APM Blog

Thursday, 02 November 2017 13:12

The Benefits of Radiofrequency Neuroablation

Nerves play an important part when it comes to pain. They’re responsible for transmitting pain signals from the painful areas of your body to the central nervous system (i.e. the spinal cord and brain). It makes sense, then, that nerves can also play an important part when it comes to treating that pain. That’s where radiofrequency neuroablation comes in.

Background and Uses

Radiofrequency ablation (RFA) – also called radiofrequency rhizotomy and radiofrequency neurotomy – was first used to treat back pain in 1975 by CN Shealy.[1]  In a paper regarding the topic the following year, Shealy concluded that in properly selected patients, 82% experienced partial to total pain relief with no neurologic complications.[2]

 RFA is used to treat pain stemming from the facet joints, both in the spine (lumbar and thoracic) and neck (cervical). Facet joints are where each vertebra connects with the vertebrae above and below it. These joints both stabilize the spine and limit excessive motion.[3]Normal wear and tear, injury and disc degeneration can all cause issues with the joints, resulting in back or neck pain. In a systematic review in the journal Pain Research and Management, five out of six studies found that in cases of chronic back pain resulting from such facet issues, performing RFA resulted in statistically significant reductions in pain.[1]

The procedure is ideal for pain that hasn’t responded to conservative therapies, such as physical therapy or medication. Before the procedure, physicians will typically perform a diagnostic nerve block to ensure that the patient is a good candidate for the procedure.

How it Works

During an RFA procedure, heat from an electrode is used to cauterize one or more nerves, thus disrupting pain signals to the brain.

To begin, after the patient has received medicine to help them relax and the area around the injection site has been numbed, the physician inserts a small tube called a cannula into the spinal area and guides it to the right nerve with the help of an X-ray device. An electrode is inserted through the cannula and its position is tested with a small jolt before the nerve is heated.[3]

To heat the nerve, a high frequency electrical current is administered, which causes molecule movement and produces thermal energy.[1] This, in turn, creases a small lesion within the nerve, disrupting its ability to transmit pain signals. The doctor may treat several nerves, if necessary.

Following the Treatment

After an RFA procedure, pain relief may not be immediate. The injection site will be sore and back or neck pain may still persist, but, if the correct nerves were treated, the pain will gradually decrease over several weeks.

Partial or total pain relief from radiofrequency can last for several months. Nerves do grow back, however, so the procedure may need to be repeated. But, unlike invasive surgeries or long-term medication usage, there are few serious side effects to the procedure, allowing you to get back to a better quality of life.

More Information

To learn more about radiofrequency neuroablation, or to schedule an appointment with a pain specialist to discuss treatment options, click here.

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

[1] Leggett, Laura E., Lesley Jj Soril, Diane L. Lorenzetti, Tom Noseworthy, Rodney Steadman, Simrandeep Tiwana, and Fiona Clement. "Radiofrequency Ablation for Chronic Low Back Pain: A Systematic Review of Randomized Controlled Trials." Pain Research and Management 19, no. 5 (September/October 2014): 146-E153.

[2] Shealy, C. Norman. "Facet Denervation in the Management of Back and Sciatic Pain." Clinical Orthopaedics and Related Research, no. 115 (March/April 1976): 157-64.

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

The first line of treatment for illnesses of all sort isn’t usually found in the doctor’s office – it’s found in the medicine cabinet. The same is just as true, if not more so, for pain. Backache? Leg pain? Headache? Most people turn to the anti-inflammatory and pain-relieving power of over-the-counter medicines. But, just like any other medications, there can be drawbacks to these easily obtainable pills. Learning when to take them – and when to default to the expertise of a physician – may give you the best chance of effectively managing your pain.

Knowing Your Options

At the onset of pain, most people reach for either an acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (Aspirin, Advil, Aleve), also known as NSAIDs, which can be very effective in fighting pain. In fact, these medications are recommended in the CDC’s new guidelines, which say, “In particular, acetaminophen and NSAIDs can be useful for arthritis and low back pain.”[1]

Acetaminophen, which is a component of more than 500 OTC and prescription medications,[2] is both a pain reliever and fever reducer. It can be useful for relieving headaches and common aches and pains. According to the Journal of Pharmacy and Therapeutics, though, the way in which the drug blocks pain is largely unknown.[3]

NSAIDs, found in more than 550 medicines, are able to temporarily relieve both pain and inflammation, according to the FDA, by blocking the body’s production of chemicals that are believed to be associated with pain and inflammation.[4] It can be useful for people experiencing arthritis or muscle strains and sprains.

