When Chronic Pain Takes Away Your Life


loss 3Pain changes us. The minute we start to hurt, we make adaptions to how we move, what we do, and where we go. When we keep re-organizing our lives around our pain, we can become separated from our typical daily routine. The more we start to pull back, the less likely we are to go to work, exercise, walk, or even leave the house. Once this happens, we feel ourselves disconnect emotionally from friends, loved ones, and co-workers. Very quickly, we can start to lose much of what we value and enjoy about our lives.

Unfortunately, this kind of loss can be the biggest casualty of having chronic pain. Let’s take a look at some of the life-changing types of losses that I see patients face on a regular basis and where to look for help.

  • FamilyAs I often say, when one person at home is in pain, everyone who is living there hurts. A pain problem affects each person in the household in some way. The pain experience can disrupt how we interact with those closest to us. It may cause us to have mood swings or may prompt us to pull away from others, making it more difficult for everyone at home to communicate and support each other. Sadly, this can sometimes fracture relationships or even break up marriages.
  • Intimacy If you find yourself avoiding intercourse because of pain, then you aren’t alone. For example, this can be a common problem for patients with low back pain or fibromyalgia. But in my experience, patients are often reluctant to bring this up with their doctor, and so, aren’t able to get the help they need. Besides the physical difficulties that can arise, the emotional consequences of being in pain can also make intimacy a big challenge. Feeling stressed or depressed over your health can stand in the way of bonding deeper with a significant other.
  • IncomeTragically, I have seen patients lose their careers, their life’s savings, and even their homes because of chronic pain. I have even seen some patients become homeless or start to live out of their cars, all because they could no longer stay employed because of the amount of pain they were in. Limitations with lifting, bending and carrying, as well as difficulties with tasks like keyboarding or even just sitting at a desk, can mean the loss of a long-standing career or can stand in the way of getting get back into the workforce. And beyond the financial consequences, there can be a deep-seated loss of self-esteem and self-identity from losing a career or no longer being a breadwinner.
  • Fun – Let’s face it, we all need to laugh, play, and have some fun in life. But sometimes the pain we feel stands in the way of doing some of the things we enjoy the most. That can include everything from the sports we like to play, keeping up with a favorite hobby, to dancing or just getting out of the house to visit friends or see a movie. Being in pain is no fun, but staying in pain can make having fun a big challenge, too.

An important step to overcoming loss is finding the right help. Ask your physician to help you find valuable resources like counselors, therapists, or pain psychologists who can help you process what you have been through while also helping you learn constructive tools that you can use to move forward. Community centers and public health organizations may also offer options, and there are now a lot of virtual online counseling and coaching resources available if you are having trouble finding the right resources close to home. Talk to a physical therapist or movement expert for guidance in becoming more active and engaged with recreational activities, work functions, and even explore what can be done to re-ignite your love-life.

The wounds from the loss we experience can run deep, but finding the healers out there can be a crucial step toward recovery.

Medical Marijuana a Hit With Seniors


Seniors are giving rave reviews for medical marijuana.

In a new survey, those who turned to it for treating chronic pain reported it reduced pain and decreased the need for opioid painkillers.

Nine out of 10 liked it so much they said they’d recommend medical pot to others.

“I was on Percocet and replaced it with medical marijuana. Thank you, thank you, thank you,” said one senior.

Another patient put it this way: “It [medical marijuana] is extremely effective and has allowed me to function in my work and life again. It has not completely taken away the pain, but allows me to manage it.”

Study co-author Dr. Diana Martins-Welch said, “The impact of medical marijuana was overwhelmingly positive. Medical marijuana led them to taking less medications overall — opioids and non-opioids — and they had better function and better quality of life.” Martins-Welch is a physician in the division of geriatric and palliative medicine at Northwell Health, in Great Neck, N.Y.

The biggest complaint the researchers heard about medical marijuana was the cost. “It’s an out-of-pocket expense. Insurance doesn’t cover it because it’s federally illegal,” Martins-Welch explained.

As for unwelcome side effects, Martins-Welch said sedation was what she heard about the most. “A lot of people don’t like feeling sleepy,” she said.

It’s also important to work with your doctor to find the right dose, since pain experts say that too little or too much doesn’t ease pain.

Thirty-one states have some type of medical marijuana law on the books, according to the National Conference of State Legislators.

“Every state has its own laws, like what a qualifying condition is. There are a lot of differences. And you can’t take a product from one state and cross another state line,” Martins-Welch said.

According to federal law, medical marijuana is still illegal in the United States. “There are legal fears. Some practitioners worry that the DEA [U.S. Drug Enforcement Administration] might come after them,” she added.

Medical marijuana is different than just picking up some pot and smoking it.

“The goal with medical marijuana is to find the dose that gives a therapeutic benefit without a high, or slowing reaction time or causing sedation,” Martins-Welch said. “To find that right dose, we start low and go slow.”

