The Reality of it All

Hello and thanks for stopping by, now that i have gotten some of the sterile aspects and medical information on chronic pain out of the way for those of you who are curious or just do not understand how chronic pain is defined i plan to get to what chronic pain really means and how it changes not just the sufferer but all the people that are in he or she(s) life. First I'm not looking for pity as most people with this disease will tell you,I'm not asking you to understand my personal situation and most of all I m not trying to put you in my shoes, i wouldn't wish this on my worst enemy. I want you to know that i had a life before this and i enjoyed every second of it,don't get me wrong because i thank God everyday that i wake up and pray that there are many more days, many more years that i will be graced with to spend time with my family and children especially my youngest son who is only 8 years old, my wish is to be here for a long time so that i can see him grow from the beautiful boy he is to the beautiful man that I'm sure he will be, i also look forward to my first grandchild from my oldest son and wonderful wife, i look forward to spending a lot of time with him or her, either way grandpas going to spoil them, well that's it for now, my next posting I m comptemplating whether i should start form the good times to the bad or vice versa, or maybe flashbacks and flash forwards to confuse the hell out of you, i will know soon, so Thanks for stopping by, i hope you come back and also share your story, i welcome all comments. God Bless

In The Beginning 'God Said' Let There Be Suffering

Hello everybody, i Thank You for stopping by on my little place on the Internet. Fisrt of all ive been a chonic pain sufferer for 20 years and im sure if your a cronic pain sufferer and this is what brought you to my blog then you may know all to well how this untreated dibilating disease has impact you nd your loved one life. What my plan is to try to give the most accurate informtion on this disease and also share my struggle with you, I encourge yo to leave your comments and questions below in the comment box or Email me at jobjjb48146@gmail.com and i will be happy to give you all the information that you need or want to help you make it through this life long sentence call Chornic Pain< /b>. First of all i will say that even though im in th medical field or i should say was in the medical field, i will offer no medical advice, any information given on this site is purely for educational purposes only! What you choose to do with this information if your 18 or older is up to you. I claim no responsiblty for your actions and always encourage you to seek professional medical advice when dealing with anything to do with the topic of tis blog. Now that this is out of the way i will first start off with statistics and numbers, i believe you will be shocked on what you read, enough off this junk, lets get started. by the way its taken me long hard hours to present this informtion to you, although this is 100% Free would like to ask you to give a small donation through the Paypal button on this sit to site on the upper right corner of this page, if you cant afford one i hope that you find this information usefull and enjoy reading my story, I look forard to reading yours as well,Thank You and God Bless

Expect Analgesic Failure

EBPMA better understanding of potentially high therapeutic failure rates in pain Expect Analgesic Failure, But Seek Success management may be a first step toward doing better with currently available treatments. Clinically, this means expecting analgesic failure, assessing pain, and considering options for stopping and switching therapies. This also requires casting aside a reliance on what works for “average” patients, and asking what works best, for whom, in what circumstances. Most analgesic medications work well, but in only a relatively small percentage of people, according to Andrew Moore from Oxford University and colleagues writing in the British Medical Journal [Moore et al. 2013]. They propose a transformation in thinking about how analgesic efficacy and harm should be assessed, and suggest several practical implications of a better understanding and appreciation of therapeutic failure rates: “No single drug will treat successfully more than a minority of patients with a painful condition. Successful pain relief is also likely to improve sleep, depression, fatigue, quality of life, function, and ability to work. Experience (and some evidence) suggests that failure with one drug does not necessarily mean failure with others, even within a class. We do not know the best order in which to use drugs, in terms of efficacy, harm, or cost. Success or failure can be determined within 2-4 weeks, and success, when achieved, tends to be long lasting. Because success rates are low, a wide range of drugs is needed to do the best for most patients, especially in complex chronic conditions.” Measuring Success Individual patient responses to any therapy vary greatly, Moore et al. observe. Pain relief measurements delineating successful outcomes typically are not distributed along a normal bell-shaped curve, but are usually bimodal; that is, most patient responses are either very good (above 50% pain relief) or very poor (below 15%). Therefore, the frequency distribution curve is more “U-shaped”; rather than the classic bell curve in which most responses fall toward the center and correspond with the mean (average). Due to the U-shaped response distribution, research outcomes based on averages are unhelpful and misleading since “average” pain relief is actually experienced by few, if any, patients. The mean score