Meditation is a fairly new phenomenon in our Western culture, but research shows that the origins of meditation go back at least five-thousand years. One type that I've found particularly helpful for my own chronic pain management and that I teach my patients is the Buddhist discipline of "mindfulness meditation." This is a moment-to-moment awareness of what our bodies are doing. The goals of meditation are to understand one's mental processes, develop the power to control these processes and gain freedom from one's mind-set.

Patrick Randolph, Ph.D., and his colleagues, from Texas Tech University, have created a Pain and Stress Management Program (PSMP) based on Eastern meditation techniques, which, when combined with medication, improve patients' pain symptoms significantly better than drug therapy alone. The PSMP is an eight-week regimen that uses the Buddhist discipline of mindfulness meditation.

Neuroscientist Dr. Shanida Nataraja has a more scientific approach to meditation. In her new book, The Blissful Brain, she aims to de-mystify the subject by bringing together findings of recent clinical research on meditation's effects on the mind and body.

Dr. Nataraja collated the results of several studies worldwide, which suggest that meditation reduces stress and heart-rate, lowers blood pressure and cuts the risk of cardiovascular disease. It has also been found to boost immune function, melatonin levels and psychological well-being. This makes it an excellent component of any chronic pain management treatment plan. To see more information regarding Dr. Ntaraja please click here.

Our first Addiction-Free Pain Management® Center of Excellence, Sierra Tucson, utilizes Awareness-Based Sensory Integration (ABSI) as a key approach in breaking the cycle of pain and psycho-emotional reactions. This specific mindfulness technique teaches patients to break down their subjective experience into identifiable parts, making individual sensations less likely to become overwhelming and allowing them to be experienced differently. Additionally, ABSI teaches vital skills and empowers individuals to deal with difficulties in all aspects of their lives.

Dr. Mark Pirtle the Associate Director of the Sierra Tucson's Pain Program teaches patients mindfulness meditation and has developed educational components to help them implement it as an integral component of their pain management treatment plan.

Anyone working in the chronic pain treatment field knows about the importance of physical activity and exercise as an important component of a chronic pain treatment plan. This month I want to share a report that I found on the Mayo Clinic website entitled "Exercise takes the edge off chronic pain."

For the past 25 years I have always included activity pacing and safe, medically approved exercise in the treatment plans I helped my patients develop. I've highlighted here what the Mayo Clinic report calls "the benefits of movement." If you want to see the entire report, go to www.mayoclinic.com and in their search engine type in "Exercise takes the edge off chronic pain."

The Benefits of Movement

As tough as it may be to start an exercise program, your body will thank you. Are you skeptical? Consider the facts. Exercise can:

• Prompt your body to release endorphins. These chemicals block pain signals from reaching your brain. Endorphins also help alleviate anxiety and depression — conditions that can make chronic pain more difficult to control. "Endorphins are the body's natural pain relievers," Dr. Laskowski says. "Endorphins have the potential to provide the pain-relieving power of strong pain medications, such as morphine."

• Help you build strength. The stronger your muscles, the more force and load you'll take off your bones and cartilage — and the more relief you'll feel.

• Increase your flexibility. Joints that can move through their full range of motion are less likely to be plagued with aches and pains.

• Improve your sleep quality. Regular exercise can lower your stress hormones, resulting in better sleep.

• Boost your energy level. Think a walk around the block will wipe you out for the rest of the day? Not likely, and if you do it again tomorrow and the day after, it'll be easier each time. In the long run, regular exercise can actually give you more energy to cope with chronic pain.

• Help you maintain a healthy weight. Exercise burns calories, which can help you drop excess pounds and reduce stress on your joints — another way to improve chronic pain.

• Enhance your mood. Exercise contributes to an overall sense of well-being. It increases blood and oxygen flow to all your tissues, livening up your skin tones and nourishing your brain. These positive effects perpetuate themselves. The better you look and feel, the greater your confidence and motivation to keep exercising.

• Protect your heart and blood vessels. Exercise decreases the risk of high blood pressure, diabetes, heart attack and stroke.

I am always keeping an eye out for new and interesting information for our website, and recently I came across a website I've never been to before; www.health24.com. The report I found there discussed recent research regarding people who were HIV Positive and were experiencing neuropathic pain symptoms. One statistic I found significant was that up to 62 percent of HIV-infected patients develop extensive painful neurological pain extending into the legs that is either due to the disease itself or is a side effect of HIV drug treatment, according to a report in the Journal of Pain and Symptom Management.

I'm including a portion of that research below and if you want to read the entire report please go to www.health24.com and search for "Patch helps brain pain in HIV+."

