Pain physician & PhD statistician
People working long hours at desks & under stressful conditions often develop headaches, hand numbness, pain of the neck, upper back, and shoulder. Under clinician guidance, regular & gentle stretches in the office can be helpful.
Because pain is so deeply wired in the brain as a danger signal, patients with pain often avoid touching or using painful areas. However, stimulation & use actually help some neuropathic pain conditions. “Graded desensitization”, by stimulating nerves just enough to be uncomfortable, resets painful nerves in some pain conditions. Beginner Massages Using body lotion, apply…
Patients struggling with chronic pain find it difficult to engage in exercises. Yet research shows that physical activities is one of the most effective treatments for many pain conditions. It is important for patients to be strategic about exercise, & invest the limited time & energy on sustainable, beneficial forms of exercises. Walking & Nordic walking…
Sleep is a key contributor to chronic pain. Impaired sleep worsens pain, which in turn prevents patients from getting restful sleep. When pursuing treatment for chronic pain, it is important to not overlook simple, non-drug strategies that can markedly improve sleep. During the day Develop a regular energizing morning routine. Start the day with 3 minutes…
For chronic pain conditions, gabapentinoids (gabapentin & pregabalin) are often first-line treatments because of their effectiveness & safety. They bind to a2d which alters activity of calcium channels on nerves, thereby modulating pain signals before they reach the brain. Pharmacology of gabapentinoids The absorption of gabapentin & pregabalin differ. Gabapentin absorption is slow. Beyond a…
CGRP plays a key role in central chronic pain by mediating “neurogenic inflammation”. In this process, sensory nerves which usually carry electrical signal from the body instead broadcast inflammatory signals into it. CGRP is the most important of the inflammatory signals. Treating CGRP can be helpful for chronic migraine & pain. Neurogenic inflammation Small sensory…
Several pain medications require the liver enzyme CYP2D6 to become active. But some herbal supplements & medications can interfere with this enzyme. Patients on these medications should consult with a doctor before starting herbal supplements. Drugs activated by CYP2D6 Hydrocodone Oxycodone Codeine Tramadol Drugs deactivated by CYP2D6 Amitriptyline Nortriptyline Desipramine Duloxetine Venlafaxine CYP2D6 inhibitors Drugs: Bupropion Cimetidine…
The liver enzyme CYP3A4 is the key body mechanism for metabolizing pain medications. Patients who take pain medications must be aware that drugs, herbs, & genes can complexly alter CYP3A4 activity. Ask your doctor before making changes. Drugs metabolized by CYP3A4 Fentanyl Buprenorphine Oxycodone Methadone Diazepam Midazolam Alprazolam Metoprolol Losartan Amlodipine Rivaroxaban Dabigatran Apixaban Tacrolimus CYP3A4…
While the science of nutrition continues to evolve, I have seen many patients with pain profoundly improve after making one of the following dietary changes. Such changes are low-cost, & are low-risk when made under medical guidance. Patients with chronic pain may find it worthwhile to try one or more of these diets. Gluten-free diet…
Small sensory nerves throughout the body gather information & interact with the body directly. This nerve-body interface underlies many diseases. In chronic pain, nerves cause “neurogenic inflammation” by activating blood vessels, skin, & immune cells. This is the site of action of many pain treatments. Key nerve-body interfaces Neural-vascular: Sensory nerves open blood vessels. This…
