Tag Archives: research

Studies Find Opioids Ineffective

“Opioids are often ineffective for some types of pain at any dose. Pain intensity scores were unchanged postoperatively in patients receiving titrated opioid analgesia in accordance with Agency for Health Care Policy and Research guidelines when compared with a matched control group before guideline implementation. None of our patients with chronic nonmalignant pain receiving opioids according to protocol had complete relief of pain.

Although opioids themselves may not cause addiction, the high prevalence of addiction in the general population and the even higher comorbidity of addictive disorders with psychiatric illness mean that a substantial minority of patients with chronic pain treated with opioids display problem behavior that makes opioid management arduous, if not impossible. The proportion of problem cases appears to be 10% to 15% of patients with chronic pain selected for opioid maintenance analgesia.

It is true that many patients do tolerate remarkably high daily doses of opioids and are able to function as well as before using the drugs. However, it is equally true that at least as many patients seem to be unable to tolerate any opioid at even the lowest dose. We must be respectful of the serious array of side effects of these agents. Tachyphylaxis and gradual adjustment of opioids may avoid respiratory arrest, but constipation, nausea, sedation, and confusion often become limiting adverse effects. ”

Links to articles and studies:

Opioids for chronic nonmalignant pain
Choosing suitable candidates for long-term therapy.

Systematic Review: Opioid Treatment for Chronic Back Pain: Prevalence, Efficacy, and Association with Addiction
Opioids are commonly prescribed for chronic back pain and may be efficacious for short-term pain relief. Long-term efficacy (≥16 weeks) is unclear. Substance use disorders are common in patients taking opioids for back pain, and aberrant medication-taking behaviors occur in up to 24% of cases.

God

Coping with Chronic Pain

Litchfield,Conn., resident Lois Pike talks about coping with invisible diseases, those ailments that cause chronic pain and make daily life a challenge, and how she overcomes them with God’s help.

About Sandy

http://www.sandycarlson.net

There are the video clips of Strange Attractions, Exploring Graffiti, an ongoing research project into the creative aspects of this visual art form. You’ll find more on this topic at strangeattractions.info.

There are audio-visual meditations based on prayers and scripture from various faith traditions.

There are videos I have created for Wisdom House (wisdomhouse.org) and Buddhist priest Brian Vaugh (buddhismtoday-brianvaugh.blog spot.com).

Contact me via sandycarlson.net if you’d like to hire me for your video needs.

Non-Surgical Ligament Reconstruction

Is it impossible to have a healthcare system that is driven by profits to also be focused on inexpensive and permanent solutions?

When reports on ESPN this week revealed that some US Olympic Ski Team members left the country and went where they could use what is considered ìalternativeî treatments for relief of their injuries and pains, it once again elevated the question of why Medical insurance and workmans comp in the U.S. wonít cover procedures like that.

In many cases, these treatments prove markedly more effective than traditional therapies. The treatment called prolotherapy, used to strengthen weakened ligaments, is widely accepted and used in other countries with national health care systems, including Canada.
Prolotherapy has been considered ìinvestigationalî for 70 years by the Medicare board; insurance companies will cover it when Medicare decides to cover it.

The practice of prolotherapy is used by both medical doctors (MDís) and osteopathic physicians (DOís), such as Dr. Jo Ann Douglas of Colorado Osteopathic & Sports Medicine, to treat several different types of chronic pain. It may be the latest alternative therapy to hit the sports medicine scene.

Doctors are using the treatment successfully for tennis elbow, Achilles tendonitis, patellar tendonitis, back problems, and other common sports injuries. Prolotherapy is also effective in cases of arthritis, fibromyalgia, whiplash, and chronic pain in the neck, back, shoulder, ankle, and sciatica. It relieves disk problems unresponsive to more conservative treatment.

According to Dr. Douglas, there are approximately 600 licensed physicians in the U.S. that perform this procedure. ìProlotherapy treats the cause of the problem; that is, instability. We inject a solution into the ligament or tendon where it attaches to the bone, which stimulates the bodyís own healing response by creating blood flow to the area, recruiting immune system cells that clean the area, and construction cells (fibroblasts) that rebuild the tissues.

ìThis is the exact opposite of the current standard of care, which treats pain and inflammation with anti-inflammatories. Prolotherapy promotes the bodyís inflammatory process so that the body can heal itself. In most cases, commonly prescribed anti-inflammatory medications and drastic measures like surgery or joint replacement may not help, and often hinder or even prevent the healing process.î

According to Dr. Douglas, ìmany patients do not understand why insurance companies will not reimburse for this technique. In many cases it may save the patient from chronic pain management or surgery, which would save money for insurance companies and Medicare as well as treat the cause of the problem for the patient.î

The federal government hears issues from large special interest groups loud and clear. The drug companies, surgeons and chiropractors are heard; whereby the 600 doctors who perform prolotherapy are a very small voice in the healthcare system. In fact, they were not heard at all until Olympic Athletes went to Mexico to get prolotherapy.
Vioxx was covered by insurance, even though it had risks. Surgeons continually change their methods and the new surgery techniques are covered by Medicare and insurances. Secondly, surgeons use cortisone for temporary relief even though cortisone has been proven to cause ligament and tendon deterioration, which may only lead to surgery.
X-rays and MRIís do not always reveal injuries. The number of qualified doctors specifically trained to administer prolotherapy is growing. There are training programs at medical schools now that teach this technique, including how to properly diagnose these injuries.

