FAQ Category: Pain

There are various problems associated with the use of intrathecal pumps. Withdrawal from the delivered medication, accidental over sedation or overdose are often caused by human error. Withdrawal can happen when the amount of medication remaining in the pump is miscalculated and runs out. Delivering too much medication can result in accidental over sedation or even overdose. The pump itself can malfunction. Newer units are proving to be more reliable however. Catheter tubing that is attached to the pump and then placed near the spinal cord can break, become clogged or dislodged. A newer complication that has been recognized is the formation of an inflammatory mass called a granuloma at the catheter tip. This can be the source of more serious neurological deficits.

Presently, morphine and ziconotide have been approved for delivery by intrathecal pump for pain. Baclofen has been approved for intrathecal delivery for spasticity. Doctors often use medications in the intrathecal pump that have not been approved by the FDA but seem to be safe and effective.

Whether or not someone will have chronic back pain does not necessarily depend on the severity of pain. Studies show that psychological factors such as depression, stress, and focus on body symptoms can influence the degree, duration, and debilitation associated with the pain.

An original study that took place in the United States, has since been replicated with similar findings in the United Kingdom. This study, as well as other studies, demonstrate that chronic pain exists in other countries.

Yes, there is. The Food and Drug Administration, FDA, approved one in 2004 for use in the United States. While their initial cost is greater, these units are projected to last ten to 25 years, providing a substantial cost savings over the course of a lifetime.

Yes, presently the nonrechargeable units last two to five years, depending on their use. The newer spinal cord stimulator systems have rechargeable batteries that can last ten to 25 years depending on their use.

Finding risk factors to predict which patients will move from acute pain to chronic pain is the subject of much research and debate. As you pointed out, finding a reliable way to do this may help with management and prevention of chronic low back pain. The result could be a huge savings of pain, suffering, and financial cost for millions of people.

So far, there isn’t a single approach being used by everyone. In 2006, a study was published by two American researchers (Von Korff and Miglioretti) using the Chronic Pain Grades to predict pain a year later. This tool doesn’t rely just on how long patients have had pain to define chronic pain. Intensity and influence on function are also considered.

The methods used by the American group were retested in the United Kingdom (U.K.). Patients with acute low back pain from five different general medical practices in North Staffordshire were included. Outcomes after one year were compared with measures of pain and depression used to predict chronic pain.

They found the Chronic Pain Grade could be used by different populations in different health care systems. However, there were some major differences in some of the results.

The British researchers rechecked their cut off scores to make sure they used the same levels as the American group. They weren’t sure the same risk scores could be used as predictive or prognostic factors among different groups. For example, a score above 18 suggested an increased risk of having chronic pain 12 months later.

They concluded the American cut-off points weren’t the problem. It was more likely the timing of when the testing was done. The sooner the test was done after onset of back pain, the more likely the test scores would predict chronic back pain. This led the researchers to suggest using the Chronic Pain Grade for patients who see their physicians but don’t get better and come back for follow-up care.

CRPS, complex regional pain syndrome, is a painful syndrome that is not yet understood by the medical community. It is brought on by some sort of trauma, such as a break or surgery. The problem lies with doctors not being able to tell who will develop CRPS and who won’t.

If you have to have the surgery again, there is some research that has found that some patients may be identified as at risk for CRPS through different types of testing. If you are concerned about this happening again, speak with your doctor about your concerns and to see what you can do about them.

Mindfulness meditation is a well-known body-mind technique. It was first used for patients with chronic anxiety or pain back in 1979. It has since been studied closely and developed further.

Today, the Mindfulness-Based Stress Reduction Program (MBSR) is a well-respected program. It is often used for a variety of chronic pain conditions. And a recent study from the University of Pittsburgh showed that it can be very helpful with older adults.

The MBSR program has several steps that can be adapted to each patient. The techniques are taught while doing everyday activities such as sitting, walking, or lying down. Breathing exercises and focus on each area of the body from head to toe are taught.

Patients are trained to pay attention to the process without judgment. Learning how to let go and accept the pain are the first steps to acceptance of the pain experience while increasing activity and improving function.

Many patients find they are able to sleep better and use fewer drugs for sleep and pain control while actively practicing MBSR. There’s probably nothing to worry about with your grandmother. You might want to try a session or two yourself to better understand the concept.

Acupuncture is a technique of inserting and manipulating tiny needles into points on the body. The goal is usually to relieve relieving pain.

