Clinical Trials For Chronic Pain Management

Many patients who have chronic pain are interested in the latest research and want to be a participant in order to get the newest form of treatment. Unfortunately there are not a lot of recent trials that have advanced to the human level for pain medication. Research is also limited in novel approaches to pain. The total funding for pain research related topics is about two percent compared to the total amount of research on all medical areas, even though 30 percent of the population is dealing with pain related issues.

The truth about research is that it is very tedious. For new drugs, it usually starts with trying to find a compound that may have some modifying affect on a part of the pain pathways that we currently understand. Current studies are trying to find new pathways that impact the perception of pain in the nervous system. In reality, much of the research is still at the basic level. We can’t treat pain until we fully understand what is going on in the body when we perceive pain. From the basic science, at some point we hope to be able to find new ways and compounds to manage pain.

Chronic Pain Research Trials

When a new treatment is found, research begins on the computer with complex models to try to predict what is going to happen in living systems. If the basic research is positive, then the study of living systems can begin. Initial studies may be just in cell cultures to see if a compound is toxic. The next level may then be to try a compound out on a lab animal such as a mouse and observe if it’s safe and if it changes the animal’s response to a disease or problem. The initial process of exploration can take years, and most compounds wash out and are found to be ineffective or toxic.

Clinical Trials Pain Chronic MN

If a compound finally clears all the initial hurdles, and may appear to be beneficial for humans, then clinical trials may begin. Human trials have multiple phases. Initially, they are looking at a small group of very clear cases of a problem and whether a drug is safe and is helpful over a control group. The statistics at this stage are that 1 in 30 people have a serious side effect and 1 in 10,000 dies. If the drug is found safe, trials are enlarged, and the safe and effective dose is sought out. The third phase involves an even larger group to further determine safety and make sure it actually does what it is supposed to do. In all these human trials, the subjects are usually highly selected. Subjects must only have the very specific condition and not have other medical problems.

Many patients who have chronic pain have multiple medical issues. Often, chronic pain involves multiple stimuli and causes. Pain is not a simple problem and those who have ongoing pain need to alter their manage strategies, as there is no magical solution. Expecting to join a research study as a chronic pain patient is a very limited option. Very few studies are being performed, and most have very strict criteria to become a subject.

Chronic pain is a very tough medical problem to manage. At this time there are no magic options to control pain. Often pain takes multiple strategies to manage. Constantly looking for that one pill, shot or intervention is often futile. The best solution is usually working with an experienced pain physician and developing an individualized plan that addresses your needs. It usually will not rid you of pain, but it can make life more enjoyable.

Smoking Worsens Chronic Back Pain

Smoking Back Pain chronicNew findings out of the Association of Academic Physiatrists Annual Meeting revealed another reason why you shouldn’t take up smoking if you want to have a healthy body. Researchers say smoking has been linked to worsening of degenerative disc disease in the cervical spine.

Degenerative disc disease is a natural process that occurs as we age, but that doesn’t mean everyone will suffer from painful symptoms. The condition occurs as the cervical discs between our vertebrae slowly break down over decades of use. If the condition worsens too much, the jelly-like central portion of the disc can rupture, causing pain and irritating local nerves. Living a healthy lifestyle can help prevent a speedy degeneration of your discs.

Smoking, on the other hand, has the opposite effect. Lead researcher Dr. Mitchel Leavitt said smoking can harm the small blood vessels in your back, which can make it difficult for oxygenated blood to flow in your back, exacerbating degenerative disc disease.

“Smoking is not healthy for a person’s intervertebral discs given the risk of developing microvascular disease – a disease of the small blood vessels – due to nicotine abuse,” Dr. Leavitt said. “Intervertebral discs receive their nourishment from the microvasculature that line the endplates on either side of each disc; when these blood vessels are damaged, the discs do not receive nourishment and this may speed up the degenerative process.”

Chronic Back Pain and Smoking

To understand how smoking contributed to chronic back pain, researchers evaluated CT scans of 182 patients who did not necessarily have back pain. 34 percent of individuals identified as smokers, and five cervical discs were given a grade on a 0-3 point scale with a 3 score denoting severe disc height loss. A five-disc total score between 0-15 was assigned to each individual.

