Manipulating Statistics About Chronic Pain

Chronic Pain Abuse StatsA newspaper headline read this week, “1 in 3 Medicare Patients took Opioids” in the last year. Is that as big a deal as the headline made it out to be? Probably not. If one starts to think about the article and read the whole story, it becomes ridiculous. The study being cited actually reports that 1 in 3 Medicare recipients overall received at least one prescription for an opioid medication in the last year. The article and the study indicated this was a major problem.  

Some facts should be thought about when analyzing such a study. First, one in three people suffers from chronic pain. Further, chronic pain tends to be more common in the elderly and disabled, the very population that has Medicare. One prescription within a year’s time is probably not significant. Many people have significant medical procedures within one year, including dental procedures, numerous outpatient surgeries, or even painful diagnostic studies. Others have injuries that may be extremely painful for several days. The common thread is that all these things are appropriate for short-term opioid use to control pain. Obtaining one prescription within a year for a third of all Medicare patients would probably be very normal.

Interpreting The Stats

The focus of the study and the article is to emphasize how bad and problematic are opioids. If one stops and thinks for a second, making that conclusion on the basis of “1 in 3 Medicare patients have received a prescription for opioids in one year” is terrible. Acute pain is exactly what opioids are best used to treat, especially for just a few days. It would not be surprising to find out that 1 in 3 Medicare patients had a significant medical procedure for which an opioid was prescribed.

A more devastating fact should be that 1 in 3 people suffer from chronic pain. The causes of pain are extremely varied. The headlines of the paper are all about addiction. There are very few about how widespread pain is a problem. The big alarm is about death related to drug abuse. Addicts are obtaining billions of dollars for further treatment and research from the government. There are no headlines about how people struggle day to day with dealing with pain and still trying to continue with life. 

Addiction to opioids and the increases in deaths is a problem. The solution in reality is probably to treat the true problem, which is the pain. Better pain medications that are not addictive definitely are needed. Research in the basic science of pain and how to prevent it is needed even more.  

The Future of Stem Cells and Chronic Pain

Chronic Pain Mn stem cellsInteresting information and thoughts can come from odd places. Earlier this week NPR Science Friday was discussing the potential of stem cells in curing disease. New techniques have become available to take a person’s own stem cells and turn them into cells with specific functions. The target has been to fight cancer within the body more effectively than using drugs to kill the cancer cells. The body fights infection usually very effectively, if we can train the body to fight similar problems using its own cells, then we may have ability to fight many different kinds of problems affecting the body.  

After fighting cancer, the next challenge being studied is how to modify and stop diseases that affect the body. Major medical problems that have definite potential to be solved are diseases like diabetes and rheumatoid arthritis. These diseases are problems when the body is fighting itself. In diabetes, the pancreas stops producing insulin while in rheumatoid arthritis the body damages the joints. These diseases are well understood, and thus leading to strategies to reverse these problems. For diabetes, stem cells are being turned into pancreas cells that produce insulin. Rheumatoid arthritis is a disease of inflammation, and stem cells are being turned into cells that stop the inflammatory process.

Stem Cells and Pain

Pain is much more complex than many of the first targets stem cells are working toward helping. Pain is generated from many structures, and there are multiple locations in the body are involved. Damaged or dysfunctional muscles, tendons, ligaments, joints, discs in the spine, and nerves are just a few of the problems. Not one single issue is present but many problems usually co-exist. A single solution to pain will be much more difficult. The most difficult problems will be those where pain comes from multiple sources and the brain short circuits on the signals, where central sensitivity to pain occurs. When a primary single problem can be isolated, then the potential for a solution may become feasible.

Back and neck pain have become early targets for trying to find solutions with stem cells. Discs in the spine often become painful, and reasons may include degeneration, tears, and disc herniation. Surgery can remove a herniated disc fragment, but it does not repair the disc damage. Stem cells may be able to repair the disc and return the disc to normal structure at some point in the future. Another solution may be to use stem cells to repair nerves that have been damaged. Stem cells are starting to be used to help treat spinal cord injuries, but success in this area has not yet been fruitful.

