Pain updates & medical news
(last updated: 9-3-07)


Archives of the
USC-Richeimer Pain Updates

Pain News Topics:
(See what is new this past month.)

New Medicines for Pain Treatment

Research on Procedural
Treatments for Pain

Complimentary Medicine & Pain Therapy

Migraines and Headaches

Back and Neck Pain

Cancer Pain

Fibromyalgia & Arthritis

Neuropathic and Other Chronic Pain Conditions

Post-operative Pain

Pain Management Reviews & Overviews

The Science of Pain

Use of Opioid (Narcotic) Medications

MEDICAL & HEALTH NEWS LINKS

 

New Medicines for Pain Treatment
(Updated 7-7-02)


The different patterns of blood pressure elevation by rofecoxib and nabumetone

Antiinflammatory medications can increase blood pressure. The pattern of this increase may be different for the newer selective COX-2 (cyclooxygenase-2) inhibitors. The clinical significance of this difference is not known.


COX-2 Inhibitors--The New Antiinflammatory Medications--May Impair Bone Healing

A study on rats treated treated with COX-2 inhibitors revealed delays in the healing of bone fractures. This impairment of bone healing has been a known problem with the older, traditional antiinflammatory medications (NSAIDs). It was hoped that this problem might be reduced with the new, selective cyclooxygenase-2 inhibitors. This study in the Journal of Bone and Mineral Research suggests that an answer to the problem of NSAID impaired bone healing has not yet been found.


Are Cannabinoids an Effective and Safe Treatment Option in the Management of Pain?

This review of twenty randomized and controlled trials reveals that cannabinoids are no more effective than codeine in controlling pain. Furthermore, the depressant effects of cannabinoids on the central nervous system that limit their use. Before cannabinoids can be considered for treating spasticity and neuropathic pain, further valid randomised controlled studies are needed.


Are COX-2 Inhibitors as Effective as Conventional NSAIDs in Acute Pain?

Rofecoxib (Vioxx) in 50 mg doses seems to be more effective than celecoxib (Celebrex) 200 mg in acute pain.


Pre-Incisional Dextromethorphan Reduces Post-operative Pain

Dextromethorphan is an NMDA receptor antagonist. In theory, such a medication should help block the increased neuronal sensitivity that develops after a painful stimulus. This study supports this theory. Patients who received dextromethorphan 120mg intramuscularly, prior to incision, reported less post-operative pain, and used less post-operative pain medicine.


Lamotrigine for Post-Stroke Central Pain

A small, controlled study, with 30 patients, showed that lamotrigine 200 mg per day provided relief in 44% of patients with post-stroke central pain. One patient had to discontinue the study because of a rash. Otherwise the drug was well tolerated.


Development of the Aerosol AERx (R) Pain Management System is Underway

New opioid delivery systems are being developed. Aradigm is developing aerosol-based drug delivery alternatives to injectable therapeutics. Current development programs focus on diabetes, pain management, cystic fibrosis and the pulmonary delivery of emerging protein therapeutics.


COX-2 Inhibitors Show Good Pain Relief, Safety Record

Studies on the COX-2 inhibitors (Celebrex and Vioxx) show that their efficacy mirrors that of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment in osteoarthritis, rheumatoid arthritis and wound pain, according to Gary Williams, MD, who spoke at a symposia given here during Digestive Disease Week. In fact, the toxicity has been so low and the safety profile so promising that there is speculation COX-2 inhibitors will all but replace NSAIDs.


Venlafaxine For the Treatment of Painful Diabetic Neuropathy

In the United States, an estimated two to three million diabetic patients have at least one type of neuropathy as a consequence of their disease, Dr. Kunz said. Ten percent of patients with diabetic neuropathy experience associated pain that is often severe and can interfere with their quality of life. By the sixth week, 56 percent of patients treated with extended-release venlafaxine 150 to 225 mg experienced significantly reduced pain intensity versus 39 percent who received 75 mg per day and 34 percent who received placebo.


