Author: Dr. Ilonka Meyer

Dr. Ilonka Meyer is the Clinical Director and Founder of MindBodyPainSpecialists.  She also holds an appointment as Acting Director of the Pain Service and Pain Specialist at the Austin Hospital in Heidelberg, Melbourne.  Ilonka has a strong interest in interventional pain treatments, peri-operative pain and medication optimisation and cancer pain.   Ilonka is skilled in Clinical Research, Medical Education, Coaching, and Healthcare Management. Her main research focus lies in interventional pain medicine in the peri-operative population, cancer pain and the health economic benefits of pain and medication optimisation in patients both pre-and postoperatively.

Explore The Healing Power Of Music Therapy: A Guide To Enhancing Well-Being And Alleviating Chronic Pain

Music therapy, an established health profession using music and its elements—rhythm, melody, and harmony—to address physical, emotional, cognitive, and social needs of individuals, has garnered attention for its potential in managing chronic pain.

Chronic pain, defined as pain persisting beyond the normal time of healing, affects millions globally, reducing quality of life and increasing dependency on medication. Traditional pain management strategies may not always provide the desired relief or may lead to undesirable side effects.

As an alternative, music therapy emerges as a holistic and non-invasive approach, offering a new hope for those suffering from persistent pain. Through this therapy, individuals engage in music listening, songwriting, improvisation, and music discussions guided by a certified music therapist, aimed at pain relief and improving overall well-being.

This article delves into how music therapy can serve as a beneficial intervention in the realm of chronic pain management, highlighting its principles, effectiveness, and practical applications.

Understanding Music Therapy

selective focus photo of brown guitar on white pillowImage courtesy: Unsplash

Music therapy is an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals. Through musical involvement in the therapeutic context, clients’ abilities are strengthened and transferred to other areas of their lives. Music therapy also provides avenues for communication that can be helpful to those who find it difficult to express themselves in words.

Definition and Components of Music Therapy

At its core, music therapy involves the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. It encompasses a broad range of activities, including listening to music, singing, playing musical instruments, and even composing music. The specific methods used in music therapy may vary depending on the client’s needs but often involve both active and receptive music experiences designed to facilitate changes that are non-musical in nature.

The components of music therapy can be categorized into several key areas:

– Assessment: Evaluating the client’s emotional well-being, physical health, social functioning, communication abilities, and cognitive skills through musical responses.

– Planning: Developing a customized music therapy intervention plan that targets specific goals.

– Implementation: Engaging the client in music therapy activities to address the identified goals.

– Evaluation: Reviewing and documenting the client’s progress and adjusting the therapy plan as needed.

Music therapy is a versatile modality that can support the development of a wide range of skills, assist in managing stress, alleviate pain, enhance memory, improve communication, and promote physical rehabilitation.

Exploring Chronic Pain

Chronic pain is a pervasive and complex condition that affects millions of people worldwide. Unlike acute pain, which is a normal sensation that alerts us to possible injury, chronic pain persists, often for months or even longer.

Definition and Causes of Chronic Pain

Chronic pain can be defined as pain that lasts beyond the normal time for healing, typically persisting for more than three months. The causes of chronic pain are varied and, in some cases, can be difficult to pinpoint. It may arise from an initial injury, such as a back sprain, or there may be an ongoing cause, such as illness. However, some people suffer chronic pain in the absence of any past injury or evidence of body damage.

Common causes of chronic pain include:

  • Injury: Even after an injury has healed, pain might persist, leading to chronic pain. This is sometimes due to nerve damage or a malfunctioning of the pain sensors in the affected area.
  • Arthritis: Osteoarthritis and rheumatoid arthritis are common causes of chronic pain due to the wear and tear or inflammation of joints.
  • Back Problems: Chronic back pain can be due to issues such as disc problems, chronic strain, or conditions like scoliosis.
  • Fibromyalgia: This is characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas.
  • Nerve Damage: Conditions like diabetic neuropathy, where high blood sugar levels cause damage to nerves, can result in chronic pain.
  • Headaches and Migraines: Chronic headaches, including migraines, tension headaches, and cluster headaches, can lead to persistent pain.
  • Infections: Some infections can cause long-lasting pain even after they have been treated, due to residual damage or inflammation.
  • Cancer: Cancer and its treatment can result in chronic pain due to the tumor pressing on nerves or other structures, or side effects from chemotherapy, radiation, or surgery.
  • Surgical Pain: Pain that persists after surgery can become chronic, a condition known as post-surgical chronic pain.
  • Psychological Factors: Stress, depression, and anxiety can exacerbate or even contribute to the development of chronic pain, creating a cycle where pain leads to more stress, which then leads to more pain.
  • Neurological Conditions: Conditions like multiple sclerosis or Parkinson’s disease can cause chronic pain as part of their spectrum of symptoms.
  • Unknown Causes: Sometimes, chronic pain occurs without an identifiable physical cause, which can make treatment and management particularly challenging.

Impact of Chronic Pain on Quality of Life

The impact of chronic pain on an individual’s quality of life can be profound. It can lead to significant physical limitations, making it difficult to perform daily tasks or maintain employment. Chronic pain is also associated with emotional effects, including depression, anxiety, and feelings of helplessness. Social relationships can be strained, and the financial burdens associated with ongoing medical treatment and lost wages can be substantial.

Chronic pain not only challenges the person experiencing it but also places a strain on health care systems and societies due to the extensive resources required for management and support. Addressing the multifaceted nature of chronic pain requires a comprehensive and multidisciplinary approach, of which music therapy may be an integral part.

The Link Between Music Therapy and Chronic Pain Management

Music therapy has emerged as an innovative and therapeutic approach in the management of chronic pain. This complementary form of therapy utilizes music and its various elements, such as rhythm, melody, and harmony, to create an environment conducive to healing and pain relief. The premise behind music therapy is not only to offer an alternative pain relief method but also to address the psychological and emotional aspects associated with chronic pain conditions.

How Music Therapy Can Alleviate Chronic Pain

Music therapy’s effectiveness in managing chronic pain is supported by various scientific principles and research findings. The impact of music on pain management can be understood through several mechanisms:

1. Distraction

Music can divert a person’s attention away from pain, reducing their perception of it. This distraction can be particularly effective for chronic pain, where the brain’s focus on pain signals can amplify their intensity. By engaging the brain with music, it’s possible to decrease the focus on pain signals, thereby reducing the experience of pain.

2. Release of Neurotransmitters

Listening to music can stimulate the release of neurotransmitters like dopamine and endorphins, which are the body’s natural painkillers. These substances can elevate mood and produce analgesic effects, reducing the sensation of pain. The emotional responses elicited by music can also lead to increased endorphin release, further aiding in pain relief.

3. Regulation of Stress and Anxiety

Chronic pain is often associated with elevated levels of stress and anxiety, which can exacerbate pain perception. Music therapy has been shown to reduce stress and anxiety levels, which can, in turn, decrease pain sensitivity. Music with a slow tempo, in particular, can have a calming effect, slowing down breathing and heart rate, and promoting relaxation.

4. Emotional Expression

Music therapy provides a medium for emotional expression and processing, which can be particularly beneficial for individuals dealing with the psychological effects of chronic pain. By expressing themselves through music, patients can release emotional tension, which may contribute to pain and stress.

5. Cognitive-Behavioral Effects

Music therapy can also support cognitive-behavioral therapy (CBT) techniques by reinforcing positive coping strategies and altering negative pain-related thoughts. This can help modify the emotional and psychological aspects of pain perception.

6. Enhanced Pain Modulation

The brain’s ability to modulate pain can be influenced by music. The engagement with music can activate neural pathways that compete with pain pathways, thereby modulating pain responses. This effect can lead to a reduction in the intensity of pain experienced.

7. Improved Sleep Quality

Chronic pain often disrupts sleep patterns, which can worsen pain perception. Music therapy can improve sleep quality by promoting relaxation and reducing stress, thereby creating a positive feedback loop that can reduce chronic pain.

Scientific Evidence Supporting the Efficacy of Music Therapy for Pain Relief

Numerous studies have provided evidence supporting the efficacy of music therapy in pain relief. Research indicates that patients who undergo music therapy report significant reductions in pain intensity, anxiety, and the need for pain medications. A meta-analysis of clinical trials revealed that music therapy not only reduced patients’ perception of pain but also improved their overall quality of life. These findings underscore the potential of music therapy as a viable component of a comprehensive pain management strategy.

Benefits of Music Therapy Beyond Pain Management

Beyond its direct impact on pain management, music therapy offers a host of additional benefits. It assists patients in developing coping mechanisms, enhances emotional well-being, and promotes social interaction, thereby contributing to a holistic approach to health. Music therapy can also improve sleep quality and cognitive function, aspects often adversely affected in individuals suffering from chronic pain.

