News & Research Archive — Here is a history of past Research for 2010 2009, 2008 or 2007

To begin I want to reiterate my belief that there is no such thing as a "bad" medication. How it's used, what it's used for and who uses will determine either positive or negative outcomes. For most people, acetaminophen is something of a mystery as it appears in many combination cough and cold products, as well as prescription pain medications, such as Vicodin and Percocet. Since a wide variety of medications contain this ingredient, consumers may not realize that the multiple products they take all contain acetaminophen, an error that can cause significant liver damage in a very short time.

The maximum daily dosage of acetaminophen historically has been 4,000 mg which can cause dangerous side effects for someone with liver disease if taken in excessive dosages, or by a person who drinks large amounts of alcohol. This dosage was recommended for revision in June of 2009 by an FDA advisory panel who voted 21-16 to lower the maximum daily dose of nonprescription acetaminophen, currently equal to eight pills of a drug such as Extra Strength Tylenol.

In addition, the panel voted 24-13 to limit the maximum single dose of acetaminophen to 650 mg. The current single dose of Extra Strength Tylenol is 1,000 mg. The panel also voted 26-11 to make the 1,000-mg dose of acetaminophen available only by prescription. It should be noted that the FDA is not required to accept the panel's recommendations, but it typically does so.

Due to these and other concerns John Hopkins Medical center recommends that even though acetaminophen is the drug with the lowest overall risk of side effects, someone using acetaminophen on a regular basis should see their doctor periodically to be monitored for adverse effects.

However, there are many legitimate benefits for using acetaminophen. For example, a 2004 study that was presented at the 9th World Congress of the Osteoarthritis Research Society International (OARSI) in Chicago showed that the over-the-counter pain reliever acetaminophen, when used as directed, is a safe and effective treatment option for patients suffering from the pain of osteoarthritis of the hip or knee.

According to the results of this study, acetaminophen was found comparable in safety to placebo. There were no statistically significant differences in the number of serious or non-serious adverse events between patients treated with either dose of acetaminophen and placebo. The results of this study confirm that when used as directed, acetaminophen is an effective and safe choice for patients with osteoarthritis and reinforce the American College of Rheumatology guidelines that recommend acetaminophen as a first line therapy to relieve osteoarthritis pain.

Along with its other benefits, acetaminophen is less likely to interact with other medications or irritate the stomach. It is also considered safe for patients with conditions such as heart disease and diabetes.

Below is information from the manufacturer of TYLENOL® (active ingredient acetaminophen) that they posted on their website for people who want—or need—to take it, so they can do so in a responsible and safe manner.

Importantly, you can confidently continue to take TYLENOL® according to the directions currently on the package and can prevent inappropriate use by:

1. Reading the label before each use and always following the directions
2. Never taking more than the recommended dose
3. Never using two products containing acetaminophen at the same time
4. Keeping medicine out of the reach of children
5. Consulting a healthcare professional with questions

The safety and efficacy of acetaminophen has been established through more than 50 years of clinical use and scientific investigation and it is safe when used as directed.

With all the concerns about the high toll prescription drug abuse and addiction takes, it is exciting to see recent research on a non-pharmacological medical approach to help alleviate back pain and increase quality of life. Electrical stimulation has been used in many different ways for decades, but there is now a newer procedure that is showing even better results.

As an intervention for chronic back and/or leg pain, spinal cord stimulation can be an effective alternative or adjunct treatment to other interventions that have failed to manage pain on their own. Spinal cord stimulation alleviates pain by electrically activating pain-inhibiting neuronal circuits in the dorsal horn and inducing a tingling sensation (paresthesia) that masks the sensations of pain.

Exciting new research on a Minimally Invasive Spine Surgery and Spinal Cord Stimulation procedure was presented at the American Academy of Pain Medicine's (AAPM) 26th Annual Conference held on February 3 - 6, 2010 in San Antonio, Texas. Below are excerpts from a PR NewsWire press release dated February 4, 2010.

In the first study, Daniel Bennett, MD, DABPM, from Integrative Treatment Centers in Denver, Colorado performed the minimally invasive facet arthrodesis procedure on 102 spinal joints in patients with recurrent facet-mediated (joint) low back pain... The goal of studying facet arthrodesis was to see if this treatment method could reduce pain, increase function, and reduce the use of medicines for a longer – hopefully permanent – duration...

Following the procedure, subjects were placed in a rigid lumbar brace for 16 weeks. At the one year follow-up, pain was reduced from 79 to 23 on a Visual Analog Scale (VAS) and function was improved from 33.46 to 8.32 on an Oswetry Disability Index (ODI). Both VAS and ODI are commonly used measurement tools to assess pain. In addition, 92 percent of the patients reported discontinuing use of narcotic medications. Only four patients' grafts dislodged, but only one of these patients reported continued pain.

"This is an impressive technique which had a profound positive effect on the patients in this pilot study," said Dr. Bennett. "It has the potential to be a long-term solution to intractable back pain due to joint disease."

