Thứ hai, 20 Tháng 10 2014 17:34

The journey from pain relief to addiction

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(ĐTĐ) - New research reveals that Australians are consuming more prescription drugs than ever before. Among the most dangerous and addictive families of drugs are opioids, strong pain killers used for people with injuries and drug dependencies. Increasingly the drugs seem to be being abused, as Shevonne Hunt writes.
 

Thứ sáu, 10 Tháng 10 2014 17:28

What is Massage Therapy?

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(ĐTĐ) - Think back to the last time you bumped your elbow walking through a doorway. After shouting “Ow!” what was the first thing you did? Likely, you instinctively rubbed the sore area to ease the pain. This is the idea behind massage therapy – relieving pain and promoting wellness through touch.
 

(ĐTĐ) - On October 6th, all hydrocodone combination products will be reclassified in the U.S. as a Schedule II drugs under the Controlled Substances Act. For all of those involved in dealing with chronic pain — prescribers, pharmacists, and patients — the impact could be more than minimal.
 

Thứ sáu, 06 Tháng 6 2014 21:33

New Drugs May Help Prevent Migraines

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(ĐTĐ) - Two experimental drugs may help prevent migraines in people who suffer multiple attacks a month, according to preliminary findings from a pair of clinical trials.
 

The drugs, one given by IV and one by injection, are part of a new approach to preventing migraine headaches. They are "monoclonal antibodies" that target a tiny protein called the calcitonin gene-related peptide (CGRP) -- which recent research has implicated in triggering migraine pain.

In one study, patients saw a 66 percent reduction in their migraine attacks five to eight weeks after a single dose of the IV drug -- known for now as ALD403. That compared with a 52 percent decrease among patients who were given a placebo, or inactive, infusion.

In the other trial, patients receiving the injection drug saw a similar benefit from three months' worth of biweekly treatments.

The findings, scheduled to be presented Tuesday at the American Academy of Neurology's annual meeting in Philadelphia, are preliminary. And experts stressed that many questions remain.

Still, migraine sufferers can "take heart" that new drugs, specific to the pain condition, are under development, said Dr. Peter Goadsby, a neurologist at the University of California, San Francisco, who worked on both studies.

Right now, he said, the drugs used to prevent migraines are all older medications that were originally developed to treat other conditions. They include certain antidepressants, high blood pressure medications and anti-seizure drugs.

In contrast, the experimental medications aimed at CGRP are the first "designer drugs" for preventing migraine, said Dr. Richard Lipton, a headache expert who was not involved in the studies.

These early findings are "very encouraging," said Lipton, who directs the Montefiore Headache Center in New York City. "To me, this proves the concept that targeting CGRP can be effective," he said.

However, larger, longer-term studies are still needed to confirm the drugs' effectiveness and safety, Lipton and Goadsby said.

The trial testing ALD403, the IV drug, included 163 patients who were randomly assigned to receive either a single dose of the drug or a placebo infusion. Before treatment, all of the patients were suffering migraines five to 14 days out of every month.

Five to eight weeks later, patients given the drug were having 5.6 fewer "migraine days" per month on average -- a 66 percent drop. The placebo group also saw an improvement, of 4.6 fewer migraine days. Still, the benefit of the drug was significant in statistical terms, Lipton pointed out.

In the other trial, 217 patients received either the injection drug -- by the name of LY2951742 -- or a placebo, biweekly for 12 weeks.

Again, both groups got some migraine relief, but the benefit was bigger for patients on the real drug. They had 4.2 fewer migraine days a month, or a 63 percent decline. The placebo patients had three fewer migraine days, or a 42 percent decrease.

Some big questions remain, however. Researchers have to figure out how long the effects of the medications last, and how often they would need to be given, Goadsby said.

In the short term, the drugs seemed "well tolerated," Lipton said. People in the injection-drug trial had higher rates of abdominal pain and respiratory infections than the placebo group. And in the IV-drug study, people on the real drug had no more side effects than the placebo group.

Still, Lipton said, "a lot more people need to be followed to prove [the drugs'] safety."

He acknowledged that some patients might balk at the idea of an IV drug, which would have to be given by a doctor. An injection drug might be more acceptable, he said.

