Are You Back on the Pain Chain?

By Ann Marie Gaudon, PNN Columnist

Societal messages constantly tell us that we need to control any and all pain before we can be happy.

What happens when this is not possible? I’ve said it before: In order for me to be pain-free, I would have to be rendered unconscious.

Control of “clean pain” -- biological pain that can’t be fixed --  is very attractive, but in a never-ending quest to control it, we end up with the pain controlling us. That’s when “dirty pain” begins -- we focus too much attention on the negative thoughts and feelings associated with pain.

One form of dirty pain is called “Mental Scripts.” These include what our mind tells us about our pain experience. Here are some examples: 

• Searching for reasons you’re in pain: You might say to yourself, “I told you not to lift that. You know what happens when you aren’t careful!” 

• Yelling epithets to yourself in your head: Your mind might be shouting, “You hopeless idiot! You’re such a failure at life!”   

• Reciting rules you’ve established for yourself around your pain: You might tell yourself, “Exercise is not an option while I’m in pain,” or “I cannot live a good life with pain.” 

A second type of dirty pain is called, “Avoidance Behaviours.” This means anything you do or avoid doing in order to try not to feel pain. This behaviour can be particularly perilous because the act of avoiding an experience due to some feared outcome does not always reduce pain, it can actually increase pain. Here are some examples: 

• Using medications in an attempt to avoid pain altogether rather than to dampen your pain enough to live your life.  

• Refusing to exercise altogether because you are in pain. 

• Refusing to work or volunteer in any capacity because you are in pain. 

A third type of dirty pain we subconsciously engage in is called “Values Discrepancy.” This means choosing avoidance and moving far away from the life that you want to live.  

When you are knee-deep in Values Discrepancy you are living the antithesis of a life that you value. For example: 

• Giving up on a higher education because you fear the pain will not allow you to concentrate. 

• Quitting your dream job because of the pain you felt when you were there. 

• Choosing not to have a family because parenting could be difficult if you are in pain.

Avoidance behaviours (a form of trying to control) are indeed very seductive. They look like the answer. Have you ever seen an advertisement for any type of pain control? The patient takes the magic pill or treatment, the pain is completely resolved, and the patient is seen happily playing tennis or rolling around in the grass with their child.

Western culture rarely if ever shows us reality. The control paradigm is such that the more choices we make attempting to control the pain, the smaller and less meaningful our lives end up. We become stuck on the “Pain Chain.” For chronic pain patients, the manifestation of dirty pain typically looks like this:

The more we struggle against what is uncontrollable, the more we will suffer. The good news is that no one is fated to suffer from dirty pain for the rest of their lives. If you find yourself suffering from any of these symptoms, find yourself a qualified therapist in chronic pain management.

When chronic pain is part of our lives, we need more resilience, not less. We grow resilience by practicing and learning not be ordered around by our thoughts and feelings. Psychotherapy can help you with workable solutions to rise above life-draining, self-defeating patterns of behaviour.  

I once was choked off in the Pain Chain, and now I help others to unleash themselves. With the right tools, it is possible to get back to living a life in the service of our values – not in the service of our pain.

Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for over 30 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.

Treating Chronic Pain With Lasers

By Madora Pennington, PNN Columnist

Months after surgery for my badly broken foot, the last scab finally fell off, revealing to my horror that the surgical incision had not closed. I have Ehlers-Danlos Syndrome (EDS), a genetic condition that prevents my body from building proper collagen. Poor wound healing is a common complication for people like me. 

A search for a treatment that would help led me to Dr. Harold Kraft, a Southern California anesthesiologist who has built an entire practice around using high-powered lasers. Kraft’s main focus is pain --- from sciatica and back pain to neuropathy, neuralgia and myalgia, as well as post-surgical pain and soft tissue injuries. 

Another thing lasers do is facilitate wound healing. After a few appointments, my wound closed but appeared fragile and Frankenstein-looking. With more treatments, it rapidly filled in, coming to look smooth, strong and, surprisingly, pretty.

I was eager to try laser for my Ehlers-Danlos aches as well. My strange body seems to sustain soft-tissue injuries from the ordinary tasks of life, draining my energy and taxing my nervous system. From the laser treatments, I experienced relief I had never before felt.

Kraft has learned a lot from administering over 20,000 treatments on patients. He noticed Ehlers-Danlos patients got exceptional pain relief from the laser treatments, and came to find that nearly all are super-responders.

“About 90% of EDS patients respond to laser treatment, and get faster and more profound pain relief than typical patients,” Kraft notes.

Light Amplification

The word “laser" is an acronym for Light Amplification by the Stimulated Emission of Radiation. No longer limited to science fiction movies, lasers are now a part of everyday life. You’ve probably seen lasers used as pointers during presentations, as bar code scanners, and in DVD players. In medicine, lasers can be used for precision cutting, such as in LASIK vision surgery or for excising a tumor. For cosmetic purposes, a laser can improve skin imperfections or whiten teeth.

Light particles, or photons, from the laser pass through the skin and stimulate the cells’ mitochondria to release anti-inflammatory modulators, nerve and vascular growth factor. This causes healing and repair.

Kraft came to having a pain practice late in life. He had retired from a long career of performing anesthesia during surgery and left medicine entirely for the business world, developing software for data aggregation. All that changed when his wife took their long-suffering pug for a new treatment.

Harley, a most beloved dog, had trouble walking. He had not benefited from joint supporting supplements like glucosamine and chondroitin, nor acupuncture and doggie physical therapy. But after four treatments of high dose laser from a veterinarian, Harley could walk again. The Kraft’s were elated and also intrigued.

Kraft convinced a family friend who had back pain to see that same veterinarian for lasering, even though she is a human. Like Harley, she found pain relief.

Seeing the promise of what this could offer, Kraft began training in laser techniques and got laser machines of his own. He went back to practicing medicine, treating pain exclusively with lasers. Kraft uses Class IV lasers, which are the most powerful available. He employs them at high doses, in order to do the most good for patients. Great care must be taken in this endeavor.

“The more power you use, the more care you need to operate and the more likely that misapplication can cause harm,” Kraft says. “There is no discomfort during treatment, although the patient may feel the heat from the laser. It is powerful, non-invasive, and the results can be permanent or long-lasting.”

Kraft says about 7 out of 10 patients get significant improvement, including chronic pain sufferers who failed at other treatments. Genetics seem to play a factor in how well a patient responds. Some are just faster than others. A small percentage respond immediately. Most experience benefit between 4 and 10 treatments, and only about 30% do not respond after 14 or so treatments.

What does the science say about laser therapy? While there isn’t an abundance of research on the healing power of Class IV laser, some exist and are worth noting:

• A small study in the Journal of Athletic Training concluded that Class IV laser therapy is “an effective treatment modality to increase blood flow in the soft tissues” to promote healing.

• A pilot study assessed Class IV laser therapy for postoperative pain in 100 patients who had coronary bypass surgery, and found it to be effective.

• A double-blind study of tendonitis caused by repetitive-motion found Class IV laser treatments gave long-term relief with no adverse effects.

• Another double-blind study on 38 women with fibromyalgia showed that Class IV laser therapy improves pain, upper body range of motion, and quality of life. 

Chronic and acute pain are notoriously difficult to treat, especially in an era when fewer doctors are willing to treat pain or prescribe opioid medication. Pain patients have fewer options.

Dr. Kraft imagines a world where patients will have easy access to laser therapy at their primary care doctor or physical therapist. In addition to running his busy practice, Dr. Kraft has invented an improved laser, one that would optimize treatment regimen. He hopes to have it to market in two years.

Madora Pennington writes about Ehlers-Danlos and life after disability at LessFlexible.com. Her work has also been featured in the Los Angeles Times.

