As many people known, pets can bring joy, excitement and energy into a home. What’s less well-known is that pets may also improve your physical and mental health – and help to improve pain levels in the process.

Physical Improvements

Obviously exercise is a key component to healthful living (and pain relief), and pets – especially dogs – are a great way to help you get out of the house and start exercising regularly. Dog owners are actually 54% more likely than non-dog owners to get their daily recommended level of physical activity.[1] Going on walks, throwing the ball around and going to the park can not only serve to make your furry friend happy, but also loosen up your muscles, lubricate your joints and help you shed a few extra pounds, which can all serve to lessen pain levels.

Pets have also been shown to have various other physical benefits. Owning a pet has been associated with lower blood pressure and cholesterol levels, as well as a lower likelihood of obesity.[1]

Social Improvements

The common adage “man’s best friend” belies an underlying fact about animals: They are a great means of social support. For more than half of pet owners, pets are considered as much a member of the family as a spouse or child. In fact, 35% of married or cohabitating people say their pet is a better listener than their spouse.[2] Plus, pets can help you meet other like-minded individuals, whether that’s on a walk, during a training class or at a doggy daycare.

According to APM behavioral health specialist Mary Papandria, surrounding yourself with supportive individuals – or pets – can help you stay positive when pain is at its worst. Without adequate social support, she says, individuals can often experience a worsened perception of pain, increased disability and lessened benefits from treatment.

Numerous studies have shown that having adequate social support can lead to better psychological and physiological health.[2] Greater social support can improve heart and immune system health – in addition to self-esteem – while poor social support has been found to correlate to increased mortality rates.

Mental Improvements

One of the main ways pets can help those in pain is through boosting their overall mood. Those experiencing chronic pain often deal with abnormally high levels of anxiety and depression, but pets can help combat that. For one, the social support that pets lend has been shown to help people feel more relaxed and less stressed.[3] Pet owners also tend to experience a higher sense of well-being. [2][3] This may be due, in part, to the responsibility of owning a pet. Researchers have suggested that taking care of an animal may give people a sense of purpose.[3] This may even correlate to better functional ability; in older populations, those with a dog or cat have been shown to better perform daily activities, like climbing the stairs or bending and kneeling.[3]

Pets also offer a source of distraction, which is often important for pain sufferers when pain is particularly bad.

Pets and Traditional Care

For those who are able to adequately take care of a pet, they can be an enriching – and sometimes pain-relieving – addition to your life. Like other kinds of social support, it’s possible that owning a pet can help people respond better to various types of treatments. Plus, an effective treatment plan can help relieve pain and restore function, meaning you can spend more time with your furry friend. Now that sounds like a positive cycle.

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[1] Levine, Glenn N., Karen Allen, Lynne T. Braun, Hayley E. Christian, Erika Friedmann, Kathryn A. Taubert, Sue Ann Thomas, Deborah L. Wells and Richard A. Lange. “Pet Ownership and Cardiovascular Risk: A Scientific Statement from the American Heart Association.” Circulation (May 9, 2013).

[2] McConnell, Allen R., Christina M. Brown, Tonya M. Shoda, Laura E. Stayton, and Colleen E. Martin. “Friends with Benefits: On the Positive Consequences of Pet Ownership.” Journal of Personality and Social Psychology 101, no. 6 (2011): 1239–52. doi:10.1037/a0024506.

[3] Casciotti, Dana and Diana Zuckerman. “The Benefits of Pets for Human Health.” National Center for Health Research (2016). Accessed September 13, 2016.

When it comes to controlling pain symptoms, many sufferers opt out of prescription pills and instead gravitate toward a more natural solution: herbal supplements. And it makes sense, since plants have been used for centuries as go-to remedies for a plethora of conditions. But not all supplements are as effective as touted – and some come with serious side effects.

Drawbacks to Herbal Supplements

Herbal supplements aren’t held to the same rigorous standards as that of traditional medications.[1] That means that, according to the journal Surgical Neurology International, “some manufacturers inflate products’ claims and may not cite possible side effects and potential drug interactions.” And while they are still inspected by government agencies, since they are considered a food item, their preparation is not standardized, meaning the true concentration of the drug may vary between brands – and even sometimes within a brand.

This lack of regulation and standardization has made it difficult for researchers to study the true effectiveness and potential side effects of these natural remedies. However, there is initial, promising research for various supplements, although more research is needed.

Commonly Used Supplements

Chronic inflammation is at the core of many pain-causing conditions. Certain herbs can help control and reduce this inflammation, aiding with both pain relief and healing. Below are a few commonly used plant-based pain remedies. Before starting any supplement, always consult your healthcare provider.

