Chronic Pain Sufferers

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Pain Management

Modest Exercise Helps Chronic Pain Patients
Physical conditioning in chronic pain patients can have immediate and long-term benefits, according to a new study presented at the American Academy of Pain Medicine 24th Annual Meeting.
Medscape Medical News 2008

Fentanyl Gel Patches Recalled Due to Manufacturing Defect
A cut edge in the drug reservoir may lead to direct exposure to fentanyl gel (Duragesic) resulting in potentially fatal adverse events.
Medscape Medical News 2008

Spinal Stenosis Treatment - What the Data Says
Research reveals that surgery for spinal stenosis, usually a laminectomy, can very effectively provide pain relief as well as an increased level of functioning for the first two years. After that, there is still improvement, although not as much.

But doctors and researchers really don't have a lot of data on other types of treatments for spinal stenosis. Let's find out what is known, what is not known and what the gaps in knowledge mean to you.

NSAIDs May Not Be Best Bet for Low Back Pain
review of the literature on drug relief for low back pain (LBP) suggests that the popular nonsteroidal anti-inflammatory drugs (NSAIDs) are no more effective than other drugs such as acetaminophen, narcotic analgesics, and muscle relaxants.
Medscape Medical News 2008

Intensive Patient Education May Be Effective for Acute or Subacute Low Back Pain
A Cochrane review suggests that for patients with acute or subacute nonspecific low back pain, intensive, individualized patient education seems to be effective.
Medscape Medical News 2008

Edema in a Patient Receiving Methadone for Chronic Low Back Pain
A week after starting a regimen of etodolac, gabapentin, and methadone, a 45-year-old woman with chronic low back pain said she felt "drunk" and had swelling in her lower extremities.
Am J Health-Syst Pharm 64(24) 2007

Fold-Over Defect Causes Another Recall of Fentanyl Pain Patches
This time from Actavis, which has initiated a recall of 14 lots; direct exposure to fentanyl gel may lead to potentially fatal adverse events.
Medscape Medical News 2008

Fentanyl Patches Recalled by Manufacturers
It has not been two months since fentanyl, a prescription patch used for moderate to severe pain, was last in the news. Two brand manufacturers and one generic manufacturer are now recalling some of their fentanyl patches because of leaky packaging. Find out which ones, including lot numbers and, more importantly, what to do to protect yourself from unwanted exposure to this addictive narcotic medication.

Pain Medicine
American Academy of Pain Medicine (AAPM) 24th Annual Meeting
Read clinically focused news coverage of key developments from the meeting.

Don't Get Burned - Icy Hot Product Recall
If you use Icy Hot Heat Therapy products for your back or neck, here's some news for you. The company has recalled several of their products because consumers were getting skin irritation and burns. Icy Hot products are air activated cremes, ointments and patches used for temporary relief of back strain, and muscle/joint pain, including arthritis. Check this list to see if the product you use is being recalled.

Is Botox a Safe Treatment for Pain?
Recently the FDA has received reports of adverse events happening to people who've gotten botox injections. In these cases, the Botox was used for all different kinds of things, regardless of whether the FDA had approved those usages or not. While they are looking into this, the question that's still out there is - is botox a safe treatment for chronic back or neck pain?

Chronic Pain May Harm the Brain
A new study indicates that chronic pain has a widespread impact on overall brain function, a finding that may offer a possible explanation for many of the common cognitive and behavioral comorbidities seen in such patients.
Medscape Medical News 2008

No Clear Evidence to Support Use of Antidepressants for Chronic Low Back Pain
A new review of 10 studies concludes that there is currently no clear evidence to support the use of antidepressants to reduce pain and depression in the management of chronic low back pain.
Medscape Medical News 2008

Patient-Controlled Analgesia Safe, Effective in Postcraniotomy Pain Management
Intravenous patient-controlled analgesia (PCA) is safe and effective for managing pain after major intracranial surgery compared with conventional as-needed (PRN) therapy, according to research presented at the 37th Critical Care Congress of the Society of Critical Care Medicine.
Medscape Medical News 2008

Advice, Training in Lifting Techniques May Not Improve Prevention of Back Pain
A systematic review published in the February 1 Online First issue of the BMJ shows no evidence to support use of advice or training in lifting techniques in the workplace with or without lifting equipment to prevent back pain or consequent disability.
Medscape Medical News 2008

How Old is Your Spine?
Certain back or neck conditions are more likely to appear at particular times in a person's life. Here is a breakdown of a few common conditions and the ages they tend to appear.

Ankylosing Spondylitis "Almost Nailed" with Discovery of Two Causative Genes
An international collaboration of researchers has identified two new genes responsible for the occurrence of ankylosing spondylitis, a debilitating form of arthritis that affects the spine. This development will likely have a very positive effect when it comes to screening for and treating this most difficult disease.

What to Do with Ankylosing Spondylitis
Ankylosing spondylitis is an autoimmue disease that causes the spine to fuse. It is a form of arthritis. Unfortunately, getting a diagnosis can be a challenge because symptoms are easily mistaken for more common back issues.

Neck Arthritis - Cervical Spondylosis
Cervical spondylosis, aka neck arthritis, is another type of spinal arthritis that is generally caused by aging and its effects on the spine. Here is a comprehenisve overview.

Massage Your Own Neck
Here's a quick massage technique that you might be able to do without generating an audience. It will soften your levator scapula muscle. The levator scap is the muscle that makes a "sore spot" in your upper shoulder area when you are stressed or overworked.

How to Simply Stretch Your Neck
Follow this illustrated step-by-step guide to stretch your neck - it will only take a minute or two. If you have neck issues, just be careful not to work through pain.

Massage Your Own Shoulders
The trapezius muscle is the one on top of your shoulders, sitting there like an epaulet. As you probably know, it can get very sore after hours at a computer. This simple and quick self-massage technique can help you relax it. You can also try the technique on your co-worker or friend (work culture permitting, of course).

Core Strengthening for Back Pain
Once exclusive to the realm of Pilates, core strengthening exercise is now found in nearly every gym, clinic, and fitness DVD catalogue. It comes in many flavors, but always involves working abdominal and other postural muscles to help create and maintain reliable upright posture.