One third of the population suffers from some sort of chronic pain. Creative thought and solutions have been slowly developed in many areas of medicine. One of the biggest problems in medicine is pain. In the United States hardly anything is being spent on the research to understand pain and develop new solutions to pain. All the current focus is on the treatment of drug addiction. This country needs to start looking at the cause of pain and its solutions in order to prevent problems with addictive drugs. Stopping the prescription of opioid pain medications does not solve the problem of pain, and only has a limited effect on the problems of addiction. Creative thinking and research may lead to solutions that solve pain, and stem cells may be a new secret weapon in the future.

Will Doctors be Replaced by Computers?

telemedicine minnesota computersTechnology and computers are taking over many tasks in society. For instance, in the past in grocery stores, a clerk typed in the price of an item into a cash register to sum up the total of items. Now, a scale is built into a barcode scanner and cashiers are not really needed.  In law offices, smart scan machines are reading legal documents and checking for errors, a job that used to be reserved for new lawyers. So if computers are invading the world, will doctors be necessary to see patients and determine the right treatment? The answer is complex.

The Future of Telemedicine

Computers are currently used for a multitude of tasks in the medical field.  There are robots that assist in surgery, and in some hospitals, robots are the carriers of medications and supplies throughout the premises. Specialized computers are now scanning X-rays and looking for abnormalities, as sometimes subtle changes are better spotted by computers than humans. In intensive care wards, computers often monitor the extensive data of each patient and can spot trends and suggest treatment options based on extensive data analysis. With increasing data in medicine, computers can often analyze any number of problems and help determine solutions based on the probabilities suggested by the information.

Telemedicine is also a burgeoning field. This can be a variety of medical activities from providing long distance consults with video chats through a remote clinic and provider or specialist, to a visit that is with a nurse, patient or a long distance provider. Remote monitoring of data by a specialist for an intensive care unit and remote reading of radiology imaging is also being done.

Computers can analyze information and find patterns in data if programmed well, however, they cannot yet substitute for the personal interactions of a patient and doctor. A computer still is unable to do a complete physical exam and understand subtle abnormalities portrayed by a patient. Assembling the information from a history, exam and studies, as well as interpreting responses to treatment performed to determine what may be beneficial next in management is also currently beyond the ability of a computer without extensive interaction with a physician.

Computers can be a great assistant in medicine. The human factor of personal interaction with a patient and performing a physical exam is essential in the ability to treat any patient. Many times I have reviewed a patient’s history and studies prior to a visit in order to form a tentative plan, and after the visit found a totally different problem with a need for a different treatment plan. The human factor is often essential in patient treatment, the compassion and the individualized management coordinating a plan. At this time computers may be an assistant but they are not ready to replace the doctor.

What Patients Are Saying About Daith Piercings

Daith piercing work minnesotaOur post on Daith piercings has been by far our most popular blog post, and it’s clear many people are fed up with their chronic migraines. We’ve never touted the Daith piercing as a surefire fix to migraine pain, we’ve only stated that it’s a relatively cheap alternative option for individuals who are fed up with failed treatments. Some people took issue with the fact that the piercing isn’t backed by clinical science, and while it draws on some of the same pain pathways as acupuncture, we made it clear that there was no hard science behind the pain management technique.

Well, our readers have taken to the comment section of the original post, and many have shared their first-hand experience with the piercing. Again, it may not be for everybody, but here’s what patients who have had the piercing are saying about it.

I’ll provide more anecdotal, non-scientific “evidence.” Mine cost $25 each. BEST money ever spent. Ever. Chronic migraine sufferer for over 20 years. This has been the only thing that has consistently worked. Now I can deal with the sinus/hormone headaches and not have them compounding and piggybacking each other. Given a choice between a piercing I could remove or narcotics, it would be a piercing every single time. My piercer is great, though. I don’t know that I would have trusted any one else to do it- unless she gave the ok.