  • White willow bark: As early as 400 BC, people were utilizing willow bark to reduce pain and inflammation.[2] Its use has continued throughout the centuries and it’s now used commonly to treat such conditions as back pain, joint pain, osteoarthritis, headaches and tendinitis. Willow bark works similarly to aspirin in reducing inflammation, but it isn’t accompanied by aspirin’s dangerous gastric side effects.[1] Current research on the plant has been promising, with various randomized trials demonstrating an efficacy similar to aspirin. 1[3][4] The supplement can cost more than aspirin, however, and shouldn’t be used in any situation in which taking aspirin would be dangerous.

  • Omega-3: Omega-3s (fish oil) have been used as a form of treatment since the late 18th[1] And for good reason. Omega-3 polyunsaturated fatty acids have since been shown to be incredibly effective in terms of decreasing inflammation. Currently, it‘s recommended by the American Heart Association to decrease vascular inflammation and thus help in the prevention of coronary artery disease.[1] Currently research suggests omega-3s may help moderately improve such conditions as arthritis,[5][6] non-surgical back and neck pain and cervical and lumbar disc disease,[7] allowing people to rely less on NSAIDs. Unfortunately, most of the studies on omega-3s and pain are small and the topic warrants further investigation.

  • Frankincense (bowswellia serrate): Boswellia is a species of tree and the resin, more commonly known as frankincense, has been shown to have anti-inflammatory and anti-arthritic properties. It was traditionally used as a component in folk medicine to treat chronic inflammatory diseases. In more recent years, small studies have shown boswellia’s positive effects on such conditions as osteoarthritis and rheumatoid arthritis.[8]

Supplements and Integrative Care

Some natural supplements on their own may provide noticeable relief of pain and inflammation. But to achieve optimal pain relief, natural supplements should ideally be paired with more conventional treatments, like physical therapy and a balanced diet, as well as interventional treatments, like injections and nerve blocks. An integrative model like this addresses pain and inflammation through a variety of channels, thereby ensuring optimal pain relief.

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[1] Bost, JeffreyW, Adara Maroon, and Joseph C. Maroon. “Natural Anti-Inflammatory Agents for Pain Relief.” Surgical Neurology International 1 (December 13, 2010): 80.

[2] University of Maryland Medical Center. “Willow Bark.” August 05, 2015. Accessed February 9, 2017.

[3] Schmid, B, R Lüdtke, H-K Selbmann, I Kötter, B Tschirdewahn, W Schaffner, and L Heide. “Efficacy and Tolerability of a Standardized Willow Bark Extract in Patients with Osteoarthritis: Randomized Placebo-Controlled, Double Blind Clinical Trial.” Phytotherapy Research 15, no. 4 (June 2001): 344–50.

[4] Shara, Mohd and Sidney J. Stohs. “Efficacy and Safety of White Willow Bark ( Salix Alba ) Extracts.” Phytotherapy Research 29, no. 8 (May 22, 2015): 1112–16.

[5] The Natural Standard Research Collaboration. “Omega-3 Fatty Acids, Fish Oil, Alpha-Linolenic Acid.” November 01, 2013. Accessed February 9, 2017.

[6] University of Maryland Medical Center. “Omega-3 Fatty Acids.” Accessed February 9, 2017.

[7] Maroon, Joseph Charles and Jeffrey W. Bost. “Ω-3 Fatty Acids (fish Oil) as an Anti-Inflammatory: An Alternative to Nonsteroidal Anti-Inflammatory Drugs for Discogenic Pain.” Surgical Neurology 65, no. 4 (April 2006): 326–31.

[8] Siddiqui, M. Z. “Boswellia Serrata, A Potential Antiinflammatory Agent: An Overview.” Indian Journal of Pharmaceutical Sciences 73, no. 3 (May-June 2011): 255-261.

Chiropractor. Pain professional. Primary care physician. Acupuncturist. When it comes treating your pain, there are a lot of routes you can choose. But evaluating your options, sifting through the plethora of information out there and determining the best plan of care for your particular situation can be an overwhelming task. Understanding the differences between your options can be the first step toward getting the best possible care. Let’s start with primary care physicians and pain management doctors.

The Benefits of Primary Care

Primary care physicians (PCPs) see roughly 52% of the chronic pain patients receiving treatment in the U.S.[1] Of the remaining patients, 40% see chiropractors, 7% see acupuncturists and 2% see pain physicians. Clearly, PCPs are trusted and sought out as one of the first lines of defense in pain care. Much of that is likely due to their training and relationship with patients, in addition to their ability to refer patients to a variety of specialists and coordinate care accordingly.

Primary care physicians are highly trained in the medical field. In addition to four years of medical school, PCPs usually spend three to seven years in internship and residency programs – typically in either family medicine, internal medicine or pediatrics.[2] During that time, they receive training in diagnosing and treating the most common health problems, in addition to perfecting the interpersonal communications skills necessary to work effectively in a 1-on-1 patient environment.