Yoga for Back Pain Overview
Doing yoga cultivates a balance between the flexibility and strength of the muscles of the body, often the real culprit in back pain. It can also provide a core workout.

Pilates for Back Pain
Pilates is one very popular way to develop abdominal muscles, and core strength.

Stretch Your Spine in the Morning
If you wake up feeling compressed, try these spine lengthening stretches.

Great Morning Body Mechanics
When you wake up, is your back stiff or sore? If so, spend a few moments breathing deeply and stretching your body then follow this step-by-step guide for getting out of bed safely.

A Gallery of Comfortable Sleeping Positions
You can use pillows in all kinds of ways to help support your back and hips when you sleep. The trick is to experiement to see how to pillow prop so that your joints are in neutral positions, and do not feel strained. This image gallery may give you some ideas to get you started.

Triangle Pose and Your Back - Hips, Hips, Hips!
Hips play a central role in supporting body posture. With a close physical connection between hips and spine, it's no wonder that many people have back pain! There's hope, because a correctly done triangle pose, or trikonasana, will reintroduce you to your hip joints and get them mobile again.

How to do Triangle Pose
The hip work emphasized in triangle pose is an important step in relieving back pain. But there are other points to this pose, too. Let About.com's Yoga guide, Ann Pizer take you through the sequence of getting into triangle pose.

Yoga for Spinal Flexibility
When doing yoga to increase your back's flexibility, balance is the word, especially if you have had an injury. Balance is achieved by doing a combination of actions that oppose one another as you move through the poses. For back pain sufferers, it doesn't have to be a challenging workout, but it does need to be well thought out.

Healing Pain
I can only imagine what it must be like to share tea with my doctor. Or to be in the presence of a medical professional who does not ignore the emotional or spiritual aspects of my pain, nor its extenuating life circumstances --to spend time with a person who is equally versed in, as well as committed to the healing of the technical aspects of my pain as they are the nature of my suffering. Dr. Ann Berger is such a doctor; her book, "Healing Pain", is an opportunity for a virtual visit.

Communicating Your Symptoms Accurately
Many people find it tough to establish a rapport with their doctors. Regardless of the reason, the one thing you have is the ability to accurately communicate your back or neck pain symptons to your health care provider. In the doctor-patient relationship you, and only you are charged with providing the crucial information from which your diagnosis can be determined.

Living With Back Pain
Depending upon the severity of your back pain, you are probably making lifestyle adjustments in order to accomodate this unwanted intruder. And while doctors have their place in the healing and managing of pain, there is much you can do for yourself.

Alternative Medicine for Your Back and Neck
According to the National Center for Complementary and Alternative Medicine, back pain is the #1 reason why people seek alternative medicine, and neck pain is #3. There are a number of viable disciplines that can have a positive effect.

Back Pain Treatments
Find out about back pain treatments from A-Z.

New Data in Breakthrough Pain, Neuropathic Pain, and Low Back Pain From APS 2007: An Expert Interview With David M. Simpson, MD
Learn about new data in breakthrough pain, neuropathic pain, and low back pain from APS 2007 in this interview with David M. Simpson, MD.
Medscape Neurology & Neurosurgery 2007

Yoga for Back Pain
If you are going to try yoga for your back pain, treat yourself as a beginner. Here are some pointers on starting yoga.

Before You Do Yoga For Your Back
People with back pain have to be extra careful when trying out exercise. Yes, doing yoga to help your back may give you pain relief, but establishing a practice that is safe and meaningful for your condition requires that you know more about why and how to do certain poses. It also means that you should know when not to do a pose.

Yoga for Back Pain - Tadasana
Mountain pose is the first of the yoga standing poses. Contrary to what it may seem, mountain pose is not easy. If you do it correctly, it will work nearly every single muscle you have.

Muscle Relaxers Slow Down Low Back Pain Recovery
Muscle relaxers are often prescribed for episodes of low back pain. They can help get you ready to do some work in physical therapy. But do they help long term recovery?

Chronic Pain Common Among Retired Football Players, Can Compound Depressive Symptoms
A recent survey of retired football players found that their rate of depression was similar to that in the general population, but almost half had chronic pain.
Medscape Medical News 2007

Spinal Cord Stimulation: Indications and Outcomes
Spinal cord stimulation is the most commonly used implantable neurostimulation modality for management of pain syndromes. What are the current indications and its efficacy in treating these diseases?
Neurosurg Focus 21(6) 2006

OxyContin
Last week, executives at Purdue, maker of OxyContin,

stunned the world by taking responsibility for a deliberatly fraudulent marketing campaign for this potentially lethal drug.

Trigeminal and Occipital Peripheral Nerve Stimulation for Craniofacial Pain: A Single-institution Experience and Review of the Literature
The authors present their initial experience with peripheral nerve stimulation for craniofacial pain, summarize published data, and discuss some technical details of the procedure.
Neurosurg Focus 21(6) 2006

Psychological Factors in Spinal Cord Stimulation Therapy: Brief Review and Discussion
In this article, the author briefly reviews some of the data on psychological factors involved in spinal cord stimulation therapy.
Neurosurg Focus 21(6) 2006

Heat Wrap Therapy for Short Term Low Back Pain
Take your low back pain into any physical therapy clinic, and you will likely be given some heat or ice as part of your treatment. But is it the most effective way to treat low back pain?

