Pain Product Warnings August 2012

One thing this site, (updates.pain-topics.org - see link below) does very well, is keep people up to date with the latest developments in drugs that pertain to their own illness. The world of Big Pharma and governmental health departments is constantly changing and things you take for granted regarding your medications can change very quickly.

Aug 2012 – Pain Product Announcements; Warnings
Wednesday, August 1, 2012

Featured Items: generic pregabalin approved; FDA REMS approval for long-acting and extended-release opioids; makers of unapproved oxycodone products warned to stop; defective
All brand names are trademarks of their respective manufacturers. Compiled by Winnie Dawson, MA, RN, BSN.

Generic Pregabalin – Several Firms Receive FDA Approval     

Teva Pharmaceutical Industries, Lupin Ltd, and Watson Laboratories all received a July 2012 FDA approval of their application to produce pregabalin, the generic equivalent of Lyrica. The drug is indicated for neuropathic pain of diabetic peripheral neuropathy, post-herpetic neuralgia, and fibromyalgia, as well as adjunctive treatment for adults experiencing partial onset seizures. The capsules will be available in 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, and 300 mg strengths. For administration and safety information, see the pregabalin Medication Guide.

REMS Approval for Long-Acting and Extended-Release Opioids
      After 3 years in development, the FDA has approved a shared Risk Evaluation and Mitigation Strategy (REMS) for the makers of all extended-release (ER) and long-acting (LA) opioid analgesics. The program is part of the FDA’s overall plan to reduce opioid prescription abuse while providing safe access to patients who need opioids to treat moderate to severe chronic pain. The educational component of the program includes prescriber training, patient counseling information, and a medication guide for each opioid product. Healthcare professionals will learn strategies for analyzing the risks and benefits in appropriate patients, as well as techniques for monitoring and counseling patients. Read the Pain-Topics UPDATE on the REMS approval for more information and links to useful resources.

Unapproved Oxycodone Products – FDA Instructs Makers to Stop     

Consistent with the FDA’s ‘Unapproved Drugs Initiative,’ the FDA issued a July 2012 Federal Register Notice advising companies that are manufacturing and distributing unapproved oxycodone products to stop these activities. This action is intended to protect consumers from immediate-release oxycodone drug tablets, capsules, and oral solutions that have not received FDA evaluation for safety and efficacy. The manufacturers were given 45 days to cease production and 90 days to discontinue shipment of existing drugs. See the FDA News Release for questions regarding this action and a list of National Drug Code (NDC) numbers for the unapproved single-ingredient oxycodone products.

http://updates.pain-topics.org/2012/08/aug-2012-pain-product-announcements.html

Back Pain In Pregnancy

Ub Channel Acupuncture

Whether you're looking to lose weight or just want a way to get rid of that nasty cold, eHow has all the answers you're looking for..Easing labor pain may help reduce postpartum depression in some women, early research suggests 3D tumors grown in the lab provide new perspective for cancer drug .TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..The best possible care starts with finding an experienced doctor who can treat you at a top-rated hospital. But it's also important to be an informed patient, so .What's in a Name? What Every Consumer Should Know About Foods and Flavors; 4 Medication Safety Tips for Older Adults; FDA: Cutting-Edge Technology Sheds Light on .CDC's Division of Nutrition, Physical Activity, and Obesity works to maintain health and prevent chronic disease by promoting healthy eating and active living for .Low back pain fact sheet compiled by the National Institute of Neurological Disorders and Stroke NINDS ..

Spine Worx Realignment Device Video

Uterine Fibroids

Low back pain fact sheet compiled by the National Institute of Neurological Disorders and Stroke NINDS ..Easing labor pain may help reduce postpartum depression in some women, early research suggests 3D tumors grown in the lab provide new perspective for cancer .The best possible care starts with finding an experienced doctor who can treat you at a top-rated hospital. But it's also important to be an informed patient, so .TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..What's in a Name? What Every Consumer Should Know About Foods and Flavors; 4 Medication Safety Tips for Older Adults; FDA: Cutting-Edge Technology Sheds Light .Whether you're looking to lose weight or just want a way to get rid of that nasty cold, eHow has all the answers you're looking for..CDC's Division of Nutrition, Physical Activity, and Obesity works to maintain health and prevent chronic disease by promoting healthy eating and active living for .

Accepting The Pain Of Neuropathy And Moving Forward

Today's post from instituteforchronicpain.org (see link below) is a self-help article with a difference - it makes sense! Most self-help articles are well-meaning but stuffed with clichés and so-called new age philosophy and go over most people's heads. What we need is to know why we need to become proactive in our health problem and why that will do us good. This article sets out to explain how not fighting our pain (as we're expected to do) is the first step towards learning to live with it and improve it. Worth a read...even for cynics.

Finding Hope in Acceptance  
Author: Murray J. McAllister, PsyDPosted on August 26, 2013

At first thought, it might seem crazy to accept that your pain is chronic. When I bring it up with patients, many of them tell me, not without some irritation in their voice, “I’ll never give up hope of finding someone who can fix me!” Indeed, it’s common to think that accepting the chronicity of your pain is the same thing as giving up hope that you’ll ever get better. So, why in the world would you ever want to accept that your pain is chronic?

Contrary to what you might think, accepting that your pain is chronic is the first step in actually getting better. It opens up a whole new way of getting better, a way that takes into account the realities of your pain condition. As such, it’s a new and more realistic way to have hope.

To understand the point more clearly, let’s briefly review two different models of healthcare – two different ways that we get better when having an illness or injury. These two models are what we might call the ‘acute medical model’ and the ‘rehabilitation model.’ The latter is sometimes called the ‘self-management model.’ (For a more thorough review of these models of healthcare, click on this post here.) 


Acute Medical Model

The acute medical model of healthcare is what most of us think of when we go to see a healthcare provider. When sick or injured, we go to a provider who determines what’s wrong and provides a treatment that cures us. The healthcare provider is an expert who usually knows more about the condition and the treatments than we do. The treatments themselves are usually medications or procedures that act on us. We don’t typically get better by doing things ourselves. Rather, it’s the treatments that get us better and we rely on healthcare providers to provide us with those treatments. Lastly, getting better in the acute medical model is usually thought of as getting cured. We return to our usual state of health — how we were before we became ill or injured.

Hope of getting better within the acute medical model lies in finding the right healthcare provider who knows what’s wrong and knows how to cure you. In this model, hope lies external to you. You find it in the expertise and treatments of a healthcare provider.

Now there’s nothing wrong with the acute medical model. It’s all well and good when we have a condition for which there actually is a cure. Indeed, it’s likely the best thing to do. But, what do you do when you have a condition for which there is no cure?

Rehabilitation Model

The answer to the question, of course, isn’t to give up hope and do nothing. There’s actually a different way of getting better. It’s the rehabilitation model of care. It requires, however, redefining how to get better and even redefining what it means to get better.

In the rehabilitation model of care, the emphasis is on what you, the patient, do to get better — not on what the healthcare provider does to get you better. Specifically, the focus is on the patient acquiring the abilities to make healthy changes, which, when done over time, have a positive impact on the chronic health condition that you have. These changes fall into two categories: a) changes in health behaviors, or what’s often referred to as lifestyle change, and b) changes in coping, or what’s often referred to as stress management. The goal of learning and engaging in these health behaviors over time is two-fold: you reduce the symptoms of the condition and you reduce the impact that the chronic health condition has on you. In other words, you get so good at self-managing the condition that it no longer is as problematic as it once was. As a consequence, you can move on with the rest of your life, engaging in the meaningful activities of life – such as work, family activities, social and recreational activities.

Notice that the rehabilitation model doesn’t promise a cure. The reason is that the conditions for which the rehabilitation model is best suited are those conditions that are chronic. They have no cure. Nonetheless, the patient does get better in very real and meaningful ways.

Notice too that hope gets redefined. It allows for having hope even when there is no cure. Finding a cure is not the only way to get better. Therefore there’s still hope. It’s just a different way to have hope, a hope that realistically takes into account the chronic nature of the condition you have, but nonetheless points to how to how you still can get better.