In fact, it’s important to work with a doctor because there’s a “therapeutic window” with THC, the active component in marijuana that causes the high, according to Dr. Mark Wallace, a board member of the American Pain Society.

If you get a dose that’s within that window, the pain is relieved. If you get too little, you won’t get pain relief, and if you go over the therapeutic window, pain is actually worsened, Wallace explained.

The study included a 20-question survey of nearly 150 seniors who had used medical marijuana for chronic pain. The seniors had received their medical marijuana from dispensaries in New York or Minnesota.

The average age of the seniors was 61 to 70, and 54 percent were female. Many (45 percent) used a vaporized oil in an e-cigarette device. Twenty-eight percent used a medical marijuana pill.

Twenty-one percent said they used medical marijuana daily, while 23 percent said they used it twice a day. Another 39 percent said they used it more than twice a day, the researchers noted.

About half the time, medical marijuana had been recommended by a doctor. One-quarter of the seniors decided to try medical marijuana at the urging of a friend or family member. Almost all — 91 percent — would recommend medical marijuana to someone else.

When asked how medical marijuana affected their pain levels, the seniors reported going from a 9 (on a pain scale of zero to 10) down to 5.6 a month after starting the medical marijuana.

Wallace said he’s seen many positive results from the use of medical marijuana in his patients.

“The geriatric population is my fastest-growing patient population. With medical marijuana, I’m taking more patients off opioids,” he said.

“There’s never been a reported death from medical marijuana, yet there are 19,000 deaths a year from prescription opioids. Medical cannabis is probably safer than a lot of drugs we give,” Wallace said.

Medical marijuana can also stimulate appetite, Martins-Welch said, which is a “godsend for cancer patients,” though extra eating may not be a welcome side effect for everyone.

Martins-Welch said it’s best to discuss potential drug interactions with your doctor, but it’s usually OK to mix marijuana and opioids. She said she’d caution against mixing medical marijuana with alcohol.

The study findings were presented recently at the American Geriatrics Society meeting in Orlando, Fla. Studies presented at meetings are typically viewed as preliminary until they’ve been published in a peer-reviewed journal.

How Necessary Are Opioids for Chronic Pain?


The continued ravages of the opioid epidemic have prompted researchers to reconsider whether opioids are an appropriate treatment strategy for chronic non-cancer pain. In this 150-Second Analysis, F. Perry Wilson MD, MSCE, looks at a trial appearing Tuesday in JAMA that compared opioid to non-opioid therapy in patients with chronic knee and back pain and found virtually no data to support using opioids in this setting.

When two treatment modalities are being compared, I can usually find something positive to say about both of them.

But today we have this study, appearing in the Journal of the American Medical Association, comparing opioid to non-opioid regimens for chronic back or knee pain and I am hard-pressed to find a single data point that argues FOR the use of opioids in this setting.

240 Veterans Affairs patients with moderate to severe chronic knee or back pain were randomized to one of the two treatment strategies, each of which had three tiers. Take a look:

The opioid group first tier was characterized by short-acting pain killers, then escalated to longer acting agents, and finally capped out with transdermal fentanyl.

The non-opioid regimen was a bit more clever, in my opinion. Tier 1 was acetaminophen and NSAIDs. Providers could then escalate to other oral meds (I particularly like the underused amitriptyline appearing in this tier) and topicals, and finally capped out with tramadol.

Now, I know what you’re thinking. Isn’t tramadol an opioid? I asked lead author Dr. Erin Krebs that very question. She reminded me that this trial started in 2010: “This was before all the concerns about opioid overdose and addiction and back then a big concern was is it ethical to deprive patients of opioids if they fail all these non-opioid medications.”

Times have certainly changed. But regardless, only 13 patients in the non-opioid group ever required escalation all the way to tramadol.

And the results did not look good for opioids. The primary outcome was pain-related function which improved substantially in both groups but did not differ between the groups. Raw pain scores ended up being a bit better in the non-opioid arm.

Adverse events, as you might expect, were significantly higher in the opioid group, but fortunately no opioid abuse was detected.

One common criticism you hear about opioid trials is that researchers simply didn’t give enough – if they had titrated up more aggressively, patients would have better pain control. While the investigators limited the total morphine equivalents to 100 mg per day, Dr. Krebs told me very few patients bumped into that ceiling.

“The vast majority of folks stopped before 50, and it wasn’t because we had a limit there. It’s because simply that seemed to be the best dose for them.”

Are opioids dead for chronic back or knee pain? I think they are on life support. But the real key to this study was the careful titration of non-opioid pain medication in that group. Most of us try Tylenol and Advil and then give up. With close monitoring, patient feedback, and a willingness to try multiple interconnected agents including tricyclics, physicians may find that treating chronic pain is not so painful after all.