Spinal Nerve Root Stimulation
This article analyzes the techniques of spinal nerve root stimulation for chronic pain conditions and discusses the advantages and disadvantages of each.
Neurosurg Focus 21(6) 2006

Motor Cortex Stimulation and Neuropathic Facial Pain
The authors present a review of the literature on motor cortex stimulation, focusing on surgical technique, device programming, safety, and efficacy; and they suggest guidelines for standardization.
Neurosurg Focus 21(6) 2006

Deep Brain Stimulation for the Treatment of Various Chronic Pain Syndromes
The authors of this study present their experience with deep brain stimulation for the treatment of chronic pain states that that do not respond to less invasive or conservative treatment options.
Neurosurg Focus 21(6) 2006

Motor Cortex Stimulation for Intractable Pain
Learn about the history, technique, and outcome of motor cortex stimulation for patients with refractory deafferentation pain syndromes.
Neurosurg Focus 21(6) 2006

Highlights from Pain, Opioids, and Addiction: An Urgent Problem for Doctors and Patients
Read highlights from the joint meeting of the National Institute on Drug Abuse and the American Medical Association on opioid prescribing, chronic pain, and prescription drug abuse.
Medscape Neurology & Neurosurgery 2007

Inflammatory Bowel Disease Linked to High Prevalence of Neurological Disorders
Initial 2-year results from an ongoing prospective cohort study show inflammatory bowel disease increases the risk for subsequent neurological disorders, new research suggests.
Medscape Medical News 2007

Stiff Neck & Meningitis
If stiff neck is any indication, it is difficult to distinguish the symptoms of certain common problems from those of meningitis. Take the Meningitis Awareness Quiz to see test your knowledge on this potentially lethal cause of a stiff neck. It may save your life!

Beliefs and Back Pain
A recent survey of doctors published in the April 9, 2007 issue of Archives of Internal Medicine inquired about the role of religion and spirituality in patients' health outcomes and points of view. How does religion or spirituality feature in your health?

Establish Core Support
With the buzz phrases "core support" and "core stabilization" here to stay, it may help to find out how to position yourself so that you can access the deep abdominals, those muscles that support your spine upright.

Pelvic Power
Sometimes it is very simple things like breathing and being aware of your body's positions that yield the best results for back pain relief. Read my review of Pelvic Power, a delightful little book that will explain your spinal anatomy to you, and offer easy exercises for developing awareness.

Strengthen Your Pelvic Floor
The pelvic floor muscles lie at the very bottom of your spine and pelvis, playing a key role in posture. Now you can strengthen them to help you develop ideal spinal alignment.

Advances in Opioid Analgesia: Maximizing Benefit While Minimizing Risk
Review the latest strategies and best tools for patient selection, pain assessment, and optimal pain management.

Arthritic Pain Activates Brain Regions Involved in Emotions and Fear
The findings from a new study suggest that arthritic pain has a strong emotional component that is not present with experimental pain conditions.
Reuters Health Information 2007
Opioid and Nonopioid Therapies for the Management of Pain
From AAPM 2007: Read about new advances in opioid and nonopioid therapies for the management of pain.
Medscape Neurology & Neurosurgery 2007

Neuropathic Pain Severity Predicts Response to Duloxetine
Patients with diabetic peripheral neuropathic pain (DPNP) who have more severe symptoms are more likely to respond to duloxetine, according to a report in the March issue of Diabetes Care.
Reuters Health Information 2007

Radiofrequency Denervation Probe Recall
One pain management procedure, called radiofrequency denervation involves inserting a probe into your skin. Recently there has been a recall of 134 of these probes by one manufacturer. Read about the recall.

Massage Your Own Shoulders
Tight shoulder and neck muscles deserve a massage. For many people, one of the most tense and painful of neck muscles is the trapezius muscle. Here is a technique for massaging your own trap muscle. Try it right now --- and feel the tension in your neck and shoulder muscles just melt away!

Yoga for Back Pain - Free E-Course
My 6 day free E-Course can get you started on the basics with instructions, safety modifications and information on the benefits and potential dangers for 4 beginning poses. Each lesson will also contain short articles on related topics to give you the foundation you need to make your yoga practice safe and meaningful to your pain managment efforts.

Chronic Pain and Sleep
Approximately 2/3 of chronic pain sufferers experience sleep problems. When a chronic pain sufferer experiences fragmented sleep, a vicious cycle ensues - sleep disruption caused by chronic pain exacerbates the pain, which in turn interrupts sleeps. Compounding the problem is that some chronic pain medications tend to disrupt sleeping patterns.

10 Tips for Getting to Sleep with Chronic Pain
Chronic pain and sleep disruption often work together to create a viscious cycle. Sleep hygiene, or the habits around getting a good night's sleep, are simple suggestions that may make a big difference.

Getting Out of Bed Safely for Your Back
March 5-11 is National Sleep Awareness Week. Let's take a look at how to get out of bed in the morning in a way that protects your back.

Effective Communication Between Clinicians and Patients in Chronic Pain Management
Learn about ways to improve communication between clinicians and patients to help optimize outcomes in chronic pain management in this engaging video Spotlight.
Medscape Neurology & Neurosurgery 2007

Spinal Cord Stimulation May Treat Axial Low Back Pain
Researchers are reporting encouraging preliminary results with spinal cord stimulation to relieve axial back pain associated with failed back surgery syndrome.
Medscape Medical News 2007

Botulinum Toxin A Injections Possible Treatment for Refractory Headache Syndrome
A new study suggests that botulinum toxin A may be helpful in treating patients with refractory headache syndrome. A retrospective review showed reduction in the number and duration of headaches in patients with chronic migraines, daily headaches, and cervicalgia headaches who had failed conventional treatment.
Medscape Medical News 2007

Deep Brain Stimulation Improves Cervical Dystonia Over Long Term
Bilateral pallidal deep brain stimulation (DBS) shows favorable long term results in patients with persistent cervical dystonia, Canadian and US researchers report in the February 6th issue of Neurology.
Reuters Health Information 2007

Love Tips for Back Pain Sufferers
Back pain can be an intruder into your sex life and even ruin your relationship, if you are not careful. This article presents six things you can do to keep the love in your life when you suffer from back pain.

Fun Ways to Adapt Your Sex Life to Your Back Pain
Because of your back, you may find yourself in the position of having to accept the impossibility of being vigorous during sexual activity. A good strategy to keep enjoying sex despite back pain is to choose sensuality over sexuality. This can be accomplished by trying new activities and being open to new experiences.

