Tuesday, June 28, 2011

CHRONIC PAIN AND DEPRESSION



CHRONIC PAIN and DEPRESSION are co-morbid conditions. It means that they are linked to each other. Many of Chronic Pain patients complain of Depression and many of Depressed patients suffer from some sort of Chronic pain. In many cases Depression can be secondary to Chronic Pain because of the effects Chronic pain had on one's life. If a pain patient is not able to work and have financial problems as a result, if they can't contribute to the family or social life, if they can't continue any leisure activities they used to do, if they don't have proper sleep and enough energy, then there is no surprise if Depression sets in. On the other hand many pain patients would feel the pain more when their mood is down. Depression augments or magnifies the pain symptoms. In reality we find Chronic pain and Depression very commonly together. The term CHRONIC PAIN SYNDROME is made to describe this link. Chronic Pain Syndrome is the sum of Physical and Psychological symptoms of a Chronic Pain patient. Because of this link between Chronic Pain and Depression it is important that any treatment or management plan also be directed to manage these conditions together to be effective. These efforts should not be limited to medications that work on both conditions, like anti-depressants, but it should be expanded to Cognitive and Behavioral treatments along with patient educations. Comprehensive and multi-disciplinary pain management programs are shown to be more effective than using only one modality. After understanding this link between Depression and Chronic pain, multi-disciplinary approach to pain management makes more sense.

Saturday, June 25, 2011

NEW TREATMENT FOR CHRONIC LOW BACK PAIN APPROVED BY HEALTH CANADA

Health Canada recently (end of April 2011) approved Cymbalta or Duloxetine 60mg once daily for CHRONIC LOWER BACK PAIN indication. It has been studied in randomized clinical trials comparing it's effect to Placebo. It is shown that this medication is effective and has reasonably less side effects than other similar medications. Cymbalta is clasified as an anti-depressant and along it's effects on depression, it has indications for use in FIBROMYALGIA and now CHRONIC LOWER BACK PAIN. Although the daily dose is indicated as 60 mg, many patients may be able to tolerate it if started at a lower 30mg daily dose and after a few days increased to 60mg once daily.

Friday, June 24, 2011

CHRONIC PAIN IS A CONDITION, SUFFERING IS AN OPTION!!


What does this mean. Chronic pain is a condition, suffering is an option. This may sound very simplistic and judgemental at first. But in my years of practice in chronic pain, I have many things that makes me believe in this, or at least accept that there is some elements of truth in this idea. Chronic pain is a medical condition that sets in for many reasons. But once people are affected by this condition, you can see a huge difference in their level of suffering. Some patients suffer so bad that their life become a real burden to them. Others with similar conditions can run a productive life and be as happy as they can under the circumstances of chronic pain. But why? How can this be possible that the same condition can destroy one patients life but the other patient can manage it quite well. Some think the difference is in their threshold for pain. Meaning that some people feel more pain with a painful event than others. But suffering is far deeper than than. My experience shows the difference is in the mind set of different patients. The way our outlook to the world is, would define the world to us. some of us can keep a positive process of thinking while in pain and some can't. We now know about the plasticity or ability to change and adapt in our brain. It appears that the positive thinkers by repeating this process of positive thinking, can enforce it and as a result would suffer less than other with the negative outlook of mind. So negative thinking carves in more negativity in brain, including suffering and positive thinking carves in more ability to manage suffering. It sounds simple but it is hard to do. Only with staying on the course of positive thinking with relaxation and meditation exercises on a regular basis, one can master the ability to manage the suffering and as such, you can call it a decision.
Stay the course and think positive to suffer less.

Wednesday, June 22, 2011

GENE THERAPY AND CHRONIC PAIN


When my patients ask me, Doc, if I am so bad at this age, what will happen to me when I am older, I always tell them this: before you get old, we will find better ways to manage your pain. This is more of a wish than a promise. We all know that there are a lot of research being done for finding new ways to manage the chronic pain. One of the new areas of medicine that I believe will change the shape of medicine in future is GENE THERAPY. In recent years, researchers have been successful to find a method of Gene Therapy by injecting an agent kalled AAV8 into the spine to control the transmit of pain from spinal cord to brain. This method is still under investigation but provides a lot of promise for serious chronic pain sufferers in near future. If it is approved as a safe and effective method of treatment in human, it can replace many pain medications. More and more studies like this are coming out and make the wish of finding a new and better way to manage chronic pain more like a promise.