About 12 percent of Americans suffer migraine headaches, according to the U.S. National Institutes of Health. Many of them can manage with pain relievers, but about one-third need preventive medication, Lipton said.

However, he added, only around 10 percent take preventive drugs, often because they don't work or the side effects are intolerable. "There's a huge need for new preventive medications," Lipton said.

The current studies were funded by Alder Biopharmaceuticals, which is developing ALD403, and Arteaus Therapeutics, the developer of LY2951742.

Research presented at meetings should be viewed as preliminary until published in a peer-reviewed medical journal.

Source WebMD.com 

(ĐTĐ) - Question: Are medication overuse headaches associated with use of nonsteroidal anti-inflammatory drugs?
 

Response from Jenny A. Van Amburgh, PharmD, CDE (Assistant Dean of Academic Affairs; Associate Clinical Professor, School of Pharmacy, Northeastern University; Director, Clinical Pharmacy Team Director, Residency Program, Harbor Health Services, Inc., Boston, Massachusetts):

Medication overuse headache (MOH), previously called "rebound headache," is a secondary chronic daily headache associated with an overused therapeutic agent in a headache-prone patient.[1] MOH is a headache that is present for at least 15 days per month in the setting of overuse of acute headache treatment.[1,2]

"Overuse" is defined as the use of any analgesic over a 3-month period for a minimum number of days per month, depending on the type of medication. For simple analgesics, overuse is defined as use on 15 or more days per month.[3] That number drops to 10 days per month for ergotamine, combination analgesics, triptans, opioids, or the combination of short-term medications. MOH is markedly worsened during the period of overuse and typically resolves within 2 months of discontinuation of the offending agent.[2]

About 1% of the North American population experiences MOH.[2] Patients with primary headaches (eg, migraines, tension-type headaches, or cluster headaches) are more likely to develop MOH than are those who use long-term analgesics for other types of pain.[1,2] Transformation from primary headache to MOH is insidious and takes place over months to years.[2] The clinical picture varies depending on the causative medication, but headaches generally occur soon after awakening and present with neck pain.[4] Any medication indicated for the treatment of headache can cause MOH if used excessively.[2]

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common over-the-counter (OTC) medications used to treat headache, and therefore it is critical to understand the propensity of NSAIDs to cause MOH. Scher and colleagues[3] evaluated patterns of medication use among individuals with episodic headache and MOH. Aspirin and ibuprofen were negatively associated with development of MOH; however, OTC analgesic combination products containing caffeine were associated with increased risk.

Bigal and colleagues[5] assessed the role of various medications in the development of MOH in patients with episodic migraine. They found that NSAIDs were protective against development of MOH in patients with less than 9 days of use per month but were associated with increased risk in patients with 10 or more days of use per month. In addition, women using NSAIDs were at higher risk of developing MOH than men.

Starling and colleagues[6] examined the evidence for MOH risk associated with NSAID use in patients with migraine. They found that acute NSAID use was associated with development of MOH in patients with a high baseline frequency of migraine, but might be protective in patients with low baseline migraine frequency. Although causality of NSAIDs and headache progression has not been established, patients having 10-14 headache days per month may be at risk for MOH with NSAID therapy.

MOH is more easily prevented than cured.[2] The recommended treatment is withdrawal of the offending agent, a process that may be difficult and painful for the afflicted individual. Therefore, it is important that clinicians provide strategies for appropriate use of MOH-causing agents.

Individuals should be counseled to limit use of any headache medication, including NSAIDs, to less than 10 days per month and avoid use of caffeine combination products entirely unless otherwise directed by their healthcare provider. Those who experience frequent headaches should consult their healthcare provider to discuss preventative behavioral modifications and prophylactic medications.

Acknowledgment: The author wishes to acknowledge the assistance of Tayla N. Thompson, PharmD; Karrie E. Juengel, PharmD; and Clara C. Ofodile, PharmD, PGY1 Residents, at Northeastern University School of Pharmacy, in collaboration with Federally Qualified Health Centers and the Program of All-Inclusive Care for the Elderly, Boston, Massachusetts.

