Andre Machado, MD, chairman of the Neurological Institute at Cleveland Clinic, thinks opioids are remarkable.
“But ‘remarkable’ can have 2 meanings,” he says. “It can be a positive remarkable, or a negative remarkable. And the long-term use of opioids, when we use it chronically, is often remarkable in the wrong direction.”
Now available from APTA’s Move Forward Radio: a conversation with Machado, who is leading an innovative pain treatment research project that puts a combination of physical therapy and behavioral therapy at the front lines of pain treatment, and takes a cautious approach to the use of opioids. Machado shared his thoughts on opioids and the need for a cultural shift on attitudes about pain in a recent TIME magazine opinion piece. His Move Forward Radio interview delves even deeper into his beliefs on what constitutes truly effective pain treatment.
Experts from 12 European countries now unanimously recommend supervised exercise as a primary intervention for individuals with fibromyalgia. According to an updated clinical practice guideline (CPG) by the European League Against Rheumatism (EULAR) published in BMJ, physical therapy with graded exercise is the only intervention that received the group’s strongest recommendation.
The previous EULAR guideline found very few studies on pharmacologic or nonpharmacologic treatments for fibromyalgia, but that has changed. The current CPG is based on an analysis of 275 published articles and 107 systematic reviews. Authors looked at how well interventions addresseed, pain, fatigue, sleep, and daily functioning, and assigned levels of support for each intervention: “strong against,” “weak against,” “weak for,” and “strong for.”
We now know that there’s much more to pain than simply what is happening in the painful body part, and attention has turned to the role of the brain. But not even this mysterious organ can tell us everything we need to know about pain, at least not yet.
You may wonder why the brain is part of the discussion about pain at all. After all, we’re not talking about a brain disease such as Alzheimer’s or stroke.
When people experience pain in the forearm, inside or outside of the elbow while gripping, lifting or holding objects, they most commonly are suffering from “tennis or golfer’s” elbow.
Tennis elbow, also called lateral epicondylitis, refers to pain at the outside of the elbow and the group of muscles on the top of your forearm closest to your elbow. Golfer’s elbow, also called medial epicondylitis, refers to pain at the inside of the elbow and the group of muscles on the inside of your forearm closest to your elbow.
Tennis or golfer’s elbow are both due to irritation and inflammation of the tendons — part of the muscle that connects it to the bone — and muscle belly as they attach to the bones that make up the inside and outside of your elbow.
Both conditions are most commonly caused by repetitive motions, such as gripping tools, bricks or objects, typing or starting a weight-lifting routine too rapidly. Such motions in the same direction on a regular basis lead to muscle imbalances.
Maybe it’s not only teachers who get a headache from their students’ lip smacking, bubble popping and gum cracking.
Dr. Nathan Watemberg of Meir Medical Center in Kfar Saba, Israel, has evidence that gum-chewing teenagers, and younger children as well, may be giving themselves a pain in the head. His small study focused on child and adolescent gum-chewers suffering from migraines and other chronic headaches.
“Out of our 30 patients, 26 reported significant improvement, and 19 had complete headache resolution,” said Watemberg. “Twenty of the improved patients later agreed to go back to chewing gum, and all of them reported an immediate relapse of symptoms.”
He is hoping that his findings, to be published in Pediatric Neurology, could offer a simple way to treat migraine and tension headaches in gum-chewers without the need for additional testing or medication.
What’s the thing you do best? Our biggest strengths can contribute significantly to our happiness, success and well-being — and to those of the people around us.
According to newly-released Gallup data, using one’s best talents can also play a role in one’s comfort. In more than 120,000 interviews conducted during the latter half of 2012, Gallup found that the more people use their strengths throughout the day, the less likely they are to say they feel physical pain.
Despite existing health problems, 50 percent of people who do what they do best for at least 10 hours a day said they experience pain, while 69 percent of people who use their top strengths for three hours a day or less said they experience pain, according to the new report. The relationship also exists among people without any ongoing health issues, albeit more weakly: 13 percent of people who use their strengths for 10 or more hours a day reported physical pain, while 17 percent of people who use their strengths for three hours or fewer did.
Whether the people using their strengths all day long are simply more positive people or just more distracted is still to be determined, according to Gallup. But it’s certainly something to consider when reaching into the toolbox of pain management techniques. In addition to playing to your strengths, here are 10 more all-natural, little-known ways to make yourself more comfortable, fast.
