With CRPS, pain emerges as the result of a previous trauma, but instead of healing over time, it becomes worse. To make things even more complicated, you begin to experience a range of additional symptoms, such as skin discoloration and sensory changes. Complex regional pain syndrome (CRPS) is excruciating and difficult to cope with. Fortunately, researchers continue to make progress as they search for potential new treatments for CRPS.

What is CRPS?

Complex regional pain syndrome (CRPS) is a chronic pain and sensory condition. In most cases, it affects the arms and legs after nerve damage occurs. This is classified as CRPS-II. The nerve damage causes the brain to send confusing and incorrect signals that lead to debilitating pain. While every case is different, CRPS typically develops after an injury, surgery, stroke, or heart attack.

Patients without a confirmed nerve injury are said to have CRPS-I, previously known as reflex sympathetic dystrophy syndrome (RSD). However, some research points to evidence of nerve injury in CRPS-I patients, which makes these classifications tricky. Because of this, some medical experts believe CRPS won’t be classified into two separate types in the future.

While burning and throbbing pain is the main symptom of CRPS, it can come with many other symptoms, including:

• Swelling of the area
• Sensitivity to touch or cold
• Skin temperatures changes
• Skin color and texture changes
• Muscle spasms
• Joint stiffness
• Changes in nail and hair growth
• Difficulty moving the affected area

Every case of CRPS is different. Symptoms may come and go or change over time. For some patients, the condition will go into remission. But others will experience intense pain and other symptoms for months or even years to come.

Who can get CRPS?

Because CRPS is related to nerve damage, it can affect men and women of all ages.

However, it is most common in women around the age of 40. It is incredibly rare to see CRPS in elderly people and children under the age of 10.

How is CRPS diagnosed?

At this point in time, there is no test that provides a clear CRPS diagnosis. Your doctor will evaluate your symptoms, as well as your medical history. This will include a close look at pre-existing health conditions, surgeries, medical procedures, and any injuries.

The symptoms of CRPS are similar to other conditions, such as arthritis, generalized muscle diseases, and even Lyme diseases. What sets CRPS apart from these is the correlation between symptoms and an injury to the affected area. Your doctor may perform certain tests to rule out these types of treatable conditions in order to confirm a CRPS diagnosis.

What are common CRPS treatments?

Researchers have discovered that treatment is most effective when started as early as possible. Your doctor will work to find a combination of treatment options for your specific case. These may include:

• Over-the-counter pain relievers
• Antidepressants and anticonvulsants
• Nerve blocks
• Intravenous ketamine
• Physical therapy
• Transcutaneous electrical nerve stimulation (TENS)
• Biofeedback
• Spinal cord stimulation
• Botulinum toxin (Botox) injections
• Topical local anesthetic creams and patches, such as lidocaine

5 new treatments for CRPS pain and symptom management

Unfortunately, there is currently no cure for CRPS, but doctors and scientists continue to research the condition.

Here is some of the cutting edge research into new treatments for CRPS, or the potential for new ones in the future.

1. Deep brain stimulation (DBS) for chronic pain shows promise

Deep brain stimulation (DBS) is a surgical procedure that involves implanting electrodes in the brain. These electrodes deliver electrical impulses that block or change the abnormal brain activity causing pain.

Previously, doctors have taken an analgesia-based approach, which is the inability to feel pain. However, a study conducted at Cleveland Clinic found that shifting the focus to areas of the brain that control emotion and behavior could provide better results. By manipulating the affective sphere of the brain, some patients will experience improved quality of life or relief from pain-related disability.

Read more: https://consultqd.clevelandclinic.org/first-randomized-controlled-trial-of-dbs-for-chronic-pain-shows-promise/

2. Study of the immunological causes for CRPS reveals possible treatment option

International researchers from across Europe came together to conduct a study into the immunological causes for CRPS. They looked at inflammation in the brain, especially when it comes to inflammatory mediators (messengers that act to promote a response).

One of these mediators is referred to as Interleukin (or IL-1). While it’s known to induce body responses for repair, there are a number of conditions in which IL-1 production seems to be partially to cause for the disease.

In this study, researchers transferred the antibodies from patients with CRPS to mice and found that these antibodies caused a CRPS-like condition. An important element of transferred CRPS was inflammation in pain-related parts of the mouse brains. The team found that by blocking IL-1 with a drug called anakinra, they could both prevent and reverse these changes in the mice.

According to Dr. Andreas Goebel of the University of Liverpool’s Pain Research Institute, the results support previous observations that patients with persistent CRPS should respond well to immune treatments.

Read more: https://medicalxpress.com/news/2019-06-treatment-option-complex-regional-pain.html

3. Regenerative therapy case studies demonstrate the possibility of improved function

While regenerative therapy still requires more research and study, it has been promising in several case studies involving pain. A recent controlled study showed the effectiveness of platelet-rich plasma in carpal tunnel syndrome. The goal is to allow for self-healing by exposing injured tissue to a high volume of growth factors.

In one particular case of CRPS out of Colorado, a family nurse practitioner suffered an injured nerve on the top of her hand after an IV start. This resulted in severe pain, as well as an inability to use her hand due to the onset of CRPS.

She visited Dr. Chris Centeno, MD of Centeno-Schultz Clinic and agreed to have platelet lysate carefully injected around the nerve to break up scarring. This allowed nerve function to improve about a month after the procedure. She reported continued improvement over the entire course of her treatments. Though it’s an isolated case, it may show the potential for more research into this treatment approach.

Read more: https://regenexx.com/blog/new-treatments-for-crps-ivys-story/

4. Identification of autoantibody response in complex regional pain syndrome

Using a mouse model of CRPS, several researchers from the Veterans Affairs Healthcare System worked to identify autoantigens in the skin of an affected limb. An autoantigen is usually a normal protein or protein complex that is instead recognized by the immune system of patients suffering from a specific autoimmune disease.

The results of the study stated:

“In addition to increased abundance, KRT16 demonstrated autoantigenicity, since sera from both fracture mice and CRPS patients showed increased autoantibody binding to recombinant kRT16 protein.”

Researchers say this is a critical step towards towards redefining CRPS as having an autoimmune set of causes. It may even pave the way for more mechanism-based therapies.

Read more: https://www.semanticscholar.org/paper/Identification-of-KRT16-as-a-target-of-an-response-Tajerian-Hung/65ece7a403e178af97be66ac19367c7ddf0970ff

5. Neridronate approved as a treatment for type I complex regional pain syndrome in Italy

Neridronate was recently tested as a treatment for CRPS-I in a randomized, double-blind, placebo-controlled trial. Approximately 82 patients with CRPS-I in either the hand or foot were randomly assigned. Some received either an intravenous infusion of 100 mg of neridronate every three days (for a total of four times) or the placebo.

In the double-blind phase, the visual analog scale (VAS) for pain was significantly lower in the neridronate-treated group after 20 days of treatment. It continued to decrease for the following 20 days. Pain induced by passive motion, as well as increased sensitivity were significantly reduced in patients who were treated with neridronate compared to the placebo group.

Read more: https://journals.sagepub.com/doi/full/10.1177/1179559X17732971

The future of CRPS research

Doctors and scientists all over the world continue to research every facet of CRPS in order to better understand the condition, and in turn, find a cure. These are some of the studies that we can expect to learn from in the coming years.

Clinical evaluation of the effects of mirror therapy

Patients with CRPS-I will undergo a study at the Department of Physical Medicine and Rehabilitation, Hand Rehabilitation Unit at the Medical Faculty of Ankara University. The purpose is to research the clinical effects of CRPS alternative treatments, specifically mirror therapy.

Patients will be split into two groups (the mirror group and control group). The mirror group will receive mirror therapy for 30 minutes per day in addition to routine treatment. Mirror therapy will include several different flexing exercises, as well as various object grasping activities according to the status of the patient’s hand functions. Each patient will undergo a total of 20 sessions.

Every patient participating in the study will be assessed before and immediately after the treatment, as well as one month after the trial. Each assessment will include pain severity, grip strength, lateral pinch strength, hand circumference measurements, hand dexterity, hand function in daily living activities, and health-related quality of life.