The conditions for which the rehabilitation model is best suited are chronic conditions, where there is no cure, such as chronic pain syndromes, diabetes, heart disease, and spinal cord injuries, among others.

Finding Hope in Acceptance

Acceptance that your pain is chronic is the first step in pursuing the rehabilitation model of care. Rehabilitation is hard work. It also takes time. You don’t do it if you think that a cure is just around the corner. Once you recognize, though, that your chronic pain really is chronic, it becomes your life-saver – or life-retriever. You start to get your life back. You learn how to self-manage your pain and you practice it to the point that you move on with the rest of your life. Your life doesn’t have to be about chronic pain.

Patients can keep their life on hold when they insist on finding hope only in a cure. They seek out appointment after appointment, attempting to find the right specialist who will know what to do to make their pain go away. Oftentimes, they seek out surgeries or interventional procedures that seem as if they might be a cure, but aren’t. Each time they seek out a new specialist, there is hope. Each time, though, it gets dashed because there really is no cure for chronic pain. Chronic pain really is chronic.

The point, here, is not a criticism of such patients. What we are describing makes sense if you think of healthcare as only the acute medical model. If we think of healthcare providers as specialists who fix us when sick or injured, it makes all the sense in the world to look for the right one who can do the job – even if you have to try one after another. It’s a hard lesson to learn when realizing that it’s only sometimes that healthcare providers act like a mechanic. A lot of the time, we have no fixes. So, again, I’m not judging when I describe patients who fail to accept that their pain is chronic. We can all understand how it happens. They are trying to find hope in a cure.

What if, though, at the end of the day, the hope is really a false hope? It can become a vicious cycle that leads to depression and oftentimes more pain. Hope is found with each new procedure, but each procedure fails to cure the pain and so hope is dashed. If hope is defined by finding a cure, and if there really is no cure, then you are left helpless – and hopeless.

Maybe it’s best to find a new way to have hope.

You find it by accepting that chronic pain really is chronic. You accept that you are not going to get better by finding a cure. Rather, you accept that you are going to get better by learning to self-manage it. You learn how to make healthy changes in your life that, when done over time, reduce your symptoms and reduce the impact that chronic pain has on your life. You get so good at managing chronic pain that it is no longer the preoccupying problem that it once was. Your life consists of the stuff of life and chronic pain comes along for the ride, but remains in the side car.

It’s okay if you don’t know how to do it yet. Most patients have to learn how to do it. Oftentimes, I remind patients that you’re not born with the knowledge of how to self-manage pain successfully. People have to learn it. And it’s okay if you don’t know how and have to learn it.

What matters, though, is that you learn how. It’s possible to learn how to self-manage pain and do it successfully. People learn how to do it everyday in chronic pain rehabilitation programs. And you can too.

You just have to first accept that your chronic pain is really chronic.

(For more information, please see: “What is chronic pain?” or “Why the healthcare system refuses to accept the chronicity of chronic pain.”)

http://www.instituteforchronicpain.org/blog/finding-hope-acceptance/

How Friends And Family Can Help Pain Sufferers

Today's post from paincommunity.org (see link below) looks at another aspect of care-giving when it comes to people living with relentless pain. This time it gives tips for family and friends and presents them from the point of view of the sufferer him- or herself. Many people with chronic pain feel misunderstood, disbelieved, unappreciated, ignored even and this is a plea for a little more understanding from those around them. of course, nobody pretends that people in pain are easy to live with but sometimes family and friends are at a loss as to how to help. This article suggests a few ideas.

What Can I Do? Tips for the Families and Friends
Posted by Janice Reynolds | January 14, 2014

The presence of persistent (aka chronic) pain is often “the elephant in the room”. For those of us who have persistent pain, daily living can be a challenge. Though we may not “look” like there is a problem, there is. For some, our pain is well controlled and for others it isn’t. For all of us, pain dictates how we spend our day as well as how we do things. It is very fatiguing even at the best. These are some thoughts and suggestions I wish to pass on to our family and friends. This is a response to the well-meaning comment: “What can I do?” This simple question can be overwhelming.

Tips That Can Make a Difference:
 
1. Don’t avoid me. Be the friend or loved one you have always been. Please visit. Find out or call first to be sure it is a good time for company.

2. Let’s talk together about it. Try not offer advice unless asked. You might start off by asking if I feel like talking about it at that moment or later.

3. Pain isolates; cry with me; laugh with me; let me know my feelings and needs are all right. Be patient and caring. Acknowledge my pain. Validate my feelings good and bad; loss, hope, sadness, anger, acceptance.

4. Remember persistent pain doesn’t mean the same level of pain is present all the time. Even if I have a good pain plan there are times my pain can elevate and spiral out of control. If you notice non-verbal cues, like a change in my mood, becoming very still or more restless or the inability to tolerate noise or light, encourage me to use the familiar techniques I depend on to lessen my pain; this could include taking recommended medications.

5. Don’t be afraid to touch me. Ask first if you have doubts; holding my hand lightly may be okay where squeezing it isn’t.

6. Learn the difference between physical dependence and addiction; I may depend on pain medication but may not have a problem with the misuse or abuse if it. These are very different situations.

7. If there is something you don’t understand, let me know so I can better explain it. Never be judgmental. Do not be afraid to be honest with me either.

8. Help me make a grocery list, if needed. Either offer to go with me or even shop for me.

9. Offer to watch my children or pay for a reliable babysitter for a while so I can have a little alone time with my spouse or by myself. They can probably use a break from me as well.

10. Cook or bring over a meal on occasion. Preparing something for the freezer for a time when I am having a bad day would be a life saver.

11. If you find I have fallen behind with cleaning, gently offer to help—dust, vacuum, wash dishes or clothes.

I know there are others. What would help you the most? Please pass this along to the families and friends of people you know who live with pain (including yourself); maybe we will get the elephant out of the room or at least halfway out the door.

http://paincommunity.org/what-can-i-do-tips-for-the-families-and-friends/

Anti Opioid Measures Affect Genuine Pain Sufferers

Today's post from the always excellent pain-topics.org (see link below) talks about the current political hysteria concerning opioids and opioid abuse across the world. True there are recreational users who abuse both the drugs and the system but there are also so many neuropathy and other non-cancer pain sufferers who depend on these drugs to get by each day. Authorities in many lands are introducing stringent measures to control opioid abuse but innocent people are being caught up in the backlash and being denied the drugs they need and deserve. You can almost understand the motives behind this when talking about drug abuse but if the reason also involves money, as is suggested here in Australia, then it is clearly unacceptable to chronic pain sufferers. A very interesting article.

Opiophobia Alive & Well in Oz
Posted by SB. Leavitt, MA, PhD Thursday, January 24, 2013

With all the recent ruckus over prescription opioids and sensational news headlines in the American press inciting fears of these medications, it is easy to believe that the United States is the only country facing such challenges. Apparently, the news is even worse from “down under” in Australia.

According to a brief news item — by Renee Viellaris and appearing in The Australian on January 19, 2013 [here] — physicians will “begin weaning some patients off pain medication as the nation's insatiable habit of pill popping has left health and law enforcement agencies buckling under pressure.” New pharmaceutical guidelines, to be presented this year to state and federal health ministers, will disallow prescribing some patients with “highly addictive and popular pain pills.”

The news report claims that the move has been prompted by the financial drain on the federally-funded Pharmaceutical Benefits Scheme (PBS) from excessive analgesic prescribing, misuse of the medicines, and “research showing long-term use of opioids is counterproductive.” Based on 2010 figures from the Australian National Centre for Education and Training on Addiction (NCETA), in that single year demand for subsidized prescriptions for two types of popular analgesics — oxycodone and fentanyl — cost taxpayers an extra $18 million [$18.9 million USD].