The patch was applied once to affected areas for 60 minutes. The main outcome measure was the percent change in a pain rating scale score from the start of the study through two to 12 weeks after treatment. Treatment with the patch produced a sustained reduction in pain scores of roughly 40 percent on average over the follow-up period. A treatment response, defined as a 30 percent or greater reduction in pain, was seen in eight patients (67 percent), including four with a 50 percent or greater reduction.

Most patients experienced an increase in pain during the 48 hours after the patch was applied, which resolved in the first week after treatment. The patch gives long-lasting relief except for the expected local pain and redness. "NGX-4010 was tolerated well and no safety concerns were identified," the investigators report.

"The most important finding is that the high-concentration capsaicin patch produced long-lasting (i.e. at least three months), significant pain relief in HIV-associated peripheral neuropathy with a good safety profile," Simpson said. While encouraging, the results will need to be replicated in controlled trials, he added. "This is an exciting time in research of new treatments for neuropathic pain," such as HIV-related pain, shingles and diabetic neuropathy, "with new drugs on the horizon." – (Reuters Health)

While some healthcare providers doubt that fibromyalgia really exists, anyone living with it certainly has a different experience. Unfortunately for both patients and their healthcare providers, treatment can be confusing and frustrating. For example, many general practitioners still use opiates as the only pain management intervention and in my work this type of medication only approach is a big problem. Over the past several years we have seen more evidence that a multidisciplinary approach is best in order to obtain positive treatment outcomes.

One such series of research studies by the National Fibromyalgia Association (NFA) have confirmed that diet and nutrition play a significant role in the management of fibromyalgia pain. The NFA (2006) also reports that success relies upon utilizing a multidisciplinary and multidimensional approach that incorporates lifestyle and dietary changes to achieve optimum health and well being.

The NFA also states that nutritional therapy practitioners are successfully using diet to treat and prevent illness, as well as restore the body to a natural healthy equilibrium. Some healthcare practitioners believe that deficiencies of minerals and vitamins could be responsible for much of the disease and weakness in the body. Symptoms that can result from these type of deficiencies include fatigue, lethargy and susceptibility to colds and viruses.

Another report came out in October 2007 published by ScienceDaily that discussed why painkillers don't work for 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, click:

http://www.sciencedaily.com/releases/2007/09/070927131357.htm.

I just found another report published by Science Daily (Mar. 10, 2008) that stated "Researchers at the University of Michigan Health System have found a key linkage between pain and a specific brain molecule, a discovery that lends new insight into fibromyalgia, an often-baffling chronic pain condition."

The report goes on to say that "when levels of the brain molecule called glutamate went down in patients with fibromyalgia, their pain decreased. The results of this study, which appears in the journal Arthritis and Rheumatism, could be useful to researchers looking for new drugs that treat fibromyalgia, the authors say." To read this March 10, 2008 report: click here.

The Mayo Clinic suggests that treatment for fibromyalgia includes both medication and self-care. The emphasis is on minimizing symptoms and improving general health. For medication management they discuss finding the best combination of appropriate drugs such as analgesics, antidepressants, muscle relaxants, and pregablin (Lyrica). Fortunately, they didn't stop there and also cited the importance of implementing cognitive behavioral therapy and other nonpharmacological interventions.

Works Cited

University of Michigan Health System (2008, March 10). Pain In Fibromyalgia Is Linked To Changes In Brain Molecule. ScienceDaily.

University of Michigan Health System (2007, October 3). Why Don't Painkillers Work For People With Fibromyalgia? ScienceDaily.

University of Michigan Health System.

National Fibromyalgia Association (NFA).

The Mayo Clinic.

One of the most challenging types of chronic pain that many people are suffering with is neuropathic pain. In neuropathic pain the peripheral or central nervous systems are malfunctioning and actually become the cause of the pain. Neuropathic pain is usually perceived as a steady burning and/or "pins and needles" and/or "electric shock" sensations and/or tickling. The difference is due to the fact that "ordinary" pain stimulates only pain nerves, while a neuropathy often results in the firing of both pain and non-pain (touch, warm, cool) sensory nerves in the same area, producing signals that the spinal cord and brain do not normally expect to receive.

As anyone living with neuropathic pain knows, the treatment is frustrating and often ineffective. While acute short-term pain is usually easy to manage and most chronic pain conditions can be treated effectively, neuropathic pain is a major treatment challenge for both patients and their healthcare providers. Unfortunately, neuropathic pain often responds poorly to standard pain treatments and occasionally may get worse instead of better over time. For some people, it can lead to serious disability.