Read more: https://www.centerwatch.com/clinical-trials/listings/187499/complex-regional-pain-syndrome-type-i-clinical-evaluation-effects-mirror/

Investigations of pathophysiology of dystonia and CRPS

Dystonia is a movement disorder in which a person’s muscles contract uncontrollably. The purpose of this study is to understand why people with CRPS often develop dystonia, and if these reasons are different in people with focal hand dystonia.

This detailed study will require participants to either stay at the clinical center for five or six days or have several different outpatient visits.

During testing, participants in the study will undergo MRI scans and transcranial magnetic stimulation (TMS) sessions. Participants with the ability to determine two separate stimuli as different will be tested by using a weak electrical shock to their fingers. They will also be asked to feel small plastic domes with ridges.

Read more: https://clinicalstudies.info.nih.gov/ProtocolDetails.aspx?A_17-N-0126.html%20@External@CRPS#eligibility

Low-dose naltrexone treatment for CRPS

Stanford Medicine’s Systems Neuroscience and Pain Lab is conducting a study sponsored by the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA).

They believe there is significant evidence to suggest that the FDA-approved drug naltrexone can effectively treat certain types of pain, fatigue, and sleep disorders (in low doses). This will be the first official study of the effectiveness of LDN as a CRPS treatment medication.

Participation will last 14 to 28 weeks and gives patients an opportunity to receive LDN treatment at no cost. The study will require up to five in-person visits to Stanford, as well as weekly questionnaires and daily pain scores.

Read more: https://med.stanford.edu/pain/snapl/current-studies/crps.html#about_the_study

Learn more about new treatments for CRPS

The medical field is always changing. New technology and breakthroughs come as a result of years-long studies and research. If you’re living with CRPS, the best way to learn more is to work with a pain specialist.

At Arizona Pain, our team stays up-to-date on CRPS news and cutting edge techniques in pain relief. We have extensive experience working with patients who are experiencing chronic pain from CRPS. Our comprehensive approach allows us to tackle your pain from every angle.

Contact us to find out how we can help alleviate your symptoms through new treatments for CRPS.

Red light therapy is a non-invasive therapy that claims to help treat everything from chronic pain to acne on a cellular level. Also known as low-level laser therapy (LLLT), low-power laser therapy (LPLT), and photobiomodulation (PBM), red light therapy may be a good solution for complex health issues. But what is red light therapy really, and how does it work?

What is red light therapy?

Red light therapy is simple in both theory and practice. Our bodies require light to function well. This light is delivered naturally by the sun, of course. In some cases, a more concentrated version of certain types of light can be highly beneficial.

In red light therapy, safe, low concentrated wavelengths of red and near-infrared light is focused on the body. This can be done as a whole-body treatment or only in targeted areas. The natural red light painlessly penetrates the skin and moves into the body.

In theory, it works due to your body’s use of adenosine triphosphate (ATP).

Once the red light passes through the skin, the mitochondria (part of every cell) absorbs it and begins to produce more ATP. This ATP provides energy for every cell in your body. The extra production of ATP may increase each cell’s ability to do its job. Cells store the ATP for when they need a quick burst of energy—much like a bank holds your money until you need to use it. When ATP production slows, cells have a harder time functioning because they don’t have enough energy to function. Red light therapy can help theoretically fill up a cell’s bank so that energy is available when needed.

This burst of ATP has many potential positive responses in the cells. Cells are able to repair and rebuild more easily, with free movement of oxygen and other fluids. In addition, signaling pathways from cells are opened, which may stimulate healing and trigger an anti-inflammatory response.

History

While you cannot get red light therapy benefits from simply swapping out the lightbulb at your desk, the treatment is now available in a variety of venues, from gyms and spas to your own home.

This therapy has only been around for the past 50 years (since lasers were invented), but the therapeutic use of light in not new. The use of light to “balance the four humors” has been around since antiquity. In 1903, the Nobel Peace Prize in medicine was awarded to Niels Ryberg Finsen for his work with artificial light in therapeutic settings.

So, the color may have changed, but the practice of using light goes back to the 8^th century BCE. Today, red light therapy is gaining attention as a potential treatment option for a wide variety of conditions and symptoms.

What are red light therapy benefits?

This therapy seems to target many conditions that are caused by either local or systemic inflammation. Today we recognize light therapy as treatment for the following conditions:

• Rickets
• Psoriasis
• Lupus
• Vitiligo
• Fungal infections
• Eczema
• Sleep disorders
• Emotional well-being and mental health

Consider the following study results.

• For wound healing, red light therapy results include reducing inflammation and stimulating the formation of new blood cells
• Patients with acne see their pores unblocked, inflammation reduced, and skin rejuvenated
• Red light therapy reduces muscle fatigue and soreness and improves recovery time

It also works to improve the health of the skin by:

• Increasing collagen production
• Protecting the cells from further damage
• Improving overall circulation

Red light therapy research is even beginning to build up a body of research for a number of chronic pain conditions.

Red light therapy for fibromyalgia

When using red light therapy for fibromyalgia, the research is mixed. All researchers agree that fibromyalgia pain is complex and challenging to treat. One review of studies in 2018 found that when using red light therapy over a long period of time, patients saw a reduction of pain and restored function. This occurred especially when therapy was focused on trigger points.

Small-scale studies have had positive results, including:

• Relieving pain and improving quality of life
• Improvement of all fibromyalgia symptoms

Other studies are ongoing, but with the low risk of side effects, it seems that red light therapy for fibromyalgia is promising. Adding red light therapy for fibromyalgia is not associated with a risk of side effects. It can be a safe addition to other forms of treatment.

Red light therapy for chronic pain

The U.S. Food & Drug Administration has approved red light therapy for treating minor pains (including arthritis). There is also some evidence that it helps with multiple chronic pain conditions.

Osteoarthritis is a common, wear-and-tear form of arthritis that affects older adults. This condition usually progresses over time and can impact a person’s quality of life. A study in 2014 found red light therapy offered a significant reduction of pain and improvement in function short-term.

For rheumatoid arthritis (another progressive and painful inflammation of the joints), red light therapy reduced pain and improved function in 70% of participants. This result was found in a meta-analysis of 13 research trials. The meta-analysis did note, however, that there was no significant discussion of how the placement, duration, wavelength, and frequency of treatment affected these results.

When it comes to common chronic pain conditions, lower back pain patients may also benefit from this approach. Another randomized, controlled trial of red light therapy addressed this as a treatment option. Over a period of seven weeks, researchers found that the treatment reduced back pain without any adverse effects.

It is clear that some people have received tremendous benefit from this treatment. It is equally clear that more research is needed in this newer avenue of pain management.

How does red light therapy work?

Red light therapy is a complementary therapy that can be a positive addition to other treatments for a variety of conditions.

Read on to learn more about how it works, what to expect during treatment, and answers to other frequently-asked questions.

What is the basic mechanism behind this therapy?

As mentioned above, the mitochondria of your cells, sometimes called the “energy generators,” soak up the rays of the red light. They use this light to then create more energy in a cycle that can help with healing and rejuvenation of tissues and other cells that create them.

Red light therapy actually increases the number of mitochondria as well. In theory, more mitochondria storing more energy promotes more healing.

What types of red light therapy are there?

There are two particular wavelengths of red light therapy—660 nanometers and 850 nanometers—that seem to produce the best result.

How do you receive red light therapy?

Red light therapy can be delivered in one of three ways:

1. Lamp or panel of lights
2. Special device
3. Laser with a red light

The main consideration is that the wavelength is of sufficient strength to be therapeutic. In other words, tanning salons that put a red light bulb in their tanning beds and market them as “antiaging” may not be the best place to receive therapy. Look instead for specially-engineered devices.

Does red light therapy hurt?

Red light therapy delivers light in such a low amount that it does not hurt. There are no UV rays present, so the risk for burning is also not present.

However, concentrating light too close to the skin for a prolonged period of time can be painful.

Can red light therapy be used on its own?

At this point, the consensus seems to be that this therapy is a great addition to a comprehensive treatment plan for the targeted condition, but not a primary treatment.

For example, if you suffer from fibromyalgia, you might receive red light therapy in addition to making changes to your diet, exercising, and taking medication.

Is red light therapy covered by insurance?

