Opioids are a powerful class of drugs, but their use is coming under more and more scrutiny, mainly due to the high levels of prescription misuse, addiction and overdose. While finding alternatives to opioids is one component of this often complicated issue, determining what factors predispose people to abuse and addiction may be just as important.

Previous research into opioid abuse and addiction has revealed several factors that play into the development of opioid use disorder (such as a personal or family history of substance abuse,[1] psychological problems[2] or a history of abuse before adolescence[3][4]), but a new study has revealed a surprising new factor that has the ability to increase the risk of opioid addiction by a staggering 41%: pain levels.

Study Overview

The study, titled “Pain as a Predictor of Opioid Use Disorder in a Nationally Representative Sample,” was published in July in the American Journal of Psychiatry.[5] The research was large scale, utilizing data of about 34,000 patients, which was obtained through the National Epidemiologic Survey on Alcohol and Related Conditions. The objective was to determine what relationship, if any, exists between moderate to severe pain and the likelihood of developing prescription opioid use disorder.

The study measured pain on a five-point scale based on how much it interfered with a patient’s daily life, and prescription opioid use disorder was determined through a structured interview. Both of these components were measured at baseline (between 2001 and 2002) and again three years later.

Key Findings

The study found that moderate to severe pain was significantly linked with opioid use disorder, both at the start and three years later. In fact, these individuals had a 41% increased risk of developing the disorder. This finding was independent of several demographic and clinical characteristics, including age, gender and anxiety and mood disorders.

The authors also found that despite women and older adults being more likely to report pain, it was men and younger adults who were more likely to experience opioid use disorder, lending more evidence to the theory that age and gender do, indeed, have an impact on the risk of developing opioid-related issues.

Implications for the Future

These finding not only point to the need for appropriate screening and monitoring for those on opioids – especially for those with more severe pain conditions – but they also demonstrate the need for effective interdisciplinary care from the onset. In a press release regarding the study, senior author Dr. Mark Olfson, a psychiatry professor at Columbia University Medical Center, said, “In light of the national opioid abuse epidemic, these new results underscore the importance of developing effective, multimodal approaches to managing common painful medical conditions.”[6]

Effectively treating painful conditions before they get to the moderate or severe stage has the ability to substantially lower the disconcerting trend of opioid abuse and addiction. Similarly, offering comprehensive alternatives to opioids no matter the pain level can effectively diminish reliance on these risky drugs. These steps, paired with close monitoring for signs of addiction among at-risk individuals, pill counts and drug testing for those on long-term opioid maintenance, may be able to reduce the number of those with opioid use disorder while simultaneously improving care for the chronic pain population as a whole.

Advanced Pain Management is committed to providing such a multidisciplinary, individualized approach, in addition to a safe, patient-centered medication management program. To learn more, call (888) 901-PAIN or download our in-depth guide to opioids and pain.

Download your free opioids and pain in-depth guide

[1] Michna, Edward, Edgar L. Ross, Wilfred L. Hynes, Srdjan S. Nedeljkovic, Sharonah Soumekh, David Janfaza, Diane Palombi, and Robert N. Jamison. "Predicting Aberrant Drug Behavior in Patients Treated for Chronic Pain: Importance of Abuse History." Journal of Pain and Symptom Management 28, no. 3 (September 2004): 250-58.

[2] Martins, S. S., M. C. Fenton, K. M. Keyes, C. Blanco, H. Zhu, and C. L. Storr. "Mood and Anxiety Disorders and Their Association with Non-medical Prescription Opioid Use and Prescription Opioid-use Disorder." Psychological Medicine 42, no. 06 (June 2012): 1261-272.

[3] Kendler, Kenneth S., Cynthia M. Bulik, Judy Silberg, John M. Hettema, John Myers, and Carol A. Prescott. "Childhood Sexual Abuse and Adult Psychiatric and Substance Use Disorders in Women." General Psychiatry 57, no. 10 (October 2000): 953-59.

[4] Naqavi, Mohammad Reza, Masood Mohammadi, Vahid Salari, and Nouzar Nakhaee. "The Relationship between Childhood Maltreatment and Opiate Dependency in Adolescence and Middle Age." Addiction & Health 3, no. 3-4 (2011): 92-98.