Since PCPs work with a consistent patient base, guiding individuals through multiple instances of illness or injury, they have the opportunity to form closer relationships with their patients than many specialists do. This can contribute to greater knowledge about each patient, better communication and increased levels of trust.[3]

Primary Care and Pain

PCPs are no doubt knowledge on a wide variety of conditions and health issues, but there are areas in which their training differs from than that obtained by specialists. One such region is pain. According to the book Relieving Pain in America, while treating pain is an essential aspect of primary care, “there are strong indications that pain receives insufficient attention in virtually all phases of medical education.”[4] In other words, there are indicators that the treatment of pain is not being taught adequately in medical schools, residency programs or even continuing education courses.

As of 2011, only four U.S. medical schools offered a required course specifically on the topic of pain, although the topic was covered in a general course at 80% of schools. Canadian schools, in comparison, had twice the hours of instruction on pain topics. The Journal of Pain study which presented this finding concluded that “pain education for North American medical students is limited, variable, and often fragmentary.”[5]

Understandably, many primary care physicians don’t feel adequately prepared to manage pain. In fact, in a survey of 500 PCPs, “only 34% reported feeling comfortable treating people with chronic noncancer pain.”[4]

That’s where pain specialists come in.

Coordinated Care with Pain Specialists

A 2011 report from the Institute of Medicine recommended that “primary care physicians – who handle most frontline pain care – should collaborate with pain specialists in cases where pain persists.”[6] That’s because the training pain physicians receive makes them especially qualified to deal with long-lasting or difficult to treat pain.

Advanced Pain Management physicians, for instance, are well-trained in the area of pain. They’re highly educated and credentialed in pain management and anesthesiology, in addition to possessing specialty internship and fellowship training. (A fellowship occurs after a residency and provides more training in a desired subspecialty.) Throughout all of this training, pain specialists gain an in-depth knowledge of the physiology of pain, in addition to a thorough understanding of the skills necessary to perform interventional, pain-reducing procedures. They also study the specialized tests necessary for diagnosing pain conditions and the appropriate prescribing methods for pain medications.[7]

While Advance Pain Management (APM) doesn’t require a referral from your PCP, we are committed to working with your existing healthcare team to coordinate your care for the best possible outcome. This may also include working with other specialists, including physical therapists and behavioral health providers, to adequately address all aspects of your pain condition. By incorporating a team from an array of specialties, each with their own strengths and skills, you can be assured of a personalized, effective care plan best suited for your needs.


[1] Breuer, Brenda, Ricardo Cruciani, and Russell K. Portenoy. "Pain Management by Primary Care Physicians, Pain Physicians, Chiropractors, and Acupuncturists: A National Survey." Southern Medical Journal 103, no. 8 (August 2010): 738-47.

[2] The Road to Becoming a Doctor. Washington, D.C.: Association of American Medical Colleges.

[3] Parchman, Michael L., Sandra Burge. “The Patient-Physician Relationship, Primary Care Attributes, and Preventive Services.” Family Medicine 36, no. 1 (2003):22-7.

[4] Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, D.C.: National Academies Press, 2011.

[5] Mezei, Lina, and Beth B. Murinson. "Pain Education in North American Medical Schools." The Journal of Pain 12, no. 12 (December 2011): 1199-208.

[6] "Report Brief: Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research." Institute of Medicine of the National Academies, June 2011.

[7] "The Specialty of Chronic Pain Management." The American Society of Regional Anesthesia and Pain Medicine. 2014. Accessed March 14, 2016.

Get moving. Call (888) 901-PAIN (7246) or click to schedule a consultation now.

Toward the end of September and beginning of October, a plethora of crops are ready to harvest. Tomatoes, peppers, melons and squash, including pumpkins, continue to ripen and will fill our harvest baskets until the first killing frost, says gardening expert Melinda Myers. “And, even with cooler temperatures,” she says, “mid-summer plantings of cool crops like broccoli, Brussels sprouts, cauliflower and kale will mature. Their flavor actually improves after a light frost.” Even late plantings of things like greens, radishes, turnips and beets continue to grow and can be harvested as they mature throughout the fall season.

But before you head out to the garden to start gathering your harvest haul, make sure you know the best way to pick your plants in order to avoid doing damage – to both the plants themselves and to your body.

Grab the Right Tools

“Too often we head to the garden for a few minutes,” says Myers, “and an hour and a half later we are still out there, often without the equipment that protects our bodies.” Don’t fall into that trap. Without the right tools, you run the risk of hurting yourself and damaging your plants to the point where they will no longer keep producing

Consider investing in a sharp knife or garden scissors, which can make harvesting easier and do less damage than picking. For fruit trees, physical therapist Courtney Wack suggests using an apple picker to minimize repetitive hand motions.

When shopping for tools, “buy tools with wider handles, or bulk them up yourself with foam or a washcloth and some tape,” Wack suggests. This, along with stretching out your hands and wrists, can reduce the risk of hand pain later, especially for those suffering from arthritis.