References

  1. Headache Classification Committee of the International Headache Society (HIS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629-808.
  2. Abrams BM. Medication overuse headaches. Med Clin North Am. 2013;97;337-352.
  3. Scher AI, Lipton RB, Stewart WF, Bigal M. Patterns of medication use by chronic and episodic headache sufferers in the general population: results from the Frequent Headache Epidemiology Study. Cephalalgia. 2010;30:321-328.
  4. Tepper SJ. Medication-overuse headache. Continuum (Minneap Minn). 2012;18:807-822.
  5. Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache. 2008;48:1157-1168.
  6. Starling AJ, Hoffman-Snyder C, Halker RB, et al. Risk of development of medication overuse headache with nonsteroidal anti-inflammatory drug therapy for migraine: a critically appraised topic. Neurologist. 2011;17:297-299.
Source Medscape.com
Thứ bảy, 26 Tháng 4 2014 21:04

Greater Use of Meds to Halt Opioid Overdose Epidemic Urged

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(ĐTĐ) - US addiction experts are urging expanded use of medications to combat the "opioid overdose epidemic" plaguing the country.
 

In a commentary published April 23 (2014) in the New England Journal of Medicine, National Institute of Drug Abuse (NIDA) director Nora Volkow, MD, and colleagues from other US Department of Health and Human Services (HHS) agencies call upon healthcare providers to expand their use of medications to treat opioid addiction and reduce overdose deaths.

In addition, they describe a number of misperceptions that have limited access to these potentially lifesaving medications.

The reasons include inadequate provider education and misunderstandings about addiction medications by the public, healthcare providers, insurers, and patients. One common, long-held misperception is that medication-assisted therapies (MATs) merely replace one addiction for another ? a view that is not backed by science.

"When prescribed and monitored properly, medications such as methadone, buprenorphine, or naltrexones are safe and cost-effective components of opioid addiction treatment. These medications can improve lives and reduce the risk for overdose, yet medication-assisted therapies are markedly underutilized," Dr. Volkow said in a release.

Between 1999 and 2010, the death rate from prescription opioid overdose in the United States more than quadrupled, a rate that far exceeds the combined death toll from cocaine and heroin overdoses.

Rates of emergency department visits as well as substance-abuse treatment admissions related to prescription opioids also increased markedly during the past few years, as have prescription opioid–abuse costs to insurers.

These health and economic costs are similar to those associated with other chronic diseases, such as asthma and HIV infection, the authors note. These "alarming trends" have prompted the HHS to take multiple federal, state, and local actions, including expanding access to medication-assisted therapies to help patients recover.

"A key driver of the overdose epidemic is underlying substance-use disorder," the authors write. Similar to other chronic diseases, "addiction is generally refractory to cure, but effective treatment and functional recovery are possible."

Part of that functional recovery must involve the appropriate use of existing MATs, including use of methadone, buprenorphine, and naltrexone.

These medications have been shown to reduce the risk for overdose and improve lives, the authors note. In Baltimore, for example, increasingly, the availability of methadone and buprenorphine roughly halved the number of fatal overdoses from heroin between 1995 and 2009.

Many treatment facilities also favor abstinence as the best treatment model for addictions and do not routinely offer MATs. Inadequate dosing when MATs are used is also systemic and further reinforces lack of faith in their use, inasmuch as patients often return to opioids because treatment was ineffective, the authors note.

Other barriers to appropriate use of MATs include both policy and regulatory issues, including limits on the dosages prescribed; annual or lifetime medication limits; initial authorization and reauthorization requirements; and "fail first" criteria that require the use of other therapies first before attempting to introduce an MAT.

As Dr. Volkow and colleagues point out, HHS agencies are now actively collaborating with public and private stakeholders in an effort to both expand access to and improve the use of MATs.

They are also directing efforts toward the development of new pharmacologic treatments for opioid addiction and improved delivery systems for current medications, including the development of nasal sprays.

At the same time, Dr. Volkow emphasizes that it is critical to make sure policies that curb inappropriate prescribing of opioid analgesics not infringe on the critical and even lifesaving use of the same agents when clinically indicated.

