Fibromyalgia: A Real Disease

Fibromyalgia minnesota pain careFibromyalgia is a syndrome that causes diffuse pain throughout the body. Unfortunately, many practitioners still believe it is strictly a psychological disorder and many of the patients are faking symptoms. New research has now been finding objective changes that correlate to the symptoms in fibromyalgia. These findings however are not leading to tests to prove whether a person does or does not have the syndrome.

Diffuse whole body pain with muscle tenderness, abdominal complaints, headaches, fatigue, and sleep issues all are prominent characteristics of fibromyalgia. Currently, the diagnosis is made by history and exam of a patient, then by excluding other diseases such as diabetes, thyroid dysfunction and rheumatoid arthritis. The disease is much more common in females and first becomes symptomatic in the mid- to late-twenties but sometimes as late as the fifties to early sixties. The severity can be highly variable, from mild to disabling. Treatment is basically symptomatic at this time.

New Fibromyalgia Research

Dr. Anne Louise Oaklander of Massachusetts General Hospital studied 27 patients with fibromyalgia as diagnosed with the American College of Rheumatology criteria of the disease, and used a group of 30 matched control subjects. Skin biopsies were taken of the lower leg and 41% of the patients met the criteria of small fiber polyneuropathy. Her team also studied a group of 41 patients who had fibromyalgia begining as a juvenile, and 59% of those had small fiber polyneuropathy as diagnosed with a skin biopsy. Further study of these same patients indicate some of them appeared to have an immune component, like those with rheumatoid or lupus arthritis, and when treated similarly they improved in symptoms. Small fiber polyneuropathy is also seen in diabetes and vascular disease and is associated with the pain these patients experience. Unfortunately, the definitive test for this type of neuropathy is a biopsy (which is a removal of a small patch of skin) and microscopically examining it for nerve fiber endings, which is quite complex.

The importance of this study is that these findings indicate that there is real pathology behind fibromyalgia. It is not psychosomatic or imaginary. It also makes the disease more understandable. The small nerve fibers are those that carry pain sensations. If these fibers are abnormal, the result is pain. These fibers exist throughout the body, in the limbs one would have muscle pain, in the head one would get headaches, and in the trunk one might have stomach problems.

Small fiber neuropathy and peripheral neuropathy are currently best treated with medications that affect nerve cell function. The common medications, know as neuropathics, including gabapentin, Lyrica, Cymbalta, some other antidepressants, and a few miscellaneous medications are helpful. Opioids are very poor medications for this and help very little if at all. Fibromyalgia seems to respond in a similar way, and if it is a small fiber neuropathy, the same treatments would be beneficial.

Improving the understanding of the cause of fibromyalgia and the changes that exist in the body hopefully will lead to better treatment.  Not all patients with fibromyalgia have these findings of small fiber neuropathy on biopsy. This syndrome may have different causes, and the treatment may vary due to these differences. Knowing that about half of the patients at least probably have small fiber neuropathy allows physicians to focus treatments that are effective for these problems. Further, the youngest patients with fibromyalgia commonly have immune system dysfunction and treatment for these disorders has also been showing promise. Fibromyalgia is slowly moving from a “psychological” problem to an objective medical syndrome with definitive findings.

Does The Daith Piercing Work For Migraines or Headaches?

Daith PiercingOur blog on daith piercings for headaches and migraines has been by far our most popular blog. So many people have asked us about the piercing or shared their story in the comments section of the blog. In fact, we’d go out on a limb and say that the comments section on the original blog is one of the best places on the internet for honest reviews about the success of the piercing.

Instead of forcing you to sift through all the comments, we thought we’d share some personal stories in a blog so it’s easier to learn what people have to say. We did something similar to this in a blog a few months ago, but we’ve received so many new comments that we wanted to do it again. So without further adieu, here’s what people are saying about the daith piercing.

Stories About Daith Piercings

My 23-year-old daughter had her right daith done and I had my left done two weeks apart this summer. Neither of us has had a significant migraine since. She’s had virtually none and I’ve just had a couple of smallish headaches and felt some pressure. I’m a 10-15 a month migraine person and she’s on a daily preventative and used to get 6-7. I hope this stays helping. It was so totally worth it. ~N.C.