Although medical doctors who do prolotherapy will continue to be few until more evidence accumulates, osteopaths like Dr. Douglas have a long track record with the procedure.

Each injection treatment varies in cost, ranging from less than $100 for smaller joints to several hundred dollars for larger or more complex joints such as those in the neck and back. Most people need 4-6 treatments ó usually administered in a series of injections three weeks apart ó to stabilize the joint

WHY ISN’T PROLOTHERAPY COVERED BY MEDICAL INSURERS?
Modern allopathic medical research demands that therapies be proven by double-blind methods. This means that neither the patient nor the physician know which therapy is used. For medications, the pills can easily be made to look alike, and a sugar pill used as a placebo is presumed to have no therapeutic value.

For procedures like prolotherapy and most surgeries, there is no adequate placebo. Cortisone cannot be used as a placebo because cortisone can only be injected 3 times a year; typically, prolotherapy requires 4-6 treatments.

The Medicare board wants more data to show the effectiveness of prolotherapy. Drug companies pay for research when it is profitable. They are unlikely to pay for research on prolotherapy because this would not be a profitable venture. In fact, drug companies and surgeons would profit less if prolotherapy would be more widely used, since fewer people would need pain medication and they could avoid expensive surgeries or complications from surgeries.

Dr. Douglas can be contacted through her Website (www.mycodo.com) which further explains this procedure.

Jo Ann Douglas, M.S,D.O.
Board Certified by the American Osteopathic Board of Neuromusculoskeletal Medicine
Colorado Osteopathic & Sports Medicine

Stem cells repair damaged spinal cords in mice


Injections of human stem cells seem to directly repair some of the damage caused by spinal cord injury, according to research that helped partially paralyzed mice walk again.

“We set out to find whether these cells would be able to respond to the injury in an appropriate and beneficial way on their own,” said Brian Cummings, first author of the paper.

“We were excited to find that the cells responded to the damage by making appropriate new cells that could assist in repair. This study supports the possibility that formation of new myelin and new neurons may contribute to recovery.”

Mice that received human neural stem cells nine days after spinal cord injury showed improvements in walking ability compared to those that received either no cells or a control transplant of human fibroblast cells, which cannot differentiate into nervous system cells.

The bulk of injected stem cells formed oligodendrocytes, a different type of cell that forms myelin, the insulation coating that is key for nerve fibers to transmit the electrical signals they use to communicate.

The research was funded by the nonprofit Christopher Reeve Foundation and the National Institutes of Health. StemCells Inc. of Palo Alto, Calif., provided the fetal-derived stem cells.


one the net

National Geographic

Prialt users?

We are a research firm conducting a telephone study with individuals who are currently using Prialt. For participating in the 45 minute phone study, you will be paid $75.

If you are interested or have questions, please call us at 1-800-297-7710 and ask for Project # 328. We will ask you a few quick questions to determine if the study is appropriate for you.

Cyclobenzaprine

In another front in the quest to find effective nonopioid pain management strategies, Childers and associates[10] have found that low doses of cyclobenzaprine, a muscle relaxant related to the tricyclic class of antidepressants, when given as monotherapy, is as effective as cyclobenzaprine and ibuprofen combined. In addition, the low dose — 5 mg 3 times daily — is as effective as a higher dose used in other research with cyclobenzaprine — 10 mg 3 times daily. In this 7-day study, Childers and colleagues randomized 867 patients with acute muscle spasm of the back or neck to 5 mg of cyclobenzaprine 3 times daily or 400 mg or 800 mg of ibuprofen. All 3 treatment groups had a significant improvement over baseline (P < .001). The findings led the investigators to conclude that for musculoskeletal pain with a spasmodic component, cyclobenzaprine monotherapy, even at a low dose, is as effective as combination therapy with ibuprofen, a finding that broadens the options for patients who cannot take ibuprofen.

MD – Pain clinics in Maryland

AGS Foundation For Health in Aging
http://www.healthinaging.org/

Non-profit organization established by
the American Geriatrics Society to build a bridge between the
research and practice of Geriatrics and the Public, and to
advocate on behalf of older adults and their special health
care needs.

American Alliance of Cancer Pain Initiatives
http://www.aacpi.wisc.edu

National organization dedicated to promoting cancer
pain relief nationwide by supporting the efforts of state and
regional pain initiatives.

American Cancer Society
http://www.cancer.org/docroot/home/index.asp

Nationwide, community-based voluntary health
organization that is committed to fighting cancer through
research, education, patient service, advocacy, and
rehabilitation. It provides health information and support for
patients, families, friends and professionals.

