Pain Treatment Centers

Stephen T. Pyles, MD-Spinal Stimulation Therapy for Pain Management

Cannabinoids – Time for a More Rational Cannabis Policy

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cannabinoidsIndividuals who suffer from severe chronic pain are caught in a double bind. Opioids contribute to the enormous societal harms of unintentional overdose, diversion and addiction, and data on their long-term effectiveness are conflicting and inadequate (Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health pathways to prevention workshop. Ann Intern Med. Published online Jan. 13, 2015 doi:10.7326/M14-2559). But for patients who are helped by opioids, policies and regulations to address societal harms are, in some cases, impeding access to treatment, making it difficult even to find a knowledgeable physician. The need for safer and more effective analgesics has never been greater.

Answers do not lie in pitting one serious disease (i.e., chronic pain) against another (i.e., addiction) but in seeking scientific breakthroughs that lead to serious analgesic benefits without addictive properties or risk for respiratory depression. Rigorous research of cannabinoids has the potential to unlock a medicinal benefit on a societal scale. But committing to the necessary research requires rethinking how we classify cannabinoids as a controlled substance.

Inching Toward Safer Pain Treatments

Tetrahydrocannabinol (THC) produces the “high” effect associated with marijuana. On its own, cannabidiol (CBD) displays a plethora of actions including anticonvulsive, sedative, hypnotic, antipsychotic, anti-inflammatory and neuroprotective properties, and is believed to have fewer undesirable psychoactive effects than THC (Phytother Res 2009;23:597-602). Some research indicates that cannabinoids may provide analgesia for various pain conditions (Rambam Maimonides Med J 2013;4:e0022). Practically speaking, harnessing the potential medicinal benefits of marijuana without these unwanted effects would be a long-awaited breakthrough for science. Despite many strictures, scientists—largely from other countries—are inching closer to the finish line with products that could replace opioids in some instances.

 

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Pain Medicine News,  Lynn R. Webster, MD

 What is Spinal Cord Stimulation?

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Spinal cord stimulation Spinal cord stimulation is a method that can be used to treat chronic back pain. This is a serious issue for many people who find that this pain can slow them down significantly or even interfere with activities of daily living, leaving them homebound and without relief. Spinal cord stimulation is one way around the problem, with an alternative that can be implanted in your doctor’s office.  However, it helps to know how it works to know whether or not this is an option to treat your chronic pain issues.

The process relies on an electrical current that is implanted in the back and sends electric pings to the spinal cord. These pings stop the nerve receptors in your spine from allowing you to feel pain. It is generally conducted using a simple sedative and a local anesthesia medication and is often done once as a test to see how your body — and back pain – responds to the treatment, before scheduling for a full course of spinal cord stimulation treatments.

Moreover, if you respond well to the treatment, your doctor may install a permanent stimulator in your abdomen, just under the skin, with wires inserted that lead to the place in your spine where the pings are necessary. The insertion of the stimulator into the abdomen is perfect for greater stability under the skin.

You can use spinal cord stimulation for an hour or two each day, three to four times a day. It will cause a tingling feeling in the back instead of the extreme and limiting pain you may have experienced in the past. This is perfect for those with chronic pain that has not responded to other forms of treatment, including medications and physical therapy.

There are risks, including infection, headaches, bladder issues and more associated with spinal cord stimulation. However, for many patients, the benefits far outweigh any risks and provide an “out” to those that have felt forced to live with chronic back pain.

However, it should be noted that this is an option that should be considered only after other less-invasive options have been exhausted, including physical therapy for the back to reduce inflammation and promote natural healing. Spinal cord stimulation is best, in fact, for those that have tried other options and feel frustrated that nothing has worked.

Causes of Chronic Pain

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painChronic pain can wreak havoc on your entire life, not only causing physical anguish, but also mental depression as well. This is, in part, due to the lasting nature of this type of pain and also because for some conditions, there is no way out of it. However, it does help to know the reason for chronic pain and what diseases and conditions most commonly cause it. This type of pain affects up to 1 in every 10 adults and generally most commonly associated with back-related issues, though a number of other conditions can be to blame, as well.

Chronic pain is characterized by pain that does not go away as it normally would after an episode of being sick or a specific injury. This type of pain is often described as a burning or electrical-feeling, as well as aching and/or shooting. It can be soreness, tightness, a stiff feeling or just plain uncomfortable. Symptoms of chronic pain include an inability to sleep because the pain is keeping you up at night, withdrawal from the activities of daily living, depression, an immune system that is significantly weakened, moodiness, a sense of helplessness of hopelessness, irritability and more.

However, the good news is that this type of pain doesn’t have to stop you in your tracks. There are ways to deal with, mostly starting with understanding how to manage it and what causes it. Back pain is one of the major causes of chronic pain. From spinal stenosis, which is characterized by a narrowing of the canal in the spine, to a slipped disc, there are a number of back injuries that can cause lasting pain.

Compression fractures are also contributes to chronic pain as is spinal deformities and damage to the soft tissue around the spine. Another common cause of chronic pain is headaches, brought on by excessive fatigue, stress and injuries around the neck of back. Migraine headaches are a common cause of chronic pain as are cluster headaches, which are caused by overly large blood vessels that lead into the head area. Headaches are considered to be chronic if they occur at last half the days in the month for three months at a time.

Another common cause of chronic pain is join pain, mostly related to arthritis. This is not only felt by elderly individuals, as younger people can struggle with arthritis as well. Pain signals coming right from the brain is another cause of chronic pain. This can be caused by nerves that are in the midst of a healing process, as they tend to over-fire and cause more intense feelings of pain. This can result from diabetic neuropathy, which is a common side effect of diabetes, and sciatica, which is the nerve that runs from the back all the way down to your feet. If this nerve is damaged or compressed in any way, the shooting pain that results can be downright debilitating.

Additional diseases that can cause chronic pain include cancer, in which the pain is caused by tumors that can develop just about anywhere on the body, as well as fibromyalgia, which can also cause extreme fatigue and sleeping disorders. Depression is another common cause of chronic pain, which may come as a surprise to some people to know that mental imbalances can cause this kind of pain, but this is a fact and it can be challenging to resolve without resolving the depression itself.

Chronic pain in can be managed, particularly if the cause of the pain is identified. From medicinal options to meditation and other holistic methods, there are ways to manage this pain so that it doesn’t take over your life. Pinpointing the cause and attempting to treat it is just the first step in the process. Resolving not to give up and working closely with medical professionals to reign in the pain is the best way to stay persistent in taking on this issue and winning over it.