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March 22, 2019

All About Opioids

Our brains and bodies are equipped to manage pain.  We have built in systems that release chemicals to make us feel better, chemicals called neurotransmitters, and many of these are released in the brain, but also throughout the body.   You are familiar with some of the big ones like serotonin, which calms us down, and dopamine, which makes us feel happy.   (Side note: Serotonin, turns out, is produced in our gastrointestinal system as well as the brain ).

Basically, the mechanism is this: neurotransmitters release from a nerve cell and transfer to another nerve cell and so on, sort of like a game of telephone except the message remains the same. All of our basic functions require neurotransmitters to do their jobs, as nerve cells communicate with one another and share information all over our body and brain

These neurotransmitters are our natural stress and pain fighters, but sometimes our bodies don’t produce enough of these opioids to save us from feeling severe or chronic pain or from suffering from extreme stress.  (Which begs the question to be asked:  how do we strengthen our ability to produce and use our own opioids?  More about that later in a future post. ).   Which is where prescription opioids comes in to the equation. Opioids act like those naturally-occurring neurotransmitters but in much larger concentrated quantities. They attach to your brain’s natural opioid receptors and go to town. Opioids flood the brain’s reward and pleasure systems, signaling our brains to block out the pain, lower our stress, and calm us down.

The problem is because our bodies weren’t designed to release and use opioids in this way,  repeated opioid use changes our brains at the cellular level, and essentially begins tearing it down, or creating a monster in residence.  Once altered, our brains literally respond differently to stress and pain.  Our brains stop producing our own natural opioids, and consequently we need more.  Our tolerance to opioid medication continues to grow, and so the longer we use and the more we use, the more we need.  Sadly, long-term opioid use also alters the way our brains respond chemically to triggers. We become hyper-sensitive and triggered  to use simply by being around the people, places and/or objects. So it’s not a matter of willpower or character weakness –it’s an actual alteration in our brains as a result of sustained opioid use.  Scary.

Sadly, addiction, or dependency as we are now calling it, can occur within 3 days use. Often we are prescribed it for no less than 3 weeks post op.  Can you imagine the impact this has on susceptible groups?  Women, who tend to have more chronic pain than men, are susceptible to quicker dependency than men as well.  The 12-17 year old population are increasingly exposed to opioid prescription with surgeries, and in 2015 over 112,000 were dependent on pain relievers.  And I’m not even going to go into the stats on the 220% -400% increase in deaths from prescription pain relievers in men, women and adolescents.

Here’s a recent finding:  taking ibuprofen with acetaminophen is nearly as effective with pain management as an opioid.  Well, if that’s the case, and given how dangerous opioid usage is, why ever use an opioid, except in an extreme situation?

Honestly, I have done probably what a lot of you have done:  saved John’s left over hydrocodone and oxycontin for a “just in case” scenario.  But after this conference, we marched them down to our local pharmacy.  They will send them back to the pharmaceutical companies where they will be incinerated.  It’s a national program.  I encourage you all to do the same.

 

Information cited from these sources:

https://www.cdc.gov/vitalsigns/prescriptionpainkilleroverdoses/index.html

https://www.drugabuse.gov/drugs-abuse/over-counter-medicines

https://www.cdc.gov/vitalsigns/opioid-prescribing/

 

Next up:  well, then Karen, HOW the HECK are we supposed to manage the pain?

 

 

 

March 16, 2019

What I Learned at my conference on the Neuroscience of Pain – Part 1
Chronic pain is one of the most underestimated healthcare problems today. In the US, more people live with chronic pain than cancer, heart disease and diabetes combined. 16% of 16-23 year olds will experience persistent pain. This increases to 20% and 30% of the 20 and 30 year old population, and by age 42 it picks up speed hovering between 35-37 % all the way through our 90’s. Basically, in a given year, over 100 million Americans have some form of persistent pain, and per capita, we are outspending our global neighbors on it (approx. $7800 per capita in the US versus $3000-$4700 in Canada and Europe). Granted, we also outstrip most of our neighbors in population, so it would make sense we have more problems here with pain. Quite honestly, we are experiencing a pain epidemic.
This raises some questions in my mind. Why is this? What is creating such a crisis? 
So. Pain. 2 kinds, folks. Acute and chronic. Acute pain is directly linked to an injury, is relatively more sharp and severe than chronic pain, and typically lasts 3-6 months. Chronic pain is defined as experiencing pain for more than 12 weeks. It may arise from an injury or from no clear cause. Fatigue, sleep disturbance, reduced appetite and mood changes often accompany chronic pain. Chronic pain usually reduces movement, which further reduces flexibility, strength and stamina, which in turn, can create disability and despair.
Chronic pain releases a cascade of emotionally-driven learning events that reorganize the brain. Rephrased: the area of the brain responsible for emotional reactions, becomes the boss of your brain and becomes highly sensitive in interpreting sensations as pain, even if those sensations have nothing to do with harm, hurt, or injury.
So, essentially, an impulse coming into the body, can be relatively harmless, but when the information reaches the brain, it passes from the prefrontal cortex to the amygdala, which then reacts to the information. Processing gets sent around the brain, and the consensus interpretation sent out down to a body part is, “THAT HURTS!”
Or put more simply, it is like having a drama queen in charge of interpreting your sensations. How do you think that goes over for the body?  What can we do about THAT?

October 23, 2018    My Specialty

People ask me: what is your specialty? I chuckle and reply: “I take time to problem solve, ask questions and provide what is needed.”

Example: 3 months ago, a patient called me. She had fractured the upper part of her humerus (upper arm) and had just been discharged from a PT and her MD agreed she was ready for discontinuing PT as well. But this gal didn’t think so; she still had some vague and uncomfortable symptoms in her arm that neither professional adequately explained to her what it was.

So, afraid she would re-injure herself, afraid of what these uncomfortable symptoms were, she sought help elsewhere, and found me. We initially talked on the phone, and agreed upon a consultation/evaluation. During the initial evaluation, I concluded that while her arm was healed (the bone was solid and the tendons were solid), her function was still lagging behind, and explained what was probably causing the sensations she didn’t understand and feared; most likely restriction of fascia, scarring, muscle tightness with weakness, and faulty motor coordination during tasks.

I explained what I could do to help and what her role in the process would be. We discussed her goals and she agreed to the plan.

What was this plan? I performed soft tissue mobilization, and taught her how to do it herself. I taught her to recognize the faulty motor programs she had incorporated unknowingly, and showed her how to correct them. I taught her how to work on her strengthening, building on what her previous therapist had correctly prescribed. Finally, I helped interpret what her body was saying in the “uncomfortable messages” it was giving as she moved and exercised. In summary, I helped her understand how healing felt and not to fear it, but to embrace it and guide it.

We worked together for 3-4 weeks, and then I went on vacation for 2 weeks. When I returned, she was fine: happy, confidant and ready to be discharged. She exuded the confidence I believe is necessary for all patients to have if they are to succeed.

She in turn gifted me with her gracious words: “You gave me hope. You encouraged me. You taught me how to be independent in my care and not be afraid anymore.”

What is my specialty? How do you put that into words? I take time with you. I ask questions and problem solve. I teach. I’d like to say that I empower, encourage and somehow enlighten my patients in regards to their health and well being.