Category Archives: Chronic Pain

Frequency Specific Microcurrent And Other Non-Invasive Treatments For CRPS By Dr Katinkka

Source of Featured Image of Dr Katinka van der Merwe:

https://drkatinka.com/about/

Dear Pain Matters blog readers,

As mentioned in the previous blog post, Dr Katinka van der Merwe (aka Dr Katinka) at The Neurologic Relief Center, Arkansas, USA, has expertise in various non-invasive pain treatments including Frequency Specific Microcurrent.

https://painmatters.wordpress.com/2017/04/29/woohoo-australias-one-girl-chantelle-baxter-is-finally-on-the-road-to-recovery-from-crps/

Frequency Specific Microcurrent may be beneficial for neuropathic pain and injury to the spinal cord as well as other painful conditions (see References for papers by FSM expert, Dr Carolyn McMakin).

This blog post discusses Sunday, a CRPS patient who obtained significant pain relief following Frequency Specific Microcurrent and other non-invasive treatments during her first week at The Neurologic Relief Center.

Sunday’s Treatments For CRPS Including Frequency Specific Microcurrent 

Sunday is a welder by trade who lives with her young daughter in Texas.  Sunday used to enjoy an active life that included basketball and softball.

Unfortunately, Sunday had a motor vehicle accident (MVA) that involved rolling her truck 6 times.  Tragically, Sunday suffered severe headaches for 3 years after this MVA.  Sunday said that her intense headaches affected 7 areas in her head including the right side, adding that they felt like a knife going in and out of her head.

Shortly after her MVA, Sunday developed severe CRPS that affected her right hand to above her right elbow.  Even a light touch on her right arm was excruciating.  Sunday also had complete numbness in all 3 middle fingers in her right hand as well as some swelling in her right forearm and hand.

Sunday stated that her severe pain never went away after her MVA, with the exception of 3 days of relief obtained during a nerve block done to the back of her head.  Her pain levels were always ‘5’ or greater, regardless of her pain treatment.  Sunday also tried epidurals (where her entire right arm was numbed), Botox injections, electroshock therapy, topical pain medications, acupuncture and many more pain treatments. Sadly, nothing helped.  Sunday stated that her severe and unrelenting pain was starting to affect her mental state.

In 2015, Sunday travelled interstate from Texas to Arkansas in the hope that she might find some pain relief at The Neurologic Relief Center, headed by Dr Katinka.  Dr Katinka’s non-invasive treatments were different from Sunday’s other pain treatments to date.  This is because Dr Katinka focused on treating the original injury caused by her car accident.  In Dr Katinka’s view, Sunday likely sustained an injury to her upper cervical region during her motor vehicle accident that may also have led to CRPS in her right arm.

Following treatment of her injured upper cervical spine on her first day, Sunday’s pain levels dropped to a ‘4’. After her 2nd day of treatment, Sunday’s pain dropped further to a ‘3’.  On her 3rd day of treatment, Sunday’s pain was a ‘4’ prior to undergoing Frequency Specific Microcurrent (FSM).

Guess what happened next??

During her 1st FSM treatment on her 3rd day, Sunday started to feel some tingling in her 3 fingers!  Wow!!  (Until now, Sunday had endured 3 years of numbness in these 3 middle fingers, post-MVA.)  Sunday’s pain levels also dropped to a ‘3’ after FSM.  Finally, there was no more pain above Sunday’s wrist and her pain was now limited to the base of her wrist following her successful FSM therapy.

In Sunday’s words,

‘It does not hurt [above the wrist] … It’s awesome … It’s awkward … It’s weird … Just my joints are sore, but everything else is not [sore] …’

Thus, Sunday felt more than 50% better within only 1 week of treatment at The Neurologic Relief Center!  Sunday’s pain due to CRPS was now limited to her right wrist only and a tingling sensation had finally returned to her 3 fingers for the first time after 3 years of numbness following her MVA.  The swelling in her right arm was also reduced.

Sunday’s first week at The Neurologic Relief Center offered hope that a life with less pain and greater right hand function was now possible!  Sunday was excited about completing the full 10-week treatment program at this Center shortly.

Summary

Frequency Specific Microcurrent may offer pain relief and improved function for some chronic pain patients including CRPS patients.  As such, FSM warrants further investigation (see References for papers by FSM expert, Dr Carolyn McMakin).

It is heart-warming to see that some CRPS patients such as Sunday are finally getting their lives back thanks to passionate and compassionate Pain Doctors including Dr Katinka!

Sabina Walker

Blogger, Pain Matters (in WordPress)

REFERENCES 

Sunday’s CRPS Story – 3 YouTubes by Dr Katinka van der Merwe

(1A) Sunday’s 1st Day of Treatment for CRPS (16 March 2015)

https://m.youtube.com/watch?v=6oS-_tZRcmQ

(1B) Sunday’s 3rd Day of Treatment for CRPS (18 March 2015)

https://www.youtube.com/watch?v=nf_3GoygF4s

NB This YouTube includes a discussion of Frequency Specific Microcurrent.

(1C) Sunday’s 5th Day of Treatment for CRPS (20 March 2015)

https://m.youtube.com/watch?v=Ddl-iXxpJDU

Frequency Specific Microcurrent for Pain 

(2A) McMakin, Carolyn. Frequency Specific Microcurrent in Pain Management (3 December 2010); Pages 1-256.

eBook ISBN: 9780702049255
Paperback ISBN: 9780443069765

https://www.elsevier.com/books/frequency-specific-microcurrent-in-pain-management/mcmakin/978-0-443-06976-5

(2B) McMakin, Carolyn. Nonpharmacologic Treatment of Neuropathic Pain Using Frequency Specific Microcurrent. The Pain Practitioner (2010); 20(3); 68-73.