Bunny Boy and Me: A True Story About Chronic Pain and Unconditional Love

By Pat Anson, PNN Editor

When most people think of therapy and support animals, a dog or cat immediately come to mind. But after years of struggle with chronic pain from lupus and fibromyalgia, Nancy Laracy needed a different kind of animal.

“Our family had been through so much that I felt we all needed a family pet other than our lizard. And because my husband was allergic to dogs and cats, we settled on a rabbit,” Nancy explained.

She adopted a baby red satin rabbit, a breed known for its calmness and sociability. “Bunny Boy” quickly became part of the Laracy family and would have a profound effect on Nancy’s life. She wound up writing a book about her furry friend, “Bunny Boy and Me: My Triumph over Chronic Pain with the Help of the World’s Unluckiest, Luckiest Rabbit.”    

“Little did I know that Bunny Boy would become my third child in so many ways and that he would be the perfect therapy for my pain,” Nancy told PNN. 

“I had tried acupuncture, massage therapy, chiropractic, mainstream medicine, slept on a magnetic mattress — just about anything. But it was Bunny Boy who took me away from my pain as he slept with me, snuggled with me, and grew to know when I needed him the most. When I had his warm body on mine, I could feel the muscle pain lessen and of course the stress as well.”

Nancy started taking Bunny Boy to her doctors’ appointments, where he had a similar effect on other patients.

“I would see the positive reaction of the patients in pain, sitting in the lobby while we were there. If only for a short time, Bunny Boy would run around, jump on their laps when they allowed him to, knock the magazines all over, and make the patients laugh and smile,” she said. 

In a cruel irony, Bunny Boy got sick and was diagnosed with a similar autoimmune disease, and needed multiple surgeries for a severe jaw abscess. Most rabbits don’t respond well to painful invasive medical procedures, but Bunny Boy was a plucky hare with a strong will to live.

“I provided that same comfort to Bunny Boy as he underwent numerous surgeries and treatments that normal rabbits don’t survive, but he survived due to the strength and love he received from me and my family,” Nancy said.

“The vets who cared for him eventually called him ‘Iron Bunny’ and said to me over and over again that he was only surviving so many things due to our bond which formed in sickness and in health.”

Bunny Boy not only survived, he helped pioneer a new medical treatment that Nancy credits with saving her life, which she discusses in her book.

Bunny Boy lived a long life for a rabbit – nine years – and Nancy went on to adopt a new rabbit that she named Muffin, who also became a therapy animal.

“I started first by visiting nursing homes to see if she had the right temperament. Not only did I visit the patients in their rooms, but they wanted me to visit the patients in physical therapy and it was amazing how Muffin could help the patients increase their physical therapy programs, simply by sitting on their laps during some of their exercises,” Nancy said.

“For arthritis and fibro patients it is important to keep moving at some level and having pets helps us do that. For me a bunny was perfect because I believe it would have been too difficult for me to walk a dog that dragged me or walk a dog regularly period. A bunny is litter trained, doesn’t have to be walked, and they are equally as endearing and social as a dog or cat.”

Bunny Boy and Me is featured in PNN’s Suggested Reading section, along with other informative books on chronic pain and pain management. Nancy is donating all proceeds from her book to charity.

Missouri Finds Managing Pain Without Opioids Isn’t Easy

By Lauren Weber, Kaiser Health News

Missouri began offering chiropractic care, acupuncture, physical therapy and cognitive-behavioral therapy for Medicaid patients in April, the latest state to try an alternative to opioids for those battling chronic pain.

Yet only about 500 of the state’s roughly 330,000 adult Medicaid users accessed the program through December, at a cost of $190,000, according to Josh Moore, the Missouri Medicaid pharmacy director. While the numbers may reflect an undercount because of lags in submitting claims, the jointly funded federal-state program known in the state as MO HealthNet is hitting just a fraction of possible patients so far.

Meanwhile, according to the state, opioids were still being doled out: 109,610 Missouri Medicaid patients of all age groups received opioid prescriptions last year.

The going has been slow, health experts said, because of a slew of barriers. Such treatments are more time-consuming and involved than simply getting a prescription.

A limited number of providers offer alternative treatment options, especially to Medicaid patients. And perhaps the biggest problem? These therapies don’t seem to work for everyone.

The slow rollout highlights the overall challenges in implementing programs aimed at righting the ship on opioid abuse in Missouri — and nationwide. To be sure, from 2012 to 2019, the number of Missouri Medicaid patients prescribed opioid drugs fell by more than a third — and the quantity of opioids dispensed by Medicaid dropped by more than half.

Still, overdoses linked to legal and illicit opioids killed an estimated 1,132 Missourians in 2018 and 46,802 Americans nationally, according to the latest data available. Progress to change that can be frustratingly slow.

“The opioids crisis we got into wasn’t born in a year,” Moore said. “To expect we’d get perfect results after a year would be incredibly optimistic.”

Despite limited data on the efficacy of alternative pain management plans, such efforts have become more accepted, especially following a summer report of pain management best practices from the U.S. Department of Health and Human Services. States such as Ohio and Oregon see them as one part of a menu of options aimed at curbing the opioid crisis.

St. Louis chiropractor Ross Mattox, an assistant professor at chiropractic school Logan University, sees both uninsured patients and those on Medicaid at the CareSTL clinic. He cheered Missouri’s decision to expand access, despite how long it took to get here.

“One of the most common things I heard from providers,” he said, “is ‘I want to send my patient to a chiropractor, but they don’t have the insurance. I don’t want to prescribe an opioid — I’d rather go a more conservative route — but that’s the only option I have.’”

And that can lead to the same tragic story: Someone gets addicted to opioids, runs out of a prescription and turns to the street before becoming another sad statistic.

“It all starts quite simply with back pain,” Mattox said.

Practical Barriers

While Missouri health care providers now have another tool besides prescribing opioids to patients with Medicaid, the multistep approaches required by alternative treatments create many more hoops than a pharmacy visit.

The physicians who recommend such treatments must support the option, and patients must agree. Then the patient must be able to find a provider who accepts Medicaid, get to the provider’s office even if far away and then undergo multiple, time-consuming therapies.

The effort and cost that go into coordinating a care plan with multiple alternative pain therapies is another barrier.

“Covering a course of cheap opioid pills is different than trying to create a multidisciplinary individualized plan that may or may not work,” said Leo Beletsky, a professor of law and health sciences at Northeastern University in Boston, noting that the scientific evidence of the efficacy of such treatments is mixed.

And then there’s the reimbursement issue for the providers. Corry Meyers, an acupuncturist in suburban St. Louis, does not accept insurance in his practice. But he said other acupuncturists in Missouri debate whether to take advantage of the new Medicaid program, concerned the payment rates to providers will be too low to be worthwhile.

“It runs the gamut, as everyone agrees that these patients need it,” Meyers stressed. But he said many acupuncturists wonder: “Am I going to be able to stay open if I take Medicaid?”

Structural Issues 

While helpful, plans like Missouri’s don’t address the structural problems at the root of the opioid crisis, Beletsky said.

“Opioid overutilization or overprescribing is not just a crisis in and of itself; it’s a symptom of broader structural problems in the U.S. health care system,” he said. “Prescribers reached for opioids in larger and larger numbers not just because they were being fooled into doing so by these pharmaceutical companies, but because they work really well for a broad variety of ailments for which we’re not doing enough in terms of prevention and treatment.”

Fixing some of the core problems leading to opioid dependence — rural health care “deserts” and the impact of manual labor and obesity on chronic pain — requires much more than a treatment alternative, Beletsky said.

And no matter how many alternatives are offered, he said, opioids will remain a crucial medicine for some patients.