Charged with providing access to treatment programs, the Substance Abuse and Mental Health Services Administration (SAMHSA) is encouraging MATs through the Substance Abuse Prevention and Treatment Block Grant as well as through regulatory oversight of medications used to treat opioid addiction. In addition, it has developed an Opioid Overdose Toolkit designed to educate first responders in the use of naloxone to prevent overdose deaths.

"It also gives local governments the information they need to develop policies and practices to help prevent and respond appropriately to opioid-related overdose," she added.

In addition, the Centers for Medicare and Medicaid Services is working to enhance access to MATs through a more comprehensive benefit design, as well as a more robust application of the Mental Health Parity and Addiction Equity Act.

However, the authors point out that success of these strategies requires engagement and participation of the medical community.

The authors report no relevant financial relationships.

N Engl J Med. Published online April 23, 2014. Full article

Source Medscape.com

(ĐTĐ) - Patients receiving an anticoagulant for deep vein thrombosis (DVT) or pulmonary embolism (PE) who take a nonsteroidal anti-inflammatory drug (NSAID) or aspirin for pain or headache, even for a few days, are at heightened risk for a major bleed, according to a new study published online April 14, 2014 in JAMA Internal Medicine [1].
 

The researchers examined bleeding risk from aspirin or an NSAID (other than aspirin) in patients in the EINSTEIN-DVT and EINSTEIN-PE trials who were randomized to either the low-molecular-weight heparin enoxaparin followed by warfarin or acenocoumarol or to the oral anticoagulant rivaroxaban (Xarelto, Bayer/Janssen).

The trials discouraged the use of NSAIDs, yet about a quarter of the patients took them. Compared with patients who avoided these painkillers, those who took an NSAID had a 2.4-fold higher risk of a major bleed and those who took aspirin had a 1.5-fold higher risk.

"Even though [this warning about major bleeds with NSAIDS or aspirin] is on the warfarin label . . . I don't think people believed it," lead author Dr Bruce L Davidson (University of Washington School of Medicine, Seattle, WA), told heartwire . "I certainly didn't believe it," he said. "The risk had not been quantified, and the notion that one-quarter of the major bleeds happened within eight days of use is stunning."

Doctors who manage patients taking warfarin or the new oral anticoagulants should tell them which over-the-counter (OTC) drugs are NSAIDs, Davidson said.

They should warn patients, "Don't take an NSAID [and] don't take casual aspirin. . . . Take aspirin if you need it for coronary artery disease. Otherwise, take [acetaminophen, not more than 4 g a day] for pain, discomfort, or fever. Don't risk it."

OTC Ibuprofen, Aspirin, or Acetaminophen

In the past, to treat a headache or sore muscles, many people took aspirin or acetaminophen, but now people commonly take an NSAID such as ibuprofen, Davidson noted.

Earlier work has shown that patients with atrial fibrillation (AF) who are on anticoagulants and take aspirin have an increased bleeding risk. However, the bleeding risk in patients receiving an anticoagulant for DVT or PE who take an NSAID or aspirin is poorly documented, the researchers write.

They examined the risk of clinically relevant bleeds, including major bleeds—those that were fatal, occurred at a critical site, or required a major transfusion—and nonmajor bleeds in 8246 patients in the EINSTEIN-DVT and EINSTEIN-PE trials who were randomized to rivaroxaban or enoxaparin/vitamin-K antagonist (VKA).

Ibuprofen

The increase in bleeding was similar in the rivaroxaban-treated and enoxaparin/VKA patients.

Event Events/100 patient-years HR (95% CI)
NSAID Use No NSAID Use
Clinically relevant bleed 37.5 16.6 1.77 (1.46–2.16)
Major bleed 6.5 2.00 2.37 (1.51–3.75)

Bleeding Risk for Patients on Anticoagulants, Aspirin Use vs No Aspirin Use

Event Events/100 patient-years HR (95% CI)
NSAID Use No NSAID Use
Clinically relevant bleed 36.6 16.6 1.77 (1.46–2.16)
Major bleed 4.8 2.2 1.50 (0.86–2.62)

Patients had a similar risk of bleeding whether NSAIDs and aspirin were taken for a short or long time.