Because this treatment is relatively new, most insurance companies do not offer even partial coverage. When it is used as a treatment for skin conditions, your dermatologist may be able to get partial coverage. They can at least ensure your payment goes towards your deductible.

When received in medical settings, each treatment generally costs between $25 and $85 dollars. At-home options cost anywhere from $50 to $250.

How often should I get red light therapy?

Each therapy session lasts about 20 minutes. Most providers recommend ten, 20-minute sessions once a week for ten weeks. They then recommend follow-up sessions every few months.

Your exact treatment plan may differ, depending on the condition being treated and any other treatments you are receiving.

Is red light therapy safe?

As with all treatments, the key question (beyond, “what is red light therapy?”) is whether or not the treatment is safe. The main concern with red light therapy is dosage. Too much light on the skin can eventually cause damage to the tissues, but too little is not effective.

If you are treating yourself at home with red light therapy (more on that below), there is always the risk of using the light improperly. This can result in damage or burns to skin. In the case of red light therapy delivered by laser, damage to the eyes is of slight concern.

The best way to protect yourself against the minimal risk of side effects is to either receive red light therapy in a medical setting or to get assistance from your doctor when you begin treatment. They can advise you on which type of equipment to buy and how to use it safely.

How to get started with red light therapy

Your first therapy session starts when you find a skilled provider. Start with your doctor or pain specialist to see if they have any recommendations for you.

A quick “red light therapy near me” search can also help. This will help you locate spas, integrated health centers, and dermatologists who offer this service near you. Take care to read any online reviews and ask friends and family for recommendations before booking an appointment.

At your appointment, you may have an intake period you’ll discuss information about your condition and any treatments. If your provider is a pain specialist, they will review your diagnosis and ask questions about any current symptoms.

This therapy is administered in a couple of different ways, depending on the area targeted. You’ll either lie down under the lights or your provider will use a lighted wand over the treatment area. You may need to adjust your clothing to access the treatment area, but you won’t generally need to disrobe.

At-home red light therapy

If you’d like to try red light therapy at home, the first thing you need to do is to acquire a tool to deliver the red light.  Again, check in with your doctor for recommendations first.

The internet offers many different reviews of red light therapy products, which can also be helpful. You have lots of choices, from handheld wands to full-body panels that can be hung on the back of a door.

Keep in mind the following guidelines when selecting your at-home device:

• Include protective goggles no matter what device you buy (and make sure to wear them!)
• Look for wavelengths of 650 and 850 nanometers
• Read and follow all manufacturer’s guidelines

It can be helpful to keep a symptom tracking journal when you begin a new treatment plan as well. This is especially true for treatments administered at home.

Learn more

We hope this has helped answer the question, “What is red light therapy?” for you. At Arizona Pain, we see red light therapy as another tool in our integrated, comprehensive approach to helping you get your life back from pain.

Get in touch today to schedule your first appointment!

Your immune system is a complex system that is responsible for fighting off infections, bacteria, and viruses. As we continue to respond to the ongoing COVID-19 pandemic, the effects of pain on the immune system is an important topic. Unfortunately, data shows that those with compromised immune function are more likely to contract the virus and experience severe symptoms that could be fatal. With this in mind, it’s important to understand the connection between chronic pain and your immune system.

Does pain lower immune system response?

Chronic pain is defined as ongoing pain that lasts more than six months. In many cases, it continues long after the initial injury or illness that prompted the pain has healed. This type of pain can make your everyday routine feel difficult, if not impossible. This often leads to depression and long-term increased levels of stress.

When you’re in a state of constant stress, cortisol levels in the body tend to rise, which can lead to a decline in immune system function. This may cause you to be more susceptible to unpleasant side effects and a range of different illnesses. In addition, research shows that chronic pain may actually have a significant impact on your genes and how they work in regards to immunity.

Fortunately, you can help combat the effects of pain on the immune system with some lifestyle changes. It doesn’t take much to boost your immunity and increase your chances of staying healthy. Read on for important tips that may help you boost your immune system every day after we discuss some of the latest research on pain and the immune system.

What are the effects of pain on the immune system?

Despite tremendous efforts to find breakthrough treatment options, there are still thousands of people who suffer from ongoing pain. In fact, chronic pain is one of the most common causes of disability worldwide.

In order to better understand the effects of pain on the immune system, scientists continue to conduct extensive research on how to help this population. Here is what we know so far.

Chronic pain changes our immune systems

Chronic pain may reprogram the way genes work in the immune system, according to a study by McGill University.

The team examined DNA from brains and white blood cells of rats using a method that mapped DNA marking by a chemical called a methyl group. Methyl marks are important for regulating how these genes function. This sort of chemical marking is part of the growing field of epigenetics, which involves modifications that turn genes on or off, reprogramming how they work. Researchers were surprised to find a number of genes that were marked by the chronic pain. In fact, hundreds to thousands of different genes were changed.

“We found that chronic pain changes the way DNA is marked not only in the brain but also in T cells, a type of white blood cell essential for immunity,” says Moshe Szyf, a professor in the Faculty of Medicine at McGill. “Our findings highlight the devastating impact of chronic pain on other important parts of the body such as the immune system.”

Fortunately, the findings in this study could lead to new ways of diagnosing and treating chronic pain. For example, some of the genes found to be marked by chronic pain could become new targets for pain medications.

Link between immune function, osteoarthritic pain and progression

According to McMaster University researchers, the immune system plays an important role in the amount of pain and disease progression experienced by patients with osteoarthritis (OA).

The study found that monocytes, the white blood cells necessary to regulate immune responses, were more activated and pro-inflammatory in women with osteoarthritis. In addition, elevated inflammation and body mass index were associated with this increased activation. When compared with a control group of 22 women of the same age without OA, this combination resulted in increased pain and progression of knee osteoarthritis.

“It is the first study, to our knowledge, to specifically characterize changes in circulating monocytes in individuals with OA compared to healthy women,” said senior author Dawn Bowdish, a professor of pathology and molecular medicine at McMaster, and member of the McMaster Institute for Research on Aging.

The immune-suppressive effects of pain

In this larger collection of studies, researchers studied immune-suppressive effects of painful experiences in both humans and animals.

Stressors such as foot shock and tail shock can provoke pain without tissue damage in rats. The result has been diminishing immune functions, including mixed lymphocyte reactions in lymph node cells.

In humans, surgery has been known to result in immune suppression as well. The invasiveness of the surgery has been associated with the magnitude of immune suppression. Due to the crucial role played by the immune system in maintaining health and resisting infection and disease, this reflects the importance of pain management.

How to boost your immune system

While these studies do indicate a significant relationship between chronic pain and the immune system, it’s not all bad news. There are many ways to naturally strengthen your immune system every day.

By boosting your body’s natural defenses, you will have a better chance at fighting off infections and viruses, regardless of whether you’re dealing with chronic pain. Note, however, that these natural remedies can and should never take the place of your doctor’s guidance. While you can boost your immune system’s health, preventing transmission of illness, as we explain below, is your best approach.

Get plenty of sleep

The importance of sleep can’t be underestimated, especially when it comes to fighting off illness. In a study of 164 healthy adults, those who slept fewer than six hours each night were more likely to catch a cold than those who slept six hours or more each night.

What’s more, studies show that getting a full night of shut-eye may also help reduce inflammation and pain. Researchers at the University of California, Los Angeles (UCLA) found that treating insomnia in the elderly could lead to reduced inflammation and chronic pain. Those who were successfully treated for insomnia had a lower level of C-reactive protein (CRP), an identified marker of inflammation. When someone is suffering from an attack of inflammation, CRP levels rise. Adults over 55 who were treated for insomnia had continued low levels of this protein.

If your chronic pain is leading to sleep deprivation, or if poor sleep is exacerbating your pain, get help. A pain doctor along with a sleep specialist can assist in finding the right treatment.

Maintain a healthy weight with a nutritious diet

There are so many benefits to eating more nutritious meals. Even if you don’t see an immediate change in your pain level, you can improve your health to fight off illness. In order for the cells in your immune system to function properly, you need to follow a healthy diet. This is a diet that includes, whole grains, vegetables, fruits, lean protein, and healthy fats.