I just had my daith piercing done a week ago in hopes of helping with my chronic migraines. So far I’ve had two migraines since, so I don’t think it is helping, but I believe mine are largely hormone related so I don’t know that a piercing would be able to help. Just wanted to say that I still think it’s a cute piercing and will keep it regardless AND the pain really wasn’t that bad. I went to a local tattoo shop with a great reputation and the pain was no worse than my other cartilage piercing that I had had done before. It hurt worse putting the actual earring in, but overall really not a bad pain level. Good luck!

I have suffered from migraines for the past several years. I would get one and it would last for several days, then 1 day off, then back to migraines. I was desperate and had heard of the daith piercing. I did not put much stock into it. Again, I was desperate, so I got it done. I was a little painful (pain is subjective). My piercer said that he was not a doctor and could not cure migraines, but just about everyone that he had done, had good results. I wasn’t expecting a miracle. Even if it just cut down on the frequency, that would have been fine. It has been 2 months and I have not had a single migraine. I stopped taking my preventative when I got the piercing to see if it would work. This doesn’t work for everyone, but it worked for me. Even if my migraines come back, I had a few months pain free and that is so worth it.

I suffered from migraines and headaches. I gotten the daith piercing and it helped a lot I don’t get them any more. My tattoo artist is also a piercer and done it for me. The only thing that really hurt was the clamp cause where it’s in the ear it’s a hard place to get too and you’ll feel some pressure for a couple days but it’s worth it in the end.

I’ve had migraines for 44 years. Mostly left sided. Many times in cycles of 2-3 weeks of either waking up with one, or going to bed with one. Nausea, noise, light sensitivity… the whole bit. I can’t take most migraine meds because of a heart issue. Not much to help with them, pretty much most meds might as well be candy. Went in for the piercing during the third day of a migraine. Yes, it hurt for a brief moment, but compared to weeks of headaches, it was NOTHING!!! As soon as the piercing went in, the intense pain behind my eye and the nausea were gone! And the next morning, absolutely no headache and no ‘headache hangover’ as after most migraines. So far, so good. If it doesn’t work, I have not lost much, and will take it out. If it continues to work….GREAT! Many people seem to want many scientific studies done on this, but, I believe for the most part, most studies are funded by pharmaceutical companies, and what company that makes lots of money on migraine meds, would want to study something that could cut down on their business?!?! Just my opinion, but drugs aren’t always the answer to fix things, like some doctors believe. If you truly suffer with debilitating migraines, then you are always looking for a way to make the pain stop. What do you have to lose?

Hi, I had suffered with migraines for 35 years. I used to get around 3 a week but my tablets did work if I took them in time or didn’t wake up with the migraine. I was told to get the piercing on the side I have the most frequent migraines which is my left side. I had the piercing 3 months ago and have had no left sided migraines since, just 2 on my right side buy I can cope with only 2 migraines in 3 months. The piercing does hurt when you have it done but for me, well worth it.

I have been a migraine sufferer since I was a young girl and now I am 57 yrs. old, I have tried it all, Botox worked the best but still had many Migraines and insurance eventually stopped paying, I recently had the daith or rook piercing done, the next day I had the worst migraine but since then I am in shock how, (So Far) it is working for me, I sure hope it continues, its been about 8 weeks, I NEVER go that long without a migraine, so hoping it continues!

I had nearly daily migraines. Imitrex made me too groggy but Excedrine Migraine deadened the pain enough to “function”. Avoiding triggers wasn’t always an option since I had barometric migraines (trigger: weather changes). It was only a week ago I got a Daith Piercing….I have not had any headache all week…a record for the last several years. I feel better so I’ve gotten better sleep than I remember for ages.

So as you can see, it’s certainly helped some patients. For more information, or to read more comments from readers, check out the original post!

There Are No Magic Pills For Chronic Pain

Magic Pill Chronic PainAs we’ve said in a bunch of previous blogs, there’s no “magic pill” to cure all your symptoms associated with chronic pain. It takes hard work on the patient’s end and a medical team dedicated to finding the right solution. It’s not going to be easy, but it will be worth it.