 

(2C) Thomas, Brooke. Carolyn McMakin: The Resonance of Repair (A 68 Minute-Podcast Interview with Carolyn McMakin). Liberated Body (23 December 2014); LBP 030.

https://www.liberatedbody.com/podcast/carolyn-mcmakin-lbp-030

 

 

 

 

 

“Happy Disabiliday!” A Letter To You All From Paula Orecklin, A CRPS Patient From Canada

Featured image and photo credit:  Dario Schor 

You may remember Paula Orecklin, the inspirational Canadian CRPS patient whom I wrote about in yesterday’s blog post:

Let’s Talk To An Inspirational Young Canadian Woman, Paula Orecklin, About CRPS, Sativex, Physiotherapy and Neuroplasticity

https://painmatters.wordpress.com/2017/04/10/lets-talk-to-an-inspirational-young-woman-paula-orecklin-about-crps-sativex-physiotherapy-and-neuroplasticity/

(There are additional References and Links at the end of this blog post.)

This week, Paula sent me a beautiful letter to share with all of you (see below).  Paula’s letter contains a very important message for everyone, on behalf of all people living with disabilities including chronic pain.

I feel delighted and honoured that Paula decided to share her inspiring letter and beautiful photos with my Pain Matters Blog (as well as any other media that Paula chooses).

Upon reading Paula’s letter, I thought to myself,

“Paula’s idea to start a ‘Disabiliday‘ tradition for patients whose lives are challenged by disability and pain is fabulous!  In fact, any day, whether it is April 1 or otherwise, is a great day to celebrate people who face adversities and obstacles due to disability including pain, and to also be grateful for our own blessings.”

Quoting from Paula’s her own words written to all of you from the bottom of her beautiful, caring and generous heart:

This past Saturday, April 1, 2017, I held the world’s newest disability holiday – Disabiliday. I just entirely made up a holiday. I figure someone has to have started every other celebration, so why can’t I do the same?

Last year, I had my 15th anniversary of having Complex Regional Pain Syndrome, a severe chronic pain disease. With such a large milestone, I knew I could either get very depressed, or make something positive out of it. It wasn’t something I could just ignore. Instead, I chose to make a celebration out of it. I hadn’t just been in pain for 15 years – I was in pain for 15 years and was still going.

It became my Disabiliday.

The event turned out to be so positive and wonderful that I decided to hold a second one this year. I ended up making more progress this past year than I ever had, in terms of function and ability. I wanted to celebrate that as much as anything – that I’ve been in pain for 16 years and am now going somewhere. I don’t really know where yet, but I figure I have another year to figure that out.

I think Disabiliday could also be relevant to other people with disabilities. When you’re disabled, you can often feel isolated, or like you’re not having the same kind of lifetime milestones other people have. Maybe you can’t move out and have a housewarming, or maybe you can’t have a long term relationship with engagement and marriage and babies. Of course, plenty of people with disabilities do just those things and I’d never discount them or their lives – but I, at least where I am right now, don’t feel like I’m able or ready for them. And even birthdays can feel like you aren’t where you should be in life, especially compared to people around you.

So I wanted to do something new and different. I wanted something that fit where I am in life, where I am emotionally.

And thus, Disabiliday. A day to celebrate that despite the amount of pain I’m in, despite the limitations my disease has enforced, I still am. I still have worth. I still have a presence in people’s lives. I still am going.

Surrounding myself with the support structure I’ve been so lucky and honoured to have found in my life, I was able to sit back and take in just how many people love and care about me. Without them, I would never have gotten through so many years of pain. They’ve made the time worth it.

Disabiliday is a way of reinforcing my place in life. The place in my life, and in my family and friends’ lives. Emotionally and psychologically, all of the normally invisible ways people care were made evident. It might seem silly to just make up a holiday out of nothing but a terrible pun my friend came up with to have a Disabilitea Party that I later expanded because if I’m going to make up a celebration I might as well get a full day out of it, but the meaning really is there.

And it was a lot of fun too. I got my hair and makeup done at Sephora and Mario’s Salon (now Aura Polo Park) respectively last year and felt amazing once I was all made up. This year I got my hair highlighted, trimmed, and makeup all done at Aura Garden City. It’s superficial to some extent, but I felt so much better once finished. It’s an external thing, of course, but that doesn’t mean it doesn’t matter.

Last year we went to Sam Po Dim Sum and also introduced all of my non-Jewish Winnipegger friends to the deliciousness that is a shmoo torte from Gunn’s Bakery. It’s this layered angel food and whipped cream confirmation that’s North End of Winnipeg Jewish tradition.This year I upped my game with a wonderful dinner at Kildonan Park’s Prairie’s Edge restaurant and a cane cake from Dolce Bake Shop.

I’ve used two canes for quite a few years now (when I wasn’t in a wheelchair), and I’m finally, finally starting to walk on my own. In fact, I made a great entrance to my party by walking in. That alone made the night amazing.

IMG_0291.JPG

Photo Credit:  Dario Schor

But I wanted to step it up. I went to this awesome bakery (I recommend the chocolate cupcakes with pistachio buttercream icing) and had the pastry chef make a custom cake for me- a replica of one of my canes.

And man, did slicing that thing up feel good!

IMG_0319-3.JPG

Photo Credit:  Dario Schor

Other highlights of this year’s Disabiliday party included a featured guest, my physiotherapist Maria Pawlyshyn of Movement360 Inc. She is a huge part of why I’ve made so much progress this past year. Working with her, I’m doing better than I ever have since developing Complex Regional Pain Syndrome.

Other features included a dinosaur balloon- a DisabliT-rex of course (I hate myself for these puns just as much as you do) – and a truly stunning purse my mom and I designed and she made for the event (see top photo). We’ve made a lot of purses over the years, but this one has to be one of the best. Just really gorgeous. The writing on the front of it is my handwriting.