Furthermore, while alternative pain management therapies may lessen opioid prescriptions, they do not address exploding methamphetamine addiction or other addiction crises leading to overdoses nationwide — even as a flood of funds pours in from the national and state level to fight these crises.

“Prescribers reached for opioids in larger and larger numbers not just because they were being fooled into doing so by these pharmaceutical companies, but because they work really well for a broad variety of ailments.”

— Dr. Leo Beletsky, Northeastern University

The Show-Me State’s refusal to expand Medicaid coverage to more people under the Affordable Care Act also hampers overall progress, said Dr. Fred Rottnek, a family and addiction doctor who sits on the St. Louis Regional Health Commission as chair of the Provider Services Advisory Board.

“The problem is we relatively cover so few people in Missouri with Medicaid,” he said. “The denominator is so small that it doesn’t affect the numbers a whole lot.”

But providers like Mattox are happy that such alternative treatments are now an option, even if they’re available only for a limited audience.

He just wishes it had been done sooner.

“A lot of it has to do with politics and the slow gears of government,” he said. “Unfortunately, it’s taken people dying — it’s taken enough of a crisis for people to open their eyes and say, ‘Maybe there’s a better way to do this.’”

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

Do You Have ANT’s? How Awareness Helps Avoid Negative Thoughts

By Dr. David Hanscom, PNN Columnist  

This is the third in a series of columns on awareness -- a meditative tool that can be used to calm the nervous system to reduce pain and anxiety.  In my previous columns, I looked at environmental awareness (how mindfulness lowers stress hormones) and emotional awareness (how moods affect how we feel physically). 

The third level of awareness I’d like to introduce you to revolves around judgment and storytelling. On this level, you create a “story” or a judgment about yourself, another person or a situation. These judgments tend to be criticisms that are rough and inflexible. The brain has a bad habit of focusing on negative judgments that ramp up our emotions. 

We can categorize these negative thoughts into ten “errors of thinking” outlined by Dr. David Burns in his book “Feeling Good.” Burns calls these thoughts “ANTS,” which stands for automatic negative thoughts.

For example, imagine someone at work walked by you and didn’t acknowledge you. You might think they’re upset with you about a situation that occurred the day before. The error in thinking in this case would be “mind reading.” You can’t read other people’s minds. 

It’s possible that the other person had just received some bad news and wasn’t engaging with anyone. But you don’t really know. If you make assumptions, you’re wasting a lot of emotional energy.

Labeling 

Then there is the error of labeling. For example, a frequently late spouse becomes “inconsiderate.” A forgetful teenager becomes “irresponsible.” In the act of labeling, especially negative labeling, you’re overlooking circumstances and someone’s good qualities, limiting your capacity to enjoy being with them. 

Then there are the labels we have for ourselves: you knock something over and call yourself “clumsy.” If a lover breaks up with you, then you’re “unlovable.”  

Rehashing these critical judgments in our minds turns them into deeply embedded stories. Such stories are much harder to move on from than single judgments. Once a judgment sets into a story, you tend to lose all perspective. Over time, faulty thinking can become your version of reality. 

In my own experience, whenever I have an “ANT,” I become either angry or anxious (or both). I am also sometimes more reactive or impulsive. These emotions fuel negative thought and it becomes repetitive. As the thought keeps whirling around, it becomes stronger, along with my emotions. They quickly destroy my day and negatively affect my relationships. 

I’ve heard this thought pattern described as a vicious cycle or whirlpool. These kinds of thoughts, or stories, can become recurrent and might last for years. They take on a life of their own even though they are often fairly outrageous.  

Regardless of what sets these patterns of thinking off, they are a universal part of the human experience. This is true whether chronic pain is involved or not. With chronic pain you have the added frustration of the physical stimulus to keep these circuits really spinning.  

Self-Perceived Flaws 

To better understand the story concept, consider common situations where the brain focuses on a self-perceived flaw that is not physically painful. It might be your height, weight, the shape of your body, or even an individual body part. Or it might be some particular quality, such as a lack of intelligence, athletic skill, musical talent, etc.  

Thinking about these flaws over and over snares you in a destructive cycle of spinning neural circuits. For example, many years ago I had a patient with neck pain who was absolutely convinced that he was “stupid.” His self-labeling wasn’t rational, as he was clearly a bright guy. I don’t know if his view of himself somehow triggered it, but he eventually developed a significant chronic burning sensation around his mouth. 

Something similar often happens in the entertainment industry, where performers commonly focus only on their negative reviews. My wife, who is a tap dancer, has seen this in her profession for years. She pointed out to me that a performer might have 99 positive reviews but will fixate on the one that’s negative. It’s a common saying among entertainers that, “You’re only as good as your worst critic.” 

ANT’s and Relationships 

Another common phenomenon is focusing on a spouse or partner’s negative traits. The other person usually has innumerable positive qualities that are forgotten in the face of their “flaw.” Over time the “story” we tell ourselves can become so strong it can break apart an otherwise great relationship. 

One particular event from my own life comes to mind. It shows how creating stories has the power to disrupt your peace of mind and detract from your enjoyment of life. 

One day my wife and I were taking my father for a ride up to beautiful Point Reyes, located on the coast north of San Francisco. About 20 minutes into our trip I noticed that the car’s low-tire-pressure light had come on. It was a brand new car with only a thousand miles on it, so I thought it was probably just a malfunctioning light.  

I wasn’t convinced that we’d made the correct decision to buy this car in the first place -- it was more expensive than I was comfortable with -- so I was more than a little frustrated that the warning light had a glitch. 

I stopped to put a little air in the tire, just in case, and then kept driving for another 45 minutes. As we approached Point Reyes in the early afternoon, we realized that the tire was really low, so I pulled over to change it. But when I opened the trunk, there was no spare.  

The story in my head was starting to ramp up as I wondered in frustration why a new car wouldn’t have a spare. I called the car company’s roadside assist line and they told me these new cars had “run-flat” tires that should be good for 150 miles at a maximum speed of 50 miles per hour.  

I felt a little insecure about that concept. We were a long way from the last large town we’d passed and I thought that we should turn back. My wife thought that since my father rarely made it to California from the East, we should go out to dinner. So, we headed toward a restaurant. About three miles down the road the tire exploded. 

It was now about four o’clock in the afternoon and we were miles and miles from anywhere. Our only option was to get towed courtesy of AAA. It was hard for me to accept the fact that I had to get my new car towed for a flat tire.  

The tow truck driver showed up to take us to the service station and let the three of us ride in the cab, with my wife sitting on my lap. She started to complain about the bumpiness of the ride, which I found a little annoying. “I’m the one on the bottom, why are you complaining?” I thought.  

She wanted to have dinner in San Rafael and take a taxi home. I started to grind my teeth to keep my mouth shut. 

Magnifying the Problem

This is how the afternoon unfolded for me. Starting with the low tire, I’d made a decision to enjoy my time with my family in spite of the problem. I took note of my frustrations and concentrated on listening to the conversation and staying involved in the day. I was successful for a while -- until the tire blew up.  

Then my anger began to bubble. I became aware that in spite of everything I’d learned about dealing with stress, I was greatly magnifying the problem with the ANT thoughts in my head. I was thinking things like, “I can’t believe I got talked into buying this car” and “My wife made me buy it.” 

Although there might’ve been some truth in the things I was telling myself, I recognized that it wasn’t helping us get through the situation. Nonetheless, I wasn’t able to minimize my suffering through the stress relief techniques that had helped in the past, which was frustrating. I tried to talk myself out of it, but it didn’t work. 

Then I began to go really dark with thoughts like, “How can I be married to this woman?” I began to notice how irrational and big these thoughts had become. It felt like a bomb had exploded. I was miserable way out of proportion to the situation. 