Medication Misuse

According to a survey released this year by the American Gastroenterological Association (AGA), Americans regularly ignore dosing information on the OTC medicines we ingest. [5] This is especially true for individuals suffering from chronic pain. In fact, 43 percent of chronic pain sufferers reported that they knowingly have taken more than the recommended dosages of OTC medications. And 28 percent of those sufferers have experienced complications due to an overdose of these medicines.

Overdosing on OTC meds isn’t something many people take into consideration when they begin an acetaminophen or NSAID regimen. But the fact that 66 percent of those with chronic pain believe the directions on pain medications are merely guidelines and 27 percent are willing to take more medicine than directed “because they incorrectly believe their symptoms will disappear faster,” according to the AGA, means overdoses are more common than you might think. An average gastroenterologist will see around 90 cases of OTC pain medicine overdose each year.

Problems also arise when individuals utilize both OTC medicines for pain and multi-symptom OTC medicine for allergies, colds or flu symptoms, since it’s likely they may contain the same active ingredient. Taking both can increase your daily dosage of acetaminophen or NSAID, putting you at an increased risk of dangerous side effects.

Common Side Effects

NSAIDs have the potential to cause bleeding in the stomach or digestive track, especially among patients older than 65, those with a history of stomach ulcers or those taking blood thinners or corticosteroids.[6] In addition, NSAIDs can increase the risk of heart attacks and strokes, and the FDA has recently strengthened label warnings regarding these issues.[1]

Acetaminophen is known to be easier on the stomach than NSAIDs, but it still has its side effects. Particularly, large doses or prolonged usage may damage the liver, especially if individuals drink more than three alcoholic drinks a day. 6[7]

And while deaths from OTC overdoses aren’t as common as those from medications like opioids, they do occur. In 2010, 881 died from an overdose of acetaminophen, while 228 died from NSAIDs.1

Treatment Options

According to the AGA, “Americans living with chronic pain can get relief safely, but it is important to work with a healthcare professional to effectively manage chronic pain.” 2 A healthcare provider, especially one well-versed in pain management,  can not only ensure that your dosage of OTC medications is appropriate and that they do not interact or overlap with any of your other medications, but they may also be able to provide treatment options for more prolonged pain relief, including injections, nerve blocks and implants. While OTC pain relievers do provide a degree of relief, oftentimes they don’t treat the true cause of the pain. Thus, when pain persists despite OTC medication usage, it may be time to seek alternative treatment in the form of pain management.

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

[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] American Gastroenterological Association. "Know Your Medicines." 2016. Accessed April 06, 2016. http://gutcheck.gastro.org/know-your-medicines/.

[3] Toussaint, K., X. C. Yang, M. A. Zielinski, K. L. Reigle, S. D. Sacavage, S. Nagar, and R. B. Raffa. "What Do We (not) Know about How Paracetamol (acetaminophen) Works?" Journal of Clinical Pharmacy and Therapeutics 35, no. 6 (December 2010): 617-38.

[4] Hertz, Sharon. "The Benefits and Risks of Pain Relievers." U.S. Food and Drug Administration. September 24, 2015. Accessed April 06, 2016. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107856.htm.

[5] American Gastroenterological Association. "Executive Summary: Gut Check: Know Your Medicine Survey." 2016. Accessed April 06, 2016. http://gutcheck.gastro.org/gut-check-know-medicine-survey/.

[6]"11 Things You Should Know about Common Pain Relievers." Harvard Health. October 9, 2015. Accessed April 06, 2016. http://www.health.harvard.edu/pain/12-things-you-should-know-about-pain-relievers.

[7]American Gastroenterological Association. "FAQs." 2016. Accessed April 06, 2016. http://gutcheck.gastro.org/faqs/.