And to reduce the risk of knee pain during prolonged periods of kneeling, a padded knee pad combined with a proper stance can go a long way. With the kneeler in position, drop down onto one knee and keep one foot one the ground to give your back more stability.

Carry Carefully

When it comes to transporting your haul to the house, make sure to do so carefully; fruits and vegetables can easily sustain damage en route, and so can you. “Stack veggies in a shallow basket or crate to minimize bruising,” says Myers. And empty the basket often, both to prevent bruising and because carrying too much weight in front of you can increase the strain on your back.

For greens like lettuce (on which you harvest the outer leaves when they reach 4 to 6 inches) and chard (8 to 10 inches), take a bucket of water into the garden and place the greens into it to keep them fresh.

To haul your harvest back indoors, squat to grab your basket of produce, tightening your core muscles, then lift with your legs. Don’t forget to keep the basket or crate close to you as you walk and avoid twisting at the waist. Or consider looking for a basket or bag you can wear on your back and use both straps to disperse the weight more evenly.

Protecting Perennials

Perennial plants like raspberries, strawberries and fruit trees, along with spring-harvested perennials like asparagus and rhubarb, require their own kind of care to protect them throughout the winter. “Do not fertilize them now,” warns Myers, since “fertilization stimulates late-season growth that can be killed in winter.” After a frost, she advises, remove any diseased or insect-infected leaves, but do not compost. Instead, contact your city for ideas on how to dispose of this type of material.

For protection from animals, consider erecting a fence around your fruit trees and bushes or use a repellent labeled for use on edibles. Scaring the animal away through the use of visual or auditory scare devices is also an option, although it’s not as effective in urban areas. In suburban and rural areas, noise-makers and motion-activated water sprayers may be useful. Or try visual items like reflective tape or predator statues to keep critters at bay. For the best results, use a combination of tactics, monitor them throughout the year and make adjustments as needed.

Pace Yourself

Although it’s tempting, don’t try to harvest all of your plants in one day. Spread it out over multiple days to reduce the risk of overworking yourself and your muscles. If you do pull a long harvesting shift, though, make sure to take frequent breaks, walking around and stretching every 20-30 minutes.

You can also try to enlist the help of a friend – both to share in the work and take home some of the produce. Having a partner means being able to switch between strenuous tasks, like carrying or picking produce, and easier ones, or even allow you time to rest. Besides, says Myers, “most gardeners plant more than they can use.” You’ll be grateful for both the extra help in the garden and the fact that they take some of your bountiful harvest off your hands.

Weed Out The Pain Toolkit Download

Thursday, 02 November 2017 11:31

New Study Suggests Morphine could Prolong Pain

It’s well-known in the medical world that the drugs often prescribed to treat pain – morphine, oxycodone and other opioids – can actually make patients more sensitive to pain (a side effect called hyperalgesia). But a study published in May in the Proceedings of the National Academy of Sciences[1] found even more evidence of the serious side effects of opioids – especially when prescribed at the onset of pain. The authors discovered that these drugs, when administered after a nerve injury, actually doubled the duration of the pain.

Overview of the Study

 “Pain after disease/damage of the nervous system is predominantly treated with opioids, but without exploration of the long-term consequences,” the study says. So to delve further into these consequences – particularly to test their hypothesis that morphine may contribute to “persistent sensitization,” as they call it – the study’s authors conducted a study on rats whose sciatic nerves (a nerve running down their hind legs) had been painfully constricted.

Ten days after the constriction, the rats were given either saline or morphine for five days. Over the next three months, the rats’ sensitivity to pain was tested.[2] The researchers found that the rats who received saline returned to normal sensitivity levels within about six weeks, while those who had morphine took 12 weeks to recover (in addition to experiencing increased sensitivity overall).  

The data, the authors concluded, showed that not only can morphine amplify pain (hyperalgesia), but it can also seriously prolong it, even after the treatment is stopped. This seems to be due to an inflammatory response taking place in the spinal cord.


There are several limitations to the study. Since the study was undertaken on rats, there is no guarantee that the process works the same way in humans. In addition, the rats were genetically similar – and all male – meaning that the human reaction to morphine may not be so homogeneous (although there is unpublished data that supports the idea that morphine could extend pain even longer for female rats).[3]


Researchers are already working on drugs and methods to intercept and reverse the inflammatory response caused by morphine. In fact, this study also found that by inhibiting the inflammatory responses, they could permanently reset the amplified pain to normal levels. This could prove useful down the road in making opioids more effective – thus requiring lower doses and lessening the chances of overdose. 

However, for the time being, this study reinforces the already strong indication that opioids should be prescribed with caution. Their large number of serious side effects, paired with the lack of evidence showing any long-term benefit,[4] suggests the need for other treatments to deal with pain. Minimally invasive procedures or complementary treatments – like physical therapy or behavioral health – may help to fill this gap.