American Chronic Pain Association
http://www.theacpa.org

Organization offers support and information for people
with chronic pain, with over 400 chapters and support groups
throughout the U.S., Canada, Mexico, Australia and Europe.

American Pain Foundation
http://www.painfoundation.org

Independent nonprofit organization serving people
with pain through information, advocacy and support. Its
mission is to improve the quality of life for people with pain
by raising public awareness, providing practical information,
promoting research, and advocating to remove barriers and
increase access to effective pain management.

American Society For Pain Management Nursing
http://www.aspmn.org/

An organization of professional nurses dedicated to
promoting and providing optimal care of individuals with pain
through education, standards, advocacy and research.

Beth Israel Medical Center Dept. of Pain Medicine & Palliative Care
http://www.stoppain.org

Resource and information center with support
and information for patients, caregivers and professionals.

JCAHO Standards For Pain Management Revisions 2001
http://www.jcrinc.com/subscribers/perspectives.asp?durki=3243&site=10&return=2897

Develops professionally based standards and evaluates
and accredits general and rehabilitation hospitals, long term
care and assisted living facilities, clinics, home care
agencies and other health care organizations and programs in
the United States.

Johns Hopkins Chronic Pain Treatment Program
http://www.hopkinsmedicine.org/jhhpsychiatry/pain.htm

Comprehensive, multidisciplinary pain center for
the reduction of intractable chronic pain and its accompanying
emotional and medical complications.

Maryland Cancer Plan
http://www.marylandcancerplan.org

A new comprehensive cancer control planning
initiative to update the Maryland State Cancer Plan. It is
housed under the office of the Maryland State Council on
Cancer Control and includes subcommittees on pain management
and end of life issues.

Maryland General Assembly
http://mlis.state.md.us/

Provides information about the Maryland State
Legislature, including names and contact information of
Maryland Senators and Delegates, who sponsored a bill, what
the bill is about and what actions were taken.

Maryland Health Care For All!
http://www.healthcareforall.com/

Grassroots coalition working to ensure that all
Marylanders have access to quality and affordable health care.

Maryland Quality Care End-of-Life Council
http://www.oag.state.md.us/Healthpol/SAC/

Created in December 2002, the
Council advises the Office of the Attorney General, the
Department of Aging, and the Department of Health and Mental
Hygiene. It also advises the General Assembly on changes in
laws related to the provision of care at the end of life.

Maryland State Advisory Council on Pain Management
http://www.dhmh.state.md.us/ohcq/council/home.htm

Established in November 2002 to provide advice and
recommendations regarding issues of acute and chronic pain
management by Maryland health care providers, as well as the
pain management needs of adults and children.

Medbank of Maryland
http://www.medbankmd.org/

Non-profit organization whose mission is to provide
access to prescription medications for chronically ill,
low-income, underinsured/uninsured Maryland residents. MEDBANK
assists healthcare providers and patients in completing the
paperwork required to enroll patients in Pharmaceutical
Company Patient Assistance Programs.

National Initiative for Rheumatoid Arthritis
http://www.rheumatologycme.org/

Independent multi-component education program
offering online CME course, case studies, slides and other
resources for healthcare professionals.

Pain and Addiction Medicine Information Site (ASAM)
http://www.asam.org/pain/pain_and_addiction_medicine.htm

Information and resources on addiction
medicine and pain management from the American Society of
Addiction Medicine.

Pain Connection
http://www.pain-connection.org/

Non-profit human service agency in
Maryland that provides monthly pain support groups, information,
referrals and community education.

Pain Law Initiative

Mary Baluss, an attorney from
Washington, DC, is the Director of the Pain Law Initiative and
specializes in pain management cases, hospice care and end of
life care issues. She has developed and litigated legal
concepts intended to improve access to pain relief. She
advocates for both patients and the physicians who prescribe
opioids for chronic pain. She is also the General Counsel for
The National Foundation for the Treatment of Pain
http://www.paincare.org/. Ms. Baluss can be contacted
at the following address, phone numbers and/or email:

Mary Baluss, Esq.
Pain Law Initiative

2850 Arizona Terrace NW
Washington, DC 20016
202/244-0710 (phone)
202/361-2775 (cell-preferred number)
202/318-3027 (fax)
[email protected]

Sickle Cell Information Center
http://www.scinfo.org

Sponsored by the Georgia Comprehensive
Sickle Cell Center at Grady Health System, the site o patient
and professional education, news, research updates and
worldwide sickle cell resources.

Stronger Bones
http://www.strongerbones.org/osteoporosis.html

Resource devoted to promoting bone
health and preventing osteoporosis, provided by the Maryland
Department of Health & Mental Hygieneís Office of Chronic
Disease Prevention.

University of Maryland Medicine Pain Center
htttp://www.umm.edu/pain/

Comprehensive, multidisciplinary pain center for
the assessment and treatment of chronic pain syndromes.