Whether or not acupuncture really works remains under debate in the medical community. A recent review (2007) found that the evidence supporting the use of acupuncture is growing. Research is ongoing in the areas of chronic low back pain, neck and/or headache pain, nausea, and quitting smoking. The evidence seems to show that acupuncture is effective for some (but not all) conditions.

Comparing true acupuncture with sham acupuncture has resulted in similar benefits. Patients receiving sham treatment were touched at various acupuncture points with a look-alike acupuncture needle. The sham needle was blunt (not sharp) and did not go through the skin.

In one large, well-designed study from Harvard Medical School, patients treated with the sham acupuncture actually had better results than the patients who received true acupuncture therapy. The researchers weren’t sure what to make of their results. Clearly, more studies are needed to find out who can benefit from this modality. There is a need to identify the frequency and duration of acupuncture treatment in order to be most effective for each condition.

Laser acupuncture is the use of a low-level laser beam to stimulate an acupuncture point. The laser is used instead of an acupuncture needle. It is painless and noninvasive. Penetration into the surface of the skin is very shallow (reportedly about 0.8 of one millimeter).

A small red-beam laser pen is used. The device is similar to the red-beam laser light using in scanners at airports and grocery stores. According to research done by acupuncturists at Harvard Medical School, it is safe for home use.

Laser acupuncture is being used for a wide range of conditions such as low back pain, nonunion fractures, carpal tunnel syndrome, arthritis, and wound healing. It may also be used with acute injuries and for muscle relaxation.

This is a fairly new device. The Food and Drug Administration lists low-level laser therapy as a form of Biostimulation laser. Based on clinical data, it has been cleared for use in the temporary relief of pain. The FDA has not approved or recommended its use for other conditions.

Talk to your father’s medical oncologist. This is the doctor who plans, administers, and follows-up with the chemotherapy. There are some side effects of the disease and some from the treatment. It may be possible to adjust the medication dose to help with the disabling symptoms that can occur as a result of the treatment.

Many cancer patients experience a loss of function because of the pain they are having. Others find that their fatigue level and other symptoms combined with the pain keep them from completing tasks that used to be automatic.

There are some tests that can be taken by cancer patients to help identify just how much the pain is interfering with function. This guides the physician in knowing when to treat medically for pain relief or control.

One of those tests is a self-report survey called the brief pain inventory (BPI). This test measures pain interference with physical function such as general activity, walking ability, and normal work. It also measures the effect of pain on mood, relations with others, enjoyment of life, and sleep.

A social worker or psychologist can help you find the best test tools to use right now. Your oncologist will advise you what to expect along the course of cancer treatment. It may just be a matter of time before some of these functions are restored without actually doing something directly about them.

Pain is experienced differently by people and cannot be judged. The underlying condition may cause greater loss of function for some people with the same condition compared with others.

Chronic pain patients seem to experience the pain differently from patients with another diagnosis. For example, cancer patients are more likely to experience a decline in daily activities compared to a chronic pain patient with low back pain.

They may have the same self-reported intensity of pain but the pain interferes more with the function of the cancer patients. At the same time, noncancer chronic pain patients report a greater effect of their pain on psychologic function.

Most pain experts say that pain is a subjective experience. It should be accepted for what it is and how it affects the person. It may be like the old expression, You can’t really understand another person’s experience until you’ve walked a mile in their shoes.

Dependence on someone who has helped us out of a rough spot is natural. Part of the behavioral program should focus on learning new coping skills and letting go of that attachment.

Incorporating new coping skills and using them on a daily basis takes time. Often this process goes beyond what third party payers will reimburse. You still have several options.

You can request an extension of coverage of services. Your physician and therapist will probably have to write letters of justification. A relapse plan may be required. If your coverage is extended, then the remaining sessions should focus on preventing recurrence of symptoms.

This can be done several ways. A daily journal, diary, log, or blog can help you. Self-monitoring in this way will guide your daily coping, relaxation, and distraction practices. Practice positive self-statements. Practice coping skills and think about the new ways you’ve learned to solve problems.

Pay attention to areas where daily life events and stressors affect your pain and function. Applying all your new skills consistently everyday may help offset some of these added bumps in the road.

The cost of ongoing professional help may be more than you can afford. If your insurance carrier doesn’t approve additional treatment, perhaps paying out-of-pocket for one or two relapse-prevention sessions would be worth it for you.

Family and social support is very important for anyone coping with chronic pain. The fact that she has participated in a cognitive behavioral therapy (CBT) program is a definite advantage. This means she has been introduced to coping strategies and ways to change how she thinks about her pain.