Synvisc for osteoarthritis of the Hip

Synvisc is an injectable, elastoviscous hylan preparation that has similar elasticity and viscosity to human synovial (joint) fluid, providing shock absorption and lubrication. This preliminary study indicates that Synvisc injected into hips with osteoarthritis is safe and effective in providing significant and sustained pain relief in most patients. Based on these positive findings, the company expects to initiate a large, multi-center pivotal clinical trial. Synvisc is already approved to treat osteoarthritic knee pain.


Venlafaxine Reduces the Pain of Diabetic Neuropathy

Study results showed that patients who took Effexor XR in doses ranging from 150-225 mg per day had significantly less pain, compared to placebo. This may help the 6 million sufferers of painful diabetic neuropathy, a condition of nerve damage caused by diabetes.


New York Magazine reviews recent developments in Pain Medicine.

Pain Killers
This article reviews new treatments and new attitudes that are finally giving chronic sufferers hope of living pain-free lives.  Dr. Richeimer is one of several experts quoted.

New York Magazine -- Cover Story: Pain Killers

 

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Older "New Medications" Citations

Research on Procedural Treatments for Pain
(Updated 7-19-02)


Long-term Experience with Implanted Intrathecal Drug Administration Systems for Chronic Mechanical Low Back Pain

This retrospective review of 36 patients reveals that the patients report reduced pain and improved quality of life. Ability to return to work was not affected.


Radiofrequency Neurolysis for Facet Arthropathy: A Retrospective Case Series and Review of the Literature

For several years, blocks of the median branch nerves have been a tool in the treatment of arthritic spine pain. This study of the radiofrequency ablation technique is not controlled, but it does follow the patients for one year after the procedure. 71% of the low back patients, and 85% of the neck pain patients had good or excellent responses for average durations of 6.5 to 10.8 months.


Vagus Nerve Stimulation Suppresses Pain

Ten patients with implanted vagus nerve stimulators for epilepsy control were studied. The stimulators were able to reduce the pain associated with ongoing stimulation. There was no effect on patients given a single painful stimulus. Vagus nerve stimulators may have a role in reducing the hypersensitivity pain associated with neuronal windup.


Spinal Cord Stimulation in Patients with Chronic Reflex Sympathetic Dystrophy

In carefully selected patients with chronic reflex sympathetic dystrophy, electrical stimulation of the spinal cord can reduce pain and improve health-related quality of life. (N Engl J Med 2000;343:618-24.)


Intradiscal Electrothermoplasty

This study of 53 patients with evidence of discogenic pain indicates that intradiscal electrothermoplasty (IDET) can eliminate or dramatically reduce the pain. The patients were compared to a control group that was treated with physical therapy.

The procedure (also called intradiscal thermal anuloplasty [IDTA]) involves using x-ray guidance to insert a needle into the disc. A wire is threaded through the needle into the disc. The wire is then heated, apparently destroying abnormal nerve sprouts that invade disrupted discs, and also triggering remodeling of the proteins that form the wall of the disc.


Bone cement may reduce the pain of osteoporosis.

Patients with severe osteoporosis may suffer with painful compression fractures of the spinal vertebrae. The technique of injecting bone cement into the fractured vertebra may reduce the otherwise difficult-to-treat pain . The technique can also be used in patients suffering with vertebral fractures caused by tumors.

Another variation of this procedure is kyphoplasty. Prior to injecting the bone cement, a small balloon is inserted and inflated. This expands the collapsed vertebra back back towards its original shape. The balloon is then removed and the bone cement injected.

Repairing Fractured Spines

 


Gamma knife treats trigeminal neuralgia with less risk.


Epidural blocks help prevent the chronic pain of postherpetic neuralgia.

In patients with acute herpes zoster (shingles), epidural blockade provided much faster pain relief and reduced residual pain.  This adds to the evidence that epidural blocks help to prevent the chronic, persistent pain of postherpetic neuralgia.

The effects of epidural blockade on the acute pain in herpes zoster. 
Arch Dermatol. 135(11):1359-1364.
ABSTRACT  |   FULL TEXT


Research is underway to destroy nerves involved in pain transmission.

Research is underway to develop medications that selectively target and destroy nerves involved in pain transmission.