Dr. Steve Hambleton, federal president of the Australian Medical Association, confirmed that “some patients with noncancer pain would have to be weaned off the drugs because they were too expensive and were no longer clinically appropriate. Patients with long-term back or hip pain and those with sporting injuries who take the popular drugs face being directed to alternative therapies, including yoga.”

Hambleton called for more money from government to set up chronic pain clinics in hospitals, but conceded that the new regulations will dramatically change how pain is treated, and at a time when policy makers are also coping with an ageing population. “Some patients will have to be weaned off (and will have to do) things like physical therapy and focus on what you can do and not what you can't — more of a positive attitude,” he said in the news article.

The news report concludes that, “Research provided by NCETA shows that the per capita amount of morphine-equivalent drugs Australians are taking has exploded in the past 30 years.” Furthermore, “the number of Queenslanders on opioid dependence programs is dramatically increasing.”

COMMENTARY: The news report, brief as it is, tells a grim story of what may lie ahead for patients with chronic pain in Oz. And, unfortunately, this is not unlike what is occurring or may happen in other parts of the world, including the U.S.

Our quick scan of the websites of Australian organizations — Chronic Pain Australia serving patients/advocates, and the Australian Pain Society serving healthcare professionals — found no mention of these dire developments. Among other concerns, it would be interesting to know of what research evidence authorities are examining that proves the long-term use of opioid analgesics is “counterproductive.”

The news article notes that the number of persons in Queensland entering opioid-dependence treatment programs has been “dramatically increasing.” However, an accompanying chart shows the rise was only 19% — from roughly 4,900 to 5,800 persons — during the 5-year span 2008 to 2012. It does not say what proportion was attributable to prescription opioid abuse/addiction, or whether this was actually a favorable trend suggesting that more persons with substance-use problems are seeking and getting much needed care. [The U.S. CDC had presented some time ago similarly puzzling data on treatment-program admissions, discussed in an UPDATE here.]

Saving money on federally-funded prescription plans may seem like a worthwhile goal, but we wonder if authorities have considered the unintended consequences — financial and otherwise — of leaving large populations adrift to suffer chronic pain. It seems rather cavalier to suggest that these patients should adopt more positive attitudes and participate in alternative therapies, like yoga, since such interventions only work if they can get out of bed and move nimbly about without adequate pain-relieving medication.

http://updates.pain-topics.org/2013/01/opiophobia-alive-well-in-oz.html

Deep Brain Stimulation Helps Neuropathic Pain

Today's post from newswise.com (see link below) talks about one of the latest stories concerning neuropathic pain treatment and that is deep brain stimulation. This is where a small electrode is inserted into the brain and activated to produce an electrical signal designed to interrupt abnormal activity. It's precisely this sort of research which gives us hope that it won't be too long before pain can be controlled without resorting to powerful drugs. However, it will probably never be cheap, or available to all, even if it is proved to be of benefit to all people living with chronic pain. That said, it looks as though it may well be an effective option for some patients and that must be a good thing.

For Some, Deep Brain Stimulation Brings Lasting Improvement in Neuropathic Pain
Released: 2/13/2013 10:00 AM EST
Source Newsroom: Wolters Kluwer Health: Lippincott Williams & Wilkins


Large Study Shows Continued Improvement with Longer Follow-up, Reports Neurosurgery

Newswise — Philadelphia, Pa. (February 13, 2013) – For many patients with difficult-to-treat neuropathic pain, deep brain stimulation (DBS) can lead to long-term improvement in pain scores and other outcomes, according to a study in the February issue of Neurosurgery, official journal of theCongress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

About two-thirds of eligible patients who undergo DBS achieve significant and lasting benefits in terms of pain, quality of life, and overall health, according to the report by Sandra G.J. Boccard, PhD, and colleagues of University of Oxford, led by Tipu Aziz FMedSci and Alex Green, MD. Some outcomes show continued improvement after the first year, according to the new report, which is one of the largest studies of DBS for neuropathic pain performed to date.

Most Patients Benefit from DBS for Neuropathic Pain
The authors reviewed their 12-year experience with DBS for neuropathic pain. Neuropathic pain is a common and difficult-to-treat type of pain caused by nerve damage, seen in patients with trauma, diabetes, and other conditions. Phantom limb pain after amputation is an example of neuropathic pain.

In DBS, a small electrode is surgically placed in a precise location in the brain. A mild electrical current is delivered to stimulate that area of the brain, with the goal of interrupting abnormal activity. Deep brain stimulation has become a standard and effective treatment for movement disorders such as Parkinson's disease. Although DBS has also been used to treat various types of chronic pain, its role in patients with neuropathic pain remains unclear.

Between 1999 and 2011, that authors' program evaluated 197 patients with chronic neuropathic pain for eligibility for DBS. Of these, 85 patients proceeded to DBS treatment. The remaining patients did not receive DBS—most commonly because they were unable to secure funding from the U.K. National Health Service or decided not to undergo electrode placement surgery.

The patients who underwent DBS were 60 men and 25 women, average age 52 years. Stroke was the most common cause of neuropathic pain, followed by head and face pain, spinal disease, amputation, and injury to nerves from the upper spinal cord (brachial plexus).

In 74 patients, a trial of DBS produced sufficient pain relief to proceed with implantation of an electrical pulse generator. Of 59 patients with sufficient follow-up data, 39 had significant improvement in their overall health status up to four years later. Thus, 66 percent of patients "gained benefit and efficacy" by undergoing DBS.

Benefits Vary by Cause; Some Outcomes Improve with Time
The benefits of DBS varied for patients with different causes of neuropathic pain. Treatment was beneficial for 89 percent for patients with amputation and 70 percent of those with stroke, compared to 50 percent of those with brachial plexus injury.

On average, scores on a 10-point pain scale (with 10 indicating the most severe pain) decreased from about 8 to 4 within the first three months, remaining about the same with longer follow-up. Continued follow-up in a small number of patients suggested further improvement in other outcomes, including quality-of-life scores.

Deep brain stimulation has long been regarded as potentially useful for patients with severe neuropathic pain that is not relieved by other treatments. However, because of the difficulties of performing studies of this highly specialized treatment, there has been relatively little research to confirm its benefits; only about 1,500 patients have been treated worldwide. The new study—accounting for about five percent of all reported patients—used up-to-date DBS technologies, imaging, and surgical techniques.

Dr. Boccard and coauthors acknowledge some important limitations of their study—especially the lack of complete patient follow-up. However, they believe their experience is sufficiently encouraging to warrant additional studies, especially with continued advances in stimulation approaches and technology. The researchers conclude, "Clinical trials retaining patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series."

About Neurosurgery
Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world's most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.
LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).


http://www.newswise.com/articles/for-some-deep-brain-stimulation-brings-lasting-improvement-in-neuropathic-pain?ret=/articles/list&category=medicine&page=1&search[status]=3&search[sort]=date+desc&search[section]=10&search[has_multimedia]=

Pelvic Pain Pregnancy

Back Pain During Pregnancy

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Back Pain During Pregnancy

Ectopic Pregnancy Symptoms

As your pregnancy progresses, you may develop aches and pains in your hips and pelvic area. This is a normal sign that your pelvic girdle is preparing for childbirth..Learn the causes and symptoms of pelvic pain during pregnancy and find out whether what you're feeling is normal or requires immediate attention from your doctor..You might be feeling pelvic pressure during pregnancy, especially during the ninth month and especially once lightening occurs when your baby drops into the pelvic .Consumer information about the symptoms and locations of pelvic pain, and the causes in women and men. Examples of causes of pelvic pain include ectopic pregnancy .Hey so this is my 4th pregnancy and I have never experienced this pain before. Is it SPD because dr's and midwives don't seem to be bothered and it's getting me down..Pelvic girdle pain PGP , which is also sometimes known as symphysis pubis dysfunction SPD , is a condition that causes discomfort or pain in the joints at the .Find out how to cope with pelvic pain in pregnancy, including the condition symphysis pubis dysfunction SPD , or pregnancy-related pelvic girdle pain PPGP .Pregnancy-related pelvic girdle pain abbreviated PGP causes pain, instability and limitation of mobility and functioning in any of the three pelvic joints..Pelvic pain and problems urinating may mean you have a bladder infection. Pain in the back just below the rib cage on one side of the body is called flank pain..Pelvic pain SPD Approved by the BabyCenter Australia Medical Advisory Board. Eberhard-Gran M. 2010. Pelvic girdle pain in pregnancy: the impact of parity..