Spinal Cord Stimulation – A clinically valuable treatment option for chronic pain


https://speciality.medicaldialogues.in/spinal-cord-stimulation-a-clinically-valuable-treatment-option-for-chronic-pain/

Surgeons Debate Core Causes of Chronic Pain After Hernia Repair


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Michael Kavic, MD, a hernia surgeon and editor-in-chief of the Journal of the Society of Laparoscopic Surgeons, is calling on practicing surgeons, surgical educators and medical device manufacturers to re-evaluate their approach to inguinal hernia repair, recommending less reliance on synthetic mesh repair as the go-to method for repairing inguinal hernias.

In a presentation at Minimally Invasive Surgery Week, Dr. Kavic called the incidence of chronic pain after mesh hernia repair a “potential time bomb for the surgical community and medical device suppliers.

“The surgical community, as well as the industry that garners huge profits from the use of synthetic materials, must address this troubling issue,” said Dr. Kavic, professor emeritus of surgery at Northeast Ohio Medical University and a leader in the field of hernia surgery. “The evidence is mounting that mesh, which was generally thought—and promoted—to be inert, now appears not to be so.”

An extended version of his speech was published in the July-September edition of the Journal of the Society of Laparoendoscopic Surgeons (20[3]. pii: e2016.00081).

However, other surgeons disagree with Dr. Kavic’s arguments, saying he both amplifies the extent of chronic pain after hernia repair and simplifies the causes.

“The number of people with chronic debilitating pain is around [4%] to 6% so I don’t think this qualifies as an epidemic,” said Guy Voeller, MD, a professor of surgery at the University of Tennessee Health Science Center, in Memphis. “While it may not be an epidemic, it is certainly an important issue and I agree with Dr. Kavic in that respect. I think we were always focused on recurrence rates prior to mesh introduction. I don’t think that we really looked at pain. It doesn’t mean it didn’t occur prior to mesh introduction and it doesn’t mean that mesh-based repairs are the cause.”

Synthetic mesh repair became the standard of care because it solved the problem of high recurrence rates. But an unintended and unforeseen consequence of mesh repair is chronic postoperative pain, Dr. Kavic pointed out.

In 2001, Dutch researchers who surveyed adults who underwent inguinal herniorrhaphy reported that more than 25% of patients experienced pain in their groin one year after surgery and 11% reported pain that was interfering with work or leisure activity (Ann Surg 2001;233:1-7). Ten years later, a German study reported a 16.5% incidence of chronic pain six months after mesh repair (Ann Surg 2011;254:163-168). Nevertheless, a wide range of pain incidence, from 0% to 45%, has been reported in studies, with a broad range of definitions, making it difficult to know the true incidence of chronic pain.

Approximately 800,000 inguinal hernia repairs are performed each year in the United States. Since 2000, repairs not using mesh have represented less than 10% of groin hernia repair techniques.

If one in 10 patients experience debilitating pain after a mesh hernia repair, millions of patients could be affected worldwide, Dr. Kavic noted in an interview following his presentation.

“I don’t think this is a matter of Chicken Little saying the sky is falling. The science is pretty good to show there’s a problem with chronic pain and the reason for the chronic pain is the mesh itself and the behavior of it. This could be far-reaching in its consequences.”

Dr. Kavic noted that the cause of chronic pain is not well understood, but he cited research led by Robert Bendavid, MD, a surgeon and senior consultant at Canada’s Shouldice Clinic, in Toronto, where hernia surgeons do not use mesh. Dr. Bendavid has linked chronic pain to nerve ingrowth into the mesh. He and his colleagues reported that the degree of mesh innervation was significantly higher in patients who required mesh removal for pain than in patients who had mesh excised for recurrence (Hernia 2016;20:357-365). The finding was based on an analysis of 33 hernia meshes: 17 were excised because of severe pain, two for combined pain and recurrence, and 14 sampled during revision for recurrence without pain.

Dr. Bendavid and his co-authors noted that neither triple neurectomy nor careful nerve preservation—often recommended for the prevention of chronic pain—eliminated pain after hernia repair. “Perhaps because we have forgotten that nerves, in response to some evolutionary mechanism, tend to regenerate, undergo changes imposed by prosthetic elements and architecture, mimicking entrapment and compartment syndromes,” they wrote.

Mesh shrinkage, loss of pliancy and increasing rigidity may also be contributing factors, Dr. Bendavid’s group reported in an earlier study (Int J Clin Med2014;5:799-810).

But these arguments oversimplify the cause of chronic pain, according to other hernia surgeons. Dr. Voeller points out that randomized studies in Europe have directly compared Shouldice repair with a Lichtenstein repair, and found less pain (Langenbecks Arch Surg 2004;389:361-365). He cited a number of studies that indicate mesh repairs are associated with less chronic pain than nonmesh repair, including a randomized clinical trial with a 10-year follow-up that showed mesh repair was equal to nonmesh repair with regard to long-term persistent pain and discomfort interfering with daily activity (Surgery 2007;142:695-698). The EU Hernia trialists (Hernia 2002;6:130-136) and a Cochrane review (Cochrane Database Syst Rev 2002;4:CD002197) also reported lower rates of persisting pain after mesh repair.