Implementing Music Therapy for Chronic Pain

To harness the therapeutic potential of music therapy for chronic pain, understanding the various approaches and techniques involved is essential, as is choosing the right type of music and effectively integrating music therapy into the patient’s overall treatment plan.

Different Approaches and Techniques in Music Therapy

Music therapy encompasses a range of approaches and techniques tailored to the individual’s needs and preferences. These include active participation methods, such as singing, playing instruments, or composing music, and receptive techniques, where patients listen to and analyze selected pieces of music. Furthermore, guided imagery with music involves listening to music while visualizing positive images, which can facilitate relaxation and pain relief.

Choosing the Right Music for Pain Management

The choice of music in therapy is key to its effectiveness. Personal preference plays a significant role, as familiar and personally meaningful music can have a stronger impact. However, therapists often recommend music with a slow tempo, low pitch, and smooth rhythms to promote relaxation. Nature sounds and classical music are commonly used, but ultimately, the selection is customized to each patient’s emotional and therapeutic needs.

Integration of Music Therapy into Treatment Plans

For music therapy to be most effective in managing chronic pain, it should be integrated into a comprehensive treatment plan that may include medication, physical therapy, and psychological counseling. Cooperation between healthcare providers, music therapists, and patients is crucial to develop a holistic treatment strategy that addresses the physical, emotional, and psychological components of chronic pain. Through such integration, music therapy can significantly enhance the overall well-being and quality of life for those living with chronic pain.

Conclusion

Music therapy presents itself as a unique lens through which we can view and manage chronic pain, offering a complementary approach that lies outside the realm of conventional medicine. As research continues to expand our understanding of its benefits, individuals struggling with long-term pain conditions may find solace and relief through its application. By tapping into the emotional and psychological aspects of healing, music therapy provides a holistic path towards managing discomfort and enhancing the overall quality of life.

For those living with chronic pain, integrating music therapy into their treatment regimen could mean:

– Discovering new coping mechanisms for pain

– Experiencing a reduction in symptoms associated with pain

– Gaining a sense of control over their health

It’s important to remember that while music therapy has shown promising results, it should complement, not replace, traditional pain management strategies. Consulting with healthcare professionals and certified music therapists can offer guidance on how best to incorporate this therapeutic approach into an existing pain management plan.

In sum, music therapy harbors the potential to not only alleviate symptoms of chronic pain but also to impart a deeper sense of wellbeing and peace to those it serves. As we move forward, fostering a greater understanding and appreciation for the healing powers of music could significantly enhance the lives of individuals grappling with the persistent challenge of chronic pain.

Disclosure: The information in this article is not intended to replace your doctor’s medical advice, diagnosis or treatment. If you require more information, or have any questions, please speak to your doctor/ specialist.

References

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  3. Sanfi, I. and Christensen, E., ‘Perspectives on Music Imagery and complex chronic pain’.
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  7. Guétin, S., Cousin, J., Touchon, J., and Hérison, C., ‘Effects of music therapy on the chronic pain experienced by patients undergoing spa therapy: A multicentre study (n = 1151)’, Annals of Physical and Rehabilitation Medicine, 2014, https://dx.doi.org/10.1016/J.REHAB.2014.03.919.
  8. Müller-Busch Hc, and Hoffmann, P., ‘[Active music therapy for chronic pain: a prospective study].’, Schmerz, 1997, https://dx.doi.org/10.1007/S004829700030.
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The Gut-Brain Connection: How Gut Health Impacts Mental Well-being

The interconnectedness of the human body’s systems is a marvel of biological engineering, and among these connections, the gut-brain axis stands out for its significant impact on our overall well-being. This fascinating link between our digestive tract and the brain opens a window to understanding how gut health can profoundly influence mental health. The fascinating concept that the state of our gut microbiome—trillions of bacteria living in our digestive system—can affect our mood, cognition, and mental wellness is gaining credence among researchers and medical professionals alike. As we delve deeper into this topic, we’ll explore the mechanisms behind the gut-brain connection, highlight the critical role of serotonin—a neurotransmitter produced in the gut—and discuss how optimizing gut health may be a key to enhancing mental well-being.

Understanding the Gut-Brain Connection

The gut-brain connection is an emerging field of study, emphasizing the bidirectional communication network that links the enteric nervous system of the gut with the central nervous system. This intricate connection suggests that the state of our gut health can have profound effects on our mental well-being and vice versa.

The Role of the Microbiome

The human microbiome, comprising trillions of microbes in the gut, plays a pivotal role in this connection. These microorganisms not only aid in digestion and the absorption of nutrients but also in the synthesis of neurotransmitters critical for brain health. Research shows that a diverse and balanced gut microbiome can contribute to improved mood, cognitive function, and a reduced risk of psychiatric disorders. Conversely, imbalances in the gut’s microbial community—known as dysbiosis—can trigger inflammation and negatively impact mental health.

Influence of Gut Health on Serotonin Production

Serotonin, often dubbed the “feel-good” neurotransmitter, is central to managing mood, sleep, appetite, and even cognitive functions. Intriguingly, approximately 90% of the body’s serotonin is produced in the gut, not in the brain as commonly presumed. This production is largely influenced by the state of the gut microbiome. A healthy, balanced gut environment encourages the production of serotonin, which in turn supports overall mental wellness. On the other hand, an unhealthy gut might lead to diminished serotonin levels, potentially contributing to mood disorders and depression.

Exploring the Gut-Brain Axis

The gut-brain axis provides a complex, multidirectional pathway through which the gut and brain communicate. Understanding this axis unveils the significant impact gut health has on mental health and highlights potential therapeutic targets for the treatment of mental health conditions.

Impact of Gut Health on Mental Health Conditions

Several studies have underlined the crucial role gut health plays in mental health conditions. For example, individuals with irritable bowel syndrome (IBS) are more likely to suffer from anxiety and depression. There’s also evidence suggesting that people with a diverse gut microbiome have a lower risk of developing psychiatric disorders. Probiotic and prebiotic interventions, aimed at improving gut health, have shown promise in alleviating symptoms of depression and anxiety, hinting at the potential of gut-focused therapies in treating mental health conditions.

Signals Between the Gut and the Brain

Communication between the gut and the brain occurs through several pathways, including the immune system, neurological pathways, and hormonal signals. This communication ensures that the brain is aware of the gut’s state and vice versa. For instance, certain gut bacteria can produce neurotransmitters and short-chain fatty acids that influence brain function. Additionally, stress or mood changes can alter gut function and microbiome composition, showcasing the bidirectional nature of the gut-brain axis.

The Vagus Nerve: A Key Player

The vagus nerve, the longest cranial nerve, acts as a direct communication line in the gut-brain axis. It sends signals both ways: from the brain to the gut and from the gut to the brain. This nerve is crucial in regulating homeostatic functions and plays a significant role in transferring gut-derived signals to the brain. Studies have found that stimulating the vagus nerve can lead to changes in the gut microbiome and, conversely, that alterations in gut microbiota can affect brain function via the vagus nerve. This highlights the importance of the vagus nerve in mental health and its potential as a target for therapies aiming to mitigate mental health disorders through gut health optimization.

In conclusion, the relationship between gut health and mental well-being is complex and multifaceted, involving a plethora of mechanisms and interactions. Optimizing gut health through dietary and lifestyle changes, probiotics, and prebiotics offers a promising avenue for supporting mental health. Future research focused on unveiling further details of the gut-brain connection could revolutionize our approach to mental health care.

Optimizing Gut Health for Mental Well-being

The intricate relationship between gut health and mental well-being implies a symbiotic connection that stresses the importance of nurturing our gut to enhance our mental state. To cultivate an environment that favors mental wellness, understanding and optimizing gut health becomes crucial.

Importance of a Balanced Diet

A balanced diet plays a pivotal role in maintaining gut health and, by extension, mental well-being. Diets rich in fiber, such as fruits, vegetables, and whole grains, promote the growth of beneficial gut bacteria. These bacteria are instrumental in producing short-chain fatty acids, which have been shown to support brain health and reduce inflammation, a known cause of cognitive decline. Additionally, incorporating foods high in omega-3 fatty acids, like salmon and flaxseeds, can further fortify the gut-brain axis by reducing the risk of mood disorders.

Reducing the intake of processed foods, sugars, and unhealthy fats is equally important as these can disrupt the delicate balance of the gut microbiome, leading to an increase in harmful bacteria. This imbalance can trigger inflammatory responses, affecting both the gut and the brain, and potentially exacerbating mental health issues.

Probiotics and Prebiotics: Supporting Gut Health

Probiotics and prebiotics are key elements in maintaining and restoring a healthy gut microbiome. Probiotics, live bacteria found in fermented foods like yogurt, kefir, and sauerkraut, can increase the diversity and number of good bacteria in the gut. They help balance the gut microbiome, which is essential for mental health, as an imbalanced microbiome has been linked to various mental health disorders.