Studies show that micronutrients and dietary components have very specific roles in the development and maintenance of an effective immune system. For example, vitamin A and zinc regulate cell division, making them essential for a successful and quick response within the immune system.

Doctors and scientists both confirm that eating whole, healthy foods can:

• Lower blood pressure
• Protect against chronic conditions, ranging from cancer to stroke
• Help prevent inflammation
• Protect your heart
• Lead to weight loss, which can lessen pressure that leads to issues like joint pain

If you’re looking for more details about the right foods to eat, find out how to create a chronic pain diet that works.

Exercise regularly

If you work out for the first time after a long break, it’s normal to wake up the next day with sore muscles. However, another workout a few days later is generally less painful. While scientists have studied this for decades, naming it the “repeated bout effect,” they haven’t been able to determine exactly why people feel less sore the second time around. What they do know is the immune system plays some role in how muscle repairs itself and protects against additional damage.

One study at BYU produced evidence that shows the surprising presence of very specific immune workers called T-cells.

“You think of T-cells as responding to infections, not repairing muscles–but we found a significant accumulation of T-cells infiltrating damaged muscle fibers,” said Robert Hyldahl, assistant professor of exercise science at BYU. “Our study is the first to show T-cells present in human muscle in response to exercise-induced damage.”

In addition to keeping your heart healthy and your weight in check, this study suggests that exercise may even help boost your immune system. Keep in mind that it does not need to be rigorous exercise to be beneficial. Consider incorporating gentle yoga or morning walks into your daily routine. Create a home exercise program that fits your lifestyle.

Reduce stress as much as possible

The power of your mind can be a double-edged sword. Scientific research shows that stress and immune function are closely related. When you’re experiencing a stressful event, your brain sends defense signals that prompt the release of hormones. These hormones are trying to prepare you for emergency situations, but they have a depressive impact on immunity. This can reduce white blood cells and even increase tumor growth and development.

For those dealing with chronic pain, stress can be an everyday battle.

It doesn’t have to be a single traumatic event or even a significant personal issue. The simple burden of pain can lead to stress. With this in mind, it’s important to find ways to reduce the harmful effects of stress. Exercise, healthy eating, and even meditation are great ways to naturally reduce stress. If these lifestyle changes aren’t helping, talk with your doctor about other options. Acupuncture, therapy, and other methods of treatment can help you reduce stress and improve immune function.

How to protect your immune system

In addition to living a healthy lifestyle, there are a few basic ways to protect your immune system on a daily basis. First, practice vigilant hand washing, especially whenever you leave your house and touch things in public. Take extra consideration to wash your hands for a full 20 seconds in order to be effective, and follow full hand washing instructions from the CDC here. If you don’t have access to soap and water, carry hand sanitizer with you wherever you go. The CDC recommends using an alcohol-based hand sanitizer that contains at least 60% ethanol.

In light of today’s COVID-19 pandemic, it’s also important to practice basic social distancing for the foreseeable future. Maintain at least six feet of distance from other people in public and avoid crowded places. This is the best way to reduce your risk of exposure to anyone who may be ill.

In situations where you have no choice but to be in public, wear a mask to protect yourself and those around you. Data shows that wearing a mask helps reduce your risk of exposure to the virus and could stop person-to-person spread. Find a mask that fits comfortably in order to keep you from touching your face.

Get help with chronic pain

Coping with chronic pain can leave you feeling exhausted and overwhelmed. While we encourage you to try the recommendations presented here, we understand that sometimes basic lifestyle changes still aren’t enough, and that’s okay. Remember, living with pain isn’t normal.

At Arizona Pain, we work as a team to develop a plan to tackle your pain from every angle. This may include many facets from our comprehensive care program, including minimally invasive medical procedures, chiropractic manipulations, and nutritional guidance. These methods can increase your chances of keeping your pain under control, so you can live a healthier life.

If you live in Arizona and need help managing your chronic pain, contact the Arizona Pain team or click the button below to get in touch with one of our pain specialists. Our trustworthy, compassionate team at Arizona Pain is ready to help you.

Telemedicine is not a new technology—it has been in use since the 1950s. Back then, when you weren’t able to get to your doctor, a quick phone call and description of symptoms stood in for an in-office visit. These days, telemedicine has so much more to offer patients and their doctors, though. And, due to the COVID-19 pandemic, telemedicine for pain management doctors has quickly become a critical resource. If you’re a healthcare professional, here’s how to offer telemedicine for pain management at your clinic. Are you a patient who is looking for telemedicine for pain management options in Arizona? Contact Arizona Pain to learn more about our telehealth options.

Why is telemedicine for pain management important?

Telemedicine (also referred to as telehealth) is the practice of using technology to conduct a medical visit when an in-person visit isn’t possible or practical.

There are three main types of telemedicine for pain management:

1. Video appointments: These utilize video conferencing software to connect patients and their doctors in a virtual setting
2. Virtual check-ins: Virtual check-ins for established patients can be conducted on the phone or through a mobile device, like a text
3. eVisits: This type of telemedicine is best used for follow-up questions for patients who have a visit history with your practice and can be conducted through email or text

When it comes to pain management, telemedicine is crucial in times where patients cannot attend an in-person visit, such as when:

• Pain patients have comorbidities that make travel impossible
• There is a major health or weather event that would make travel dangerous to the patient
• The distance a patient would have to travel is prohibitive or impossible (note that although rates of chronic pain in rural communities are similar to urban areas, 60% of the areas in the U.S. designated as Health Professional Shortage Areas are rural)

Connecting healthcare professionals

Telemedicine is also a powerful tool for doctors across the world to connect. It allows doctors to consult with each other and share sensitive health information about patients they are treating.

Using technology to bridge distance allows primary care specialists to recruit the best pain doctors to help in patients’ cases, no matter where they’re located. It also encourages collaborative medicine, allowing all of a patient’s doctors to communicate on their case.

Combined with better access to healthcare via telemedicine, this collaborative approach is improving outcomes for patients with chronic pain—no matter where they live.

Pros and cons of telemedicine for chronic pain

Telemedicine brings care to patients who are not able to access it in person. There is evidence that telemedicine actually improves outcomes for chronic pain patients. Telemedicine can also address chronic pain patients suffering from opioid use disorder. It can save patients and doctors thousands of dollars in chronic pain treatment costs.

However, no form of medicine is perfect, and telemedicine does have risks.

One risk involves patient security. Telemedicine frequently involves transferring patient files over wireless internet connections. It is crucial that sensitive health information is protected as it is delivered in this way.

In addition to minimizing risk by selecting a HIPAA-compliant telehealth platform, doctors and other practicing in home offices need to take steps to ensure the security of their home or office wireless connection.

There is also room for error if medical professionals on either side of the telemedicine connection lack necessary credentials or licenses. Technicians could end up completing tasks or giving medical advice on subjects outside their area of expertise.

As telemedicine becomes more popular, protections are being implemented to ensure a safe environment and equal access for patients.

How does telemedicine for pain management work?

So how does telemedicine for pain management work? If you’re a practitioner, we first encourage you to watch this telemedicine webinar, which includes input from our own Arizona Pain doctors. In it, they discuss actionable strategies for setting up a telemedicine program for your clinic.

To summarize, though, a patient will typically initiate the appointment. If the visit is simply for a medication refill or to ask a question, this can be done via email over a secure platform. Many large medical practices use their patient portals to complete this type of visit.

For video appointments, the process is similar in that the patient initiates the appointment. On the appointed time, the patient checks into a virtual “waiting room” with a medical professional (e.g., a nurse or physician’s assistant). In the waiting room, patients offer their verbal consent to the visit and state the reason for the visit, just as they would in the office.

Once the patient is checked in, the nurse notifies the doctor. The doctor then joins the patient for a secure and private visit. After the visit, the doctor writes up their notes, authorizes prescription refills, and recommends any other follow-up visits or treatments.

The entire visit is remarkably similar to an office visit, except patients don’t have to leave home to receive care. You can watch the webinar to learn more about how to set up your desk, accessing records, and more.

How to offer telemedicine for pain management

Offering telemedicine for pain management is a great way to add value to the services you already provide for your patients. In addition to the webinar we linked to above, the American Medical Association has also published an extensive guide to setting up your telemedicine practice.