tells us nothing about how many patients will experience clinically useful pain relief; hence, Moore and colleagues suggest that research should be moving toward “responder analyses” — focusing and reporting on the proportion of patients achieving outcomes that patients themselves consider to be worthwhile. In that regard, the authors observe that patients want large reductions in pain intensity (typically at least 50% relief and ideally no worse than mild pain), with amelioration of associated problems, such as sleep disturbance and depression, but without common adverse events interfering with treatment. Patients who get better (responders) typically do well, experiencing improvements in fatigue, depression, and sleep interference, plus better function and quality of life. Non-responders gain none of those benefits. From a research perspective, as well as in daily practice, the authors suggest that all persons who discontinue treatment for any reason should be considered as non-responders. Furthermore, the scientific assessment of analgesia and the clinical practice of analgesic delivery could be simplified into 3 guiding principles: A) measure pain in individual patients, B) expect analgesic drugs to fail to provide a good response in most patients, and C) prepare for the next step if and when failure occurs. Defining Analgesic Failure In their article, Moore et al. examine some drug-specific success and failure rates for postoperative pain, migraine, and chronic musculoskeletal and neuropathic conditions, using data predominantly from good quality reviews and meta-analyses. In a table, they list outcomes for 44 studies evaluating placebo in comparison with NSAIDs and various other drugs (eg, acetaminophen, triptans, antidepressants, antiepileptics, and others). Only 2 studies of opioid monotherapy were included, both for chronic noncancer pain. Overall, and with but a few exceptions, less than half of patients achieved at least a 50% reduction in pain intensity (responder definition), and failure rates were highest over the long term in patients with chronic pain conditions. Of the 44 studies, success rates were above 50% for only 4 drugs in acute postoperative pain (acetaminophen + ibuprofen; acetaminpohen + oxycodone; etoricoxib; ibuprofen + codeine) and 1 drug for migraine (zolmitriptan). For all other drugs and in all other conditions, fewer than half of patients achieved at least a 50% reduction in pain intensity. Analgesic failure rates generally ranged from 55% to ≥87%. Data for opioids in chronic noncancer pain were available only for tapentadol and oxycodone in a combined analysis of osteoarthritis and chronic low back pain trials; tapentadol (200-500mg) had a failure rate of 90% and oxycodone (40-100mg) had a failure rate of 100%. Those rates took into account therapeutic responders compared with placebo responders, and it should be noted that in absolute terms, on their own, 30% of tapentadol-group patients and 21% taking oxycodone did experience analgesic success. As Moore et al. observe, “The magnitude of the failure to achieve good pain relief, especially over the longer term in chronic pain, is sobering.” The high failure rates reported in their paper are a consequence of using patient-centered definitions of benefit combining a significant level of pain relief (>50%) with tolerable adverse events (ie, allowing continuation in therapy), using high standards of evidence, and avoiding major imputation bias (ie, focusing on responders). These higher standards are backed by considerable evidence supporting their validity, but they do portray less favorable outcomes than are often reported in the research literature. Moving Toward Pragmatic Approaches The use of responder analyses changes judgments of benefit and risk. In cases of therapeutic failure, patients without benefit should be exposed to no risk because the drug is stopped when they drop out of treatment. The good news is that success is often achieved within the first 2 weeks or so of treatment or not at all, the authors note, and benefits tend to be enduring. Obviously, only successfully effective drugs should continue to be prescribed. Of some importance regarding chronic pain, Moore et al. observe that typical clinical trials may inadvertently underestimate treatment efficacy if the data are closely examined. Fixed-dose regimens may exacerbate adverse events and discontinuations, resulting in higher failure rates. An alternate approach would be to allow patient-directed drug titration to achieve adequate pain relief with tolerable adverse events; at that point, only subjects with treatment success (responders) would be randomized blindly between continuing therapy and placebo. Such trial designs would have lower failure rates and more directly mimic what occurs in clinical practice. Additionally, the authors continue, drug therapy is rarely the only treatment used for chronic pain; however, clinical trials designed for regulatory purposes consider only single, or unimodal interventions. A most essential pragmatic implication of high failure rates is that populations with pain need access to a broad range of analgesics and/or other interventions to have a better chance of success. According to Moore et al., the problem is a dearth of research data to help in devising therapy starting, stopping, and switching rules. In other conditions, like depression, switching medications is often effective; randomized trials have shown that any antidepressant used initially may benefit fewer than half of patients, but the majority can benefit when failures are followed by switching to other medications for depression. Practical Implications of Therapeutic Failures Essential