“If you look at the clinical data, laparoscopic repairs, when they are done properly, definitely had less chronic pain, and it’s a mesh-based repair,” Dr. Voeller said.

He said the study from the Shouldice Clinic that looked at nerve fibers in explanted mesh was too small to conclude nerve ingrowth causes chronic pain. “You can’t make that jump.” He added, “You’ll never be able to have chronic pain as a never event with hernia repair. There are too many variables, including the surgeon’s ability, patient characteristics and techniques of repair.”

Shirin Towfigh, MD, a surgeon at Cedars-Sinai Medical Center, in Los Angeles, and the Beverly Hills Hernia Center, in California, believes Dr. Bendavid’s research “partially” explains the epidemic of chronic pain after hernia repair. She attributes long-term pain to the presence of mesh, as well as poor surgical technique and misunderstanding of anatomy.

“All efforts by industry were to maximize ease of repair, basically making it idiot-proof. The marketing was focused on fast surgery, small incisions, etc.,” she said. “The result was little attention to the delicate anatomy of the groin and lack of adequate training on all of these new [meshes] that were sprouting. I personally feel this is the main reason for the increase in mesh-related chronic pain,” she said.

Patients with chronic pain generally have meshomas, nerve injury, nerve entrapment, erosion or obstruction of the spermatic cord, Dr. Towfigh said.

William Hope, MD, president of Americas Hernia Society and a hernia surgeon at New Hanover Regional Medical Center, in Wilmington, N.C., believes the cause and the solution to chronic pain lies somewhere between the positions of Drs. Kavic and Voeller.

“To me, mesh and technique may contribute to chronic pain, but I do not think the problem is that simple and is likely multifactorial that we don’t completely understand yet,” Dr. Hope said.

It’s hard to know what the incidence of chronic pain was prior to mesh repair, as historically surgeons did a poor job of assessing patients’ long-time pain, he said. “We are recognizing it more. Chronic pain is a problem. I’m not sure ‘massive’ is the right word but it is a ‘difficult’ problem.”

He agrees with recently updated inguinal hernia guidelines published by the European Hernia Society that state the use of mesh has significantly decreased hernia recurrence rates and “at present is likely the best option we have available.”

But he feels surgeons rely too much on mesh as a go-to technique. “I think education is important and one of the main problems, at least in the U.S., is there are very few surgeons and training programs that are performing nonmesh/tissue repairs, so younger surgeons are not learning these techniques or the anatomy.”

Dr. Kavic asked surgical educators to change their approach to teaching hernia repair, calling for more emphasis on anatomic knowledge and physiologic function of the groin. Trainees should be required to perform a minimum number of pure tissue hernia repairs, as well as mesh repairs, he said.

He said all surgeons who offer hernia repair need to be able to complete the operation both open and laparoscopically, with and without mesh. They need to stay updated on the latest findings on mesh outcomes and mesh materials, he said. “They need to understand the risks and talk to their patients about the risks.” He also said, “Surgeons need to get involved with their institutions and their device companies. It comes down to all of us.”

New Device Can Ease Chronic Pain Without Drugs, Thanks to Brain Stimulation


IN BRIEF

This new method of pain treatment can prevent risky side-effects such as addiction, dependence, and overdose-related deaths – and it does so using electricity.

OPIOID MEDICINES

Abuse of prescription pain killers or opioid medicines is common. But then again, how else can you treat chronic pain? Unfortunately, addiction is a terrible side-effect that can lead to overdose-related deaths.

But now a research team from the University of Arlington seems to have found a better and more efficient solution: Electrical stimulation.

By delivering electrical currents—which can block pain signals at the spinal cord level—into a deep, middle brain structure, it might be possible to treat chronic pain without the intervention of drugs. At the same time, the technique can spur the release of dopamine, which helps with the emotional distress typically associated with long-term pain.

A SHOCKING STUDY

“This is the first study to use a wireless electrical device to alleviate pain by directly stimulating the ventral tegmental area of the brain,” said Yuan Bo Peng, UTA psychology professor. “While still under laboratory testing, this new method does provide hope that in the future we will be able to alleviate chronic pain without the side effects of medications.”

Yuan Bo Peng, UTA Psychology Professor.

The team experimented with a custom-built wireless implant, which through electrical stimulation of the ventral tegmental area effectively reduced the sensation of pain, even blocking pain signals in the spinal cord.

This could greatly benefit the almost two million Americans who are addicted or dependent on opioid medicines. The Centers for Disease Control that 165,000 Americans died of opioid-related overdoses from 1999 to 2014.

