Category Archives: Pain Management

A better method for pain medication research

A better method for preclinical pain medication research – December 18, 2015January 19, 2016 by Tom Ulrich

The global market for pain medications is huge — some estimates predict it will hit $41.6 billion by 2017.

However, the costs of pain medicine development are huge, too; it takes roughly $900 million to bring a new analgesic compound to market.

In part, this is because some 80 percent of compounds that look promising in preclinical animal studies (largely in rodents) fail in late-stage clinical trials.  
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The Nuts and Bolts of Low-level Laser (Light) Therapy

Here are my annotations of five studies showing the efficacy of photobiomodulation (PBM), also called LLLT, for pain, depression, and muscle function. (as of 2/9/2018)

The Nuts and Bolts of Low-level Laser (Light) Therapy – Ann Biomed Eng. 2012 Feb;  /PMC3288797/

This full-text article explains how LLLT works.

Soon after the discovery of lasers in the 1960s it was realized that laser therapy had the potential to improve wound healing and reduce pain, inflammation and swelling.

In recent years the field sometimes known as photobiomodulation has broadened to include light-emitting diodes and other light sources, and the range of wavelengths used now includes many in the red and near infrared   Continue reading

Crash Course for Submitting Comments to CMS

#HPM Crash Course in Submitting Comments to CMS | Matthew Cortland on Patreon – Feb 2018 – by Matthew Cortland

Mr. Cortland gives excellent advice for the best way to write your comments on opioid policy. Though his words are aimed at Hospice & Palliative Medicine (HPM) clinicians, I believe many of us chronic pain patients have just as much knowledge and experience with this subject.

CMS has published their proposed changes to Medicare for 2019.

Here are the changes that, in my view, may be the most concerning to Hospice & Palliative Medicine (HPM) clinicians:  

  1. Starting to crack down on opioid ‘potentiator’ drugs – like gabapentin and pregabalin.
  2. Limiting opioids to 90 MME per day.
  3. Making it more difficult for patients to fill two or more long-acting opioids.    Continue reading

How to Defeat the Prior Authorization Process

Using the PA (Prior Authorization) Process to Deny Necessary Medication – National Pain Report – January 15, 2018 – By Steve Ariens, PD.

Retired pharmacist and chronic pain advocate Steve Ariens has some tips for chronic pain patients in fighting their insurance companies.

As we enter a new year, many PBM (Prescription Benefit Managers) and insurance companies are using the war on drugs and “opiate crisis” as an excuse/reason to cut back on the coverage of pain medications and other controlled medications

Placing a medication on an insurance company’s formulary plan gives the patient the impression that a particular medication is covered until the “asterisk” behind its name indicating that it simply requires a Prior Authorization (PA) in order to get it paid for.   Continue reading

Same pain relief from Opioids and OTC meds?

No Differences Seen Between Opioids, OTC Pain Drugs for Extremity Pain in ED – Pain Medicine News – Jan 2018

There were no clinically meaningful differences in pain reduction at two hours after ingestion among four oral analgesics—two opioids and two over-the-counter painkillers—to treat acute extremity pain in the emergency room, according to a new trial.

A total of 416 patients at two urban emergency departments (EDs) in Bronx, N.Y., were equally randomly assigned to one of four combination, single-dose treatment groups:

You will see that they are using extremely low doses of opioids and much less acetaminophen than in the non-opioid dose, which contains a hefty dose of 500 ibuprofen and 1,000mg of acetaminophen.   Continue reading

Biopharma betting on pain drugs with a checkered past

Biopharma is betting on pain drugs with a checkered past – By DAMIAN GARDE – Jan, 2018

It was supposed to be a $10 billion idea, one that would help wean the world off its opioid dependence and give the drug industry a bounty of lucrative new products.

But the bottom fell out for a new class of pain medicines, called NGF inhibitors, when patients in clinical trials starting inexplicably blowing out their joints.

When we tinker with low-level biological functions in our bodies, we are only looking for one result, the desired outcome. But once we find it, we are too ignorant (and blinded by greed) to understand how our tinkering must also affect other parts of other biological functions.   Continue reading

Epidural Steroids Associated With Decreased Bone Density

Epidural Steroid Injections Associated With Decreased Bone Mineral Density, Increased Risk for Vertebral Fracture – Jessica Martin – January 25, 2018

Another reason to avoid epidural injections for pain:

In this systematic review and critical literature appraisal, researchers evaluated 8 studies (n=7233) that reported on the effects of epidural steroid injections on bone mineral density, osteoporosis, vertebral fracture, or osteopenia.

Across all studies, mean changes in bone mineral density ranged from 0.06% to 1.25% in the lumbar spine and from −2.87% to 0.45% in the femoral neck.   Continue reading

High-Intensity Laser Therapy Improves Chronic Pain

High-Intensity Laser Therapy Improves Chronic Pain, Reduces Opioid Dependence – Pain Medicine News – DECEMBER 26, 2017

Scientific evidence has been accumulating over the last 10 years regarding the usefulness of high-intensity laser therapy (HILT) for the treatment of a variety of acute and chronic pain syndromes.

Devices used for HILT operate at wavelengths between 660 and 1,275 nm and at power levels from 1 to 75 watts (Table).

Compared with low-level laser devices (<1 watt), these HILT devices can penetrate tissue to depths ranging from 5 to 15 cm while producing only low levels of thermal accumulation in the tissue. Continue reading

Risks Associated With Antidepressant Meds

Risks Associated With Neuropathic Pain Treatment – Tara Haelle, MS   – March 07, 2017

The misleading original headline about Neuropathic Pain Treatment grabbed my attention, but I was disappointed to find that the article is only about antidepressants, one of the many non-opioid medications being used for chronic pain of any kind.

Still, the study shows that these alternatives to opioids, which are so readily prescribed in place of “dangerous” opioids, have very serious side effects and dangers too.

Death and serious outcomes resulting from overdose or poisoning from drugs used to treat depression more than doubled during the last decade and a half, found a recent study, with amitriptyline topping the list.  Continue reading

Pain Experts declare Opioids Useful in Some Patients

Pain Experts: Opioids Useful in Some Patients For Managing Chronic Pain – Pain Medicine News

I’m heartened to see the JAMA article I posted about a month ago, JAMA: Opioids Useful For Some Chronic Pain, receive additional coverage and attention in this popular doctor-oriented medical publication.

Selected subgroups of patients with chronic pain definitely benefit from this potent class of medication, according to the authors of a commentary piece in JAMA.

“There are more than 10 million Americans on opioids for chronic pain,” said Kurt Kroenke, MD, professor of medicine at Indiana University School of Medicine, in Indianapolis.   Continue reading