practice principles for pain management should include assessing pain, expecting and recognizing analgesic failure, and reacting to it by pursuing analgesic success rather than blindly accepting failure. In any condition, the order in which analgesics should be tried is predicated on efficacy and safety, and adjusted for individual patient characteristics and response, suggest Moore and colleagues. The authors further observe that guidelines developers often restrict treatment recommendations to 1 or 2 drugs for any pain condition. The developers consider similar drugs to operate as a class, overlooking the fact that there can be important differences in pharmacokinetics or drug interactions across similar medications. Less restrictive guidance recommendations, centered on patient-practitioner interactions — taking into account clinical wisdom as well as available evidence — may do better, Moore et al. affirm. The authors additionally suggest that regulatory authorities need to recognize that therapeutic failure is the norm and set standards of acceptance based on real-world expectations. For example, Moore et al. note that European regulators have refused to license any drug for fibromyalgia because of inadequate average effect sizes, ignoring the fact that these drugs work well (≥50% reduction in pain intensity) for treating this difficult condition in around 10% of patients. New drugs are unlikely to be much better, the authors suggest, so a change in regulatory attitudes is overdue, would be sensible, and will benefit patients. Finally, Moore and colleagues acknowledge that chronic pain conditions are complex and associated with considerable comorbidity. Coupled with the nuances of neurobiological pain modulation, central nervous system transformations, and genetic influences, high failure rates with single pharmacologic interventions are unsurprising. “The new game in town is specificity of effect for specific targets, but with only a small percentage of patients benefiting,” they state. “We need to determine how best to use the interventions we have to provide better care for more people at lower cost.” COMMENTARY: Assertions about the importance of failure are somewhat unusual in scientific discourse; yet, Moore and colleagues believe that pain medicine has reached a degree of maturity where it can constructively confront, embrace, and learn from better understandings of therapeutic failings. That may or may not be the case; for example, some current arguments against opioid analgesics for chronic noncancer pain seem to demand that either the therapy works well and for all patients or it is unacceptable — there is no middle-ground or acceptance of failure. The studies examined by Moore et al. in their paper, with the respective analgesic failure rates, are exemplary but not exhaustive of the possibilities — eg, dose/frequency variations and combinations of different agents — when it comes to effective pharmacotherapy for various pain conditions. Nor were the studies critiqued from quality-of-evidence perspectives; yet, there are important lessons to be learned. Additionally, a soon to be published paper by Moore, as sole author [2013, see ref below], further explores some of the essential principles and is worth examining. Plus, readers with a deeper interest in evidence-based pain management should be following our series on “Making Sense of Pain Research” [see article listing here], which discusses the many factors affecting research quality. Here is further comment on several of the critical points that emerge from the papers by Moore et al. [2013] and Moore [2013]: Analgesic failure refers to the clinical reality that any medication (or other intervention) will not work for all patients all of the time. In most cases, as demonstrated by the research evidence provided by Moore et al., the very best analgesics provide ≥50% pain relief in roughly half of treated patients. This amounts to a number-needed-to-treat (NNT) of about 2 compared with placebo; that is, for every 2 patients treated with active drug rather than placebo 1 additional patient will benefit. For almost any medication, an NNT=2 would be a large and clinically significant effect size; yet it does not begin to approach the 100% response rate that patients and many practitioners may desire or expect. Furthermore, Moore et al. found that NNTs for various analgesics can range widely up to NNT>100, depending on the pain condition; however, even in the worst of cases, a certain percentage of patients (albeit, possibly extremely small) can benefit. The important message is that therapeutic failure is quite common and in significant proportions of patients, but this should not deter pursuing another analgesic within the same or different class of drug. Oftentimes, expectations need to be lowered to the level of clinical reality; eg, while long-term opioid therapy may not benefit all patients with chronic noncancer pain, it does help a certain proportion of patients and significantly so. There is no such thing as an “average” patient, even though research trials tend to define outcomes based on average, or mean, scores on efficacy measures. In doing this, research can be misleading, since the greatest proportions of patients either experience successful outcomes (eg, >50% pain relief) or very poor results (eg, <15% pain relief). Interestingly, mean placebo responses tend to follow the same pattern, which can result in small absolute differences between active therapy and placebo overall (hence increasing NNT values to less significant levels [NNT is calculated by 1 divided by the absolute difference between groups on a measure]). The most vital question is: what works, for