Prebiotics, on the other hand, are types of dietary fiber found in foods like garlic, onions, and leeks that feed the beneficial bacteria in the gut. Ensuring a diet rich in probiotics and prebiotics can foster a gut environment conducive to mental health resilience.

Stress Management and Gut Health

Stress is not only a mental burden but also a physical one that can significantly affect gut health. The gut-brain axis enables bidirectional communication between the gastrointestinal tract and the brain, meaning stress can lead to gut inflammation and gut flora imbalances. Techniques for managing stress—such as meditation, yoga, and deep-breathing exercises—not only reduce the mental impact of stress but can also mitigate its adverse effects on gut health. By managing stress effectively, one can support a healthier gut-brain connection and, consequently, improve mental well-being.

Lifestyle Changes for a Healthier Gut-Brain Connection

poached egg with vegetables and tomatoes on blue plateImage courtesy: Unsplash

Incorporating simple lifestyle changes can significantly enhance the gut-brain connection, fostering both physical and mental health improvements.

Regular Exercise and Its Effect on Gut Health

Regular exercise has been shown to have a profound impact on the diversity and number of beneficial gut microorganisms. Physical activity promotes the growth of beneficial gut bacteria, which can produce compounds beneficial for brain health. Moreover, exercise helps to reduce stress, further supporting a healthy gut-brain axis. Engaging in moderate exercise for at least 150 minutes per week is recommended to reap these benefits.

Quality Sleep and Gut Health

The quality and quantity of sleep significantly influence gut health. Disruptions in sleep patterns can affect the microbiome’s balance, leading to an increase in stress levels and potentially worsening mental health conditions. Prioritizing good sleep hygiene—maintaining a consistent sleep schedule, creating a restful environment, and avoiding stimulants before bedtime—can help in preserving a healthy gut microbiome. Quality sleep supports the body’s natural rhythms and promotes a positive mood, enhancing the overall well-being of both the gut and the brain.

Optimizing gut health through a balanced diet, stress management, and lifestyle choices not only supports a robust digestive system but also a resilient and healthy mind. By fostering a harmonious gut-brain connection through these practical steps, we can significantly enhance our mental well-being and overall quality of life.

Conclusion: Nurturing Your Gut for a Healthier Mind

The intricate relationship between the gut and the brain underscores the undeniable impact that gut health has on mental well-being. Recognizing the gut-brain connection opens up innovative pathways for managing and potentially improving mental health through dietary and lifestyle changes. By prioritizing gut health, individuals can take proactive steps toward not only enhancing their digestive health but also supporting their mental and emotional well-being.

– Consume a diverse range of fiber-rich foods to encourage a healthy and diverse microbiome.

– Incorporate fermented foods into your diet, such as yogurt, sauerkraut, and kefir, to boost beneficial bacteria in the gut.

– Stay hydrated and maintain a balanced diet rich in fruits, vegetables, and lean proteins.

– Limit the intake of highly processed foods, which can negatively affect gut health and, consequently, mental health.

– Practice regular physical activity, which has been shown to positively influence the diversity of the gut microbiota.

– Consider discussing the use of probiotics with a healthcare professional to determine if they are a suitable option for supporting your gut and mental health.

Implementing these simple yet effective strategies can lead to significant improvements in gut health, which, in turn, can enhance mental well-being. By fostering a healthy gut microbiome, individuals may experience a reduction in the symptoms of mental health disorders and an overall improvement in their quality of life. The gut-brain connection illustrates the profound influence of our diet and lifestyle choices on our mental health, highlighting the importance of nurturing our gut to nurture our mind.

References

  1. Dinan, T. & Cryan, J. (2017) ‘Brain-Gut-Microbiota Axis and Mental Health’, Psychosomatic Medicine, 79, pp. 920–926. Available at: Psychosomatic Medicine.
  2. Arneth, B. (2018) ‘Gut–brain axis biochemical signalling from the gastrointestinal tract to the central nervous system: gut dysbiosis and altered brain function’, Postgraduate Medical Journal, 94, pp. 446-452. Available at: Postgraduate Medical Journal.
  3. Allen, A., Dinan, T., Clarke, G., & Cryan, J. (2017) ‘A psychology of the human brain–gut–microbiome axis’, Social and Personality Psychology Compass, 11. Available at: Social and Personality Psychology Compass.
  4. Järbrink-Sehgal, E. & Andreasson, A. (2020) ‘The gut microbiota and mental health in adults’, Current Opinion in Neurobiology, 62, pp. 102-114. Available at: Current Opinion in Neurobiology.
  5. Bercik, P., Collins, S. M., & Verdú, E. F. (2012) ‘Microbes and the gut‐brain axis’, Neurogastroenterology & Motility. Available at: Neurogastroenterology & Motility.
  6. Holingue, C., Budavari, A. C., Rodriguez, K., Zisman, C. R., Windheim, G., & Fallin, M. (2020) ‘Sex Differences in the Gut-Brain Axis: Implications for Mental Health’, Current Psychiatry Reports, 22(1), pp. 1-11. Available at: Current Psychiatry Reports.

10 Commonly Used Terms in the World of Pain Medicine Explained

In our world of pain medicine, we as specialists often use terminology that is poorly understood. Having a basic understanding some of the words used can greatly empower patients to understand their chronic pain problem and the treatment plan offered better. This article aims to break down the 10 commonly used terms used in pain medicine, providing you with clear explanations, examples, and related terms.

1. Pain

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain is subjective and unique to each individual. It acts as a warning system for our bodies, signalling that something is wrong and needs attention.

2. Acute Pain

Acute pain, also known as short-term pain, is a type of pain that typically lasts for a relatively brief duration, usually less than 3 months. It arises from a specific cause such as surgery, injury, or infection, serving as a protective mechanism that alerts us to take immediate action in order to prevent further harm. This type of pain is a vital warning sign, urging us to address the underlying cause and seek appropriate treatment. As the underlying cause is effectively addressed or the affected area heals, acute pain usually subsides, allowing the body to regain its normal pain free state.

3. Chronic Pain

Chronic pain is persistent, ongoing pain that lasts longer than 3 months. It may be caused by an initial injury or condition, but it can also manifest without a clear cause. Chronic pain can have a significant impact on a person’s daily life, often affecting mental and emotional well-being, sleep, and overall quality of life.

4. Nociceptive Pain

Nociceptive pain is a type of pain that results from the activation of pain receptors (nociceptors) in response to potentially harmful stimuli, such as heat, cold, or pressure. It is typically associated with tissue damage or inflammation, like that experienced during an acute injury, such as a fractured arm or arthritis.

5. Neuropathic Pain

Neuropathic pain is caused by dysfunction or injury to the nervous system. This type of pain occurs when nerve fibers become damaged or dysfunctional, leading to abnormal pain signals sent to the brain. Examples include diabetic neuropathy, occipital neuralgia or post-herpetic neuralgia.

6. Nociplastic Pain

Nociplastic pain, also known as central sensitization pain, is a relatively new term used to describe a complex phenomenon. It refers to pain that originates from altered nociception, meaning the way our nervous system detects and processes pain signals, even in the absence of any evident tissue damage or inflammation. This type of pain is often associated with chronic conditions such as fibromyalgia, irritable bowel syndrome (IBS), or chronic pelvic pain syndrome.

In nociplastic pain, the nervous system becomes hypersensitive, amplifying pain signals and causing individuals to experience pain more intensely than expected. Understanding and recognizing nociplastic pain is crucial for effective management and treatment of these chronic pain conditions.

7. Allodynia

Allodynia refers to a heightened sensitivity to touch or other stimuli that should not normally cause pain. For example, some individuals with neuropathic pain may experience pain when they lightly brush their skin or wear clothing.

8. Central Sensitisation

Central sensitisation is a process where the central nervous system (brain and spinal cord) becomes overly sensitized to pain signals, causing a heightened perception of pain. This can result in allodynia, hyperalgesia (increased pain sensation), or the persistence of pain even after the initial cause resolves.

9. Pain Threshold

The pain threshold is the point at which a stimulus (such as pressure, heat, or cold) elicits a painful sensation. This threshold can vary between individuals and can be influenced by factors like stress, sleep, and mood.

10. Pain Tolerance

Pain tolerance is the maximum level of pain that an individual is willing to endure. This can also vary between individuals and can be influenced by factors like genetics, previous experiences with pain, and coping strategies.

Conclusion

Understanding these commonly used terms in the world of pain medicine can help patients better communicate with their healthcare providers about their pain. It is important to remember that pain is complex and multifaceted, and it may require a combination of treatments to effectively manage it. By having a good understanding of these terms, patients can play an active role in their pain management and make informed decisions about their treatment plan.