[5] Blanco, Carlos, Melanie M. Wall, Mayumi Okuda, Shuai Wang, Miren Iza, and Mark Olfson. “Pain as a Predictor of Opioid Use Disorder in a Nationally Representative Sample.” American Journal of Psychiatry July 22, 2016.

[6] Columbia University Medical Center. “Significant Pain Increases the Risk of Opioid Addiction by 41 Percent: First Study to Make Direct Link Between Pain, Opioid Addiction Risk.” July 22, 2016. Accessed November 21, 2016. https://www.sciencedaily.com/releases/2016/07/160722092937.htm.

Pain comes in many forms – and alternative pain treatment options do, as well. So . Should you seek acupuncture for low back pain? What about for fibromyalgia? And when are massage, relaxation and yoga warranted? At the beginning of September, the National Center for Complementary and Integrative Health – part of the National Institutes of Health (NIH) – went a long way toward answering this question, reviewing five decades of research to find the answer.

Overview of Research

The NIH review was published in Mayo Clinic Proceedings in September and contained data from 105 U.S. randomized controlled trials that were conducted over the past 50 years.[1] The trials covered a range of pain conditions, including low back pain, fibromyalgia, neck pain, osteoarthritis of the knee and migraine pain. It also looked at a variety of complementary treatment approaches, including acupuncture, massage, yoga, tai chi and dietary supplements, among others.

Although the review was wide-ranging and included a plethora of studies, there were some limitations. In some trials, the number of participants was small (with fewer than 100 individuals) and not very diverse, which could explain some of the conflicting results seen across the trials. However, throughout all trials, there were no serious side effects reported and very few mild side effects (like muscle soreness), meaning that overall, complementary treatments are a reasonably safe option for pain sufferers.

Back Pain

As one of the most common pain conditions, back pain has been the subject of many studies regarding complementary treatments. It may have something to do with the fact that people in the U.S. spend roughly $8.7 billion out-of-pocket each year on complementary approaches to manage their back pain, an amount which far exceeds any other condition.[2]

This review looked at back pain studies on acupuncture, massage therapy, osteopathic manipulative therapy, spinal manipulation and yoga. The NIH found that acupuncture and yoga, in particular, may be the most beneficial for patients with low back pain. There is also weaker, but still moderately positive evidence for: massage therapy, which may provide short-term relief; spinal manipulation, which can provide modest pain relief if performed often enough; and osteopathic manipulation, which may help improve pain, but has limited effects on function/disability.

Neck Pain and Knee OA

In terms of neck pain, the review looked at studies involving massage and spinal manipulation. They found that although spinal manipulation demonstrated no significant improvements in terms of pain and function, massage therapy did provide some benefits. If done often enough – say an hour 2 or 3 times a week – massage was able to help reduce pain and improve function in the short-term.

For osteoarthritis of the knee, the team reviewed studies regarding various dietary supplements, in addition to more active therapies. They found mixed results for glucosamine and chondroitin, but ultimately concluded there was little evidence to suggest these supplements were any better than taking a placebo. Tai chi, on the other hand, resulted in significant improvements for individuals with knee OA, and acupuncture was proven useful, as well.

Migraine Pain and Fibromyalgia

Studies regarding alternative treatments for severe headache and migraine pain were rare, with only one included for acupuncture, one for massage and two for omega-3 fatty acids. According to these studies, there is no benefit of acupuncture or massage in terms of pain severity, and the data for omega-3s is contradictory. Relaxation techniques, however, have been the subject of more research and have been shown to reduce both the frequency of headaches and the level of disability they cause. Even better results were achieved when relaxation was combined with another form of treatment, like medication or cognitive behavioral therapy.

The studies regarding complementary approaches for fibromyalgia have often been small and inconclusive, yet, according to this review, there is some evidence to suggest that mindfulness-based stress reduction can reduce stress and sleep disturbances associated with fibromyalgia and that tai chi may help reduce symptoms.

Multidisciplinary Approach

As the review found, many complementary approaches can be useful for the treatment of pain, but oftentimes more improvement can be seen when complementary approaches are paired with interventional ones. The physicians at Advanced Pain Management are dedicated to working with other practitioners to provide individualized and comprehensive pain relief. To learn more, call (888) 901-7246.

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[1] Nahin, Richard L., Robin Boineau, Partap S. Khalsa, Barbara J. Stussman, and Wendy J. Weber. “Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States.” Mayo Clinic Proceedings 91, no. 9 (September 2016): 1292–1306.