I have had my daith and tragus pierced foe just over 10 years now…and was always super skeptical when I would read articles like this and how the daith piercings helped with migraines…..however….last week I had to take my earrings out to play indoor netball (I forgot to cover them up at home)….. I couldn’t get the earrings back in at the end of the game so I decided that I would leave them out permanently (being a good role model to my babies)… In the week that I had them out I had horrendous migraines and over ten spasmodic and intense nose bleeds…. I decided to put the earrings back in because I missed having them in my ear…and to be quite honest…this week I’ve had no severe migraines and zero nosebleeds…could just be a coincidence..but might not be … ~ J.R.

I had it done on February 13th and it is the best thing I ever did.  Have only taken my Maxalt 4 times and today is July 16th it has truly made a difference in my life with my migraines and headaches in general ~ H.S.

I just recently received my Daith Piercing and was able to wake up migraine free after more than 10 years of crippling migraine pain. Not only do I have multiple sclerosis but I also suffer from a large chairi malformation. I have tried every intervention and medication out there to receive little to none relief from my migraines. Since getting my piercing, I have actually had the blessing of waking up migraine free (something I truly couldn’t remember the last time it had happened). Not to mention, the piercing was next to nothing in cost when compared to other treatments I have tried so this was worth the try for me. I would recommend the piercing for anyone who suffers enough migraines that interrupt their lives for days at a time. The piercing itself was about 10 seconds of pain and nothing compared to a 5-6 day migraine. ~ V.E.

I live in MN. I went to a place today called The Holy Mackerel to get my daith pierced. I highly recommend it. I actually was getting a headache prior to my piercing and within hours it went away. I’m praying that’s a sign that it is going to work. The piercing itself doesn’t hurt that much and Verno at the Holy Mackerel is great ~ H.M.

Have had mine 4 months and no migraine. A few dull headaches but no migranes! ~ T.L.

Chronic Pain and Depression

Chronic Pain DepressionThe majority of people will deal with chronic or nagging pain at some point in their life, and new estimates suggest that 1 in 10 adults will be diagnosed with chronic pain every year. Even though these numbers are really high, as a society, we’re not doing a very good job of solving the problem of chronic pain.

Even when chronic pain is managed and controlled, it can lead to other issues. When you’re constantly dealing with physical pain, it can be mentally and emotionally exhausting, and the same can be said in the inverse. If you aren’t in the right mindset, it can be difficult to stay active and really work towards preventing chronic pain.

Recently, a new study decided to take a closer look at the connection between chronic pain and mental health – more specifically, depression and chronic pain. For their study, researchers out of the University of Edinburgh in the United Kingdom examined physical and mental health assessments of more than 100,000 individuals.

Depression and Pain

After looking at the findings, researchers uncovered:

  • People who have partners with depression were more likely to experience chronic pain.
  • A person whose spouse was depressed had an 18.7 percent increased risk of suffering from chronic pain.
  • Also of note, having a parent with chronic pain increased a person’s likelihood of developing chronic pain by 38.4 percent.

“We hope our research will encourage people to think about the relationship between chronic pain and depression and whether physical and mental illnesses are as separate as some believe,” researchers wrote.

At the end of the day, this research shines a little more light on another potential avenue for chronic pain management. Sometimes we need to go beyond the root source of the pain and look at environmental and other contributing factors. If we can improve our mental health and the mental mindset of those around us, we might be able to reduce the number of people who have to battle chronic pain on a daily basis.

The Veteran’s Association and Chronic Pain

pain va minnesotaThis week there was another article on the pain management problems at the Veteran’s Association. As with all practices, the VA has had a long history of pushing opioids/narcotics as a main treatment strategy. Then suddenly a year ago, the VA decided these were not great management options and everyone had to be weaned to low dose or off these medications.

