Tag Archives: TENS

Nutrition important in the care of patients with chronic pain

Nutrition important in the care of patients with chronic pain, and recommended they take essential fatty acids (omega-3 and omega-6 fatty acids) and use olive oil in cooking.

Best avoided, are inflammation-inducing fats such as corn oil and margarine.

Some patients may benefit from switching from coffee to green tea, and avoidance of any food allergens such as wheat, corn, dairy products, and red meat.

Also recommended nonpharmacologic approaches for chronic pain such as cognitive therapy and mind-body approaches — meditation and yoga — as well as exercise and physical therapy.

High-tech distractions

August 2004 issue of Scientific American describes how pain of severe burns may be eased by the ultimate in high-tech distractions, virtual reality game.

Clinical studies are showing how effective virtual reality is at fighting burn pain. In an article in Scientific American, Hoffman described how they used a special virtual reality helmet that would work in a magnetic resonance imaging (MRI) scanner to confirm this. The team studied five regions of the brain that are known to be associated with pain processing. “We found that all five regions showed significant reductions, and the amount of reductions during VR, the amount of reductions in pain-related brain activity, ranged from 50 percent to 97 percent,” says Hoffman. “The incoming pain signal is not even being processed during VR. There’s much less pain being processed by the brain when the person’s in VR.”


more on www.sciencentral.com

Related

Engadget is pointing us to the news that TV may also be something of a painkiller for kids. Basically, the researchers drew blood from a bunch of kids in various situations — and discovered that those who were watching TV found it less painful. Of course, this may not be all that surprising.

Turning PKG off stops the pain!

After injury, pain sensors in the body can lapse into a hyper-excited state. Long after the original injury is gone, these pain cells keep on sending intense pain signals. Columbia University researchers report that an enzyme called protein kinase G or PKG is responsible for this long-term hyper-excitability of pain sensors. Rats studies show that turning PKG off stops the pain.

From the August issue of the journal Neuroscience.

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

Florida Pain Patient Faces Decades in Prison for Pain Medication

Richard Paey, 45, of Hudson, Florida, is disabled. Injured in a traffic accident in 1985 while attending law school at the University of Pennsylvania, Paey suffered a severely herniated disk in his lower back. A first surgery failed, and a second operation, an experimental procedure involving screw inserted into his spine, only aggravated matters. It left his backbone splintered and the mass of nerves surrounding it mangled. Paey, who relies on a wheelchair for mobility, was left in excruciating chronic pain, which he treated with prescribed opioid pain relievers.

But Paey’s odyssey from being just another of America’s tens of millions of chronic pain sufferers to a Florida jail cell was about to get underway. Paey and his family had been living in New Jersey, where a physician prescribed large amounts of opioid pain relievers for Paey, but when they moved to Florida, they could not find doctors willing to provide the high-dosage prescriptions needed to fend off the pain that tormented him.

Paey, who has also been diagnosed with advanced multiple sclerosis, resorted to filling out prescription forms obtained from his New Jersey doctor and eventually came to the attention of the Drug Enforcement Administration and the Pasco County Sheriff’s Office. Investigators reported watching Paey and his wheelchair roll into one pharmacy after another to pick up fraudulent prescriptions, adding up to more than 200 prescriptions and 18,000 pain pills in a year’s time.

No one could take so many pills, investigators suspected. Paey must be a drug dealer. And they charged him as one, even though no one has ever presented any evidence that Paey did anything with the pain pills except ease his own pain. Now, after two mistrials, plea bargain offers made and withdrawn, and plea bargain offers rejected by Paey, prosecutors have managed to win a conviction. A week from today, a Florida judge will decide Paey’s fate, although if the judge follows state law, there is not much to decide. As a convicted Florida “drug trafficker,” Paey faces a mandatory minimum sentence of 25 years in prison.

In a last minute bid to win freedom for Paey, who is currently imprisoned in the hospital wing of the Pasco County Jail and is being treated with a morphine pump while in jail, his attorneys will use the occasion of next Friday’s hearing to ask that the verdict be dismissed on the grounds that Paey’s New Jersey physician, Dr. Steven Nurkiewicz, lied on the stand when he testified that he did not give Paey permission to fill out undated prescription forms.

