found Deserving of Treatment? – Jan 2008 – Jay M. Baruch, MD

Easing pain strikes me as an elemental human endeavor. But… doing so can be complex and nuanced in ways that much of medical treatment is not.

Inadequate pain treatment, termed oligoanalgesia, was recognized by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001 as a public health problem.

Across health care settings, pain is undertreated; the ED is no exception [2-6]. Physicians and nurses consistently underestimate the pain experienced by ED patients, which means that some leave the ED with little if any relief.  Continue reading

Empathetic Response to Chronic Pain

A Spouse’s Response to a Patient’s Pain – By Cheryl Zigrand – October 05, 2017

Though this article is almost a year old, it points out that empathy is still a healing force, despite its recent demonization for supposedly promoting a patient’s “catastrophizing“.

While it may be common sense that everyday interpersonal experiences play a role in the link between close relationships and physical health, few studies have been able to make any firm conclusions. Recently, however, researchers set out to close the gap in what is known about how spouses’ responses may or may not affect long-term physical functioning.

The research team, based at Penn State University, examined the association between the expression of pain made by patients with knee osteoarthritis and how their spouses responded to it, and changes in the patients’ physical function over 18 months.   Continue reading

Cause and genetics of local anesthetic resistance

Whole-exome sequencing of a family with local anesthetic resistance. – PubMed – Minerva Anestesiol. 2016 Oct

Many people with EDS experience eventually discover that local anesthetic doesn’t work on them.

This seems so improbable that doctors simply cannot believe it and cause their patients much suffering when they slice into the skin for some procedure for which it should be numbed.

Local anesthetics (LA) work by blocking sodium conductance through voltage-gated sodium channels.   Continue reading

Ethics Approach to Opioid Treatment of Chronic Pain

This article is a response by Mitchell J. Cohen, MD and William C. Jangro, DO
A Clinical Ethics Approach to Opioid Treatment of Chronic Noncancer Pain” by Ballantyne JC, Fleisher LA –  Pain. 2010

Given the current state of knowledge regarding long-term opioid treatment, we suggest that dilemmas associated with this treatment are best approached using patient-centered clinical ethics.

We believe principle-based, deontological, and classical Hippocratic ethical approaches have less relevance in sorting out current controversies surrounding opioid treatment.

Indeed, effective medical treatment should always be “patient-centered” and not predetermined by some rules invented by politicians seeking to take advantage of this collective cultural insanity to increase their power.  Continue reading

New painkillers could thwart opioids’ fatal flaw

New painkillers could thwart opioids’ fatal flaw | Science | AAAS– Nov 2017 – By Meredith Wadman

When people die from overdoses of opioids, whether prescription pain medications or street drugs, it is the suppression of breathing that almost always kills them.

The drugs act on neuronal receptors to dull pain, but those in the brain stem also control breathing. When activated, they can signal respiration to slow, and then stop.

Countering this lethal side effect without losing opioids’ potent pain relief is a challenge that has enticed drug developers for years.   Continue reading

Spinal Surgery Does Not End Opioid Use for Pain

Expectations Versus Reality: Spinal Surgery Does Not End Opioid Use for Pain – RELIEF: PAIN RESEARCH NEWS, INSIGHTS AND IDEAS By Stephani Sutherland – July 2018

People seeking medical treatment for back pain often end up in a surgeon’s office.

Most of those individuals hope—and expect—that surgery will reduce their pain enough to make opioid painkillers unnecessary after the operation.

But that scenario seems to be the exception rather than the rule, according to a new report published in the journal PAIN.   Continue reading