Loss of Nerve: A Molecular Approach to Better Treatment of Chronic Pain
JAMA. 2000;283:187
FULL TEXT


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Complimentary Medicine & Pain Therapy
(Updated 5-20-01)


Randomized Trial Comparing Traditional Chinese Medical Acupuncture, Therapeutic Massage, and Self-care Education for Chronic Low Back Pain

Therapeutic massage fared best in this study of 262 patients. Medical acupuncture was relatively ineffective.


Hypnosis and Pain Relief

Hypnotic suggestions can reduce pain sensation in highly susceptible subjects. Interestingly, suggestions of analgesia can induce alterations of pain perception even in poorly susceptible subjects; however these effects did not occur in the area of the body where the patient was instructed to feel pain relief.


Long-term effects of glucosamine sulphate on osteoarthritis

Long-term effects of glucosamine sulphate can moderate the symptoms and changes to joint structure associated with osteoarthritis.


A Randomized Trial of a Cognitive-Behavior Intervention

Compared to information giving and educational approaches, the risk for developing a long-term disability was lowered ninefold for the cognitive-behavior intervention group. The cognitive-behavior group also demonstrated a significant decrease in physician and physical therapy use as compared with two groups receiving information, in which such use increased. These findings underscore the significance of early interventions that specifically aim to prevent chronic problems.


Magnetic Pads May Affect Pacemakers

People with pacemakers or implanted defibrillators should never use those new magnet-laced mattress pads touted to ease back pain because the magnets could temporarily shut off the heart devices. Magnets, purported to treat different aches and pains, are being slipped inside shoe insoles, wristbands, back braces and other gadgets. Most such magnets are more than 6 inches from the pacemaker, and therefore Dr. Thomas Mattioni, of the Arizona Heart Institute in Phoenix, does not consider them dangerous. But mattress pad magnets might get too close to the pacemaker.


Hypnosis Reduces the Pain of Minor Surgical Procedures

People who were hypnotized while undergoing minor surgical procedures without a general anesthetic needed less pain medication, left the operating room sooner and had more stable vital signs than those who were received the usual anesthesia.


Magnets were not effective for the treatment of chronic low back pain.


Glucosamine and Chondroitin for osteoarthritis

Studies indicate a benefit, but the magnitude of this benefit is not clear.


On Pins and Needles? Pediatric Pain Patients' Experience With Acupuncture.
Pediatrics 105: 941-947, 2000. [Abstract]

60-70% of children (mostly teenagers) and their parents found acupuncture to be helpful for chronic pain. The most common diagnoses in the study were migraines, endometriosis, and reflex sympathetic dystrophy (RSD).


Acupuncture helps with acute, post-operative pain.

A well controlled study demonstrates the efficacy of acupuncture for acute, post-operative pain.

Evaluation of Acupuncture for Pain Control After Oral Surgery: A Placebo-Controlled Trial
 Arch Otolaryngol Head Neck Surg.
1999;125:567-572
ABSTRACT   |   FULL TEXT

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Back and Neck Pain
(Updated 4-26-05)

Long-term Experience with Implanted Intrathecal Drug Administration Systems for Chronic Mechanical Low Back Pain

This retrospective review of 36 patients reveals that the patients report reduced pain and improved quality of life. Ability to return to work was not affected.


Radiofrequency Neurolysis for Facet Arthropathy: A Retrospective Case Series and Review of the Literature

For several years, blocks of the median branch nerves have been a tool in the treatment of arthritic spine pain. This study of the radiofrequency ablation technique is not controlled, but it does follow the patients for one year after the procedure. 71% of the low back patients, and 85% of the neck pain patients had good or excellent responses for average durations of 6.5 to 10.8 months.


Multidisciplinary Rehabilitation for Chronic Low Back Pain

Ten randomized, controlled trials were reviewed. They provide evidence that intensive multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain and improves function in patients with chronic low back pain. Less intensive interventions did not show improvements in clinically relevant outcomes.


Are Neck Flexion, Neck Rotation, and Sitting at Work Risk Factors for Neck Pain?

This study prospectively followed 1334 workers for three years. The strongest finding is that sitting at work for more than 95% of the working time seems to be a risk factor for neck pain. There is also a trend for a positive relation between neck flexion and neck pain. No clear relation was found between neck rotation and neck pain.


