Women and Elderly With Pain At Elevated Risk For Opioid Abuse

Women elderly chronic painA nationwide survey of alcohol and substance abuse uncovered that chronic pain oftentimes plays a big role in why individuals begin to abuse opioids. The study revealed that individuals with chronic pain are 41 percent more likely to develop prescription opioid use disorders or to become addicted to opioids, according to the new report.

For their study, researchers looked at reported opioid use disorders and demographic factors, including age, gender, family history and other behavioral factors in more than 34,000 adults. The data was collected in two segments over a three-year period.

“These findings indicate that adults who report moderate or more severe pain are at increased risk of becoming addicted to prescription opioids,” explained Mark Olfson, Professor, Columbia University Medical Center in the US. “In evaluating patients with pain, physicians should also be attentive to addiction risk factors such as age, sex and personal or family history of drug abuse.”

Who’s At Risk?

After examining the results, researchers uncovered:

  • While men or younger adults remain the ones at higher risk for these disorders, women and older adults who became addicted to opioids are observably the ones who also reported chronic pain.
  • Participants who reported chronic pain with prescription opioid use disorders were also those concurrently suffering from mood and anxiety disorders.

Researchers concluded by saying that the results show physicians need to be more aware of the opioids they’re prescribing and to whom they are prescribing them to. They believe enhanced monitoring of some patients at greater risk for abuse can help prevent people from abusing opioids.

Prescription pain pills can certainly help provide relief for patients with chronic pain, but they should never be viewed as a solution. Exercises, physical therapy and even some surgeries can help provide temporary and permanent relief. Instead of managing pain, we need to keep treating it and solving the problems.

Electrical and Magnetic Brain Stimulation For Chronic Pain

electrical stimulation brain chronic painA newer area of research in the management of pain is the use of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). Both these areas of research were started in the 1990’s and have been shown to provide some degree of pain relief. The most difficult part of these technologies is knowing what is being stimulated, and being able to effectively target specific regions of the brain. Both techniques are generally believed to be non-invasive since stimulation is superficial to the skin. Additionally, both of these technologies are still basically considered experimental.

rTMS and tDCS

Repetitive transcranial magnetic stimulation is more complex than tDCS. A magnetic coil is held near the scalp and a current though the coil creates an intense magnetic pulse that passes through the scalp to the brain and depolarizes neurons while altering brain signals. The magnetic pulses need to be aimed using MRI guidance. Further, signals can be given at different frequencies, and high frequency treatments may have some effect on pain, but they do not tend to last much beyond the treatment sessions that are done daily. It is thought that the magnetic pulses can affect the cognitive and emotional aspects of pain perception.

Transcranial direct current stimulation (tDCS) is simpler in application and cost, but full understanding of its mechanisms of action are less clear. It is believed that the current triggers changes at the cellular level in the brain in the form of an analgesic effect, and it also changes the way pain signals are transmitted. The technique involves sending weak currents across the scalp, either exciting neurons or inhibiting neurons by the way the current travels between electrodes. A variety of portable devices and protocols are being developed to deliver appropriate signals. The placement of electrodes and the pattern, intensity and frequency of currents used is being investigated. The most common use of these techniques are for headaches, neuropathic pain and fibromyalgia. Combining tDCS with aerobic exercise has been found to be especially helpful for some fibromyalgia patients.

So far the risks of these technologies has been found to be relatively low for adverse events. rTMS has the most risks, as it can affect blood pressure, breathing and seizures. tDCS has no significant known risks at this time, but since it could affect moods, it may have negative effects on issues like depression. How these new techniques will be incorporated into effective pain management strategies is far from clear. Since we know many pain conditions stem from how the brain is perceiving or misinterpreting sensory signals associated with pain receptors, changing the transmission of these signals in the brain may help manage various conditions.

Short Takes on Electricity For Chronic Pain

tens chronic pain electricityElectricity is used in many areas of medicine. Most of the time it is used to power medical equipment, but a newer trend is to use electrical currents to treat pain. From old techniques to new ones, electricity is being used more and more as an alternative to treat many pain conditions. Below is a look at how electricity is being used.

TENs

A TENs unit is transcutaneous electrical nerve stimulation. This technique uses a small battery powered pack to transmit an electrical signal between skin patches. Usually two or four patches are used and a variety of electrical signals can be programmed. The patches are placed around the painful area, often the neck, shoulders, or low back and the signals are used to block the transmission of pain sensation. Pain related to tight muscles and sometimes spine pain can be effectively managed with TENs unit. Computer chips and miniaturization has allowed a small battery pack to deliver a wide variety of electrical signals superficially to block pain.

Cefaly

This is a trade name device for cutaneous electrical nerve stimulation of the head for migraines. It is a headband type device that is battery powered and available by prescription only. It has been approved by the FDA. The device is supposed to generate a small current that will stimulate the trigeminal nerve peripherally. The unit runs for 20 minutes and stops automatically. Trials over in Europe indicated that the frequency and intensity of migraines were reduced by using this device.