DisabiliTrex and I.jpg

Photo Credit: Dr George Fulford

We also filmed the Disabiliday parties for a documentary Dr. George Fulford of the University of Winnipeg and I have been filming for a few years now, with the assistance of Steven Mellor for sound. Originally meant to be the first of a series of five minute videos of young adults with disabilities, this project has ended up capturing the huge amount of progress I’ve made over the past couple years. I was at my worst, nearly entirely wheelchair bound, when we started this project and I’ve made such huge gains. To actually walk on my own – I never expected ever to do that again in my life.

In other bragging about things news, my wonderful friends got me the most amazing sets of rings for a Disabiliday present. This isn’t quite as materialistic as you might think. For many years now, I’ve developed open sores and wounds all over my body. My doctors think that with the amount of pain I’m in, always, the skin has just sort of gotten very weak and opens up into wounds. I don’t do anything to create them, I’d like to explain – they just open up without any influence or action on my part. They eventually close up but leave scars. Even though the scars eventually start to fade, it doesn’t help because more new wounds have already opened up.

To detract attention from all of my wounds, I wear lots of rings (and wear makeup) to both cover up wounds on my fingers and to attract attention away from wounds on the rest of me. My friends know this, and so rings really do mean a lot to me. Plus they are adorable and I totally love them too.

So Disabiliday does really have some meaning. One one level, I realize how weird – and how self-important – it is to make up your own holiday and expect people to celebrate it. On another hand, this matters to me, and my friends honestly do support it. If it makes me feel better, if it doesn’t harm anyone else…why not? Maybe a lot of people – if they were to ever even hear about it – will think me stuck up or even that I’m celebrating being a victim of my disease, but I can’t help that. All I can do is lay out my reasoning here and hope maybe other people might understand. That’s really all anyone can ever do, really.

Finally, I want to thank Prairie’s Edge for hosting us, Dolche Bake Shop for a delicious cane, and Aura Garden City for totally making me over.

And I really want to thank my best friend, Eryn Schor, for not only organizing both of my Disabiliday events, but actually sticking around for the better part of five hours as I got all made up. Now there is a truly loyal friend! She means so much to me and has been by my side since we met in elementary school. Without her, these events would never have happened.

Thanks also go to Dr. George Fulford for filming the whole event – and for filming my life over the past few years, and to Steven Mellor on sound. Dealing with that boom mike was not easy!

And lastly, thanks to my parents. My dad was unable to be in town for the event, so we just got him on Skype on a phone to take some family photos. With my parents, all of my friends, and my health care providers, with all of their love, care, support, understanding, work, and through their thought, research, and education, I can truly say that despite the amount of pain I’m in, the past 16 years have been entirely worth it.

Happy Disabiliday!

IMG_0362.JPG

Photo Credit:  Dario Schor

I am certain that most of you will be equally touched by Paula Orecklin’s letter just as I am!

Sabina Walker, Pain Matters Blogger

PS  Are there any thoughts on Paula’s idea of a ‘Disabiliday‘ tradition from the rest of you in ‘Pain Matters Blog Reader-Land’?  If yes, please feel free to comment…

FURTHER REFERENCES AND LINKS ON PAULA ORECKLIN, CRPS PATIENT:

(1) Paula Orecklin – UNE Patient Case Study – April 4, 2013

https://www.youtube.com/watch?v=_aAVOCGW5ac

(2A) CRPS Video on CRPS by PARC (a CRPS website)

https://painmatters.wordpress.com/2014/10/26/crps-video-on-crps-by-parc-a-crps-website/

(2B) This blog post also includes details and links to a video/DVD called:

Living a Life in Pain – The Story of RSD/CRPS (by Sarah Panas, film maker):

http://www.rsdcanada.org/parc/english/parc/news.htm

This video is also accompanied by a 5-minute trailer:

Living a Life in Pain: The Story of RSD/CRPS – Trailer’

http://www.youtube.com/watch?v=uB1TPVND9iU

Let’s Talk To An Inspirational Young Canadian Woman, Paula Orecklin, About CRPS, Sativex, Physiotherapy and Neuroplasticity

Featured Image provided by Paula Orecklin.

Sativex

Sativex is a cannabis-based mouth spray that is used for nerve pain relief in various painful conditions including cancer, complex regional pain syndrome (CRPS) and multiple sclerosis (MS).  It may also reduce spasticity, muscle spasms and sleep disturbances in MS patients (similar to the benefits of medical cannabis).

For more on Sativex, please see my blog post called ‘Medical Cannabis (Medical Marijuana) And Nerve Pain’.

A CRPS Patient, Paula Orecklin 

You may remember Paula Orecklin from my older blog post called ‘CRPS Video On CRPS By PARC’ (26/10/14).

I recently invited Paula to share more of her inspiring story including her challenges with severe chronic pain and her positive experiences with Sativex, physiotherapy and neuroplasticity work.  Paula immediately replied:

“I like being able to do something positive with all of this pain. If this can help other patients, I’m all over it. Sharing my story, talking to other people…I have to make something good out of all of this pain, you know? And I do have a lot of experience, I guess.”

Paula Orecklin (29) from Winnipeg, Manitoba, Canada, has complex regional pain syndrome (CRPS) that involves constant, severe pain in her right knee and lower right leg as a result of twisting her right ankle back in 2001 when she was only 13 years old. Thereafter, Paula couldn’t even put her right foot to the floor without triggering one vicious blast of pain after another, leaving her bedridden and literally screaming in bed for the next 2 weeks. Following this tragic and life-altering event, Paula had to resort to crutches (and later on, canes) for mobility and due to excess pain. She was wheelchair-dependent for a few months during 2004 – 2005 (caused by ‘blowing out her left knee’) and also for 3 years from 2013 to 2015 (due to unbearable pain leading to monthly ER visits for half a year).