Knowledge about Back Pain
(see this table)

Incorrect information about back pain is a common problem. Unfortunately, the need for more accurate information is present both among patients and primary care physicians. The problem of managing back pain might be reduced by closing the knowledge gap.



Policy Statement about Smoking from The American Association of Orthopedic Surgeons

Some points from the policy statement:
--Smokers develop fragile bones that are susceptible to fracture.
--Elderly smokers have a 41 percent increase in the rate of hip fracture.
--Smoking often delays healing of fractures and wounds.
--Smokers may also experience more low back pain than nonsmokers.
--Smokers have a higher complication rate from surgery than nonsmokers.


The effect of exercise on percentile rank aerobic capacity, pain, and self-rated disability in patients with chronic low-back pain: A retrospective chart review

The charts of 258 patients with chronic low back pain were studied. Exercise was associated with reduced pain and disability scores.


Too Much Back Surgery?

Experts at the American Academy of Pain Medicine share their concerns that too much back surgery is bein performed. Dr. Hubert Rosomoff found that 99% of his patients were able to avoid surgery by participating in two weeks of intensive rehabilitation.


Intradiscal Electrothermoplasty

This study of 53 patients with evidence of discogenic pain indicates that intradiscal electrothermoplasty (IDET) can eliminate or dramatically reduce the pain. The patients were compared to a control group that was treated with physical therapy.

The procedure (also called intradiscal thermal anuloplasty [IDTA]) involves using x-ray guidance to insert a needle into the disc. A wire is threaded through the needle into the disc. The wire is then heated, apparently destroying abnormal nerve sprouts that invade disrupted discs, and also triggering remodeling of the proteins that form the wall of the disc.


Use of Epidural Corticosteroids in Low Back Pain

This review of the last 33 years of the literature indicates that the use of epidural steroid injections is warranted for the treatment of low back pain, especially among those patients that have failed to improve with more conservative treatments.


Does the Size of a Herniated Disc on MRI Predict Back & Leg Pain?

Narrow spinal canals or herniated discs can be associated with leg pain. However, it is not known whether quantitative measurements of the spinal canal or herniated disc are sensitive and specific for low back-related leg pain. This study suggest that the most sensitive and specific threshold value was 6.8 mm. These findings must be confirmed in a larger population before they are applied clinically. J. Magn. Reson. Imaging 2000;12:439-443. 2000 Wiley-Liss, Inc.


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Older "Back & Neck Pain" Citations

Migraines and Headaches
(Updated 5-2-02)


Tizanidine Plus Nsaid Aids Management of Analgesic Rebound Headache

As discussed in our August 2000 newsletter, pain relieving medications can increase the frequency of headaches by causing "rebound headaches." Tizanidine is a muscle relaxant with properties that might make it a useful adjunct in the process of withdrawing opioid pain medicines as part of the treatment of rebound headaches.


 

Patients with Severe Migraines Benefit from Early Intervention with Sumatriptan

The response to oral sumatriptan 50 mg was improved if the patients took the medication when their pain was still mild. This fits the pattern that we are seeing in many areas of pain medicine: treat pain early.


Recovery from Rebound Headaches Can be Prolonged

Even with avoidance of the analgesics which produced the rebound headaches, it can take 6 months before patients recover to the point of experiencing 6 consecutive headache free days.

For more information about rebound headaches, see our August 2000 Pain Update.



Acetaminophen is Safe and Effective for the Treatment of Migraine

Although most persons with migraine treat their headaches with over-the-counter medication, systematic data on the safety and efficacy of widely used treatment, including acetaminophen, are sparse. This study found that acetaminophen was highly effective for treating pain, functional disability, photophobia, and phonophobia in a population-based sample of persons with migraine, excluding the most disabled persons with migraine. The drug also had an excellent safety profile and was well tolerated.


Botulinum toxin type A for treatment of migraine: An open-label study

Among 77 true migraine subjects treated prophylactically with botulinum toxin type A (Botox), 51% reported complete response over an average duration of 4.1 months. No adverse effects were reported. Botox was found to be a safe and effective therapy for both acute and prophylactic treatment of migraine headaches. Further research is needed to explore and develop the complete potential for the neuroinhibitory effects of botulinum toxin.


Glucosamine for migraine prophylaxis?