Toronto Poly Clinic

Saturday, June 18, 2011

ART THERAPY AND CHRONIC PAIN


Art therapy can help chronic pain patients. It is more than just changing the focus from PAIN to ARTS. It changes the quality of life and allows a chronic pain patient to have a better quality of life.

Play the video and listen to this CHRONIC PAIN PATIENT who uses ART THERAPY to heal herself:



Toronto Poly Clinic

Friday, June 17, 2011

PHANTOM LIMB PAIN

Phantom Limb Pain is the pain of a limb that does not exist. Most of the times it happens after amputation. Although the amputated limb does not exist anymore, the patient feels pain in parts of that limb. For example a patient who has lost his foot may feel burning in the toes. This is considered a type of Neuropathic Pain. The treatment is very difficult and was limited to the use of some medications of different classes of medications that are usually used in treatment of Neuropathic pain.
However, lately there are some promises with the use of Mirror Therapy. In this treatment, a mirror is put besides the healthy limb and the patient sees the mirror image of that limb, which would look exactly like the lost limb to the patient's brain. This action would push the brain to start working the way it should be working, instead of getting pain signals in the lost limb. If interested, you can search mirror therapy and learn more about this interesting treatment. 

Watch the video at the link bellow.
www.youtube.com/watch?v=YL_6OMPywnQ

Toronto Poly Clinic

Sunday, June 12, 2011

TRIGEMINAL NEURALGIA

TRIGEMINAL NEURALGIA or TN is a very disturbing chronic pain condition. The pain of Trigeminal Neuralgia is felt on one side of face. It is usually a series of sharp pain attacks that can last form a few seconds to a couple of minutes. The main difference of this pain from other causes of face pain like Post Herpetic Neuralgia is the consecutive nature of pain in a series of sharp pain attacks compared to constant pain in other conditions. Trigeminal nerve is the fifth cranial nerve that comes out of brain and exits the skull at the base of skull, coming into the face. It is a sensory nerve and is divided into three branches: Ophthalmic, Maxillary and Mandibular. Each branch gives sensation to one part of the face from forehead to mid face and lower part of the face. It is believed that this nerve may get compressed by an artery that is very close to it on its path. This compression may cause damage to the covering of the nerve. Damaged nerves may send pain signals to brain instead of sensory signals. Trigeminal nerve's covering may become compressed by other reasons like tumours, or become damaged secondary to other diseases like MS.

Diagnosis of Trigeminal Neuralgia is through proper history taking, paying attention to the nature of the pain, proper physical examination to rule out other causes and some diagnostic tests like: MRI of brain to rule out tumors or MS and MRA (magnetic resonance Angiography) to observe the nerve compression by the artery.

Treatment of Trigeminal Neuralgia can be by medication, injections or surgery. Anti-epileptics and Anti-depressants can help to control pain in many patients. If medications are not enough, injection of a chemical substance to block or kill the nerve may be helpful but can leave some numbness on the face. Radiation and Vascular surgery may be needed to control the pain in sever cases that do not respond to other treatments. Of all the different treatment options, vascular surgery is the most invasive treatment and has the highest success rate for prevention of pain recurrence.

Over the years, I have dealt with many patients who suffer from this condition. I have seen the enormous suffering they have to go through each day of their life. Patients need to know that early treatments would provide better outcomes than late interventions. So, inform yourself and see your doctor as soon as the pain starts.

Dr. Kevin ROD -  Toronto Poly Clinic

Saturday, June 11, 2011

CHRONIC PAIN TREATMENT


Who is responsible for CHRONIC PAIN TREATMENT? Is it the family doctor? OR the specialist? Is it the physiotherapist or the psychologist? Will it be done by a nutritionist, a counsellor, social worker, Yoga master or spiritual header? Will it be achieved by traditional medicine or the the new advances in medications? Is the healing done by the doctor or by the self management efforts of the patient?
The reality is that the answer is all and at the same time none of the above. The main key to healing is when the patient comes out of the passive state of waiting to be healed by one or all of these. When the patient takes an active role in these efforts and becomes a member of the treatment team, then the patient earns the healing. 