"We wonder whether it is widely appreciated that NSAIDs, available over the counter in most places, put patients receiving anticoagulant therapy at nearly double the risk of clinically important bleeding," the researchers write.

"Physicians should inform patients about the potential for increased bleeding with these readily available, commonly used drugs and advise patients to curtail their casual use," they conclude.

Bayer Healthcare and Janssen Pharmaceuticals sponsored the two EINSTEIN clinical trials, collected and maintained the data, and performed the analyses that the authors requested. Davidson was paid by Bayer for steering-committee and related work for the EINSTEIN studies. Disclosures for the coauthors are listed in the paper.

Source Medscape.com
Thứ năm, 17 Tháng 4 2014 08:49

Treating Pain With Acupuncture

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(ĐTĐ) - Acupuncture is a type of traditional medicine that first began back in the East. It’s thought that it might have begun around 3300 BCE. Although the exact time is uncertain.
 

It’s thought that energy flows through our body in a specific pattern. When this route is disrupted, vital organs aren’t receiving oxygen and other essential nutrients. This is what causes disorders to occur. So an acupuncturist will apply either needles, heat or lasers to specific areas of the body known as meridians to remove the obstacle.

This will stimulate the nerves, tissue, muscle and organs, which will activate the body’s natural defense and restore the natural energy flow, qi. The end result would be relief of your symptoms, and improve overall wellbeing.

There is a total of 12 meridians, the one chosen depends on the symptoms that you are experiencing.

How Do These Little Needles Cure So Many Aliments?

Although the exact reason why acupuncture works so well is uncertain, there are several theories. They include gate, Neurotransmitter, Augmentation of Immunity and Circulatory

Doctors believe that the nervous system sends messages to your brain through what is known as the gate. When the gate has so many different messages it will become overloaded and stop sending the pain messages. So acupuncture overwhelms the smaller gates, causing it to shut down. This is what’s known as the gate theory.

With the neurotransmitter theory,it’s thought that the chemical neurotransmitter nor adrenaline and Serotonin is stimulated by acupuncture, this increases the body’s natural response while decreasing their symptoms.

The endorphin theory is similar to the one above. Doctors believe that acupuncture causes your body to release endorphins. The increased endorphin level decreases our symptoms.

The Augmentation of immunity theory states that acupuncture raises the levels of white blood cells, hormones, triglycerides, prostaglandins, gamma globulins and other essential body levels. This increase helps the body to create homeostasis, an overall wellbeing.

Circulatory theory believes acupuncture will either open the blood vessels wider or constrict then, make them smaller. This fluctuation is what causes the symptom reduction.

Chamcuu

What Can Acupuncture be used for?

People use Acupuncture to treat numerous disorders. Because I’m unable to list them all I’ve chosen the most common. If your illness isn’t listed, please check with an acupuncturist first, before giving up on this treatment choice.

Some of the most common include; pain reduction in the back, neck, face and shoulder. It’s also shown to relieve headaches, migraines, sports injuries, muscle spasms and contractures. Many use it for disorders like; TMD.

Fibromyalgia, neuropathy, myofacial, sciatica, radiculitis, arthritis, neuritis, tendonitis, neuralgia, osteoarthritis, bell’s palsy, sexual issues, infertility, gynecological problems, respiratory illness, insomnia, allergies, PMS, skin diseases, digestive issues and cancer treatment.

Some say it helps with constipation, nausea and vomiting. It is known to reduce stress and depression, it has helped people stop smoking and it helps strengthens your immune system.

How Bad Does This Treatment Hurt?

If you’re like many, the thought of having needles poked into your skin makes you a little squeamish. It did me too at first, but then I did a little research and found out the needles that’s used is extremely tiny in diameter.

In fact the largest needle an acupuncturist might use is 0.0137 inches thick. Where a needle used to draw blood is 1. 5 inches in diameter. That is a huge difference. Many I talked to say they don’t feel the needles, because they are so tiny

Does it really work or is it a hoax?

Many people use to believe that acupuncture has the placebo effect. Recently MRI’s have been done during an acupuncture. It has shown a difference in brain wave patters during the procedure.