An uncontrolled pilot trial of glucosamine therapy for migraines followed a fortuitous observation that migraine headaches ceased in a patient receiving glucosamine for osteoarthritis. A further ten patients with migraine or migraine-like vascular headaches, refractory to established preventive or abortive therapies, were treated with daily oral glucosamine. After a lag of 4-6 weeks, a substantial reduction in headache frequency and/or intensity has been noted; in some cases, the benefit appears to be dose-dependent.


Verapamil in the Prophylaxis of Episodic Cluster Headaches

Oral zolmitriptan is effective in the acute treatment of cluster headache

Two placebo controlled studies show the effectiveness of these medicines for episodic (versus chronic) cluster headaches.


Migraines Are A Unique Brain Disorder

Abnormally hyperexciteable neurons trigger trigger migraines. These neurons suddenly fire off electrical pulses at the back of the brain, triggering waves of electrical activity that ripple across the brain. In minutes, blood flow jumps, until the wave passes and blood flow sharply drops. The resulting pain comes from either the brainstem activation or blood vessels inflamed by the rapidly changing blood flow -- or both.

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Older "Migraine and Headache" Citations

Cancer Pain
(Updated 3-8-00)

 

The American College of Physicians Home Care Guide for Advanced Cancer.

The American College of Physicians presents The ACP Home Care Guide for Advanced Cancer.  This is a tremendously valuable resource for individuals and families who are caring for a dying family member.  The management of pain is only one of the chapters.  There are eleven other useful chapters including the the management of confusion and agitation, and what to do before and after the moment of death.


Management of pain associated with advanced cancer.

The American College of Physicians & The American Society of Internal Medicine present an excellent overview of the medical treatment of pain associated with advanced pain.

Management of Pain and Spinal Cord Compression in Patients with Advanced Cancer
Janet L. Abrahm, MD, for the ACP-ASIM End-of-Life Care Consensus Panel

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Fibromyalgia & Arthritis
(Updated 7-19-02)


Peripheral and central sensitization in fibromyalgia: pathogenetic role

Research is revealing abnormal sensitivity of components of the nervous system involved in sensing and tranmitting pain.


Corticosteroid Injections, Physiotherapy, or a Wait-and-See Policy for Lateral Epicondylitis

The pain of lateral epicondylitis, "tennis elbow," is relieved with steroid injection, but long-term outcomes are better with physical therapy or waiting.


Cognitive-Behavioral Treatment of Rheumatoid Arthritis

This study of patients with sero-positive rheumatoid arthritis indicates that cognitive-behavioural intervention, offered as an adjunct to standard clinical management early in the course of RA, is efficacious in producing reductions in both depression and physical joint pathology.


Long-term effects of glucosamine sulphate on osteoarthritis

Long-term effects of glucosamine sulphate can moderate the symptoms and changes to joint structure associated with osteoarthritis.


Rheumatology: Evaluation of the patient with pain all over

Not all cases of diffuse body pains are fibromyalgia. This article reviews the differential diagnosis and the appropriate evaluation and work-up.


Is Rheumatoid Arthritis Caused By a Damaged Rather Than Overactive Immune System

Patients with rheumatoid arthritis have prematurely aged immune systems,'' said Dr. Cornelia Weyand, the rheumatologist who led the study. ``Until now we have thought that these patients had overactive immune systems, which is why we have aggressively treated the symptoms of rheumatoid arthritis with medications that suppress the immune system,'' said Weyand, whose findings were published in the Proceedings of the National Academy of Sciences.


Substance P in Patients with Fibromyalgia and Myofascial Pain Syndrome

Substance P (SP), a neurotransmitter stored within the sensory, pain transmitting, nerve fibers, is likely to be involved in the pathogenesis of musculoskeletal pain. We investigated SP nerve fibers in the upper trapezius of patients with fibromyalgia (FM) and myofascial pain syndrome (MPS) by immunochemistry. Our results point to a peripheral hyperactivity of this component of the nervous system in FM as well as in MPS. These findings support the notion of pathogenetic involvement of the afferent nervous system in the development and perception of myofascial pain.