Thursday, 02 November 2017 13:05

The Truth Behind Failed Back Surgery Syndrome

Back surgery doesn’t always mean the end of pain. In fact, a large portion of people still experience back and leg pain despite undergoing various types of spinal surgery, a condition universally called failed back surgery syndrome (FBSS). Fortunately, for those suffering from FBSS and for whom repeat surgery is not indicated – which is often the case – there are options to reduce the residual pain so sufferers can get back to a more normal quality of life.

Prevalence and Overview of FBSS

The true prevalence of FBSS isn’t entirely known, and estimates place the number anywhere between 5-50% of patients who undergo spinal surgery.[1] What is known is that the condition can come about from various types of surgeries and may be the result of removing bone (laminectomy or foraminotomy) or disc material (discectomy) or even a fusion of spinal segments.[2]

Failed back surgery syndrome doesn’t necessarily mean a failure on the part of the surgeon or that the pain is worse after surgery. FBSS simply refers to pain that persists after surgery – whether that pain is worse, unchanged or even slightly improved. In the case of FBSS, the outcome of the surgery just doesn’t meet the pre-surgical expectations of the provider and patient.[1]

Possible Causes

It’s thought that several factors can play into the development of FBSS.[2] Issues before surgery that can affect the outcome include spinal instability or anomalies in clinical images, in addition to preexisting conditions like diabetes, autoimmune disease and peripheral vascular disease.[3]

Psychological issues, like depression and anxiety, also play a role and patients with them are more likely to have unsatisfactory outcomes from surgery. [4]  Complications after surgery, like excessive inflammation leading to the development of fibrotic tissue, [2] can also result in unfavorable outcomes.

Treatment Options

Repeat spinal surgery is actually less likely to succeed than the primary surgery.[5]This means that oftentimes additional treatments provided by a pain management physician are needed to address the residual pain after spinal surgery.

Depending on the condition, pain management specialists have various options when it comes to managing FBSS pain. Oftentimes, they will utilize minimally invasive treatments such as epidural steroid injections, blocks or radiofrequency neuroablation. These, paired with physical therapy and other comprehensive treatments, can often lead to improved pain levels and overall quality of life.

Other times, physicians may turn to spinal cord stimulation, or SCS, a treatment that’s been proven more effective for FBSS than repeated surgery.[6] SCS delivers low voltage electricity to the spinal cord, interrupting pain signals before they reach the brain. With SCS, patients are able to try the system before permanent implantation and, once they receive the permanent version, are often able to reduce their reliance on opioids. Intrathecal pumps, which deliver medication directly to the spinal cord to block pain signals, may also be considered.

Preventing FBSS

However, as researchers note, preventing FBSS is much easier than treating it.[3] Preventing FBSS comes down, in large part, to proper patient selection for surgery,  meaning that for many, surgery may not be the right option. But for patients for whom spinal surgery is not indicated – or those who are hesitant to undergo such a serious surgery – there are other, less invasive treatment options. These may include some of the same options utilized to treat FBSS – like injections, blocks and radiofrequency – among others.

Learn More

If you’re looking for treatment options for FBSS – or are considering alternatives to spinal surgery – call (888) 901-PAIN (7246) to learn more today.

Download your free opioids and pain in-depth guide

[1] Taylor, Rod S., and Rebecca J. Taylor. “The Economic Impact of Failed Back Surgery Syndrome.” The British Journal of Pain 6, no. 4 (November 2012): 174-181.

[2] Russo, Marc. “Failed Back Surgery Syndrome: Pain That Persists after Surgery in a Subset of Patients.” International Neuromodulation Society. April 2002. Accessed August 30, 2016. http://www.neuromodulation.com/assets/documents/Fact_Sheets/fact_sheet_fbss.pdf

[3] El-Sissy, Mohamad H., Mohamad M. Abdin, and Amr M.S. Abdel-Meguid. “Failed Back Surgery Syndrome: Evaluation of 100 Cases.” The Medical Journal of Cairo University 78, no. 2 (March 2010): 137-144.

[4] Bordoni, Bruno, and Fabiola Marelli. “Failed Back Surgery Syndrome: Review and New Hypotheses.” Journal of Pain Research 2016, no. 9 (January 12, 2016): 17-22.

[5] Thomson, Simon. “Failed Back Surgery Syndrome – Definition, Epidemiology an Demographics.” British Journal of Pain 7 no. 1 (February 2013): 56-59.