As if the havoc rain wreaks on my hair weren’t sufficient… how many times can I suffer actual physical pain — in the form of a throbbing, debilitating headache — during a thunderstorm before I can officially blame the weather for it?
Considering that more than 30 million people in the U.S. suffer from excruciating migraines, verifying the possible link between seasonality and headaches is no joke (especially since I’ve already cut out other well-known triggers, such as red wine and chocolate — to no avail).
I asked pain management experts to weigh in on this connection: Do weather changes spur on my migraines, or is this rumor full of hot air?
The verdict: Weather definitely causes some headaches
If you suffer from headaches, then warm weather, drastic temperature changes, low barometric pressure and even lightning bolts are not your friends. Scientists are still trying to figure out the precise mechanism behind weather-induced migraines, but the link is genuin
Too much pain medication may have been part of the problem for teens reporting chronic headache months after suffering concussions, researchers reported here.
Nearly half of adolescents with post-concussion headaches lasting 3-12 months showed either complete resolution of symptoms or a reduction to pre-concussion levels after discontinuing their analgesics, according to Geoffrey Heyer, MD, and Syed Idris, MD, both of Nationwide Children’s Hospital in Columbus, Ohio.
The findings emerged from a retrospective chart review of 104 consecutive adolescent patients treated at Nationwide Children’s for concussion. Of these, 77 reported chronic headache after the injury, and 54 of this group were deemed to have “probable” medication overuse headache.
Under the ICHD, medication overuse headache may be diagnosed in patients with frequent headaches (at least 15 days per month) that either developed or worsened while using headache medications such as over-the-counter or prescription analgesics. The diagnosis is considered “probable” if either such medications have not yet been withdrawn or if the headaches continued for up to 2 months after medications were stopped.
According to some studies, more than 100 million people in North America live with—or perhaps more accurately, don’t find it easy to live with—days and nights filled with chronic pain. They know that persistent pain does more than make one achy and perhaps a bit cranky. Chronic pain has been associated with a significant increase in the rate of depression and anxiety. Most of those who have to endure chronic pain may also have problems with attention, memory, high blood pressure and related heart problems, along with sleep issues. Common causes of pain include degenerative spine disease, lower back pain, rheumatoid arthritis, osteoarthritis, fibromyalgia, HIV, migraine, neuropathy and complications of shingles.
This population includes approximately five million people with Type 2 diabetes who experience chronic pain, a condition called painful diabetic neuropathy (PDN). It is estimated that about half of them suffer pain that keeps them from getting to sleep, or when they do, staying asleep.
Neuropathy in Type 2 diabetes can frustrate both patients and their doctors and other health providers. Although there is a range of treatments, including pharmaceutical painkillers, antidepressants, anticonvulsants, steroid and cortisone injections, analgesic patches, vitamin B shots and hot/cold packs, relief is often elusive or sporadic. People with chronic pain may need a deep, restorative night’s rest to fully function.
It feels like “somebody stabbing me through the eyeball with a knife,” “pencils stabbing my ears,” or “explosions going off in my head.” These are some of the ways that Dr. Audrey Halpern’s patients have described the vascular headaches known as migraines. The pain is so severe that it can “cause disability,” said Dr. Halpern, a clinical assistant professor of neurology and migraine expert at NYU Langone Medical Center. “Even if you can make it to work or a social event with a migraine, most of the time you’re not going to be functioning at full capacity.”
The National Headache Foundation (NHF) estimates that more than 37 million Americans suffer from migraines. Women are three times more likely than men to have migraines, which usually strike people between the ages of 15 and 55. While research continues to shed new light on what causes migraines and what they do to the brain, many people don’t understand how debilitating a migraine can be or what makes it different from a bad headache.
According to the NHF, a migraine is generally diagnosed after a patient has had at least five previous headaches that lasted between four and 72 hours. Migraine-related pain is usually felt on one side of the head, and it can be accompanied by nausea and sensitivity to light (photophobia) or sound (phonophobia).
A number of things can trigger migraines including lack of sleep, sunlight, certain foods, hormone levels, noises, staring at a screen, and stress. Brain cells set off the release of chemicals that cause blood vessels around the brain to swell and transmit pain signals.