Centipede Venom: The New Pain Medicine?

October 7, 2013June 24, 2014 / Thomas Cohn, MD

The search is on throughout the scientific community for new medications for every known disease. Cancer and heart research are often the glamour areas, now a new pain medicine may be on the horizon. Centipede venom has been found on an experimental basis to be a powerful pain killer in mice. It is a toxin that acts on a protein that influences pain sensation. Mice that are given an injection of the purified venom can withstand a significant increase in pain.

The Goal of Research

The goal of research is to find a chemical that helps with pain but does not have the side effects of current strong pain medications like opioids/narcotics. Morphine and similar compounds have many side effects and are addictive with high potential for abuse and overdose. The goal of new compounds is to minimize the bad parts and control pain better. In mice, the new centipede venom appears to be very effective in pain control.

Unfortunately, this is just the first step to determine if centipede venom will be useful in humans. Once a compound is found to be useful, the next step is to determine if it will be useful in mammals and then humans begins. Chemicals that work in mice do not necessarily work in humans.

Further Questions & Testing

Then there are the questions of whether the drug causes other problems, and what dose is safe and effective and for how long. Another issue is how the compound must be delivered to the body to be effective. One of the recent medications, snail venom (ziconotide) is only effective if given to the spinal fluid, which makes this drug very difficult to use. Many compounds cannot be taken orally because the stomach is highly acidic and often will destroy drugs. For a pain medication that is useful, an easy delivery system is essential for every day use.

Research goes on daily to find new medications that help improve our lives. As we live longer, pain is becoming a common problem that most people have to confront. Hopefully, science will find new and effective drugs to take care of pain.

Fibromyalgia Pain Treatment Options

October 2, 2013November 17, 2015 / Thomas Cohn, MD

Fibromyalgia is a painful condition in which the body hurts all over. It is more common in women, and often comes with other problems such as:

Stomach acid issues
Irritable bowels
Sleep issues
Depression
Headaches

Treatment is aimed at managing the symptoms and understanding the disease. Fibromyalgia treatment begins with making an accurate diagnosis, and educating the patient on the best treatment options.

A Team Approach to Treatment

The most effective approach to treatment is attacking the condition with a team of medical professionals consisting of:

Nurses
Physical therapists
A Psychologist
A Physical Medicine Doctor

A multi-disciplinary approach is helpful to shift the patient away from a perception of helplessness, defeat, and frustration and toward a positive and active lifestyle. Psychology is beneficial in changing attitudes from defeat and depression to understanding and self-motivation. Psychologists use a variety of techniques including cognitive behavioral therapy and biofeedback to influence changes. Physical therapy is necessary to teach the patient to go from being inactive, to exercising. Nursing is helpful to work with sleep problems, diet, nutrition, and understanding lifestyle and medication issues.

Medications & their Effectiveness

Pharmacologic strategies include prescription and non-prescription medications. There are three drugs approved for Fibromyalgia, and many others that have limited affects. The most commonly used drugs that are approved are Cymbalta and Lyrica. They both decrease the sensitivity of the nervous system to excessive signals that influence pain. Amitriptyline and Nortriptyline at low doses also have similar affects and are helpful with sleep. Narcotics and anti-inflammatory medications are not effective in management and usually lead to more problems than solutions.

Nonprescription medications have varied success rates and the research is not solid to support their effectiveness. S-adenosine-L-methionine(SAM-e) has been used for joint pain and general pain, and is commonly used in Europe. Tryptophan and melatonin may improve sleep and help with mood. Fish oil is felt to help with joint and spine pain, and may help control cholesterol levels. Glucosamine and chondroitin sulfate have been used to help control joint pain. These supplements are generally felt to be safe. Whether they are going to be helpful is open to question but they should not cause problems.

Fibromyalgia is best treated by a knowledge team of practitioners, headed by an experienced Physical Medicine pain physician. The goal of treatment is to improve function and activity level, and manage pain symptoms. Education and psychological well-being are important. Fibromyalgia is a real syndrome, when treated appropriately can be successfully managed.