Neuropathic Pain Whats Going On

Today's excellent post from painblogr.org (see link below) looks at the nature of pain and may well help you understand what's happening to you when you suffer from nerve pain. It's a confusing area (every neuropathy patient will testify to that) but this article explains the basics of pain in such a way that the reader can go:'ok, so that's what's happening inside my brain'. Believe me, every consultation with a doctor or specialist will be a lot clearer if you've already absorbed this basic information. Worth a read.

Explainer: what is pain and what is happening when we feel it?
Lorimer Moseley Posted on: November 19, 2015

“If someone has a pain in his hand […] one does not comfort the hand, but the sufferer.” – Philosopher Ludwig Wittgenstein, 1953

What is pain? It might seem like an easy question. The answer, however, depends on who you ask.

Some say pain is a warning signal that something is damaged, but what about pain-free major trauma? Some say pain is the body’s way of telling you something is wrong, but what about phantom limb pain, where the painful body part is not even there?

Pain scientists are reasonably agreed that pain is an unpleasant feeling in our body that makes us want to stop and change our behaviour. We no longer think of pain as a measure of tissue damage – it doesn’t actually work that way even in highly controlled experiments. We now think of pain as a complex and highly sophisticated protective mechanism.
How does pain work?

Our body contains specialised nerves that detect potentially dangerous changes in temperature, chemical balance or pressure. These “danger detectors” (or “nociceptors”) send alerts to the brain, but they cannot send pain to the brain because all pain is made by the brain.

When you’re injured, the brain makes an educated guess which part of the body is in danger and produces the pain there. Pain is not actually coming from the wrist you broke, or the ankle you sprained. Pain is the result of the brain evaluating information, including danger data from the danger detection system, cognitive data such as expectations, previous exposure, cultural and social norms and beliefs, and other sensory data such as what you see, hear and otherwise sense.

The brain produces pain. Where in the body the brain produces the pain is a “best guess scenario”, based on all the incoming data and stored information. Usually the brain gets it right, but sometimes it doesn’t. An example is referred pain in your leg when it is your back that might need the protecting.

It is pain that tells us not to do things – for example, not to lift with an injured hand, or not to walk with an injured foot. It is pain, too, that tells us to do things – see a physio, visit a GP, sit still and rest.

We now know that pain can be “turned on” or “turned up” by anything that provides the brain with credible evidence that the body is in danger and needs protecting.

All in your head?

So is pain all about the brain and not at all about the body? No, these “danger detectors” are distributed across almost all of our body tissues and act as the eyes of the brain.

When there is a sudden change in tissue environment – for example, it heats up, gets acidic (cyclists, imagine the lactic acid burn at the end of a sprint), is squashed, squeezed, pulled or pinched – these danger detectors are our first line of defence.

They alert the brain and mobilise inflammatory mechanisms that increase blood flow and cause the release of healing molecules from nearby tissue, thus triggering the repair process.

Local anaesthetic renders these danger detectors useless, so danger messages are not triggered. As such, we can be pain-free despite major tissue trauma, such as being cut into for an operation. Just because pain comes from the brain, it doesn’t mean it’s all in your head.

Inflammation, on the other hand, renders these danger detectors more sensitive, so they respond to situations that are not actually dangerous. For example, when you move an inflamed joint, it hurts a long way before the tissues of the joint are actually stressed.

Danger messages travel to the brain and are highly processed along the way, with the brain itself taking part in the processing. The danger transmission neurones that run up the spinal cord to the brain are under real-time control from the brain, increasing and decreasing their sensitivity according to what the brain suggests would be helpful.

So, if the brain’s evaluation of all available information leads it to conclude that things are truly dangerous, then the danger transmission system becomes more sensitive (called descending facilitation). If the brain concludes things are not truly dangerous, then the danger transmission system becomes less sensitive (called descending inhibition).

Danger evaluation in the brain is mindbogglingly complex. Many brain regions are involved, some more commonly that others, but the exact mix of brain regions varies between individuals and, in fact, between moments within individuals.

To understand how pain emerges into consciousness requires us to understand how consciousness itself emerges, and that is proving to be very tricky.

To understand how pain works in real-life people with real-life pain, we can apply a reasonably easy principle: any credible evidence that the body is in danger and protective behaviour would be helpful will increase the likelihood and intensity of pain. Any credible evidence that the body is safe will decrease the likelihood and intensity of pain. It is as simple and as difficult as that. 

Implications

To reduce pain, we need to reduce credible evidence of danger and increase credible evidence of safety. Danger detectors can be turned off by local anaesthetic, and we can also stimulate the body’s own danger-reduction pathways and mechanisms. This can be done by anything that is associated with safety – most obviously accurate understanding of how pain really works, exercise, active coping strategies, safe people and places.

A very effective way to reduce pain is to make something else seem more important to the brain – this is called distraction. Only being unconscious or dead provide greater pain relief than distraction.

In chronic pain the sensitivity of the hardware (the biological structures) increases so the relationship between pain and the true need for protection becomes distorted: we become over-protected by pain.

This is one significant reason there is no quick fix for nearly all persistent pains. Recovery requires a journey of patience, persistence, courage and good coaching. The best interventions focus on slowly training our body and brain to be less protective.

This article was originally published on The Conversation. Read the original article here.

The article is the first in our series on Pain. Further articles will explore who pain affects, how we describe and experience pain across cultures and genders, and the effect of chronic pain on the economy.

Lorimer Moseley, is Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South Australia

http://painblogr.org/explainer-what-is-pain-and-what-is-happening-when-we-feel-it

Tapentadol A New Alternative For Neuropathic Pain

Today's post comes from marketwatch.com (see link below) and is a press release for Tapentadol, a new centrally-acting opioid made by Janssen Pharmceuticals to control neuropathic pain. Far be it from me to promote either a company or an opioid but we're always looking for alternatives to the treatments that either don't work, or have unpleasant side effects. This is another opium derivative, so there will undoubtedly be issues regarding side effects and addiction for some people but the tests look promising. The post is long because Janssen have provided a complete description of how the drug works and what the potential side effects may be and that's worth reading. One assumes that this information will all appear on the leaflet inside the box when the drug achieves general release. Tapentadol will not be for everybody, as is the case for all similar treatments but it may be a breakthrough for some. Time will tell.
More information about Tapentadol can be found here (and is easier to digest),

Phase 3 Data Show NUCYNTA® ER (tapentadol) Extended-Release Tablets Provide Pain Management for Patients with Diabetic Peripheral Neuropathy (DPN)

Study results presented at the 31st Annual Scientific Meeting of the American Pain Society

press release May 17, 2012,

RARITAN, N.J., May 17, 2012 /PRNewswire via COMTEX/ -- Janssen Pharmaceuticals, Inc. today announced the results of an investigational Phase 3 study suggesting NUCYNTA® ER (tapentadol) extended-release tablets were significantly more effective than placebo in providing pain management among adults with chronic moderate to severe, painful diabetic peripheral neuropathy (DPN). Results of the study were presented at the 31st Annual Scientific Meeting of the American Pain Society being held May 16-19 in Honolulu, Hawaii.

Diabetes affects nearly 26 million people in the United States(1)- and its prevalence is expected to grow significantly during the coming decades(2). Over time, people with diabetes can develop a type of nerve damage called neuropathy. Approximately 60 to 70 percent of people with diabetes have some form of neuropathy(3). The most common type is diabetic peripheral neuropathy, which causes pain or loss of feeling in the toes, feet, legs, hands, and arms.