whom, in what circumstances? Along with that, it must be remembered that pain relief is but one measure of therapeutic success that may be meaningful to patients. In overcoming a slavish reliance on “averages,” Moore et al. appear to be advocating for “per-protocol” analyses in pain research trials that focus on “responders.” That is, subjects who drop out of a study for any reason are considered as therapeutic failures, even if they had achieved some degree of pain relief at the time of their discontinuation. This recognizes that benefits outweigh risks in treatment responders — they achieve desired outcomes with tolerable adverse effects, if any, over an extended period of time. In contrast, much of the pain research uses “intention-to-treat, or ITT” approaches, whereby outcomes in all subjects are taken into account whether or not they complete the trial. In some cases, the last observation (eg, pain score) prior to discontinuation is carried forward (LOCF) in final analyses, as if it represents an overall therapeutic effect. Moore and colleagues argue that this approach interjects bias into the analyses, and may be acceptable for statistically determining if an intervention has any analgesic effect, but not for determining clinical effectiveness for individual patients. In other words, if patients cannot continue with a therapy for some reason they will not realize further benefits; the fact that they might have achieved some benefits up to a point in time, but then had to drop out prematurely due to adverse effects, may rescind the value of the therapy. As much as anything, Moore and Moore et al. are advocating for a pragmatic, patient-centered, practice-oriented approach to understanding therapeutic failure and success in pain management. This might be somewhat of a paradigm shift for how research in the pain field is conducted and how regulatory and other bodies reach decisions on drug approvals and labeling. In essence, an unbiased focus on therapeutic response requires that treatments should be stopped when they do not work to avoid undue exposures to risks; however, those patients who do respond sufficiently, no matter how small in numbers, can experience large benefits to offset against rare but potentially serious harms. A degree of failure should not defeat the pursuit of success when it comes to pain management

Commonly Used Pain Medication

When it comes to treating chronic pain, there are seemingly countless choices out there. How do you know what pain medication is right for you? Different types of pain medications are prescribed for different diagnoses, but there are still many choices available. Sometimes, you may have to try a few different kinds of pain medication, or even a combination of a few, in order to get relief. Opioids (Narcotics) for Chronic Pain Opioids are pain medications used for moderate to severe chronic pain. Though their long-term use has been somewhat controversial, most providers feel when carefully monitored, opioids have a place in chronic pain management. Opioids may be short-acting or long-acting pain medications, however in chronic pain management the latter is more commonly used. Different types of opioids are used for different types of chronic pain. These pain medications are available in both pill or patch form. Intravenous opioids are also available, though they are more commonly used for cancer pain, or as post-surgical acute pain medication. Some examples of opioids used to treat chronic pain are oxycodone and fetanyl. Opioids may be used alone, or they may be combined with other pain medications such acetaminophen. While opioids are often effective against chronic pain, they do have potential complications. Opioids can cause nausea, drowsiness, constipation, sexual dysfunction and may lead to physical dependence. If you take opioids regularly for chronic pain, your doctor should monitor you closely for signs of pain medication complications. NSAIDs for Chronic Pain, and Acetaminophen NSAIDs and acetaminophen are non-opioid analgesics, pain medications often used for mild to moderate chronic pain. NSAIDs and acetaminophen may be used alone to treat chronic pain, or they may be combined with other pain medications such as opioids and adjuvant analgesics. They may also be used to control breakthrough pain. Unlike opioids, many NSAIDs are available over-the-counter. Acetaminophen is also available for purchase without a prescription. However, stronger prescription versions are also available for chronic pain treatment. Some examples of NSAIDs used for chronic pain are ibuprofen, naproxen and meloxicam. While NSAIDs and acetaminophen are readily available pain medications, they do have potential side effects. Long-term use increases the chance of these side effects, however even short-term use can leave you vulnerable. These include gastrointestinal ulcers and bleeding as well as increased potential for bruising. Some types of NSAIDS, in particularly the selective COX-2 inhibitors, may increase your risk for heart attack or stroke. However, each medication is different and you should talk to your doctor about the risks and benefits of each. Antidepressants for Chronic Pain Antidepressants are adjuvant analgesics. They are not formulated specifically as pain medications, though they can effectively treat certain types of chronic pain. Antidepressants are thought to control chronic pain in two ways. First, they may change the way pain is perceived from the spinal cord to the brain. Second, they may decrease anxiety and help regulate sleep. Not all types of antidepressants are useful as chronic pain medications. Tricyclic antidepressants (TCAs) such as amitriptyline, selective serotonin