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
Artificial Intelligence, Lower Back Pain, and the Cleveland Clinic – By Chuck Dinerstein — December 20, 2018
Two physicians from Cleveland Clinic write almost breathlessly about how artificial intelligence will revolutionize the treatment of back pain – a highly remunerative area to physicians that has no one ascendant, best treatment regimen.
What is so troubling, at least to me, about the vaporware they are peddling is both their confidence in its application, and the way cost pervades their view.
I’m glad someone else is pointing out what I’ve observed as well: all aspects of healthcare are more and more beholden to financial interests instead of medical ones. Continue reading
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
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
Trust me, I’m a patient: pain education for professionals from a lay perspective – Br J Pain. 2012 May – Dorothy Helme – Lay member, British Pain Society Patient Liaison Committee.
A young woman with arthritis talking about the rising tide of hostility to disability claimants says: ‘People think I’m faking. I’ve lost friends over it. Pain is invisible and hard for people to understand.’ How many of us could say that we have never thought that someone reporting pain is faking or, at the very least, making too much fuss?
This is the society in which we live: intolerant of the pain of others. Continue reading
Neuroinflammation: Treating the Underlying Cause of Chronic, Severe Pain – Tori Rodriguez, MA, LPC – September 08, 2017
I’m pleased that EDS is known, at least to some doctors, to be so painful that it qualified for Dr. Tenant’s short list of “pathologic conditions that cause the most persistent or constant pain”:
“Neuroinflammation due to microglial activation is the underlying cause of severe persistent or constant pain, and unless it is suppressed, no real treatment of the cause of pain can be realized,” Dr Tennant told Clinical Pain Advisor.
“Time has taught us that there is a relatively short list of pathologic conditions that cause the most severe, chronic pain — every pain practitioner should have awareness of these,” he added. Continue reading
Incorporating Functional Medicine Into Chronic Pain Care – Practical Pain Mgmt – By David J. Schaefer, DO, MPH and David Cosio, PhD – June 14, 2017
A 4-session functional medicine program can help patients take ownership of their health by teaching them about proper diet, sleep hygiene, exercise, and stress management.
What Is Functional Medicine?
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
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