Category Archives: Pain Management

Tapentadol (Nucynta) Prolonged Release: A Review

Tapentadol Prolonged Release: A Review in Pain Management – free full-text /PMC6422986/ – 2018 Nov

Tapentadol prolonged release (tapentadol PR) [Palexia® SR in EU] is a long-acting tablet formulation of the strong central analgesic tapentadol, which acts as both a μ-opioid receptor (MOR) agonist and a noradrenaline reuptake inhibitor.

Tapentadol PR is approved for chronic pain in various countries, with its EU indication (severe chronic pain manageable only with opioid analgesics) being the focus here.

Well-designed trials and clinical practice data support tapentadol PR use in this setting.    Continue reading

Pharmacological rationale for tapentadol/Nucynta

Pharmacological rationale for tapentadol therapy: a review of new evidence – free full-text /PMC6526917/ – 2019 May

Chronic pain could be considered as a neurological disorder.

Tapentadol is an analgesic drug which acts both as a μ-opioid receptor (MOR) agonistand as a noradrenaline reuptake inhibitor (NRI), thereby generating a synergistic action in terms of analgesic efficacy, but not for the burden of adverse effects.

Therefore, tapentadol can be defined as the first “MOR-NRI” drug. This molecule holds the potential to address at least some of the current limitations of analgesic therapy due to its unique mechanism of action and has shown to be safe and effective in the treatment of chronic pain of cancer and noncancer etiologies including nociceptive, neuropathic and mixed pain.   Continue reading

EBM only works for the mythical “average patient”

Evidence-Based Medicine (EBM) figures prominently in these efforts and is vigorously pursued and implemented by corporate healthcare (whose prime directive is to create profit for shareholders).

Biomarkers May (or may not) Indicate Chronic Pain

Biomarkers May Indicate Chronic Pain, Aid Personalized Treatment – Pain Medicine News – by Kaitlin Sullivan – Apr 2020

People who suffer from chronic pain may have abnormal levels of 11 biomarkers related to metabolites and nutrient deficiencies, according to a retrospective observational study published in Pain Physician (2020;23[1]:E41-E49).

Although the research is still in its early phase, these findings provide a snapshot of physiologic abnormalities found in a subset of patients with chronic pain.

“Subset” is the critical word here. If these “abnormalities” aren’t found in ALL patients with pain, how can they be used as “biomarkers” for pain?

Continue reading

Flaws Found in Interventional Treatment Guidelines

Flaws Found in Interventional Treatment GuidelinesPain Medicine Newsby Harry Fortuna – Mar 2020

Assessors were unable to give full votes of confidence to any of the four recently evaluated interventional guidelines created by major North American pain medicine societies.

Of further concern,

  • only half of the sample studied was found to be of high methodological quality, and
  • none of the guidelines surveyed adeptly involved all stakeholders such as patients, providers and payors.

Continue reading

Is Opioid Induced Hyperalgesia a Clinical Reality?

Most “studies” and “research” and pure rantings involving chronic opioids for chronic pain mention that pain patients on high opioid doses might have (must have) hyperalgesia, meaning the opioids themselves are causing the pain. They make it sound like a known scientific fact that that OIH causes problems for many patients who take opioids. but this has *never been proven* in humans.

If you’ve been told by anyone that your pain must be hyperalgesia, you can point them to this article, which summarizes the current evidence and presents a survey that only proves that some doctors suspect it sometimes.

JPM | Free Full-Text | Opioid Induced Hyperalgesia, a Research Phenomenon or a Clinical Reality? Results of a Canadian Survey | HTML – April 2020   Continue reading

Review: opioid management for chronic noncancer pain

Long‐term opioid management for chronic noncancer pain – free full-text /PMC6494200/ Cochrane Review: Jan 2010

I’ll start with these two key findings in the author’s conclusions from this extremely long Cochrane Review:

1. Many patients discontinue long‐term opioid therapy (especially oral opioids) due to adverse events or insufficient pain relief; however, weak evidence suggests that patients who are able to continue opioids long‐term experience clinically significant pain relief.

2. Whether quality of life or functioning improves is inconclusive. Many minor adverse events (like nausea and headache) occurred, but serious adverse events, including iatrogenic opioid addiction, were rare. Continue reading

The most dangerous trend in spine surgery

The most dangerous trend in spine surgeryby Laura Dyrda | August 16, 2019

Spine surgeons reveal the trends in healthcare that could have a negative impact on spine surgeons and care delivery in the future.

  • Timothy Witham, MD. Johns Hopkins Bayview (Baltimore)

The usual issues, mainly insurance companies dictating the way we care for patients and limiting the opportunities for patients to receive certain treatments.   Continue reading

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