reuptake inhibitors (SSRIs) such as duloxetine and some others such as nefazodone are commonly used to treat both chronic pain syndromes and nerve pain. Monoamine oxidase inhibitors (MAOIs), on the other hand, are not as effective in pain control. Anticonvulsants for Chronic Pain Though it might sound strange, anticonvulsants, usually used to control seizure disorders, can also be used as pain medication. Anticonvulsants are also adjuvant analgesics. Because they work by inhibiting certain types of nerve transmissions, they can decrease neuropathic pain sensations, such as those caused by trigeminal neuralgia or diabetic neuropathy. Anticonvulsants commonly used as pain medications include gabapentin and pregabalin. Topical Analgesics Topical analgesics are pain medications that are applied to the skin. They are available as creams, lotions or patches. Some types of topical pain medications may be purchased over-the-counter, while others require a doctor’s prescription. The work in a few different ways, depending on their active ingredient. Some topical analgesics contain pain medication that is delivered through the skin, such as trolamine salicylate (Aspercreme). Others contain a skin irritant that can interfere with pain perception, such as capsaicin. Using Pain Medication Wisely You may take a certain type of pain medication for your condition, or you may use a variety of those listed above to control your pain. Whatever the case, be sure to use your medication only as directed. Many pain medications have drug interaction warnings, including several of those listed above. If you are taking multiple pain medications, be sure to inform your doctor so he can alert you to any potential complications.

'Chronic Pain'- More Facts ( Migraines)

Nursing a migraine today? New research shows you're not alone. More than a quarter of Americans suffer daily pain, a condition that costs the U.S. about $60 billion a year in lost productivity. And how often you're in pain depends largely on the size of your paycheck. Americans in households making less than $30,000 a year spend nearly 20% of their lives in moderate to severe pain, compared with less than 8% of people in households earning above $100,000, according to a landmark study on how Americans experience in pain. The findings, published Thursday in the British journal the Lancet, also found that participants who hadn't finished high school reported feeling twice the amount of pain as college graduates. "To a significant extent, pain does separate the classes," says Princeton economist Alan Krueger, who authored the study along with Dr. Arthur Stone, a psychiatry professor at Stony Brook University. Krueger notes that the type of pain people reported typically fell on either side of the rich-poor divide. "Those with higher incomes welcome pain almost by choice, usually through exercise," he says. "At lower incomes, pain comes as the result of work." Indeed, Krueger and Stone found that blue-collar workers felt more pain, from physical labor or repetitive motion, while on the job than off, which at least offers hope that the problem can be mitigated. This finding "emphasizes the need for pain preventing measures [in the workplace] such as better ergonomics," wrote Juha H.O. Turunen, a professor of social pharmacy at Finland's University of Kuopio, in an accompanying commentary to the report. People with chronic pain also worked less, the new study found, costing U.S. businesses as much as $60 billion annually. These conclusions are in line with previous studies on productivity lost to common pain conditions, including a 2003 report finding that nearly 15% of the U.S. workforce's output was diminished by ailments such as headaches and arthritis. What's new in Kruger and Stone's study, however, is the level of detail with which the researchers were able to chronicle the lives of Americans in pain. With the help of the polling firm Gallup, they asked nearly 4,000 survey participants to diarize their daily activities over a 24-hour period. From these personal accounts, the researchers saw the impact pain had on people's emotional states. Though participants said interacting with a spouse or friend lowered their pain, those suffering chronic pain tended to socialize much less. They also spent a lot more time watching television�about 25% of their day compared with 16% for the average person. Pain also appeared to be a major driver of health-care costs. Krueger and Stone found that Americans spent about $2.6 billion in over-the-counter pain medications and another nearly $14 billion on outpatient analgesics in 2004, the most recent data available. But in these numbers, too, there may be a distinction between the haves and the have-nots. A 2005 study in Michigan showed that minorities and the poor have less access to such drugs than wealthier Americans because local pharmacies don't stock enough pain medications such as oxycodone or morphine. "Those [pharmacies] in white ZIP codes were more than 13 times more likely to have sufficient supplies," says lead researcher Dr. Carmen Green, an anesthesiology professor at the University of Michigan. "I have patients who have to drive 30 miles or more just to get their pain medications." One characteristic that pain doesn't seem to distinguish is gender: according to Krueger and Stone's study, men and women were nearly equally likely to find themselves in pain. Another is age. People reported more aches and pains as they got older, though surprisingly that pain tended to plateau from ages 45 to 75. "Maybe people reach a point in their career where they move up the ladder into a desk job," Krueger says. "Or maybe they've just learned how to cope with the pain."