Pain Sensitivity May Be Altered in Veterans With PTSD
Military veterans with posttraumatic stress disorder (PTSD) show reduced pain sensitivity compared with healthy controls, and altered pain processing may be responsible, according to findings from a functional imaging study.
Reuters Health Information 2007

Headache and Sleep Disorders: Review and Clinical Implications for Headache Management
Learn about the comorbidity of headache and sleep disorders, clinical implications for headache evaluation, and sleep screening strategies conducive to headache practice.

Relating to Pain
While in the Back and Neck Forum, I found this Chronic Pain Poem, which has been a hit with the forum's visitors. Can you relate? Tell us how by adding a comment or posting in the forum.

Overview of Treatment for Back and Neck Pain
Next to exercise, a multidisciplinary approach to back pain is rated (by Consumer Medical Reports) as the most effective treatment. To this end, I have written descriptions of some of the most common treatments for back and neck.

Yoga for Back Pain - The Cat-Cow Pose
The Yoga for Back Pain pose this month is the Cat-Cow Pose. As usual, Ann Pizer, About's Yoga guide shows us how to do the pose, and I have some statements to make about how and why the pose is good for your back and when it might not be so good.

Acute Hypothalamic Stimulation Not Effective for Ongoing Cluster Headache
Although long-term hypothalamic stimulation is effective in improving drug-resistant cluster headache, researchers report that stimulation did not effectively resolve acute attacks.
Medscape Medical News 2006

Dynorphin A Tied to Chronic Neuropathic Pain
The endogenous opioid dynorphin A can activate non-opioid bradykinin receptors, leading to neural excitation. This may be important in the maintenance of chronic pain, researchers report in the December issue of Nature Neuroscience.
Reuters Health Information 2006

Methadone-Related Fatalities Underscore Need for Careful Dosing
The US Food and Drug Administration (FDA) has warned healthcare professionals regarding reports of fatal and life-threatening respiratory depression and cardiac arrhythmias in patients newly receiving oral methadone HCl for pain control and those who switched to the drug after receiving other strong narcotics.
Medscape Medical News 2006

Living with Pain
Pain, great or small, has altered your way of life. If your back or neck condition is chronic, you may find yourself coming to terms with the fact that life...read more

The Middle Way: A Practical Approach to Prescribing Opioids for Chronic Pain
The use of opioids for nonmalignant chronic pain remains controversial. The authors of this Viewpoint discuss the complexities of opioid therapy and present a balanced approach to prescribing opioids.
Nat Clin Pract Neurol 2(11) 2006

Off-label Ketamine Use Studied for Pain Management
The investigators review the current evidence supporting the role of ketamine in pain management.
Medscape Pharmacists 8(2) 2006

Yoga for Back Pain
Yoga can be great for the back. For safety's sake, it is good to go into it with your eyes open, and by being prepared to ask questions of both your teacher and your doctor. Learn about selecting the appropriate style of yoga, what props can do and why yoga could be helpful for back pain

National Invisible Chronic Illness Week
People in chronic pain tend to be invisible -- What does that mean?

September is National Pain Awareness Month

What is Pain Medicine?
Healing Pain by Dr. Ann Berger. This book provides excellent insight into pain management, and, according to the author, offers a sure-fire program. Read the review.
A 2006 Mayo Clinic study on Acupuncture for Fibromyalgia showed promising results. Read the write up.
While about 15% of people experience sleep disturbance, The National Sleep Foundation and Spine-Health report that 2/3 of chronic pain sufferers experience sleep problems. What's up with Chronic Pain and Sleep Disturbance?
Tips for Getting to Sleep and Staying Asleep for chronic pain sufferers.
You may wonder, why does depression accompany my chronic pain?. Chronic Pain and Emotional Health may provide some answers for you.
The Dangers of Vicodin
Understand and Take Responsibility for Chronic Pain
Managing Chronic Pain Holistically

HIPAA and Your Medical Records - You Have Rights!
About's Headaches editor, Teri Robert is a patient advocate. Very often the articles she writes have applications wider than her topic alone. With the subject of back and...read more

Understanding the Low Back
The largest vertebrae are those that make up the low back. Why? To answer this question, you can think of the spinal column as analogous to a stack...read more

How To Take Personal Responsibility For Chronic Pain
Chronic pain does not behave according to the same rules as acute pain. Finding the cause of chronic pain can be difficult or impossible. Because chronic pain is elusive, often the patient is discounted or compromised in the process of diagnosis and treatment. It might take a patient months, if not years of doctors' visits to get a definitive diagnosis. Worse, the patient may be told that the pain is "all in your head", and be advised to "just deal with it". This article offers suggestions on how to effectively take responsibility yourself.

Botulinum Toxin A Not Effective for Myofascial Pain
Treatment with botulinum toxin A (BTXA) does not appear to be useful for chronic myofascial pain in the shoulder and arm.
Reuters Health Information 2006

Types of Neck Injuries
Some neck injuries are just bothersome, while others can be life-changing. This article provides general classifications and treatments of neck injuries.

Pramipexole May Decrease Fibromyalgia Symptoms
In a randomized trial, this dopamine 3 receptor agonist improved scores on assessments of pain, fatigue, function, and global status and was safe and well tolerated.
Medscape Medical News 2005

Daily Back and Neck Care Tips
Sign up and receive a free back care tip via e-mail every day! Tips will be on a variety of topics such as back pain, neck pain, chronic pain, prevention,...read more

Anti-Inflammatory Cytokine Levels Low in Patients With Widespread Chronic Pain
The transcription and expression of interleukin (IL)-4 and IL-10 appear to be reduced in patients with fibromyalgia and other chronic widespread pain conditions, a group of physicians in Germany report.
Reuters Health Information 2006

Peripheral Nerve Trauma Causes Chronic Pain by Protein Kinase G Activation
Chronic pain caused by peripheral nerve injury or inflammation is mediated by activation of protein kinase G (PKG) transcription, which in turn leads to long-term hyperexcitability, according to the results of an animal study conducted by researchers at the College of Physicians and Surgeons of Columbia University in New York.
Reuters Health Information 2006

IV Acyclovir Plus Oral Valacyclovir Helpful in Postherpetic Neuralgia
A two-week course of intravenous acyclovir followed by oral valacyclovir for a month helps most patients with postherpetic neuralgia, according to results of a phase I/II study published in the July Archives of Neurology.
Reuters Health Information 2006

Multiple Sclerosis
Statins May Help in MS by Curbing Leukocyte Migration Across Blood-Brain Barrier
Statins reduce the permeability of the blood-brain barrier (BBB) and restrict the migration of inflammatory leukocytes across it, and could thus be beneficial in multiple sclerosis, according to a report from Canada in the July Annals of Neurology.
Reuters Health Information 2006

Ten Tips for Preventing Back Pain
Preventing back pain may be the simplest way to deal with it. There are many things that can be done to prevent back pain. Here are 10 of them...

