How Adverse Events Affect Children With Chronic Pain

children painChildren with chronic pain who experience adverse childhood events (ACEs) are more likely to suffer an increase in symptom severity, according to new research. This suggests that chronic pain should be monitored even more closely if a child is subjected to difficult or stressful events.

For the study, researchers grouped children with chronic pain conditions or rheumatic diseases into one of three groups:

  • Pain with zero adverse childhood events
  • Pain with one adverse childhood event
  • Pain with two or more adverse childhood events

Although the researchers didn’t spell out exactly what type of adverse events were tracked for the study, they did mention that a wide array of adverse events were used as data points. They said traumatic experiences included a range of physical, mental and sexual abuse, and things like divorce or family mental illness.

“The results indicate that children with chronic pain and/or rheumatologic diseases who are exposed to ACEs are at increased risk of worse functional disability, greater pain-related symptomatology, and a higher burden of co-morbid mental health conditions,” researchers wrote. Patients who had experienced two or more adverse childhood events had “more somatic symptoms, worse functional disability, and a higher proportion of mental health conditions.”

Mental Health And Chronic Pain Symptoms

As we’ve talked about at length on the blog in the past, chronic pain and your mental health are closely connected, so it should come as no surprise that children with chronic pain who experience traumatic life events would be at risk for more severe pain symptoms. Chronic pain is not just a physical condition, and mental factors like stress or anxiety can absolutely make physical symptoms worse.

While the study only focused on children, the results should likely be applied to all populations that are dealing with a chronic pain condition. If you experience an adverse event in your life, don’t be surprised if your pain or your symptoms worsen. It’s not ideal, but it’s a direct result of this new mental stress and fatigue.

The only bright spot about this news is that it helps us understand that we need to be aware of the physical issues that may come along with a psychologically traumatic event. If we’re aware of how these events can impact our physical health, we can help patients get the care they need sooner or develop some coping skills to lessen the effects of the event. Patients should also be up front with their pain care providers about what’s going on in their life so that providers can help them appropriately manage your pain. You don’t need to go into great detail about your divorce or family loss, but let your pain care specialist know that you’re going through some stressful life events and that you’re aware stress and worsening symptoms can go hand in hand.

We want to help you find pain relief, and that involves treating the physical, mental and emotional aspects of your condition. To connect with a provider who will help treat all these aspects and more, reach out to Dr. Cohn and his team today.

Nanoparticles Could Make Opioids Obsolete For Chronic Pain

nanoparticlesPainkillers are currently used to treat a number of different pain conditions, but everyone knows they are far from a perfect solution. Traditional opioids carry a high risk of addiction and overdose, which is why researchers are so keen on finding another way to calm irritated nerves and help block nerve signals. With the help of nanoparticles, they may do just that.

According to an international team of researchers, we may soon be able to use nanoparticles to deliver drugs into specific compartments of nerve cells, allowing us to better treat pain while also reducing the risk of dependency that comes with traditional opioids. Researchers said the nanoparticle delivery method has proven successful in rats and mice, and they hope to improve the science so the results are replicable in humans.

“We have taken a drug—an FDA-approved anti-vomiting medication—and using a novel delivery method, improved its efficacy and duration of action in animal models of inflammatory pain and neuropathic pain,” said Nigel Bunnett, PhD, chair of the Department of Basic Science and Craniofacial Biology at New York University (NYU) College of Dentistry and the study’s senior author. “The discovery that nanoparticle encapsulation enhances and prolongs pain relief in laboratory animals provides opportunities for developing much-needed non-opioid therapies for pain.”

Nanoparticle Delivery

The team of researchers began by studying a family of proteins called G protein-coupled receptors, which are an area that are targeted by roughly one-third of clinically used drugs. The standard line of thinking was that these receptors function at the surface of nerve cells, but the team discovered that when activated, the cells moved within a compartment called the endosome. Inside the endosome, the receptors continue to function for prolonged periods, and this activity is what drives pain perception.