“The state knew Dr. Nurkiewicz was lying when he said he did not provide the prescription forms and that he only prescribed small numbers of pain pills, but they said he wasn’t on trial, and they won’t charge him with perjury,” said Paey’s wife Linda. “We tried to get a mistrial, but they were still able to put Nurkiewicz on the stand knowing that he had lied,” she told DRCNet. “They feel like the end justifies the means, that my husband is a bad person, and that they’ve invested too much money in prosecuting him to let him get away. Now they will lose face if they drop the charges,” she said.

“We were so naÔve when this began,” she said. “They accused him of selling the medicine and we said no, he’s a pain patient. I thought that once they saw that was true, they would understand. But no. They not only charged him as a drug trafficker, but they harassed his doctors to stop him from getting more pain medication.”

Paey’s family and a growing number of supporters are not merely relying on the courts for justice, but taking his case to the court of public opinion. A letter writing campaign to local newspapers is underway, and the St. Petersburg Times has editorialized on Paey’s behalf. Paey has also drawn support from national organizations including the Pain Relief Network (http://www.painreliefnetwork.org) and the November Coalition (http://www.november.org), a group working to end the drug war and free its prisoners. This evening, supporters will hold a vigil outside the Pasco County Courthouse in Port Richey.

“Richard Paey is a hero, not a criminal,” said Siobhan Reynolds, founder and executive director of the Pain Relief Network, as she prepared to board a flight for Tampa Wednesday. “The more people hear about this case, the more disturbed they are. He refused plea bargains because he would not be complicit in criminalizing his own efforts to save his own life,” she told DRCNet. “This is about medicine and medical care, not about illegal drugs or drug trafficking, and it is startlingly clear that local prosecutors and the DEA have totally lost track of that distinction.”

The Pain Relief Network and other Paey supporters will ask the prosecutors to not stand in the way of the acquittal motion, Reynolds said. “We are calling on them to join the motion to acquit. This was not a real crime, only a statutory one,” she said. “We want them to do the right thing for this suffering individual.”

The conviction of Richard Paey comes as Florida is in the midst of its own version of drug czar John Walters’ war on prescription drug abuse. Alongside such high profile actions as the investigation of Rush Limbaugh and the nearly monthly arrests of pain management physicians, the Florida legislature has been at work crafting a prescription monitoring bill that would allow doctors and law enforcement to access a database showing prescriptions to all potentially addictive drugs statewide.

As part of the White House’s National Drug Control Strategy, Walters is pushing for more states to join the 15 that already have such programs. They would help reduce abuse by allowing physicians and law enforcement to spot patients seeking multiple prescriptions, Walters said. Paey’s representative, state Sen. Mike Fasano, is sponsoring the bill in the state Senate. The bill would protect patient privacy by making it a felony to unlawfully divulge patient information, Fasano told the Orlando Sentinel in February.

But Paey’s case shows the danger of such a database, said Reynolds. “Richard Paey was prosecuted three times in the very same district that is represented by Senator Mike Fasano, the sponsor of Florida’s prescription monitoring bill. Fasano’s claim that prosecutors won’t use private medical information gathered in government computers against patients in pain, is exposed for the hollow assurance it is,” Reynolds said. “Law enforcement already looms over medicine to such an extent that patients with the highest dose requirements, those with the most severe pain, can’t find medical help. Prescription Drug Monitoring Programs only ensure that the under-treatment of pain will continue to plague our most vulnerable citizens and their families.”

Still, the Senate bill and its companion bill in the Florida House are moving.

Meanwhile, Paey’s supporters are gathering for a last minute effort to bring him home.

“John Chase of the November Coalition and Siobhan Reynolds have really been working hard to get the word out,” said Linda Paey. “I couldn’t do all this myself. But we are encouraged by all the support we are finding out there. The Times editorial certainly helped. And my coworkers and neighbors have been very supportive. There are people I don’t know who pull up in my driveway and offer their support,” she said. “It’s a little shocking.” She has also had nibbles from the CBS news program 60 Minutes, Paey said.

Linda Paey is not pleased with local law enforcement and prosecutors. “They have done nothing but try to prosecute my husband, and they used the most disgusting tactics. They’re used to threatening everyone with long mandatory minimum sentences, then getting them to cop a plea and get probation,” she said. “If these people are so dangerous they need mandatory minimum sentences, why do they turn around and give them probation?” she asked.