Another study looked at the addition of spinal cord stimulation (SCS) to conventional medical management (CMM). Following a lumbosacral spinal surgery to alleviate pain, some patients continue to experience persistent or recurrent chronic pain – also called Failed Back Surgery Syndrome (FBSS). They report persistent pain, disability, reduced health-related quality of life, and incur high Medicare costs.

To evaluate the addition of SCS to known surgical CMM, a trial of the effectiveness of SCS was conducted. One hundred patients suffering from FBSS from twelve centers in different parts of the world were randomized into two equal groups. One group received SCS, while the other received CMM.

At the end of six months, 48 percent of the SCS group experienced greater than 50 percent pain relief as compared to 9 percent in the CMM group.

Thirty-eight percent of the SCS group also achieved greater than 30 percent back pain relief in comparison to 14 percent in the CMM group.

Additionally, at the six month point, participants who were not satisfied with the group to which they were randomized were allowed to cross over. Thirty patients of the CMM group crossed over to the SCS group while only 4 patients from the SCS group crossed to the CMM group.

Since 1996 I have been advocating the use of a multidisciplinary approach to chronic pain management, especially when accompanied with coexisting psychological disorders, including addiction. For many years I have encouraged participants at my trainings to include the use of a variety of non-medication based approaches for any chronic pain management condition, with pain focused psychotherapy topping the list.

When people are undergoing chronic pain management they are impacted in three major areas. Physically there is damage, injury or disease to a part of the body and the pain receptors in that area send a signal to the brain. Psychologically the brain interprets that ascending pain signal and sends a message to the cognitive section or the brain as well as the limbic system that controls emotions. Finally there is a social and cultural context in which to experience the pain in a way that reduces suffering.

Given this biopsychosocial nature of chronic pain management it is imperative to utilize a multidisciplinary treatment team approach. True multidisciplinary pain management involves interventions such as physical therapy, massage, medication management, counseling or therapy, biofeedback, occupational therapy, exercise physiology, an anesthesiologist or pharmacologist, as well as a case manager. It may also involve some type of movement therapy such as Tai Chi, spiritual wellness classes, yoga or meditation.

In our era of reducing resources, and limited access to a multidisciplinary team approach, many people are not getting the help they need and deserve for effective chronic pain management. I've said many times that knowledge is power, but especially so for people living with chronic pain. I've recently subscribed to a website that shares my premise; PainEDU.org.

This site published a report on January 5, 2010 titled "Use of Psychotherapeutic Co-interventions for Pain" that I found especially validating. In fact, it covers much of the same ground as my Addiction-Free Pain Management® system regarding the use of psychotherapy for more effective chronic pain management. I've posted some highlights from PainEDU.org which has the entire post if you want to read it.

The Importance of a Multidisciplinary Team

Chronic pain involves a complex interaction of physiological and psychosocial factors, and successful intervention requires the coordinated effort of a treatment team with expertise in a variety of therapeutic disciplines. Although some clinics offer a single treatment approach, most pain programs use a blend of medical, psychological, vocational, and educational techniques. Treatment modalities for chronic pain generally include medical assessment, medication management, pain-reduction treatments, didactic instruction, relaxation training, biofeedback, physical therapy, psychotherapy, and vocational counseling.

An interdisciplinary staff coordinates efforts to rehabilitate the pain patient and provides a comprehensive discharge and follow-up plan designed to meet the patient's short- and long-term needs. The patient's active participation in the treatment plan is strongly encouraged. Among the predictors of success in a multidisciplinary pain program are the patient's motivation to cope with pain and his or her external support systems.

Education

Most people with chronic pain have an inadequate understanding of the nature of their painful condition. It is important for them to be knowledgeable about their pain and the treatments designed for them. Information can be conveyed through patient manuals on chronic pain, video presentations, handouts, individual sessions, and interactive programs on the Internet. Topics for educational sessions may include:

1. Physiology of pain
2. Medication for chronic pain
3. Exercise and pain
4. Stress management
5. Sleep disturbance
6. Assertiveness training
7. Posture and body mechanics
8. Problem solving
9. Weight management and nutrition
10. Vocational rehabilitation
11. Sexual issues
12. Positive thinking
13. Relapse prevention

In general, patients who understand their condition, and who have been exposed to relevant management techniques, maintain a perception of control over their pain and show higher rates of success in meeting their goals. Active learning techniques, including the completion of homework such as periodic surveys, checklists, diaries, or questionnaires are an important part of the educational approach.

Cognitive/Behavioral Therapy

Pain patients frequently show signs of emotional distress, with evidence of depression, anxiety, and irritability. Therapy with a cognitive/behavioral orientation helps patients gain control of the emotional reactions associated with chronic pain. Specific problem-solving strategies can be offered during therapy sessions, including:

1. Identifying maladaptive and negative thoughts
2. Disputing irrational thinking
3. Constructing and repeating positive self-statements
4. Learning distraction techniques
5. Working to prevent future "catastrophizing
6. Examining ways to increase social support.

Personal relationship issues can also be explored. The patient's strengths and positive coping mechanisms should be emphasized.

News & Research Archive — Here is a history of past Research for 2010, 2009, 2008 or 2007