The etiology and management of neuropathic pain were discussed in sessions at the annual meeting of the American Pharmacists Association, held March 17-21, 2006, in San Francisco. Here is a brief overview of their findings:

• When considering pharmacologic options to treat chronic pain, we first think of nonopioids (eg, acetaminophen, nonsteroidal anti-inflammatory agents), opioids, and co-analgesics. Generally speaking, the nonopioids are unlikely to provide any significant degree of pain relief in patients with neuropathy. Given the complicated nature of neuropathic pain, it is not surprising to find that, at best, an opioid or co-analgesic agent will effect a 30% reduction in the pain severity rating. In fact, this response is considered to be "clinically important" and, at this level, patients will report "moderate relief" or say they are "much improved." The medications used to treat neuropathic pain commonly cause adverse effects and are frequently involved in drug interactions. Careful analgesic selection and dosage titration are required, as many patients with neuropathic pain are elderly, take multiple medications, and have numerous comorbid conditions.

• At present there are only 5 co-analgesic agents that carry US Food and Drug Administration (FDA)-approved indications for neuropathic pain. These are carbamazepine (Tegretol [Novartis]) for trigeminal neuralgia, gabapentin (Neurontin [Parke-Davis]) and transdermal lidocaine (LidoDerm [Endo]) for postherpetic neuralgia, duloxetine (Cymbalta [Eli Lilly]) for diabetic neuropathy, and pregabalin (Lyrica [Pfizer]) for both diabetic neuropathy and postherpetic neuralgia. However, there is a significant body of literature demonstrating the effectiveness of these and other co-analgesics in treating a wide variety of neuropathic pain states.

• Robert Dworkin and colleagues[12] considered the evidence base of analgesics and co-analgesic clinical trials in the management of neuropathic pain. They concluded that first-line recommendations included gabapentin, the 5% lidocaine transdermal patch, opioid analgesics, tramadol hydrochloride, and tricyclic antidepressants (TCAs). Since that time, Dworkin has published further reports that add the serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants (eg, venlafaxine and duloxetine) and pregabalin as first-line medications for neuropathic pain.[13]

Currently, Lawson Health Research Institute scientists are tackling one of the worst pains for humans in a $1-million, three-year research project. Dr. Dwight Moulin and Dr. Patricia Morley-Forster at London Health Sciences Centre are leading the investigation to find the best way to treat neuropathic pain. I will be very interested to see the results of this project.

Most people will readily agree that regular exercise is good for you, and when combined with a healthy diet will help people gain or lose weight, and generally improve their quality of life. Unfortunately, many people with a chronic pain condition mistakenly believe that they can no longer get the full benefits of exercise. Egoscue (1998) is very adamant that flexibility and mobility are the keys to successful chronic pain management.

I recently found a new study highlighting the benefit of even modest exercise titled Modest Exercise Helps Chronic Pain Patients that was presented on February 15, 2008 at the American Academy of Pain Medicine 24th Annual Meeting. Please see an excerpt below.

• The review aimed to determine the effect of a 3-week aerobic training program on physical conditioning and to assess the acute effects of a brief, 10-minute exercise protocol on pain, mood, and perceived exertion. The final sample of 28 patients — lowered from 54 due to factors such as lack of motivation to exercise and fear of exercise — had an immediate perception change about exercise upon starting the program.

• Measures of heart rate, mood, pain, and perceived exertion were obtained. On average, patients received 5 hours of conditioning per week, in addition to routine daily activities. Results demonstrated significant short- and long-term benefits of exercise. Patients showed a statistically significant reduction in exercise-induced cardiac acceleration from admission to 3 weeks. The brief exercise protocol also produced significant immediate antidepressant and anxiolytic effects. The research suggests that relatively modest exercise leads to improved mood and physical capacity, which has further implications for mortality risk. The review also suggests that brief exercise is a safe, cost-free, nonpharmacological strategy for immediately reducing depression and anxiety [which often accompany living with chronic pain].

Exercise can and should be part of all pain management plans. The type and frequency of exercise is the important factor which requires someone with experience and clinical skills to develop an effective—and safe—program. Rest and immobilization periods (or up-time and down-time), should also be an integral foundation of the plan.

Other important considerations include the style of exercise, the progression of intensity, the frequency or quantity, and the prevention of additional injury. As mentioned earlier, hydrotherapy and water exercises can be very beneficial for people with chronic pain issues.

Caudill (2001) discusses the importance of aerobic exercise at least three times a week to improve health and weight management. Many people with pain are afraid that their pain will increase if they become too active. However, the risks of not exercising far outweigh the fear of what "might" happen as a result of developing an exercise regime. Caudill states that if people are careful and progress slowly, they are not likely to worsen their condition.