I met a lady who sees an acupuncturist for cancer treatment. She’s in her 10th year of remission.

How is the Areas Chosen?

Since there are specific connected energy routes that flows through our body, to our vital organs. The doctor will look at your medical history, and the symptoms that you’re experiencing.With his knowledge in traditional oriental medicine, new research and experience, he will choose the areas accordingly.

How Often Should I Go?

The amount of needed treatments depends on three things; the type of disorder, the severity and how long the person’s been suffering. This is why some only require a few treatments, while others may take a little longer. The acupuncturist can recommend the specific amount of time you will need. Of course, as your body heals, your need for acupuncture will decrease.

Does This Treatment Take a Long Time?

The length of the visit depends on the treatment plan. Generally it doesn’t last for more than an hour. Once the needles are placed the doctor may choose to leave them up to forty-five minutes. Again it depends on the severity of the disorder.

Are There Things I Should and shouldn’t do Beforehand?

Before the Treatment

If you feel hungry you’re allowed to eat a small light meal.

Be sure to wear something that is loose and comfortable. So it will be easier to do your treatment.

Afterwords

Don’t drink, take drugs, put yourself in a stressful situation, or do too much activity for 6 hours. Many acupuncturist will advise you to use these 6 hours to rest.

Make sure you jot down any changes you’re feeling and questions you might have.

Don’t eat a large meal for at least an hour afterwards.

What will happen when I Arrive?

Once you arrive the acupuncturist will get your full medical history. They will also ask you about your symptoms and ask you about personal habits. The acupuncturist will palpate different areas of your body and check pulse points. All of these steps will help the acupuncturist determine your plan of care.

The Prickly Truth

Acupuncture began in China thousands of years ago. Since making its way to the western culture its cured people of numerous illnesses. Although many don’t believe this treatment’s helpful, MRI and personal testimony have proven otherwise.

Source Chronicbodypain.net
Thứ ba, 15 Tháng 4 2014 07:24

Effects of Chronic Alcohol Abuse on Pain Management

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(ĐTĐ) - Many people turn to alcohol to solve problems. Alcohol is more than a way to relax or a way to forget hard times for some of these people. They use it in an attempt to self-medicate for a number of situations: sadness, insomnia, stress, and in some cases, even pain relief. Since pain and stress often exacerbate each other, it’s not hard to see why approximately 28% of chronic pain sufferers use alcohol in an attempt to manage their pain.
 

Alcohol can have a mild analgesic, or pain relieving, effect due to the way it affects the central nervous system. However, this is purely an incidental effect. Alcohol has no direct value as a pain reliever. Quite to the contrary, the use of alcohol for pain management can cause serious problems, especially with excessive consumption or when mixing alcohol with pain medication.

Many over-the-counter pain medications (such as acetaminophen or ibuprofen) can contribute to damage to internal organs, such as the stomach or liver. Alcohol can damage these same organs, so mixing alcohol with these medications significantly increases the risk of lasting damage to internal organs. Many prescription medications can cause side effects; one of the more common being drowsiness. Alcohol, as a central nervous system depressant, also causes drowsiness. Combining alcohol with a prescription medication not only significantly increases the likelihood of nausea, vomiting, and sleepiness, but also can significantly slow the body’s non-voluntary functions, leading to decreased heart rates, slowed breathing, sometimes resulting in death.

Alcohol can lead to one feeling sleepy, which many take as a sign that is a sleep aid. However, alcohol use can disrupt sleep patterns just as much as chronic pain can. Sleep deprivation can cause many types of harm to the body. Some of the more prominent effects of sleep deprivation are on emotional well-being: irritability, depression, and fatigue, both mental and physical. This has a negative impact on a person’s ability to cope with pain, making the pain feel more severe and the patient feel hopeless as to finding a resolution to the pain. This can lead some to a vicious cycle: Sleep deprivation leads to exacerbation of pain leads to alcohol consumption leads to disruption of sleep cycle leads to sleep deprivation, repeat, repeat, repeat.

While the temptation is understandable, alcohol consumption does not help with chronic pain relief. Talk with your doctor about your pain condition. He can not only help you determine the best course of treatment, but also the amount of alcohol consumption that is safe for you.

