For a long time, there has been known to be a link between depression ,lonliness and chronic pain. Holidays are periods of time that are known to exacerbate the emotional component of chronic pain and enhance feelings of sadness, despair and depression. Suffering individuals may not be able to get access to their doctor or the health care system due to scheduling conflicts. The immune system and repair systems of our bodies fail to function effectively when high levels of stress induced cortisol are circulating. This may complicate a stable chronic pain condition and thwart further healing. Critically needed quality sleep may be adversely affected. Furthermore ,a lack of a support sysytem like a family or human contact may predispose a chronic pain patient to overuse /misuse of their medications. This may perhaps be one reason that more deaths partially linked to suicides and /or accidental overdoses may occur around the holiday seasons. I encourage anyone who knows a person or family member suffering with chronic pain or depression to reach out to that person and offer love, kindness and support. The healing potential of this simple geature will offer far more support to the lonly depressed individual than more medication,therapy or other costly interventions. More information about the management of chronic pain may be found on the twitter feed @johnfpetraglia
The “Bermuda Triangle ” I am referring to is not the geographic location which is known to affect navigation systems of planes and ships in the areas south of Bermuda forming roughly a triangle but a time of year that commonly affects people who suffer with depression , chronic pain and lonliness. Seasonal affective dosorder
( SAD ) has been well written about for years and is the time when the days in the Northern Hemisphere are shorter. Theoretically , the amount of sunshine is limited and thus Vitamin D formation /conversion and the formulation /transport of many neurotransmitters is affected. In the figurative sense , the “Bermuda Triangle ” is a time between Halloween and New Years when depression , potential overuse/misuse of medications , increase in the use of alcohol and overall despair may peak. To exemplify, recent series of tradgedies involving players in the NFL ( which occurred within the Bermuda Triangle ) . One of these events focused on the murder/siucide of one young rising football player and his fiancee, leaving their three month old, an orphan. Another incident which occurred in Texas involved the death of another rising football star in a fatal accident in which a teammate was charged with vehicular manslaughter. Alcohol was known to play a role. The point I am making is not to sensationalize these tragic events, but to call attention to this time of year when rationalize judgement appears to be impaired. Emotion can take over with alcohol and drugs playing a supporting role. Accidental deaths may then surge during this time frame. It is not known if susceptibility to common ailments , cancers, etc may also contribute to an overall weakness of the immune system at this time, but it is known that the link between depression , chronic pain and suffering can affect the immune system. This can ultimately affect sane rational judgement and proper use of the medical system during this usual Joyous Season. Please be AWARE !!
The podcast radio interview on KSTE radio with myself and Cary Nosler on the Wide World of Health regarding proper diagnosis and the essence of the “Great Pain Jack ”
Recently, there was an LA Times interview that focused on the number of prescription overdose deaths in Southern California. The primary focus of this article was to call attention to a disproportionate number of prescription overdose deaths that primarily occurred with the pain management physicians.
Unfortunately, the article had a negative slant which appeared to infer that it was seen as the responsibility of doctors that prescribe these powerful medications to better police their patients (before they offer these medications) and the state medical boards to better police the doctors that prescribe these medications.
It also seemed to infer a causal link between prescription overdose deaths, the coroner’s reports of the deceased and the prescription writing of the doctor whose name was on the bottle of the person that overdosed. Unfortunately, this takes a simplistic view on the management of these chronic pain patients.
On many occasions, the pain management physician is stuck between a rock and a hard place trying to determine if the patient is an appropriate candidate for medication usage. The patient may have had a previous doctor that had written a prescription for pain medications that would more than likely produce a dependency condition on these medications.
That is not to say that the patient was an addict.
If for some reason the doctor stopped writing medications, or if the patient did not follow the rules of the clinic, he would then likely get referred to a pain management physician. The pain management physician will thus inherit this problem of patient management. Unfortunately, the pain management physicians are also often “dumped on” by other medical specialists to solve their problems.
There is no benefit, credit or accolades that occur when the pain management physician makes an accurate diagnosis and proper treatment is initiated. But ff a mistake is made or complication occurs regarding the patient’s understanding of how to properly take medications, or if there is a miscommunication between the patient and the doctor, there is too often a rush to judgment to blame the pain management physician who prescribes these very powerful medications and performs these very life-changing procedures.