How to Do a Pelvic Tilt
Pelvic tilts are great for low back problems due to poor posture and muscle atrophy, and provide a starting point for spinal stabilization exercise programs.

Therapy Insight: Fibromyalgia---Different Type of Pain Needing A Different Type of Treatment
This Review describes a multimodal approach to treating this central pain syndrome, using neuroactive drugs that modulate sensory processing.
Nat Clin Pract Rheumatol 2(7) 2006

Tips for Maintaining an Already Healthy Spine
Simple things can work wonders when it comes to maintaining an already healthy spine. This is called preventative maintenance, and its equivalent is an old saying you may have heard: "An ounce of prevention is worth a pound of cure."

Causes of Poor Posture

Poor posture is a strong contributor to back pain, due to inherent muscle imbalance associated with it.

Advances in Neuropathic Pain
From APS 2006: Read reports of interest about neuropathic pain.
Medscape Neurology & Neurosurgery 2006

Pediatric Pain Highlights
From APS 2006: Read about new advances in pediatric pain.
Medscape Neurology & Neurosurgery 2006

Advances in the Pharmacologic Treatment of Chronic and Breakthrough Pain
From APS 2006: Read about new data in the treatment of chronic and breakthrough pain.
Medscape Neurology & Neurosurgery 2006

Coxibs Versus Combination NSAID and PPI Therapy for Chronic Pain: An Exploration of the Risks, Benefits, and Costs
Learn about studies qualitatively that compare the risks and benefits of cyclooxygenase-2 inhibitors relative to an alternative therapy of a nonselective nonsteroidal antiinflammatory drug combined with a proton-pump inhibitor and circumstances when coxibs may be appropriate.
Ann Pharmacother 40(6) 2006

Assessing Pain Intensity in Older Adults
Learn about the reliability and validity of self-assessment and observational pain scales in older populations with and without dementia.
Geriatrics Aging 9(6) 2006

Navigating Decisions in Neuropathic Pain
Explore the underlying mechanisms of neuropathic pain, and learn about the latest pharmacologic options for treating patients with postherpetic neuralgia and diabetic neuropathy.

Pain Assessment in the Nonverbal Patient: Position Statement With Clinical Practice Recommendations
Can you effectively manage pain in the elderly with advanced dementia, infants and preverbal toddlers, and intubated and/or unconscious patients? Learn more here.
Pain Manag Nurs 7(2) 2006

Spinal Stimulation Relieves Pain in Patients With Lower-Limb Ischemia
Spinal cord stimulation reduces pain and increases quality of life in hemodialysis patients with critical lower-limb ischemia, according to Italian researchers.
Reuters Health Information 2006

Alternative Medicine for Back and Neck Pain
Alternative medicine is big business these days. While "Buyer Beware" is always a good thing to take shopping with you, many alt med techniques have proven to be quite effective in some cases.

Self-Care & Back and Neck Pain - New ECourse
Interested in finding ways you can take care of your pain yourself? Hot off the press, is my new 6-week course that offers techniques, tips and ideas for taking charge of your pain. Caution - this may be self-empowering! Please note, the contents of the ecourse are general in nature and not meant in anyway to provide diagnosis or prescription. If you have a medical condition or injury, please seek your doctor's approval before trying the techniques presented.

DEA vs Effective Chronic Pain Treatment
A recent issue of Pain Medicine examines issues of balance between the Drug Enforcement Administration's (DEA) duty to combat drug abuse and physicians' responsibility to treat chronic pain. What do you think is the current state of affairs regarding this balance? To vote or view results of the poll, click on the title above.

May 10, 2006 � The US Food and Drug Administration (FDA) has approved safety labeling revisions to advise of the increased risk for toxicity associated with use of amoxicillin in elderly patients and others with impaired renal function; the potential for positive opiate screening results in patients receiving ofloxacin oral therapy; the risk for fetal harm associated with use of divalproex sodium-coated particles in capsules during pregnancy; and the risk for hyperammonemia with or without encephalopathy in patients treated with divalproex sodium who receive concurrent topiramate therapy.

Amoxicillin (Amoxil) May Be Linked to Risk for Increased Toxicity...

On January 26, the FDA approved safety labeling revisions for amoxicillin capsules, tablets, chewable tablets, and powder for oral suspension (Amoxil, made by GlaxoSmithKline) to warn of the increased potential for toxic reactions associated with its use in elderly patients.

Although an analysis of data from a study of 1811 patients (15% aged 61 years or older; 7% aged 71 years or older) and clinical experience have not identified differences between elderly and younger patients with respect to response to amoxicillin therapy, a greater sensitivity to the drug among older individuals cannot be ruled out.

Because amoxicillin is excreted substantially by the kidney, patients with impaired renal function may be at increased risk for toxic reactions. The FDA notes that elderly patients are more likely to have decreased renal function and caution should be used when administering amoxicillin in this population. Monitoring of renal function during therapy should also be considered.

According to the FDA, severely impaired patients with a glomerular filtration rate (GFR) of less than 30 mL/minute should not receive the 875-mg tablet. Patients with a GFR between 10- and 30 mL/minute should receive 250 or 500 mg (depending on infection severity) every 12 hours. In patients with a GFR of 10 mL/minute or less and those receiving hemodialysis, the dosing interval be extended to 24 hours.