Download your free opioids and pain in-depth guide

[1] Grace, Peter M., Keith A. Strand, Erika L. Galer, Daniel J. Urban, Xiaohui Wang, Michael V. Baratta, Timothy J. Fabisiak, Nathan D. Anderson, Kejun Cheng, Lisa I. Greene, Debra Berkelhammer, Yingning Zhang, Amanda L. Ellis, Hang Hubert Yin, Serge Campeau, Kenner C. Rice, Bryan L. Roth, Steven F. Maier, and Linda R. Watkins. "Morphine Paradoxically Prolongs Neuropathic Pain in Rats by Amplifying Spinal NLRP3 Inflammasome Activation." Proceedings of the National Academy of Sciences 113, no. 24 (May 2016).

[2] Servick, Kelly. "Why Taking Morphine, Oxycodone Can Sometimes Make Pain Worse." American Association for the Advancement of Science. May 30, 2016. Accessed July 19, 2016.

[3] Sanders, Laura. "Morphine May Make Pain Last Longer." Science News. May 30, 2016. Accessed July 19, 2016.

[4] Dowell, Deborah, Tamara M. Haegerich, and Roger Chou. "CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016." Morbidity and Mortality Weekly Report (MMWR) 65, no. 1 (March 18, 2016): 1-49.

The placebo effect is well-known, especially when it comes to clinical trials. Conventionally, patients receive a placebo believing they are getting an active medication and afterward report improved symptoms. But the ethical problem of giving patients a placebo without their knowledge has impeded its use as a treatment method. Until now, that is. A new study[1] has found that patients who knowingly take a placebo for the treatment of chronic low back pain see improvements in both pain and function – which could lead to another avenue of treatment for those battling chronic pain.

Study Overview

The study, titled “Open-Label Placebo Treatment in Chronic Low Back Pain,” was published in the December issue of PAIN, the official journal of the International Association for the Study of Pain.

The authors selected 97 patients (83 of whom completed the trial) with chronic low back pain, who were then examined by a nurse and board certified pain specialist before receiving a brief overview of the placebo effect. The majority of these patients were already undergoing some kind of treatment for their pain, mostly NSAIDs. (Patients taking opioids were not included in the study.)

Some of the patients were instructed to continue with their treatment as usual, while the others were told to add a placebo pill (in a bottle clearly labeled “Placebo”) twice daily to their existing regime. They were instructed not to make any other lifestyle or medication changes during the study. Both groups spent three weeks doing their respective treatments, while monitoring their average, minimum and maximum pain levels, as well as their level of disability. At the end of the trial, the group that did not take placebo was also given the chance to incorporate it into their treatment for three weeks.

Key Findings

At the end of the three weeks, both groups of patients were brought in for an interview, during which they rated their maximum, minimum and usual pain, as well as their back-related dysfunction. Those in the placebo group experienced a 30% reduction in both usual and maximum pain, while those in the normal treatment group only experienced a 9% reduction in usual pain and a 16% reduction in maximum pain.

Similarly, the placebo group saw a 29% drop in pain-related disability, while those in the normal treatment group saw almost no improvement.[2] These results were seen despite the fact that 70% of the placebo group was initially either skeptical of the placebo or didn’t believe it would have much of an effect.

After the normal treatment group was allowed to utilize placebos for three weeks, they also saw significant pain relief (a 29% decrease in maximum pain and a 46% decrease in minimum pain) and an improvement in back-related disability (which decreased by 40%).

Implications for the Future

It’s not entirely clear why placebos produced such staggering pain relief, but the researchers did put forth several theories. The success could be due, in part, to the positive way placebos were introduced to the group. Presenting the experiment to participants in a positive manner – for instance, as a “novel mind-body clinical” option – may have helped curate hope in the participants. For chronic pain patients who often feel hopeless in the face of ineffective treatment options, this may have been enough to convince them to suspend their disbelief, the researchers hypothesize.

The effects could also be attributed to the physical process of taking a pill. Several other studies have recently shown that the ritual aspects related to pill-taking – like opening the bottle and swallowing – may be linked to positive placebo responses.

No matter the reason, what is clear is that many patients currently suffering from chronic low back pain – and possibly other chronic conditions, as well – might benefit from adding a placebo to their treatment plan. While further studies are necessary to determine how best to utilize this new information on the placebo effect  and how it might relate to longer-term relief, these findings do suggest that placebos may eventually become an important component of treatment, reducing the need for other (possibly harmful) types of drugs.

Download your free opioids and pain in-depth guide

[1] Carvalho, Cláudia, Joaquim Machado Caetano, Lidia Cunha, Paula Rebouta, Ted J. Kaptchuk, and Irving Kirsch. “Open-Label Placebo Treatment in Chronic Low Back Pain.” PAIN 157, no. 12 (December 2016): 2766–72.