References:

  1. International Association for the Study of Pain. (2022). IASP Pain Terminology. Available at: [https://www.iasp-pain.org/resources/terminology/](https://www.iasp-pain.org/resources/terminology/).
  2. Australian and New Zealand College of Anaesthetists (ANZCA). (2020). “Acute Pain Scientific Handbook.” Available at: https://www.anzca.edu.au/resources/endorsed-guidelines/acute-pain-scientific-handbook.
  3. Chapman, C.R., Vierck, C.J., 2017. ‘Pain as a disease: an overview’, Journal of Pain Research, 10, pp.2003-2008. Available at: https://www.tandfonline.com/doi/abs/10.2147/JPR.S138864.
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DECODING LOW DOSE NALTREXONE’S EFFECT ON PAIN

For those unfamiliar with the medication, Naltrexone is typically used in the management of alcohol or opioid dependence. It works by blocking the euphoric effects and feelings of intoxication, providing a useful tool for individuals with substance use disorders to avoid relapses. It’s an “opioid antagonist,” meaning that it blocks the action of opioids in the brain.

What is Low Dose Naltrexone (LDN)?

Low Dose Naltrexone (LDN) is a term that refers to doses of this medication ranging from 1 to 5 milligrams. This is significantly lower than the average dose used for managing opioid addiction, which is typically 50 milligrams. LDN is non-addictive, safe, and cost-effective, and is becoming more recognized for its potential benefits.

How Low Dose Naltrexone (LDN) works

What makes LDN work is its unique method of action. It temporarily blocks the opioid receptors in the brain and immune cells, leading to an increase in the production of endorphins. As you may know, endorphins are the body’s natural painkillers.

But that’s not all LDN does—it also promotes an upsurge of opioid receptors, further enhancing the body’s capacity to regulate pain and mood. Additionally, there is evidence that LDN has immune-modulating effects, helping to boost immune function.

This makes LDN a multifaceted medication capable of addressing pain management but also offering potential benefits for mood regulation and immune system support.

What are the potential benefits and uses of Low Dose Naltrexone (LDN)?

The use of LDN has been linked to benefits in treating conditions like autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis.

It has also shown promise in managing pain related to central sensitization conditions such as Ehlers-Danlos Syndrome and Fibromyalgia.

There’s even evidence to suggest LDN can aid in the treatment of mood disorders like depression and anxiety.

What are the potential side-effects of Low Dose Naltrexone (LDN)?

Due to its low dose, LDN is generally well-tolerated, with very few reported side-effects. Some patients may experience mild side-effects like nausea, headache, or insomnia when first starting LDN treatment. These symptoms are usually temporary and tend to improve with continued use of the medication.

When should I start seeing the potential benefits from taking Low Dose Naltrexone (LDN)?

The time required to observe benefits from LDN varies between individuals, but typically, positive effects can be noted within a few weeks to months. It is crucial to work closely with your healthcare provider to determine the best dosage and treatment plan for your specific condition.

Disclosure: The information in this article is not intended to replace your doctor’s medical advice, diagnosis or treatment. If you require more information, or have any questions, please speak to your doctor/ specialist.

References:

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  2. Patten, D. K., Schultz, B. G., Berlau, D. J. (2018). The safety and efficacy of low-dose naltrexone in the management of chronic pain and inflammation in multiple sclerosis, fibromyalgia, Crohn’s disease, and other chronic pain disorders. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 38, 382–389.
  3. Metyas, S., Yeter, K., Solyman, J., & Arkfeld, D. (2018). Low dose naltrexone in the treatment of fibromyalgia. Current Rheumatology Reviews, 14, 177-180. DOI: 10.2174/1573397113666170321120329
  4. Smith, J. P., Bingaman, S. I., Ruggiero, F., Mauger, D. T., Mukherjee, A., McGovern, C. O., & Zagon, I. S. (2011). Therapy with the opioid antagonist naltrexone promotes mucosal healing in active Crohn’s disease: a randomized placebo-controlled trial. Digestive diseases and sciences, 56, 2088–2097. DOI: 10.1007/s10620-011-1653-7
  5. Younger, J., Noor, N., McCue, R., & Mackey, S. Low-dose naltrexone for the treatment of fibromyalgia: Findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels. Arthritis and Rheumatism, vol. 65, 2013, pp. 529-538. DOI: 10.1002/art.37734.

Harnessing the Power of Pulsed Radiofrequency for the treatment of Meralgia Paraesthetica (Lateral Cutaneous Nerve of the Thigh Pain)

Living with chronic pain can be debilitating and impact one’s quality of life. Fortunately, advancements in pain management have led to innovative treatments, one of which is pulsed radiofrequency (PRF) therapy. In this blog, we will explore the latest research surrounding the use of PRF for the treatment of lateral cutaneous nerve of the thigh (LCN) pain. Let’s delve into the world of PRF and its potential benefits for those suffering from LCN-related discomfort.

Understanding Pulsed Radiofrequency Therapy

Pulsed radiofrequency therapy is a non-invasive treatment approach that specifically targets and modulates the activity of nerves to relieve pain. It involves the application of low-intensity electrical pulses directly to the affected nerves. By delivering these pulses in a pulsatile manner, PRF aims to disrupt the transmission of pain signals, offering a potential method for pain management.

Unlike continuous radiofrequency therapy, which generates heat to create a thermal lesion on the nerves, PRF utilizes brief bursts of energy. This unique characteristic of PRF minimizes the risk of tissue damage and allows for a more controlled and precise treatment. The pulsatile nature of PRF enables the modulation of nerve activity without causing thermal injury, making it a safer option for patients.

The therapeutic effects of PRF are thought to be multifactorial. By modulating the activity of nerves, PRF can potentially interrupt or modify the transmission of pain signals to the brain, resulting in pain relief. Additionally, PRF may also have anti-inflammatory effects, helping to reduce pain and inflammation in the targeted area. The exact mechanisms of action of PRF are still being studied and understood, but its potential to offer pain relief with minimal risk of tissue damage makes it an intriguing option for patients seeking alternative pain management approaches.

Lateral Cutaneous Nerve of the Thigh Pain

LCN pain, also known as meralgia paresthetica, is a condition that manifests as tingling, numbness, and burning sensations in the outer thigh. It occurs due to compression or irritation of the lateral cutaneous nerve of the thigh (LCN), which is responsible for supplying sensory fibers to the skin of the lateral thigh.

There are several factors that can contribute to the development of LCN pain. One common cause is obesity, as excess weight can put pressure on the LCN, leading to symptoms. Additionally, wearing tight clothing, such as belts or pants, can also compress the nerve and result in discomfort. Trauma, such as injury or surgery, can damage the LCN and cause pain as well. Finally, individuals with diabetes may be at a higher risk for LCN pain, as the condition can affect nerve function.

Treatment options may include conservative measures such as wearing looser clothing, weight management, and physical therapy exercises to alleviate pressure on the nerve. In some cases, medications or injections, such a local anaesthetic injections or pulsed radiofrequency treatment may be recommended to manage pain.

Efficacy of PRF for LCN Pain

Recent studies have highlighted the efficacy of PRF in managing LCN pain. Research published in PAIN MEDICINE has reported successful treatment outcomes, including complete and sustained relief of thigh pain following PRF therapy. Another study from Regional Anaesthesia and Pain Medicine demonstrated the benefits of ultrasound-guided PRF ablation of the LCN for treating meralgia paresthetica.

Mechanisms of PRF and Pain Relief

The exact mechanisms by which PRF alleviates pain are still being elucidated. However, it is believed that the electrical pulses disrupt the abnormal transmission of pain signals, modulating the activity of pain-sensitive nerve fibers. This modulation can lead to reduced pain perception and improved function.

Considerations and Side Effects

PRF therapy is generally considered safe and well-tolerated. However, like any medical procedure, there are potential side effects and contraindications. Common side effects include temporary skin numbness, mild discomfort at the treatment site, and mild bruising. It is crucial to consult with a qualified pain specialist to assess the appropriateness of PRF therapy based on individual circumstances.

Summary and Recommendations

Pulsed radiofrequency therapy holds promise as a non-invasive and effective approach for managing LCN pain. Research published in reputable journals such as PAIN, PAIN MEDICINE, and Regional Anaesthesia and Pain Medicine supports the use of PRF for treating LCN-related discomfort. However, it is essential to consult with a pain specialist to evaluate suitability for treatment and discuss potential risks and benefits.

In conclusion, pulsed radiofrequency therapy offers hope to individuals suffering from lateral cutaneous nerve of the thigh pain. By utilizing this advanced technique, we can potentially alleviate their symptoms and enhance their overall well-being.

Remember, seeking personalized medical advice from a qualified professional is crucial before considering any treatment option.

