Chronic Pain: Medication Decisions

Chronic Pain: Medication Decisions

In a perfect world, the body functions normally and smoothly, however, very often, the body can undergo changes as compared to normal and regular state (homeostasis). During an illness or an environmental change – both internal and external – the body deviates from this homeostasis. As a consequence, various mechanisms are set off which can lead to a myriad of symptoms like fever, fatigue and pain, et cetera. Out of these, the symptom that is most bothersome for patients is pain.

Pain is defined as a highly unpleasant physical sensation caused by illness or injury. Pain can be sharp and horrendous when it is acute in its onset (sudden pain, like in injury), or it can be agonizing when it is chronic (extended over a long period of time).

To relieve pain, there are many pain-killers available in the market but doctors prioritize different pain killers according to the intensity, frequency, cause and character of pain. Where IV pain killers can be used in case of sudden trauma, a different approach is needed in case of chronic pain. Following are some types of painkillers used for chronic pain:

1. Acetaminophen:

Acetaminophen (brand name: Panadol, Tylenol, etc.) is considered as a first line treatment for mild to moderate pain, e.g. trauma, headaches or muscle pain and can help manage osteoarthritis and back pain. It may also be combined with opioids to reduce the amount of opioid needed. Though it is not exactly known how the drug works but scientists think it might inhibit COX-3 (a type of cyclooxygenase enzyme that makes pain-producing prostaglandins).

Acetaminophen is not as effective as NSAIDS (another type of pain killer) but is generally safe for chronic pain management, however, it is contraindicated in alcoholics and in people with renal or hepatic impairment.


“Non-steroidal anti inflammatory drugs” are one of the most common pain killers available in the market. Drugs like Aspirin and Ibuprofen (brand-name: Brufen) are a household name and work by inhibiting both COX-1 and COX-2 inhibitors.

NSAIDS are generally safe for chronic use but they only work up to a certain limit of pain. They may cause nausea, stomach pain, hemorrhages or ulcers as adverse effects. They are also known to cause kidney problems, fluid retention and high blood pressure. The elderly, those with kidney problems, history of stomach ulcers and diabetics, should avoid these drugs.

3. COX-2 inhibitors:

Just like NSAIDS, these also inhibit COX-2 enzymes (but not COX-1). However, these are known to be as effective as NSAIDS, with lesser side-effects like stomach ulcers, hemorrhages, dizziness, nausea, kidney problems, fluid retention and high blood pressure.

Celecoxib (brand name: Celebrex) is used for relieving muscle sprains, strains, back and neck injuries, headaches, menstrual cramps.

4. Antidepressants:

Some antidepressants like amitriptyline, nortriptyline (brand name: Pamelor) and SNRIs like duloxetine, venlafaxine and milnacaprin (Cymbalta, Effexor XR, Savella, respectively) not only treat depression but also help relieve chronic pain, including back pain, fibromyalgia and diabetes-related nerve pain (diabetic neuropathy). Since chronic pain and depression go hand in hand, antidepressants may just hit two birds with one stone. Adverse effects may include nausea, vomiting and dizziness.

5. Antiepileptics

Antiseizure or antiepileptics are used for the treatment of chronic nerve pain, including post herpetic neuralgia and diabetic neuropathy (with stabbing/shooting pain) include gabapentin (Gralise, Neurontin) and pregabalin (brand names: Hilin, Lyrica). Pregabalin is has both anti-inflammatory analgesics and antipyretic properties that fight against joint diseases like osteoarthritis by minimizing friction and roughness between joints and strengthening cartilage.

6. Opioids:

Opioids are a well known class of drugs, the more famous ones being codeine and morphine. Opioids are one of the strongest pain killers available in the market and are notorious for causing dependency with tolerance (deteriorating desired effect), i.e the more drugs taken, the lesser the pain relief.

Opioids work by mimicking endorphins (the body’s natural painkillers) by activating pleasure centers and reducing the pain. This can create an imbalance with the body’s actual levels and there may be changes in breathing, heart rate and alertness. Due to such a wide array of adverse effects, opioids are used as a last-ditch effort, when the former options have not been helpful.