Recently, I read a story about one family’s plight with chronic pain and felt compelled to share it. Originally posted in the New York Post, Michelle Makin pens a piece about how one family has battled through the troubles associated with chronic pain, learning the lesson we preach – that’s there’s no magic pill, but solutions are in reach.

A Daughter’s Battle Against Chronic Pain

As Veronica marks her 16th birthday this month, we are sharing an update in hopes of de-stigmatizing and demystifying life with chronic pain, fatigue and other undiagnosed chronic illnesses.

It’s been a year since Veronica lay bedridden, unable to breathe normally, felled by a mysterious combination of neurological and physiological complications that dozens of doctors couldn’t quite pinpoint. We thought we had a definitive answer when she was diagnosed with Tourette syndrome last July. But it turned out to be the tip of a medical iceberg.

Though her alarming bout with ‘‘air hunger” dissipated and she willed herself back to school part-time, she could still barely make it through each day. Despite normal blood tests, her exhaustion, brain fog, migraines and weight loss made it nearly impossible to function.

If you’ve suffered from chronic illness, you know the social ostracism that comes with it. ‘‘It’s all in your head,” ‘‘Stop being so dramatic” and ‘‘You don’t look sick” are some common responses from armchair doctors.

For teens, the isolation is wrenching. Veronica lost almost all of her ‘‘friends” last summer — too shallow or self-absorbed to care or comprehend her condition. Depression set in. We were losing her to an abyss of hopelessness.

Then came the Mayo Clinic. The renowned Rochester, Minn., practice runs a Pediatric Pain Rehabilitation Center for adolescents and young adults with chronic illnesses. It’s basically a three-week boot camp to equip young patients and their families with skills to get their lives back through cognitive-behavioral therapy, physical therapy, occupational therapy and recreational therapy.

We learned that Veronica’s basket of seemingly random co-morbidities is common among those diagnosed with dysautonomia, postural orthostatic tachycardia syndrome, hypermobility and pain-amplification syndrome. Her brain and body are wired differently; the triggers are unpredictable. We learned that the ‘‘what” of Veronica’s symptoms didn’t matter as much as the ‘‘how” to help her cope day to day.

There are no magic pills. It’s a tough-love crash course in hard work, personal responsibility and mind over matter. I’m not exaggerating when I say some patients enter the program in wheelchairs or on crutches — and leave on their own two feet with the ability to walk or even run after months or years of inactivity. The goal isn’t to eliminate pain or cure sickness, but to restore functionality.

For Veronica, exposure to and bonding with other teens saddled with similar conditions — and in some cases, much worse — was life-changing. It’s one thing to be told by a specialist ‘‘you’re not alone.” It’s another to join a family of survivors riding the chronic-illness roller coaster together.

Since completing PPRC last fall, Veronica has had more good days than bad. She didn’t let her migraines, second shoulder surgery for subluxation, severe joint pain or OCD stop her from finishing her sophomore year of high school. She has remained close to several of her fellow PPRC grads and made new friends at home.

She received a lot of help along the way. A caring counselor helped her become an athletic trainer at her school, which enabled her to rebuild her social life.

Mental-health professionals successfully treated her OCD and depression using a combination of medication and exposure therapy — an agonizing but effective treatment that required her to confront her fears. Gifted physical therapists continue to treat her joint pain and train her to manage it.

One of the most intriguing aspects of PPRC is the mandate to stop dwelling on symptoms. Talking and thinking about pain or fatigue all the time reinforces the neural pathways for pain and fatigue.

Instead, we focus on the small triumphs each day. We measure life, to borrow blogger Christine Miserandino’s famous analogy, by the spoonful: getting up on time, being able to walk on the treadmill for 10 minutes, completing simple chores, eating well, having a good laugh, breathing free and easy.

So, how’s Veronica doing? The short answer is that she’s doing — and that’s a gift we never take for granted. Happy birthday, my sweet 16 badass. Per aspera ad astra.