[6] North, Richard B., David H. Kidd, Farrokh Farrokhi, and Steven A. Piantadosi. "Spinal Cord Stimulation versus Repeated Lumbosacral Spine Surgery for Chronic Pain: A Randomized, Controlled Trial." Neurosurgery 56, no. 1 (2005): 98-106.

So your doctor says you need a nerve block, but you’ve never even heard of this type of procedure before. You start thinking: What will this entail? Will it hurt? And, most importantly, will it really help relieve my pain? Let this in-depth look at nerve blocks answer all your most pressing questions.

Definition and Types

Nerve blocks do what the name implies: They block the pain signals traveling along a nerve or a group of nerves before they get to the brain.[1] Nerves work like sensory superhighways, transmitting sensations – like pain – from the source to the brain. Blocks involve injecting various types of medications around the nerve or nerves to stop the transmission of pain.

There are two main types of nerve blocks that may be performed at different points in the body; some nerve blocks will be diagnostic, helping doctors find the source of the pain to better determine future treatment, while other blocks may be therapeutic, providing prolonged pain relief.

  • Diagnostic blocks are utilized to determine if a specific nerve or nerves are the source of the problem. During this procedure, a doctor will inject a temporary numbing agent around the nerves, which – if the right nerves were targeted – will relieve pain for a few hours or days. You will then be told to go about your day, moving around as normal and monitoring your pain levels for signs of improvement. If you and your doctor deem the block successful, you may have another block to verify these results, or just move on to a more lasting treatment option, like radiofrequency neuroablation.
  • Therapeutic blocks aim to relieve pain for a longer period of time. This is due to the type of medication injected around the nerves, which will include an anesthetic for short-term relief and an anti-inflammatory medication for longer relief.

Procedure Overview

To begin, you may be given sedation to help you relax, but you will remain awake during the procedure. Your provider will use a local anesthetic to numb the area around the nerves that are being treated. Using a state-of-the-art X-ray device called a fluoroscope, along with contrast dye that’s been injected into the region, your physician will locate the nerve or nerves that may be causing the problem. A mixture of pain-relieving medications will then be injected around the nerves.

Following the procedure, you will usually be able to go home in about 30 minutes. After a nerve block, people may feel soreness at the site of the injection.

Therapeutic Outcomes

The ultimate goals of therapeutic nerve blocks are similar to those of many other procedures: decrease pain, increase function, decrease opioid usage and increase the ability to perform physical therapy. Yet everyone responds differently to different procedures and nerve blocks are no exception.

After the nerve block procedure, it’s possible that the pain may return after the anesthetic wears off but before the anti-inflammatory medication takes effect. This is normal and should decrease within a few days. Usually, more than one injection will be required to provide sustained relief from pain, and relief may last longer after each injection. The amount and frequency of these injections will depend on your specific condition.

Learn More

To learn more about nerve blocks, including if they may be right to help treat or diagnose your condition, please schedule a consultation with one of our experienced pain management providers by calling (888) 901-PAIN. You can also learn more on our treatment pages:

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[1] “ViewMedica Patient Engagement Videos.” Swarm Interactive 2016. Accessed October 6, 2016. http://www.viewmedica.com/.

Published in Pain-Treatment

The national numbers on opioids are clear: Opioids are a dangerous drug with concerning risks and side effects. But what’s going on beneath those numbers, among the individuals currently taking opioids for chronic pain, is equally important. Specifically, how helpful do they find opioids in treating their pain – and what drawbacks are they seeing from prolonged use? A new study presented at the America Society of Anesthesiologists’ annual meeting sought the answers to these crucial questions.

Study Overview

The study, titled “Do Patients Perceive Opioid Treatment as an Effective Way to Mange Chronic Low Back Pain?,”[1] was one of the research projects presented as part of the ANESTHESIOLOGY 2016 annual meeting.

The authors utilized data from a January 2016 survey of more 2,000 low back pain patients. They chose low back pain, in part, because these patients are more likely than patients with other types of pain to be treated with opioids. In fact, 46% of the survey respondents were currently utilizing opioids for pain.

The respondents were divided into three categories based on their opioid usage: those currently on opioids, those who were not currently on opioids but had been in the past year (28%) and those who had never been on opioid therapy (26%).