[2] Nahin, Richard L., Barbara J. Stussman, and Patricia M. Herman. “Out-of-Pocket Expenditures on Complementary Health Approaches Associated with Painful Health Conditions in a Nationally Representative Adult Sample.” The Journal of Pain 16, no. 11 (November 2015): 1147–62.

 

This holiday season, don't let shopping become a pain - in your back, neck or anywhere else. Nowadays, there are easier ways to stock up on gifts for everyone you love - and avoid pain in the process. Here are a few quick tips.

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Download your free stretching exercises for pain reduction

Thursday, 02 November 2017 10:54

Infographic: Chronic Pain's Effect on the Brain

Chronic pain doesn't just change the way your body works; it can also wreak havoc on your brain. In fact, pain can result in changes to multiple important regions of the brain, which are involved in many critical functions and processes. Learn more about how your pain may be affecting you - and how you can work to stop it - with our pain in the brain infographic. 

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

Thursday, 02 November 2017 10:50

How to Avoid Headaches through Diet

We all know that foods have the ability to impact pain levels. Some foods (and drinks) are linked to increased inflammation, for instance, while other foods can noticeably decrease it. It turns out, according to a recent report, that the things we consume are also linked to migraines. The new review found that there are several key foods to avoid – and several to include in your diet – if you want to steer clear of headaches.

Study Overview

The review, titled “Diet and Headache” was published in two parts in the publication Headache: The Journal of Head and Face Pain.[1] The researchers examined 180 research studies that dealt with the connection between diet and migraines. Although the role of diet in headache pain management is still a controversial topic in the headache field, the researchers note, their goals were to determine which foods are linked to the onset of headache pain and what a comprehensive, headache-reducing diet might look like.

Key Findings

One of the main items that was found to impact headaches was, in fact, caffeine. Both not consuming enough caffeine – aka caffeine withdrawal – and consuming too much caffeine were found to trigger headache symptoms. So if you’re a regular coffee consumer, try not to abruptly decrease your intake. But also be careful not to exceed 400 milligrams of caffeine a day (which comes out to a little over 3 cups), since that seems to be the maximum amount migraine sufferers can handle. Even if you’re not a regular migraine sufferer, it may be a good idea to cut back, since large amounts of caffeine have actually been shown to cause symptoms related to anxiety and depression.

MSG, a component in many processed foods, was another ingredient strongly linked to headaches. Limiting MSG is pretty simple; the FDA requires it to be listed on packaging as monosodium glutamate, so checking the labels of foods before you buy them could help you reduce it in your diet. It’s often found in things like Chinese food, salad dressing, snack foods, ketchup and barbecue sauce, among others. According to the review’s authors, it’s most likely to trigger an attack when it’s in a liquid, like soup.

Alcohol, especially red wine and vodka, may be problematic for some with headaches, although the researches note that there’s less evidence demonstrating this. Similarly, nitrates – preservatives in processed meats – may have the ability to trigger headaches in about 5% of people.

A Change in Diet

An elimination diet, in which you avoid foods and ingredients known to trigger headaches, is one approach to avoiding the onset of a migraine. The other is adopting a comprehensive diet, one that decreases the bad ingredients while upping the good. These include diets that are low in fat (where fat is less than 20% of the daily diet) and carbohydrates, in addition to those that increase omega-3 fatty acids (flaxseed, salmon, cod, scallops) while decreasing omega-6 fatty acids (vegetable oils, peanuts, cashews). (If you’re considering adopting one such diet to help with your headache pain, always consult a physician to ensure the diet is safe and that you remain healthy.)

Gluten-free diets, on the other hand, haven’t been shown to reduce the likelihood of headaches unless the person suffers from celiac disease.

Implications for the Future

This study may help a lot of people prevent painful headache occurrences, but the authors do note that more clinical trials on the topic will be needed. Yet switching to a healthier diet is no doubt a smart plan of action, one that can not only lead to fewer migraines, but also decreased inflammation and pain throughout the body, as well as weight loss and the prevention of heart disease.

If headaches are still interfering with your daily life, consider seeking help from a pain management physician, who will be able to suggest various treatment options based on your condition.

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

[1] Martin, Vincent T. and Brinder Vij. “Diet and Headache: Part 1” and “Diet and Headache: Part 2.”  Headache: The Journal of Head and Face Pain 56, no. 9 (October 2016).