Complex Regional Pain Syndrome (CRPS) – Causes & Treatment

September 30, 2013November 17, 2015 / Thomas Cohn, MD

Complex regional pain syndrome (CRPS) is a pain problem manifested by severe pain. It is a poorly understood disorder that causes intense pain.

With CRPS, the nervous system becomes hyper sensitized – normal sensations become amplified. The thermostat for pain sensitivity becomes set at the wrong level. The sympathetic autonomic nervous system also becomes hyperactive. This combination of problems leads to severe pain in the affected area, often a hand or foot.

2 Types of CRPS

There are two basic types of CRPS:

Type I occurs with no known nerve injury
Type II occurs in association with a known nerve injury

CRPS describes an array of painful conditions characterized by regional symptoms seemingly disproportionate to the usual course of trauma or injury. The pain is regional, not in a specific nerve or muscle distribution. The patient will report sensory changes such as:

Hyperesthesia
Changes in skin color
Edema and temperature changes
Motor changes – inability to move the affected region

It usually begins in one limb, often diagnosed months after onset, and is 3 times more common in females. The initial injury is usually minor, such as an ankle sprain. Because of this, there is often a delay in finding an expert who recognizes the diagnosis and can initiate treatment.

How to Treat CRPS

Treatment of CRPS is difficult, but should be done in four steps:

The first step is evaluating and treating any treatable injuries that contribute to the pain. This may include surgical interventions for injuries such as ankle sprains.
The second aspect is controlling the sympathetic aspects of pain and the neuropathic pain with injections and medications.
The third part is rehabilitation and physical therapy, restoring mobility and decreasing pain sensitivity.
The last part is psychology to use cognitive strategies to control central pain perceptions.

Complex regional pain can be devastating. The earlier it is diagnosed, the better the prognosis. Experienced pain management physicians are essential in improving the outcome. It can be successfully treated and there are many good interventions available. Find an experienced Pain physician, and find a solution.

Pain Medication & Alcohol – A Dangerous Mixology

September 27, 2013June 24, 2014 / Thomas Cohn, MD

It is always wise to be careful about drinking alcohol when taking any medication. All medications can interact with other substances you ingest. For example, meds can interact with vitamin supplements, and even certain foods that you eat.

It is no surprise then that one should be careful with mixing alcohol and medications (including pain medications). In this article, I will discuss some of the most common medications and how they interact with alcohol in the body.

Opioids & Pain Meds

The most common concern about alcohol is with opioid/narcotic pain medications. These drugs include:

Percocet
Vicodin
Oxycodone
Oxycontin
Morphine
Codeine
Fentanyl

All narcotics can affect your cognitive ability and judgment, and alcohol can have the same effect. The combination of the two is not always additive, and the alcohol can greatly diminish both of the above. Thus your judgment could become very poor, and the toxicity increased such that either drug can essentially cause death. If one is on a stable dose of narcotic, people can usually function without impairment. An occasional alcoholic drink should be safe. You may feel more impaired then usual, but you should not be toxic.

Neuropathic Meds

Many pain patients also use neuropathic medications like gabapentin, or other seizure type drugs, and antidepressants. These drugs also can affect cognition, and mixing with alcohol can worsen this ability. Alcohol is metabolized and broken down in the body by the liver, and the same process is also used by many of these medications. Therefore, alcohol and these medications can also interact in unpredictable ways. Again, if you have been on these medications long-term, then an occasional drink is likely safe, but heavy drinking is not a good idea.

Ibuprofen, Tylenol, & other Over the Counter Meds

Over the counter pain medications such as ibuprofen and acetaminophen/Tylenol are generally very safe if taken as directed. Unfortunately, people often take a little more than directed in the hopes that they will work better. Mixing alcohol with these drugs can be very dangerous. Anti-inflammatories like ibuprofen can cause stomach irritation. Mixing them with alcohol can cause severe ulcers and stomach bleeding. Acetaminophen alone can easily be toxic to the liver. Mixing this with alcohol has led to fatal liver failure.