References

  1. Park D, Chang MC. The mechanism of action of pulsed radiofrequency in reducing pain: a narrative review. J Yeungnam Med Sci. 2022 Jul;39(3):200-205. doi: 10.12701/jyms.2022.00101. Epub 2022 Apr 7. PMID: 35385898; PMCID: PMC9273139.
  2. Rollin M. Gallagher, MD, MPH, Pulsed Radiofrequency Treatment: Biological Mechanisms and Clinical Evidence, Pain Medicine, Volume 6, Issue 6, November 2005, Pages 401–402, https://doi.org/10.1111/j.1526-4637.2005.00077.x
  3. Alaa Abd-Elsayed, MD, MPH and others, Lateral Femoral Cutaneous Nerve Radiofrequency Ablation for Long-term Control of Refractory Meralgia Paresthetica, Pain Medicine, Volume 21, Issue 7, July 2020, Pages 1433–1436, https://doi.org/10.1093/pm/pnz372
  4. Fowler IM, Tucker AA, Mendez RJ. Treatment of meralgia paresthetica with ultrasound-guided pulsed radiofrequency ablation of the lateral femoral cutaneous nerve. Pain Pract. 2012 Jun;12(5):394-8. doi: 10.1111/j.1533-2500.2011.00522.x. Epub 2011 Dec 7. PMID: 22151457.
  5. Van Zundert, Jana,d,*; Patijn, Jacoba; Kessels, Alfonsb; Lamé, Ingea; van Suijlekom, Hansc; van Kleef, Maartena. Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: A double blind sham controlled randomized clinical trial. Pain 127(1):p 173-182, January 2007. | DOI: 10.1016/j.pain.2006.09.002

PTSD AND CHRONIC PAIN

One of the most common physical problems reported by people with post-traumatic stress disorder (PTSD) is chronic pain.

In one study of volunteer firefighters with PTSD, approximately 50% were having pain (mainly back pain) compared with only about 20% of firefighters without PTSD. Other research has found that, in some studies, the prevalence rate of chronic pain in patients with a primary diagnosis of PTSD is as high as 80%.2.

What’s more, people with PTSD often have other mental health disorders that can contribute to or worsen their pain, such as depression and anxiety. All of these factors can make it difficult to manage pain effectively.

There are a number of theories about why chronic pain is so common among people with PTSD, but the most likely explanation is that the stress of trauma can actually change pain perception, including the way pain is processed in the brain.

When you experience a traumatic event, your nervous system goes into “survival mode.” This causes a number of changes in your body, including an increase in the level of stress hormones like cortisol. These changes can make you more sensitive to pain and can also cause changes in the way pain is processed in the brain.

In one study, researchers found that people with PTSD had changes in the way their brains processed pain signals. These changes were similar to those seen in people with chronic pain disorders like fibromyalgia and migraines.

What is Post-Traumatic Stress Disorder?

Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event.

According to the National Institute of Mental Health, it’s estimated that 2-20% of all people who have experienced traumatic events develop PTSD. In Australia, around 1-2% of adults experience PTSD each year, while approximately 12% experience PTSD in their lifetime.

What is a traumatic event?

Normal stressors experienced in daily life, such as paying the bills or the car breaking down, and even major life stressors, such as buying a house, do not constitute serious traumatic events.

Serious traumatic events, that could lead to the development of PTSD, could include (but are not limited to):

  • War zone exposure
  • Physical or sexual assault
  • Serious accidents
  • Natural disasters
  • Torture

What are the symptoms experienced in PTSD?

Persistent re-experiencing of the traumatic event

Persistent re-experiencing of the traumatic event, indicated by one or more of the following:

  • Recurrent distressing recollections of the event (intrusive thoughts)
  • Recurrent distressing dreams of the event 
  • Acting or feeling as if the event was recurring (e.g. flashbacks)
  • Psychological distress to cues resembling event
  • Psychological reactivity to cues resembling event

Avoidance symptoms

Persistent avoidance of stimuli associated with the traumatic event, as indicated by one or more of the following:

  • Avoidance of thoughts or feelings that are reminders of the event
  • Avoidance of activities, places, people or conversations that are reminders of the event

Negative alterations in cognition and mood

Persistent negative alterations in cognitions and mood indicated, by two or more of the following:

  • Markedly diminished interest or participation in significant activities
  • Feelings of detachment or estrangement from others
  • Inability to experience positive emotions
  • Inability to recall important aspects of the trauma
  • Exaggerated negative beliefs or expectations
  • Distorted blame of self or others about the trauma 

Hyperarousal symptoms

Persistent symptoms of increased arousal are indicated by two or more of the following:

  • Sleep disturbance
  • Irritable behavior or outbursts of anger
  • Problems with concentration
  • Hypervigilance
  • Reckless or self-destructive behavior
  • Exaggerated startle response

Why does PTSD and chronic pain so often occur together?

There are a few possible explanations.

One reason is quite obvious – many traumatic events cause physical injuries that lead to chronic pain. Think about it – living through a natural disaster, being the victim of physical assault, or serving in combat can inflict serious bodily harm that leads to long-term pain. 

But underlying vulnerabilities may also play a role in developing both conditions. Studies suggest that there are shared risk factors – such as impulsivity, depression, anxiety, and sleep disturbances – that can predispose someone to both PTSD and chronic pain.3,4 It’s also worth noting that people who experience more severe trauma are more likely to develop both chronic pain and PTSD.5

Shared Vulnerabilities

One explanation for the link between PTSD and chronic pain is that they may share underlying vulnerabilities. For example, both conditions have been linked to genetic factors, trauma exposure, and psychological distress. Additionally, people with PTSD are more likely to develop other mental health conditions, such as depression and anxiety, which are also risk factors for chronic pain. Therefore, it is not surprising that PTSD and chronic pain often occur together.

Physiological Changes

Another explanation for the link between PTSD and chronic pain is that trauma can lead to changes in the body that result in increased sensitivity to pain. For example, trauma has been shown to cause changes in the nervous system that can make people more sensitive to pain. Additionally, people with PTSD often have trouble sleeping, which can further increase their sensitivity to pain.

Treatment overlap between PTSD and chronic pain

Post-traumatic stress disorder (PTSD) and chronic pain are both conditions that can have a profound impact on a person’s quality of life. Disruptions in sleep, concentration, and mood are common in both conditions, and both can be difficult to treat.

There are several therapies that are effective for treating PTSD, including cognitive behavioral therapy (CBT), cognitive processing therapy, prolonged exposure, and eye movement desensitization and reprocessing. These therapies can also be helpful for treating comorbid chronic pain.

In addition, pharmacotherapy treatments such as selective serotonin reuptake inhibitors (SSRIs) and venlafaxine have been shown to be effective for treating both PTSD and chronic pain. As a result, there is considerable overlap between the treatment of these two conditions.

If you are experiencing both chronic pain and symptoms of PTSD, it is important to seek professional help so that you can receive treatment for both conditions.

Disclosure: The information in this article is not intended to replace your doctor’s medical advice, diagnosis or treatment. If you require more information, or have any questions, please speak to your doctor/ specialist.

References:

  1. Australian Department of Veterans’ Affairs. Managing Post-traumatic stress disorder. https://www.dva.gov.au/health-and-treatment/injury-or-health-treatments/mental-health-care/managing-posttraumatic-stress
  2. DSM V. Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatry Association.
  3. Posttraumatic stress disorder in the National Comorbidity Survey. (1995). Posttraumatic stress disorder in the National Comorbidity Survey., 52(12), 1048–1060. DOI: 10.1001/archpsyc.1995.03950240066012
  4. Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. (2013). Meta-analysis of the efficacy of treatments for posttraumatic stress disorder., 74(6), e541–50. http://doi.org/10.4088/JCP.12r08225
  5. Lehinger E, Reed DE, Nabity P, Brackins N, Villarreal R, McGeary C, Blount T, Cobos B, Jaramillo C, Eapen BC, Pugh MJ, Potter J, Peterson A, Young-McCaughan S, Houle T, McGeary DD. An Examination of Chronic Pain Indices and the Updated Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental-Disorders-Fifth Edition. Mil Med. 2021 Nov 2;186(11-12):e1199-e1206. doi: 10.1093/milmed/usaa529. PMID: 33301040; PMCID: PMC8902930.
  6. Fishbain DA, Pulikal A, Lewis JE, Gao J. Chronic Pain Types Differ in Their Reported Prevalence of Post -Traumatic Stress Disorder (PTSD) and There Is Consistent Evidence That Chronic Pain Is Associated with PTSD: An Evidence-Based Structured Systematic Review. Pain Med. 2017 Apr 1;18(4):711-735. doi: 10.1093/pm/pnw065. PMID: 27188666.
  7. A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims., 70(4), 867–879. http://doi.org/10.1037/0022-006x.70.4.867

What is oMEDD (Oral Morphine Equivalent Daily Dose)?

Did You Know That Pain Specialists Can Calculate Any Opioid Dose Back to the Daily Oral Morphine Equivalent Dose?