“Until this study, the ventral tegmental area of the brain was studied more for its key role in positive reinforcement, reward and drug abuse,” said Peng. “We have now confirmed that stimulation of this area of the brain can also be an analgesic tool.”

Source:futurism.com

A new painkiller is being designed that won’t get users high, and it could save thousands of lives


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  • Thousands of Americans are dying from opioid overdoses , but patients with chronic pain are finding it hard to get medications they need.
  • Recent solutions to the problem have focused on making pain pills tougher to abuse, but research suggests that’s not enough.
  • Scientists are now focused on creating painkillers that don’t cause feelings of euphoria.

In the last 16 years, more than 183,000 Americans have died from overdoses related to prescription opioids. As a result, policymakers have tried to make the medications harder to get.

Those efforts seem to have had a somewhat positive impact on the rate of overdoses, but have left patients with chronic pain in a tough spot. Not only is it sometimes hard for these people to get their medications, the increased public attention around opioid risk has made some of them concerned about taking the drugs in the first place – or even having them in the house.

That’s why a handful of companies are focused on creating an entirely new type of painkiller – one that won’t get people hooked. One of those companies is Nektar Therapeutics, which is currently studying a new drug candidate that enters the brain too slowly to cause the feelings of euphoria that many painkillers are known for.

“We have the possibility of being the first new opioid in almost 25 years,” Dr. Stephen K. Doberstein, Nektar’s senior vice president and chief scientific officer, told Business Insider. “I think we’ve reinvented the opioid molecule.”

A drug that enters the brain too slowly to make people feel good

While drugs like oxycodone are excellent at reducing pain, they can also produce powerful feel-good sensations that can be addictive. But recent studies of Nektar’s new painkiller, which is still in clinical trials, suggest that it wouldn’t cause any such high .

The drug is called NKTR-181, though Doberstein likes to call it just “181”.

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“181 is a medicine that I’m very passionate about,” he told Business Insider last year .

On Monday, Nektar released the results of a new study designed to look at how well the drug can relieve chronic low-back pain.

The findings were very positive: More than half (51.1%) of the patients who took NKTR-181 said their pain went down by 50%, as compared to less than 38% of the patients who were given the placebo.

Those results build on previous studies that found the drug did not make patients feel euphoric or high .

“Our answer there – to the question of whether we’re causing euphoria or not – is emphatically no,” Doberstein said.

Nektar isn’t alone in its quest to create a high-free opioid.

Epiodyne, a company started by a research team at the University of San Francisco’s School of Pharmacy, is designing a pain drug that wouldn’t trigger a surge in dopamine , a chemical messenger in the brain that is involved in emotions like desire and pleasure. Other companies have also been showing an interest in such research as opioid overdose deaths continue to spike.

Still, the vast majority of development has gone into making so-called “abuse deterrent” drug formulations – pills designed to be impossible to melt down and inject or smash and snort. Since 2010, the US Food and Drug Administration has approved a handful of these pills, and 30 moreare currently in development.

“Everyone just wants to figure out how to lock it up in a pill better,” Doberstein said.

But there’s little evidence that those deterrents alone can stem the tide of overdose deaths. Promoting abuse-resistant drugs could encourage doctors to continue overprescribing them. And most of the new pills can still be abused when swallowed.

“I am not convinced that we can engineer our way out of this epidemic, and I would caution against over-relying on abuse-deterrent formulations to do so,” Dr. Caleb Alexander, an associate professor of epidemiology at Johns Hopkins, told the Associated Press last year.

That’s where Nektar hopes to come in.

“Our goal here is to have a safe and effective medicine that doctors and patients can feel confident that they’re not going to get high from,” says Doberstein. “That’s something I’m excited about.”

Source:http://www.businessinsider.in

Acupuncture Confirmed Helpful for Chronic Pain


Chronic pain is an exceedingly common condition impacting an estimated 76.5 million Americans, one-third of whom describe their pain as severe and “disabling.” When it comes to treating ailments such as chronic pain, I definitely prefer non-toxic options to modern medicine’s poor excuses for “cures.”

One such option is acupuncture, which can be an effective option for a number of health problems, but pain in particular.

Acupuncture

Story at-a-glance

  • A recent analysis of the most robust studies available concluded that acupuncture has a clear effect in reducing chronic pain, more so than standard pain treatment
  • Study participants receiving acupuncture reported an average 50 percent reduction in pain, compared to a 28 percent pain reduction for standard pain treatment without acupuncture
  • Other treatment modalities for pain include massage, chiropractic, energy psychology tools, and neuro-structural integration technique (NST)
  • Alternatives to over-the-counter and prescription pain medications include astaxanthin, ginger, curcumin, boswellia, cayenne cream, bromelaine, Cetyl Myristoleate, and evening primrose, black currant, and borage oils

In a recent analysis published in the Archives of Internal Medicine,1 researchers concluded that acupuncture has a definite effect in reducing chronic pain, such as back pain and headaches – more so than standard pain treatment. Real acupuncture also produced slightly better results than using sham needles, which suggests the benefits of needling are due to more than the placebo effect.