500 Billion Dollars'- The cost of 'Chronic Pain' to Americans

More than 100 million adults in the United States are affected by chronic pain conditions, costing over $500 billion annually in medical care and lost productivity. When acute pain becomes chronic, it often results in missed work, disability, and significantly high cost of care.[1,2] In hopes of improving the condition, medical care often involves expensive and high-risk passive interventions, such as polypharmacy, opioid analgesics, high-tech imaging, implantable stimulators, and surgery. Yet, half of the persons seeking care for pain conditions still have pain 5 years later, and up to 25% of them receive long-term disability.[3-5] Despite nearly one-third of the population suffering from chronic pain to some extent, most people assume these conditions are incurable. Not so, says the International Myopain Society [myopain.org]. At their upcoming 2013 Myopain Congress — August 15-18, 2013 in Seattle, Washington, USA — members from the group will present results of research that show myopain conditions, such as myofascial pain (MP) and fibromyalgia (FM), are the most common cause of chronic pain and that these conditions can often be improved with a variety of treatments that focus on education and training to reduce muscle pain instead of high cost passive treatments.[6] Two prior studies of clinic populations found that myopain conditions were cited as the most common cause of pain, responsible for 54.6% of chronic head and neck pain[7] and 85% of back pain.[8] Another study, in a general internal medicine practice, found that among those patients that presented with pain, MP was found in 29.6% of the population and was the most common cause of pain.[9] The lack of awareness of these muscle pain conditions is surprising. Everyone, at some point in their lives, has experienced acute muscle pain associated with muscle spasm or repetitive strain. However, when acute pain becomes chronic, patients and their healthcare providers can become confused and overlook the muscle in favor of treating other conditions, particularly joint pathology. This lack of understanding leads to misdiagnosis and mistreatment, along with progression of an acute problem to chronic pain. Then, the behavioral and psychological components of chronic pain become misunderstood, and some providers assume the patient’s experience of pain is imagined or exaggerated. Thus, the principals of etiology, diagnosis, and management of myopain conditions are relevant for all healthcare providers. Etiology of Myopain Acute injury to the muscles through trauma or repetitive strain from sustained muscle contraction are the most common onset factors. This can result in localized progressive increases in oxidative metabolism and metabolic distress at motor endplates, particularly in type I muscle fibers that are associated with static muscle tone and posture. Tenderness and pain in the muscle, as mediated by type III and IV muscle nociceptors, are activated by locally released noxious substances — eg, potassium, histamine, kinins, or prostaglandins. If multiple peripheral and central factors facilitate the nociceptive input through modulation at the brain stem, peripheral and central sensitization and chronic pain will result.[10,11] This explains how diverse factors can either exacerbate or alleviate the pain, such as stress, repetitive strain, poor posture, relaxation, medications, temperature change, massage, local anesthetic injections, and electrical stimulation. Clinical Presentation The pain found with MP and FM is frequently described as a “chronic dull aching pain” and is associated muscle and soft tissue tenderness. The tenderness sensations in myofascial pain are termed trigger points (TrP), which are localized tender points in palpable bands of skeletal muscle, tendons, and ligaments that reflect peripheral sensitization. In contrast, the diagnostic criteria for FM includes the presence of tender points at specific locations of the body that reflect central sensitization. Studies have also shown that the pain in FM is considerably more severe and spread over a larger body area than the pain found in patients with MP. Treatment of Myopain There are 3 essential elements in treating myopain: 1) stretching, postural, and relaxation exercises; 2) reduction of all contributing factors that strain the muscle and heighten peripheral and central sensitization; and 3) if needed, direct therapy to muscles through counterstimulation to desensitize the soft tissues, using physical medicine modalities or muscle injections. The short-term goal is to restore the muscles and joints to normal function, posture, and full joint range of motion with gentle stretching exercises. This is followed long-term with a regular muscle stretching, postural, conditioning, and strengthening exercise program, as well as long term control of contributing factors. The difficulty in long-term management often lies not only in treatment of the muscle and joints, but also in the complex task of changing the identified contributing factors, since these can be integrally related to factors in the 7 realms of patients’ lives. These realms include body, cognitive, emotional, behavioral, spiritual, social, and physical environments. Many