Quoting from Paula’s 2013 YouTube (pre-Sativex treatment):

‘…Every single second, I am in pain, from my knee down to my toes. On my right leg, all there is is pain…there is always solid pain from my knee down. On top of that pain, I have other kinds, all different forms [of pain]…stabbing, shooting, burning, visceral, aching, throbbing…This is with all of my medications…’

See YouTube called ‘Paula Orecklin – UNE Patient Case Study – April 4, 2013’:

https://www.youtube.com/watch?v=_aAVOCGW5ac

Following 3 years in a wheelchair due to severe pain, Paula was offered Sativex for the first time in 2015.  In 2016, thanks to Sativex (and other medications), the support of a fantastic physiotherapist and neuroplasticity work with an excellent pain psychologist, Paula was finally able to trade in her wheelchair and crutches for walking canes!

unnamed-3.jpg

Image provided by Paula Orecklin.

However, despite Sativex, Paula still has constant, severe pain every single second of her life. In her words:

[CRPS] still has all sorts of horrible kinds of pain [despite Sativex]. I can be doing well and suddenly ‘a giant poker’ has been stabbed through my leg. I was at a meeting on Saturday and in the middle of it, my foot set on fire. I’m always in pain and then on top of that, there are all sorts of different kinds of pain that come on extraordinarily suddenly. What I said in the video [3 – 4 years ago] is exactly what [still] happens today.’

Thus, while Sativex does not eliminate Paula’s base level of constant and severe pain nor her initial sudden pain attacks from occurring, it can block the repetitive flare cycles. By preventing these ongoing vicious pain cycles in 5 minutes, Sativex enabled Paula to finally undergo physiotherapy to improve her function and mobility. In Paula’s words:

“…Sativex is good at keeping the huge flare cycles down… I’m doing better functionally, so much better. But it doesn’t really work on my constant level of pain.”

Before Sativex, Paula suffered from out-of-control pain levels due to sudden and repetitive waves of pain spikes that would combine with her initial pain spike. One pain spike would lead to another pain spike, and on and on it went. This vicious and ongoing pain spike cycle often led to extremely high pain levels until finally her other medications kicked in.

Paula started using Sativex sublingual mouth spray 2 years ago. While it ‘tastes pretty disgusting, like spraying mosquito repellent into your mouth’, Paula said that she was doing very well as Sativex helps her manage her pain levels better. Being a mouth spray, Sativex has the advantage of gaining faster access directly into the blood capillaries via diffusion through the tissues under the tongue.

Paula has a prescription for a refill bottle of Sativex every 8 days. Sativex is not covered by public healthcare where Paula lives in Manitoba, and at CDN256.05 a bottle, Sativex is not cheap. Even though Paula’s private insurance helps defray most of the cost, Paula is still left out-of-pocket CDN60 per bottle. Using up to 12 sprays a day (and even up to 15 sprays on very painful days), a bottle of 90 sprays can go very quickly.

Despite its costs, Paula finds Sativex’s ability to block the repetitive flare cycles worthwhile. For the first time in her life, Paula has finally found a way to stop the vicious and ongoing cycles of pain spikes before they even start. This enables Paula to do physiotherapy and neuroplasticity training despite ongoing, unrelenting and severe pain. For example, she is now able walk between 1 to 2.4 miles with the aid of 2 walking canes.

Paula does not have any side effects from Sativex other than feeling ‘fuzzy everywhere’ on ‘really bad days’ when more than 9 – 10 sprays and increased hydromorph IR are required.

While Paula has tried medical marijuana (medical cannabis), she found it ineffective against her painful flare-ups. In contrast, Sativex is able to stop her pain flares in 5 minutes hence preventing a vicious circle of painful flare-ups. Furthermore, because Sativex looks like a regular inhaler, it is easier for Paula to be seen using Sativex than, say, medical marijuana. In other words, Sativex is not associated with the social stigma associated with using medical marijuana for pain management.

[I’ve gone from being] forced … to leave university, to carrying the Olympic torch [see photo below], to helping found a local CRPS support group, to creating my own Disability holiday….that after 15 years I …still [attend]. I’m going to celebrate it again this March…after 16 years I’m actually going somewhere now.  I’ve managed to make as much of a life out of my circumstances as I can.”

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Image provided by Paula Orecklin.

On behalf of all Canadians with chronic pain, Paula was formally honoured and selected to be an Olympic torchbearer for the 2010 Vancouver Olympic Winter Games. Paula had to practice walking and holding up one of her old crutches (in lieu of the Olympic torch) for 6 – 7 months beforehand.

One very early morning on a cold wintry day at -30C in January 2010 in Virden, Manitoba, Paula successfully fulfilled her pledge to carry the Olympic torch for 500 meters without mobility aids! Needless to say, being chosen as an Olympic torchbearer for the 2010 Winter Olympics to represent all Canadians living with chronic pain was one of Paula’s proudest achievements.

Thanks to a multi-disciplinary approach to CRPS that involved:

  • Sativex treatment;
  • Hydromorph IR and other conventional pain medication;
  • Physiotherapy;
  • Neuroplasticity work (with her pain psychologist); and
  • Various other pain strategies,

Sativex made a huge difference to Paula’s quality of life by opening the door for the first time to physiotherapy, regular exercise and neuroplasticity work, leading to a dramatic improvement in her CRPS symptoms including repetitive painful flares.

In her own words:

‘I’ve found in the past few months that not only have I been able to do more, be out and see people, exercise and still not fall apart, but I’ve also been increasing my tolerance to everything. I’ve actually been using less breakthrough medication, both Sativex and my hydromorph IR. I’m genuinely doing better. I think I’m down to about a bottle every 13 days right now.’

‘Without Sativex, I would never have been able to get to where I am today.

The neuroplasticity would have helped with my own depression due to pain and my understanding of pain and just generally improved my mental state.

But no real improvement physically would have been possible without Sativex.’

‘I’m doing better than I have in a very long time. Sativex is absolutely critical to this upswing. With Sativex, I can give myself medication with every flare of pain. It kicks in in only 5 minutes. The pain doesn’t have a chance to build on itself but is cut down quickly. I can also give myself another spray in 5 minutes if the pain keeps getting worse or doesn’t go down enough.