Watch the video. URL:https://youtu.be/dhhdmahBQU8

According to Time magazine:2

“The findings counter those of the last large study on the subject, which found that the needle technique was no better than a fake acupuncture treatment – using random pricking with toothpicks – in reducing people’s pain. But Vickers says his meta-analysis of the data, in which researchers reviewed 29 previous studies involving 17,922 participants, does a few things the previous studies did not.

For one, he and his colleagues began by looking at only the most rigorous trials involving acupuncture and pain relief – those that directly compared acupuncture treatment with some type of sham needle therapy in which needles were either inserted only superficially or placed in locations that are not known by acupuncture standards to be key treatment points in the body.

The authors of the analysis contacted each of the researchers on the previous studies to discuss with them how they separated the two treatment groups. By limiting their review to the most robust studies published, the authors could assess with more confidence acupuncture’s true effect on participants’ reports of pain before and after treatment.”

Clear and Robust Effects of Acupuncture

The researchers also went the extra mile by retrieving the raw data on self-reported pain. By standardizing the various study participants’ responses, they were able to more accurately assess and compare them as a whole. The team discovered a “clear and robust” effect of acupuncture in the treatment of:

  • Back pain
  • Neck pain
  • Shoulder pain
  • Osteoarthritis
  • Headaches

On a scale of 0 to 100, participants who started out with a pain rating of 60 experienced an average 30 point drop (a 50 percent reduction) in response to the real acupuncture treatments (using needles); a 25 point drop when receiving sham acupuncture; and a mere 17 point drop when receiving “standard pain care” that did not include acupuncture. According to the lead author:3

“The effects of acupuncture are statistically significant and different from those of sham or placebo treatments… So we conclude that the effects aren’t due merely to the placebo effect.”

Furthermore, as reported by HealthDay:4

“The authors stressed that although the superiority of true acupuncture over sham acupuncture appeared to be relatively small, the real-world choice patients face is not between acupuncture or fake acupuncture but rather between acupuncture or no acupuncture at all. And in that context they suggested that their findings are ‘of major importance for clinical practice.’

‘Basically what we see here is that the pain relief difference from acupuncture versus no acupuncture is notable, and important, and difficult to ignore,’ [lead author] Vickers said.”

What is Acupuncture?

Acupuncture is an ancient Chinese medical practice with roots that go back thousands of years. According to the Eastern mindset, your body is a cohesive unit, or whole – a complex system where everything within it is inter-connected, and where each part affects all other parts. A major component is the acceptance of an invisible flow of chi (or ki). This chi can be translated as “energy” or “life force,” which circulates through meridians in your body. When energetic blocks or deficiencies occur within a meridian, an imbalance is created that can cause a ripple effect of physical symptoms. Needles inserted into certain points along the meridians can stimulate sluggish chi, disperse blocks, or otherwise manipulate the flow of energy.

 

In essence, lack of balance within this bio-energetic system – which also includes blood flow and nutrients – is the precursor to all illness. Your body exhibits symptoms when suffering from inner disease and if it is not rebalanced, these symptoms may lead to acute or chronic illnesses of all kinds.

Chinese medicine, contrary to Western allopathic medicine, does not treat symptoms, but rather seeks to find the origin of the imbalance that produced the symptoms in the first place. Another major difference is that acupuncture, which is part of Traditional Chinese Medicine (TCM), is remarkably safe with few, if any, negative side effects, so it certainly doesn’t hurt to try.

Traditionally, acupuncture is used to treat all kinds of health problems. In many Asian cultures, you see an acupuncturist in the same way you’d see a primary care physician here in the West, and in some US states acupuncturists are in fact considered primary health care physicians. Still, many Westerners have been slow to grasp this type of holistic view, where your body is perceived as being perfectly capable of self-correction and healing without drug intervention. Scientists are still at a loss to explain why acupuncture works, but for those who get relief or healing, the mechanics may not be of great importance.

Other Alternative Pain Treatments

Besides acupuncture, there are a number of treatment modalities that can help ease pain, such as:

  • Emotional Freedom Technique (EFT): Few people want to be told that their pain is psychological or emotional in origin, but there’s quite a bit of evidence that backs this up. Underlying emotional issues and unresolved trauma can have a massive influence on your health, particularly as it relates to physical pain. According to Dr. John Sarno, a psychiatrist who uses mind-body techniques to treat patients with severe low back pain, EFT has a greater than 80 percent success rate
  • Chiropractic adjustments: According to a recent study published in the Annals of Internal Medicine5 and funded by the National Institutes of Health, patients with neck pain who used a chiropractor and/or exercise were more than twice as likely to be pain free in 12 weeks compared to those who took medication
  • Massage: Massage releases endorphins, which help induce relaxation, relieve pain, and reduce levels of stress chemicals such as cortisol and noradrenaline – reversing the damaging effects of stress by slowing heart rate, respiration and metabolism and lowering raised blood pressure. It is a particularly effective therapy for stress-related tension, which experts believe accounts for as much as 80 to 90 percent of disease
  • Neuro-Structural Integration Technique (NST): NST is a gentle, non-invasive technique that stimulates your body’s reflexes, which can provide relief for back pain. Simple movements are done across muscles, nerves and connective tissue, which helps your neuromuscular system to reset all related tension levels, promoting natural healing. The results can be both profound and lasting, and are usually apparent within two or three sessions.