CBT often includes education about pain and how chronic pain affects us. The therapist helps patients challenge the way they think, feel, and act. Maladaptive patterns and negative thoughts are replaced with positive statements and actions. Coping skills like methods of problem solving and ways to express thoughts and feelings are usually part of the CBT program.

It’s not uncommon for patients who have completed a series of CBT sessions to have a relapse of their symptoms. Daily follow-up, self-monitoring, and practice are needed to maintain the benefits of this program.

It might help if she goes back for one or two extra CBT sessions to review and practice what she has learned. It may be helpful if you went with her. Having a close friend, family member, or partner learn the program can be very useful.

Many CBT therapists encourage their clients to keep a daily pain-journal. This helps them see unhealthy patterns starting to repeat themselves. Seeing the connection between life events, stress, and pain can be another helpful tool for managing pain and monitoring progress.

Relaxation therapy definitely has a place in managing chronic pain. Muscle tension, anxiety, and stress can increase your level of pain and/or your ability to cope with pain. Relaxation therapy comes in many forms. Exercise for some people is a form of relaxation. Yoga, dance, Tai chi, and aerobic exercise (walking, biking) are just a few examples of exercise that seems to help reduce stress, fatigue, and depression.

Biofeedback is another tool used to help promote relaxation. This can be as simple as a handheld device (Thermistor TM) to measure temperature of your fingers or as complex as formal therapy with a physical therapist. Physiologic quieting (R) is a specific relaxation technique developed by a physical therapist that can be used at home very effectively. The patient uses an audio tape, Thermistor, and breathing exericses to lower the heart rate, blood pressure, and reduce muscular tension.

For anyone with chronic low back pain, a single approach to your discomfort may not be as effective as combining several methods at the same time. Psychologists suggest an approach called cognitive behavioral therapy (CBT). Studies show that CBT in addition to other treatment methods for chronic back pain is quite successful.

With CBT, relaxation therapy is combined with positive self-talk, minimizing negative or self-destructive thoughts, and changing beliefs about pain. The main focus of CBT is to replace poor coping skills and maladaptive beliefs and emotions with healthier ones. This approach deals with the psychologic and social factors affecting chronic pain.

Other methods such as pain relievers, acupuncture, and chiropractic care help with the biologic side of pain. For best results, it’s recommended that a program is used that addresses all the biologic, psychologic, and social aspects of chronic pain.

Researchers don’t quite understand how acupuncture works, but there are several theories. One theory is that the introduction of the needles releases chemicals and endorphins that help manage the pain, while another theory says that the needles affect a patient’s pain threshold. However it works, the Chinese belief is that the body’s health is a balance of two forces, the yin and the yang.

If the forces are not in balance, as would happen with illness or accident, this must be fixed and acupuncture is able to fix this.

The acupuncturist locates various points that are believed to be responsible for certain areas of the body and by inserting the acupuncture needles into these points, balance is achieved.

Side effects with acupuncture are rare and usually mild, such as some bleeding at the site, bruising perhaps. In some rare cases, patients have contracted hepatitis or septicemia from contaminated needles.

Not all people should have acupuncture. If you have a bleeding disorder, an infection on the skin or some other damage to the skin where the needles would be placed, you should not have acupuncture. As well, if you are pregnant, allergic to metal, or are taking medications to thin your blood, you should proceed with caution.

Treating patients with a history of drug addiction for pain is not easy. The doctors have to weigh the importance of pain relief with the issue of potential drug abuse. The fact that your sister is aware of this issue is a good thing, because it opens a dialogue between her and her doctors.

There is hope for people in your sister’s situation. There are medications that have lower addiction potential and experienced doctors can follow treatment plans that limit the risk of addiction.

The best thing for your sister to do is to have a discussion with her doctor and, if possible, a pain management specialist. By discussing the issues and her options, there is likely a solution for her so she doesn’t have to continue living in pain.

A patient with a history of drug abuse and addiction can be hard to treat for pain after surgery because there is often the lingering fear of the patient getting addicted again. That being said, you should not be suffering from pain if you don’t have to be.

Patients who take buprenorphine for addiction are able to have surgery and be treated, although the treatment has to be done by a doctor who understands how the medications work with each other.

Buprenorphine is also given for pain relief, so if you are already taking it, the surgical pain might be manageable just by changing the doses of the medication. If you experience what is called break-through pain, pain that happens despite taking pain killers, there are some types of medications that your doctor can order that will be given over a short-term.