Options of management were not really given to anyone; it was just going to be the policy. This week, it was announced that one of their lead physicians has been awarded a grant to study options in weaning. Two options seem to be available, either with help of physical therapy and psychology, or possibly a slow wean by the pharmacist or with your physician.

Weaning Off Opioids

Pain is extremely complex. When a cause of the pain can be identified and treated, it is the best of all cases. Unfortunately, about a third of the population in general does suffer from chronic pain, and in many cases there is no reversible cause. Options to manage pain then become the course. Sometimes it is simple to manage and very successful. However there are oftentimes multiple generators of pain signals and it becomes difficult to develop a successful management routine. Treating pain does take a degree of compassion and it also often requires multiple strategies. Just saying no to drugs, especially to opioids, is a bit short sighted.

Addiction and abuse of opioid medications is extremely well documented. Overdose deaths are becoming rampant. Those who have pain are not resistant to having problems with opioid addiction. Furthermore, combining some medications, like those for anxiety or sleep with opioids significantly increases the risk of overdoses. Patients who have had problems with addiction to drugs, smoking or alcohol also have higher risks for addiction.  

There are many ways to treat painful conditions. One of the most important aspects of treatment of pain is working with a skilled, experienced, board certified expert in pain management. These are medical experts who hopefully have extensive ability to identify the causes of pain and develop multiple treatments to help manage the combination of problems causing the pain. They can help coordinate a variety of disciplines covering psychological needs, physical therapy, interventions and all the way through a variety of medications. As noted, there is not a single magic cure, especially not medication alone.

Unfortunately, the VA has seen a problem with opioid abuse and decided that this should be the focus of pain management. The goal appears to be to kill the devil, and get rid of this class of medications for most patients. Pain is much more complex than treatment with a single medication. Some people are dependent upon this as part of their overall management. At this time, there are not a lot of effective medications to treat pain. Research is making strides at better understanding the mechanisms involved in pain and the cells in the body that perpetuate the problems. Still we are definitely lacking solutions.

Instead of making opioids the enemy, maybe there is a better strategy. At this time we need to work on better treatments for pain instead of just eliminating medication options. Using pain management experts who can employ multiple strategies to properly diagnose and treat pain problems is what is needed. The recognition is needed that decisions on treatment options of pain should be made by pain experts, not by addiction experts administering a budget policy. Pain is truly complex and not simple to fully diagnose, manage, or treat.

Could We Soon See A Vaccine For Heroin?

vaccine heroinThe death of Prince has been a turning point of how serious the opioid addiction epidemic has become. Almost every medical pain specialist has been aware of the problems with opioids, pain and addiction, but now others are taking note. There are many concerns with prescribing opioids, from whether they actually help control pain, are there better treatments, and how many additional problems they are causing. We know one of the big problems caused by opioids that has become horribly worse is opioid addiction. Many people with and without pain are addicted to opioids. A new way to help treat addiction is in development – vaccines.

The information for this blog comes mainly from an article by Susan Giados published in the July 9,2016 issue of Science News Magazine. For those who are interested in a variety of scientific topics, this is a twice a month magazine, usually about 30 pages long packed with short fascinating articles. Well worth looking into.

The Heroin Scene

Heroin and opioid medications are accounting for about 30,000 overdose deaths a year. Here’s how it came to be popular in the US.

1960’s – Heroin first came on the drug scene in big numbers in the early 1960’s. It was a strong drug that produced an intense high. Most users came to the drug while searching for more intense highs, but the drug was not particularly pure or cheap.

1970’s – Major education and opium eradication efforts into the 1970’s suppressed its use.

1980’s and 1990’s – The late 1980’s introduced long acting opioids like OxyContin onto the market, and big pharma pushed these drugs as safe and as the answer to any all pain was simply to take a pill.

2000’s – By the early 2000’s opioids were the first and most common way to treat pain, and every doctor was prescribing them. The rate of addiction rose drastically, and as the awareness has grown, the access to prescriptions has slowly become harder. Opioid addicts now were everywhere.