Source Pain.com

(ĐTĐ) - There are numerous treatments available for the symptoms associated with fibromyalgia. Fibromyalgia is classified as a disorder of pain processing due to abnormalities in the ways in which pain signals are processed in the central nervous system.
 

Patients suffering from fibromyalgia often complain of depression, insomnia,irritable bowel syndrome, painful and tender points or “trigger points.” Tender points are pain points or localized areas of tenderness around joints, but not the joints themselves. These areas of tenderness or sensitivity can be felt just below the skin in specific parts of the body.

In contrast to tender points, trigger points are firm nodules that can be felt in tight, rope-like muscles and when pressure is applied on a trigger point, the pain is felt in the area and can shoot pain to other body parts. This is not the same as the feeling associated with pressing on a tender point as it is felt in a localized area only.

The types of pain associated with fibromyalgia is believed to be caused by a “glitch” or “disconnect” in the way in which pain is processed by the body. This glitch and its repercussions occur when a person has a hypersensitivity to stimuli that are not normally painful.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has reported that their research has shown that people who suffer from fibromyalgia have reduced blood flow levels to the parts of the brain that normally allow the body to deal with pain.This increase in sensitivity to pain and the inability of the brain to manage pain creates the conditions of a chronic pain concern.

Patients with fibromyalgia most often report symptoms associated with chronic pain. As neurochemical changes in one’s body increases one’s sensitivity to pain, the chronic pain worsens. Sufferers begin to have pain in other parts of the body that do not normally hurt.

This spread of tender points and the intensity and duration of pain results in additional stress on a patient’s ability to sleep well, and the cycle of pain and the inability to ease that pain can spiral a person into deep depression.

Below are approaches to easing some of the symptoms of fibromyalgia. Some approaches note the importance of medication while other combine medication with alternate methods to ease pain, increase one’s quality of sleep, and reduce depressive thoughts and feelings.

Amitriptyline is considered to be the most common medication prescribed to treat fibromyalgia. Its efficacy has been demonstrated in controlled studies, and it is known to enhance stage three and stage four sleep (these stages are also known as deep, slow-wave, or delta sleep). As sleep deprivation and insomnia are often-cited complaints by sufferers with fibromyalgia, Amitriptyline is an excellent choice for these patients to consider.

What is Amitriptyline?

Amitriptyline is a tricyclic antidepressant, and it is widely used to treat chronic neuropathic pain (i.e., any pain due to nerve damage) and fibromyalgia. These types of chronic pain can be treated very successfully with antidepressant drugs in small doses.

The dosage amount is noteworthy as it is below dosage sizes at which Amitriptyline acts as an antidepressant. Amitriptyline works by increasing amounts of natural substances in the brain that are necessary for the brain to maintain mental balance.

 

Amitriptyline may also used to alleviate post-herpetic neuralgia (the burning and stabbing pains associated with shingles), treat eating disorders and is sometime prescribed to prevent migraine headaches.

For patients with multiple sclerosis, Amitriptyline is used to treat painful paresthesias in the arms and legs (e.g., burning sensations, stabbing pains, “pins and needles”) caused by damage to the pain-regulating pathways of the spinal cord and brain.

What the Studies Say

In one study, researchers found that a 25 mg dose of Amitriptyline (Elavil) (Note: Elavil is a brand name drug that is no longer available in the U.S. by this name. Generic versions are available) or a 20 mg dose of fluoxetine (Prozac) reduced symptoms of fibromyalgia, the combination of the two medications was twice as effective as either agent when taken on its own. This study’s report also noted that dosages used are slightly lower than those needed to treat depression.

Older agents, such as Amitriptyline, may be used at a daily dosage rate of 10 mg taken two to three hours before bedtime. This dosage schedule allows for the peak sedative effect to be realized when the sufferer is sleeping.Taking this small dose earlier than at bedtime may also allow the user to avoid undesired carry-over sedation upon awakening. Moreover, administration time can be adjusted depending on individual patient’s response to its effect.

 

A significantly improved quality of sleep was reported in patients who participated in a study that evaluated the efficiency of Amitriptyline (50 mg doses).