Thursday, 02 November 2017 10:48

How Injections Work to Alleviate Your Pain

The causes of chronic pain are undoubtedly diverse, from aging spinal discs and spinal stenosis to joint irritations and even failed back surgery. But there is one thing that many painful conditions have in common: inflammation.[1] Reducing that inflammation – the goal of a variety of injection procedures – can be a key component to achieving pain relief.

The Inflammatory Response

Inflammation is a natural reaction, part of the immune response our bodies enact to help themselves heal.[2] But inflammation, in addition to causing redness, swelling and even loss of function, can result in acute or prolonged pain.

According to the Institute for Quality and Efficiency in Health Care[2], various cells are involved in the inflammatory process. Tissue hormones cause your blood vessels to expand, allowing more blood to reach the injured tissue. Defense cells are brought along with that blood to assist with the healing. But these cells can irritate your nerves, causing pain signals to be sent to the brain. 

In chronic painful conditions, unlike acute cases of external injury or your body fighting against pathogens, this inflammation lasts from several weeks to several years. That means the related pain and sensitivity, instead of fading, continues on for the long-term.

Putting out the Fire

The goal of injections are to calm this inflammatory response – or “put out the fire” of inflammation. This is done by delivering combination of inflammation-reducing medications directly to the nervous system.[3] Typically, a local anesthetic (for short-term relief) and a steroid medication (for longer-term inflammation reduction) will effectively relieve pain for up to several months.

Injections can sooth the pain related to a variety of back problems, in addition to irritated shoulder, knee or hip joints, but in every case they work the same: The injected medications work to relieve inflammation, thus decreasing the firing of pain neurons within the nerves and spinal cord and helping to alleviate your pain.

Targeted Relief

At Advanced Pain Management, the physicians are specially trained in administering inflammation-reducing injections. To ensure that each injection of medication gets directly to the exact source of the pain, they utilize a specialized X-ray device called a fluoroscope during procedures.

Before injecting the medications, the physician uses an injection of dye, which shows up on the X-ray image, to verify that the needle is placed correctly. This extra step confirms that the medication is being injected exactly where it’s needed.

 Get Moving

The pain-reducing effects of injections can not only increase an individual’s tolerance for activity, but also their ability to undergo physical therapy. Advanced Pain Management’s comprehensive and individualized approach to pain management often includes a physical therapy component, which can help prolong and increase the pain-reliving effects gained from injections, in addition to preventing pain recurrence and re-injury.

Combined, physical therapy and injections can also help individuals decrease their reliance on opioid pain medications, reducing the risks associated with these powerful drugs.

Injections are a safe, low-risk way to treat pain at the source and get you moving again. To find out more about the injections APM offers, take a look these interactive animations or call (888) 901-PAIN (7246).

 

[1] Tal, Michael. "A Role for Inflammation in Chronic Pain." Current Review of Pain 3, no. 6 (November 1, 1999): 440-46.

[2] Institute for Quality and Efficiency in Health Care. "What Is an Inflammation?" PubMed Health. January 7, 2015. Accessed March 08, 2016. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072482/.

[3] "Patient Engagement Videos." ViewMedica. 2015. Accessed March 08, 2016. https://viewmedica.com/.

Test after test, doctor after doctor, and still no relief. Those with chronic pain know the cycle well. This seemingly never-ending search for relief, paired with pain’s constant presence, can oftentimes breed frustration, anger, even outright depression. It can also strain one of the most important things in life: your relationships with the ones you love. But, just like with every other aspect of pain, it’s all a matter of finding the right treatment.

Relationship Stressors

There are multiple ways in which the presence of pain can be detrimental to even our closest relationships. According to Advanced Pain Management licensed psychologist Mary Papandria, “Oftentimes, the pain patient becomes fixated on their pain. That’s all they talk about, think about, focus on. Their world becomes smaller and smaller … [and] they have little time or attention for other people in their lives.” As a result, their loved ones, including their spouse, friends and family, can feel neglected and unimportant.