Catalano and Hardin (1996) note the fact that people who gradually incorporate exercise into their pain management treatment plan return to a higher level of functioning and maintain more effective pain management. They also recommend a program of exercise that includes proper posture and stretching. Catalano and Hardin also show a secondary gain for exercise—reducing isolation tendencies.

Works Cited

Catalano, E., & Hardin, K. (1996). The chronic pain control workbook: A step-by-step guide for coping with and overcoming pain. Oakland, CA: New Harbinger.

Caudill, M. (2001). Managing pain before it manages you. New York: Guilford Press.

Egoscue, P. (1998). Pain Free: A revolutionary method for stopping chronic pain.
New York, NY: Bantam.

Modest Exercise Helps Chronic Pain Patients (2008). American Academy of Pain Medicine 24th Annual Meeting: Abstract 105.

According to a special report from Pain-Topics.org, practitioners prescribing opioids for pain should be prepared to deal with patients' problems in using the medicines. Patients should not be discharged from treatment if opioid abuse or addiction occurs.

Chicago, IL, January 20, 2008 --(PR.com)-- "Any practitioner prescribing opioids for chronic use should be accountable for having a strategy in place if medication abuse or addiction occurs," says Peggy Compton, RN, PhD. "Providing daily opioid pain relievers without suitable addiction expertise or support in place puts both the pain-management practitioner and patient at risk for poor outcomes." For the full article click:

http://pain-topics.org/clinical_concepts/comments.php#Compton.

Many pain management providers find themselves in a difficult position. They want to provide effective pain management for their patients with chronic pain but are confronted more and more with prescription drug abuse or addiction issues. They are also being scrutinized by government departments such as the Drug Enforcement Agency (DEA) who are looking for over-medicated patients and prescription drug diversion. Because of this, providers are deciding they don't want to deal with this type of pain patient and are discharging them or severely limiting the pain management interventions these patients need and deserve for fear of being targeted.

This can avoided, and patients can get the help they need, if practitioners are diligent about putting certain policies and procedures in place. Pain management providers will have a much better chance of providing the level of care they want, protecting their patients from overdoses and shielding their practice. Below are recommendations by the Federation of State Medical Boards of the United States Inc. This organization has adopted the following criteria to support the physician's treatment of pain, including the use of controlled substances. They recommend the following six guideline areas:

• Evaluation of the Patient
• Treatment Plan
• Informed Consent and Agreement for Treatment
• Periodic Review
• Consultation Model Policy for the Use of Controlled Substances for the Treatment of Pain; page 16 Adopted May 1, 2004
• Medical Records

For a full look at their model policy for the use of controlled substances for the treatment of pain including details of the above six areas please go to: http://www.fsmb.org/RE/PAIN/default.html For more information about how to manage prescription medication abuse and/or addiction issues in your practice, please join us at an upcoming multidisciplinary training, call for a consultation to discuss ways to specifically implement the above guidelines from an Addiction-Free Pain Management® approach, or check out our publications page.

On December 11, 2007 FoxNews.com reported on a survey by the University of Michigan's Institute for Social Research, which looked into the drug use of 8th, 10th and 12th graders nationwide. According to the 2004 National Institute on Drug Abuse's (NIDA) financed survey released Tuesday at the White House, illicit drug use by teens continued to gradually decline overall this year, but the use of prescription medication painkillers remains popular among young people. To see this full article please go to http://www.foxnews.com/story/0,2933,316463,00.html.

The survey found that OxyContin was one of the most popular prescription drugs for adolescents. This is confirmed by many addiction treatment professionals around the country who are reporting that prescription opiates are more popular than alcohol and marijuana for many youth. This should not be surprising due to the inappropriate marketing and news stories about OxyContin. Fortunately, the Connecticut-based maker of this powerful painkiller and three of its current and former executives pleaded guilty last year to misleading the public about the drug's risk of addiction. Purdue Pharma L.P. and the executives were forced to pay $634.5 million in fines.

The NIDA Monitoring the Future survey of 8th, 10th, and 12th-graders found that 9.3 percent of 12th-graders reported using Vicodin without a prescription in the past year, and 5.0 percent reported using OxyContin, making these medications among the most commonly abused prescription drugs by adolescents. Many teens get their "supply" from parents, other family members or friends. Many of the pain clinics I consult for are advising their patients to obtain a "medication safe" for the stronger opiates in order to protect their children and others who might try to divert/steal the medication.

NIDA hopes to decrease the prevalence of this problem by increasing awareness and promoting additional research on prescription drug abuse. Prescription drug abuse is not a new problem, but one that deserves renewed attention. It is imperative that as a Nation we make ourselves aware of the consequences associated with the misuse and abuse of these medications. For updated and accurate information about any drugs of abuse (including prescription drugs) please visit the NIDA website http://www.nida.nih.gov and use their search feature to find the information you need.

