Tag Archives: treatment

Palliative Care for Chronic Pain

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.

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CB2 receptors: Pain Tx Without Tolerance or Withdrawal

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

Possible Use of Stem Cells to Treat Chronic Pain

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

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

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

New Device Treats Arthritis Pain with Heat

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

Evidence-based Medicine: Losing the Patient’s Voice?

Evidence-based Medicine: Losing the Patient’s Voice?

I remember sitting in on a number of addiction medicine boards and committees when the concept of “evidenced-based treatment” came to the forefront. It was very exciting because this concept offered the prospect of great progress and comfort.

For years, the concept of simple outcome evidence for each patient worked as every specialty picked its own guideposts and bettered patient care.

Currently, however, there is an increasing trend toward claiming that the only evidence of effective treatment is that derived from a double-blind, randomized controlled study.   Continue reading

Scrambler Therapy: Non-Invasive Non-Drug Pain Treatment

Scrambler Therapy − A New Way to Treating Chronic Pain Without Drugs or Invasive Devices | National Pain Report

This electronic device works by “scrambling” the pain messages sent through the nerves to your brain.

Drug-free treatment for neuropathy

To help my own patients, I introduced FDA-cleared Calmare Pain Therapy Treatment (scrambler therapy), a U.S. FDA 510(k)-cleared and European CE mark-certified, non-invasive pain therapy device.

This free-standing device is painless for the patient, has no side effects and requires no medication.   Continue reading

Pain Assessment and Management

Improving the Quality of Care Through Pain Assessment and Management | Chapter 17 of  “Patient Safety and Quality: An Evidence-Based Handbook for Nurses”

At some point in life, virtually everyone experiences some type of pain. Pain is often classified as acute or chronic:

  1. Acute pain, such as postoperative pain, subsides as healing takes place.
  2. Chronic painis persistent and is subdivided into cancer-related pain and nonmalignant pain, such as arthritis, low-back pain, and peripheral neuropathy.

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Pain Cure or Pain Management?

Deciding when to say when: pain cure? or pain managed? | HealthSkills Blog

When is it time to say “All this looking at pain cure, or reducing your pain isn’t working, it’s time to accept that pain is going to part of your life.”?  It’s difficult for so many reasons whether you’re the person experiencing the pain, or the clinician trying to help. It’s also incredibly important.

Cures for pain that persists are not easily found.

One possibility is that the underlying disease or dysfunction has not yet been treated – pain in this case is the experience we have when there’s an unresolved threat to body tissues.  Continue reading