I was guilty of multiple errors in thinking. They came in the form of labeling – “My wife is irresponsible”— and catastrophizing -- “Why did we get married?”  

Through it all, I negated her many positive qualities. To cite one, she’s great at keeping things light, no matter what the problem. And unlike me, she was able to keep her cool throughout the day. 

In the past, I would’ve remained in this agitated state of mind for days, with some carryover lasting for weeks. I wouldn’t have been able to separate my wife’s actions from my thoughts and realize that the problem wasn’t her, it was my reaction to the situation.  

It was a major step for me to become aware of how out of proportion the stories in my head had become. This degree of awareness changed the game for me. 

Eventually, we did get towed home. We went out to dinner. I still love my wife. And I learned yet another lesson in humility.

Dr. David Hanscom is a retired spinal surgeon. In his latest book -- “Do You Really Need Spine Surgery?” – Hanscom explains why most spine operations are unnecessary and usually the result of age-related conditions that can be addressed through physical therapy and other non-surgical methods.

Medicare to Cover Acupuncture for Back Pain

By Pat Anson, PNN Editor

The Centers for Medicare & Medicaid Services (CMS) has finalized a decision to cover acupuncture for Medicare patients with chronic low back pain. Up to 12 visits in 90 days to an acupuncture therapist will be paid by Medicare, but no more than 20 treatments annually.

Acupuncture is an ancient Chinese treatment in which practitioners stimulate specific points on the body by inserting thin needles through the skin. About 3 million Americans receive acupuncture treatments, mostly for chronic pain. Some private insurers already cover acupuncture, but there is little consensus in the medical community about its value.

Lower back pain is the world’s leading cause of disability. CMS researchers reviewed clinical studies and found evidence that older adults with chronic back pain showed small improvements in pain and function after acupuncture treatments, although the exact mechanism of action was “unclear” and there was “inconclusive evidence” about the most effective acupuncture technique.

“Expanding options for pain treatment is a key piece of the Trump Administrations’ strategy for defeating our country’s opioid crisis,” Health and Human Services Secretary Alex Azar said in a statement. “Medicare beneficiaries will now have a new option at their disposal to help them deal with chronic low back pain, which is a common and sometimes debilitating condition.”  

The decision to cover acupuncture overturns decades of previous rulings that took a dim view of the procedure. In 1980, CMS said the use of acupuncture as an anesthetic was “not considered reasonable and necessary.”

In 2004, the agency rejected acupuncture as a treatment for fibromyalgia and osteoarthrosis because there was “no convincing evidence for the use of acupuncture for pain relief.”

CMS said it was “keenly focused” on finding alternatives to opioid painkillers.

“We are dedicated to increasing access to alternatives to prescription opioids and believe that covering acupuncture for chronic low back pain is in the best interest of Medicare patients,” said CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt.

“We are building on important lessons learned from the private sector in this critical aspect of patient care. Over-reliance on opioids for people with chronic pain is one of the factors that led to the crisis, so it is vital that we offer a range of treatment options for our beneficiaries.”

A recent study of over 140,000 Army veterans with chronic pain found that non-drug therapies such as acupuncture significantly reduce the risk of suicide, as well as alcohol and drug abuse.  

The Truth About Chronic Pain

By Dr. Rachel Zoffness, PNN Columnist

I’ve never been an athlete, but I’ve always loved exercising because of how it makes me feel. One beautiful spring day, I went for a run. On the way downhill, I was stopped by a sudden pain in my knee. When I woke the next morning, I couldn’t step out of bed without burning pain radiating from my feet, up my leg and into my hip.

I was couch-bound for the better part of a year. I saw countless doctors, was prescribed many medications, and would’ve done anything to stop the pain. That was the beginning of a decade-long journey with chronic pain.

I’ve dedicated my life to understanding pain, and not just because of that injury.

I’m a pain psychologist and assistant clinical professor at UC San Francisco School of Medicine, where I teach pain neuroscience to medical residents. I also founded a private practice dedicated to people living with chronic pain.

One of my earliest patients was a teenager. He’d been bedridden with multiple medical diagnoses for four years, seen 12 physicians and tried 40 medications. But nothing worked.

Not surprisingly, he was depressed and anxious. He had no life, no friends and no hope.

DR. RACHEL ZOFFNESS

As a pain psychologist, I use cognitive behavioral therapy (CBT) as one of my primary treatment tools, so we started a CBT-for-pain program. In addition to other strategies, it involved “pacing” or resuming select activities one small step at a time.

It was hard work, but little by little, he got healthier. As his functioning and mood improved, his pain did, too. Within 6 months he resumed school and rejoined his soccer team. His pain wasn’t gone – but it was significantly reduced and he knew how to manage it. He says pain will never control his life again.

Many of us have noticed this link between how we feel emotionally and how we feel physically. That’s because pain is never purely physical. This is confirmed by neuroscience research indicating that pain is produced by multiple parts of the brain, including the cerebral cortex (responsible for thoughts), prefrontal cortex (which regulates attentional processes), and the limbic system – your brain’s emotion center.

Dialing Back Pain

Imagine that you have a “pain dial” in your central nervous system that controls pain intensity. The function of this dial is to protect you from danger or harm. It can be turned up or turned down by many factors, including:

1. Stress and anxiety

2. Mood

3. Attention (what you’re focusing on)

When you’re feeling stressed and anxious – your thoughts are worried, your muscles are tense and tight, and the pain volume is turned up.  

When your mood is low, you’re miserable and depressed, and your brain similarly amplifies pain volume. 

This is also true when your attention is focused on pain. When you’ve stopped going to work, seeing friends and engaging in hobbies, your prefrontal cortex (which controls attention) sends a message to your pain dial, turning it way up. 

However, the opposite is also true. 

When stress and anxiety are low – your body is relaxed, your thoughts are calm and you’re feeling safe. Your cerebral cortex and limbic system send messages to your pain dial, lowering the volume so that pain feels less bad. 

When your mood is high, your thoughts are positive, you’re feeling happy and you’re engaged in pleasurable activities. Your brain determines that little protection is needed, so pain volume is reduced. 

And finally, when you’re distracted – you’re absorbed in activities, like watching funny movies with friends. The pain dial is turned down, so pain is less bad. 

In summary, when you’re relaxed, happy, distracted, and feeling safe, your pain volume is lower. The pain is still there -- it hasn’t magically disappeared -- but it’s quieter. Softer. Less. 

The truth about chronic pain is this: Your thoughts, beliefs, emotions and attention can all adjust pain volume. 

This does not mean that pain is “all in your head.” It isn’t. Your pain is real, as real as mine, and no one should ever tell us otherwise. It does mean that there are many ways to change pain. One is medication. Multiple medications have been shown to effectively turn down the pain dial.  

There are other methods for lowering pain volume, too. CBT, mindfulness and biofeedback are three biobehavioral approaches to pain management that research suggests can be helpful. They aren’t magic cures and they take time. But if you’ve never tried to manage your pain with these techniques, consider them. They’ve helped me immensely on my chronic pain journey. 

When I was learning about mindfulness, I remember thinking, “What could mindfulness possibly have to do with physical pain?”  

And then something fascinating happened.  

During the first year of my practice, my pain changed. It didn’t go away entirely and I wasn’t cured. But the pain changed. It became less intense, less frequent, less distracting, and got less in the way of the rest of my life. 

Rachel Zoffness, PhD, is a pain psychologist and assistant clinical professor at the UCSF School of Medicine. Rachel serves on the Steering Committee of the American Association of Pain Psychology, where she founded the Pediatric Division. She is the author of The Chronic Pain and Illness Workbook for Teens. You can find Rachel on Twitter @DrZoffness.  