Key Findings

As part of the survey, patients were asked how successful they felt opioids were at relieving their pain levels. When taken together, only 13% of all respondents selected “very successful.” The most highly selected answer was “somewhat successful,” which was selected by 44% of people. Of the others, 31% said “moderately successful” and 12% said “not successful.” When the results were divided by opioid usage status, “somewhat successful” was still the most common answer for those currently on opioids, while those previously on opioids most commonly selected “not successful.”

The study also examined side effects and stigmas associated with opioid use. The researchers found that the vast majority – 75% – experienced side effects due to their opioid treatment. The most common of these side effects were constipation, sleepiness, cognitive issues and dependence.

On top of that, 41% of people reported feeling judged based on their usage of opioids. And, as it turns out, this feeling of being judged was unique to opioids; despite 68% of respondents also taking antidepressants, only 19% felt judged for using those.

Implications for the Future

These results put further emphasis on the dangers and inefficacy of long-term opioid treatment for chronic pain. Not only does their use create additional physical and social problems, but for most people they don’t even effectively address the pain.

Lead author Dr. Asokumar Buvanendra of Rush University in Chicago sees this as yet another reason pain patients should seek care from a multidisciplinary pain management specialist.[2] Whether it’s interventional procedures, physical therapy, alternative medications or complementary therapies, pain management providers are able to offer and coordinate a variety of services that oftentimes not only work better than opioids, but also pose far fewer side effects.

“Patients are increasingly aware that opioids are problematic, but don’t know there are alternative treatment options,” said Dr. Buvanendra in a press release regarding the research. If you want to learn more about what treatment options are available for your condition, call (888) 901-PAIN to speak to a member of our care team staff.

Download your free opioids and pain in-depth guide

[1] Buvanendran, Asokuma, Rae M. Gleason, Mario Moric, Sherry J. Robison, Jeffrey S. Kroin. “Do Patients Perceive Opioid Treatment as an Effective Way to Manage Chronic Low Back Pain? A Survey of Opioid Treatment Perception and Satisfaction.” ANESTHESIOOGY 2016 Annual Meeting (October 23, 2016). Accessed January 3, 2017, http://www.asaabstracts.com/strands/asaabstracts/abstract.htm;jsessionid=431585AA0967E7E27C850BD8C99D1E06?year=2016&index=3&absnum=4614

[2] AMERICAN SOCIETY OF ANESTHESIOLOGISTS, Many Back Pain Patients Get Limited Relief From Opioids And Worry About Taking Them. 2017. Web. 9 Jan. 2017.

Published in Back Pain

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.

Download your free stretching exercises for pain reduction

[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. http://umm.edu/health/medical/altmed/herb/willow-bark.

[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. http://www.mayoclinic.org/drugs-supplements/omega-3-fatty-acids-fish-oil-alpha-linolenic-acid/evidence/hrb-20059372.

[6] University of Maryland Medical Center. “Omega-3 Fatty Acids.” Accessed February 9, 2017. http://umm.edu/health/medical/altmed/supplement/omega3-fatty-acids.

[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.

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/

Published in Pain-relief

The idea of utilizing stem cells to repair and restore the human body has been a subject of public attention since the early 1990s.[1] However, most of this attention has been focused on diseases like Alzheimer’s, Parkinson’s and heart disease – not on the far more common condition of chronic pain. But that’s beginning to change, and researchers are discovering the exciting possibilities that stem cells could offer for the treatment of various pain conditions – especially back pain.

An Introduction to Stem Cells

Stem cells, in a word, are “undifferentiated.” That means that unlike other cells in the body, they have the potential to develop into a wide variety of other cells. They also carry with them the ability to repair and restore internal systems. So, in theory, it’s possible for stem cells to help repair tissues, muscles, blood, bones and organs, aiding growth and possibly even replacing missing pieces.[1]

Stem cells can be gathered from several locations, including but not limited to bone marrow and adipose (or fat). When it comes to pain management, the most studied and most well-suited type appears to be that gathered from stem cell-rich bone marrow. For the purposes of pain management, these bone marrow cells are most commonly collected from the back of the hip.[2] Once they’re collected, they may be conditioned in various ways, like centrifuging, which make the stem cells as potent as possible. They’re then injected at the site of the issue, with the hope of helping the affected tissue or system regenerate itself.