Amoxicillin is indicated for the treatment of infections due to susceptible (only beta-lactamase�negative) strains of designated microorganisms. Applicable conditions include ear, nose, and throat infections; genitourinary tract infections, skin-skin structure infections; lower respiratory tract infections; and gonorrhea. The drug is also indicated for use with clarithromycin and lansoprazole to eradicate Helicobacter pylori infection, thereby reducing the risk for duodenal ulcer recurrence.

Ofloxacin (Floxin) Therapy May Cause False-Positive Results on Opiate Screening

On January 20, the FDA approved safety labeling revisions for ofloxacin tablets (Floxin, made by Ortho McNeil Pharmaceutical, Inc) to warn of an interaction with laboratory diagnostic testing associated with its use.

According to the FDA, some quinolones, such as ofloxacin, may produce false-positive urine screening results for opiates when using commercially available immunoassay kits. Confirmation of positive opiate screens by more specific methods is therefore advised.

Ofloxacin tablets are indicated for the treatment of various infections caused by susceptible Gram-negative and Gram-positive bacterial strains in adults aged 18 years and older. Applications include acute bacterial exacerbations of chronic bronchitis; uncomplicated skin-skin structure infections; nongonococcal urethritis and cervicitis; mixed urethral and cervical infections; acute pelvic inflammatory disease; uncomplicated cystitis; and complicated urinary tract infections.

Divalproex Sodium Capsules (Depakote) May Be Linked to Risk for Fetal Harm

On January 11, the FDA approved safety labeling revisions for divalproex sodium-coated particles in capsules (Depakote, made by Abbott Laboratories, Inc) to advise of the risk for teratogenicity associated with their use during pregnancy and against concomitant use of topiramate.

Divalproex sodium is a stable coordination compound comprised of sodium valproate and valproic acid in a 1:1 molar relationship.

Because valproate and valproic acid are linked to a potential risk for neural tube defects, its therapeutic benefit in women of childbearing age should be carefully weighed against the risk for injury to the fetus, particularly during the first trimester of pregnancy. The Centers for Disease Control and Prevention have estimated the risk for spina bifida in children exposed to these drugs during the gestation period to be approximately 1% to 2%.

Although other congenital anomalies (eg, craniofacial defects, cardiovascular malformations, and anomalies involving various body systems) have also been reported, their incidence remains unclear.

The FDA notes that consideration of divalproex sodium teratogenic potential is particularly important when contemplating its use for the treatment of a spontaneously reversible condition (eg, migraine) that is not usually associated with permanent injury or death.

The FDA also warned that concomitant administration of valproic acid and topiramate (Topamax, made by Ortho-McNeil Pharmaceutical, Inc) has been linked to a risk for hyperammonemia with or without encephalopathy in patients who have tolerated either therapy alone.

Clinical symptoms often include acute alterations in level of consciousness and/or cognitive function with lethargy or vomiting. In most cases, symptoms and signs abated with discontinuation of either drug.

According to the FDA, the adverse event is not related to a pharmacokinetic interaction, and it is unclear whether topiramate monotherapy is associated with hyperammonemia. Although not studied, it is possible that concomitant use of the drugs may exacerbate existing defects or unmask deficiencies in susceptible persons. Patients with inborn errors of metabolism or reduced hepatic mitochondrial activity may therefore be at increased risk for hyperammonemia.

The FDA recommends that hyperammonemic encephalopathy be considered in patients who develop unexplained lethargy, vomiting, or changes in mental status; measurement of ammonia levels is recommended in these cases.

Divalproex sodium is indicated as monotherapy and adjunctive therapy in the treatment of complex partial seizures that occur either in isolation or in association with other types of seizures. It is indicated as sole and adjunctive seizure therapy for simple and complex absence seizures and adjunctively in patients with multiple seizure types that include absence seizures. Divalproex sodium is not approved by the FDA for the treatment of migraines.

Topiramate is indicated as initial monotherapy for partial onset or primary generalized tonic-clonic seizures in patients aged 10 years and older; as adjunctive therapy for partial onset or primary generalized tonic-clonic seizures in adults and pediatric patients aged 2 to 16 years; for the treatment of seizures associated with Lennox-Gastaut syndrome in patients aged 2 years and older; and for migraine prophylaxis in adults.

http://www.fda.gov/medwatch/SAFETY/2006/jan06.htm

Challenging Perceptions in Chronic Pain
Review the clinical, social, and economic costs of chronic pain and how to treat it with medications such as the COX-2 selective inhibitors.

Fentanyl Effervescent Buccal Tablets in Patients With Chronic Pain
Learn about the features of fentanyl effervescent buccal tablets (FEBT) which are currently in development for chronic pain.
Medscape Neurology & Neurosurgery 8(1) 2006

The Use of IV Steroid Injection: IV steroid injection is a treatment used when a herniated disk causes severe sciatica. The IV injection reduces pain and inflammation. Sciatica is a common condition affecting around 40% of adults at some point in their lives. It is marked by pain down the leg, but might have one of several causes.

About the Study: Researchers from Brigham and Women's Hospital in Boston looked at the benefits of using an IV steroid therapy for pain and inflammation in sciatica cases. The sciatica cases they looked at were caused by disk herniations or bulging disks that caused pressure on a nerve root, which in turn caused leg pain. 65 patients were involved in the study. One group of patients recieved methylprednisolone, while the other received a placebo.

Pain Reduction Measurements: The researchers found that the improvement in pain offered by the IV treatment was minimal. Specifically, on a 100-point scale, patients reported an improvement of 6 points.

Length of Pain Relief : Furthermore, the pain was back in a few days. Researchers compared pain scores of patients recieving the injections with patients who received a placebo. After a few days, their pain scores were about equal.

Conclusions: Researchers concluded that IV steroid injections are not the best solution for sciatica.

Bibliography:
Intravenous Steroids of Little Help in Acute Sciatica. Newswise Press Release February 10, 2006. Retrieved from: http://www.newswise.com/articles/view/517944/?sc-dwtr. February 10, 2006.