Emotional Awareness: How I Learned to Connect with Life and Disconnect from Pain

By Dr. David Hanscom, PNN Columnist

Last month I wrote about the importance of environmental awareness – being aware of your moods, anxiety and other senses and learning how to calm them through active meditation.

In this column we’ll look at emotional awareness – living a life full of rich relationships and satisfying endeavors. You must understand the nature of someone else’s emotional needs before you can interact with them in a meaningful way.

In the presence of chronic pain however, this is a problem. When you are in pain, you are justifiably angry, which can block emotional awareness. You are just trying to survive and don’t have the capacity or energy to reach out to others.

Another problem with pain-induced anger is that it not only disconnects you from others, but also from yourself. You are so used to being in this agitated state that you feel it is the norm.

I am quite aware of this scenario, as this was my experience. I was constantly agitated, but did not perceive it as anger. I thought I could hear what others were saying and see issues through their eyes. I was idealistic and thought I was right – but was so wrong.

It wasn’t until I had every layer stripped away in the midst of suffering from severe chronic pain, that I could see the problem. Meanwhile, I lost my marriage.

Self-Discovery

The problem with becoming emotionally aware is that you have to allow yourself to feel unpleasant emotions, such as anxiety, sadness, vulnerability, shame and so on. If you don’t allow yourself to feel the dark side of life (which is core to the human experience), then you won’t be able experience deep joy, happiness and love.

My strategy for most of my life was to suppress all negativity and keep my emotions on an even keel. One of my nicknames was “The Brick.” At the time, I thought it was a compliment because it meant I was tough.

It all worked until it didn’t. At age 37, I began to experience severe anxiety in the form of panic attacks. They came out of the blue and I had no idea what had hit me. I didn’t emerge from this hole for another 13 years.

Unless you actively choose a journey of self-discovery, you can’t connect with your true emotional state. You must commit to stepping outside of your mind and looking at yourself from a different perspective.

Ask yourself these questions: Am I open? Am I coachable? Can I really listen and feel?

That is a starting point. Once you get in touch with what’s going on in your mind, you can embark on a powerful journey. Allowing yourself to feel your emotions is a learned skill with many ways of accomplishing it. You will fail endlessly, but the key is remaining open and persistent.

Many people choose not to take this journey. But they make that choice at their own peril. It is what you’re not aware of that will run your life. The result may be a lot of physical and emotional suffering for the individual and especially for those close to him or her.

Why don’t more people pursue a path of self-discovery? It may be because in our culture most of us spend a lot of emotional energy trying to look good to people around us. We also try to look good to ourselves.  

Truly connecting with your emotions is an act of humility. Most people don’t want to do something so difficult and unpleasant. However, it’s also extremely rewarding and makes life so much easier in the end. It was the beginning of my recovery from my own chronic pain.

Dr. David Hanscom is a retired spinal surgeon. In his latest book -- “Do You Really Need Spine Surgery?” – Hanscom explains why most spine operations are unnecessary and usually the result of age-related conditions that can be addressed through physical therapy and other non-surgical methods.

How to Avoid the Holiday Blues

By Pat Anson, PNN Editor

For many of us, the holiday season wouldn’t be complete without Christmas cookies, jelly donuts, plum pudding, chocolate babka, or even the much-maligned fruit cake.

But if you're prone to depression or have an inflammatory condition, you might want to avoid those sweet treats. Or at least enjoy them in moderation.

New research by clinical psychologists at the University of Kansas suggests that dietary sugars found in many holiday foods can trigger metabolic, inflammatory and neurobiological processes that can lead to insomnia, digestive problems and depression – which all enhance physical pain.

"A large subset of people with depression have high levels of systemic inflammation,” said lead author Stephen Ilardi, PhD, an associate professor of clinical psychology at KU. "When we think about inflammatory disease we think about things like diabetes and rheumatoid arthritis - diseases with a high level of systemic inflammation. We don't normally think about depression being in that category, but it turns out that it really is.

“We also know that inflammatory hormones can directly push the brain into a state of severe depression. So, an inflamed brain is typically a depressed brain. And added sugars have a pro-inflammatory effect on the body and brain."

Depression Causes Sugar Cravings

Dwindling daylight in winter can worsen depression and prompt people to consume more sweets, which provide a temporary emotional lift.

"One common characteristic of winter-onset depression is craving sugar," Ilardi said. "So, we've got up to 30% of the population suffering from at least some symptoms of winter-onset depression, causing them to crave carbs - and now they're constantly confronted with holiday sweets.

"When we consume sweets, they act like a drug. They have an immediate mood-elevating effect, but in high doses they can also have a paradoxical, pernicious longer-term consequence of making mood worse, reducing well-being, elevating inflammation and causing weight gain."

The KU research team analyzed a wide range of studies on the physiological and psychological effects of sugar, including the Women's Health Initiative study, the NIH-AARP Diet and Health Study, and studies of Australian and Chinese soda-drinkers. Their research is published in the journal of Medical Hypotheses.

Ilardi says consuming high amounts of sugar could be as physically and psychologically harmful as drinking too much liquor.

"We have pretty good evidence that one alcoholic drink a day is safe, and it might have beneficial effect for some people," Ilardi said. "Alcohol is basically pure calories, pure energy, non-nutritive and super toxic at high doses. Sugars are very similar."

The average American gets about 14% of their calories from added sugars – the equivalent of 18 teaspoons of sugar each day. Most people know a high-sugar diet can lead to diabetes, obesity and cardiovascular problems.

Another way to look at sugar is to think of it as fuel for bacteria.  

"Our bodies host over 10 trillion microbes and many of them know how to hack into the brain," Ilardi said. "The symbiotic microbial species, the beneficial microbes, basically hack the brain to enhance our well-being. They want us to thrive so they can thrive.

“But there are also some opportunistic species that can be thought of as more purely parasitic - they don't have our best interest in mind at all. Many of those parasitic microbes thrive on added sugars, and they can produce chemicals that push the brain in a state of anxiety and stress and depression. They're also highly inflammatory."

Ilardi recommends eating a minimally processed diet rich in fruits, vegetables, fish and whole grains, while avoiding red meats, refined grains, fructose and other unhealthy foods. As for sugar, the KU researcher urges moderation -- not just during the holidays, but year-round.

Poppy Seed Tea: Deadly Potion or Potent Pain Reliever?

By Pat Anson, PNN Editor

You can find poppy seeds in cakes, cookies, muffins and salad dressings. The tiny versatile seed is even used in cosmetic products as a skin moisturizer and exfoliant.

What you may not know is that poppy seeds can also be used to make tea. The bitter homemade brew doesn’t taste good, but some chronic pain sufferers have discovered poppy seed tea is a potent pain reliever.

“This fall I will be growing opium poppies and extracting my own medicine. I did grow a few plants last year and the tea I had made from those poppy pods was extremely helpful,” said Ed, a pain patient in Texas who was taken off opioid medication by his doctor.

“I do know the dangers and illegality of doing this, but a man has to do what a man has to do for relief. I have exhausted every legal option I can think of. There is absolutely no help from the medical community around here.”

Ed is not alone. He and other patients who have lost access to opioid painkillers have learned that unwashed poppy seeds contain opium alkaloids that, when soaked in water, can be converted into morphine and codeine.

It takes hundreds of poppy seeds to brew a single cup, but the seeds can be purchased cheaply in bulk for about $10 a pound from online retailers like Amazon and eBay.

“This means for under $15/week I can be back to being a partially functional human being. I am doing way better than I was on the measly 20mgs of Oxy I had been struggling and stressing to get from the doctors,” said another pain sufferer, who claimed she used poppy seed tea to wean herself off oxycodone.

