Tarantula Venom May Help Provide Chronic Pain Relief

February 29, 2016 / Thomas Cohn, MD

We spoke briefly in the past about how researchers are looking at spiders as a potential source of relief for patients battling chronic pain, and new research suggests that a tarantula may hold some answers.

According to researchers in Australia, the Peruvian Green Velvet Tarantula, native to South America, may help advance our knowledge of chronic pain reception and expression. A bite from the spider isn’t deadly enough to kill, and in fact, it may have some benefits. Researchers say the venom actually helps to inhibit pain receptors in the body.

“Our group is specifically interested in understanding the mode of action of this toxin to gain information that can guide us in the design and optimization of novel pain therapeutics,” said Sónia Troeira Henriques, senior research officer at the University of Queensland’s Institute for Molecular Bioscience.

The peptide toxin, referred to simply as ProTx-II, works to block pain signals by binding to the membranes of nerve cells.

“Our results show that the cell membrane plays an important role in the ability of ProTx-II to inhibit the pain receptor,” said Henriques. “In particular, the neuronal cell membranes attract the peptide to the neurons, increase its concentration close to the pain receptors, and lock the peptide in the right orientation to maximize its interaction with the target.”

Venom and Chronic Pain

Based on the new findings, researchers are hoping to mimic the effects of the venom in drug form. They see at as a new avenue in the pursuit of pain management.

“Our work creates an opportunity to explore the importance of the cell membrane in the activity of peptide toxins that target other voltage-gated ion channels involved in important disorders,” said Henriques.

The Australian team isn’t the only one studying the role of venom in chronic pain management. Researchers out of Germany are exploring the benefits of snail venom in pain control, citing an added benefit that the venom decomposes quickly and thus is less likely to lead to dependency and abuse. That research is farther along, as a drug has already been created using the snail venom. The drug is called Prialt, and it is being used as a spinal pain injection to treat pain from failed surgery, cancer and AIDS.

Obama Weighs In On Opioid Crisis in America

February 23, 2016 / Thomas Cohn, MD

President Barack Obama shot down a proposal on Monday from the nation’s governors designed to curb America’s opioid and heroin crisis. The proposal called for limiting the number of high-powered painkillers a doctor could prescribe at a time, but Obama said the move could block access to drugs that people truly need.

“If we go to doctors right now and say ‘Don’t overprescribe’ without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we’re not going to solve the problem, because the pain is real, the mental illness is real,” Obama said. “In some cases, addiction is already there.”

The recommendation had received bipartisan support at the National Governors Association’s winter meeting, but President Obama rejected the sweeping proposal. The president thanked the governors for crossing party allegiances to come to a solution, but he didn’t think it adequately addressed the full scope of the problem.

“This is an area where I can get agreement from Bernie Sanders and Mitch McConnell. That doesn’t happen that often,” Obama said.

Opioids in America

According to the Centers for Disease Control and Prevention, heroin and prescription painkillers play a roll in the deaths of 78 Americans every day. Certain prescription opioids are seen as gateway drugs to heroin, which is cheaper and often much easier to obtain.

Vermont Govermor Peter Shumlin criticized Obama for rejecting the proposal, saying, “You can’t convince me that we’ve got 250 million Americans in chronic pain.”

The fact of the matter is that opioids are likely over-prescribed in this country, and while some doctors certainly hand them out too easily, for some patients, it is truly the only option that keeps their pain at bay. For others, surgery or costly therapy sessions are out of the question, so they rely on those painkillers to manage their pain. Dr. Steven Stack, president of the American Medical Association, praised Obama for shutting down the blanket rule which would have undoubtedly hurt a large portion of actual chronic pain sufferers.

“The complexity of the problem makes it difficult to create a successful one-size-fits-all approach,” Stack said.

Stack is right. There is no perfect one-size-fits-all approach to chronic pain care, just like there is no magic pill to solve one’s pain. In the end, we need comprehensive exams to understand to underlying cause of pain, and we need to work with patients to understand their treatment options and the potential implications of each. It’s much harder than simply prescribing a painkiller, and it also takes work on the patient’s end to work to get better and not just rely on their pain pills, but this duel-responsibility approach is what it’s going to take to start reversing the opioid crisis.