Remember: If the doctor is trying harder than patients to get them better, there is something wrong. Patients are the corner stones of healing and the most important part of the CHRONIC PAIN TREATMENT TEAM. After all without patients all of the above mentioned treatments would not be of any value.

Dr. Kevin ROD - Toronto Poly Clinic

FREE YOUR MIND WITH MUSIC

Relax and enjoy, the immediate benefits will be pleasant.
Spiritual music can free your mind from focusing on your pain. Art is a beautiful method of therapy. Check this out.

http://youtu.be/4h5dI6m6Eh8

Enjoy,
Dr. Kevin ROD

Friday, June 10, 2011

CHRONIC PAIN PATIENTS FEEL LONELY


Chronic Pain Patients feel lonely. Only people who have suffered from chronic pain can truly understand this. If you bleed or break a bone, people can see your injury and will relate to it. But chronic pain can't be seen. No one knows how a chronic pain patient has to fight each moment of life with ongoing pain, fatigue, sleep problems, anxiety, depression, financial and family problems. Chronic pain is an enemy with many faces. One has to fight in many sides of this battle at the same time. IT is difficult to keep a happy face and function as normal looking as possible while one is suffering so much. But the worst of all and the most unpleasant experience is when a chronic pain patient feels nobody believes them. The feeling of loneliness is like a prison with no exit door. In many of chronic pain management programs, group therapy is incorporated as one of modalities. My experience is that the group therapy is one of the most popular parts of the these programs. The reason I found, is not the therapy itself. The reason is that pain patients will see in these groups that they are not alone. 


Loneliness is the most disturbing feeling one can experience. Even in real prisons of all times, the worst punishment is to put someone in solitary confinement. Chronic pain feels exactly like that. The best suggestion I can give is to join groups or organizations that chronic pain patients can get together and share ideas with each other. For example in Canada we have the Canadian Pain Coalition http://www.canadianpaincoalition.ca/ for pain patients to get together. All around the world there are groups like this but we need to inform ourselves and participate. Once pain patients get together they can feel less lonely and start to have a common voice to get their needs met. Get together and suffer less.

Tuesday, June 7, 2011

NEUROPATHIC PAIN

NEUROPATHIC PAIN is a common pain condition. It happens when the nerve fibres are damaged or become dysfunctional. Nerve fibres can be damaged by trauma, hormonal conditions like diabetes, viral infections like AIDS or Herpes infection in face or chest, side effects of Alcohol or some medications and treatments, amputation or degenerative changes.This list is not comprehensive and any other reason that can cause injury or dysfunction to nerves, may cause NEUROPATHIC PAIN.

Symptoms of Neuropathic pain is a pain with unusual characteristics. Tingling and numbness, shooting and burning pain are prominent characteristics of this condition. Diagnosis of Neuropathic pain is by a careful history taking and paying attention to the characteristics explained above along with a physical examination by a physician trained in evaluation of Neuropathic pain. Treatment of this condition is directed towards causes and symptoms. For example in Diabetes, a better control of blood sugar level may lead into better management of pain. Medications used are from anti-inflammatory, anti-depressant, anti-epileptic or if needed opioid classes. At times procedures like blocking the irritated nerve by local anaesthetics may be needed.

NEUROPATHIC PAIN may be difficult to manage. Patients should take an active role in self management as well as being a team member with the health care professionals team to manage this condition. Proper NUTRITION, EXERCISE, MEDITATION and staying as FUNCTIONAL as possible can make a huge difference in over-all quality of life for a Neuropathic Pain patient.

Dr. Kevin ROD



Saturday, June 4, 2011

CHRONIC PAIN MECHANISM, THE MYSTERY OF CHRONIC PAIN

ENDOMETRIOSIS, WHY IS IT PAINFUL? WHY DOES IT HURT SO MUCH?