approaches such as cognitive-behavioral techniques, biofeedback, mindfulness meditation, and stress management have been used as part of a comprehensive integrative care model. About the 2013 Myopain Congress The 2013 Myopain Congress hopes to raise awareness that muscle pain is a physical disorder that is real, measurable, and treatable. This landmark conference will present the latest basic and clinical research, scientific abstracts, and workshops on muscle pain and other soft tissue pains to train practitioners in therapeutic approaches [see more information here]. The International Myopain Society was founded in 1983 as a nonprofit, international, interdisciplinary healthcare organization for research scientists, physicians, dentists, other healthcare professionals dedicated to exchanging ideas, conducting research, or learning more about myopain conditions. Since its inception 20 years ago, the Society has held international congresses every few years, and has spawned the Journal of Musculoskeletal Pain and several organizations that provide hands-on workshops. After Seattle, the next Congress will be in Australia in 2015. Persons interested in joining the organization and/or attending the Congress should visit myopain.org. REFERENCES: Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. National Academies Press, Washington, DC; June 29, 2011. DHHS. National Institutes of Health PA-13-118 [available here]. Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost Productive Time and Cost Due to Common Pain Conditions in the US Workforce. JAMA. 2003;290:2443-2454. Kato KSP, Evengard B, Pedersen NL. Chronic widespread pain and its co-morbidities: a population-based study. Arch Intern Med. 2006;166(15):1649-1654. National Center for Health Statistics. Health, United States, 2006, Special Feature on Pain With Chartbook on Trends in Americans. Hyattsville, MD [PDF available here]. Bennett R. Myofascial Pain Syndromes and the Fibromyalgia Syndrome: A Comparative Analysis. In: Fricton J, Awad EA, editors. Myofascial Pain and Fibromyalgia. New York: Raven Press; 1990: 43-66. Fricton J, Kroening R, Haley D, Siegert, R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surgery, Oral Medicine, Oral Pathology 1985;60(6):615-623. Rosomoff HL, Fishbain DA, Goldberg M, Santana R, Rosomoff RS. Physical findings in patients with chronic intractable benign pain of the neck and/or back. Pain. 1989;37:279-87. Skootsky S, Jaeger B, Oye RK. Prevalence of myofascial pain in general internal medicine practice. Western Journal of Medicine. 1989;151(2):157-60. Fricton J. Masticatory Myofascial Pain: An explanatory model integrating clinical, epidemiological, and basic science research. Bull. Group Int. Rech. Sci. Stomatol Odontol. 1999;41:14-25. Shah J, Heimur J. New Frontiers in Pathophysiology of Myofascial Pain. Pain Practitioner. 2(2):26-33.

Welcome to my Nightmare!!

Hello, thanks for stopping by my little slice of the Web. First of all i would like to get through all the technical garbage for all those you who may not be one of the 116 Millions of Americans suffering from 'Chronic Pain' Then I would like to get into the reality of this 'EVIL' life altering disease at least from my perspective. I hope everyone will share their stories as well. God Bless --------------------------------------------------------------------------------------- Serious, chronic pain affects at least 116 million Americans each year, many of whom are inadequately treated by the health-care system, according to a new report by the Institute of Medicine (IOM). The report offers a blueprint for addressing what it calls a “public health crisis” of pain. The reasons for long-lasting pain are many, from cancer and multiple sclerosis to back pain and arthritis, and the chronic suffering costs the country $560 to $635 billion each year in medical bills, lost productivity and missed work. “I’m shocked and surprised at the magnitude of [the problem],” said Dr. Perry Fine, president of the American Academy of Pain Medicine, while attending the press conference on Wednesday announcing the release of the IOM report. He was not associated with the research. Yet the reports’ authors said they believed that they had actually underestimated the incidence of chronic pain — that which lasts 30 to 60 days or more and takes a toll on personal and professional life — because their data didn’t include people living in settings like nursing homes. Further, as baby boomers age, the rate of chronic pain increases daily. “Pain is an experience that affects virtually every one of our citizens,” says Dr. Philip Pizzo, dean of the Stanford School of Medicine, who chaired the committee that wrote the report. “For many patients, chronic pain becomes a disease its Issued at the request of Congress as part of President Obama’s health reform legislation, the report calls for a “cultural transformation” — an attitude shift on the level of that seen over the last 50 years toward smoking — to spur more coordinated action to help treat Americans’ pain. Pain patients have long been viewed with skepticism and suspicion, rather than understanding, presenting a barrier to care. Rising rates of prescription drug misuse, addiction and overdose have further led to the establishment of legal and regulatory