Smoking Worsens Chronic Back Pain

February 22, 2016October 25, 2017 / Thomas Cohn, MD

New 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.

Cyrotherapy for Chronic Pain

February 17, 2016October 25, 2017 / Thomas Cohn, MD

Cyrotherapy is a relatively new approach to treating some types of chronic pain. The therapy involves short-term exposure to very cold temperatures. It works because the skin reacts to the cold temperatures and sends messages to the brain that work as a stimulant to normal bodily functions. This exposure also helps trigger the release of anti-inflammatory molecules and endorphins.

In fact, the therapy is already being used by a particular subset of people who deal with pain on a frequent basis – professional athletes. These athletes use cyrotherapy for a number of reasons, including to:

Reduce pain
Improve recovery time
Improve therapy results

Researchers hope that through more study, we can expand this therapy to chronic pain sufferers.

Cyrotherapy Risks

In any treatment where you’re working with elevated or decreased temperatures, there will be risks involved. Some potential risks of cyrotherapy include:

Nerve damage
Tissue damage
Burning sensation on skin

Medical data shows that roughly 1,500-2,000 injuries happen each year due to cyrotherapy, but the majority of the injuries are due to inexperience or overexposure. It’s also worth noting that a woman died last year after using a cyrotherapy chamber without supervision, adding to the idea that it should only be pursued with the assistance of a well-trained specialist.

Recently, the University of Texas was awarded a 4-year grant to study and improve cyrotherapy techniques. Their goal is to learn exactly how blood flow is affected by cyrotherapy, and they want to introduce antioxidants and substances into the bloodstream to block certain nerve responses. In essence, they want to better learn how to manipulate pain responses during cyrotherapy, which could be a breakthrough for chronic pain sufferers.

We plan on keeping an eye on the University of Texas as well other research facilities who are attempting to build on this therapeutic program. People have been icing injuries and using cold packs for hundreds of years, hopefully we can continue to build on that premise.

What is the Best Treatment For Low Back Pain?

February 10, 2016October 25, 2017 / Thomas Cohn, MD

A recent study in the New England Journal of Medicine reported that the best treatment for low back pain was exercise. It would be great if the answer was that simple, just to exercise and everything will be better. However we all know life is not that easy, if it was no one would be going to the doctor and no one would have ongoing problems with pain.

Anyone who has had low back pain that did not go away quickly has struggled with finding the answer of what is wrong and what should be done about it. Every patient that comes and sees a specialist for back pain is asking the same questions. Most have tried to exercise, but for many it just doesn’t work. The main reason is because pain extremely complex, and when it does not go away easily, there are usually complex interactions occurring between multiple structures perpetuating pain signals. Studies that show simple solutions to back pain often concern only a small segment of those people who have problems. These are people with muscle strains and no other structural, psychological or nervous system changes affecting the lumbar region.

Best Bet For Back Pain

Simple problems like muscle strains, no matter where they are in the body, tend to heal. The best solution is often exercise to promote structural repair and to strengthen the muscle so that it is not re-injured. Sometimes one can do this on their own and at other times working with a trainer or other healthcare professional is necessary. The key here is that the damage is not permanent and can be reversed with the proper care.

Those who have complex pain often need a more comprehensive treatment plan. The first step is finding a good expert who can determine what is causing problems and devise an overall management strategy. Complex problems often have components that are not reversible, such as general age-related joint or disc degeneration. The goal then becomes how does one manage the symptoms and keep them from interfering with other functions. It often takes multiple different things from drugs, injections, exercise and possibly surgery to control the problem. Essential to treatment in most cases is of some type of exercise. Movement keeps the body healthy and often improves healing of most structures in the body including the back. Exercise is definitely one of the most important elements toward healing a sore back, but doing the right type and intensity along with other interventions from medical providers is often necessary. If a sore back does not get better with simple exercise, seek out expert medical advice.