Essentially, there are six steps to set up telemedicine visits at your clinic.

1. Check in with your existing EHR vendor

Does your existing EHR vendor have telemedicine capability? If so, that might be the best place to start. They will already be HIPAA compliant and have some functionality at least for eVisits.

If not, select a reputable vendor. Reputable vendors offer secure and HIPAA-compliant technologies that protect patient privacy while offering good functionality and support.

2. Design an office set-up for doctors and other medical personnel

If doctors are consulting outside of the office, they need a workspace. This might include two computer monitors: one for the video consultation and one for the patient record. The set-up that works best for your practice will vary.

At a minimum, doctors need secure hardware that can handle video conferencing.

3. Train all medical personnel

Don’t skip this step. Training doctors and their supporting personnel is a crucial part of implementing telemedicine for chronic pain.

This includes helping everyone to become familiar with the telemedicine platform and process, including the rules for patient consent.

4. Design your workflow

Ask yourself these questions before you get started to design your typical workflow:

• What is the process for patient check-ins?
• How long will appointments last, and how many will be available?
• What conditions are eligible for telemedicine visits, and which require an office visit?

5. Don’t forget to document visits

Documenting visits for pain patients is crucial, especially if you are consulting with other doctors or prescribing pain medications. This includes asking for and receiving verbal consent to the visit from patients. It also includes notes on symptoms and changes to a patient’s condition or treatment plan

6. Be aware of prescription rules

It’s important to note that prescribing rules in telemedicine generally require that patients have a previous relationship with a doctor. This is an important protection in the fight against overprescribing opioids or other high-risk medications.

However, these rules may be relaxed during a health crisis, with telemedicine coverage expanded and in-state prescribing rules suspended. Always look to your professional regulatory board for guidance.

Connect with your patients 

Once you have your plan to implement telemedicine for chronic pain in place, let your patients know about it. Contact patients with simple tutorials on scheduling and availability. Consider adding a “frequently asked questions page” to your medical practice site. Send out an email newsletter to inform them of your new services. You can learn more about communicating telehealth options to your patients here.

If you are a patient looking for pain management telehealth options in Arizona or a medical provider with questions about how to get started using telemedicine for pain management in your state, the Arizona Pain team may be able to help.

Get in touch!

Do you suffer from chronic pain that isn’t responding to traditional treatments? Becoming part of a clinical trial can give you access to cutting-edge treatment options for your pain. Here’s answers to your most frequently-asked questions about our clinical trials.

What is a clinical trial?

A clinical trial is a type of study examining one or more medical treatments to evaluate their safety and effectiveness for treating a particular medical condition. Often these studies are conducted to compare patients receiving a new treatment to patients receiving no treatment, an older treatment, or a placebo (a treatment that resembles the treatment of interest, but without providing any therapeutic benefit).

The purpose of this comparison is to see if the new treatment is better than the available alternatives. Patients taking part in a study may be randomly assigned to one of these conditions and may be blinded, meaning they are not informed which condition they are receiving (though they are informed of all possible study treatments before beginning the study).

The researchers who have contact with the patient are often blinded to the patient’s assigned treatment as well; a study design referred to as a double-blinded study. These study elements (randomization, placebo control and double-blinding) allow researchers to be more confident about the differences in treatments.

When are clinical trials performed? 

Many clinical trials are conducted in order to get Food & Drug Administration (FDA) approval for a new treatment. A company that developed a treatment and funds studies of it, known as a sponsor, will work with the FDA to design one or more studies and provide the FDA with updates on their progress. When the study is completed, they present the results to the FDA and may receive approval. FDA approval allows this new treatment to be widely used. Typically, insurance companies and other payers, such as Medicare, will also pay for the treatment at this point.

However, clinical research doesn’t necessarily stop just because a treatment receives FDA approval. Often the FDA will require the sponsor to continue to conduct clinical trials on the treatment to check for side effects that may have been missed in the initial research. These studies, called post-approval studies, tend to be different in that patients may not be randomized and the treatment itself may be paid for through insurance.

What are the pros and cons of taking part in a clinical trial?

Taking part in a clinical trial can be beneficial to patients in several ways. They may receive a new treatment that is potentially more effective than existing treatments. If they receive an older treatment, in many studies it is provided at no cost. Even when patients are randomized to a receive a placebo treatment, some studies use a crossover design, meaning after an initial period (e.g., three months), these patients will be switched over to the therapeutic treatment. In some studies, patients also receive payments for study visits to cover the cost of transportation as well as their time.

As with any medical treatment, there can be side effects to new treatments. In most cases these are mild and temporary, but they can be serious. Taking part in a study also requires a patient to take part in multiple visits at a clinic or other facilities. The risks and benefits should be carefully considered before a patient agrees to take part in a trial. In addition to the individual risks and benefits, taking part in a study can help advance medical science. New drugs, devices and surgical procedures must go through this process before they are available to the public.

How can I enroll in a clinical trial? 

Even if a patient is interested in a study, it may not be possible for them to enroll. Each trial is looking for a specific type of patient, such as patients with moderate to severe nerve pain resulting from surgery. Interested patients must typically complete one or more visits potentially involving questionnaires, a physical examination, imaging and other screening procedures in order to determine if they are eligible for the study.

At Arizona Pain, we are committed to advancing the treatment of pain. We are currently enrolling patients in several active clinical trials. Patients who are interested in enrolling in a clinical trial can contact me or speak with their providers at Arizona Pain. You can also check back here on the blog for more details on our current studies.

Ted Swing has thirteen years of research experience in psychology and pain medicine and four years of teaching experience, has published in top psychology and medical journals, and has presented his research at major conferences. He received his Ph.D. in Social Psychology from Iowa State University and has been the Research Director at Arizona Pain since May 2012.

Notoriously difficult to diagnose, fibromyalgia causes very real pain to those affected by it despite remaining a mystery in many other ways. A musculoskeletal disorder, it’s characterized by a lowered pain threshold and extra sensitivity to situations that would cause an unaffected person no pain at all. Fibromyalgia research is constantly looking for emerging therapies that could help a patient reduce their pain. Here’s three of the latest.

Fibromyalgia research tackles causes

Although fibromyalgia affects roughly 2 to 4 percent of the U.S. population (about 9.5 million people), its exact cause remains unknown. Maybe a single cause is so hard to pin down because the development of fibromyalgia has been linked to a number of different factors, some combination of which could be the culprit.

Researchers believe that any of the following may contribute to a person’s risk for developing fibromyalgia:

• Genetics
• Psychological and emotional factors
• Illness
• Trauma
• Neurobiology
• Environmental factors

For example, a genetic mutation might make someone more likely to develop the disorder, while others argue that fibromyalgia can be triggered by an infection or sickness. And some experts link the onset of the disorder to physical or emotional trauma, as patients who present with fibromyalgia have often also been diagnosed with anxiety, depression, or post-traumatic stress disorder.

One thing’s for sure: Fibromyalgia affects more women than men, with nine women diagnosed for every one man. This may be a result of certain reproductive hormones present in women, but nothing can be decisively said as to why women are at a higher risk than men.

Why fibromyalgia hurts

The cause may be unclear, but the pain is easier to explain. Once the condition presents itself, fibromyalgia pain results from an unusually high amount of certain chemicals in the brain that are responsible for triggering pain signals. This is also called a neurochemical imbalance.

At the same time, although we don’t completely understand why, pain receptors in the brain become extra sensitive to pain, causing contact that would otherwise not be uncomfortable to be very painful for a person suffering from fibromyalgia.

These pain symptoms can be accompanied by a range of other problems, including:

• Irritability
• Trouble falling asleep or staying asleep
• Difficulty remembering things, also called fibro fog
• Depression
• Anxiety
• Headaches
• Fatigue
• Stiff joints
• Numbness or tingling sensations
• Difficulty swallowing
• Irritable bowel syndrome
• Poor bladder control
• TMJ (temporomandibular joint) disorders

You can find out more about fibromyalgia in the following video.

Diagnosing fibromyalgia

Unfortunately, there is no chemical test available to directly confirm a person is afflicted with fibromyalgia. Instead, a doctor must use a number of other methods to make a diagnosis.