barriers, such as prescription databases, that can prevent even legitimate pain patients from getting much-needed drugs. “There’s abuse on both sides,” Pizzo says. “There is abuse that occurs when individuals are drug-seeking and abuse that occurs in that people who need pain medications may not have access because physicians won’t prescribe or the state has regulatory barriers.” Making matters worse is the media and political attention that has been devoted to painkiller abuse and addiction. Conversely, very little attention is given to chronic pain, which affects a far greater number of people. About 9.3% of the population has drug or alcohol problems serious enough to require treatment, while severe chronic pain affects at least one in three Americans. (And yet, two national institutes are devoted to the research of addiction: the National Institute on Alcoholism and Alcohol Abuse and the National Institute on Drug Abuse. IOM committee members considered calling for a new National Academy on Pain, but ultimately decided that economic and other restrictions would preclude it at this time.) Although prescribing of opioids has almost doubled — going from 3.2% of the population in 1988-94 to 5.7% in 2005-08 — it’s not clear that this is out of line with the rise in pain in the population or that the drugs are going to the right people. MORE: An Addict’s Battle With Painkiller Addiction Reveals Outdated Rehab Tactics During the press conference on Wednesday, pain patient and journalist Melanie Thernstrom, an author of the IOM report, said that committee members had received more than 2,000 comments on its website from pain patients and doctors. “It’s extraordinary how many patients describe themselves as feeling like collateral damage in the war on drugs because of extraordinarily burdensome [requirements to get opioid medications],” she said. Thernstrom went on to describe cases in which patients who had been on a stable and effective low dose of medication for years were suddenly cut off by their doctors for no apparent reason. She also spoke of cases in which the required monthly doctor visits caused patients to take time off work and travel hours to see a doctor who would prescribe. “Many pain patients, in fact, are paying the price for a policy not designed for their benefit,” she said, adding that doctors said they prescribed less than they thought was appropriate because of fear that law enforcement was “looking over their shoulder.” In a passage addressing the question of painkiller misuse, the report notes in italics for emphasis that “the majority of people with pain use their prescription drugs properly, are not a source of misuse, and should not be stigmatized or denied access because of the misdeeds or carelessness of others.” “Ironically, while many people with pain have difficulty obtaining opioid medications, nonmedical users appear to obtain them far too easily,” the report says. MORE: Most Addicts Get Painkillers From Friends or Family, Not Doctors But the barriers to appropriate care go beyond the issue of painkiller misuse. There are only about 3,000 to 4,000 pain specialists in the entire U.S., which means that primary-care physicians, whose numbers are also dwindling and who are not educated specifically about pain, are left to treat most pain with little specific guidance about effective care. In medical school, students receive only a few hours at most of education on pain treatment. Meanwhile public and medical misperceptions are widespread about the nature of pain, its causes and the way it affects individual patients. Misinformation is fueled by the fact that comprehensive research is lacking, even on basic questions like how many people suffer from disabling chronic pain and how well existing drugs like opioids treat long-term pain. Gaps in insurance coverage exacerbate many patients’ problems: health-care plans may not cover pain-management consultations or certain therapies. They may sometimes also offer perverse incentives in pain treatment, Pizzo says, describing how a plan might refuse coverage for physical therapy while covering an invasive surgical procedure, which can lead to unnecessary expenses and care. The IOM report specifically asks the National Institutes of Health to develop a lead agency to focus on fighting pain and directs the Department of Health and Human Services to develop a major initiative against pain, involving both public and private organizations, by the end of 2012. In response to a question about how the needed changes will actually take place, Pizzo said that “will ultimately reside in accountability at many levels.” “With tobacco and smoking, what happened is a mobilization of all the important stakeholders,” said committee vice-chair Noreen Clark of the University of Michigan. The authors called on patient advocates to get involved and to “be aware of their strength and the important role they can play in bringing about cultural transformation.” Added Thernstrom: “The most important message to get out is the concept of pain itself as a disease. The majority of primary care physicians do not agree with this even though there is overwhelming research in both humans and animals [showing that] pain causes damage to the nervous system. It’s dangerous not to treat pain