I can take up to 12 sprays a day and there aren’t really any side effects. I can get a kind of drugged feeling, but it’s not a high nor is it particularly strong. I have to be careful to spray under different parts of my tongue (ie sometimes my tongue’s left side, sometimes up front in the middle, sometimes on the right) so I don’t get wounds under my tongue. However I’ve never had a single one develop. It’ll sting a little when I’ve used a ton of sprays in one spot, but that’s just a reminder to be sure to move it around. And this might be of clinical significance since my skin is very delicate and develops wounds from my CRPS. ….

I mean, the drug is no magical cure, but it’s been absolutely essential to my progress. Without it, I might have gotten some psychological benefit from the neuroplasticity, but I definitely couldn’t be able to move any better. I’d never have ever been in a place where I could work with my physiotherapist. Before Sativex, I was in my wheelchair for nearly everything. I was finally able to walk again because of [Sativex].’

‘I’ve been working with an amazing physiotherapist since this spring. I was finally able to start walking, but was doing it so unevenly I was hurting my good side’s hip. She’s made a big impact on getting me moving.’

‘…I just came home from the gym, did really well I was powering around the track, listening to music, just … moving. And that kind of feels like a medical miracle. I was in such horrible shape for so long, and it just feels so good. And painful of course, but that’s just a given.’ 

‘I’m doing better now than I have in so many years … I’ve never in my life been able to have sustained progress like this.  I’m still disabled, and there are so many things I still can’t do, but that’s not really what I’m concerned with right now. I’m just happy to see where I am now.’ 

‘Sativex has been really important in my life over the past two years, but I just don’t want it to come off like it’s a … well, miracle. It isn’t. It’s made a massive impact on my life, but I’d say that my massive improvement over the past year is only a third down to the spray.’

Paula added, ‘None of anything would have been possible without hydromorphone IR, nor the rest of my medications. Nothing would be possible without my pain specialist at the pain clinic. It really has been a team effort, and that’s not even counting my other physicians, or the essential support network I have. My parents support me 100%, and that’s both emotional and financial. My mother, in particular, is my caregiver and is a huge part of my life. I’m very lucky to have friends who understand and care too. My best friend’s support over the years has meant so much to me too.’ 

‘Now none of those other things helps in the same ways Sativex does. Without it, I wouldn’t be able to move forward and make sustained progress for what is literally the first time in my life since hurting my leg. I’d never managed to go forward at all, ever; plateauing was all I could hope for. But I still feel like all of those other things are coming together to really help me in way that Sativex alone couldn’t. In fact, what’s really amazing is that I’m actually not using as much Sativex as I used to. Everything’s coming together much better than I ever could have expected. My leg is actually dealing with things better, not needing the same amount of as-needed medications. For the first time too, I’m actually finding other non-medicinal things like heat packs are actually helping. Before, it was just way worse when I didn’t have them, but it didn’t lower the pain exactly. So you can say it is kind of a holistic thing – but one that needed Sativex to open the door to it, if that makes sense…’

Having said all of the above, Paula emphasized:

‘[I am] actually never without pain … Sativex helps to stop the vicious circle of escalating pain cycles in 5 minutes.’

‘…I’m still in rough shape. But when that rough shape is so much better than the rougher shape I was in [before Sativex]…

‘[CRPS] is still incredibly disabling. But when you start so low, every few inches up makes a big difference.

Paula’s positive experience with Sativex may offer hope and inspiration to other pain patients to also add Sativex into their overall pain management therapy.

Thank you, Paula, for sharing your beautiful story with us! Despite living with constant, severe pain, your strength and inner beauty never cease to amaze me! People like you are the inspiration and main driving force behind this blog.

With positive thoughts coming your way from everywhere and everyone,

Sabina Walker

Blogger, Pain Matters

Chronic Pain and Hypnotherapy

Source of Featured Image:  http://blog.oup.com/2013/03/hypnosis-for-chronic-pain-management/

A pocket watch going through a hypnotizing motion

Dear Pain Matters blog readers,

Hypnosis including hypnotherapy and self-hypnotherapy has been used for pain management for thousands of years.  In fact, until the 19th century, hypnosis was the the sole treatment available to undergo surgery with reduced pain and suffering (Braid, 1847).

In essence, self-hypnosis may be a common experience involving an altered state of conscious awareness that may occur many times throughout each day.  Some people describe self-hypnotherapy as being similar to ‘tuning out’, daydreaming, being in a trance-like, or meditative, state or having an ‘out of body experience’.  A hypnotic experience may involve:

  • Disassociation, where the patient’s perception of his/her environment including pain is temporarily reduced;
  • Intense concentration or focused attention; and
  • Suggestibility, whereby the patient may involuntarily respond to verbal and non verbal communication.

Hypnotherapy treatment for pain management may be offered by medical hypnotherapists, and has proven to be particularly effective for treating children (e.g. during treatment of needle phobia, renal dialysis).  Clinicians may use hypnotherapy to help manage a range of conditions including phobias, addictions, anxiety, acute pain (e.g. childbirth pain, surgical pain, burns dressings) and chronic pain.  Anaesthetists in Belgium often use hypnosis as an adjunct to general anaesthesia during removal of the thyroid gland, mastectomy and plastic surgery.

Until recently, scientific evidence for (self-) hypnotherapy’s potential role in chronic pain management was virtually non existent.  Current studies report that intervention involving hypnosis may result in significant decreases in chronic pain, and that hypnotherapy was often more effective than non hypnotic interventions including physical therapy, education and attention (Elkins et al, 2007).

Imaging studies show that hypnosis can modulate activity in the anterior cingulate cortex (ACC).  The ACC links the sensory cortex (that processes the sensory part of pain) with the limbic brain regions (that process the affect, unpleasant or suffering aspect of pain as well as related negative emotions).