Acupressure May Be More Effective Than Physical Therapy at Relieving Low Back Pain
In a randomized study, acupressure was effective in reducing low back pain in terms of disability, pain scores, and functional status for up to 6 months.
Medscape Medical News 2006

Chronic Pain Linked to Spontaneously Firing C-Fiber Pain Receptors
Chronic neuropathic and inflammatory pain likely result from spontaneous firing of intact C-fiber nociceptors, according to a report in the January 25th issue of The Journal of Neuroscience.
Reuters Health Information 2006

Viewpoint: Pain Management Often Inadequate
A new study reveals a wide variety of prescribing patterns that can leave patients vulnerable to unnecessary pain.
Medscape Pharmacists 7(1) 2006

A Pilot Study Evaluating Mindfulness-Based Stress Reduction (MBSR) and Massage for the Management of Chronic Pain
The authors show that it is feasible to study MBSR and massage in patients with chronic musculoskeletal pain and that MBSR may be more effective and longer-lasting for mood improvement while massage may be more effective for reducing pain.
J Gen Intern Med 20(12) 2005

The Impact of Whiplash
The effects of whiplash are influenced by the laws of physics. Researchers disagree, however, upon the effects of whiplash when the victim's head is turned at the moment of impact.

Novel Aldose Reductase Inhibitor Controls Diabetic Neuropathy
The aldose reductase inhibitor ranirestat (AS-3201) has long-term beneficial effects on peripheral nerve function in patients with diabetic sensorimotor polyneuropathy, according to results of a 60-week study.
Reuters Health Information 2006

Transdermal Fentanyl Provides Safe, Effective Opioid Alternative for Children
A single-arm, open label trial, conducted at 66 international centers, has demonstrated the safety and tolerability of transdermal fentanyl in children with chronic pain. The agent also showed sustained efficacy during a study extension period, investigators report in the December issue of Cancer.
Reuters Health Information 2006

Exercises for Low Back Pain Should Often Match the Patient's Directional Preference
Patients with low back pain should be trained in exercise that matches their directional preference, according to the results of a multicenter, randomized trial published in the Dec. 1 issue of Spine.
Medscape Medical News 2004

Consciously Controlling Brain Activation May Reduce Pain Perception
Using real-time functional MRI (rtfMRI), subjects can be trained to consciously control activation of localized regions within the brain, and as a result control their perception of pain, results of a pilot study suggest.
Reuters Health Information 2005

Pain Meds --- Safely!
For 10 tips on using pain medication safely, Read on......read more

Intradiscal Electrothermal Therapy May Be Ineffective for Back Pain
Intradiscal electrothermal therapy (IDET) is not better than sham for chronic discogenic low back pain, (CDLBP) according to the results of a randomized, double-blind trial reported in the Nov. 1 issue of Spine.
Medscape Medical News 2005

COX-2 Inhibitors and Other NSAIDs Increase Mortality in Acute MI Patients
Post-MI patients should not use COX-2 inhibitors and they should use nonsteroidal anti-inflammatory drugs only at low doses, according to a large analysis of registry data.
Medscape Medical News 2005

Transdermal Fentanyl Effective for Pediatric Pain Patients
A study shows that a transdermal patch delivering the opioid fentanyl is a safe and effective way to control moderate to severe chronic pain in children aged 2 and older with previous exposure to opioid therapy.
Reuters Health Information 2005

The Recognition and Management of Noncancer Breakthrough Pain
Breakthrough pain is an important clinical problem that has not been well characterized in noncancer patients with chronic pain, and questions remain about appropriate treatment. In this archived Webcast from the live event that was held on Monday October 31, Drs. Donald Taylor and Lynn Webster discuss the prevalence and characteristics of breakthrough pain in noncancer patients and its management.

How do I get rid of this pain?
My Pain Management Overview offers a collection of articles, resources, news updates and more about pain management from a variety of approaches. Explore and choose the best one(s) for you.

Ours is the Decade of Chronic Pain Control and Research
Did you know that we are in the midst of the Decade of Pain Control and Research? About's Headaches and Migranes editor has the scoop, along with information about chronic pain to help build awareness of this issue....read more

Chronic Arthritis Impairs Pain Control Mechanisms
Murine studies indicate that chronic arthritis downregulates the expression of receptors that play a key role in pain control, Canadian researchers report in the October issue of Arthritis & Rheumatism.
Reuters Health Information 2005

Reducing the Public Health Burden of Herpes Zoster and Postherpetic Neuralgia
Learn about the epidemiology, natural history, and clinical manifestations of herpes zoster, examine the effects of herpes zoster on older patients, and evaluate vaccine-based preventive strategies currently in clinical development.

Preemptive Pudendal Nerve Blockade Provides No Additional Benefit
Pudendal nerve blockade administered prior to transvaginal pelvic reconstructive surgery did not diminish postoperative pain intensity or the consumption of narcotic analgesia.
Medscape Medical News 2005

Running May Reduce Muscle Pain Associated With Aging
In a prospective, longitudinal study, physically active seniors had about 25% less musculoskeletal pain than did more sedentary controls.
Medscape Medical News 2005

Analgesic Use Does Not Raise Hypertension Risk
Regular analgesic use does not seem to increase the risk of subsequent hypertension, according to a report in the September 12th issue of the Archives of Internal Medicine.
Reuters Health Information 2005

An Approach to the Evaluation of Peripheral Neuropathies
This article presents an approach to the often challenging clinical evaluation of peripheral neuropathies that is based on a structured assessment with a series of yes/no questions.
Semin Neurol 25(2) 2005

Over-The-Counter Pain Killers and Women
The Nurses' Health Study at the Brigham and Women's Hospital in Boston was released this week and indicates that daily long term use of over-the-counter pain killers by women increases their risk of high blood pressure. Aceaminophen and Ibuprofen were especially implicated in the results, while asprin seems to be safe. Read about the study.

The Healing Powers of Ice
What can you do to reduce pain, and contain the effects of an acute injury? Generally, ice is recommended immediately after a trauma. Ice also works well for many in later healing phases of an injury. About's Orthopedics Editor, Jonathon Cluett, MD offers the correct technique to ice an injury.