“Safe if used carefully. Easy to make and drink. You can add things like lemonade to make it taste better.”

DEA Warns About Unwashed Seeds

Poppy seeds make up only a tiny part of the worldwide trade in opium products, most of which comes from Afghanistan. According to The Washington Post, four times as much Afghan land is being used in poppy production today than in 2002, shortly after the U.S. invasion. Afghanistan now produces 82% of the world’s supply of heroin, far more than it did under Taliban rule.

With poppy seeds readily available online, the Drug Enforcement Administration recently closed a loophole that allowed unwashed seeds to be sold legally in the U.S. While the poppy plant has long been classified as an illegal controlled substance, the seeds were exempt because they don’t normally contain opium alkaloids. Whether by accident or design, many seeds become contaminated during harvesting.

“Harvesters, who wish to increase opium alkaloids contents on the poppy seed coats, make cuts in the opium pods before they ripen which allows the latex to seep onto the seed coats. Individuals wishing to extract the opium alkaloid content from unwashed poppy seeds, use the seeds to create a tea, which contains sufficient amounts of alkaloids to produce psychoactive effects,” the DEA said in a little publicized announcement that it was classifying unwashed poppy seeds as a Schedule II controlled substance.

“Unwashed poppy seeds are a danger to the user and their abuse may result in unpredictable outcomes including death when used alone or in combination with other drugs as reported in the scientific literature.”

The scientific literature on poppy seed tea is actually very limited. But one recent study urged policymakers to fix the “murky legal status” of poppy seeds and warn patients about the potential dangers.

“With no legal restrictions and apparent endorsement from reliable brands and trusted websites, patients may have little reason to think this tea is actually a version of morphine,” said lead author Jo Ann LeQuang, Director of Editorial Services for NEMA Research.

“I am happy to see the DEA finally take a stance,” says Madeleine Gates, PhD, an Assistant Professor of Forensic Science in the College of Criminal Justice at Sam Houston State University. “I think the poppy tea problem is just another devastating aspect of the opioid epidemic.”

In a 2017 study, Gates used four brewing methods to test 22 samples of bulk poppy seeds purchased legally on the internet. Her research, published in The Journal of Forensic Science, found that a potentially lethal dose of morphine can be brewed in a moderate amount of tea.

“When I was originally contacted to work on poppy tea, I had honestly never heard of it! Now it’s been so eye opening about the drug use that had flown under the radar for too long,” she said in an email to PNN.

Gates began investigating poppy seed tea after being contacted by the father of a 21-year-old man who died after ingesting home-brewed tea. A dozen similar deaths were cited by the DEA in its warning, but Gates believes there could be many more cases.

“I’ve spoken with physicians who are treating poppy tea addicts. I’ve also been involved in a case of a pregnant woman who naively used poppy tea during pregnancy and upon delivery her infant went into withdrawal,” she said.

“I’m sure there have been other cases that are yet to be reported or that may be overlooked. For those who may be known opioid addicts that would have morphine in their system for a hospital or autopsy toxicology test, the first thought is not to think of poppy tea. For that reason, those intoxications or fatalities wouldn’t necessarily be tied to poppy tea unless there was investigative information to link to the case.”

Poppy Tea Addiction

The Internet is filled with stories about illicit drug users experimenting with poppy seed tea. Some became addicted to the tea and went into withdrawal when they ran out of poppy seeds.

“I never got my seeds in time so the awful opiate withdrawals started. I made it two days until I had to go to hospital for withdrawals. I wanted to die!! It’s soooooo horrible. Never felt this way before,” one user posted on Reddit. “I wish I looked into this god damn tea before I started. Didn’t know the withdrawals were going to make me wanna kill myself. Please don’t get addicted to poppy seed tea. It’s awful addiction hard to stop ruins your life.”

Despite the DEA warning, unwashed poppy seeds are still being sold online. A controversial alternative health website even had a recipe for making poppy tea – since taken down — that came with a stark warning.

“Unfortunately, the abuse of or having insufficient knowledge about this tea has led to a few fatal incidences,” the recipe warns. “If you're planning on trying this tea, it's important that you're aware of your own threshold and sensitivities. It's also imperative that you test each batch of poppy seed tea to make sure that you're not unknowingly ingesting high amounts of the opiate alkaloids.”

Another drawback is that even a small amount of poppy seeds in a muffin or cookie can produce a positive reading for morphine in a drug test. That could result in a patient being dropped by their doctor or a referral to addiction treatment

But for some chronic pain patients, the urge to self-medicate is strong and worth the risk. Many, like Ed in Texas, feel abandoned by a healthcare system that has become paranoid about opioid medication. If doctors won’t treat his pain with a legal drug, then Ed believes he has a right to try whatever substance he wants.

“It is my personal observation that the so called medical ‘profession’ around here is lacking professionalism and is poor at best. At times I feel like a drowning man sinking into a deep pool of despair,” Ed wrote in an email. “It is my opinion that people with chronic pain issues should have the ability to break the cycle of the pain that plagues them. I understand the addictive nature of opiates and I feel that I am a responsible adult.”

My Healing Journey With Chronic Pain

By Mia Maysack, PNN Columnist

The first time people told me that pain begins and ends in our minds, I was just thankful there wasn't a comic book bubble over my head -- demonstrating my thought of punching them in the face.  

But I sat there to humor them, hooked up to a machine that measured my heart and other vital signs. The irony in that moment is that the provider told me to purposefully think of something upsetting to see how I’d respond. 

I could see on the screen that my blood pressure increased. I remained polite while shoving the thought aside as to how draining this office visit was and whether it was a complete waste of time. It’s so disheartening to live like we do in the first place, but then to have an appointment that makes you feel even worse than you did on arrival.

After the Doc realized I was upset, it was brought to my attention that if I'm in need of "that sort" of help I should see another type of doctor. It got even better with the suggestion on my way out the door that I should “be positive and try visualizing an ocean -- that helps!"

That’s when I made the decision to incorporate my medical background with my passion for healing and began venturing into holistic health.

Part of the training to become a “certified life coach”' is to get one for yourself. It felt awkward initially, preparing to connect with a stranger.

But between being fed up with the traditional route and reaching a point of desperation where I'd do just about anything, this connection would serve to be one of the most important contacts of my life.

My career plans had experienced multiple screeching halts over the years, whether I attempted nursing or teaching. I went back and forth quite a bit, trying to find a way to make either of them work in any capacity. But the outcome remained the same because of my physical pain, chronic fatigue and persistent illness.

Even though I am no longer able to run the hospital floor for multiple shifts or teach a classroom of 30 students, I do still possess my course work in medicine and years of work experience, not to mention firsthand experience as a patient with the healthcare system.

It was during the first phone call with my coach that the concept of energy was shaped in a new way. It was explained how our bodies not only feel and respond to experiences, but also essentially tracks them. They get stored in our physical beings and we carry them with us, for better or worse.

I began reflecting on everything I'd planned on telling this person. How I got sick at a young age and almost died. How I went through years of rehabilitation while losing the ability to pursue my passions in life. How I’ve had relentless pain no one could possibly begin to fathom. And that I'm still mourning identities that once made up who I am. 

It struck me that none of that mattered anymore because what I chose from that moment forward is what really counts.  

At a meeting recently, I was asked about my healing journey. I explained that we must first reach our lowest point of being sick and tired of being tired and sick, and then consciously move forward — making the decision to do whatever is necessary for our own sake no matter what.

I showed them what this looked like for me: bawling my eyes out in a fetal position on the cold hard floor, begging the universe for relief, and not knowing how or if I'd be able to go on. 