One of the main concerns of utilizing stem cells – and therefore one of the main areas of concentration in scientific studies – is the safety, specifically regarding abnormal cell growth. The fear is that inserting these undifferentiated cells into the body may increase the risk of spontaneous cell mutation, which could lead to the formation of tumors. Yet while this type of cell mutation has been seen when using embryonic stem cells, it has not been observed with the use of bone marrow cells.[2]

Using Stem Cells for Pain Management

Due to stem cells’ ability to restore and regenerate, their application toward pain management is a logical step. In particular, stems cells are an exciting treatment solution for conditions such as degenerative disc disease and disc herniation. Disc degeneration, which can occur due to aging or injury, causes the discs to weaken and tear, meaning they no longer provided the needed support for the spine. This can result in herniation (a rupture of the disc, which then presses painfully against spinal nerves).

The current methods for treating degenerative diseases like disc degeneration have their drawbacks: Opioids pose many dangers and side effects and invasive surgery permanently changes the body’s natural structure (sometimes unsuccessfully). Even interventional procedures like injections, which can be extremely beneficial for many patients, don’t affect change on a cellular level or help the body begin to repair itself.

Not only do stem cells work to reduce the pain and inflammation associated with these conditions, but they also work to repair and regenerate the damaged regions.[2] So far, research into the application of stem cells for back pain has been positive, although most of it has taken place utilizing nonhuman subjects. The existing studies do indicate, though, that stem cells can indeed minimize degeneration and start to regenerate disc tissue.[2]

Implications for the Future

Many organizations and companies[3] – including Advanced Pain Management – are currently studying the safety and efficacy of stem cells for the treatment of pain. There are still several aspects that need to be optimized, including at what point in care the treatment is utilized, the time between extraction and implant and the type of conditioning that happens to the cells before transplant,[2] but the preliminary data suggest this is a promising avenue for pain relief.

[1] Weintraub, Karen. “Stem Cells: Plenty of Hope, but Halting Progress.” The New York Times, September 27, 2014. https://www.nytimes.com/2014/09/16/science/stem-cell-progress-begins-to-catch-up-to-promise.html?_r=0.

[2] Zeckser, Jeffrey, Michael Wolff, Jason Tucker, and Josh Goodwin. “Multipotent Mesenchymal Stem Cell Treatment for Discogenic Low Back Pain and Disc Degeneration.” Stem Cells International 2016 (January 11, 2016): 1–13. doi:10.1155/2016/3908389.

[3] UC Davis Health System. “New Study Tests Stem Cells as a Treatment for Degenerative Disc Disease.” February 10, 2016. Accessed January 9, 2017. https://www.ucdmc.ucdavis.edu/publish/news/newsroom/10762.

Published in Stem-cell-therapy

Tolerance, dependence, addiction – some risks of long-term opioid use are well-known and often talked about. But these aren’t the only negative effects that may arise. There are actually a plethora of common side effects and risks brought about by using these medications, and almost all patients taking opioids for chronic pain (96%) will experience at least one such side effect.[1]

So whether you’re currently on a long-term opioid regimen or simply weighing your pain management options, knowing all the risks of prolonged opioid use could save you some significant suffering down the road. Let our list of seven lesser-known opioid risks and side effects help guide your decision.