In another study, results were somewhat disappointing. In 2012, results were reported from a larger study involving over 1400 participants. No supportive unbiased evidence for a beneficial effect of treating fibromyalgia with Amitriptyline was found. The authors noted, however, that its research findings must be balanced against decades of successful treatment in numerous patients suffering from neuropathic pain or fibromyalgia who have relied on anti-depressants, such as Amitriptyline.

In the end, the use of Amitriptyline by fibromyalgia sufferers appears to help them. The side effects are often minimal, and while the benefits may not be quantifiable in studies, its success in the treatment of fibromyalgia symptoms for decades cannot be ignored.

Small Doses, Good Results

The dosage of antidepressants, such as Amitriptyline must be individualized. This is particularly true when using tricyclic agents, given their variable rates of absorption, metabolism and excretion.

It is strongly recommended that dosages should be gradually increased so as not to exceed the recommended maximum dosage for the drug. Even those patients who are able to tolerate very small amounts of these types of medications may derive benefit from them.

There are some side effects of using Amitriptyline to treat fibromyalgia. These side effects may include morning sedation (a feeling akin to having a hangover), dry mouth, confusion, and urinary retention.

Amitriptyline + Exercise = More Benefits

The 2012 study noted above suggests that Amitriptyline should be used as part of the treatment of neuropathic pain or fibromyalgia, even though only a small number of patients achieve satisfactory pain relief with it alone. Let’s explore how exercise and Amitriptyline can work together to allieviate symptoms of fibromyalgia.

Non-medical approaches to treating fibromyalgia include stress-reducing activities, such as aerobic exercise and strength training. Combined with the properly managed use of Amitriptyline, patients noted a decrease in symptoms, more effective sleep, reduced joint pain, and reduced feelings of fatigue.

One type of exercise that has demonstrated a high degree of relief is long-term aquatic-based exercise. Since they combine cardiovascular exercise with resistance training, swimming, water aerobics, and other types of aquatic-based exercise programs are very efficient types of exercise for patients with fibromyalgia. As fibromayalgia sufferers also are very sensitive to cold temperatures, it is recommended that they seek out warm water pools in climate-controlled environments for water aerobics and other activities. This way the water temperature and air temperature outside the pool will not adversely affect the patient and this piece of the treatment puzzle.

Fibromyalgia can be treated in children and teens with intense physical and occupational therapy programs too. Many of these therapies are suggested for other amplified musculoskeletal pain syndromes (AMPS), such as localized or diffuse idiopathic musculoskeletal pain and myofascial pain syndrome.

These therapy programs suggest that regular physical exercise will benefit the sufferer, even if at times they must work through the pain. Once these exercise regimens are practiced with physical or occupational therapists, they can be completed in the home and provide fibromyalgia sufferers with long-term relief.

Amitriptyline + Therapy = Even More Benefits

A variety of other types of therapies can also be used in tandem withAmitriptyline. Counseling, art therapy, and music therapy have shown great results with children. These types of programs can be found at Boston Children’s Hospital (in association with Harvard University), The Children’s Hospital of Philadelphia (associated with the University of Pennsylvania), and many other American children’s hospitals. These types of programs are evidence-based, and some report total pain resolution rates close to 88%.

The efficacy of a treatment regimen that includes counseling, art therapy, and music therapy for adults with fibromyalgiahas not been studied. More often, adults incorporate cognitive behavioral therapy (CBT) and related behavioral and psychological therapies in conjunction with antidepressants, such as Amitriptyline.

Relaxation exercises, such as guided imagery and deep-breathing exercises are shown to provide some comfort and pain alleviation. These types of therapies appear to have a small to moderate ability to reduce or minimize the symptoms of fibromyalgia.

Based on the research and study findings, it is determined that a multidisciplinary approach, often including CBT, is sometimes considered to be the “gold standard” of treatment for chronic pain syndromes such as fibromyalgia. Combining the positive effects of Amitriptyline with exercise and therapy improve the pain management and overall quality of life for fibromyalgia sufferers. As noted above, each type of treatment is part of a puzzle, and once assembled can make fibromyalgia less painful and more easily managed.

Source Chronicbodypain.com
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