In chronic pain management one of the big concerns is the addiction potential of many prescription opiate medications. Physical dependency and a rapid build up of tolerance is also a concern, not only for pain management providers but also their patients. According to a new research study out from the University of California San Francisco (UCSF) morphine dependency may be blocked by a single genetic change.

It's still too early to get excited as the study was conducted on mice. Human trials are still needed, as well as validation and reproduction by other research but it does look hopeful. Many people today, especially older patients, are afraid to take their needed pain medication due to paranoia about addiction and thus are not receiving effective pain management. The media has increased this fear with reporting that labels medication like OxyContin as "demon drugs." It is true that people have died from this medication, but not as a result of taking it as prescribed.

I will post some highlights from the UCSF news release, and if you want to read the entire article go to http://pub.ucsf.edu/newsservices/releases/200801281/. The research team was lead by Jennifer Whistler, PhD, an investigator in the UCSF-affiliated Ernest Gallo Clinic and Research Center, and associate professor of neurology at UCSF. A portion of this news release is below.

"As more pain medications are being removed from the market, new strategies to overcome chronic pain become crucial," Whistler says. "If new opiate drugs can be developed with morphine's pain killing properties but also with the ability to promote endocytosis, they could be less likely to cause the serious side effects of tolerance and dependence." The research is the first direct demonstration that this single cellular change can block the body's tendency to become tolerant of the drug, she points out. Several strategies are now being tested to counter morphine addiction, Whistler says. These include development of morphine derivatives such as oxycontin, that are delivered in a time released manner or only once they have been processed in the digestive system. Other approaches seek to develop morphine derivatives that target only certain opioid receptors but not others. "The most promising aspect of these other approaches is that they have the potential to prevent or delay dependence and addiction to morphine, but few of them address the development of tolerance," Whistler said.

According to other research chronic pain currently affects well over 100 million American adults and is estimated that an excess of $100 Billion per year is spent on medical costs and lost productivity. For a chart showing the cost breakdown of pain management for several different conditions click here.

• Several reviews have demonstrated that women respond to noxious and potentially noxious stimuli with greater pain experience than men. In particular, women tend to have reduced pain threshold compared to men women respond with pain to lower intensity stimuli than men. In addition, there are numerous pain conditions that show a bias towards women: Berkley listed 38 clinical pain disorders as having a female prevalence but only 15 having a male prevalence and 24 having no sex prevalence. It is tempting, therefore, to suggest that women have a biological profile that predisposes them to experience pain at lower stimulus intensities and thus also suffer a disproportionate amount of clinical pain.

• Men's Hormones Make Them Feel Pain Differently
  Men's hormones make them “feel” pain less intensely or at least differently than women do, according to pioneering new research involving transsexuals in Germany. Female-to-male sex-change procedures involving transsexuals undergoing hormonal treatment show that post-procedure subjects say their new lives as males are literally less painful than their previous lives as females. “Testosterone appears to reduce sensibility to pain, whereas estrogen actually increases pain sensitivity,” says Professor Hartmut Goebel, director of the Pain Clinic in Kiel, Germany.

  Post-procedural transsexuals who have received testosterone as part of their sex-change report that they experience lower overall pain levels since having become men, Dr Goebel says. Not only do they experience lower levels of pain in a quantitative sense, but the quality of pain is different, he adds. “The female brain colours pain with more emotional responses,” says Goebel. “Men aren't bluffing when they say they can ignore pain. Their brains actually do in fact allow them to mask low-level pain in a way that women's brains do not.” He theorizes that “Men tend to suffer in silence, thinking it's not all that bad. But women say 'I just can't stand this' and so they seek medical help.”

• How LLLT Works
  Low level laser therapy traces its history back to the early 1960's when researchers discovered that laser light could stimulate a response at the cellular level of tissues in the body, resulting in increased energy levels (ATP, adenosine triphosphate). This increase in energy enables the body's cells to metabolize at a higher rate and speeds its natural ability to heal. In short, the body converts the laser light into a form of energy that it can use (biochemical energy) to repair itself and function at a higher efficiency level. This process is similar to the human body using the sun's energy to manufacture Vitamin D.

• LLLT is FDA Approved
  Researchers have since experimented over the decades to find out which intensities and wavelengths of light work best to promote healing in the body. Laser therapy has been successfully utilized in Europe, Asia, and Canada for years. In 2002, the Food and Drug Administration (FDA) approved the use of low level laser therapy for use in the United States.