  1. Gastrointestinal issues. One of the most prevalent side effects of opioid usage is constipation. In fact, studies have shown that 40%-45% of those on opiate therapy suffer from it.[2] But it’s not the only gastrointestinal trouble caused by opioids; it’s only one of the symptoms categorized under the title “opioid-induced bowel dysfunction,” which also includes abdominal cramping, spasm and bloating, among others.[3] But constipation is often considered one of the worst, since it’s often unmanageable with OTC treatments like stool softeners and laxatives. 2 In addition to bowel-related disorders, opioids can also cause nausea in 25% of people.
  2. Sleep-related breathing problems. Abnormal breathing while asleep is a concerning issue for those on opioids, especially those on high doses. In fact, in a small study, 92% of patients on a dose of more than 200 morphine milligram equivalents (MME) a day experienced ataxic or irregular breathing, compared to 61% of people taking less than 200 mg and 5% of people not taking opioids.[4]
  3. Cardiovascular issues. Long-term opioid use, when compared with NSAIDs, has been shown in some studies to pose an increased risk for events such as myocardial infarction and heart failure.[2][5] This is especially true for those taking codeine for more than 180 days.
  4. Hyperalgesia. Opioid-induced hyperalgesia (OIH) is another possible outcome for patients on long-term opioid therapy. In cases of OIH, the patient actually becomes increasingly sensitive to pain. Although it’s not clear how prevalent OIH is, it can certainly cause some unwanted effects, including extreme acute pain after surgery and escalating opioid dosages.[6]
  5. Increased risk of fractures. Opioid use is associated with an increased risk of fractures, especially among the elderly population. The theory behind this is that opioids affect the central nervous system, causing such symptoms as dizziness and reduced alertness. [2][7] This, in turn, can result in falls. Elderly patients taking more than 50 MME a day have recently been found to be at double the risk of fracture among the elderly population, with a yearly fracture rate of 9.95%.[2]
  6. Hormone problems. Chronic opioid therapy can also have an impact on the endocrine system, causing hormone changes in both men and women. For men, this manifests as hypogonadism, which causes a decrease in the production of sex hormones, particularly testosterone, as well as erectile dysfunction, reduced libido, fatigue and even hot flashes.[8] In women, opioids can cause a decrease in the levels of estrogen in the body, in addition to low follicle-stimulating hormone and increased prolactin. Combined, these changes can lead to osteoporosis, inappropriate milk production and light or infrequent periods.[2]
  7. Depression. Patients on opioid therapy for long periods have an increased likelihood of developing depression. In one study, 38% of people on long-term opioids had at least moderate depression. [2][9] Furthermore, other opioid side effects, like intractable constipation, can lead to or worsen depression. [2]

Opioids can be a useful component in the treatment of pain, but they’re not the only option. If you’re experiencing side effects from long-term opioid treatment – or would like to find pain relief without the use of opioids – consider talking to a pain management specialist, who may be able to recommend other treatment options, including minimally invasive procedures.

Download your free opioids and pain in-depth guide

[1] Gregorian, Razmic S., Alexander Gasik, Winghan Jacqueline Kwong, Simon Voeller, and Shane Kavanagh. "Importance of Side Effects in Opioid Treatment: A Trade-Off Analysis With Patients and Physicians." The Journal of Pain 11, no. 11 (November 2010): 1095-108.

[2] Baldini, Angee, Michael Von Korff, and Elizabeth H. B. Lin. "A Review of Potential Adverse Effects of Long-Term Opioid Therapy." The Primary Care Companion For CNS Disorders 14, no. 3 (June 14, 2012).

[3] Panchal, S. J., P. Müller-Schwefe, and J. I. Wurzelmann. "Opioid-induced Bowel Dysfunction: Prevalence, Pathophysiology and Burden." International Journal of Clinical Practice 61, no. 7 (2007): 1181-187.

[4] Walker, James M., Robert J. Farney, Steven M. Rhondeau, Kathleen M. Boyle, Karen S. Valentine, Tom V. Cloward, and Kevin C. Shilling. "Chronic Opioid Use Is a Risk Factor for the Development of Central Sleep Apnea and Ataxic Breathing." Journal of Clinical Sleep Medicine 3, no. 5 (August 2007): 455-61.

[5] 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.

[6] Lee, Marion, Sanford Silverman, Hans Hansen, Vikram Patel, and Laxmaiah Manchikanti. "A Comprehensive Review of Opioid-Induced Hyperalgesia." Pain Physician 14 (2011): 145-61.

[7] Li, L., S. Setoguchi, H. Cabral, and S. Jick. "Opioid Use for Noncancer Pain and Risk of Fracture in Adults: A Nested Case-Control Study Using the General Practice Research Database." American Journal of Epidemiology 178, no. 4 (August 15, 2013): 559-69.

[8] Smith, H. S., and J. A. Elliott. "Opioid-induced Androgen Deficiency (OPIAD)." Pain Physician 15, no. 3 (July 2012): ES145-156.

[9] Sullivan, Mark D., Michael Von Korff, Caleb Banta-Green, Joseph O. Merrill, and Kathleen Saunders. "Problems and Concerns of Patients Receiving Chronic Opioid Therapy for Chronic Non-cancer Pain." Pain 149, no. 2 (May 2010): 345-53.

Published in Opioid-Abuse

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