Alpha-Stim Aid

This is another prescription cranial electrical stimulation device. This device has electrodes that attach to the earlobes and it passes a low level current between them. Apparently studies have shown the device to help decrease pain, improve moods and sleep quality. The device is used at night and the low level currents affect the brain’s normal electrical signals, and according to the manufacturer, studies have shown reduction in pain, anxiety and improved sleep after only five treatments.

Spring TMS

This is a transcutaneous magnetic stimulator used by prescription to treat migraine headaches. At the onset of a migraine headache, the magnet stimulator is placed on the back of the head, at the top of the neck. When turned on the unit delivers short magnet pulses to the back of the head, to the occiput region of the cortex. Within 2 hours, this affects the electrical activity in the brain and in about 38% of those treated, the migraine is gone.

Come Check Out The Minnesota RSD Coalition Potluck Picnic!

MN RSD Doctor picnicIf you’re looking for something fun to do next Sunday, considering checking out the Minnesota RSD Coalition Potluck Picnic! The event will take place from noon until 3 p.m. at Hidden Valley Park in Savage, located at 5000 W 132nd street.

You can see the flyer in the sidebar, but here’s what the text says:

Bring a dish to share and don’t forget a blanket and/or chair to sit on in addition to your sunscreen. It’s going to be an afternoon jam-packed with fun, food, laughter, socializing, games, balloons and more for all ages, with maybe even a few surprises tossed in!

Some of the planned events include:

  • Silent auction
  • Speaker event
  • An awards/recognition ceremony
  • One-on-one support
  • Balloons for the kids
  • Playground activities
  • Walking trails
  • Lawn Games: croquet, lawn Yahtzee, ball games (kickball, 500, etc).

Water will be provided by the RSD Coalition, but if you want other beverages, you’ll need to bring them yourself. Alcohol is not permitted at the event.

I’m still working on managing my schedule so I can stop by, but I hope some members of the chronic pain community will consider heading over to the potluck picnic next Sunday!

More About The RSD Coalition

The Minnesota RSD Coalition is an organization dedicated to providing support for those affected by Reflex Sympathetic Dystrophy Syndrome (RSD), more recently referred to as Complex Regional Pain Syndrome (CRPS) since 2002.

The MN RSD Coalition believes a positive outlook is a vital part of our care. Everyone has a right to be heard, believed, and treated with respect and dignity. By using a humanistic approach, they encourage each member to become more self-aware, find their inner strengths, learn positive ways of communication, and use various pain reduction techniques.

In my practice I see numerous patients with Reflex Sympathetic Dystrophy Syndrome and Complex Regional Pain Syndrome. It’s not easy to treat, and persistence and a positive attitude are key, two things that are easier done in word than in practice. I commend the RSD Coalition for their work and hope that I can make it out to the potluck next Sunday.

Some Clinics Pushing Unapproved Stem Cell Therapies

Stem Cell therapy minnesotaNew research suggests that a number of health clinics across the nation are pushing unapproved stem cell treatments for a variety of conditions like chronic pain and spine injuries.

The online search revealed more than 570 clinics offering treatment options involving unapproved stem cell therapies. The majority of the clinics are located in a handful of states, including Arizona, California, Colorado, Florida, New York and Texas, but the problem isn’t just isolated to those six states. Oftentimes the therapy is marketed towards orthopedic conditions like ligament, tendon and arthritic conditions, which has roots in experimental success, but it not based in sound, proven science. In more concerning cases, stem cell therapy is being pitched as a treatment option for COPD, MS, Parkinson’s disease and other chronic conditions.

How Are Unapproved Clinics Offering These Treatments?

These “therapy sessions” are typically rather pricey and oftentimes they are ineffective, so how can these clinics exist without federal regulators breaking down their doors?

“I ask myself that question all the time,” said Leigh Turner, a bioethicist who worked on the study.

Turner is an associate professor at the University of Minnesota’s Center for Bioethics. He noted that as an industry, healthcare professionals are still learning about the benefits and uses of stem cells. These cells have the potential to mature in different types of bodily tissues, but we’re still in our infancy in terms of fully understanding how to harness the power of these cells. Unfortunately, some clinics decided to try and capitalize on the promise of the future of stem cells by marketing unfounded and potentially dangerous stem cell therapy treatments as legitimate, science-backed options.

“These businesses can be quite savvy,” he said. “I think it’s asking too much to just tell consumers to be wary. We need to be asking, why should these clinics be allowed to do this.”

Of the nearly 600 businesses offering stem cell therapies, the majority were marketing “autologous” therapies, which is a treatment that uses a person’s own stem cells from their body fat or bone marrow. About 20 percent of business claimed to use harvested stem cells from an umbilical cord or placental tissue.

The FDA passively attempted to crack down on a number of these businesses last year by sending warning letters about offering unapproved treatments to clinics in California, Florida and New York, but it’s uncertain if the letters made any real impact. The FDA has issued draft guidelines for the use of stem cells, and a public hearing on the issue is scheduled for later this year. For now, consumers need to be wary of clinics pushing stem cell options as a miracle cure.