The human body is a marvelous adaptive organism. Our brains are designed to learn from our environment and adapt. For the most part this is a good thing. Sometimes however, it leads to some very serious pain management situations. We know that pain is a signal that tells us there is damage or something wrong with our system. However, with some chronic pain conditions the system (including the brain) gets altered. The pain system gets turned on and cannot be turned off. I call this the “hijacked” brain or what is often referred to as Neuroplasticity (also called brain plasticity, cortical plasticity or cortical re-mapping).

Pain research presented by the American Society of Anesthesiologists has emphasized the molecular transduction of painful stimuli, the sensitization processes that occur after injury and long-term phenomena such as pain memory. Neuroplasticity after surgery occurs at the transduction process, in the central nervous system, where central sensitization occurs.

According to research published in Annals of the New York Academy of Sciences 933:175-184 (2001) titled “Spinal Cord Neuroplasticity following Repeated Opioid Exposure and Its Relation to Pathological Pain;” convincing evidence has accumulated that indicates there are neuroplastic changes within the spinal cord in response to repeated exposure to opioids. Such neuroplastic changes occur at both cellular and intracellular levels. Since so many people living with chronic pain are using opiates these neuroplastic changes need to be better understood and taken into account when treating a problematic chronic pain condition.

To learn more about the role of neuroplasticity in chronic pain management please check out my article Chronic Pain and the Hijacked Brain that you can download for free on our Ariticles page.

If you would like to be skill trained in a collaborative model that also addresses nueroplasticity we have two Addiction-Free Pain Management® Certification Trainings scheduled this Spring—one in Sacramento California on May 18-19 that we are sponsoring and the one at Valley Forge Medical Center and Hospital on June 10-12. It’s not to late for people to sign up and in fact by mentioning this Blog I will make sure you get a $20 discount for either training. To get this discount you must call Ellen at (916) 575-9961 and ask her for the discount. For other upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people udergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders including addiction effectively please go to our Publications page and check out my book the Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

One of the more challenging types of chronic pain involves neuropathic (burning, tingling, shooting, etc, nerve pain) symptoms that opiates do NOT adequately address. A report came out in October 2007 published by Science Daily that discussed why painkillers don’t work for neuropathic pain from fibromyalgia and states in part: “When the painkillers cannot bind to the receptors, they cannot alleviate the patient’s pain as effectively, Harris says. The reduced availability of the receptors could result from a reduced number of opioid receptors, enhanced release of endogenous opioids (opioids, such as endorphins, that are produced naturally by the body), or both, Harris says.” To read the complete report, please Click Here.

Neuropathic pain is frequent for diabetics, fibromyalgia, and shingles. Many pain management providers have tried alternative (“off-label”) medications such as Neurontin (Gabapentin) with varying degrees of success. Unfortunately, this medication sometimes causes significant side effects for many people. Fortunately, there are other medication choices such as pregabalin (Lyrica).

For example, the report presented at the American Society of Anesthesiologists (ASA) 2008 Annual Meeting regarding the Perioperative (the time period surrounding a patient’s surgical procedure; this commonly includes ward admission, anesthesia, surgery, and recovery) administration of pregabalin significantly decreases the incidence of neuropathic pain at 3 and 6 months after total knee arthroplasty (TKA), according to research. The report concluded that this procedure significantly reduced the patients’ pain. To see the entire report please Click Here.

In June of 2008 the Food and Drug Administration (FDA) approved duloxetine HCl delayed-release capsules (Cymbalta) for the management of fibromyalgia. Previously, only pregabalin (Lyrica; Pfizer, Inc) was approved to treat this painful condition. Some see this as a major victory in validating fibromyalgia as a legitimate diagnosis while others see this as a greed-driven pharmaceutical ploy. Having worked with many patients who were diagnosed and living with the pain and problems of fibromyalgia I am firmly in the first camp.

To read more about this topic please go to our 2008 Research Archive and scroll down to the Cymbalta posting. Also, near the end of the page is a posting titled Neuropathic Pain Management.

If you would like to be skill trained in a collaborative treatment smodel we have two Addiction-Free Pain Management®Trainings scheduled this Spring — one in Sacramento California in May and the one at Valley Forge Medical Center and Hospital in June. It’s not to late for people to sign up and in fact by mentioning this Blog I will make sure you get a $20 discount for either training. To get this discount you must call Ellen at (916) 575-9961 and ask her for the discount. Also, for these and other upcoming trainings you can check out our Calendar page.

For many years I’ve been proposing collaboration not competition through the use of a multidisciplinary team approach when working with people living with chronic pain and coexisting disorders including addiction. I believe it is imperative for pain management physicians to work hand-in-hand with other healthcare disciplines in order to provide the best treatment outcomes for this population.

I also believe that we need to work with the whole person, which means treatment plans for the biological, psychological, social, and spiritual domains.  This can best be accomplished by using a truly integrated multidisciplinary treatment team with the patient being the Captain of the team.  We need to work with patients—not on them.

That is why one of my research postings this month discusses a research article from the Journal of the American Medical Association that validates my belief that you can read by Clicking Here and scrolling down to that posting. 

To learn more about my views on collaboration for effective chronic pain management and coexisting disorders including addiction please check out my article Collaboration NOT Competition for Effective Chronic Pain Management that you can download for free on our Ariticles page.

If you would like to be skill trained in a collaborative model we have two Addiction-Free Pain Management® Certification Trainings scheduled this Spring—one in Sacramento California on May 18-19 that we are sponsoring and the one at Valley Forge Medical Center and Hospital on June 10-12. It’s not to late for people to sign up and in fact by mentioning this Blog I will make sure you get a $20 discount for either training. To get this discount you must call Ellen at (916) 575-9961 and ask her for the discount. For other upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people udergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders including addiction effectively please go to our Publications page and check out my book the Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.

To read the latest issue of Chronic Pain Solutions Newsletter please click here. If you want to sign up for the newsletter, please click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.