Category Archives: Pain Management

Managing pain in the era of the opioid crisis

How do we manage pain in the era of the opioid crisis? – Rita Agarwal, MD | Meds | October 2, 2019

Here’s an example of another doctor who understands that the so-called “opioid overdose crisis” has nothing to do with prescription opioids or pain patients.

“6 in 10 Kids Got Opioids After Tonsil Surgery, Study Says.”
So screams the headline from The Daily Beast.

“In the midst of the opioid crisis, doctors sent many kids home with oxycodone and hydrocodone,” it goes on to say. Another example of scaremongering and sensational headlines, or is this something we should still be concerned about?   Continue reading

EDS Requires Aggressive High-Dose Pain Therapy

Ehlers-Danlos Syndrome: An Emerging Challenge for Pain Management – By Forest Tennant, MD, DrPH Editor’s Memo – Sep 2017 – updated Feb 2020

This article was written by a doctor who specialized in chronic pain treatment until the DEA shut him down because he dared treat his patients with effective doses of opioids. He points out how our defective collagen leads to a great deal of pain in multiple bodily systems.

Until recently, Ehlers-Danlos Syndrome (EDS) was a name that elicited little relevance or urgency in the pain world.

Little did I realize that I had been treating more cases of EDS in patients who had been referred to my practice initially for more commonly recognized diagnoses such as fibromyalgia, spine degeneration, and resistant migraine. Continue reading

More Veteran Suicides Than Combat Deaths

Time to Bring the Troops Home: More Veterans Committed Suicide Last Decade Than Died in Vietnamby Matt Agorist – Mar 2020

I knew there was a high rate of suicide among veterans since pain medications have been restricted, but I had no idea that those on active duty are also dying from suicide (though I’m not terribly surprised).

It is no secret that the leading cause of death among active duty troops deployed to the Middle East is not combat or accidents, or IEDs — it’s themselves.

The Pentagon’s own statistics show that this is a crisis but it is being ignored.  

This crisis is also happening in the civilian population. No one is making the logical connection between forcing so many Americans to give up effective pain relief and the increasing numbers of suicides.  Continue reading

Conquering (or Not) Cancer Pain

Conquering Cancer Pain | Drug Topics – by Tzipora Lieder, RPh – Feb 2020

I think it’s a joke to talk about “conquering” any kind of pain. And if, like so many of us, you cannot conquer your pain, what does that say about you?

Military terms like “conquer” reformulate our suffering as a war, a battle we lose day after day, over and over again, and imply that we’re too weak (or stupid or lazy) to fight harder. The implication is that we’re too weak (or stupid or lazy) to fight hard and “conquer” the pain that plagues us.

But what does it mean to “win” this “battle with chronic pain” anyway?

In many articles like this, winning seems to be determined solely by whether or not we take opioid pain medication. All the other semi-effective semi-toxic medications used for chronic pain are seen as harmless, but if we take opioids, we are the “losers”.  Continue reading

Opioids Have Little Effect on Cognition

The Effects of Opioids on Cognition in Older Adults With Cancer and Chronic Noncancer Pain: A Systematic ReviewOct 2019

I’m only able to access the abstract here, but it says pretty much what pain patients already know: unless we’re also taking other non-opioid medications, like Gabapentin or antidepressants, there is “no effect of opioid use on cognitive domains”.

Context

Opioids are prescribed to manage moderate-to-severe pain and can be used with older adults; however, they may lead to several adverse effects, including cognitive impairment.

This is purely conjecture since it has NOT been proven.   Continue reading

Pain catastrophizing measures shown to be invalid

Let’s talk about pain catastrophizing measures: an item content analysis [PeerJ]Mar 2020

This article points out what we’ve been saying all along: chronic pain IS a catastrophe and denying that is “magical thinking”.

Finally, someone is questioning the easy and dismissive beliefs that our pain is simply a mental problem or attitude. This explanation was uncritically embraced by a healthcare system that doesn’t know how (or isn’t allowed) to treat pain effectively.

All the self-report questions used to measure this artificial construct simply represent very normal concerns about a life-changing condition that impacts every aspect of life.

Concerns have been raised about whether self-report measures of pain catastrophizing reflect the construct as defined in the cognitive-behavioral literature. Continue reading

Chronic Pain After Cancer: The Role of Opioids – part 2

Chronic Pain Following Treatment for Cancer: The Role of Opioids – Ballantyne – 2003 – The Oncologist – Wiley Online LibraryJane C. Ballantyne –  Dec 2003

This is part 2 of a long article (part 1 here) making very reasonable arguments for using opioids after cancer treatment when chronic pain persists. Her views used to be reasonable, but now she’s one of the most adamant anti-opioid zealots.

Stable Pain Treatment

Ideal chronic opioid therapy, assuming the pain and disease are stable, uses a stable dose of opioid medication

Often, chronic pain is constant and unremitting, and in that case, long‐acting drugs and formulations given round the clock are useful. Round‐the‐clock dosing allows many patients to achieve maximum functionality, without the need to focus on the next dose of drug and without the swings in analgesic level associated with as‐required dosing.   Continue reading

Chronic Pain After Cancer: The Role of Opioids – part 1

Chronic Pain Following Treatment for Cancer: The Role of Opioids – Ballantyne – 2003 – The Oncologist – Wiley Online LibraryJane C. Ballantyne –  Dec 2003

This study was done just months after Ballantyne had authored a study claiming hyperalgesia is a common problem with continued opioid use.

Ballantyne is one of the most adamant anti-opioid zealots who now insists that “opioids are bad” under all circumstances and shouldn’t be used for chronic pain, but in 2003 she was apparently still reasonable.

Opioids are the most effective analgesics for severe pain.

opioid tolerance, if it develops, is relatively easy to overcome, and other problems of opioid use, including substance abuse, are unlikely to be problematic.

So, in 2003, she believed that opioid use is unlikely to be problematic, a view directly opposed to her current position. We never see references to these positive findings of opioid use anymore.
Continue reading

Some Patients Need Adrenaline for Pain Control

Patients with Arachnoiditis and Ehlers-Danlos Need Adrenaline for Pain Control — Pain News NetworkBy Dr. Forest Tennant, PNN Columnist – Feb 2020

In this era of opioid controversy and tragedy due to forced opioid reduction, the scientific information on adrenaline-type agents can help control constant, intractable pain and help reduce opioid use.

Overlooked in the opioid controversy is the key point that an adequate supply of adrenaline-related neurotransmitters – such as dopamine and norepinephrine – are necessary in the brain and spinal cord for pain relief.

Unfortunately, constant intractable pain depletes the natural supply of endorphin, dopamine, adrenaline and noradrenalin, and their levels must be replaced to adequately control pain.  

This is just a small part of the damage wrought by our chronic pain andyou can find many more posts here itemizing all the ways that untreated pain ravages a body.  Continue reading

FDA Clears OTC Electromagnetic Pulse Therapy

FDA Clears OTC Electromagnetic Pulse TherapySteve Duffy – Feb 2020

I haven’t tried this because my pain’s location is constantly changing, but for less than $30 on Amazon, it might be worth a try for localized pain.

The over-the-counter (OTC), drug-free medical device, ActiPatch®, has obtained a new 510(k) clearance from the Food and Drug Administration (FDA) for the adjunctive treatment of musculoskeletal pain.

The topical device is a wearable version of pulsed shortwave therapy that consists of low voltage (3V) digital/analog electronics that produce a therapeutic radiofrequency field.

The electromagnetic signal pulses to stimulate neuromodulation of the afferent nerves to reduce pain and inflammation. 

Continue reading