Initially the doctor will observe the patient’s pain symptoms. According to the American College of Rheumatology, fibromyalgia is characterized by widespread pain endured for a minimum of three months. The term “widespread” means the pain should be present on both sides of the body as well as on both the upper and lower body.

The ACR also describes fibromyalgia as tenderness or pain felt at specific places on the body, including the shoulders, the upper chest, the elbows, the hips and the knees. There are a total of 18 of these specific points listed by the ACR, and a person must experience pain in at least 11 of these for the condition to be considered fibromyalgia.

But the surest way a doctor can determine a patient suffers from fibromyalgia is actually to rule out every other possible condition — a process which can be involved and lengthy. Patients shouldn’t be discouraged at the sometimes long process, however, as it means the doctors and medical staff are being as thorough as possible.

Developing fibromyalgia treatments

Treatment plans for fibromyalgia can be complex. Since there’s no cure for the condition itself, treatment must instead focus on the symptoms, on any coexisting conditions, and on any underlying medical problems that could have triggered or aggravated the fibromyalgia in the first place. We’ll discuss some of these more common treatment plans, before discussing the emerging treatments that fibromyalgia research is focusing on.

Medication

Over-the-counter pain relievers, such as acetaminophen, or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen might be recommended to alleviate some discomfort, or the doctor may prescribe something a little stronger, for example, tramadol. In some cases, anti-seizure drugs can be prescribed to effectively reduce fibromyalgia pain symptoms.

The combination of medications a doctor prescribes will ultimately depend on the patient’s exact symptoms, since these are rarely identical from patient to patient. Every person’s case is unique, with different triggers, different levels of pain, and different conditions or symptoms occurring simultaneously. For example, an antidepressant might also be necessary to fight lethargy, or a relaxant may be required to initiate sleep.

Lifestyle changes

Usually doctors will also inform the patient of lifestyle changes he or she can make at home to help with treatment. These include:

• Getting adequate amounts of sleep
• Committing to a regular exercise routine
• Eating a healthy diet
• Limiting intake of caffeine, nicotine and other stimulants

Due to fear of their symptoms and the associated pain and discomfort, people who suffer from fibromyalgia can be inclined to withdraw from society and become inactive. Doctors recommend against this, however, as those patients who remain as active as possible — without overdoing it — on a consistent basis, seem to have the best success with managing their symptoms and leading normal lives.

Many people also benefit from therapy sessions, in which they can not only discuss with a professional counselor the impact fibromyalgia has had on their lives, but also explore strategies for overall stress reduction on a day-to-day basis. This type of training can be crucial for giving patients the confidence to keep living their lives to the fullest potential, without the concern of being limited by their condition.

Emerging treatments based on new fibromyalgia research

Fibromyalgia frequently doesn’t respond well to traditional medications, but the good news is that many people find alternative remedies helpful. Therapies like oxygen chamber therapy, low-level laser therapy, and transdermal magnesium are hitting the market, giving fibromyalgia patients new options for managing pain and improving quality of life.

Oxygen chamber therapy in particular has researchers making grand promises—promises not just of pain relief, but of the possibility to reverse fibromyalgia. The treatment is still early in the study stage. However, researchers understand more about fibromyalgia every day, and this increasingly deep knowledge could one day result in a cure.

1. Oxygen chamber therapy heralds promise to reduce fibromyalgia pain

This treatment, which involves breathing in pure oxygen from a tube or while sitting in a pressurized room—hence the term “chamber”—has shown promise for helping people with fibromyalgia.

Officially known as hyperbaric oxygen therapy, the treatment been used for some time to help scuba divers heal from decompression sickness, which is when gasses in the blood form bubbles as divers move toward low pressure. The treatment also works for slow-healing wounds related to diabetes or serious infections, according to Mayo Clinic.

Enhanced functioning

Research from Rice University has also found the treatment offers hope for fibromyalgia patients. Scientists evaluated 48 women with fibromyalgia who underwent oxygen chamber therapy for two months and found that 100% of them experienced some form of benefit.

An increasing body of clinical evidence shows that fibromyalgia develops from abnormalities in the nervous system and brain pathways, many of them related to pain processing. Rice researchers found that hyperbaric oxygen therapy enhanced functioning in these faulty areas.

Fibromyalgia affects about five million people, most of them women. Researcher Eshel Ben-Jacob says:

“Symptoms for about 70% of the women who took part have to do with the interpretation of pain in their brains… They’re the ones who showed the most improvement with hyperbaric oxygen treatment. We found significant changes in their brain activity.”

In the study, participants underwent 40 treatments, each lasting 90 minutes, for five days each week over the course of two months. During treatment sessions, patients breathe in oxygen that’s pressurized three times higher than normal air. The highly pressurized nature allows lungs to absorb greater quantities of oxygen, which then gets absorbed systemically by the body.

Pain reduction

Fibromyalgia patients receiving oxygen chamber therapy also experienced a dramatic reduction in pain. The body thrives off this pure oxygen and is better able to heal, fight off bacteria, or in the case of fibromyalgia patients, process pain. Many patients who participated in the study were able to decrease the amount of medications they were taking or, in some cases, stop taking pills all together.

Researchers said oxygen chamber therapy actually reversed fibromyalgia, targeting the condition’s source, while all the pills did was ease pain, and not heal the underlying condition. Researcher Shai Efrati says:

“The results are of significant importance since, unlike the current treatments offered for fibromyalgia patients, (oxygen chamber therapy) is not aiming for just symptomatic improvement…(It’s) aiming for the actual cause—the brain pathology responsible for the syndrome. It means that brain repair, including even neuronal regeneration, is possible even for chronic, long-lasting pain syndromes, and we can and should aim for that in any future treatment development.”

These promises aren’t as grandiose as they may seem: Efrati says 70% of the research participants no longer had diagnosable criteria for fibromyalgia at the end of the study.

Oxygen chamber therapy currently has federal approval for use in 14 conditions, including serious infections and burns, but not yet for fibromyalgia, according to WebMD.

Unfortunately, until future studies prove the benefit on a wide scale and the Food and Drug Administration (FDA) approves the treatment, insurance plans won’t cover the treatments, which can cost tens of thousands of dollars because so many are needed.

We’ll be sure to keep you up to date as this exciting area of fibromyalgia research develops.

2. Fibromyalgia research focuses on non-invasive low-level light laser therapy 

With laser therapy, lasers shoot through soft tissue, and the light of the beam raises the temperature. Data is so far mixed on whether the technology works, but fibromyalgia research does show benefits that are promising. Scientists aren’t sure how the treatment works, but are working to learn more.

One possible theory that explains how low-level light laser therapy works involves a process known as photobiostimulation. This idea holds that when the energy of the laser penetrates the tissue, it creates adenosine tri-phosphate (ATP), which helps produce cellular energy.

Benefits of photobiostimulation include:

• Reduced pain and swelling
• Improved circulation
• Enhanced delivery of life-supporting materials like water, oxygen, and other nutrients

Research results for this therapy have been mixed, but several have shown promise. More research is needed to better quantify the potential for this therapy to treat pain from fibromyalgia.

Other names for low-level laser therapy are cold laser therapy, low-energy laser therapy, low-intensity laser, and monochromatic infrared light energy (MIRE) therapy.

3. Transdermal magnesium shows promise for fibromyalgia pain 

Magnesium is an important nutrient for optimal body functioning, however many people don’t ingest enough of mineral. Fibromyalgia, chronic fatigue, and anxiety may all be symptoms of a deficiency.

People often take magnesium in pill form, but transdermal magnesium involves applying magnesium directly to the skin. One way of doing this involves rubbing oil directly on the skin, where it can easily be absorbed and distributed throughout the entire body. Another option is to take a bath with Epsom salt, which is magnesium sulfate.

Gels and patches are also available, however rubbing oil on the body and taking baths have relaxation and other therapeutic benefits, and are wonderful ways to receive healthy amounts of magnesium.

Only a few small trials of fibromyalgia research have found transdermal magnesium has a large benefit, but the anecdotal evidence is vast. Plus, with magnesium deficiencies so common, transdermal magnesium is a good health practice to have.