According to a Journal of Pain review, as pain sufferers become more isolated from those they love, and more psychosocially impaired in general, spouses can become less satisfied and begin to view their marriage as maladjusted.[1]

Changing Roles

The changing roles which pain brings about are another factor that can negatively impact many relationships. As the book Relieving Pain in America, issued by the Institute of Medicine of the National Academies, puts it, “Family members find that … they must take on new roles (as caregiver and morale booster) and greater responsibilities in the family (e.g., grocery shopping, chores, errands) [and] the burden on them increases.”[2]

These extra responsibilities, which can oftentimes be incredibly overwhelming, says Papandria, can create a sense of resentment toward the pain sufferer, like he or she is using their pain as an excuse. And the individual in pain, especially if it’s a female who isn’t used to asking for help, can often feel like a burden on her partner.

“Furthermore,” states Papandria, “who the pain patient was before the pain may have disappeared. They aren’t themselves anymore and the spouse may feel that they don’t know them anymore.”

The Effects of Relationship Discord

All of these factors can create tension, frustration and anger between the two, as well as consequences beyond the relationship. For instance, husbands of patients with chronic pain, compared to those married to women without pain, report more loneliness, higher stress levels, lower activity levels and more fatigue, in addition a decline in marital satisfaction.[1]

But more than that, relationship turmoil can have an impact on pain levels and the effectiveness of treatment. In a study from the journal Behaviour Research and Therapy, one year after completing a pain program, those with non-supportive families relied more on pain medications and reported having more pain sites, while those with supportive families had less pain intensity and greater activity levels.[3]

Papandria explains it like this: The negative emotions, depression and anxiety that oftentimes accompany pain and strained relationships can “all result in a worsened perception of pain, increased disability and lessened benefits from treatment. … People tend to be pessimistic. They focus on what’s wrong vs. what’s right. As a result, they tend to view treatments as not being effective and see their pain as worse.”  Their negative emotional state could also lead them to focus too heavily on their pain, she says, causing them to take notice of every twinge and spasm – and making them think treatments aren’t helping.

A Multimodal Solution

Since pain, emotions and relationships are so inextricably linked, to effectively treat one aspect, you have to treat them all. That’s where a multimodal approach comes in.

Treating the pain through a variety of minimally invasive treatment options also helps to improve emotions and relationships. “If patients have better pain control, then they are going to be less depressed/anxious and less apt to isolate,” says Papandria. “They will also be less focused on the pain and will have the energy and attention to attend to other things and people.”

And by addressing emotional issues and strained relationships, individuals can achieve better treatment outcomes, while simultaneously learning how to communicate their fears and needs, how to identify harmful thought patterns, how to set achievable goals and how to cope with the changing roles that pain has brought to their lives.

Pain doesn’t just affect the person experiencing it – it affects the people they love and the relationships on which their lives are built. By treating the emotional pain alongside the physical, the fulfilling life that has seemed elusive for so long may once again be within reach.

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

[1] Leonard, Michelle T., Annmarie Cano, and Ayna B. Johansen. "Chronic Pain in a Couples Context: A Review and Integration of Theoretical Models and Empirical Evidence." The Journal of Pain 7, no. 6 (June 2006): 377-90.

[2] Institute of Medicine of the National Academies. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, D.C.: National Academies Press, 2011.

[3] Jamison, R. N., and K. L. Virts. "The Influence of Family Support on Chronic Pain." Behaviour Research and Therapy 28, no. 4 (1990): 283-287.

Complex regional pain syndrome (CRPS) has always been a difficult condition to treat. CRPS, previously called reflex sympathetic dystrophy (RSD), which typically causes aching or burning sensations in the arms or legs and can manifest after an injury or surgery, doesn’t always respond to the treatment methods that work for other conditions. Even individuals with an implantable spinal cord stimulator don’t always experience the desired levels of CRPS pain relief. But all of that is about to change.

A revolutionary new stimulator, which works in the dorsal root ganglion (DRG) region of the spine, has been proven extremely effective for the treatment of CRPS I and II. And in June, Advanced Pain Management became the first company in Wisconsin to begin offering it.

How it Works

DRG stimulation has the same three components as typical spinal cord stimulation (SCS): a generator with a battery, which sends out electrical pulses; insulated wire leads, which carry the electrical pulses to a specific area in your spinal cord; and the handheld patient controller, which allows you to adjust the location and strength of the stimulation. The trial is also the same: For roughly a week patients are fitted with a temporary device to determine its effectiveness for their particular pain condition.

What’s different with DRG stimulation is the location being stimulated. The dorsal root ganglion is a spinal structure densely populated with sensory nerves, which regulate signals and sensations as they travel to the brain. The DRG corresponds to particular locations in the body (like the feet and groin) meaning that stimulating it results in targeted pain relief to the specific areas affected by CRPS. This targeting means a better level of CRPS pain relief than typical SCS.