Many people who suffer from chronic pain often find themselves taking opioids to help manage their pain. While opioids can be effective at managing pain, they can also be very dangerous. That’s why it’s important for clinicians to be able to compare different opioid management regimes between patients to ensure safety and determine risk. One way they can do this is by calculating the oral morphine equivalent dose (oMEDD).

What is oMEDD (Oral Morphine Equivalent Daily Dose)?

The oMEDD is essentially a way to standardize the conversion of different opioids into a consistent unit of measurement and allow clinicians to compare different oral opioids. It’s calculated by converting the total daily dose of an opioid into an equivalent dose of oral morphine.

This conversion is necessary because different opioids have different potencies. This means that a certain dose of one opioid may not have the same effect as the same dose of another opioid. The oMEDD is a way to account for these differences and make sure that patients are receiving the correct dose of medication.

Why is oMEDD important?

Calculating the oMEDD enables clinicians to compare different opioid management regimes between patients to ensure safety and determine risk when opioids are needed as part of acute/ chronic/ cancer pain management or in palliative patients.

By understanding the oMEDD, clinicians can make more informed decisions about which opioids are appropriate for each individual patient and what dosages are safe.

How is oMEDD calculated?

There are a few different formulas that can be used to calculate the oMEDD. However, the most commonly used formula is:

oMEDD (in mg) = Dose (in mg) x Opioid Conversion Factor

The opioid conversion factor is a number that corresponds to the potency of the opioid. For example, the conversion factor for oral morphine is 1.

For example, 10mg of oral Oxycodone is equivalent to 15mg of oral Morphine. This is because Oxycodone is a more potent opioid than Morphine. Similarly, 30mg of Codeine is equivalent to 4mg of oral Morphine because Codeine is less potent than Morphine.

The oMEDD is essentially a way to standardize the conversion of different opioids into a consistent unit of measurement.

Conclusion:

If you suffer from chronic pain, it’s important that your clinician understands the oMEDD so that they can make informed decisions about your care. The oMEDD allows clinicians to compare different opioids and determine which ones are safe for you at what dosages. This information is critical in ensuring that you receive the best possible care and treatment for your chronic pain.

Disclosure: The information in this article is not intended to replace your doctor’s medical advice, diagnosis or treatment. If you require more information, or have any questions, please speak to your doctor/ specialist.

References:

  1. Svendsen K, Borchgrevink P, Fredheim O, Hamunen K, Mellbye A, Dale O. Choosing the unit of measurement counts: the use of oral morphine equivalents in studies of opioid consumption is a useful addition to defined daily doses. Palliat Med. 2011 Oct;25(7):725-32. doi: 10.1177/0269216311398300. Epub 2011 Mar 4. PMID: 21378066.
  2. Opioid Dose Equivalence Calculation Table. https://www.anzca.edu.au/getattachment/6892fb13-47fc-446b-a7a2-11cdfe1c9902/PS01(PM)-(Appendix)-Opioid-Dose-Equivalence-Calculation-Table
  3. Armstrong F, Arunogiri S, Frei MY, Lubman DI. The six Rs of managing high-risk opioid prescribing. Aust J Gen Pract. 2020 Mar;49(3):116-120. doi: 10.31128/AJGP-06-19-4967. PMID: 32113200.

PEA: A Natural Pain Killer?

Chronic pain is a persistent problem for many people. According to the Australian Institute of Health and Welfare, one in 5 Australians aged 45 and over are living with persistent, ongoing pain. Current treatments for chronic pain often come with unpleasant side effects or the risk of drug interactions, so there is a great need for new and effective therapies.

Palmitoylethanolamide (PEA) is a natural fatty acid that has analgesic, anti-inflammatory, and neuroprotective effects. In this blog post, we will discuss the current research on PEA and its potential as a treatment for chronic and neuropathic pain (nerve pain).

Palmitoylethanolamide (PEA) is present in all mammals, including humans. It is produced naturally in the body and is also found in some foods, such as chicken egg yolk and soybeans.

What is PEA?

Palmitoylethanolamide (PEA) is a fatty acid amide that is naturally produced in the body. PEA is found in high concentrations in the central nervous system. It is produced by neurons, glial cells, and immune cells. PEA belongs to a class of endocannabinoids known as N-acylethanolamines (NAEs).

How does Palmitoylethanolamide (PEA) work?

PEA binds to both CB1 and CB2 receptors, although its binding affinity is higher for CB2 than for CB1. The activation of CB2 receptors by PEA is thought to be responsible for the management of pain. Research suggests that PEA may be an effective treatment for neuropathic pain, inflammatory pain, and neuro-inflammatory conditions. 

PEA functions as an agonist at both TRPV1 and TRPA1 ion channels.TRPV1 ion channels are located on nociceptive neurons and are activated by noxious stimuli such as heat, acidic pH, and capsaicin. Activation of TRPV1 ion channels results in an influx of calcium ions into the cell, which leads to the initiation of pain signals.

TRPA1 ion channels are also located on nociceptive neurons and are activated by noxious stimuli such as cold temperatures and mustard oil derivatives. Activation of TRPA1 ion channels also results in an influx of calcium ions into the cell, which leads to pain signals being transmitted from the periphery to the central nervous system. 

You may have heard of the endocannabinoid system (ECS), but what exactly is it and how does it work?

The ECS is a complex cell-signaling system that plays a role in maintaining homeostasis in the body. This system is involved in many physiological processes, including regulating many important functions in the body including pain, inflammation, mood, and sleep. 

The ECS is made up of endocannabinoids, which are ligands that bind to cannabinoid receptors. There are two known cannabinoid receptors, CB1 and CB2. CB1 receptors are found primarily in the brain and central nervous system, while CB2 receptors are found mainly in the peripheral nervous system. Both CB1 and CB2 receptors are G protein-coupled receptors (GPCRs). 

The CB1 and CB2 receptors are activated by endogenous ( produced naturally by the body) and exogenous (plant-derived) cannabinoids. The activation of CB1 receptors is primarily responsible for the psychoactive effects of cannabinoids, while CB2 activation is thought to be responsible for the immunomodulatory and anti-inflammatory effects.

What Does the Research Say? 

There is a growing body of evidence from clinical trials supporting the use of PEA as a treatment for chronic and neuropathic pain. A number of studies have shown that PEA supplements can help to reduce pain and improve the quality of life in people with chronic pain.

One study in cancer patients found that PEA was effective at reducing neuropathic pain when used alongside standard pain medication. Another study found that PEA was effective at reducing inflammatory joint pain in patients with rheumatoid arthritis. 

A 2017 systematic review looked at 28 clinical trials on the efficacy of PEA for treating various types of chronic and neuropathic pain. The authors concluded that “PEA is an effective adjuvant therapy for chronic non-cancer related pains.” 

Another study published in 2018 found that PEA was an effective treatment for nerve damage-related pain reduction. The authors conclude that “PEA should be included in guideline-recommended pharmacological treatments for diabetic patients with painful diabetic neuropathy.” 

A recent study by Austrian researchers, published in 2022, concluded PEA has clinically relevant analgesic properties, acting on both peripheral and central mechanisms (reducing wind-up) as well as in pain modulation, therefore increasing pain tolerance.

What conditions might be improved by taking PEA as a supplement?

Conditions where people might benefit from using PEA for their pain management include (but are not limited to):

  • Neuropathic pain (nerve pain)
  • Inflammatory pain
  • Fibromyalgia
  • Radiculopathic pain
  • Peripheral neuropathy
  • Persistent post-surgical pain
  • Chronic pelvic pain
  • Visceral pain
  • Diabetic neuropathy

How long does it take to see an effect after starting PEA?

Individual patients can take up to 4 – 6 weeks to experience benefits from PEA supplementation. It is well tolerated and has no known side effects which makes PEA an option for patients who have multiple medication sensitivities or allergies.

Conclusion: 

Although more research needs to be done on PEA and its potential therapeutic applications, current evidence suggests that PEA holds promise as a treatment for chronic pain conditions due to its ability to modulate both TRPV1 and TRPA1 ion channels. 

The current emerging evidence and clinical data suggest that PEA may be an effective treatment for treating chronic pain with few side effects. If you are interested in trying PEA, speak to your healthcare provider about whether it is right for you.

Disclosure: The information in this article is not intended to replace your doctor’s medical advice, diagnosis or treatment. If you require more information, or have any questions, please speak to your doctor/ specialist.