Finding relief

While fibromyalgia research continues to pave the way for new and innovative treatments, patients should first make sure they have an accurate diagnosis. You can work closely with a pain doctor to find out if you have fibromyalgia. They can also help you learn more about complementary and advanced treatments for reducing your pain. Click here to make your appointment today.

What other fibromyalgia research areas are you interested in learning more about?

Back in 1965, Melczak and Wall published their Gate Control Theory, which led to dramatic changes in the medical community’s understanding of pain and, eventually, to the development of new types of treatment for pain. Per the Gate Control Theory, the brain sometimes regulates incoming pain signals from the body, making them seem less intense. Specifically, when there is a large transmission of signals from a neural pathway, the brain automatically decreases the perceived intensity of those signals (i.e., closing the “gate”). This explains why, if you have an injury to your hand, for example, it may help to hold or rub your arm away from the site of the injury. The increase in total nerve signals (rubbing the arm plus the injury) leads the brain to perceive the injury itself as less painful. People often engage in this sort of behavior after an injury without even realizing it. But, perhaps the most important consequence of the Gate Control Theory was the development of neurostimulation technology.

Neurostimulation basics

Neurostimulation involves the delivery of mild electrical pulses to the body to treat pain and other medical conditions. Traditional applications of neurostimulation include transcutaneous electrical nerve stimulation (TENS) units, which deliver stimulation to through the skin to the nerves in a particular region of the body, as well as spinal cord stimulators.

Spinal cord stimulators are implanted devices that consist of a battery connected to one or more leads, which deliver electrical pulses to the dorsal column of the spinal cord. When these traditional devices are operating, the patient feels a tingling sensation known as paresthesia in the targeted body part. For example, if a spinal cord stimulator is positioned to stimulate the part of the spinal cord that gathers pain signals from the legs, the person would feel paresthesia in their legs when the device is on.

In many cases, paresthesia is not a problem. Patients often like it; paresthesia is generally preferable to the pain it is replacing. However, in some cases it can create challenges.

Typically, a spinal cord stimulator is calibrated to deliver a low to moderate level of paresthesia. However, if this calibration is done while the patient is sitting, when the patient changes position (e.g., lying down) the device leads may get closer to the spinal cord, leading to more intense — potentially painful — paresthesia. Patients often turn the device settings down to a lower, less effective level of stimulation to prevent these painful increases in stimulation. This prevents shocks, but at the expense of more effective relief.

Further, certain pain conditions such as complex regional pain syndrome (CRPS) involve sensitization of the nerves, potentially causing even mild paresthesia to increase the pain in the affected body part. For these reasons, paresthesia is increasingly being viewed by pain doctors not as a necessary guide to delivering neurostimulation, but instead as a potentially unwanted byproduct of neurostimulation.

New neurostimulation technologies

Fortunately, several new neurostimulation technologies are being developed to continue to offer the substantial pain relief of spinal cord stimulators but without the potential drawbacks of paresthesia. Many of these devices are still being tested in clinical trials. We are taking part in many of those trials here at Arizona Pain. Other types are already commercially available for appropriate patients.

High-frequency neurostimulation

Traditional stimulators typically deliver stimulation at lower frequencies, such as 100 or 200 times per second. Some newer devices deliver stimulation at high frequencies, such as 10,000 times per second. The high frequency of stimulation leads the patient to not perceive paresthesia, but pain signals are still blocked. We are currently taking part in a study of a high-frequency stimulator designed by Neuros Medical for lower limb amputation pain. We are also participating in a study of a high-frequency neurostimulator created by Nevro Corp for treating non-spinal post-surgical nerve pain.

Burst stimulation

By delivering many pulses of stimulation for very short periods of time (e.g., 1/1000 of a second), it is also possible to block pain without creating paresthesia. Abbott, previously known as St. Jude Medical, developed a device that delivers such “burst” stimulation. We will be taking part in a study of these devices later this year.

Dorsal root ganglion stimulation

Another change in neurostimulation devices is to target a different part of the spinal cord. Normally, the main part of the spinal cord (the dorsal column) is targeted because it gathers pain signals from all parts of the body. A newer approach involves positioning leads to stimulate the smaller branches coming from the dorsal column, called the dorsal root ganglion (DRG). By selecting the specific DRG bundles to target, it’s possible to block pain while delivering very little paresthesia, particularly to non-painful parts of the body. This appears to be helpful for pain conditions such as CRPS. We are taking part in a study with Abbott of DRG stimulation for CRPS of the lower extremities.

Positional neurostimulation

Another way to avoid excessive paresthesia is to make the device automatically adjust stimulation based on the position of the patient’s body. Medtronic’s RestoreSensor device uses an accelerometer in the battery to make such adjustments. For example, if the device sensed the patient lying down, it would automatically reduce the stimulation in order to avoid excessive paresthesia.

Saluda Medical is developing a device that would use the stimulator leads to get feedback directly from the spinal cord about how much of the stimulation was getting through and make millisecond by millisecond adjustments to keep the stimulation at a comfortable level. We will be taking part in a study with Saluda Medical of this device later this year.

These new technologies have the potential to deliver more effective pain relief to certain patients than current devices. If you are interested in learning more about any of these studies and whether you might qualify, you can discuss this study with your pain management providers at Arizona Pain. For additional information about this study, you can contact me directly at TedS@arizonapain.com.

Ted Swing has 13 years of research experience in psychology and pain medicine and four years of teaching experience, has published in top psychology and medical journals, and has presented his research at major conferences. He received his Ph.D. in Social Psychology from Iowa State University and has been the Research Director at Arizona Pain since May 2012.

A newly-approved device, the VertiFlex Superion, may offer chronic pain patients relief from common causes of back pain and leg pain. Read on to learn more.

What causes back pain?

The most common source of chronic pain is the lower back, specifically the lumbar spine. Several painful conditions can develop in the lumbar spine, such as arthritic degeneration of the spine joints, degeneration of the intervertebral discs, and herniation of the discs (that is, bulging outward).

Another very common, painful spine condition is spinal stenosis, which refers to the narrowing of spaces in the spinal column through which the spinal cord passes. This can result from various changes to the spine, such as thickening of the bones or ligaments in the spine or misalignment of the vertebrae. As the spinal column narrows, it may put pressure on the spinal cord in certain places. This causes pain and sometimes numbness both in the back and radiating down into the legs. The pain is often increased by certain activities such as standing or walking, and may be relieved by postures such as bending forward or sitting.

What is the VertiFlex Superion?

VertiFlex developed a procedure for treating spinal stenosis pain with an implanted device called the Superion, an “H” shaped spinal spacer. This procedure involves making an incision in the back and inserting a metal tube that passes between the bones of the spine. The VertiFlex Superion spacer is inserted through the tube and locked into place against the spine, holding open the spinal column in the area where stenosis was occurring.

By creating and maintaining space at the right location, the VertiFlex Superion can provide permanent relief from spinal stenosis pain. Compared to traditional surgeries, this procedure is minimally invasive. This means most of the tissues of the back are not damaged or disrupted and patients can be discharged the same day and have a faster recovery.

VertiFlex conducted a large 470 patient randomized trial comparing the Superion to an alternative stenosis procedure. The VertiFlex Superion provided substantial pain relief, which continued through the entire three-year follow-up period. Last year, VertiFlex presented this data to the FDA and received approval for this device. VertiFlex is continuing to collect data on the safety and efficacy of the Superion through a non-randomized (meaning all qualifying patients receive the Superion) registry study.

Arizona Pain will soon be taking part in this study, called the PRESS registry. For this study, 100 patients across multiple sites around the U.S. will receive the Superion for spinal stenosis pain.

If you are interested in learning more about this study and whether you might qualify for it, you can discuss this study with your pain management providers. For additional information about this study you can contact me directly at TedS@arizonapain.com.

Ted Swing has 13 years of research experience in psychology and pain medicine and four years of teaching experience, has published in top psychology and medical journals, and has presented his research at major conferences. He received his Ph.D. in Social Psychology from Iowa State University and has been the Research Director at Arizona Pain since May 2012.

Clinical trial researchers test a variety of new treatments for various medical conditions. Clinical trials that prove successful receive approval and eventually become a part of the standard treatments for a certain pain condition. This research is incredibly important, and at Arizona Pain, we are committed to advancing the practice of pain medicine by taking part in clinical trials. We are currently enrolling certain selected patients in several clinical trials and following up their progress for a specified period of time.