In their study, researchers narrowed their focus on a G protein couple receptor called the neurokinin 1 receptor.

“Major pharmaceutical companies had programs to develop neurokinin receptor antagonists for chronic diseases, including pain and depression. However, in human trials, things fell apart,” said Bunnett. “The neurokinin receptor is the poster child for failures in drug discovery to treat pain.”

Researchers believed that those drugs failed to provide relief because they were designed to block pain receptors at the surface level of the cells, not in the endosomes. But by turning to nanoparticles, researchers can deliver a neurokinin receptor blocker called aprepitant, which is an FDA-approved drug that is used to prevent nausea and vomiting. Essentially, these nanoparticles enter the nerves that transmit pain signals and release the neurokinin receptor blocker, halting pain. In clinical trials involving mice and rats, pain completely resolved or resolved for longer periods compared to opioids and other traditional treatments. By using this technology, it also minimizes the dosage needed, which can help to prevent traditional side effects.

Researchers hope that these results can be mimicked in clinical trials involving humans, and they hope to further their understanding by eventually only targeting the nerve cells that sense pain, as this would lead to even smaller doses. Hopefully they are successful, because we can always use more effective and less dangerous ways of controlling chronic pain.

Chronic Pain Patients Struggling To Find Primary Care Services

opioids care doctorA new study published in JAMA Network Open found that chronic pain sufferers have a harder time finding primary health care because they have an active prescription for opioids.

According to the study, 40 percent of the nearly 200 primary care clinics contacted as part of study said they would not accept a new patient who takes Percocet daily for chronic pain as a result of a past injury, no matter what type of health insurance they had. An additional 17 percent of clinics said they would want more information about the patient before deciding if they would take them on, with two-thirds of this subset saying the patient would be required to come into a preliminary appointment before a decision could be made. Despite these findings, all of the clinics said they were currently accepting new patients.

The findings suggest patients with a history of chronic pain could face health care access problems.

“Anecdotally, we were hearing about patients with chronic pain becoming ‘pain refugees’, being abruptly tapered from their opioids or having their current physician stop refilling their prescription, leaving them to search for pain relief elsewhere,” said study lead researcher Pooja Lagisetty, M.D., M.Sc. “However, there have been no studies to quantify the extent of the problem. These findings are concerning because it demonstrates just how difficult it may be for a patient with chronic pain searching for a primary care physician.”

Slippery Slope

Dr. Lagisetty said for patients with chronic pain conditions, getting access to primary care goes beyond just checkups and preventative care. Having a regular physician could allow them to receive other pain-relieving treatments, and in some cases, work with the new provider to gradually and safely taper off their use of opioids. Primary care providers can also help recognize the signs of opioid use disorders or addictions, so not accepting patients simply because they are trying to manage their pain only works to further the crisis.

“We hope to use this information to identify a way for us to fix the policies to have more of a patient-centered approach to pain management,” said Dr. Lagisetty. “Everyone deserves equitable access to health care, irrespective of their medical conditions or what medications they may be taking.”

It’s easy to accept the healthy young adult at your clinic, and it can be harder to take on the patient managing multiple health conditions, but both should be guaranteed access to primary care providers. We need more doctors who are willing to take on the harder patient.

Minnesota Researching Opioid Alternatives

opioid abuse alternativesEven if you’re not a chronic pain sufferer, you’ve probably heard about the “opioid crisis” here in America. Overdoses and accidental deaths from pain medications have skyrocketed in recent years, and things are only getting more divisive as we try to put an end to overdoses. There are too many competing interests working against one another. For example:

  • You have a government officials who are supported by money from big pharma.
  • You have big pharma, who is making a lot of money through the increase in prescription medications.
  • You have some overworked doctors who jump right to pain pills instead of taking more time to find solutions.
  • You have some chronic pain patients who take the idea of opioid regulation as a personal offense.

That’s simply too many interests pulling in too many directions, and chronic pain patients are suffering because of it. However, Minnesota has recently taken some tangible steps to look for alternatives to opioids.