References:

  1. Artukoglu BB, Beyer C, Zuloff-Shani A, Brener E, Bloch MH. Efficacy of Palmitoylethanolamide for Pain: A Meta-Analysis. Pain Physician. 2017 Jul;20(5):353-362. PMID: 28727699.
  2. Guida, F., Luongo, L., Boccella, S. et al. Palmitoylethanolamide induces microglia changes associated with increased migration and phagocytic activity: involvement of the CB2 receptor. Sci Rep 7, 375 (2017). https://doi.org/10.1038/s41598-017-00342-1. https://rdcu.be/cZxUt
  3. Petrosino S, Di Marzo V. The pharmacology of palmitoylethanolamide and first data on the therapeutic efficacy of some of its new formulations. Br J Pharmacol. 2017 Jun;174(11):1349-1365. doi: 10.1111/bph.13580. Epub 2016 Sep 29. PMID: 27539936; PMCID: PMC5429331.
  4. The Effect of Palmitoylethanolamide on Pain Intensity, Central and Peripheral Sensitization, and Pain Modulation in Healthy Volunteers—A Randomized, Double-Blinded, Placebo-Controlled Crossover Trial Kordula Lang-Illievich, Christoph Klivinyi, Gudrun Rumpold-Seitlinger, Christian Dorn and Helmar Bornemann-Cimenti. Nutrients 2022, 14, 4084. https://doi.org/10.3390/ nu14194084.
  5. https://www.metagenicsinstitute.com/ce-education/science-sheets/ecs-and-pea/#:~:text=%E2%9C%93%20PEA%20supports%20the%20ECS,and%20indirectly%20activating%20cannabinoid%20receptors.

Botox – A Viable Treatment Option for Chronic Headaches?

If you suffer from chronic pain or headaches, you may have considered Botox as a possible treatment option. But what does the current research say about Botox and headache treatment? Let’s take a look.

What is Botox (Botulinum Toxin Type A)?

Botox is a purified and dilute neurotoxin produced by the Clostridium botulinum bacterium. Botox works by blocking nerve signals and paralyzing muscles. This muscle paralysis is temporary, lasting for 3 – 4 months.

When used for headache treatment, Botox is injected into specific muscles in the head and neck region. The most common injection sites are the forehead, temples, and back of the head.

Botox injections in specific sites under the skin around your face and neck can decrease brain chemicals that cause migraine pain, such as calcitonin gene-related peptides. Over time this treatment may help dull down reactions to triggers so you feel less severe headaches or nausea during an attack.

Who Should Administer Botox Injections?

Botox injections should only be administered by a trained healthcare professional. Injections should be given in very specific areas in order to minimize the risk of side effects. 

Overall, Botox is considered a safe treatment with minimal side effects when administered by a trained healthcare professional. The most common side effect is temporary bruising or soreness at the injection site. Other potential side effects include drooping eyelids, dry eyes, and headaches. These side effects are usually mild and resolve on their own within a few days. 

Current research and evidence for the use of Botox in the treatment of headaches

Several studies have shown that Botox is an effective treatment for chronic headaches and can significantly reduce pain levels. In one study, 78% of participants reported a reduction in headaches after receiving botox injections.

Another study found that botox can help to prevent migraines, with participants reporting a 50% reduction in migraine days after treatment.

A recent systematic review, published in 2022 in Pain Research and Management, found that Botox was a low-cost option for the treatment of various kinds of migraines, including chronic, episodic, unilateral, and vestibular types. Botox can reduce the frequency of migraine attacks per month and diminish the severity of pain.

A Cochrane review published in 2018, concluded that in chronic migraine, botulinum toxin reduces migraine frequency by 2 days/month and has a favourable safety profile.

The FORWARD study, published in 2019 in Headache, compare Botox to Topiramate for headache prevention in adults with chronic migraine. The study found Botox to have greater clinical utility than Topiramate, mostly because it was tolerated better and a higher number of Botox patients remained on treament.

Who might be a good candidate for Botox treatment for chronic headaches?

The best candidates for Botox treatment are those who have tried other treatments without success. Botox is also a good option for those who cannot take medication or who are unable to tolerate the side effects of medication.

Conclusion

If you are considering Botox for the treatment of your chronic headaches, there is good evidence to support its use. However, it is important that you consult with a physician experienced in managing patients with chronic headaches to ensure that the injections are administered properly.

Disclosure: The information in this article is not intended to replace your doctor’s medical advice, diagnosis or treatment. If you require more information, or have any questions, please speak to your doctor/ specialist.

References:

  1. Cochrane systematic review and meta-analysis of botulinum toxin for the prevention of migraine. Clare P Herd, Claire L Tomlinson, Caroline Rick, William J Scotton, Julie Edwards, Natalie J Ives, Carl E Clarke, AJ Sinclair. http://dx.doi.org/10.1136/bmjopen-2018-027953.
  2. Shaterian N, Shaterian N, Ghanaatpisheh A, Abbasi F, Daniali S, Jahromi MJ, Sanie MS, Abdoli A. Botox (OnabotulinumtoxinA) for Treatment of Migraine Symptoms: A Systematic Review. Pain Res Manag. 2022 Mar 31;2022:3284446. doi: 10.1155/2022/3284446. PMID: 35401888; PMCID: PMC8989603.
  3. Rothrock JF, Adams AM, Lipton RB, Silberstein SD, Jo E, Zhao X, Blumenfeld AM; FORWARD Study investigative group. FORWARD Study: Evaluating the Comparative Effectiveness of OnabotulinumtoxinA and Topiramate for Headache Prevention in Adults With Chronic Migraine. Headache. 2019 Nov;59(10):1700-1713. doi: 10.1111/head.13653. Epub 2019 Sep 26. PMID: 31559634; PMCID: PMC6899480.

YOGA FOR CHRONIC PAIN

Millions of Australians suffer from chronic pain, defined as pain lasting longer than three months. While there are many conventional treatments available, such as medication and physical therapy, some patients do not respond well to these interventions. For these individuals, complementary and alternative therapies, such as practicing yoga, may be a helpful addition.

Is there evidence to show that practicing yoga can help when you have chronic pain?

A recent systematic review analysed data from 31 clinical trials involving 2,768 participants to determine the effectiveness of regular yoga practice in treating chronic pain conditions. The review found that consistent yoga practice can lead to significant improvements in pain, disability, and mood in people with chronic pain conditions. When compared to other interventions, such as Cognitive Behavioural Therapy (CBT), the effect sizes were found to be moderate. Yoga is one of the therapies recommended by the American Pain Society for people with low back pain who do not improve with other self-care strategies.

So what exactly is yoga?

Yoga is an ancient practice that originated in India and involves a series of physical postures (asanas), breathing exercises (pranayama), and mindfulness meditation. Yoga means “union” in Sanskrit, the language of ancient India, and it is the union of body, mind, and spirit.

Yoga is a holistic practice that includes physical, mental, and emotional components.

The physical component of yoga is the asana or Yoga pose. Asana practice helps to improve flexibility, strength, and balance.

The mental component of Yoga is the breathing practice or pranayama. Pranayama helps to improve concentration and focus.

The emotional component of Yoga is the practice of mindfulness and meditation. Meditation helps to improve calmness and peace of mind.

Yoga exercises have been shown to improve a variety of conditions, including anxiety, depression, fatigue, and insomnia.

In terms of specific benefits, yoga has been shown to:

  • Relax the nervous system
  • Decrease inflammation
  • Increase pain tolerance
  • Improve sleep quality
  • Enhance mood
  • Increase sends of control over symptoms and overall well-being.

Who should do yoga?

Most people with chronic pain can benefit from doing yoga. However, it is important to find a class that is suitable for your level of fitness and flexibility.

What type of yoga might be beneficial if I have chronic pain?

It is important to note that not all yoga classes are created equal; specifically, those classes labeled “Hatha” or “Iyengar” may be more beneficial for people in pain as opposed to more “ athletic” classes such as Ashtanga or Bikram. Hatha yoga classes tend to be slower-paced and focus on holding postures for long periods, while Iyengar classes place emphasize proper alignment. If you are interested in trying yoga but are not sure where to start, it may be helpful to consult with a certified instructor beforehand.

Yoga for chronic pain series

This series, produced by the U.S. Department of Veterans Affairs for veterans, is one of the best and gentlest online yoga resources for patients living with chronic pain that we have been able to find online.

The video clips are around 5 – 7 minutes long and presented in two sections, which when done in sequence, resulting in two 30-minute yoga classes.

The series is taught by a pain psychologist and physiotherapist and follows a slow easy pace. the yoga poses are also taught in a seated position and have multiple modifications if you are unable to do certain movements.

Yoga Class 1

Introduction and breathing practice

One of the most important aspects of yoga is breathing. Proper breathing helps to oxygenate the blood and improve circulation. It also helps to ease tension and anxiety.

Several different breathing techniques can be used in yoga, but one of the most basic is simply to inhale slowly through the nose and exhale slowly through the mouth. This simple practice can help to clear the mind and focus the body, making it an essential part of any Yoga routine.

Cat-Cow Yoga Pose (Chakravaksana)

The Cat-Cow Pose, or Chakravaksana, is a simple Yoga Pose that provides numerous benefits. 