Autogenic Training:

In addition to hypnotherapy, a relaxation technique called Autogenic Training that involves self-hypnotherapy may also be useful for inducing the relaxation response.  For more details, please refer to my earlier Blog Post:

https://painmatters.wordpress.com/2014/11/05/does-autogenic-training-lead-to-less-pain/   (Does Autogenic Training Lead to Less Pain?)

Summary:

Hypnosis including self-hypnosis (e.g. Autogenic Training) can result in real and tangible physiological effects and may be able to reduce chronic pain.  As such, (self-) hypnotherapy may be a useful addition to an overall pain management strategy.

Hypnosis has no known adverse effects if properly done by qualified medical hypnotherapists who have the chronic pain patient’s best interests in mind.

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCES:

Media

(1a) Explainer: How Does Hypnosis Relieve Pain?

The Conversation (21 June 2012)

https://theconversation.com/explainer-how-does-hypnosis-relieve-pain-7060

(1b) Hypnosis for Chronic Pain Management

Oxford University Press Blog (16 March 2013)

Jensen, Mark

http://blog.oup.com/2013/03/hypnosis-for-chronic-pain-management/

(1c) Hypnosis Takes Your Mind Off Chronic Pain

Scott, Sophie

ABC News (16 September 2011)

http://mobile.abc.net.au/news/2011-09-16/hypnosis-for-chronic-pain/2902538

Peer-Reviewed Papers

(2a) Elkins G, Jensen MP, Patterson DR.

Hypnotherapy for the Management of Chronic Pain.

The International journal of clinical and experimental hypnosis. 2007;55(3):275-287.

doi:10.1080/00207140701338621.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752362/

(2b)  Elkins G, Johnson A, Fisher W.

Cognitive Hypnotherapy for Pain Management.

Am J Clin Hypn. 2012 Apr;54(4):294-310.

http://www.ncbi.nlm.nih.gov/m/pubmed/22655332/#fft

History of Hypnosis and Surgical Pain

(3) Braid, James

On Esdaile & Hypnotic Anaesthetic (from The Complete Writings of James Braid) – Letter to The Medical Times (1847)

http://www.ukhypnosis.com/2011/03/02/on-esdaile-and-hypnotic-anaesthetic-from-the-complete-writings-of-james-braid/

For German readers

(4) Meichsner, Irene. Wenn der Schmerz Schmilzt. Bild der Wissenschaft (01.07.1999).

http://www.wissenschaft.de/home/-/journal_content/56/12054/65331/

 

Is There a Link Between Prolonged Psychological Stress And Physical Pain?

Featured Image of the ocean near the beach in the sun taken by myself. 

Dear Pain Matters blog readers,

Prolonged psychological stress can perpetuate chronic pain in some patients, while other people may be prone to chronic inflammatory diseases including cardiovascular disease, type II diabetes, depression, autoimmune diseases, upper respiratory infections and poor wound healing ability.

Immune cells are normally very sensitive to circulating stress hormones (glucocorticoids including cortisol), and as such, are usually able to shut down the pro-inflammatory response in the presence of glucocorticoids.

Chronic psychological stress can reduce the circulating stress hormone’s ability to interact with its receptor leading to glucocorticoid receptor resistance (GCR).

Repeated and ongoing exposure to a long-term threatening (real or imagined) and stressful experience can lead to insufficient glucocorticoid regulation (i.e. GCR), that in turn can lead to:

  • Insufficient control over the inflammatory response towards an infection;
  • Increased duration and/or intensity of the pro-inflammatory response; and
  • Increased pain levels and other signs and symptoms of chronic diseases.  

Studies have shown that some chronic stress sufferers (e.g. parents of children with cancer, spouses of patients with brain cancer and lonely people) present with GCR (Cohen et al, 2012).

Other Biomechanisms that Influence the Pro-Inflammatory Response and its Key Role in Maintaining Chronic Pain and Inflammation-Based Diseases:

See this Blog Post for more information:

https://painmatters.wordpress.com/2014/11/13/can-vagus-nerve-stimulation-decrease-inflammation-hence-reduce-inflammatory-pain-in-some-chronic-pain-patients/

What Can Done To Reduce Prolonged Psychological Stress?:

Steps must urgently be taken to reduce repeated and ongoing exposure to a prolonged threatening (real or imagined) and stressful experience.

This brings us to all those therapies that may induce the ‘relaxation response’ and/or lead one to a calmer disposition including:

Summary:

Any therapy that can induce the ‘relaxation response’ is key to diverting attention away from repeated and ongoing psychological stress.

This will strengthen the immune cells’ ability to interact with circulating stress hormones (glucocorticoids including cortisol) and shut down an exaggerated pro-inflammatory response.

Conventional pharmacological treatment also plays an important role in reducing excessive inflammation.  The effectiveness of pharmacological drugs may be further enhanced by the body’s ‘relaxation response’, leading to lower drug dosages and fewer adverse effects.

The body’s innate ability to properly control a pro-inflammatory response is key to warding off chronic pain and disease.

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCES:

Media

(1) Study Finds Link Between Stress And Physical Pain

Huffington Post (03 April 2012)

http://www.huffingtonpost.co.uk/2012/04/03/pain-stress-link-found_n_1398767.html

Book

(2) Clynes, Manfred

Sentics: The Touch of Emotions

250 pp, Doubleday/Anchor, New York, 1977

http://senticcycles.org/home/sentics/articles/sentics.pdf – Chapter 9 only

Peer-Reviewed Paper

(3) Cohen S, Janicki-Deverts D, Doyle WJ, et al.

Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk.

Proceedings of the National Academy of Sciences of the United States of America. 2012;109(16):5995-5999.

doi:10.1073/pnas.1118355109.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341031/

 

Ziconotide (Prialt) and Complex Regional Pain Syndrome – 2 Successful Cases

Dear Pain Matters blog readers,

Almost 2 years ago, I wrote a Blog Post called:

Ziconotide (Prialt) for Nerve Pain Including CRPS?

https://wordpress.com/post/painmatters.wordpress.com/344

Quoting from my older Blog Post:

“….Ziconotide for 7 CRPS Patients ….. 2 patients had complete pain relief and as such, discontinued Ziconotide treatment altogether…… (Kapural et al, 2009).”