[2] “Study Finds Knowingly Taking Placebo Pills Eases Pain.” October 14, 2016. Accessed November 11, 2016.

The search for new pain-fighting drugs has been a difficult one. For the past 20 years, drug after drug has failed in the clinical trial stage, unsuccessfully addressing the pain they were created to relieve.[1] But a new study released this month may have found the key. It’s called Substance P – and it could mean better pain control in the coming years.

Study Overview

The study, published August 1 in the journal Antioxidants and Redox Signaling, was put together by researchers from China’s Hebei Medical University and the UK’s University of Leeds.[2] The study particularly looked at how this substance – neuropeptide Substance P – acted within nerve cells in lab and animal models.

Substance P is released by your body in response to “noxious stimuli,” or stressors. Although it has already been established that Substance P has “excitatory effects” on the central nervous system, this study sought to better determine its effects on the peripheral nervous system.

The study focused solely on acute pain, but lead researcher, Dr. Nikita Gamper from the University of Leeds, also plans to look at Substance P’s role in chronic pain. This research was sponsored by the UK’s Medical Research Council and China’s National Basic Research Program and National Natural Science Foundation.[1]

Important Findings

The researchers found that Substance P has the opposite effect on the peripheral nervous system than it does on the central nervous system. While in the central nervous system it excites neurons and promotes pain, it can actually work in the peripheral nervous system to make cells less responsive and excitable, thereby decreasing pain sensations. This is what they called the “pain paradox.” While it promotes pain in one area of the nervous system, Substance P acts as a natural painkiller in another.

This explains why many of the drugs created to fight pain ended up failing in clinical trials. Their intent was to suppress Substance P, but in doing so they suppressed it in both the central and peripheral nervous systems. They thus stopped Substance P from acting as a painkiller in the peripheral nervous system, where it would normally influence certain proteins that control the ability of pain-sensing neurons to respond to noxious stimuli.[1]

Implications for the Future

The researchers concluded that this study helps create a better understanding of how the body naturally fights pain. This, in turn, could lead to new drugs, potentially without the negative side effects of current prescription painkillers.[1]

As Dr. Gamper stated in a release regarding the study,1 “If we could develop a drug to mimic the mechanism that Substance P uses, and ensured it couldn’t pass the blood brain barrier into the central nervous system, so was only active within the peripheral nervous system, it’s likely it could suppress pain with limited side effects.”

Download your free opioids and pain in-depth guide

[1] " 'Pain Paradox' Discovery Provides Route to New Pain Control Drugs." July 28, 2016. Accessed August 12, 2016.

[2] Huang, Dongyang, Sha Huang, Haixia Gao, Yani Liu, Jinlong Qi, Pingping Chen, Caixue Wang, Jason L. Scragg, Alexander Vakurov, Chris Peers, Xiaona Du, Hailin Zhang, and Nikita Gamper. "Redox-Dependent Modulation of T-Type Ca2 Channels in Sensory Neurons Contributes to Acute Anti-Nociceptive Effect of Substance P." Antioxidants & Redox Signaling 25, no. 5 (August 1, 2016): 233-51.

Thursday, 02 November 2017 11:25

New CDC Opioid Guidelines Only a First Step

A portion of this editorial was published in the Milwaukee Journal Sentinel's Letters to the Editor section on Monday, March 21, 2016:

The Centers for Disease Control and Prevention’s new prescription guidelines strongly urge physicians to cut back their use of opioid painkillers in the treatment of chronic pain. Specifically, the CDC guidelines outline a multidisciplinary approach that includes interventional pain management, behavioral and exercise therapy, and limited use of immediate-release opioids instead of extended-release or long-acting opioids. This is long overdue. The prescription of opioid painkillers has risen fivefold in the last 20 years, and opioid abuse statistics have paralleled that rise. In fact, opioid deaths — including from heroin — reached a record 28,647 in 2014.

Dr. Jeremy Scarlett
  Dr. Jeremy Scarlett

Prescription painkillers directly account for almost 60% of that total and, as a “gateway” drug, indirectly account for a much higher percentage. All too often, addicts first become hooked on legally prescribed opioids like OxyContin and Percocet before switching to the cheaper option, heroin, after their prescription lapses.

Clearly something has to be done about this epidemic. 

Though nonbinding, the CDC guidelines will send a strong message to physicians and others in the medical community. But that is just the first step. As the Journal Sentinel noted, CDC director Dr. Thomas Frieden also pointed out the role of patients in solving this problem. In the immediate gratification culture of American society, many choose to forgo long-term solutions in favor of the quick fix provided by opioids. Frieden acknowledged that many patients try to pressure physicians and clinics by posting negative reviews on websites like Yelp or RateMD, or by complaining on social media that their pain issues weren’t taken seriously. Medical providers must resist this pressure.