We're enduring a personal hell on a continuous basis that most regular folk wouldn't be able to handle.  As far as emotions getting the best of me, they don’t anymore because I've grown to be more self-aware through the inner work that I've committed myself to.

It hasn't fixed or cured anything, and it'll continue to be a pursuit for the rest of my days. But I feel safe within my body and mind for probably the first time ever. Security is another thing we can lose as part of the pain experience. 

Nothing is nor will it ever be perfect, but I have come an extraordinary long way. I'm proud of that and believe in these concepts. I've never had more physical discomfort than I do these days but with these tools, I've also never been able to manage so well until now.

We must re-shape our perception of healing and recovery on the other side of fear. And when we're able to make it through the darkness, it then becomes our responsibility to light the way for others. It doesn't make it any easier, but we are stronger together.   

Mia Maysack lives with chronic migraine, cluster disease, fibromyalgia and arthritis. Mia is a patient advocate, the founder of Keepin’ Our Heads Up, an advocacy and support network, and Peace & Love, a wellness practice for the chronically ill and those otherwise lost or hurting.

The information in this column is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

How to Control Anxiety and Pain Through Meditation

By Dr. David Hanscom, PNN Columnist

Every sense in your body has a threshold that indicates danger – hot, cold, bitter, loud, bright, sharp, pressure, burning, nausea, etc. Without that immediate feedback from your senses, you could not protect yourself from whatever the danger is.   

When any physical threat is sensed, your body secretes chemicals and hormones to increase your chances of survival. They include cortisol, adrenaline and histamines. This chemical bath affects every cell in your body and you are on “high alert.” The feeling generated is anxiety and it is not a psychological reaction. 

Humans have a problem in that mental threats manifested by unpleasant thoughts are processed in similar area of the brain and cause the same hormonal response. But since we can’t escape our thoughts, we are subjected to sustained levels of these chemicals. One of the effects is increasing the speed of nerve conduction. All of our senses are heightened, including various types of pain.  

Environmental Awareness 

Being aware of your senses – known as environmental awareness –-- is a strategy that allows you to switch sensory input from racing thoughts to another sensation. It doesn’t matter which sense you choose.

I practice one that I call “active meditation” or “meditation on the run.” Being aware of your senses has a calming effect on your nervous system. Active meditation enabled me to be a calmer person and more effective in my work.  

As a retired spine surgeon with many years of experience, I was often referred complicated spine problems that required complex surgeries. Sometimes those surgeries resulted in complications for the patient. Although I was committed to having no complications from the first day I walked into the operating room, there was a point a few years ago when I faced up to the fact that I hadn’t been able to eliminate them. My own thoughts were interfering with my work.  

The most common interferences I felt during surgery were frustration, anxiety, distraction, complacency, and, especially, being in a rush to finish. They all detracted from the consistency of my performance. This led me to develop a somewhat defensive mindset. If I could get through the week without a surgical complication, it was a huge relief.  

Learning Active Meditation

Things changed when I decided to enlist the help of a performance coach to help me reduce any mistakes in surgery. That was a major turning point in my professional life. I brought my coach into the operating room and clinic so he could better understand my world. For 18 months, he and I underwent regular debriefings and coaching. I began to use active meditation in the operating room. 

This meditation model is not based on suppressing interference – for instance, if you’re frustrated, you don’t pretend otherwise – rather, you face these frustrations and then detach from them. Using tools and approaches that have been employed for centuries in the practices of meditation and mindfulness, I learned to identify any interference either before or during surgery, and then let go of it.  

This is how it worked: Each surgical morning, I woke up and assessed how I was feeling. Like everyone, my feelings ranged from calm and relaxed to tired and anxious. Then, I immediately started sensing every smell, touch and taste possible. I felt the water on my back in the shower. I smelled the coffee. I also reminded myself that although that day’s surgery is “just another case” for me, it’s one of the most important days of my patient’s life.  

I continued this process in the operating room. I carefully arranged the room, talked to each member of the surgical team, and reviewed the imaging studies. I was focused and immersed in what’s right in front of me, when previously I’d rush into the operating room at the last minute just before making the incision. 

During surgery, awareness allowed me to perform my next move at an optimum level. I felt my grip pressure on each surgical tool; noticed the shape of the contours of the anatomy; felt my shoulder and arm muscles stay relaxed; and just watched the flow of the case.  

If I felt any disruptive emotions intrude into my state of mind, I quickly practiced my environmental awareness techniques in order to re-focus. I learned to be more fully engaged on a higher percent of cases, so I could “program” myself into the “zone.” 

Since I started practicing active meditation, my complication rate in surgery noticeably decreased. For instance, from 1999 until 2003 I had an “acceptable” 9% rate of inadvertently entering the dural sac (a sack of fluid surrounding the brain and spinal cord). After I started using meditation, I made this mistake only two or three times a year, which is less than one percent. 

Surgery became a wonderful experience for me. I eagerly looked forward to Monday instead of Friday. I committed to getting a good night’s sleep before my surgeries.  If I woke up “wired” and uneasy, I slowed down until I felt relaxed, no matter how many things were on my to-do list.  

I continue to practice active meditation daily. Environmental awareness is more difficult outside the operating room, in the less controlled areas of my life, but it is still my go-to active meditation.   

One tool I use to practice awareness is my “to do” list. I remind myself that this list is an expression of my life, and so I practice being aware as I go about each item. For instance, when I have an appointment with a patient, I listen to myself talk to him or her.  I feel the pen on the paper as I jot down notes.  I also practice meditative techniques. such as watching the disruptive thoughts of “need to finish up here, I have other things to do” enter my consciousness and then leave.  

I remember that my goal is to engage and enjoy every second of my “to do” list. It doesn’t always work, but it’s surprising how often it does.

Environmental awareness engages me in the present moment regardless of the circumstances. It is not positive thinking, but just switching the sensory input. With repetition, it has become somewhat automatic. It is a simple strategy that can help the quality of your life, regardless of the level of your pain.  

Dr. David Hanscom is a retired spinal surgeon who has helped hundreds of back pain sufferers by teaching them how to calm their central nervous systems without the use of drugs or surgery.

In his latest book, Do You Need Spine Surgery?, David explains why spinal surgeries are often risky and unnecessary.

This column is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

‘Injectrode’ Could Revolutionize Neuromodulation Pain Treatment

By Pat Anson, PNN Editor

A team of scientists and engineers has developed a flexible electrode that can be injected into the body to stimulate damaged nerves, relieve chronic pain and treat other conditions.

The so-called “injectrode” could revolutionize neuromodulation therapy by eliminating the need for invasive spinal cord stimulators and other surgically implanted medical devices.

Researchers used a liquid silicone base -- similar to surgical glue – and mixed it with small metal particles to make it electrically conductive.

When injected around a nerve and allowed to cure, the injectrode performs much like a metal wire, but remains flexible.

Current neuromodulation treatments often rely on rigid implanted devices that can cost hundreds of thousands of dollars, require complex surgeries to install, and often fail or need to be replaced.

IMAGE COURTESY OF NEURONOFF

"Typical implants are really stiff, and so as the body moves, they wear and tear and break down. Our liquid cures, and the result is much closer to the normal elasticity of tissue. You can actually stretch it and increase its size 150 percent to 200 percent without losing its conductivity," says co-author Kip Ludwig, PhD, a professor of biomedical engineering and neurological surgery at University of Wisconsin-Madison.

“By virtue of its simplicity, the Injectrode has the potential to be less invasive, more robust, and more cost‐effective than traditional electrode designs, which could increase the adoption of neuromodulation therapies for existing and new indications.”

Ludwig and his colleagues reported their findings in the journal Advanced Healthcare Materials.