Meta-analysis Reveals Antidepressants are Effective for Fibromyalgia

Antidepressants improved sleep, fatigue, pain, and well-being, but not trigger points. Only 1 of 5 studies found a correlation between symptom improvement and depression scores. Outcomes were not affected by the type of antidepressant used. Patients using antidepressants were more than 4 times as likely to report overall improvement, and reported moderate reductions in individual symptoms, particularly pain.


Patients with fibromyalgia benefit from aerobic endurance exercise

Clinicians have long reported that exercise can help reduce the pain of fibromyalgia. This study of treatment with a 12 week exercise program provides support for this clinical practice.


Connective tissue massage in the treatment of fibromyalgia

A series of 15 treatments with connective tissue massage produced 37% pain relief, reduced depression and the use of analgesics, and positively affected quality of life.

European Journal of Pain


Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients

This study indicates that in fibromyalgia patients there are measureable symptoms which can be reduced by the class of medicines that are NMDA-antagonists. Whether this is specific for FMS patients or a general phenomena in painful musculoskeletal disorders is not known.

Pain Vol. 85, (3) pp. 483-491, 01-April-2000


Low doses of interferon-alpha hints at relief of stiffness in fibromyalgia.

Amarillo Biosciences completed a Phase II clinical study of orally administered interferon-alpha (IFN alpha). It showed promising results for sufferers of fibromyalgia syndrome, particularly for relief of morning joint stiffness.


Research is uncovering neuro-chemical changes that may underlie fibromyalgia.

Fibromyalgia is a syndrome of widespread pains throughout the body.  It can severely impair patients and frustrate their doctors.  New research is beginning to uncover neuro-chemical changes that may underlie the syndrome.

MedicalTribune.com:  Neurochemical Mediators Implicated In Fibromyalgia


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Neuropathic and Other Chronic Pain Conditions
(Updated 4-26-05)

 

Dextromethorphan for the Pain of Diabetic Neuropathy

High doses of dextromethorphan (in the range of 400 mg/day) appear to reduce the pain of diabetic neuropathy, but do not appear to be effective for postherpetic neuralgia. Interestingly, this suggests that there are different mechanisms underlying the neuropathic pain of these conditions.


Double-blind, Randomized Trial of Bupropion SR for the Treatment of Neuropathic Pain

Antidepressant medications have a well established role in the treatment of neuropathic pain--even when depression is not a significant issue. Some antidepressants appear to be more effective than others for the treatment of pain. This study suggests that bupropion may be one of the "pain effective" antidepressants.


Dextromethorphan for the Pain of Diabetic Neuropathy

High doses of dextromethorphan (in the range of 400 mg/day) appear to reduce the pain of diabetic neuropathy, but do not appear to be effective for postherpetic neuralgia. Interestingly, this suggests that there are different mechanisms underlying the neuropathic pain of these conditions.


Double-blind, Randomized Trial of Bupropion SR for the Treatment of Neuropathic Pain

Antidepressant medications have a well established role in the treatment of neuropathic pain--even when depression is not a significant issue. Some antidepressants appear to be more effective than others for the treatment of pain. This study suggests that bupropion may be one of the "pain effective" antidepressants.


Brachial Plexus Analgesia with Morphine for Complex Regional Pain Syndromes (RSD)

Nine patients suffering from complex regional pain syndrome of the arm were treated with morphine 0.16 mg/h (3.84 mg /day) applied continuously through an axillary brachial plexus catheter. In all of them an oral analgesics had not been effective. All assessments of pain and grip strength improved significantly during plexus analgesia. There were no major opioid related side-effects. The results from this pilot study indicate that continuous axillary brachial plexus analgesia with low dose morphine might be beneficial in patients suffering from complex regional pain syndrome of the arm.


Soy-Containing Diet Suppresses Chronic Neuropathic Sensory Disorders in Rats

Soy-containing diet prevented development of tactile and heat allodynia (i.e., painful response to non-painful stimulation with light touch or heat), but not mechanical hyperalgesia. We conclude that diet markedly affects chronic neuropathic sensory disorders in rats and should be standardized in animal research studies. Further studies are needed to determine the role of diet in humans with chronic pain.


Sensory Training Reduces Phantom Pain

This study, presented at the Society for Neuroscience, showed that phantom pain could be reduced by training amputees to discriminate the location and frequencies of electrical stimuli applied to their stumps.