I find it fascinating that intrathecal (IT) ziconotide treatment resulted in complete pain relief for these 2 patients.

It is worthwhile elaborating further on these 2 former CRPS1 patients here:

(1) Patient 1 –

A male patient (Patient # 1, 16 years old, male) had CRPS1 in both of his legs following an Achilles tendon tear 2 years earlier.  He suffered burning pain, hypersensitivity to touch/temperature changes and loss of proprioception in both feet.  Pain management treatments including lumbar sympathetic blockade and various oral medications were unsuccessful.  The patient used a wheelchair for mobility.

During a ziconotide trial, dosages were titrated from 2.4 mcg/d to 24 mcg/d over 3 months.  His VAS score reduced from 100 mm to 40 mm by the 4th month of the ziconotide trial, and he was able to upgrade from a wheelchair to a cane for mobility.

The patient underwent IT pump implantation, and dosages were titrated from 5 mcg/d to 7.5 mcg/d over a 7 month period (with some side effects that were treated).

During the 2nd year, ziconotide dosage was reduced to 4.5 mcg/d.  The patient was finally pain-free, and he was able to resume normal activities.

By the 3rd year, ziconotide dosage was further reduced to 1.2 mcg/d, and he stopped taking oral medications altogether.  The patient continued ziconotide treatment (ranging from 1.2 to 1.4 mcg/d) for another 4 years, and this enabled him to be pain-free and active.

Post-7 years ziconotide treatment, during which he remained pain-free, (quoting from page 299) ‘his IT pump was filled with normal saline in preparation for an explanation’ (Kapural et al, 2009).

(2) Patient 2 – 

A female patient (Patient # 2, 32 years old, female) had CRPS1 in both of her legs due to a fall 5 years earlier.  The patient suffered burning pain and hypersensitivity to touch/temperature changes, and she preferred to use a wheelchair for mobility.  Pain management treatments had failed her completely including multiple oral medications, lumbar sympathetic blockade and spinal cord stimulator, SCS (VAS score, 100 mm).

Following a successful ziconotide trial, she agreed to IT pump implantation.  Dosages were gradually titrated upwards from 10 mcg/d to 145.5 mcg/d over 2 years, with no adverse events.  The patient continued at this dosage of 145.5 mcg/d for another 6 years.

After 8 years of ziconotide treatment, the IT pump no longer worked.  While waiting for a new IT pump, the patient noticed that she no longer had any pain.  As such, she stopped taking systemic opioid medication.  She was also able to walk without an assistive device.  Her defective IT pump and SCS were surgically removed one month later.

A year following removal of her IT pump and SCS, the patient remained pain free (VAS score, 0 mm) and had returned to college (Kapural et al, 2009).

Summary:

Ziconotide treatment (via a spinally-implanted pump) can offer significant pain relief, and may even, at appropriate dosages, lead to full recovery from CRPS1 for selected CRPS patients.  

It is paramount that ziconotide be titrated to avoid serious side effects.  The importance of correct dosage was discussed at great length in an earlier Blog Post:

https://painmatters.wordpress.com/2015/08/07/ziconotide-prialt-user-reviews-is-dosage-an-issue/.

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

PS For those of you who want to learn more about cone snails (that inspired medical research into ziconotide), here is a 2 – 3 minute YouTube called ‘Killer Cone Snails’.  

NB If you find aggressive animal behaviour disturbing, please refrain from watching this YouTube:

REFERENCES:

(1) Kapural L, Lokey K, Leong MS, Fiekowsky S, Stanton-Hicks M, Sapienza-Crawford AJ, Webster LR (2009)

Intrathecal Ziconotide for Complex Regional Pain Syndrome: Seven Case Reports.

Pain Practice (2009), 9: 296–303.

doi:10.1111/j.1533-2500.2009.00289.x

http://onlinelibrary.wiley.com/doi/10.1111/j.1533-2500.2009.00289.x/abstract;jsessionid=6C89A05D226657327BD3D4FEF4221488.f04t04

More on Intrathecal Delivery of Ziconotide –

(2) Palca, Joe

Snail Venom Yields Potent Painkiller, But Delivering The Drug Is Tricky

3 August 2015

http://www.npr.org/sections/health-shots/2015/08/03/428990755/snail-venom-yields-potent-painkiller-but-delivering-the-drug-is-tricky

 

External Laser Therapy and Laserneedle Acupuncture for Chronic Pain

Featured Image:   Comb Jelly (Mnemiopsis sp.)

https://i.ytimg.com/vi/weeFO6kLu5o/maxresdefault.jpg

Dear Pain Matters blog readers,

External laser therapy is used to exert various biological/cellular effects in the body including:

  • Stimulation of various acupuncture points (via noninvasive, painless Laserneedle acupuncture); and
  • Treatment of local damaged areas within the tissue.  Local laser therapy may be done for pain management, rehabilitation and regeneration of damaged tissue.

External laser therapy uses various laser wavelengths (i.e. colours) to penetrate different depths and tissues beneath the skin including:

  • Infrared laser (800 – 900 nanometers, ‘nm’; 810 nm, may be used) – 5 to 7 cm depth below the skin;
  • Red laser (630 – 680 nm; 658 nm may be used) – 2 to 3 cm depth below the skin.  Red laser can increase cellular activity and blood circulation as well as stimulate immune cells, fibroblasts and mitochondria, leading to regeneration and improved healing including wound healing;
  • Green laser  (532 nm) – 0.5 to 1 cm depth beneath the skin.  Green light is largely absorbed by haemoglobin in the red blood cells; and
  • Blue laser (405 nm) – 1 to 2 mm depth only.  Blue laser light has anti-inflammatory effects.