The study found, among patients who had at least a one-point reduction in pain intensity during three weeks of treatment with tapentadol ER, those who continued on an optimized dose of tapentadol ER (100-250 mg twice daily) for an additional 12 weeks experienced significantly better pain control compared to those who switched to placebo(4). Treatment-emergent adverse events reported in 10 percent or more of tapentadol ER-treated patients during the double-blind maintenance period included nausea (21.1 percent) and vomiting (12.7 percent)(4).

"Painful DPN is a common and burdensome complication of diabetes, and controlling pain in people with DPN can be challenging," said Aaron I. Vinik, M.D., Ph.D., FCP, MACP, Director of Research and Neuroendocrine Unit at Strelitz Diabetes Center for Endocrine and Metabolic Disorders at Eastern Virginia Medical School, and lead investigator of the study. "These data suggest tapentadol ER provides a significant reduction in chronic pain in adult patients with DPN."

The findings of this study are consistent with those of another Janssen-sponsored study published early last year, which found tapentadol ER to be effective versus placebo for relieving moderate to severe chronic pain associated with diabetic peripheral neuropathy.

"We are pleased the Phase 3 data presented today showed tapentadol ER was effective at providing pain management for patients with chronic, moderate to severe pain associated with DPN," said Christine Rauschkolb, M.D., Ph.D., Vice President and Head of Integrated Operations, Janssen Research & Development, LLC and one of the study's authors. "Janssen has a long history of helping physicians provide responsible treatment for patients to relieve their acute and chronic pain. We are committed to developing new pain management options for the millions of Americans who have painful DPN."

About the Study

This Phase 3 clinical trial was a randomized-withdrawal, placebo-controlled study. It enrolled adult patients who had moderate to severe, chronic painful DPN for six months or more and a history of analgesic use for painful DPN for three months or more. This trial had three phases: an open-label phase, which included a 3-week titration period during which the individually optimized tapentadol ER dose (100-250 mg two times per day) was determined for each patient; a 12-week, double-blind maintenance phase, during which patients with a one-point or greater reduction in pain intensity from beginning to end of titration were randomized either to continue taking tapentadol ER (at their optimal dose) or to receive placebo; and a follow-up period with a clinic visit at four days and a telephone interview at 10 to 14 days after discontinuation of study drug.

The primary efficacy endpoint of the study was the mean change in average pain intensity from baseline (point of randomization) to the last week of the 12-week, double-blind maintenance phase, as determined by an 11-point pain rating scale or numerical rating scale (NRS; 0='no pain,' 10='pain as bad as you can imagine'). Safety assessments were performed on the open-label and double-blind safety populations (all patients who received greater than or equal to 1 dose of open-label and double-blind treatment, respectively). Treatment-emergent adverse events (TEAEs), defined as any AEs (new or worse in intensity) that occurred after the first intake of study drug during the open-label or double-blind phase, were monitored throughout the study.

In the open-label titration period, 459 patients received one or more doses of tapentadol ER and were included in the open-label safety population. At the start of the 3-week, open-label phase, the majority of patients (87.1 percent) reported severe pain (6 or more on the 11-point NRS) with a mean pain intensity of 7.3. By the end of the open-label phase, the mean pain intensity was reduced to 3.6. Treatment-emergent adverse events (TEAEs) experienced by 10 percent or more of patients during the open-label phase were nausea (24.4 percent), dizziness (17), constipation (11.8) and somnolence (10.7).

A total of 358 patients completed the open-label titration period; 318 were randomized and received one or more dose of study medication (n=152 for placebo, 166 for tapentadol ER).

Following randomization, during the double-blind treatment phase to week 12, pain increased in the placebo group (as demonstrated by the mean change in pain intensity of 1.3), while in the tapentadol ER group, efficacy was maintained, as indicated by the mean change in pain intensity of 0.28. The least-squares mean difference between the tapentadol ER and placebo groups in the change in average pain intensity was -0.95 on the 11-point NRS favoring tapentadol ER (95 percent CI, -1.42 to -0.49; p<0.001, tapentadol ER vs. placebo)(4).

For more details about the study design, please visit www.clinicaltrials.gov (NCT01041859).

Janssen Research & Development, LLC and Grunenthal GmbH, conducted this study, which Janssen Research & Development, LLC has included as part of its Supplemental New Drug Application (sNDA) submitted on October 28, 2011 to the U.S. Food and Drug Administration (FDA) for tapentadol ER tablets for the management of neuropathic pain associated with DPN in patients 18 years of age or older. The FDA currently is reviewing this supplemental application.

About Tapentadol and NUCYNTA® ER

Tapentadol is a centrally-acting synthetic analgesic. The tapentadol molecule is classified as Schedule II of the Controlled Substances Act.

NUCYNTA® ER (tapentadol) extended-release tablets are an oral analgesic available by prescription only and indicated for the management of moderate to severe chronic pain in adults when a continuous, around-the-clock opioid analgesic is needed for an extended period of time. NUCYNTA® ER is taken twice daily and available in 50 mg, 100 mg, 150 mg, 200 mg and 250 mg strengths.

Outside the United States, tapentadol is marketed by Janssen Inc. in Canada; Grünenthal GmbH discovered tapentadol and markets immediate- and extended-release formulations of tapentadol (PALEXIA®) in various countries in Europe.

IMPORTANT SAFETY INFORMATION FOR NUCYNTA® ER (tapentadol) extended-release tablets

WARNING: POTENTIAL FOR ABUSE, PROPER PATIENT SELECTION, AND LIMITATIONS OF USE

Potential for Abuse

NUCYNTA® ER contains tapentadol, a mu-opioid agonist and a Schedule II controlled substance with an abuse liability similar to other opioid analgesics.

NUCYNTA® ER can be abused in a manner similar to other opioid agonists, legal or illicit. These risks should be considered when prescribing or dispensing NUCYNTA® ER in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse, or diversion. Schedule II opioid substances, which include hydromorphone, morphine, oxycodone, fentanyl, oxymorphone, and methadone, have the highest potential for abuse and risk of fatal overdose due to respiratory depression.

Proper Patient Selection

NUCYNTA® ER is an extended-release formulation of tapentadol indicated for the management of moderate to severe chronic pain in adults when a continuous, around-the-clock opioid analgesic is needed for an extended period of time.

Limitations of Use

NUCYNTA® ER is not intended for use as an as-needed analgesic.

NUCYNTA® ER is not intended for the management of acute or postoperative pain.

NUCYNTA® ER tablets are to be swallowed whole and are not to be split, broken, chewed, dissolved, or crushed. Taking split, broken, chewed, dissolved, or crushed NUCYNTA® ER tablets could lead to rapid release and absorption of a potentially fatal dose of tapentadol.

Patients must not consume alcoholic beverages, or prescription or nonprescription medications containing alcohol. Co-ingestion of alcohol with NUCYNTA® ER may result in a potentially fatal overdose of tapentadol.

CONTRADICTIONS

NUCYNTA® ER is contraindicated in patients with significant respiratory depression, acute or severe bronchial asthma or hypercapnia in unmonitored settings or in the absence of resuscitative equipment.

NUCYNTA® ER is contraindicated in any patient who has or is suspected of having a paralytic ileus.

NUCYNTA® ER is contraindicated in patients who are receiving monoamine oxidase inhibitors (MAOIs) or who have taken them within the last 14 days due to potential additive effects on norepinephrine levels, which may result in adverse cardiovascular events.

NUCYNTA® ER is contraindicated in patients with a known hypersensitivity to the active substance, tapentadol, or any component of the product. Angioedema has been reported in association with use of tapentadol.

WARNINGS & PRECAUTIONS

NUCYNTA® ER tablets are to be swallowed whole and are not to be split, broken, chewed, dissolved, or crushed. Taking split, broken, chewed, crushed, or dissolved NUCYNTA® ER tablets leads to the rapid release and absorption of a potentially fatal dose of tapentadol.

NUCYNTA® ER tablets must be kept in a secure place out of the reach of children. Accidental consumption of NUCYNTA® ER, especially in children, can result in a fatal overdose of tapentadol.