There may be no hard and fast rule as to which drug might be more helpful but the they are tailored according to the patient’s health. They are started off with weaker pain killers to stronger ones if pain has not been managed. It is important to check in regularly with the doctor to report any adverse effect and discuss any concern.

PRP vs Steroids for Plantar Fasciitis

PRP vs Steroids for Plantar Fasciitis

Plantar fasciitis is a clinical condition in which you suffer from severe heel pain. It comes under the category of overuse injury. Overuse results in degeneration, hypoplasia, and tearing of the plantar fascia. It is more common in physically active people such as army personnel, police officers, etc. This is a chronic pain which can last for months and even years. This makes it difficult for you to walk and run. Several treatment options are available for it. Out of these, two well-known treatment options are PRP and steroid injections.
Some points are given below, which will help you understand which one of these is a better option.
Platelet Rich Plasma:
It is a natural substance obtained from the body of the subject himself. Blood is drawn from the cubital vein of the patient and then subjected to centrifugation. Different components of the blood such as red blood cells, plasma, and the buffy layer containing platelets and white blood cells are separated. PRP is collected from the buffy coat through re-centrifugation and injected into your heel at the point of maximum tenderness along the medial calcaneal tubercle. This works by boosting collagen production and maturation at the targeted area. Increased collagen treats degenerated planter fascia and heals the tears. It does not have any harmful effect on your body as it is not a synthetic substance. You feel relieved from pain, and your walking ability is significantly improved a few days after the therapy. Also, no associated side effect was detected for this method of treatment.
Corticosteroids can both be administered orally or through an injection. Composition of both these forms is different from each other. Injections are given when oral steroids do not work. Corticosteroids are injected into your heels along the medial tuberosity of the calcaneus. Cystic spaces appear, and collagen necrosis starts after the administration of steroids. After some time, the cystic spaces are replaced by fibroblast, and they start proliferating. A significant decrease was found in pain after the treatment. This is effective in treating plantar fasciitis but has associated risks and side effects.
According to a study, performed on two groups of people, one of which was given PRP treatment and the other steroid injections, PRP is found to be far more effective in treating plantar fasciitis than steroid injections. Both of them can help recover from fasciitis, but PRP showed more satisfactory results. Steroids are toxic substances which should not be taken unless necessary. Studies have shown complications such as facial rupture with steroid administration. Steroids influence a number of your body functions. Contrary to it, PRP is much safer and better mode of treatment. It is a natural substance with no potential side effects. The success rate was found to be more for PRP as compared to steroids. It is more effective as well as a long-lasting treatment method. In short, PRP therapy should be preferred over steroid injections for the treatment of plantar fasciitis if you want better results without risks.

Beware of the Amniotic and Umbilical Cord “Stem Cell” Research Bait and Switch!

Beware of the Amniotic and Umbilical Cord “Stem Cell” Research Bait and Switch!

Stem cells are cells which do not have any specialized assigned function. They have the potential to develop in any desired form. They play a role as the repair system of the human body. Whenever the need arises, they change into the form needed for example blood cells, osteoblasts, etc. There are two types of stem cells:

  • Embryonic stem cells
  • Adult stem cells

Embryonic Stem Cells (Also ECS or ES) are pluripotent stem cells which are derived from amniotic fluid and umbilical cord. Currently, researches are carrying out heavy research to discover the true potential of embryonic stem cells. However, there is always a chance that you are being manipulated based on misinformation. Here, we will discuss embryonic stem cells bait and switch.

Health care providers are using stem cells that are not viable to cheat people who are desperate to get their chronic joint or muscle pain treated. Anyone such as a nurse or a person who has no knowledge of your muscles and bones can give these injections.