External laser therapy can be applied via:

  • Single point lasers.  Only one point and 1 wavelength can be used in single point lasers; or
  • Laserneedles.  Up to 12 multi-channel lasers/points including different wavelengths/colours/power outputs may be used at the same time (e.g. Weberneedle system, Lasershower).

External laser therapy may treat various painful medical conditions including:

  • Spine syndromes/back pain;
  • Osteoarthritis;
  • Rheumatoid diseases;
  • Tendon inflammation;
  • Migraine/headache; and
  • Trigeminal neuralgia

(Michael Weber MD).

95937076bf.png

Source:   http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/external-laser-therapy/

Fibromyalgia:

A study involving laser acupuncture treatment for fibromyalgia patients reported an average Pain Scale of 4.4, post-laser acupuncture (compared to an average Pain Scale of 8.5, pre-laser acupuncture).

Further improvements occurred when laser acupuncture plus intravenous laser was offered to fibromyalgia patients (i.e. average Pain Scale of 2.9, post-laser acupuncture plus intravenous laser, compared to 8.9, pre-treatment).

Both:

  • Laser acupuncture; and
  • Laser acupuncture plus intravenous laser

were more effective for pain management than medication alone (6.8, post-medication, versus 8.7, pre-medication) and metal needle acupuncture (6.0, post-treatment, versus 8.5, pre-treatment) in fibromyalgia patients (Wieden).

(For more on intravenous laser, please refer to:
http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/intravenous-laser-therapy/.)

Possible Mechanisms:

I urge all interested readers to read Chapter 4 called ‘Rewiring a Brain with Light’, in Norman Doidge’s 2nd book, ‘The Brain’s Way of Healing’.  This book provides an excellent introduction into phototherapy (i.e. low level laser therapy; LLLT) (Doidge, 2016).  

Scientists have recently shown that humans (including the human eye and brain) may detect and perceive a single photon (Tinsley et al, 2016).  This is very interesting as it shows the sensitivity of the human body to the biological (hence potential healing) effects of natural light including its visible wavelengths from 400 to 700 nm (blue to red) and invisible wavelengths from 800 to 900 nm (near infrared).

Summary:

Whilst relatively new (and undergoing further research), external laser therapy and Laserneedle acupuncture may be useful for reducing pain in many chronic pain conditions including fibromyalgia.

Dear Pain Matters blog readers, if you would like to get in touch with Dr Michael Weber and his team, please email Martin Junggebauer on:

junggebauer@webermedical.com

Martin is an integral member of Dr Michael Weber’s team, and he will be sure to assist you with your enquiries.

http://www.dr-weber-laser-clinic.com/en/home/

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCES

(1A) Michael Weber MD

Laser in Pain Therapy and Rehabilitation

http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/pain-therapy-rehabilitation/

http://www.webermedical.com/en/the-business/dr-weber/

http://www.webermedical.com/en/weber-medical-for-professionals/the-principle/

(1B) Michael Weber MD, Robert Weber, Martin Junggebauer

Medical Low Level Laser Therapy – Foundations and Clinical Applications (2nd Edition, June 2015)

http://www.isla-laser.org/en/

(1C) Michael Weber MD, President of International Society for Medical Laser Applications (ISLA)

International Society for Medical Laser Applications (ISLA)

http://www.isla-laser.org/en/

(1D) Michael Weber MD, Thomas Fussgänger-May MD, Tillman Wolf MD

“Needles of Light”: A New Therapeutic Approach

Medical Acupuncture (2007); 19(3)

DOI: 10.1089/acu.2007.0539

http://www.my-dr.de/FG/texte/infounten/Publikationen/Medical_Acupuncture.pdf

(1E) Michael Weber MD, Zulia Frost MD

Multi-Laser Needle Acupuncture and Laser Blood Irradiation Therapy – Clinical Application of Biological Laser Therapy (Pages 1-50)

http://www.metgesacupuntors.org/resources/pdfs/congres_2009/17_30Z_Frost.pdf

Other Papers, Articles and a Blog by Fred Kahn, MD FRCS(C):

(2) Wieden, Torsten E. (MD Anaesthesiologist, Special pain therapy)

e-mail: wieden@schmerzpraxis-celle.de

Fibromyalgia in Pain Therapy – Mechanisms and Treatment Options in Laser Therapy

http://www.isla-laser.org/wp-content/uploads/Fibromyalgia-in-Pain-Therapy.pdf

(3) Pryor, Brian A

Class IV Laser Therapy – Interventional and Case Reports Confirm Positive Therapeutic Outcomes in Multiple Clinical Indications (2009)

http://www1.udel.edu/PT/PT%20Clinical%20Services/journalclub/caserounds/11-12/September/PryorLaserPromotional.pdf

(4) Class IV Laser Therapy – Case Study Reports (Pages 1-39)

http://www.madisonlasertherapy.com/uploads/6/4/3/2/6432749/class_iv_therapy_laser_case_studies_report_2013.pdf

(5) Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D, Fazekas F, Ebner F.

Acupuncture Using Laser Needles Modulates Brain Function: First Evidence From Functional Transcranial Doppler Sonography and Functional Magnetic Resonance Imaging.

Lasers Med Sci. 2004;19(1):6-11.

DOI: 10.1007/s10103-004-0291-0

http://www.ncbi.nlm.nih.gov/pubmed/15316852

(6) Norman Doidge MD

The Brain’s Way of Healing – Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity (Chapter 4 – Rewiring a Brain with Light)

Publisher: Penguin Publishing Group (26 January 2016)

ISBN: 9780143128373

http://www.normandoidge.com/?page_id=1042

(7) Blog by Fred Kahn, MD FRCS(C), LLLT Specialist

http://fredkahnmd.com/2016/07/12/current-research-on-the-management-of-pain/

(8) Tinsley JN et al

Direct detection of a single photon by humans.

Nat. Commun. 7:12172

doi: 10.1038/ncomms12172 (2016).

http://www.nature.com/articles/ncomms12172