The injectrode has been tested on laboratory animals to stimulate their nervous systems. It was used in pigs to induce heart rate changes by stimulating the vagus nerve in the neck, an approach that's shown promise for treating heart failure, hypertension, lupus and cluster headaches.

"We essentially went through the standard repertoire of electrochemical tests to show this acts like a standard wire electrode that could be used to stimulate the nerve," says co-author James Trevathan, PhD, a postdoctoral fellow in Ludwig's lab.

Ludwig co-founded Neuronoff, a company based on the injectrode, with Case Western Reserve University biomedical engineering professor Andrew Shoffstall, PhD, and Neuronoff CEO Manfred Franke, PhD. Neuronoff recently secured a $2.1 million grant from the National Institutes of Health to further develop the injectrode to stimulate spinal nerves as a treatment for chronic back pain.

The researchers are testing a scheme in which they inject the fluid around the nerve, then extrude a thin insulated string of the material back to just underneath the surface of the skin, where they inject more of the composite material. Then they can use a basic transcutaneous electrical nerve stimulation (TENS) unit to stimulate the nerve from the surface of the skin.

"We're making a bypass from the surface of the skin to the location we want to stimulate," says Ludwig, who envisions using a robotic surgical system to install the injectrode in a procedure similar to getting a tattoo.

"As we learn more and more about how to interface with the nervous system, we're not limited to what we've implanted through an invasive surgical procedure. We can actually change how we stimulate, how we talk to the nerve, because we're essentially just routing our connection to this deep nerve back to the surface of the skin."

Spinal cord stimulators have some of the worst safety records among medical devices, according to a 2018 report by investigative journalists. Stimulators are often touted as safer alternatives to opioid pain medication, but a review of FDA data found over 500 deaths and 80,000 injuries involving stimulators since 2008. Patients reported being shocked or burned by the devices and many had them removed.  

Icy Virtual Reality Freezes Out Pain

By Pat Anson, PNN Editor

Everyone knows that an ice pack or cold compress can help sooth aching joints and sore muscles. Cold temperatures slow blood circulation, reducing both pain and inflammation.

Researchers at Imperial College London took that basic first aid measure a step further by using virtual reality (VR) to immerse people in scenes of an icy Arctic landscape. And just like real ice, the VR video reduced pain perception and sensitivity.

Findings from the small study, published in the journal Pain Reports, add to growing evidence that VR technology can not only distract people from their pain, but may also activate the body’s pain-fighting response.

“One of the key features of chronic pain is you get increased sensitivity to painful stimuli. This means patients’ nerves are constantly ‘firing’ and telling their brain they are in a heightened state of pain,” first author Sam Hughes, PhD, said in a press release.

"Our work suggests that VR may be interfering with processes in the brain, brainstem and spinal cord, which are known to be key parts of our inbuilt pain-fighting systems and are instrumental in regulating the spread of increased sensitivity to pain.

In the study, 15 healthy volunteers were given a topical cream on the skin of their legs containing capsaicin – the spicy chemical in chili peppers that makes your mouth burn. The capsaicin sensitized the skin, making it more sensitive to pain from a small electric shock.

Participants were then asked to rate their pain on a scale of 0-100 (from ‘no sensation’ to ‘worst pain imaginable’) while looking at a still image of an Arctic scene on a computer monitor or watching this National Geographic video of Arctic exploration through a VR headset.

Researchers found that pain from the capsaicin cream was reduced following the VR immersion. The volunteers’ skin was also less sensitive to the electric shocks.  The same effect was not seen in people who only looked at still images of the polar environment.

Hughes and his colleagues plan further studies of VR to see what kind of dosing regimen works best for pain – such as 30 minutes of VR, four times a day – and if the pain relieving effects would be cumulative or remain only temporary.

“The aim of this study was to show VR has the ability to change the pathological processing associated with chronic pain,” says Hughes. “Using this approach does seem to reduce the overall intensity of the ongoing pain as well as the response we get on the skin. We think there could be changes in the body’s pain relief system’s which can affect how pain sensitivity is processed in the spinal cord.

“There are still many things to figure out, but one exciting aspect of our study is that the VR design we used is completely passive – meaning patients don’t need to use their arms. Potentially, it could mean that patients who are bed-bound or can't move their limbs, but with chronic pain, could still benefit from this approach.”

Previous studies have found that VR can make small improvements in the pain of hospitalized patients recovering from surgery or suffering from neurological, orthopedic, gastrointestinal or cancer pain.

Can Melatonin Put Your Chronic Pain to Sleep?

By A. Rahman Ford, PNN Columnist

Melatonin is popularly known as the sleep hormone. Less known is its potential to alleviate chronic pain and inflammation.

Melatonin is a natural hormone produced by the pineal gland in the brain. During the day the pineal gland is inactive, but at night it begins to produce melatonin and helps us sleep.

As a supplement, melatonin is widely promoted for its efficacy as a sleep aid. However, its role in reducing inflammation – a major contributor to chronic pain – may be much more important. Many chronic pain conditions are a result of underlying inflammation.

In a recent Nature article, melatonin was called a “master regulator” of inflammation. Several studies have shown that melatonin can regulate activation of the immune system, reducing chronic and acute inflammation.

Research shows that melatonin supplements can modulate inflammation by acting as powerful antioxidants and free radical scavengers. Uncontrolled free radicals in the body can lead to oxidative stress, which can cause inflammation and culminate in diseases that cause chronic pain.

There is a large body of evidence that melatonin is a potent antioxidant, even more potent than vitamins C and E.  It’s been successfully used to treat fibromyalgia and irritable bowel syndrome, diseases associated with high levels of oxidative stress.

Melatonin is also a strong antimicrobial, and emerging research shows that some chronic inflammatory conditions may be caused by infections. One study found melatonin effective in treating certain drug-resistant bacteria such as Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii. Similar results were found when testing ten different pathogens, including Escheria coli and Salmonella typhinurium, with melatonin.

Melatonin and Chronic Pain

A therapeutic role for melatonin in the treatment of painful autoimmune conditions has been theorized.  A 2013 study noted that melatonin plays a role in the pathogenesis of conditions such as multiple sclerosis and systemic lupus. In animal models of these diseases, melatonin supplements were found to have protective effects. A 2019 review concurred, concluding that melatonin can serve as a new therapeutic target in treating autoimmune diseases.

A review of the scientific literature on chronic pain syndromes found evidence of melatonin’s efficacy as an analgesic in several conditions including fibromyalgia, irritable bowel syndrome and chronic back pain. Studies also showed melatonin’s effectiveness in treating cluster headaches ad tension headaches.

A small clinical trial of 63 females with fibromyalgia found that melatonin, alone or in combination with the antidepressant amitriptyline, significantly reduced pain when compared to amitriptyline use alone. The authors concluded that the melatonin treatment had a direct effect on the regulation of pain.

There has been some evidence that melatonin supplements can help reduce lower back pain. In a 2015 study, researchers found a significant reduction in pain intensity during movement and at rest in patients with back pain.

Melatonin has also been successful in treating migraines. In an open-labeled clinical trial of 34 patients suffering from migraine, 30 mg of melatonin given 30 minutes before bedtime was found to reduce headache intensity as well as frequency and duration, with significant clinical improvement after one month.

Although the scientific evidence is only slowly emerging, melatonin is a widely-available, inexpensive and safe supplement that may aid you in your fight against chronic pain.

A. Rahman Ford, PhD, is a lawyer and research professional. He is a graduate of Rutgers University and the Howard University School of Law, where he served as Editor-in-Chief of the Howard Law Journal.

Rahman lives with chronic inflammation in his digestive tract and is unable to eat solid food.

The information in this column is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.