Steroid Medications May Effective Treatment for Neuropathic Pain

Continuous infusions of glucocorticoids (methylprednisolone) were effective in treating nerve injured rats. Of note, once daily injections did not work.


Restless Less Syndrome is associated with Sensory Neuropathy

Sensory neuropathy with loss of small nerve fibers may be the underlying problem in some patients with restless leg syndrome (RLS). These are patients with late onset restless leg syndrome, that is associated with pain, and who do not have a family history of RLS.


New Treatments for Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy is a devastating, life-altering illness that frequently affects young people. Suggestions for its management are early diagnosis, treatment of any underlying cause, treatment with sympathetic blockade when appropriate, and intensive physical therapy. If these measures fail, the use of dorsal-column stimulation may be helpful, particularly if the disorder is limited to one extremity. Intrathecal baclofen can help relieve the dystonia that occurs in some patients with reflex sympathetic dystrophy.


Intrathecal Methylprednisolone for Intractable Postherpetic Neuralgia

277 patients suffering with postherpetic neuralgia for at least one year were treated with intrathecal methylprednisolone plus lidocaine, or intrathecal lidocaine alone, or no treatment. The results indicate that the intrathecal administration of methylprednisolone is an effective treatment for postherpetic neuralgia.

For an overview of how this therapy might fit into current state-of-the-art treatment, see the accompanying editorial.


Postherpetic Neuralgia: Irritable Nociceptors and Deafferentation

Postherpetic neuralgia (PHN) is a common and often devastatingly painful condition. Top researchers in the field how different types of neural injury or dysfunction may cause the pain. Clinical examination may help to determine the type of injury.


Nitroglycerin Ointment Effective For Treating Chronic Anal Fissures

Patients treated with 0.4% nitroglycerin ointment did report a highly significant decrease in pain in the first week of treatment. The nitroglycerin was well tolerated, with only 2.6 percent of patients experiencing headaches. Dr. Beck added that, "patients with chronic anal fissures using nitroglycerin ointment have a significant and rapid reduction of pain."


Endoscopy Offers Long-Term Pain Relief For Patients With Pancreatitis

Chronic pancreatitis, long-term inflammation of the pancreas, affects up to 5 percent of the United States population. Caused by various factors including alcoholism, the disease creates severe and even crippling upper-abdominal and back pain. In many cases, Dr. Kalloo says, pain may be caused by elevated pressures in the pancreatic duct. For these patients, using an small tube or endoscope to enter the abdomen and to cut the sphincter muscle at the end of the pancreatic duct to release pressure, has proven effective.


Usefulness of Posture Training for Patients With Temporomandibular Disorders

Sixty patients with jaw pain (TMD) were randomized into two groups: one group received posture training and TMD self-management instructions while the control group received TMD self-management instructions only. The first group reported 40% improvement. The second group (without the posture training) reported 9% improvement. Posture training may be an important component to add to the treatment of jaw pain.

The Journal of the American Dental Association, February 2000.



Medical treatment options for trigeminal neuralgia (tic douloureux).

A good review of medical treatment options for trigeminal neuralgia (tic douloureux).

Trigeminal Neuralgia: New Treatment Options for a Well-known Cause of Facial Pain
Archives of Family Medicine. 1999;8:264
ABSTRACT   |   FULL TEXT

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Post-Operative Pain
(Updated 5-23-01)


The Value of Pre-Emptive Analgesia in the Treatment of Postoperative Pain after Laparoscopic Cholecystectomy

This is another study which shows that post-operative pain can be reduced by pre-operative efforts. Other studies indicate that reduced post-operative pain reduces the likelihood of subsequent chronic pain. Bit by bit, the evidence is growing that prevention works.


Pre-Incisional Dextromethorphan Reduces Post-operative Pain

Dextromethorphan is an NMDA receptor antagonist. In theory, such a medication should help block the increased neuronal sensitivity that develops after a painful stimulus. This study supports this theory. Patients who received dextromethorphan 120mg intramuscularly, prior to incision, reported less post-operative pain, and used less post-operative pain medicine.


Following arthroscopic knee surgery, the administration of both clonidine and morphine into the joint, along with bupivacaine, improves postoperative analgesia compared with either drug alone.