Study Shows a Gene that Enhances Mobility in Seniors
"Use it or lose it" is a commonly heard phrase, and pertains well to exercise as key in maintaining health as we age. Well, a recent study showed that some exercising seniors are granted extra help in the process of...read more

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		Back and Neck Injuries Chronic Pain Athletes' Issues with Back and Neck Injury and Chronic Pain Children's Issues with Back and Neck Injury and Chronic Pain Seniors' Issues with Back and Neck Injury and Chronic Pain Family & Friends New Treatments

The First Resorbable Implant for Neck Surgery
Yesterday Medtronic, a leading medical device manufacturer, announced it has a new type of implant on the market. This implant, called the Mystique is resorbable. What this means is that once the bones have fused, the implant dissolves. The...read more

A Vioxx Timeline
Well, the first case involving Vioxx and its cardiovascular side effects have been decided. About's Arthritis editor, Carol Eustice, has written a thorough and provocative article detailing the case. I thought it might be useful for you to have a...read more

		More Topics
		Diagnosis of Back and Neck Injuries and Chronic Pain Treatment and Medication for Back and Neck Injury and Chronic Pain General Health and Back and Neck Injury and Chronic Pain Exercise, Sport, Recreation and Fun Alternative Medicine for Back and Neck Injury and Chronic Pain Pain Management Attitude

One Way to Avoid Neck Pain
Everything in the body is connected to everything else. This means when one part moves, there is a chain reaction, or rippling effect throughout structures adjacent to it. Keeping that in mind, the shoulder joint is related to the neck and might affect the amount of felt pain. Read more...

The Use of Implants in Neck Surgery
This week Medtronic, a leading medical device manufacturer, announced it has a new type of implant on the market. This implant, called the Mystique � is resorbable. What this means is that once the bones have fused, the implant dissolves. The patient is no longer stuck with the device in his or her neck for the rest of their life. The Mystique � is also transparent, making it easier for doctors to see what they are doing when they perform the procedure, as well as to read the post operative X-rays. Ane, the Mystique can be shaped to fit the patient's unique bone anatomy.

Here is some background information about neck surgery and implants:

	from Anne Asher Greetings! This week: Prolotherapy Neck Injuries What to do if you are Involved in a Car Crash (I hope you're not!!!) To Your Health -- Anne

In the Spotlight

Prolotherapy
A reader wrote to me about my latest article on injection therapy, reminding me that there is a 5th, highly effective type of injection called Prolotherapy. Prolotherapy is used for weakened ligaments. Although I did not mention prolotherapy in my...read more

		More Topics
		Back and Neck Injuries Chronic Pain Athletes' Issues with Back and Neck Injury and Chronic Pain Children's Issues with Back and Neck Injury and Chronic Pain Seniors' Issues with Back and Neck Injury and Chronic Pain Attitude Family & Friends

Common Types of Neck Injuries
Neck injuries can be broadly classified by type of tissue and severity of injury. I have made a brief but informative overview of the types of neck injury so you can begin to discern what you may be feeling. Keep in mind that if you are experiencing symptoms, it is advisable to have them checked by a qualified physician, as this information is just that, information. It is not meant as a diagnosis or treatment in any way.

How to Protect Yourself Legally and Medically in the Case of a Car Accident
Knowing what to do in the case of a car accident is one of those things you wished you had investigated before the event. Unfortunately, most of us are not properly motivated to learn how to protect ourselves legally and...read more

Meditation and Chronic Pain
Many people use the practice of meditation to reduce, minimize or eliminate their chronic pain. This week, About's Chronic Fatigue Syndrome / Fibromyalgia editor, Pamela Rice Hahn, offers some suggestions to try when meditating in her article, Meditation and Pain...read more

Changes in the Meaning of Pain with the Use of Guided Imagery
Interest in the use of guided imagery for chronic pain has increased over the past two decades. In this study, the authors determined how verbal descriptions of pain changed with the use of a guided imagery technique.
Pain Manag Nurs 6(2) 2005

thumbnail Short-Term Acupuncture May Decrease Symptoms of Knee Osteoarthritis
In a randomized study, pain and joint function improved more with eight weeks of acupuncture than with minimal acupuncture or no acupuncture, but the benefit decreased over time.
Medscape Medical News 2005

Several Drugs Can Reduce Postherpetic Neuralgia Pain, Review Finds
Results of a meta-analysis suggest that tricyclic antidepressants, "strong" opioids, and gabapentinoids are effective in relieving pain of postherpetic neuralgia, British investigators report.
Reuters Health Information 2005

Long-term Effect of a Combined Exercise and Motivational Program on the Level of Disability of Patients With Chronic Low Back Pain
In this study, a combined exercise and motivation program was superior to a standard exercise program in patients with chronic and recurrent low back pain.
Spine 29(9) 2005

The Lumbar Spine
The low back is located in the physical center of the body. Because of this its responsibilities are great. All forces of motion transmit to the low back. The spine in the low back area is built to take the load and support the body in movement. Walk through The Lumbar Spine to see how all this works...

3 Non-Invasive for Head and Neck Pain
Sometimes simple is better. This can be true when headaches and neck and shoulder pain are caused by tight muscles. A few simple, focused non-invasive techniques may helpful in melting away the tension.

Diagnosis of Back and Neck Injuries and Chronic Pain

Treatment and Medication for Back and Neck Injury and Chronic Pain

General Health and Back and Neck Injury and Chronic Pain

Exercise, Sport, Recreation and Fun

Alternative Medicine for Back and Neck Injury and Chronic Pain

Attitude

Family & Friends

Biovail's Oral Pain Drug Wins FDA Approval

TORONTO (Reuters) May 06 - Biovail Corp., Canada's largest publicly traded drugmaker, said on Friday its oral version of the painkiller tramadol had won approval from the U.S. Food and Drug Administration.

The approval for Tramadol ODT in a 50-mg dose comes about four months after an FDA request to resolve labeling issues, including packaging content and format for the product's carton.

The drugmaker said it is in late-stage discussions with potential partners to commercialize the drug, which is made using Biovail technology that helps those who have difficulty swallowing tablets or who do not always have access to water.