We need to challenge our patients by counseling them on the dangers and limitations of opioids and advocating for long-term solutions through interventional procedures and lifestyle changes. Likewise, we should advocate with our lawmakers for expanded drug abuse prevention and education programs that recognize the connection between prescription drugs like OxyContin and street drugs like heroin. Reducing the demand for these drugs is as critical as reducing their supply.

I applaud the CDC for raising awareness of this issue and agree with their analysis. Namely, while opioids do have a place in the spectrum of medical care, they should only be used on a short-term basis and in responsible doses for patients who’ve tried other approaches first — and with safeguards like toxicology screenings in place. Unfortunately, guidelines for the medical community alone are only the first step. We must be increasingly vigilant in raising awareness of opioid risks among the general public. That second step will be even more critical to ending this national epidemic.

Get moving. Call (888) 901-PAIN (7246) or click to schedule a consultation now.

Thursday, 02 November 2017 11:23

Opioids’ Place in Pain Management

The issue of prescription drug abuse is making its way into the public spotlight, spurred along by an increasing number of news stories and even its inclusion as an issue in the 2016 presidential race. Opioids are a key part of that discussion, especially since deaths involving prescription opioid overdoses in the U.S. increased 3.4-fold from 2001 to 2014.[1] This staggering statistic, paired with opioids’ increasing presence in public discussion, means it’s now more important than ever to fully understand this powerful drug – and its place in treating chronic pain. What is an Opioid? According to the National Institute on Drug Abuse (NIAD), at its core, an opioid is a drug that relieves pain by reducing the intensity of pain signals reaching the brain. They also affect the brain’s limbic system, which controls emotions, effectively diminishing the effects of painful stimuli and producing feelings of pleasure and relaxation.[2][3] Some of the most common prescription drugs in the opioid category include hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), morphine (Kadian, Avinza) and codeine, among others. The illicit drug heroin also fits into this class.  Opioids’ Prevalence Combined, the various types of prescription opioids have a major presence in the U.S. Enough opioids were prescribed in 2012 for every adult in the country to have their own bottle. That’s roughly 259 million prescriptions a year.[4] In comparison, there are twice as many painkiller prescriptions per person in the U.S. than there are in Canada.[5] So why are these drugs used so widely? Well, because of the way they work, opioids have been deemed some of the most effective drugs for the relief of pain and suffering.[4] In the short term, these drugs can be particularly effective against acute pain. It’s when these drugs are used past the short term (about 90 days) that the risks associated with them start to stack up. Examining the Risks Every day in this country, 44 people die from prescription opioid overdose.[6] And roughly 1.9 million people live with a substance use disorder involving prescription opioids.[7] While it is by no means a certainty that those who utilize opioids past the 90-day window will experience these same problems, there is still cause for concern. The longer an individual uses opioids, and the higher the dose they’re on, the more chance they have of experiencing life-altering – or even life-threatening – side effects.[8] Additionally, according to prescribing guidelines from the Medical Directors’ Group in Washington, “While there is evidence that opioids can provide significant pain relief in the short term, there is little evidence for sustained improvement in function and pain relief over longer periods of time.”[9] The chronic use of opioids is associated with tolerance, meaning the same dose of opioids will become less and less effective over time. This can set the stage for escalating dosages – and escalating risk factors. Seeking a Solution While there are obvious risks involved in long-term opioid use, it doesn’t change the fact that these drugs provide relief for millions of people with chronic pain. For many, it is the only way they can get out of bed in the morning. The solution, then, must not be just to taper down their opioid usage; it must also be to provide these individuals with other options that effectively work to reduce pain in the long-term. What does this mean for your care? Advanced Pain Management physicians are committed to decreasing patients’ need for opioids by reducing their overall pain levels. They do this by offering interventional procedures – such as injections of pain-relieving medications, the administration of radio waves to ablate painful nerves and even implantable devices that can stop the brain from feeling pain – all to get patients back to a more normal lifestyle, with eliminated or reduced dependence on medication. Pain relief without the haze of medications, without being subject to the clock and a pill bottle, and without the risk of becoming yet another opioid statistic is possible. In fact, it’s just a call away. [1] “Overdose Death Rates.” National Institute on Drug Abuse. 2015. Accessed February 24, 2016. [2] Mind Over Matter: The Brain's Response to Opiates. National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, 2006. [3] "What Are Opioids?" National Institute on Drug Abuse. November 2014. Accessed March 04, 2016. [4] Rosenblum, Andrew, Lisa A. Marsch, Herman Joseph, and Russell K. Portenoy. "Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions." Experimental and Clinical Psychopharmacology 16, no. 5 (October 2008): 405-16. [5] "Opioid Painkiller Prescribing." Centers for Disease Control and Prevention. July 2014. Accessed March 04, 2016. [6] "Prescription Drug Overdose Data." Centers for Disease Control and Prevention. October 16, 2015. Accessed March 07, 2016. [7] Hedde, Sarra, Joel Kennet, Rachel Lipari, Grace Medley, Peter Tice, Elizabeth A. P. Copello, Larry A. Kroutil. “Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health.” Substance Abuse and Mental Health Services Administration (2014). [8] Bohnert, Amy S. B. "Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths." Jama 305, no. 13 (April 06, 2011): 1315. [9] Interagency Guideline on Prescribing Opioids for Pain. Washington: Agency Medical Directors' Group, 2015.