More Natural Solutions for Pain

If you have chronic pain of any kind, please understand that there are many safe and effective alternatives to prescription and over-the-counter painkillers, though they may require some patience. Among the best are:

  • Start taking a high-quality, animal-based omega-3 fat like krill oil. Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work, they positively influence prostaglandins.) The omega-3 fats EPA and DHA contained in krill oil have also been found in many animal and clinical studies to have anti-inflammatory properties.
  • Reduce your intake of most processed foods as not only do they contain sugar and additives but most are loaded with omega-6 fats that upset your delicate omega 3-6 ratio, which will contribute to inflammation.
  • Eliminate or radically reduce most grains and sugars (especially fructose) from your diet. Avoiding grains and sugars will lower your insulin and leptin levels. Elevated insulin and leptin levels are one of the most profound stimulators of inflammatory prostaglandin production. That is why eliminating sugar and grains is so important to controlling your pain.
  • Optimize your production of vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain.

In the meantime, you don’t need to suffer unnecessarily. Following are options that provide excellent pain relief without any of the health hazards that pain medications often carry.

  • Astaxanthin: One of the most effective oil-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than NSAIDs. Higher doses are typically required and one may need 8 mg or more per day to achieve this benefit.
  • Ginger: This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.
  • Curcumin: Curcumin is the primary therapeutic compound identified in the spice turmeric. In a study of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility. In fact, curcumin has been shown in over 50 clinical studies to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce Tylenol-associated adverse health effects.
  • Boswellia: Also known as boswellin or “Indian frankincense,” this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years. This is one of my personal favorites as I have seen it work well with many rheumatoid arthritis patients.
  • Bromelain: This protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful. Keep in mind that most of the bromelain is found within the core of the pineapple, so consider leaving a little of the pulpy core intact when you consume the fruit.
  • Cetyl Myristoleate (CMO): This oil, found in fish and dairy butter, acts as a “joint lubricant” and an anti-inflammatory. I have used a topical preparation for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards.
  • Evening Primrose, Black Currant and Borage Oils: These contain the fatty acid gamma linolenic acid (GLA), which is useful for treating arthritic pain.
  • Cayenne Cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body’s supply of substance P, a chemical component of nerve cells that transmit pain signals to your brain.

 Can you zap your brain back to health? Electrifying brain circuits may decrease depressive symptoms and chronic pain


brain

Rather than taking medication, a growing number of people who suffer from chronic pain, epilepsy and drug cravings are zapping their skulls in the hopes that a weak electric current will jolt them back to health.

This brain hacking—”transcranial direct current stimulation” (tDCS)—is used to treat neurological and psychiatric symptoms. A do-it-yourself community has sprouted on Reddit, providing unconventional tips for how to use a weak electric current to treat everything from depression to schizophrenia. People are even using commercial tDCS equipment to improve their gaming ability. But tDCS is not approved by the U.S. Food and Drug Administration, and scientists are split on its efficacy, with some calling it quackery and bad science.

Here’s the issue: Until now, scientists have been unable to look under the hood of this do-it-yourself therapeutic technique to understand what is happening. Danny JJ Wang, a professor of neurology at the USC Mark and Mary Stevens Neuroimaging and Informatics Institute, said his team is the first to develop an MRI method whereby the magnetic fields induced by tDCS currents can be visualized in living humans. Their results were published Oct. 4 in Scientific Reports, a Nature Publishing Group journal.

“Although this therapy is taking off at the grassroots level and in academia [with an exponential increase in publications], evidence that tDCS does what is being promised is not conclusive,” said Wang, the study’s senior author. “Scientists don’t yet understand the mechanisms at work, which prevents the FDA from regulating the therapy. Our study is the first step to experimentally map the tDCS currents in the brain and to provide solid data so researchers can develop science-based treatment.”

People in antiquity used electric fish to zap away headaches, but tDCS, as it is now known, was introduced in 2000, said Mayank Jog, study lead author and a graduate student conducting research at the David Geffen School of Medicine at UCLA.

“Since then, this noninvasive, easy-to-use, low-cost technology has been shown to improve cognition as well as treat clinical symptoms,” Jog said.