“This case should not even be in the courts,” Paey added. “Cases like this should be given to the medical board to see if there was any wrongdoing to begin with. Instead, they assume the doctor is over-prescribing or the patient is abusing the drugs, but they don’t know that. It’s an easy way for cops and prosecutors to look tough on drugs.”

“My husband refused to plea bargain because he believes this prosecution is wrong, that this should not be happening. I haven’t been able to convince him otherwise. Now he is collateral damage in the war on drugs.”

And now Richard Paey and his supporters have only a week in which to act to prevent him from being sent to prison for 25 years. Paey’s case is not only an object lesson in the way a dogmatic war on drugs creates new victims, but also a sad commentary on the state of our nation’s judicial systems. When someone is punished for actually trying to defend himself against criminal charges, as opposed to accepting a plea bargain of guilt, something is very much amiss in the halls of justice.

To read the House prescription monitoring bill online, go to:
http://www.flsenate.gov/session/…BillNum=0397

To read the Senate version, go to:
http://www.flsenate.gov/session/…&billnum=580

Antidepressants Linked to Suicide?


The FDA urged drugmakers to put new warning labels on popular antidepressant medications. Alerting to watch for suicidal tendencies, hostility and agitation in patients taking the drugs.

FDA focuses on Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro, Wellbutrin, Effexor, Serzone and Remeron and follows a warning by the British government last year advising physicians not to prescribe most widely used antidepressants to children.

FDA said it does not know whether the medications are responsible for reported side effects such as inner restlessness, agitation and suicidal thoughts in some people. Officials said they are drawing greater attention to known cautionary information while a team of outside researchers completes a comprehensive analysis of the possible risks.

Critics of the medications demanded that the FDA go further. Although Prozac is the only one of this class of drugs that has been specifically approved to treat depression in children, doctors are writing tens of thousands of prescriptions for many of the others, based on their clinical judgment that the drugs are safe and effective.

Many critics complain that a majority of studies of the drugs in children found that the medications did no better than dummy pills in treating depression, but that these studies have been hidden from doctors and the public. The companies say the studies are proprietary.

Many psychiatrists say the medications save lives and warn that discouraging patients from taking them could lead to greater numbers of suicides. They insist that suicidal tendencies or attempts among patients taking the drugs are the result of underlying disorders, not the medications.

The Public Health Advisory containing the new label warnings and cautions is available online at http://www.fda.gov/cder/drug/antidepressants/default.htm

Physiotherapy, chiropractic techniques, acupuncture and TENS.

Whilst this has usually been attempted by the time a patient reaches a Pain Clinic, appropriate physiotherapy in the form of an exercise programme is almost always of benefit. A great deal of work needs to be done to validate conventional physiotherapy techniques; usage in acute pain appears to bring little benefit over the natural history of the condition, whilst in chronic pain it can often be of only short-term efficacy. However, functional rehabilitation programmes aimed at restoration of suppleness and muscle function do appear to be of very real benefit in the long term. Chiropractic manipulation has been shown to be effective in some studies, whilst ineffective in others. Again, patient selection and the technique of the manipulator are markedly variable and will alter efficacy a great deal.

Both acupuncture and TENS are exciting great controversy at the present time in the Western world; their long standing use for chronic pain is being questioned because (again) of the lack of evidence. This remains a controversial field, but both techniques appear to be relatively simple, fairly safe in appropriate hands and reasonably cheap. Acupuncture again is said to work on descending inhibitory pain pathways and also to stimulate endorphins (as well as the body’s natural cortisone). Both positive and negative results have been shown in a bewildering variety of trials. There is certainly a powerful placebo effect, but there also seems to be a significant analgesic component, albeit this might last for only a very short period, and the benefits seen with many patients may be due to a reduction in distress and disability engendered by their interaction with the therapist.

Again it is difficult to find a wealth of hard evidence as to the efficacy of TENS, but a limited, albeit significant number of patients appear to get good benefit, and this appears in some studies to be better than placebo.

Dorsal column stimulation continues to excite interest. Clearly, this can be a useful therapy for moderate pain, especially if it encourages entry into a pain management programme-type approach.