I deliberately wrote The Great Pain Jack to outline the problems with pain management through real-life examples. The book characterize these problems with patients that are sometimes very difficult to treat.
What do you think? Why do doctors get painted as villainous? Is there a better way to diagnose prescription drugs and protect the patient?
Please see the LA Times article and feel free to post your comment on this blog or my twitter feed @JohnfPetraglia or like me on Facebook.
Diagnosis and proper treatment is important with chronic pain patients because it is essential that communication be consistent along the way in generation of the treatment plan. Dissatisfaction may be commonplace after the patient gets an improper diagnosis or in their view “mistreatment” especially by a family practitioner or a pain management doctor. If miscommunication is involved, this will often lead to controversy and/or malpractice lawsuits.
One example would be a person presents to their family Dr. with a skin condition. The doctor does not know exactly what the skin condition is but orders radiographic studies to determine what the cause is. The radiologist reads the films as “may be consistent with early necrotizing fasciitis”. The patient then goes back to the family practitioner and says “I have necrotizing fasciitis, why didn’t you diagnose and treat my condition earlier?” The doctor reassures the patient that at the time he examined the problem, the diagnosis was not clear. Unfortunately because of dissatisfaction of the patient and potentially greedy attorneys that may seek to capitalize on the condition, if there is delay in treatment and eventually a bad outcome, a malpractice suit may ensue.
This is something that clearly could have been avoided by early communication with the patient about the many possibilities of undergoing one treatment plan based on sole diagnosis. If multiple diagnoses were provided at the time of the initial presentation, then perhaps a real solution could be entertained at the outset.
Fast forward this to management of a chronic pain patient who may have an addictive personality. The person with the true addictive personality (who may really be an addict or someone that uses medication improperly) may actually get seriously injured. For example, that person may be involved in a car accident that will now be a reason to take pain medication and see the pain doctor on a regular basis. This may be very well justified as the receptors of this person’s brain are going to be more sensitive to a perceived pain syndrome.
However, when a less than scrupulous attorney may get his hands on the case, he will argue that the doctor is prescribing medications to a known addict (one of the more insidious and frivolous lawsuit charges that are now being brought against well-intentioned physicians these days)
. The inability to determine between a chronic pain patient and a true addict sometimes can be very difficult. It is often these unscrupulous attorneys and their “victimized clients” that will create malpractice cases against the providers who are so very interested in a treatment program for the affected individual.
Both of these two cases represent how misunderstanding and dishonesty at the outset of the doctor-patient relationship can ultimately affect the diagnosis and proper treatment of the individual. Honesty is really a two-way street and should be always employed between the doctor and the patient. Often times because of insurance reasons (or lack thereof), socio- economic times, or the manipulation of the system of obtaining medications by the chronic patient can lead to less than optimal outcomes for all.
Chronic pain can be identified as lasting greater than six months. The International Pain Society identifies chronic pain as that tissue injury or perceived tissue injury that persists for greater than 3 to 6 months.
Chronic pain can be of any nature or type. Usually the inciting event is initiated by a traumatic event, an organ system or a body process that goes awry , or a tissue injury that continues despite treatment. It may involve other disease states such as cancer or a neurological condition. It may also occur after major surgery or even a minor conditions such as a broken bone that heals. Often, we can identify the cause as associated with some sort of trauma.
For example, we stub our toe or we slam a small finger in the door. Most of the time, these injuries resolve and we go on with our lives. Occasionally, the pain signals become crossed in the brain and spinal cord and we can’t figure out why we’re still hurting. This may occur as a result of a car accident or failed surgery or perhaps palliative treatment of a condition like cancer. This is the beginning of becoming a chronic pain patient.
Occasionally, a doctor or health care provider will intervene and help us make the diagnosis. Occasionally we will be hijacked by our pain and seek medications through the healthcare system or on our own. The latter plan is dangerous because we’re likely to get dependent on medications were forced to experiment in treating the condition by taking medications that may be harmful or too strong for our condition. Then we complicate the diagnosis with a opioid dependency problem. This is the basis of The Great Pain Jack Pain that becomes chronic may hijack the brain into thinking that medications are the only options available. They may also alter our usual normal and rational decision-making process.