Respiratory depression is the primary risk of mu-opioid agonists. Respiratory depression occurs more frequently in elderly or debilitated patients and in those suffering from conditions accompanied by hypoxia, hypercapnia, or upper airway obstruction, in whom even moderate therapeutic doses may significantly decrease pulmonary ventilation.

Use NUCYNTA® ER with caution in patients with conditions accompanied by hypoxia, hypercapnia, or decreased respiratory reserve, such as: asthma, chronic obstructive pulmonary disease or cor pulmonale, severe obesity, sleep apnea syndrome, myxedema, kyphoscoliosis, central nervous system (CNS) depression, or coma. In such patients, even usual therapeutic doses of NUCYNTA® ER may increase airway resistance and decrease respiratory drive to the point of apnea. Alternative non-mu-opioid agonist analgesics should be considered, and NUCYNTA® ER should be employed only under careful medical supervision at the lowest effective dose in such patients. If respiratory depression occurs, it should be treated as any mu-opioid agonist-induced respiratory depression.

Patients receiving other opioid agonist analgesics, general anesthetics, phenothiazines, other tranquilizers, sedatives, hypnotics, centrally acting muscle relaxants, or other CNS depressants (including alcohol) concomitantly with NUCYNTA® ER may exhibit additive CNS depression. Interactive effects resulting in respiratory depression, hypotension, profound sedation, coma, or death may result if these drugs are taken in combination with NUCYNTA® ER. When such combined therapy is contemplated, a dose reduction of one or both agents should be considered.

Opioid analgesics can raise cerebrospinal fluid pressure as a result of respiratory depression with carbon dioxide retention. Therefore, NUCYNTA® ER should not be used in patients who may be susceptible to the effects of raised cerebrospinal fluid pressure, such as those with evidence of head injury and increased intracranial pressure. Opioid analgesics may obscure the clinical course of patients with head injury due to effects on pupillary response and consciousness. NUCYNTA® ER should be used with caution in patients with head injury, intracranial lesions, or other sources of preexisting increased intracranial pressure.

Tapentadol is a mu-opioid agonist and is a Schedule II controlled substance. Such drugs are sought by drug abusers and people with addiction disorders. Diversion of Schedule II products is an act subject to criminal penalty.

Patients should be assessed for their clinical risks for opioid abuse or addiction prior to being prescribed opioids.

NUCYNTA® ER can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing or dispensing NUCYNTA® ER in situations where the physician or pharmacist is concerned about an increased risk of misuse and abuse. Concerns about abuse and addiction should not prevent the proper management of pain. However, all patients treated with mu-opioid agonists require careful monitoring for signs of abuse and addiction, since use of mu-opioid agonist analgesic products carries the risk of addiction even under appropriate medical use.

Drug abusers may attempt to abuse NUCYNTA® ER by crushing, chewing, snorting, or injecting the product. These practices may result in the uncontrolled delivery of NUCYNTA® ER and pose a significant risk to the abuser that could result in overdose and death.

NUCYNTA® ER may cause severe hypotension. Patients at higher risk of hypotension include those with hypovolemia or those taking concurrent products that compromise vasomotor tone (eg, phenothiazines, general anesthetics).

Patients should be cautioned that NUCYNTA® ER may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery. This is to be expected, especially at the beginning of treatment, at any change of dosage, as well as in combination with alcohol or tranquilizers.

NUCYNTA® ER may be expected to have additive effects when used in conjunction with alcohol, other opioids, or illicit drugs that cause CNS depression, because respiratory depression, hypotension, hypertension, and profound sedation, coma, or death may result.

NUCYNTA® ER has not been evaluated in patients with a predisposition to a seizure disorder, and such patients were excluded from clinical studies. As with other opioids, NUCYNTA® ER should be prescribed with care in patients with a history of a seizure disorder or any condition that would put the patient at risk of seizures.

Cases of life-threatening serotonin syndrome have been reported with the concurrent use of tapentadol and serotonergic drugs. Serotonergic drugs comprise selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, drugs that affect the serotonergic neurotransmitter system (eg, mirtazapine, trazodone, and tramadol), and drugs that impair metabolism of serotonin (including MAOIs). This may occur within the recommended dose. Serotonin syndrome may include mental-status changes (eg, agitation, hallucinations, coma), autonomic instability (eg, tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (eg, hyperreflexia, incoordination) and/or gastrointestinal symptoms (eg, nausea, vomiting, diarrhea), and can be fatal.

Withdrawal symptoms may occur if NUCYNTA® ER is discontinued abruptly. These symptoms may include: anxiety, sweating, insomnia, rigors, pain, nausea, tremors, diarrhea, upper respiratory symptoms, piloerection, and rarely, hallucinations. Withdrawal symptoms may be reduced by tapering NUCYNTA® ER.

A study with the immediate-release formulation of tapentadol in subjects with hepatic impairment showed higher serum concentrations of tapentadol than in those with normal hepatic function. Tapentadol should be used with caution in patients with moderate hepatic impairment.

NUCYNTA® ER has not been studied in patients with severe hepatic impairment, and use in this population is not recommended.

Like other drugs with mu-opioid agonist activity, NUCYNTA® ER may cause spasm of the sphincter of Oddi and should be used with caution in patients with biliary tract disease, including acute pancreatitis.

NUCYNTA® ER should be used with caution in the following conditions: adrenocortical insufficiency (eg, Addison's disease); delirium tremens; myxedema or hypothyroidism; prostatic hypertrophy or urethral stricture; and toxic psychosis.

Pregnancy Category C. There are no adequate and well-controlled studies of NUCYNTA® ER in pregnant women. NUCYNTA® ER should be used during pregnancy ONLY if the potential benefit justifies the potential risk to the fetus.

ADVERSE REACTIONS

The most common (greater than equal to 10%) adverse reactions were nausea, constipation, headache, dizziness, and somnolence.

About Janssen Pharmaceuticals, Inc. and Janssen Research and Development, LLC

At Janssen, we are dedicated to addressing and solving some of the most important unmet medical needs of our time in oncology, immunology, neuroscience, infectious diseases and vaccines, and cardiovascular and metabolic diseases. Driven by our commitment to patients, we develop and bring innovative products, services and solutions to people throughout the world.

Janssen Pharmaceuticals, Inc., and Janssen Research & Development, LLC are part of the Janssen Pharmaceutical Companies.

Janssen Pharmaceuticals, Inc. provides medicines for an array of health concerns in several therapeutic areas. Innovative therapies Janssen Pharmaceuticals, Inc. offers currently include ACIPHEX® (rabeprazole sodium), DORIBAX® (doripenem for injection), ELMIRON® (pentosan polysulfate sodium), NUCYNTA® (tapentadol), NUCYNTA® ER (tapentadol) extended-release tablets and XARELTO® (rivaroxaban) tablets. The full prescribing information for NUCYNTA® ER, including boxed warnings, is available here; the full prescribing information for XARELTO®, including boxed warnings, is available here.

For more information on Janssen Pharmaceuticals, Inc., visit us at www.janssenpharmaceuticalsinc.com or follow us on Twitter at www.twitter.com/JanssenUS .

For more information on Janssen Research & Development, LLC, visit us at http://www.janssenrnd.com/ .

http://www.marketwatch.com/story/phase-3-data-show-nucynta-er-tapentadol-extended-release-tablets-provide-pain-management-for-patients-with-diabetic-peripheral-neuropathy-dpn-2012-05-17

A New Alternative To Opiates For Nerve Pain

Today's post from consultqd.clevelandclinic.org (see link below) talks about a new advance in stem cell therapy concerning mesenchymal stem cells (MSC). These have been shown to reduce nerve pain and if they are injected directly into the vein, they have also been shown to reduce the side effects and addictiveness of opioids. Of course it's not as simple as this but these wonder cells apparently also can travel to the site of nerve injury and repair nerve cells on the spot. It may all seem a bit sci-fi and magical but it is true and reveals the huge potential of stem-cell therapy for all sorts of medical issues in the future. The fact that mesenchymal stem cells (MSC) directly apply to neuropathy problems makes it an exciting development for nerve pain patients across the world. Now we have to find the money in state budgets to develop the science and insurance companies who will pay for the treatment - don't hold your breath.