RADIANT clinical trial

We are currently enrolling patients in several clinical trials testing the latest neurostimulation devices, such as spinal cord stimulators (SCS). These implanted medical devices function much like cardiac pacemakers, except that instead of affecting the heart, they use electrical pulses to reduce or eliminate pain.

For years, making adjustments to the level of stimulation required part of the controller to be held against the skin in the area the device was implanted (often the side of the low back area). St. Jude Medical has recently developed a spinal cord stimulator that can be adjusted via a Bluetooth signal from Apple mobile devices, potentially making the process of adjusting the device more convenient.

Additionally, these St. Jude Medical SCS devices are capable of delivering both the traditional tonic stimulation (which produces a tingling sensation in the region targeted for pain relief) as well as burst stimulation. Burst stimulation involves very rapid, short pulses of electrical stimulation. The speed of the pulses means that the patient does not experience the tingling sensation, potentially increasing the comfort of the stimulation for some patients who are bothered by the tingling sensation. We are taking part in the RADIANT study, a non-randomized study with St. Jude Medical to evaluate the comfort and efficacy of these newest devices. Patients who are identified as candidates for spinal cord stimulator therapy may be invited to take part in this study.

Dorsal root ganglion stimulation study

Traditional spinal cord stimulators have proven effective in treating many types of chronic pain that do not respond to other treatments such as medications, injections, and surgeries. A spinal cord stimulator includes special wires called leads that are implanted along the center of the spinal cord, an area known as the dorsal column. This placement is ideal for treating many of the most common types of pain, such as pain that radiates down from the spine into the legs. For certain types of chronic pain, however, the pain has proven difficult to treat with these devices. For example, some types of pain affect only the feet. Traditional neurostimulation devices would stimulate the entire leg in order to relieve this foot pain and might be uncomfortable for some patients.

Recently, St. Jude Medical received FDA approval for a new type of neurostimulation device targeting clusters of nerves, called the dorsal root ganglion (DRG), near the place where nerves branch off from the spinal cord. By targeting stimulation at the dorsal root ganglion (DRG), it allows more selectivity in the affected areas. This can make the stimulation more comfortable and effective for certain patients (e.g., stimulating the feet while leaving the rest of the legs unaffected). We are currently enrolling patients in this clinical trial who are good candidates for DRG stimulation in the St. Jude Medical TARGET study to further assess the efficacy of this treatment.

Peripheral amputation pain study

Patients who have undergone the amputation of a foot or leg sometimes continue to experience chronic pain, either in the stump of the amputated limb or phantom limb pain (pain perceived to be in the missing portion of the amputated limb). We are currently taking part in randomized clinical trials testing a temporary implantation of a device in patients with chronic pain due to the amputation of one or both lower limbs.

Qualifying patients will have this new device implanted in the leg for eight weeks. For the first four weeks, patients will be randomized to receive either therapeutic stimulation (which should relieve pain) or non-therapeutic stimulation (which should not relieve pain). For the next four weeks, all patients will receive therapeutic stimulation. Patients will then have the device removed and will be followed up for 12 months to ensure that there are no adverse effects.

If you are interested in learning more about one of these clinical trials and whether you might qualify for it, you can discuss this study with your pain management providers. For additional information about this study you can contact me directly at TedS@arizonapain.com.

Ted Swing has 13 years of research experience in psychology and pain medicine and four years of teaching experience, has published in top psychology and medical journals, and has presented his research at major conferences. He received his Ph.D. in Social Psychology from Iowa State University and has been the Research Director at Arizona Pain since May 2012.

There has been a lot of controversy over the last few years about the risks and benefits of opioid painkillers as well as how they are used in treating chronic pain. It is important to note, however, that this does not include certain patients such as those diagnosed with cancer or those who are undergoing end-of-life care. According to the Department of Health and Human Services, opioid abuse is a serious public health issue with drug overdose deaths being the leading cause of injury death in the United States. Opioid addiction statistics point to some chilling trends. It was reported that in 2012 over 259 million prescriptions for opioid pain medication were written, which is enough for every adult in the United States to have their own bottle. This is one reason why the CDC is concerned with an opioid epidemic in the U.S.

Opioid addiction statistics in the U.S.

Opioid pain medications are drugs that interact with the opioid receptors on nerve cells in the brain and nervous system. This class of drugs include pain meds such as hydrocodone, morphine, and fentanyl. This interaction generally produces a pleasurable effect that relieves pain as well as produces other side effects such as dizziness, nausea, vomiting, and constipation.

The American Society of Addiction Medicine released some facts and figures this year that shows a telling story of how opioids have affected the United States in the last two decades. Some of these stats include:

• Four out of five new heroin users started out misusing prescription painkillers. This led to heroin overdose deaths quadrupling from 2000 to 2013.
• Among women, the overdose death rate for prescription pain medication from 1999 to 2010 increased more than 400%. Between 2010 and 2013, female heroin overdoses tripled to 1.2 per 100,000 people.
• In one survey, 94% of people receiving treatment for opioid addiction said they chose heroin over prescription drugs because prescription drugs were far more expensive and harder to get.
• Adults are not the only ones affected by opioid addiction. In 2014, 467,000 adolescents were using painkillers for something other than medical reasons with 168,000 having an addiction. It was discovered that most adolescents who misused prescription opioids obtained them free from friends or relatives.

The Centers for Disease Control’s take on opioids for pain management

According to the CDC, since 1999, opioid prescription have quadrupled and over 165,000 people have died due to prescription opioids. In 2014 alone, 14,000 people died from overdoses involving prescription opioids.

Stats like these are why the CDC finalized new opioids guidelines for medical providers in March of 2016. The new guidelines were created to curtail the abundance of opioids being prescribed to patients, especially those that are given before other non-opioid treatments are tried. Here are some of the highlights:

• Doctors should try non-pharmacological treatment options before moving to painkillers. This is especially true for those who suffer from chronic pain.
• Before opioid therapy, physicians should establish treatments goals with realistic goals and a plan to discontinue opioid use.
• Doctors need to have an initial discussion as well as period check-ins about the realistic risks and rewards of opioid therapy. This should include the responsibilities of both the doctor and patient.
• To continue opioid therapy, there must be meaningful improvement or demonstration of efficacy of the treatment.
• Doses should be the lowest possible needed for patient relief and should be immediate-release opioids.
• Acute pain patients should only receive small quantity prescriptions that last for three days or less.
• Physicians need to carefully evaluate a patient’s potential for abuse, which includes looking at family history and prior dependency issues.

Opioids and chronic pain patients

Here at Pain Doctor, we feel it is important to reaffirm the fact that most chronic pain patients are not taking opioids to manage their condition. In fact, opioids are not a preferred method of treatment and we mostly use non-pharmacological therapy to help our patients find relief. If opioids are necessary, we use a 12-step compliance checklist to assure the safety and continued improvement of our patients.

Today, approximately 5% of chronic pain suffers use opioids for pain. However, the number of people using them for chronic pain management have decreased significantly since 2010. This can mostly be attributed to new research findings and stricter government controls on prescription opioids. Also keep in mind that opioids users are closely monitored by physicians and only use pain medication as part of an overall treatment plan rather than as a quick fix.

Given new research and controls, the medical community is looking for alternative treatment options to help manage chronic pain. This is partly due to the fact that research has shown that opioid use is less effective for managing chronic pain in the long term as well as the risk of addiction and abuse is cause for concern.

Finding help for opioid addiction

If you or a loved one is suffering from an opioid addiction, there are many programs available to provide help. The Substance Abuse and Mental Health Services Administration (SAMHSA) along with the American Society of Addiction Medicine (ASAM) provide numerous resources that can assist you in finding local treatment options.

Many of these resources are open 24/7 and can provide information about addiction as well as possible treatment options near you. They can also provide support to people who are trying to help their loved ones through an opioid addiction. Some of these include:

• National Suicide Prevention Lifeline
• National Helpline
• Substance Abuse Treatment Facility Locator
• Addiction Guide
• Addiction Center
• The Support Group Project

What are your thoughts on current opioid addiction statistics?