We may be forced and continue to seek medications that is inappropriate for our condition and possibly even participate in illicit or illegal activity surrounding the procurement of medication. All this because we didn’t identify chronic pain at the outset.
Please read further into the treatment and diagnosis of chronic pain by obtaining a copy of my book, “The Great Pain Jack”, by Dr. John F. Petraglia. Amazon.com and authorhouse.com
The basis for injection therapy is to provide two main functions. Injection therapy can be diagnostic (describes an adequately diagnosis the specific type of pain you may have) and therapeutic (treats the specific area of pain that you suffer from) in an effort to allow other modalities to continue their healing function. Injection therapy has been carried on for years.
The most primitive form of this type of therapy may be seen in the animal kingdom when an animal hurts a limb and provides sensory input to the area of perceived injury by licking it. In modern days, doctors use fluoroscopy (x-ray) and ultrasound guided techniques to specifically identify the area of injection. Of course if the area of chronic pain or dysfunction is very superficial, it is easy to determine the structure that is causing the problem. Injection therapy may therefore serve a diagnostic purpose in localizing or differentiating between two areas that may be known to produce ongoing tissue inflammation and pain.
Therapeutic and diagnostic injection therapy then will usually deliver a long-acting local anesthetic as well as a steroid derivative to treat the area of pain. The long acting local anesthetic will usually suppress painful impulses of the nerves and tissue. The steroid will usually suppress inflammation and swelling that may occur as a result. However, the steroid effect takes time to work in the tissue. Sometimes it can take up to 2 to 3 days to have an effect. The local anesthetic effect usually starts working right away and is often beneficial to minimize pain when this injection technique is utilized for acute pain.
Most of us may be familiar with this in the form of applying local anesthetic to a wound to anesthetize or “numb” an area or getting a needle injection before dental work. The duration of such injections may last for a prolonged period. Occasionally the injections are performed to produce only short-term benefit by choice. The choice of anesthetic and steroid can be switched around to accommodate the need for long or short acting duration.
S.M.A.R.T. ® Opioid therapy is a concept whereby people can have gradual reduction or “weaning “of the medication that they are taking without significant withdrawal effects adversely affecting their health. The necessity to provide a smart receptor transition is important and this has been discussed in the notion of “opioid rotation” to minimize side effects of the medication themselves. Taking this concept one step further, by targeting other types of receptors or different subtypes of the known opioid receptors in the brain and spinal cord and transitioning to these receptors, we now can treat the individual and allow an individual to reduce the amount of medication and gradually remove himself /herself from the grasp of the offending medication.
S.M. A. R. T. ® Therapy is an acronym that can best be described as follows:
- S upported – you are not left alone floundering to figure it out on your own.
- M odulation – your dosing and response to dosing will be modulated according to your individual needs based on scientific principle.
- A gonist -you will not be deprived of/placed into forced painful withdrawal of medications that your body has become dependent on or that your body needs.
- R eceptor –receptors are sites in the brain and spinal cord will be targeted for response.
- T ransition – you will transition to medications/products that reduce potential for dependency and addiction and therefore can be said it safer to take on a long-term basis that will sustain health and wellness.
For further information on S.M.A.R.T. ® opioid therapy and/or reduction of medications check out the “Great Pain Jack,” a book I written to help my patients. In this easy-to-read book, I provide examples of how people have greatly benefited from this type of therapeutic intervention.
If you’re interested in more information on chronic pain, follow me on twitter @johnfpetraglia Like “The Great Pain Jack” fan page on Facebook
The Great Pain Jack was written to help people understand how pain can sometimes “hijack” the brain.
It is commonly understood that when one has a pain condition that does not resolve, he or she should turn to a medical professional to make a diagnosis. Many times due to lack of healthcare, underfunded insurance programs, or just plain laziness, people will persist and take potent opioid medication for condition that has not yet been diagnosed.