After looking at the available data, researchers found that on average, smokers scored 1-point higher on the degeneration scale compared to non-smokers.

“This is another example of the detrimental effects of smoking. Tobacco abuse is associated with a variety of diseases and death, and there are lifestyle factors associated with chronic neck pain,” said Dr. Leavitt. “Pain and spine clinics are filled with patients who suffer chronic neck and back pain, and this study provides the physician with more ammunition to use when educating them about their need to quit smoking.”

So if you want to give your lower back the best chance to avoid chronic pain from degenerative discs, give up your smoking habit.

How To Properly Dispose of Pain Pills and Opioids

Pain Pill Disposal MinnesotaOpioid abuse has become a huge problem in the United States. After many minor procedures and trauma people are prescribed pain medication. Oftentimes people have leftover pills that end up sitting around the home. This is one source of pills that may be misused or abused by others, or the patient themselves and can lead to addiction. No one usually wants to waste their medicine, but with the abuse potential and danger of these opioids, disposal then becomes an issue.

Leftover pain medications that are opioids need to be handled properly. When storing them at home, due to the street value and abusive potential, they should be kept hidden and locked away securely. One does not want these medications to ever be lost or stolen. Furthermore, easy access may allow another household member or friend the ability to take the opioids and use or abuse them. Your safety and others is dependent on keeping all your medications secure and used only according to the directions of the prescriber.

Proper Disposal

Disposal of medications has become a major problem. Most drugs, no matter the category, are considered hazardous substances. Drugs can be toxic to other people, animals and the environment. Studies of wastewater have often showed traces of a wide variety of substances from birth control hormones, to antidepressants and narcotics. The most common recommendation for drug disposal has been to flush them down the toilet. Unfortunately this has led to the spread of many compounds into the water system and the environment. A better solution for personal disposal is to crush and mix the pills with dirt or cat litter making the drug unusable and disposing with the trash.

Currently, the best option for disposal is burning the medication in a commercial incinerator. This actually destroys and fairly safely vaporizes most medications. Minnesota does have a program coordinated by local law enforcement offices to take unused prescription medications, and these are sent for hazardous waste incineration. Unfortunately this is not the most convenient system for a lot of people. Physician offices usually do not have the ability to do this but often they can add prescription medications to other drugs and materials that are sent out as hazardous waste on a very limited basis. Pharmacies and drugstores do not generally have the ability to accept returned medications.

Hopefully in the near future, Minnesota will develop a system to encourage medication return to pharmacies for disposal in a secure and proper way. A wide spread system of pharmacy return and transfer for incineration would be ideal. For this to occur, Minnesota would need to change its law and assist with the coordination of collection and proper disposal. This would be a major step forward in reducing medication available for abuse and it would lessen the toxic effects on the environment.

The Importance of An Anti-Inflammatory Diet, Part 1

The diet we eat appears to have more and more significant influence on how healthy we are overall. Diet crazes come and go, but more research is showing that the food we eat does affect many aspects of our life. The main problem is that it is easier to eat whatever foods are available than to choose things that are healthy and helpful to us.

Furthermore the food we eat is processed differently at least initially in each and every person depending on our own genetics and the bacteria that happens to be in our gastrointestinal tract. Lastly, if we are overweight, the fat in our body may be contributing to inflammation. Losing excessive fat, exercising and eating healthy foods are all part of controlling inflammation in our bodies, and that too can contribute to a healthy lifestyle.

Researchers have identified certain foods and diet characteristics that seem to help control inflammation. Below are some suggestions with regards to a diet to control inflammation.

Anti-Inflammatory Diet

1. Start eating fish regularly – At least two meals a week should contain fish that are rich in omega-3 fatty acids. These fatty acids are the ones that are good for you by reducing C-reactive protein and interlukin-6, two proteins that enhance inflammation in the body. Eating a portion of fish like salmon, tuna, sardines, or other cold water fish is ideal.