The answer to drinking alcohol with pain medications is not simple. If one takes their medications only as directed, and has been stable on them, then having an occasional alcoholic beverage, not daily and not more than one, should be safe. Your judgment, memory, and cognition could be affected even with one drink, and you may not be safe to drive, but it should not be toxic to the body.

Yoga and Pain Relief

September 25, 2013June 24, 2014 / Thomas Cohn, MD

Note: this is a guest post by yoga instructor, Lynn Shuck.

As a yoga instructor, I’m expected to say that yoga can relieve pain. And I truly believe it can. But I do urge caution when approaching yoga for pain relief because, in fact, a class that moves too fast, or an instructor who pushes you beyond your limits can actually cause pain rather than relieve it. With good instruction and personal attention, yoga can most decidedly help with pain relief by bringing the muscles and skeleton into their natural balance.

It’s All About Skeletal Alignment

When the skeleton is aligned, the muscles work in tandem the way they are intended. If some muscles get overworked through habitual movement patterns, other muscles will stop doing their jobs and weaken. Those tight muscles can bring the skeleton out of alignment (picture the person who sits at a computer all day and becomes hunched over, chin thrust forward). If those patterns are repeated on the yoga mat, tight muscles will just continue to overwork and the skeleton will not be supported any differently than it already is.

Imbalance can also occur starting with the skeleton. Shin bones that bow back affect everything above the legs, tipping the thighs and pelvis out of alignment, which then impacts the spine. A broken bone that doesn’t heal correctly or an accident that impacts any part of the skeleton will invariably affect the way the muscles work as well. If the skeleton isn’t upright, muscles will do their best to hold up the body any way they can.

Fixing Imbalances

As an Eischens Yoga instructor and yoga therapist, I look for imbalances such as:

Tight, overly developed muscles
Bones that don’t stack properly
Collapsed or locked joints
Constriction in the breath

When a student wants to use yoga for pain relief, my intention is to keep the body from going further out of balance. Often, using simple, easily accessible asanas, we can bring the body back to better alignment – thus reducing pain and tension.

Uttanasana

As an example, Uttanasana is a simple forward fold commonly taught in most classes. Sometimes, hip and low back pain can be addressed using this pose. If I observe thighbones that sit too far away from the mid-line of the body, I might have the client roll up a towel to about 2 or 3” wide. They would place the roll between the legs at the top of the thighs near the groin. Pressing firmly into the towel at the top of the thighs without rolling onto the inside edges of the feet, I will then have the client perform Uttanasana, moving down and up in a limited range of motion several times, continually pressing into the towel. When finished, the legs will usually come into better positioning in the hip sockets reducing hip and back pain momentarily. The more regularly these muscles are used to re-align the thighbones, the longer the body will maintain this new positioning. I refer to this as using effort in the pose to create effortlessness after the pose.

Utilizing yoga for pain relief requires understanding the physical imbalances, and then using asana to bring the body back into balance. Practicing yoga without awareness may well be counter-productive, so find a teacher who specializes in pain relief and then trust your own experience. Yoga shouldn’t hurt; it should make you feel better.

Author Bio:

Lynn Shuck is a certified Eischens Yoga Instructor. She has been practicing yoga for nearly 25 years, and has been teaching yoga since 1996. Her training with Roger Eischens led her to work specifically with alignment as well as injury recovery/prevention. From 1998 to 2011, she led workshops and classes throughout the Detroit metro-area. Lynn is known for her keen eye for individual movement patterns, as well as her ability to bring yoga to all kinds of people: experienced and beginning yogis, athletes, weekend warriors, and those who think they are too stiff for yoga. Lynn relocated to Minnesota in 2011.