Access or gateway to these potent opioid medications is easily found through friends or family members. These medications will improve symptoms of the painful condition on a temporary basis. That is where the hook occurs.
Often times, people will get lulled into taking a medication for a short period but then when they’re pain condition resolves (with or without a diagnosis) they will need to continue to take medication because they are now dependent on it. If people who suffer with a painful condition would get a proper diagnosis before they start taking the medication then they’re more likely to understand that they do not need such potent pain medications to treat their condition.
The Great Pain Jack is a compilation or group of stories about many such individuals that have been “jacked by their pain”. Oftentimes after one is held hostage to their pain and “brain hijacked”, they make irrational and poor decisions regarding important life considerations. This can also been further their dependency and involvement in illicit or illegal activity. This may all be brought on by the need to procure additional opioid medication to control their symptoms of dependency .
Much is written about dependency and drug/ drug interactions with medications that clearly have a metabolic and genetic basis. We now understand that there are certain individuals that have limited ability to metabolize certain medications or classes of medications. DNA testing can be performed by looking for metabolic enzymes that break down potent medications.
With an understanding of how metabolism of medication occurs, suggestions about which classes of medications may be useful in which will be useless becomes important. Sometimes such testing is performed when medications seem to have altered effects or drug /drug interactions appeared to render the person impaired. It is likely that in the very near future such testing will be necessary before a medication is prescribed. The cost for such genetic testing has been reduced.
Further barriers towards such type of testing will be reduced as more knowledge is obtained in the medical community. This is especially true when physicians and their potential patients learn about the many possibilities of drug/drug interactions . Unfortunately, such testing is only engaged in when medications seems to have decreased benefit and oftentimes after increased dosages of these medications. Additionally medications of similar class may have been offered to the patient increasing the likelihood of chemical dependency in the process.
Read more about the Great Pain Jack, available at authorhouse and Amazon books by Dr. John Petraglia.
Today it is very easy to find prescription medication for the treatment of chronic or acute pain.
Pharmaceutical companies have rushed to find a pill for every type of medical ailment that is known to exist. This is due in part to our absolute demand to treat or heal a condition yesterday. In addition, a huge profit motive is present in the pharmaceutical industry for a compound to be discovered or “created” such as a pill to treat hormone deficiency or erectile dysfunction.
When it comes to pain medications, this is even more illustrated in the fact that treating pain is a multibillion-dollar industry. When a pharmaceutical manufacturer can come up with a medication that does not have a lot of side effects, treats chronic and acute pain and works universally on a population, that is cold a blockbuster drug. So if your doctor writes for a prescription medication and with the common acceptance of pain medication to treat pain in the form of pills, the natural and likely fear of taking very potent medications will be somewhat diminished by this activity. That is to say our defensive guard is let down and we then find easy to incorporate very potent medications into our daily regimen.
This is one mechanism that prescription medications find their way into the general and recreational use category. The lowering of the guard about responsible use and securing of the medication by some individuals may lead to pilfering or procurement of their medication by another. This may occur by accident initially and then intentionally.
Once an individual has developed a dependence on medication, either by prescription or by nefarious procurement, that individual will do what is necessary to find medication to support their dependency.
This is not to say that all these individuals are drug addicts. Many a person who has been prescribed medication and has been consistent with its use may then develop an addiction syndrome. This may happen without the person even realizing it. It may occur because of the possibility that the chronic pain problem is resolved and now the person remains psychologically and somewhat physically dependent on the medication.
With the ubiquitous number of medications including pain relievers, analgesics of the non-opioid type, muscle relaxants, tranquilizers, sleeping pills on the market, is rather easy to see how people can get “hijacked” or “jacked” by their pain.
Much controversy has been made over doctors that have been freely prescribing medications to individuals for a fee. These so-called “pill mills” are under much scrutiny these days. Most of them are not performing medicine or offering any type of pain management treatment or services as their advertisements suggest. When these “pill mills” get shut down, the dependent person that is using prescription medication is forced to go to the street to purchase or trade for these highly addictive medications. The ease of finding such a place to engage in this illicit activity is not very difficult at this time. It is highly recommended that such individuals seek treatment in a counseling or legitimate pain management treatment facility.