Thursday, 02 November 2017 11:21

Opioids and Medication Management

Advanced Pain Management (APM) is proud to be among the growing number of providers in this country working to reduce the number of opioid prescriptions given and, in doing so, prevent as many medication-related deaths as possible.  APM’s efforts align well with the recent CDC Guideline for Prescribing Opioids for Chronic Pain, which states, “Patients with pain should receive treatment that provides the greatest benefits relative to risks.”[1]

While in a majority of cases, this means nonopioid – and even nonpharmacological – therapy for the treatment of pain, there are certain circumstances where the benefits of opioids may outweigh the considerable risks. When this is the case, it’s imperative that risk-mitigating measures are put into place to ensure continued patient safety. At APM, this is referred to as medication management.

Deciding on Opioid Therapy

When a patient enters treatment at APM, our fellowship trained, board certified physicians take a complete medical history, in addition to completing a comprehensive patient consultation. During these steps, the physician will ascertain which treatments a patient has used and how they worked, the patient’s past and present usage of opioids and other medications, how their body uses pain medications and how they tolerate opioids.

In addition, a screener and opioid assessment will help the physician determine if the patient has any additional risk factors that may make long-term opioid therapy more dangerous, such as behavioral health issues or a personal or familial tendency toward addiction. Since opioid medications affect patients in different ways, honest answers to these questions will allow APM’s providers to best assess and treat each patient’s pain.

If a decision is made that opioid therapy is the right option for a patient, the physician will work with the patient, as recommended by the CDC,[1] to establish realistic goals regarding their pain and functional ability – like being able to walk around the block or sleep through the night without pain awakening them. Together, they will also discuss how and when the therapy will be discontinued if the benefits no longer outweigh the risks – for instance, if there is no increase in pain levels or the ability to function.

Risk-Mitigating Measures

If opioid therapy is warranted, every measure will be taken to reduce the risks associated with the medication. This includes prescribing opioids at the lowest possible dose necessary to achieve both pain relief and functional restoration. This may mean that patients currently on opioids will be tapered down to a more appropriate dose.

Patients taking part in APM’s medication management program are required to sign a controlled substance agreement, which outlines their responsibilities in regard to their medication, including taking their medication only as prescribed, avoiding alcohol and illegal drugs and keeping their medication safe and away from children.

The agreement also outlines other risk-mitigating measures that APM has in place, including urine drug testing and pill counts. Drug tests are completed for new patients and several times a year after that and allow providers to verify that individuals are using their medications as prescribed and not taking other medications or drugs that could be dangerous to their health. Pill counts work in a similar manner, ensuring that patients are taking their pills as prescribed and not skipping doses or taking them too often. Pill counts may be completed during or between appointments and provide another level of safety to protect patients from addiction, overdose and other negative side effects.

APM providers also check the Prescription Drug Monitoring Program,[2] a state database that lists patients’ names and the providers who have prescribed controlled substance to them, among other information. If any of the components of the controlled substance agreement are broken (for instance, if a random urine drug test comes back positive for an illegal substance), an APM provider may discontinue opioid therapy for that patient.

Interventional and Complimentary Treatments

The goal of medication management is for you to lead a more active lifestyle – but you will need more than just medication to make this happen. Opioids alone won’t take care of your pain. The CDC notes this, as well: “If opioids are used, they should be combined with nonpharmacologic therapy.”[1]

The types of therapies used will differ from patient to patient, depending on their pain type, medical history and other medical conditions. Oftentimes treatments will include a combination of interventional procedures (like steroid injections or nerve blocks), physical therapy, cognitive and behavioral therapy, smoking cessation, home exercise programs and complementary treatments like acupuncture. This focus on multiple therapies for the treatment of pain is known as a multimodal or multidisciplinary approach, which “can help reduce pain and improve function more effectively than single modalities,” according to the CDC.[1]

If you would like to learn more about APM’s personalized, multidisciplinary approach to treatment, give us a call at (888) 901-PAIN (7246) or schedule a consultation.

Download your free opioids and pain in-depth guide

[1] Dowell, Deborah, Tamara M. Haegerich, and Roger Chou. "CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016." Morbidity and Mortality Weekly Report (MMWR) 65, no. 1 (March 18, 2016): 1-49.

[2] Wisconsin Department of Safety and Professional Services. Wisconsin Prescription Drug Monitoring Program (PDMP). Accessed June 02, 2016.

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