Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence – Jun 2017 – Free full-text PMC5480856/
These are my annotations of a very long, very thorough PubMed article on pain treatments.
Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments.
This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care. Continue reading
CRISPR gene editing can cause hundreds of unintended mutations | EurekAlert! Science News – May 29, 2017
This is an example of how new drugs developed with the latest new technologies can lead to dangerous unintended side-effects that only become apparent later after many subjects have been “treated”.
When a new technology, like CRISPR gene editing, is used we cannot use past experience to assume anything and cannot predict results precisely because we’re doing something categorically different from before.
As CRISPR-Cas9 starts to move into clinical trials, a new study published in Nature Methods has found that the gene-editing technology can introduce hundreds of unintended mutations into the genome. Continue reading
Ketamine for Pain Management, Treatment of Depression – Linda Peckel – May 30, 2017
Ketamine may alleviate depression, pain, and side effects associated with opioid treatment, and may thus represent an attractive adjunct therapy for pain management, according to a novel population analysis recently published in Scientific Reports.
Nearly half of all patients with depression taking conventional antidepressants discontinue their treatment prematurely.
Researchers have sought alternatives to standard antidepressants, for which therapeutic effects are delayed by 2 to 10 weeks. Continue reading
Chronic Pain in the Aftermath of the Opioid Backlash | Complementary and Alternative Medicine | JAMA | The JAMA Network – Kurt Kroenke, MD, – May 11, 2017
National Institutes of Health (NIH) funding for pain research declined sharply from 2003 to 2007 by an average of 9% per year, and the federal response to a 2011 Institute of Medicine report on pain in the United States has been limited and disproportionally focused on reducing opioid use rather than increasing pain relief.
Analgesic options for patients with chronic pain have steadily declined
What follows in a damning review of the limited efficacy and dangerous side-effects of non-opioid medications. Continue reading
Palliative Care the Path to Better Pain Management – National Pain Report | September 2, 2016 | By Steve Ariens, P.D. Pharmacist
Steve Ariens points out that chronic pain patients, because they have an incurable disease (pain without remediable cause), should receive pain management as palliative care.
I’ve noticed others suggesting the same idea since 2013:
The latest definition of patients needing palliative care seems to include us, except for the strange requirement that palliative care should only be provided when a person will no longer need it much longer.
Cannabinoid Receptor 2: Pain Treatment Without Tolerance or Withdrawal – reposted with edits from April 2015
This article about a promising new medicine derived from cannabis was published by the National Institute on Drug Abuse (NIDA), on their site “drugabuse.gov“. (Other branches of the same government, FDA and DEA, still classify cannabis as a Schedule I drug,)
Chronic cannabinoid receptor 2 activation reverses paclitaxel neuropathy without tolerance or cannabinoid receptor 1-dependent withdrawal.
The treatment of cancer pain is often among the approved uses of medical cannabis in states where it is legal. Continue reading
Study Paves Path for Use of Stem Cells in Treating Chronic Pain
Neuropathic pain, which occurs from damage to or dysfunction of the peripheral or central nervous system, is a major source of chronic pain and is often resistant to analgesics.
Although neuropathic pain can have numerous etiologies, from diseases (eg, cancer, viral infections) to injuries/trauma (eg, stroke, surgery, spinal cord injuries), neuroinflammation is an underlying driving factor.
Studies have suggested that stem cells might offer a way to inhibit chronic pain by modulating neuroinflammation, potentially providing a more complete and definitive strategy for treating neuropathic pain. Continue reading
Misuse of Hyperalgesia to Limit Care | Practical Pain Mgmt | March 2011
John (not his real name) is a 51-year-old chronic pain patient that I have been seeing since 2003. I had begun carefully titrating him on oxycodone, Oxycontin® and Dilaudid®, which had been started by another doctor and, ultimately, settled on a dose of Oxycontin 640mg B.I.D., 32mg hydromorphone q 4 hrs prn breakthrough pain and Xanax® 1 to 1.5mg q.i.d. prn muscle spasms and anxiety. On these medicines, he was content and functional and denied any deficits or side-effects due to his medicine.
His insurance company was concerned about the expenses of his medicine and asked me to arrange for a second opinion. Given the complicating factor of his end-stage lung cancer, I arranged for an evaluation by the pain clinic of a major cancer center. Continue reading
The “right” goal when managing pain – Harvard Health Blog – Harvard Health Publications | Harvard Health Blog | December 18, 2015 | Robert T. Edwards, Ph.D.
It makes sense that the primary goal of pain treatment should be to reduce pain. However, a recent editorial in The New England Journal of Medicine makes a strong case for looking beyond pain intensity when evaluating what is “successful” pain management.
I posted my objections to this in “Intensity of Chronic Pain — The Wrong Metric?“
However, beneath the rhetoric and propaganda of this editorial, there lie some important aspects of dealing with pain that are too often overlooked, like the importance of having access to appropriate multimodal treatment, including opioid therapy.
Additionally, this article repeatedly stresses the need to tailor pain treatment to the individual. Ironically, this is the perfect argument against proposed treatment standards, like the CDC guidelines. Continue reading
Below are two articles describing a new pain treatment:
New Device Treats Arthritis Pain with Heat | National Pain Report | January 13, 2015
Avacen 100, a medical device recently cleared by the U.S. Food and Drug Administration to be marketed for the temporary relief of joint pain associated with arthritis, as well as minor muscle aches, sprains and spasms.
“It worked very well for me,” says Gabrielle Farrell, a 67-year old resident of Santa Barbara, California who has suffered from arthritis for over a decade. Continue reading