 Stem Cell Therapy for Neuropathic Pain: New Findings Show Promise
Animal studies demonstrate effectiveness

Aug. 10, 2016 / Pain Management / Research

Stem cell research at Cleveland Clinic could pave the way for an entirely new approach to chronic pain treatment that reduces medicine’s current reliance on opioid therapy for intractable pain. The modality also shows promise as a tool to reverse opioid tolerance (OT) and opioid-induced hyperalgesia (OIH), particularly problematic side effects of opioid therapy. Jianguo Cheng, MD, PhD, and his colleagues at Cleveland Clinic have developed patented methods of attenuating opioid tolerance.

Animal studies by Dr. Cheng and his colleagues have demonstrated the effectiveness of mesenchymal stem cell (MSC) transplantation in reducing hyperalgesia due to nerve injury. The group’s work has shown MSC transplantation’s effectiveness in reducing pain induced by sciatic nerve injury in rats and mice. MSC transplantation significantly reduced pain sensitivity evaluated by foot withdrawal thresholds in animals in response to thermal or mechanical stimulation. These cells produced immune modulatory and anti-inflammatory effects, promoted sensory nerve repair, and showed strong analgesic properties that could provide a safer and more effective alternative to current treatment modalities, in the management of neuropathic pain, says Dr. Cheng, Professor of Anesthesiology and Director of the Cleveland Clinic Multidisciplinary Pain Medicine Fellowship Program.

Pain medicine researchers are searching for an alternative to opioid therapy because neuropathic pain often does not respond to morphine and other opioids. Opioid analgesics can also lead to a variety of complications, ranging from itching and constipation to dependence, addiction, respiratory depression and death.

About 30 percent of neuropathy cases are caused by nerve damage associated with diabetes. However, hundreds of diseases are linked to neuropathic pain. Sources of neuropathic pain include alcoholism, amputation (which can result in phantom pain), some chemotherapy drugs (for example, Cisplatin®, Paclitaxel®, Vincristine®), radiation therapy, complex regional pain syndrome type II, trigeminal neuralgia, shingles, spinal stenosis, and central nervous system disorders, such as Parkinson disease and multiple sclerosis.

Recent research by Dr. Cheng and his group has yielded new discoveries that bode well for MSC transplantation as a potential future treatment modality. One investigation compared the analgesic effects of MSC derived from bone marrow with MSC derived from adipose tissue. Adipose-derived cells were found to be as efficacious as bone marrow-derived cells in reducing neuropathic pain in rats. The finding suggests that stem cell therapy could offer a practical option because stem cells from adipose tissue are relatively easy to obtain.

Recent investigations by Dr. Cheng and his colleagues comparing the analgesic effectiveness of intrathecal versus intravenous methods of MSC transplantation show both methods to be equally effective. The finding has important implications because intravenous transplantation of MSC could offer a safer and more expeditious route of delivery than intrathecal transplantation.

“We originally thought that stem cells would have to be introduced intrathecally in order to reduce pain, and that stem cells introduced intravenously would pass through the lungs and fail to produce analgesia,” says Dr. Cheng. “The finding that intravenous transplantation is as effective as intrathecal transplantation is encouraging.”

Dr. Cheng’s group has also discovered that MSCs can be found in the area surrounding the injured nerve following MSC transplantation. “For reasons we do not yet fully understand, these cells have the ability to migrate to the injury site to promote repair of the injured nerve fibers,” Dr. Cheng says. “The cells can sense the injury’s location and travel to it.”

Although many questions must be answered before it can be known whether stem cell therapy is safe and effective for humans, some small patient studies show potential, Dr. Cheng says. According to one observational study in Australia, MSC transplantation reduced pain in patients suffering from trigeminal neuralgia, a particularly difficult condition to treat. “Though the findings are preliminary, the study provides some evidence that what we have learned in the laboratory can be translated to clinical use,” Dr. Cheng says.

Dr. Cheng’s team has achieved analgesia with MSC transplantation from rats to mice, providing early evidence that stem cells’ anti-inflammatory and immuno-modulatory properties can be transferred between species. An important pre-clinical study will be to see whether the transplantation of human stem cells to animals also can produce analgesic and anti-tolerance effects, Dr. Cheng says.

Dr. Cheng’s team presented research at the 2016 annual meeting of the American Academy of Pain Medicine showing MSC’s potential to reverse opioid tolerance and opioid-induced hyperalgesia, problems that can compromise the safety and efficacy of opioid therapy. Intravenous transplantation of bone marrow-derived MSC significantly attenuated OT and OIH in animals whether the transplantation was performed seven days before or 14 days after the initiation of daily morphine injections. These data demonstrate that MSC transplantation can not only prevent the development of OT and OIH but can also reverse it.

https://consultqd.clevelandclinic.org/2016/08/stem-cell-therapy-neuropathic-pain-new-findings-show-promise/

Coping With Chronic Neuropathy Pain

Today's post from fibrotv.com (see link below) is another self-help post which although it applies to life in general when you're in pain, is especially applicable at this time of year, when you're workload suddenly seems to double. It's full of useful tips to help you find a balance when the pain is bad and the pressure to act in a certain way means you can't just take to your bed. You may cringe at internet 'nannies' telling you how to behave but sometimes you're just not aware of how the pressure is building up and it's only when your body screams 'enough already!' that you realise you need to take a step back. This article may help you prepare a little better.

When The Mind Says Yes But The Body Says No
Posted on October 28, 2014 237 by Jen Reynolds Posted in FibroTV Blog

Many times when you are chronically ill there are things you want to do but because of symptoms they can be difficult. This is more so for people that have suddenly became ill and had full and busy lives before they became sick. The sudden reduction in physical activity can leave someone with a chronic illness to have feelings of guilt and feeling as if they are a burden to others. Also, many people with chronic illnesses have a people pleasing trait and have a hard time saying “No” which can sometimes leave the person with the illness physically and emotionally drained. So what do you do when the mind says yes but the body says no? Here are some tips!

Don’t Judge Yourself

When you have to cancel plans, rearrange appointments, or just flat out say no to an obligation because of illness the last thing you want to do is be self critical or judge yourself. Don’t let people make you feel guilty! You know your body and if you can’t do something it is because you can’t do it at the time. Be kind to yourself and gentle with your choices that are best for your health. There are enough people that will try to make you feel bad and/or guilty for not being there. You do not have to make that any worse by making yourself feel bad.

Evaluate What You CAN Do



If a person focuses on what they can do instead of what they can not do, the world opens up to many astonishing opportunities. This positive outlook reveals it self in the form of more energy, increased creativeness and a stronger sense of competence. Focusing on what you can do instead of focusing on what you can not do will make all the difference in the world! On the other hand, when you focus on your weak points and disappointments, the world becomes terrible place of “whoa” and anguish. You may start to believe that you cannot accomplish anything so you stop trying, which may cause mental distress. These anxious thoughts fill one’s day with trepidation and drudgery, and may weigh a person down with a sense of bleakness.

To modify your self-talk or attitude you must change that inner conversation or dialogue you are having. To stop it you must catch it in action. So, pay attention to yourself. You must connect to and listen for that inner voice whenever possible. What do you tell yourself all day long?

For those with children there are obviously certain things you must do for them as you are personally responsible for your kids and you can’t just say no about things like taking them to school, the doctors, Etc etc etc. I think it is important to be open and honest with your children and let them know when you are having a rough day. They know anyways! They pick up on your energy so being up front and telling them that “Today I might not be able do everything I like with you but I will try my best to do all I can for you.” can really help them to be more prepared and understand that you have limits that day. Your kids being told up front helps them be prepared if you do have to say no to something later in the day. If your children are older make sure they help out around the house when you are not feeling well. Most kids like to help out and don’t feel as helpless in the situation of a parent being ill if you give them a few things to do (even when they give you an attitude about it). Let’s face it!! You are not a super parent anymore and that is okay! Don’t try to be. That is a lot of pressure and can be unachievable even for a healthy person!