Anesthesia & Analgesia 90:1102-1106, 2000.


Perioperative Dextromethorphan Reduces Postoperative Pain.


Preoperative Dextromethorphan Does Not Reduce Postoperative Pain in Children.


Small-Dose Ketamine Enhances Morphine-Induced Analgesia After Surgery.


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Pain Management Reviews & Overviews
(Updated 5-20-01)


Persistent Pain in Nursing Home Residents

Nationwide, 14.7% of nursing home residents were in persistent pain. Of these, 41.2% reported that they were in severe pain. Clearly, this has been a negelected area of health care.


An overview on the use of adjuvant agents in pain management.


Recent developments in pain medicine and science.

An excellent overview of recent developments in pain medicine and science.

Advances in Cancer Pain
Kathleen M. Foley, MD
Archives of Neurology. 1999;56:413
FULL TEXT


Management of pain associated with advanced cancer.

The American College of Physicians & The American Society of Internal Medicine present an excellent overview of the medical treatment of pain associated with advanced pain.

Management of Pain and Spinal Cord Compression in Patients with Advanced Cancer
Janet L. Abrahm, MD, for the ACP-ASIM End-of-Life Care Consensus Panel


The British Medical Journal's Fortnightly review: Treating acute pain in hospital.

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The Science of Pain
(Updated 5-30-01)

 

Discovery of Novel Molecule That Blocks Pain Receptor System

The nervous system modulates and controls pain via morphine like neurotransmitters, which act on nerve cell opioid receptors. Dramatic progress is being made in understanding a whole new class of receptors, the "opioid receptor-like 1" (ORL-1). This receptor may be an important regulator of pain sensitivity, as well as anxiety, learning and memory.


Neuronal Plasticity and Signal Transduction in Nociceptive Neurons: Implications for the Initiation and Maintenance of Pathological Pain

More is being learned about the cellular mechanisms that produce neuronal central sensitization and subsequent pathological pain conditions.


Neural networks of pain processing. New insights from imaging techniques

Imaging techniques such as PET, fMRI, and MEG provide detailed information about the brains' processing of pain. Until now only little is known about cortical structures mediating the cognitive pain component. In chronic pain the cortical and subcortical processing of nociceptive input is presumably modified. Reorganization in the primary somatosensory cortex is presented as an example of neuronal plasticity induced by chronic pain.


Genes may account for individual variation in pain sensitivity.


Imaging the brain in pain.


Pain inhibition and athletics.


Brief overview of cannabinoids and pain.


The genetic mediation of individual differences in sensitivity to pain and its inhibition.


A scientific review of neural plasticity and the generation of inflammatory pain.


A basic introduction to how nerves sense of pain.


A basic introduction to neuropathic pain.


A basic introduction to how opioid pain medicines work.


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Use of Opioid (Narcotic) Medications
(Updated 1-14-01)


"We Don't Carry That" -- Failure of Pharmacies in Predominantly Nonwhite Neighborhoods to Stock Opioid Analgesics

Pharmacies in predominantly nonwhite neighborhoods of New York City do not stock sufficient medications to treat patients with severe pain adequately. (N Engl J Med 2000;342:1023-6.)


Around-the-Clock, Controlled-Release Oxycodone Therapy for Osteoarthritis-Related Pain

Archives of Internal Medicine / volume:160
Around-the-clock controlled-release oxycodone therapy appears to be effective and safe for patients with chronic, moderate to severe, osteoarthritis-related pain. Improvements of mood, sleep, and enjoyment of life were noted. Typical opioid side effects occurred.


Abuse of Prescription Drugs: Is a Patient Ailing or Addicted?


Lancet's review of opioids in pain management


Risk of addiction from pain treatment is low.

When treating pain, the risk of developing addiction to pain medications is very low.  Fear of addiction often inhibits doctors from adequately prescribing analgesics.  Unwarranted fears also plague patients who are afraid to use their medications.

Doctor's Guide Dispatch

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US News Online - Health
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Ivanhoe Medical Breakthroughs
http://www.ivanhoe.com/

World Health News - newspaper style for breaking news



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Steven Richeimer, MD
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