Painful menstruation is an early
sign of ENDOMETRIOSIS
ENDOMETRIOSIS is a painful condition. It happens when some of the covering tissue of inside uterus (Endometrium) finds its way into outside of uterus. It can happen during menstrual cycles when some of the menstrual blood containing endometrium cells passes through fallopian tubes (tubes that connect ovaries and uterus)into the pelvic area. These cells will attach to the pelvic area walls. They grow and bleed with each menstrual cycle but this blood cannot exit the body. Over time this collection of blood irritates the surrounding tissue, cause inflammation and scaring. These scars can cause problems with the function of organs in the pelvic area. The bleeding with each cycle is very painful. In fact painful menstruation is one of the early signs of ENDOMETRIOSIS. There are ways to diagnose this condition by taking a good history, doing a complete abdominal and pelvic examination and doing some tests like ultrasound, CT scan or laparoscopy. 

The pain of menstruation is induced by some inflammatory elements that respond to anti-inflammatory medications. So over the counter Advil or prescription anti-inflammatory medications may help. The best is to check with a gynecologist as soon as you feel your menstrual cycle pains are more than usual. Different hormonal treatments or even surgery may be needed to treat this condition. Any time the menstruation stops, the pain will stop as well. Examples are like temporary stop of pain in pregnancy or permanent stop of pain in menopause.

Seek your doctor's help when your menstruation pain is out of ordinary.

Dr. Kevin ROD

Friday, June 3, 2011

PELVIC PAIN, WHY DO WE GET CHRONIC PELVIC PAIN?


Human pelvic area is a busy place. Many important organs in male and female are located there. Prostate, urinary bladder, uterus, ovaries, ovarian tubes, pelvic nerves, great intestine, rectum, pelvic muscles, arteries and vein, lymph nodes, pelvic area bones and any other contents of this area can be a source of pain. Just by looking at this list we can realize that finding out which of these elements is the cause of pain can be very challenging most of the times. For this reason, we usually try to find out what is the mechanism of pain generation. 

Infections, inflammations, circulation problems, tumours or at many times referred pain (pain coming from another source and being felt in pelvic area) may be the cause. A series of different specialist evaluations may be needed to sort this out. Urologists can check the urinary system causes. Gynaecologist can check out the uterus, ovaries and ovarian tubes to rule out any infection, inflammations and malignancies.

A thorough pelvic exam, different samples evaluation, ultrasound, X-Ray, CT scan or MRI may be needed to evaluate this condition. At time, maybe many times, we do all of these and there is nothing to be found. A big portion of this last group are pelvic Neuropathic pain. It means that although the structures are normal,and that is why all the tests are negative, the nerves are not functioning normally. For this condition the treatment would be to calm down the nerve by different medications used in neuropathic pain like anti-epileptics or anti-depressants or to do some injections to block the irritated nerve.

Patients can do pelvic floor exercises by contracting and releasing the muscles of pelvic area to increase the circulation and improve the core muscles of that area to support the management of pain. These exercises are found to be very helpful in long term.

It is a difficult condition and needs a lot of patience to manage.

Dr. Kevin ROD

Wednesday, June 1, 2011

CHRONIC PAIN AND POVERTY, WHAT CAN WE DO?

Many of chronic pain patients are forced into poverty. There are many employed and productive people who get injured or develop a condition that leads into chronic pain. Once chronic pain is settled, productivity and ability to work decreases. Most of us think being poor or homeless is so far or remote from us. In reality, most of members of any society are only a couple of pay checks far from falling into poverty. Chronic pain on its own is difficult to handle. Add poverty, losing ability to work and keep the house or other belongings to it, then we have a disaster. But rich or poor, we have to treat and manage the chronic pain condition.

We talk a lot about multi-disciplinary pain management, but all or most of these disciplines of therapy cost money. What to do in this situation? There have been lot of evidence coming out lately on the positive role of self management in chronic pain. If we can learn about what better choices we can make within our budget about our diet, learn to exercise and practice meditation and relaxation exercise, most of medical conditions would be better controlled, including chronic pain. When the down turn in economy happened a few years ago, I worked on developing a self management guide for patients who could not afford to pay for different therapies and we would give the guide to any body in need free of charge. What is important is that I observed a lot of treatment outcome improvement within the group that used and practiced the guide recommendations.

Self management can be one of the ways to fight the effect of poverty on our pain.

Dr. Kevin ROD