Opioid Alternatives

Earlier this month, leading medical minds met in St. Paul to talk about some alternatives to pain management to help combat the opioid epidemic. They discussed a range of possibilities, including such options as:

  • Electrotherapy
  • Radio-frequency ablation
  • Cryogenics
  • Implantable spinal cord stimulators
  • Epidural injections
  • Medical gadgetry
  • Chemical compisitions
  • Physical therapy techniques

The goal of the meeting was to help lawmakers understand that they have the ability to influence how research funding can be allocated for some of these alternatives, and that the future of these pain management techniques are worth exploring.

Dr. Clarence Shannon, an anesthesiologist who works in the University of Minnesota Pain Clinic in Minneapolis, spoke about the summit and how it’s important to test out potential treatment options before jumping to opioids.

“It’s a stair-step approach that I like to use: nonsteroidals, anti-epileptics or neuropathic medications. We’ll try radio-frequency ablation if we can. We’ll do nerve blocks. And then we’ll move up to the things like the implantable devices,” Shannon said.

These alternatives aren’t perfect solutions, and while they do have some drawbacks, the downsides are much less threatening to a patient’s health than the negative consequences of opioids. Medical devices may cost more, may be more prone to malfunction and may require battery changes, but those downsides are worth it if they can protect us against opioid abuse and overdose.

A Good Start

The pain management summit was a good start, but we need to also focus on getting everybody on the same page. We need to the government to look at the bottom line in terms of lives saved and not dollars earned. We need to take the burden off doctors so they don’t feel the need to fall back on opioid prescriptions without first exhausting some other options. We need chronic pain patients to realize that searching for alternatives does not mean the government is going to come and take away their prescriptions that they are using responsibly to manage their pain.

We need to work together to find a solution, or we can’t expect anything to change. Hopefully Minnesota can be at the forefront of that change.

Overprescribing Opioids Is A Problem In Our Own Backyard

opioid problems mnNew findings published in the Annals of Surgery suggests that clinicians at the Mayo Clinic in Rochester were routinely writing opioid prescriptions for surgical patients that exceeded regulatory guidelines currently being drafted by the state of Minnesota. The findings also uncovered significant differences in opioid prescribing among the Mayo clinics in Rochester, Arizona and Florida, as well as within surgical procedures.

Study senior author Elizabeth Habermann, who also serves as the scientific director of surgical outcomes research at Mayo, said the findings help highlight where improvements can be made.

“In light of the opioid epidemic, physicians across the country know overprescribing is a problem, and they know there is an opportunity to improve,” said senior author Elizabeth Habermann, scientific director of surgical outcomes research at Mayo. “This is the first step in determining what is optimal for certain surgeries and, eventually, the individual patient.”

Opioid Overdoses In America

According to the Centers for Disease Control and Prevention, the number of deaths involving prescription opioid overdoses have nearly quadrupled since 2000. In fact, more than 90 people died each day from either a prescription opioid or heroin overdose in 2015 alone.

Study co-author Dr. Robert Cima said doctors have been so focused on ensuring patients have their pain minimized as much as possible after surgery that they often don’t consider the possible long-term side effects of the prescriptions they’re filling.

“For the last two decades, there had been such a focus at the national level on ensuring patients have no pain,” said Dr. Cima, a colorectal surgeon and chair of surgical quality at Mayo Clinic’s Rochester campus. “That causes overprescribing, and, now, we’re seeing the negative effects of that.”

I have no doubt that the Mayo Clinic will adhere to the new guidelines being drafted at the state level in short order, but this story speaks to the larger issue of just how unregulated opioids are at some of the nation’s best hospitals. And if it’s happening there, you can bet it’s happening to a larger degree at lesser care centers.

However, these findings do cast light on the problem and should help push us towards a solution, but it’s not necessarily going to come from the top down. It needs to start with doctors. We need take time with each patient and push them towards active treatment techniques instead of passive treatments like opioids. Opioids certainly have their role in pain management, but they shouldn’t be over-relied on, as it appears they are.

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