Make Large Meals With Leftovers For Those Days You Can’t Cook

We all have to eat and we normally eat unhealthy when we are not feeling well. We turn to fast food or heavily processed food because it is cheap, easy and fast! This is where larger meals when you are having a good day and feeling up to cooking come in handy. Just put the left overs in the freezer for a night you are not feeling up to cooking and reheat. Also crock pots are awesome! Toss in the one pot meal and it slow cooks all day and you have a very healthy and homemade meal that taste like you slaved in the kitchen for hours!

Take cat naps or/and mediate during the day

We all know stress and not enough sleep makes our symptoms worse so including short naps during the early afternoon (Be careful not to take naps too late or you will be up all night!) and taking time out to meditate will reduce your stress and pain.

Don’t know how to meditate? Try free guided meditation videos on Youtube! Not all meditations are the same and you have to find ones the resonate with you and relaxes you so browse a few! There are even meditations for every belief system and religion!

Weather permitting get outside AT LEAST once a day

Even if it is just sitting in the backyard or front porch, getting outside is good for your overall health!

Here are five good reasons to get outdoors:

Your vitamin D levels rise. Sunlight hitting the skin begins a process that leads to the creation and activation of vitamin D. Studies suggest that this vitamin helps fight certain conditions, from osteoporosis and cancer to depression and heart attacks. Limited sun exposure (don’t overdo it), supplemented with vitamin D pills if necessary, is a good regimen.

You’ll get more exercise. If you make getting outside a goal, that should mean less time in front of the television and computer and more time walking and doing other things that put the body in motion.

You’ll be happier. Light tends to elevate people’s mood, and there’s usually more light available outside than in. Physical activity has been shown to help people relax and cheer up, so if being outside replaces inactive pursuits with active ones, it might also mean more smiles.

Your concentration will improve. Children with ADHD seem to focus better after being outdoors. It might be a stretch to say that applies to adults, but if you have trouble concentrating, outdoor activity may help.

You may heal faster. In one study, people recovering from spinal surgery experienced less pain and stress and took fewer pain medications when they were exposed to natural light. An older study showed that the view out the window (trees vs. a brick wall) helped recovery in the hospital.

Find something creative to do if you are bedridden for the day

Nothing is worse for your mind/body/spirit than laying around thinking about all the pain you are in. What you think about expands. It is the natural law of attraction. Finding an activity that will make you feel like you have been productive even if you are not able to get out of bed can make a huge difference emotionally. Remember our mind and body are connected so when you are not doing well emotionally it will cause more physical symptoms! Many people have found new and exciting talents through chronic illness and downtime due to injury. What excites you? Is there something you always wanted to do creatively or to help others but you never had the time to do it before? Maybe learn how to knit or scrapbook? How about writing letters to those soldiers that are serving in another country or have been injured? Sit down and write down what you would like to try and maybe you will find a new passion and a new purpose!

http://fibrotv.com/2014/10/when-the-mind-says-yes-but-the-body-says-no/

How The Brain Processes Chronic Pain

Today's post from sciencedaily.com (see link below) is a fascinating look at how the brain processes pain signals. It looks at which signals the nerve cells use to respond to a pain stimulus. Slowly but surely, scientists are building up a map of how nerve cells behave in the brain. It's been a largely unexplored area due to the complexity of brain cells but the more is discovered, the better people with chronic pain will be able to be treated in the future.
 

Brain processes ongoing pain more emotionally
Date: March 11, 2015 Source: Technische Universitaet Muenchen
 
Summary:

A momentary lapse of concentration is all it takes for a finger to become trapped or sprain an ankle -- and it hurts. Pain is the body's protective mechanism and a complex neurological phenomenon. Moreover, ongoing pain in the sense of chronic pain can be a disease, clinicians say. Scientists have now demonstrated that already during a few minutes of ongoing pain, the underlying brain activity changes by shifting from sensory to emotional processes.




The picture shows the EEG results during a short (left) and a long-lasting pain stimulus (right). The brain areas with the strongest activity are depicted in red. Short pain stimuli are processed in sensory brain areas, whereas ongoing pain is processed in frontal brain areas which are related to emotional processes.
Credit: E. Schulz et al., 2015, Prefrontal gamma oscillations encode tonic pain in humans, Cerebral Cortex

In their experiments, Prof. Markus Ploner, Heisenberg Professor for Human Pain Research at the TUM School of Medicine, and his team investigated pain perception: How does the duration of pain or the action of a placebo affect activities in the brain? For their measurements they used electroencephalograms (EEGs). The test subject wore a cap with 64 electrodes that can measure nerve cell activity in the brain throughout the experiment. This method makes it possible to chronologically pinpoint which signals nerve cells use to respond to a pain stimulus.

Pain influences emotion

The scientists used the following arrangement for their experiments: Over a period of ten minutes, 41 participants in the study were given painful heat stimuli to the hand which varied in intensity throughout the duration of the experiment. The participants were asked to continuously assess the level of their pain on a scale of one to a hundred with the other hand using a slider.

"We were absolutely amazed by the results: After just a few minutes, the subjective perception of pain changed -- for example, the subjects felt changes in pain when the objective stimulus remained unchanged. The sensation of pain became detached from the objective stimulus after just a few minutes," says Markus Ploner, describing the results.

Previous studies showed that brief pain stimuli are predominantly processed by sensory areas of the brain that process the signals from the sensory organs such as the skin. However, in their experiment with longer-lasting ongoing pain, the EEGs gave the scientists a different picture: in this case, emotional areas of the brain became active.

"If pain persists over a prolonged period of time, the associated brain activity shows that it changes from a pure perception process to a more emotional process. This realization is extremely interesting for the diagnosis and treatment of chronic pain where pain persists for months and years," explains Markus Ploner, who is also senior physician in the Department of Neurology at the TUM Klinikum rechts der Isar.

Placebos change the perception of pain

A second experiment showed that it is not just the duration, but also the anticipation of a pain stimulus that affects perception. Twenty test subjects were initially given different intensities of painful laser pulses on two areas of the back of the hand. The participants then rated verbally how strong they perceived the pain stimuli. As the experiments progressed, the subjects were once again given the same stimuli, the difference this time being that two creams had previously been applied to both areas. Although neither cream contained an active substance, the subjects were told that one of the creams had a pain-relieving effect.

The result according to Markus Ploner: "The subjects assessed the pain on the skin area with the allegedly pain-relieving cream as significantly lower than on the other area of skin." The scientists were further able to demonstrate how the brain implements this placebo effect: although the subjects were given the same pain stimuli, the nerve cells in the second run triggered a different pattern of brain activity.

"Our results show how differently our brain processes the same pain stimuli. Systematically mapping and better understanding this complex neurological phenomenon of 'pain' in the brain is a big challenge, but is absolutely essential for improving therapeutic options for pain patients," in Ploner's opinion.

Story Source:

The above story is based on materials provided by Technische Universitaet Muenchen. Note: Materials may be edited for content and length.

Journal References:
E. Schulz, E. S. May, M. Postorino, L. Tiemann, M. M. Nickel, V. Witkovsky, P. Schmidt, J. Gross, M. Ploner. Prefrontal Gamma Oscillations Encode Tonic Pain in Humans. Cerebral Cortex, 2015; DOI: 10.1093/cercor/bhv043
Laura Tiemann, Elisabeth S. May, Martina Postorino, Enrico Schulz, Moritz M. Nickel, Ulrike Bingel, Markus Ploner. Differential neurophysiological correlates of bottom-up and top-down modulations of pain. PAIN, 2015; 156 (2): 289 DOI: 10.1097/01.j.pain.0000460309.94442.44

http://www.sciencedaily.com/releases/2015/03/150311124530.htm