2. Eat more fruit and vegetables because they are packed with antioxidants – These are compounds that support your immune system and help protect it from dangerous compounds in the environment. They also may help prevent inflammation by protecting compounds in the body from breaking down and needing to be removed and destroyed. The best sources are fresh fruit and vegetables, and when cooking vegetables, just lightly steam or cook them, keeping them crisp. The daily amount should be at 2-3 cups of each a day, that would likely equal at least 2-3 pieces of fresh fruit plus your vegetables. This could also include your salads.

Anti-Inflammatory Diet Minnesota

3. Try eating nuts and seeds more often – They are great to substitute for snacks instead of empty calories like sweets. Nuts are full of anti-inflammatory monosaturated fats and are high in protein and fiber. Nuts also tend to fill you up and decrease the desire for more calories. A quarter cup of nuts, such as almonds, walnuts, sunflower seeds or pecans are great for snacks. Keep a jar available and take a few when hunger strikes. Stay away from coated or salted nuts.

4. Beans are often known as the “magical” fruit – They have some unwelcomed properties for some people, producing gas since they may be hard for some to fully digest, but beans have several anti-oxidant and anti-inflammatory compounds. They are also a low cost source of protein, packed with minerals like magnesium, iron and zinc and are high in fiber. Cooked beans can serve as a substitute for meat in sauces, and can be used as a main protein source if properly balanced in a diet. Many vegetarians use beans as their main source of dietary protein and extensive recipes are available in how to incorporate them into meals.

5. Use olive oil as one of your main monounsaturated sources of heart healthy fats – This compound is rich in antioxidants and oleocanthal, a compound that can lower inflammation and pain. The Mediterranean region uses olive oil in most of its cooking, and many use it for salad dressing. It is fine for coating hot pans, but do not try to fry foods with this oil.

On Thursday, we’ll share part 2 which includes five more tips on how an anti-inflammatory diet can help prevent chronic pain.

Cognitive Behavior Therapy Helps Those With Chronic Pain

Chronic Pain Insomnia SartellResearch out of Europe suggests that cognitive behavior therapy (CBT) could help control or reduce chronic pain by helping patients sleep better.

We’ve discussed the link between poor sleep and chronic pain on the blog before, and while we’ve shared some tips for falling asleep and staying asleep, we’ve never examined CBT’s role in the equation. According to the University of Warwick, cognitive behavioral therapy was found to be moderately or strongly effective in the majority of chronic pain patients who suffered from insomnia. Lead research Nicole Tang, PhD, from the University’s Psychology department, said CBT is better alternative that long-term drug treatment for insomnia.

“This study is particularly important because the use of drugs to treat insomnia is not recommended over a long period of time therefore the condition needs to be addressed using a non-pharmacological treatment,” said Dr. Tang. “We believe that our results will be of particular interest to primary care physicians and allied health professionals who are taking up an increasingly important role in preventing and managing long-term conditions.”

CBT and Chronic Pain

For their study, researchers conducted a meta-analysis of 72 studies involving more than 1,000 chronic pain sufferers with insomnia. Treatments varied in the individual studies, but the most popular intervention strategies were education about sleep hygiene, stimulus control, sleep restriction and cognitive therapy. They also analyzed how these approaches were delivered to the subjects. Finally, researchers looked at documented pain levels before and after intervention techniques were administered.

After conducting the meta-analysis, researchers uncovered:

  • CBT was associated with a decrease in insomnia and mild to moderate decreases in pain levels.
  • Improved sleep was associated with a decrease in depressive feelings.
  • Chronic pain sufferers who received CBT experienced improved sleep and had a wider positive impact on pain, fatigue and depression feelings.

Interestingly, intervention techniques were less effective if they were delivered electronically, either by phone or the internet.

“We found little evidence that using therapies delivered either by phone or computer benefited insomniacs. The jury is still out on the effectiveness of using automated sleep treatments. We found that, at the moment at least, delivering therapies personally had the most positive effect on sleeplessness,” Dr. Tang said.

Dr. Tang said they want to pursue further research to establish if CBT is feasible and cost effective for treating chronic pain in the long run.

Related source: Sleep Review Magazine