The study is a technological breakthrough, said Maron Bikson, study co-author and a professor of biomedical engineering at The City College of New York.

“You cannot characterize what you cannot see, so this is a pivotal step in the development of tDCS technology,” Bikson said.

How tDCS works

The science on tDCS is inconclusive. The brain-hacking technique has been shown to improve symptoms in a wide swath of neurological and psychiatric disorders, including depression, drug cravings and stroke. Scientists also have pointed to how it enhances learning, affects working memory and imparts other cognitive benefits among healthy people. However, some people say tDCS is ineffective and even harmful. In rare cases, the technique causes burns where the electrodes were applied.

Researchers have mapped the human brain and demonstrated that putting a positive current (anode) in one area and a negative current (cathode) in another will foster an environment that prompts nearby neurons either to fire more rapidly or slowly, respectively.

Theoretically, putting an anode on the right prefrontal (right side of the forehead) and parietal lobe (above the eyes and behind the right ear) influences the executive network and could enhance attention and motor ability, Wang said. Stroke patients could apply an anode in the damaged hemisphere and a cathode in the good hemisphere. This rehabilitative technique may suppress the healthy part of the brain from overcompensating and pushes the damaged area to try to become fit again.

“This technique is very cheap,” Jog said. “You can do it at home. Most studies show people only need two weeks to show improvements, and the effects can last beyond the treatment period. So the technique fosters hope, but researchers need to get a better grasp on what is happening.”

There has been some debate about whether the 1-2 milliamp (mA) zap that creates a tingling sensation in most people actually travels to the brain. A New York University researcher tested tDCS on a cadaver and said no current reached the brain. He insisted that at least 4 mA—roughly equivalent to the discharge of a stun gun—is needed to stimulate neurons to fire.

Wang, however, said tDCS does not cause neurons to fire. It creates an environment that makes it more or less likely for neurons to fire.

A new way to visualize the current delivered to the brain

The researchers validated their MRI algorithm with a phantom, where the current path and induced was known. Then they tested the method using simple biological tissue: a human calf. Finally, they repeated the process on the scalp of 12 healthy volunteers.

After 20 to 30 minutes in a scanner, the new algorithm produced an image of the magnetic field tDCS created. Researchers noted that a current did enter the body and brain. Next, scientists compared the technique with that of a computer simulation.

The phantom test highly matched the computational modeling, thus verifying the algorithm. The calf test was a moderate match. The brain test showed expected magnetic field changes under and between the electrodes. However, computational modeling was not performed on the brain test because there are too many variables, strengthening the argument that using is not ideal for understanding what really happens inside people’s heads when tDCS is applied, Wang said.

Another tDCS measurement technique in use today is fMRI, which looks at the change in blood-oxygen levels to infer which areas the current passes through. This measurement is not directly related to the electric current and could introduce false positives. So rather than playing a game of telephone, it is best to go to the primary source.

“Scientists who have comprehensively studied the tDCS literature are in broad agreement that tDCS can change function, but that application in central health and neuro-enhancement will benefit from a deeper understanding of mechanism and enhanced technology,” Bikson said. “This study is an important step in both directions.”

New Device Can Ease Chronic Pain Without Drugs, Thanks to Brain Stimulation


IN BRIEF

This new method of pain treatment can prevent risky side-effects such as addiction, dependence, and overdose-related deaths – and it does so using electricity.

OPIOID MEDICINES

Abuse of prescription pain killers or opioid medicines is common. But then again, how else can you treat chronic pain? Unfortunately, addiction is a terrible side-effect that can lead to overdose-related deaths.

But now a research team from the University of Arlington seems to have found a better and more efficient solution: Electrical stimulation.

By delivering electrical currents—which can block pain signals at the spinal cord level—into a deep, middle brain structure, it might be possible to treat chronic pain without the intervention of drugs. At the same time, the technique can spur the release of dopamine, which helps with the emotional distress typically associated with long-term pain.

A SHOCKING STUDY

“This is the first study to use a wireless electrical device to alleviate pain by directly stimulating the ventral tegmental area of the brain,” said Yuan Bo Peng, UTA psychology professor. “While still under laboratory testing, this new method does provide hope that in the future we will be able to alleviate chronic pain without the side effects of medications.”

Yuan Bo Peng, UTA Psychology Professor. 

The team experimented with a custom-built wireless implant, which through electrical stimulation of the ventral tegmental area effectively reduced the sensation of pain, even blocking pain signals in the spinal cord.

This could greatly benefit the almost two million Americans who are addicted or dependent on opioid medicines. The Centers for Disease Control that 165,000 Americans died of opioid-related overdoses from 1999 to 2014.

“Until this study, the ventral tegmental area of the brain was studied more for its key role in positive reinforcement, reward and drug abuse,” said Peng. “We have now confirmed that stimulation of this area of the brain can also be an analgesic tool.”