Now comes into play some very interesting economics. Addiction itself has driven a market to supply people with opioid medication. It spawned an under culture of “pill mills” where almost anyone could go and get a supply of opioid pills. Many people would “doctor shop” for pills, use some and sell the rest for money. Drug cartels started to get into the mix manufacturing and selling them, further fueling addicts. The government then started clamping down on the supply since about 2010. The drug cartels have long had the ability to make heroin, and now they knew they could make large, pure amounts cheaply. For addicts, those who got hooked on pain pills for any number of reasons now saw heroin as a cheaper and often easier to obtain option than prescription medications. Now heroin has become a major problem as more addicts are turning to that to treat their cravings and pain.

Addiction to opioids has become a huge problem. There now are three medications that are used in the treatment of addiction; methadone, buprenorphine, and naltrexone.  Methadone and buprenorphine are used to reduce cravings, and must be continued indefinitely.  Naltrexone is used to block receptors and is used almost exclusively to reverse opioid overdoses. Unfortunately of those who seek treatment for addiction, only 25% end up receiving medications to help prevent relapsing back into addiction. Vaccines were first attempted in the 1970’s, but the science and cost of development were barriers, and the methadone was cheap and easy to use.

Addition and Vaccines

Now a little additional primer on addiction. Opioid drugs alter the brain pleasure circuitry and cause changes in the structure and function of the brain. Opioids act on the nucleus accumbens in the brain, and they increase the amount of dopamine in the brain. Opioids also act on the mu receptors throughout the nervous system, stimulating dopamine. These are the same chemicals that stimulate the pleasure centers in the brain and reinforce enjoyable activities like eating, sex or listening to good music. Dopamine, in other words, is what is stimulated by compounds like opioids and by stimulating pleasure. Over time, drugs of abuse can change the circuitry in the brain, decreasing the sensitivity of the reward centers and disrupt the centers involved in self control. Addicts tend to lose the ability to enjoy the normal every day activities, and then they need higher and higher doses of drugs to stimulate euphoric/happy feelings. The need to feel pleasure drives the brain, impairs decision making and self-control, and then the only drive is to take drugs just to stay on an even level.

The goal of a vaccine is to train the body’s own immune system to identify the specific offending drug molecules and rid the body of them at even high doses. One of the vaccines being developed is aimed at heroin and its breakdown product morphine. To be effective, heroin in the body breaks down quickly to morphine, and both these compounds need to be targeted to be helpful. The other problem is when going after a drug, there are millions of molecules in the body suddenly, unlike an infection with a few replicating viruses. So to develop a robust vaccine to stimulate the body’s immune systems and chemicals to rid it of certain compounds like opioids is a bit difficult.  

So far scientists have been successful in developing a vaccine specific for heroin and the breakdown to morphine that works in rats. The vaccine trains the immune system to neutralize the compounds and even fatal doses of drugs can be handled. The intake of heroin or morphine no longer produces a high, and drug seeking is not pleasurable. A series of three shots was able to produce months of ability to block drug seeking and pleasure by specific opioids. A second vaccine similar to the one for heroin is being developed for fentanyl. After a number of months, the brain starts to reset to more normal patterns of stimuli producing pleasure versus the strong pull to using narcotics. Blocking the drug seeking and pleasure of opioids does also affect all the pain relieving abilities, and the vaccines essentially cause the body to destroy these compounds making them ineffective for any purpose.

Using vaccines is another tool to control addictive behavior in the future once they are perfected for human use. They will be only for specific compounds, like heroin, morphine and fentanyl and not every single narcotic in general. They will be targeted at the most abused compounds and in that way allow a person still to be able to use certain other opioids if necessary for pain control.

Addiction does occur in the pain patient population. The percent of addicted patients in studies is highly variable, on the low side it may be 2-5 percent, although a common number is up to 17% or higher. Addiction is occurring when the need to take a drug is overriding, judgement is impaired and normal activities are suppressed over the needs for getting and taking the medication. Further, the amount of drug needed is escalating fairly rapidly. When addiction becomes an issue, then being weaned from the whole category of drug is needed and appropriate psychological help for addiction and full treatment is necessary.