These people tell the patients that their own stem cells that are the adult stem cells are not so effective in relieving them from pain and discomfort. Which is definitely a wrong statement. Your own stem cells are found to be most effective in treating osteoarthritis and back pain. They make them buy the embryonic stem cells which are not even viable to earn money. The whole procedure to extract and store embryonic stem cells to keep them viable requires you to be an expert. There are clinics who administer dead amniotic and umbilical cord stem cells and claim that is alive. Dead stem cells cannot initiate the production of specialized cells to help you with your problem. As a result, you still suffer from the same chronic pain without any improvement.

These clinics use the same day stem cell procedures which do not work. A complete stem cell therapy requires stem cells that are collected through culture expanded procedures and then they are grown to get a pure population of the stem cells. Which definitely requires more than one day to get completed. Umbilical cord itself has stem cells in Warton’s jelly but the umbilical cord products that these clinics use do not have any viable stem cells. The stem cells in these products die during their sterilization, freezing and shipping to the clinics.

The stem cells derived from the patient himself are the only living stem cells that can treat the problem at its best. Adipose tissue is known to be the best source for extracting adult stem cells. Freezing kills both the embryonic and the adult stem cells.

Before opting for a clinic for your stem cell therapy, make sure that it is licensed clinic using your own adult stem cells to save yourself from a loss. No improvement has been found in pain in the patients who went for this umbilical stem cell bait.

Is Nonsurgical Treatment for Rotator Cuff Tears a Long-Term Solution?

Is Nonsurgical Treatment for Rotator Cuff Tears a Long-Term Solution?

With remarkable advancements in the field of medical science, satisfactory surgical and non-surgical treatments are available for many health conditions. Surgical intervention, usually, provides a permanent solution to the problem as compared to the medical one. However, the truth of this statement largely depends upon the condition under question. Usually, if you are diagnosed with a significantly big rotator cuff tear, you would be immediately referred to the surgery department. But, the question under discussion here is what would happen if you do not opt for surgery? Can non-surgical interventions provide a long term solution and allow you to live a normal life?

Rotator Cuff and Its Tears:

A number of muscles and tendons surround your shoulder joint and stabilize it, and collectively, they form the rotator cuff. The purpose of the rotator cuff is to keep the rounded head of your upper arm bone firmly into its shallow socket and keep it from slipping off. These muscles or related ligaments and tendons can get damaged due to acute injury, chronic overuse, or aging. Rotator cuff injury can cause sharp, debilitating pain with a decreased range of movement within the shoulder joint. It is a common condition affecting over 2 million Americans each year. There are two different types of tears:

  • Partial tear: Partial or incomplete tear damages the tendon but does not completely break it.
  • Full-thickness tear: Also called a complete tear, it detaches the tendon from the bone. So, a full thickness tear causes a hole in the tendon.

The Treatment:

Chronic shoulder and arm pain hint towards a rotator cuff injury. It is not a good idea to keep using the joint as it can further worsen the condition. Early treatment can ensure a much quicker recovery. The goal of the treatment is to reduce the pain and other symptoms and restore the normal function. Surgical and non-surgical treatments are available and the treatment best for an individual depends upon a number of factors such as age, general health, activity level, and the type of tear they have. Surgery, by no means, can be declared as the best treatment option in every situation.

In about 80% of the patients, non-surgical treatment relieves symptoms and improves mobility. For many, these non-surgical interventions act as the long term solution, allowing them to return to their normal routine. Non-surgical options include:

  • Rest: Give your joint a break and limit its use. A sling can be used for further support.
  • Activity adjustment: Avoid activities that may possibly cause pain and further damage.
  • Nonsteroidal anti-inflammatory drugs (NSAIDS): NSAIDS such as ibuprofen help reduce pain and swelling.
  • Strengthening exercises: Certain exercises can help restore normal movements and strengthen the joint.
  • Physical therapy: Physical therapy produces remarkable results and causes substantial improvement among patients.
  • Steroids: Steroidal injections can significantly help relieve your symptoms if the above-mentioned interventions fail to work.

A combination of the above-mentioned treatments can provide an effective alternative to surgical treatment.