Proven Effective

DRG stimulation was the focus of a 12-month comprehensive study, known as the ACCURATE study.[1] Researchers found that 74.2% of patients using DRG stimulation had 50% or greater pain relief after one year, versus 53% of those utilizing traditional SCS. This means that not only can DRG provide superior CRPS pain relief, but it’s also sustained over time.

For those patients who experienced paresthesia, or the tingling sensation that replaces the pain, 94.5% of them reported that the sensation was confined to the primary area of pain. With traditional SCS, only 61.2% of patients reported this. In some cases, though, paresthesia was eliminated altogether. About 1/3 of patients experienced over 80% pain relief with no paresthesia at all.

According to the study, patients also had improvements in quality of life measures, psychological disposition and physical activity levels.

Other Benefits

Unlike some other SCS systems, the DRG system doesn’t have to be recharged, since it actually uses a fraction of the energy of typical systems. While the battery will still have to be replaced (roughly every five years), battery replacement with this device has also improved, meaning an easier process.

Additionally, like traditional SCS, DRG should reduce the need for oral medications, meaning fewer opioid-related side effects. Plus the system is reversible and can be removed at any time.

Learn More about CRPS (RSD) Pain Relief

If you’re suffering from CRPS and would like to learn more about DRG stimulation – including if it may be right for you – call (888) 901-PAIN or schedule a chat with a member of our care team staff to discuss your RSD pain relief / CRPS pain relief.

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

[1] "Long Term Data Confirms the St. Jude Medical Axium System Delivers Sustained and Superior Pain Relief for Patients with Chronic Lower Limb Pain." BusinessWire.com. December 11, 2015. Accessed August 22, 2016. http://www.businesswire.com/news/home/20151211005787/en/.

Thursday, 02 November 2017 10:37

Is Chronic Pain Passed Down Through Families?

Many studies have reported that children of parents suffering from chronic pain are more likely to develop it themselves. They’re also more likely to experience negative mental and physical health outcomes due to that chronic pain. But so far, the reasons as to why this occurs aren’t entirely understood. In a recent report,[1] two researchers put forth a conceptual model exploring possible reasons for this connection, which could help address – or even prevent – the transmission of chronic pain to the next generation.

About the Report

The report, titled “Transmission of risk from parents with chronic pain to offspring,” was published on May 31 in the journal PAIN, the official publication of the International Association for the Study of Pain (IASP).

It was undertaken because “although the association between chronic pain in parents and offspring has been established, few studies have addressed why or how this relation occurs.” The study authors thus set out to create a conceptual model that could be useful in developing preventative interventions, with the goal of stopping the transmission.

Conceptual Model

The comprehensive model delved into five areas that could be involved in the transmission of pain, as well as the negative mental and physical outcomes that accompany it.

  1. Genetics. What parents pass down to their children on a biological level obviously has a place in the transmission of pain, as well as the psychological components that accompany it (like depression and anxiety). The study said that genetic factors may actually account for half of the risk of chronic pain in adults.
  2. Early neurobiological development. The way a child’s nervous system develops may be impacted by a parent with chronic pain. For instance, if a mother is dealing with the stress, depression or lack of activity brought about by pain while she is pregnant, it could affect the baby’s development.
  3. Pain-specific social learning. The “learning theory” poses that all behavior – whether good or bad – is learned. Thus some elements of the pain experience may be learned as well, such as parents’ maladaptive pain behaviors. One example of this is catastrophizing: Children see their parents’ exaggerated worries and responses to pain and subconsciously learn to mimic them.
  4. General parenting and health habits. Both the attitudes adults take toward parenting and their own health could rub off on their children, making them more susceptible to chronic pain down the road. Permissive parenting or a lack of consistency and warmth could affect future pain, the study theorized. Likewise, poor exercise and dietary habits could be passed down to children, resulting in chronic pain.
  5. Exposure to a stressful environment. Experiencing increased stress while growing up may play into chronic pain as an adult. For instance, having parents who constantly worry about financial issues or who are unable to complete daily tasks may impact the risk of developing chronic pain.