The Cat-Cow Pose stretches and strengthens the spine, neck, and shoulders. In addition, the Cat-Cow Pose helps to relieve stress and tension headaches. The pose gets its name from the movement of the spine, which resembles a cat stretching its back or a cow chewing its cud. 

To do the Cat-Cow Pose, start on all fours with your hands and knees on the ground. As you inhale, arch your back and look up towards the ceiling. As you exhale, round your back and tuck your chin towards your chest. Repeat this sequence for 10 rounds. You can also add variations to this Yoga Pose by moving your head side to side or in circles as you move through the pose. 

The Cat-Cow Pose is a gentle Yoga Pose that provides numerous benefits for the body and mind.

Child’s Pose (Balasana)

One of the most basic Yoga poses is known as Child’s Pose or Balasana. This pose can be performed by anyone, regardless of their level of experience with Yoga. To assume the position, start by sitting on your heels with your knees touching. Then, slowly lower your torso down to your thighs and stretch your arms out in front of you. If you can, rest your forehead on the ground. Child’s Pose can be held for as long as desired but is typically held for 1-2 minutes.

While Child’s Pose may seem like a simple position, it offers a number of benefits. First, the pose helps to stretch the muscles in the back, shoulders, and legs. This can help to relieve tension and pain in these areas. Additionally, Child’s Pose is believed to calm the nervous system and help promote relaxation. For this reason, the pose is often included in Yoga classes designed to help students wind down and de-stress.

Given all of these benefits, it’s no wonder that Child’s Pose is one of the most popular Yoga poses. Whether you are new to Yoga or have been practicing for years, this pose is a great way to improve your physical and mental health.

Back Bend (Anuvittasana)

Back Bend (Anuvittasana) is a yoga pose that offers several benefits. The pose helps to stretch and strengthen the back muscles, as well as the muscles of the chest and arms. Additionally, the pose can help to improve posture and relieve tension headaches. The pose is also said to energize the body and promote a sense of well-being.

To do this pose, start in a standing position with your feet together. Then, bend backward from the waist, keeping your legs straight. Reach your arms overhead, and if possible, clasp your hands together behind your back. Hold the pose for at least 30 seconds before coming back to standing.

For beginners, it is important to practice the pose with caution and stop if there is any discomfort. Those with back pain or injuries should consult with a doctor before practicing Back Bend (Anuvittasana). With regular practice, Back Bend (Anuvittasana) can provide many physical and mental benefits.

Spinal Twist (Parivrtta Sukhasana)

The spinal twist (Parivrtta Sukhasana) stretches and strengthens the back, shoulders, and neck, and can help to relieve pain in these areas. The spinal twist can be performed in a seated or standing position, and can be done with or without props. To do the pose, start in a sitting position with your legs crossed in front of you. Place your right hand on your left knee, and twist your torso to the left, looking over your left shoulder. Repeat on the other side.

Yoga is a great way to improve your flexibility and strength, and the spinal twist is one of the most basic and beneficial Yoga poses.

Corpse Pose (Savasana)

One of the most important poses in Yoga is known as corpse pose, or Savasana. This pose is often done at the end of a Yoga session, and it involves lying on your back with your eyes closed and your arms and legs spread out.

To do Corpse Pose, simply lie on your back with your legs extended and your arms at your sides. Close your eyes and focus on your breath. remain in this pose for 5-10 minutes, or longer if you wish.

The benefits of corpse pose include reducing stress, improving circulation, and helping to boost energy levels. In addition, corpse pose can also help to improve flexibility and reduce pain. For these reasons, corpse pose is an essential part of Yoga practice.

Yoga Class 2

Ocean Breath (Ujjayi Pranayama)

One of the most important benefits of yoga is its ability to help control the breath. The ocean breath, or ujjayi pranayama, is a breathing technique that is often used in yoga. This technique involves inhaling and exhaling deeply and rhythmically, with the mouth slightly open. The sound of the breath should resemble the sound of waves crashing on the shore.

Ocean breathing can help to calm and focus the mind, as well as relax the body. It is also said to improve circulation and boost energy levels. Consequently, ocean breath is an important tool for anyone interested in achieving physical and mental balance.

Bridge Pose (Setu Bandha Sarvangasana)

Bridge Pose (Setu Bandha Sarvangasana) is a Yoga pose that helps to improve flexibility. Bridge Pose stretches the chest, neck, and spine. It also strengthens the back and leg muscles.

To do Bridge Pose, lie on your back with your knees bent and your feet flat on the ground. Place your arms at your sides with your palms facing down. Take a deep breath in and lift your hips off the ground, extending your legs so that they are straight. Hold the pose for 5-10 breaths before releasing and repeating on the other side.

Mountain Pose (Tadasana)

One of the most basic yoga poses is Mountain Pose or Tadasana. This pose can be done anywhere, making it a convenient choice for busy people. In addition, Mountain Pose provides a number of health benefits. For example, it helps to improve posture and increase flexibility. Additionally, this pose strengthens the muscles in the legs, back, and abdomen.

To do this pose, simply stand with your feet together and your hands at your sides. Then, inhale and raise your arms overhead. Exhale as you reach your fingertips up towards the sky, lengthening your spine. Finally, inhale as you bring your arms back down to your sides. Remember to breathe deeply throughout the pose to reap the maximum benefits.

Tree Pose (Vrksasana)

One of the most well-known yoga poses is Tree Pose or Vrksasana. This standing balance pose helps to improve focus and concentration, while also strengthening the legs and ankles. Additionally, Tree Pose can help to improve your sense of balance and coordination. If you’re new to yoga or looking to add a challenge to your practice, here’s how to do Tree Pose:

Begin in Mountain Pose, with your feet hip-width apart and your hands at your sides. Shift your weight onto your left foot and bring your right foot to rest against your left ankle or thigh. Press your right foot firmly into your left leg then, bring your hands together in front of your chest in the Namaste position and focus your gaze on a point in front of you. Hold the pose for 30 seconds to one minute, then repeat on the other side.

Tree Pose can help improve balance and coordination while also strengthening the ankles and thighs. Additionally, the pose can help to stretch the hips, chest, and shoulders. With regular practice, you will be able to achieve a deeper stretch and hold the pose for longer periods.

Corpse Pose (Savasana)

Corpse Pose is repeated at the end of Yoga class 2 as it was at the end of class 1. This is because Corpse Pose is one of the most important yoga poses, traditionally done at the end of a yoga practice.

To do Corpse Pose, simply lie on your back with your legs extended and your arms at your sides. Close your eyes and focus on your breath. remain in this pose for 5-10 minutes, or longer if you wish.

In conclusion, if you suffer from chronic pain and have not found relief from conventional treatments, yoga may be worth exploring. Yoga has been shown to improve a variety of conditions, including anxiety, depression, fatigue, and insomnia; in terms of pain specifically, yoga has been found to help increase pain tolerance and reduce perceived pain intensity.

When choosing a class, look for those labeled “Hatha” or “Iyengar” as they tend to be more beneficial for people in pain as opposed to more “ athletic” classes such as Ashtanga or Bikram. If you are interested in trying yoga but are not sure where to start, it may be helpful to consult with a certified instructor beforehand.

Disclosure: The information in this article is not intended to replace your doctor’s medical advice, diagnosis or treatment. If you require more information, or have any questions, please speak to your doctor/ specialist.

Resources and references

  1. All YouTube links are from the Veterans Health Administration (U.S. Department of Veterans Affairs)
  2. Find a yoga therapist through Yoga Australia – https://www.yogaaustralia.org.au/ or the Australasian Association of Yoga Therapists – https://yogatherapy.org.au/find-a-yoga-therapist/.
  3. Groessl EJ, Liu L, Chang DG, Wetherell JL, Bormann JE, Atkinson JH, Baxi S, Schmalzl L. Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial. Am J Prev Med. 2017 Nov;53(5):599-608. doi: 10.1016/j.amepre.2017.05.019. Epub 2017 Jul 20. PMID: 28735778; PMCID: PMC6399016.
  4. Cramer H, Lauche R, Haller H, Dobos G. A systematic review and meta-analysis of yoga for low back pain. The Clinical journal of pain 2013; 29(5): 450-60. DOI: 10.1097/AJP.0b013e31825e1492
  5. Wieland LS, Skoetz N, Pilkington K, Vempati R, D’Adamo CR, Berman BM. Yoga treatment for chronic non-specific low back pain. Cochrane Database Syst Rev. 2017 Jan 12;1(1):CD010671. doi: 10.1002/14651858.CD010671.pub2. PMID: 28076926; PMCID: PMC5294833.
  6. Cramer H, Ward L, Saper R, Fishbein D, Dobos G, Lauche R. The Safety of Yoga: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Epidemiol 2015; 182(4): 281-93. DOI: 10.1093/aje/kwv071.