The study stated that “the outlined mechanisms, moderators, and vulnerabilities likely interact over time to influence the development of chronic pain and related outcomes in offspring of parents with chronic pain.” So by the time children are grown, these factors – or a subset of them – likely lead to a higher risk of developing long-lasting pain conditions. The authors’ hopes were that by highlighting these methods of transmission, they might open up new avenues for prevention amongst at-risk children.

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[1] Stone, Amanda, and Anna Wilson. "Transmission of Risk from Parents with Chronic Pain to Offspring: An Integrative Conceptual Model." PAIN (2016).

 

Thursday, 02 November 2017 10:26

Intrathecal Pumps and Efficient Pain Relief

Oral opioids, by their very nature, are an inefficient – as well as a potentially dangerous – option for pain relief. That’s because opioids aren’t administered directly where they’re needed; after consumption, they work their way through the bloodstream before attaching to the opioid receptors in the brain, spinal cord and other organs.[1]

Fortunately, there’s a more efficient way to administer pain-relieving medications: directly where the pain signals travel. This method, called intrathecal pump implantation (or targeted drug deliver), delivers medication right to the intrathecal space, meaning pain relief can be achieved with roughly 1/300 of the dose of oral opioids.[2] For some chronic pain patients, this means more accurate pain relief with fewer of the side effects linked to oral opioids.

Overview of Intrathecal Pumps

An intrathecal pump consists of a pump, which can contain various combinations of medication, and a catheter. The device is able to provide targeted pain relief because the catheter is placed directly into the intrathecal space, the region surrounding your spinal cord. Pain signals travel along the spinal cord to the brain; the catheter delivers medication directly to that area, effectively preventing the pain signals from being perceived by the brain.[3]

The amount of medication released into the intrathecal space is controlled with an external programmer, which is pre-set with parameters and can be used by the patient to control breakthrough pain.

Intrathecal pumps are generally recommended for people with chronic pain who have utilized conservative treatments with limited success. It may also be used for people who have had surgery but are still experiencing pain, or people for whom surgery is not likely to help.[3]

Getting a Pump

The qualification process for a pump begins with a behavioral health consult for all patients. Patients who are experiencing depression, a lack of social support or a lack of motivation toward wellness do not do as well with implantable therapies. So during this mandatory step, a behavioral health professional will ensure that the patient is in the best possible position to achieve success with the implant.

After behavioral health clearance, the patient will undergo a reversible trial of the devise to ensure effectiveness of the therapy. This important step allows each patient to try the device and make sure it provides them adequate pain relief.

During the trial, the doctor administers local anesthetic then inserts a catheter through either a needle or a small incision into the intrathecal space. The catheter is then connected to an external temporary pump.[3] The patient will be able to try the system for roughly a week, and if the patient and the physician deem the trial successful, then a permanent device will be implanted.

During the permanent procedure, the patient will typically be put under local anesthetic. The temporary catheter will be removed and replaced with a permanent one. A permanent pump will be placed under the skin, usually in the abdomen, and connected to the catheter.[3]

Follow-up Care and Side Effects

After implantation, the patient will need to visit the doctor regularly so the pump can be refilled with medications. The pump itself contains a battery that will last several years. (The battery life will depend on which type of pump is utilized.)[3] After that time, a new catheter will be implanted.

There are may be some side effects related to the implant. For instance, mild discomfort and swelling at the incision site can occur after implantation. Over time, activity may move or damage the catheter, which would then require repositioning or replacement.

Learn More

For more information regarding intrathecal pumps, or to find out if one may be right for you, call (888) 901-PAIN (7246).

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[1] "What Are Opioids?" Drugabuse.gov. National Institute on Drug Abuse (NIDA), Nov. 2014. Web. 04 Aug. 2016.

[2] Lynch, Louise. “Intrathecal Drug Delivery Systems.” Continuing Education in Anaesthesia, Critical Care & Pain 14, no. 1 (September 4, 2013): 27-31.

[3] “ViewMedica Patient Engagement Videos.” Swarm Interactive. 2015. Accessed August 5, 2016. http://www.viewmedica.com/

Advanced Pain Management Near You

Our diverse physicians, nurse practitioners and physician assistants provides patients with the most comprehensive approach to pain management. We have convenient locations across Wisconsin and Minnesota including Appleton, Chaska, Green Bay, Kenosha, Madison, Mankato, Milwaukee, Racine, Sheboygan, Stevens Point, Waukesha, Wausau and many more.

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