Category Archives: Low Back Pain

Would History Be Different If J.F. Kennedy Had Not Suffered From Excruciating Back Pain?

Feature Image of John F. Kennedy on crutches due to severe back pain in 1954 sourced from:

https://www.boston.com/news/history/2017/05/22/jfk-had-5-brushes-with-death-before-that-open-air-dallas-car-ride

Introduction

Dear Pain Matters readers,

Much has already been written about John F. Kennedy … What more could I possibly add here??

Having served less than 3 years as US President before being brutally shot down on 22 November 1963, John F. Kennedy is perhaps one of the most famous and beloved presidents in recent history.

Shock waves spread like wildfire throughout the world following his cold-blooded assassination.

(Much as I would have loved to have crossed paths with the iconic President Kennedy, I was not yet born, but rather, still in utero in the warmth of my mother’s womb during his final months.  By the time I was born several months later, the world had already lost one of its greatest leaders of the free world.)

Today’s blog post will focus on John F. Kennedy’s excruciating back pain.

Quoting his brother, Robert F. Kennedy,

AT LEAST ONE HALF of the days that [President Kennedy] spent on this earth were days of INTENSE PHYSICAL PAIN … I never heard him complain … Those who know him well would know he was suffering only because his face was a little whiter, the lines around his eyes were a little deeper, his words a little sharper. Those who did not know him well detected nothing‘ (Pait & Dowdy, 2017).

It was even suggested that President Kennedy’s challenges with Nikita Khrushchev, Premier of Soviet Union, during the Cuban Missile Crisis were nothing in comparison to his deep and personal suffering due to severe back pain. 

Who Was John F. Kennedy?

Overview

Born on 29 May 1917, the charismatic John F. Kennedy (JFK) served as the 35th president of the US from 20 January 1961 until his untimely death in Dallas, Texas, on 22 November 1963.

JFK made a genuine effort to make the world a better place.  While addressing discrimination and poverty, JFK also stood for world peace, freedom, safety, civil rights and social justice.

The media played a huge role in portraying JFK as a fit, healthy and energetic young man with strong family values.  For the most part, the media overlooked and/or downplayed JFK’s:

  • Suffering due to excruciating back pain (as well as myriad other health issues including gastrointestinal issues and Addisons disease); and
  • Extramarital affairs and lovers (far too many to count!).

Suppression of the former only adds to the stigma of chronic pain and hinders equitable distribution of resources toward pain research.

Understandably, the latter is unacceptable behaviour for a respectable President.

JFK’s Extramarital Affairs

First , let’s get to the dirt.  After all, JFK’s weakness for beautiful women was part and parcel of who he really was.  He simply adored being in the company of gorgeous and fascinating women.  And yes, many of these women found JFK equally charming and irresistible.

JFK had love affairs with Marylin Monroe, actress Anita Ekberg, East German-born Ellen Rometsch (who was married to a German Air Force sergeant stationed in Washington), Mary Pinchot Meyer (a CIA agent’s ex-wife) and two White House secretaries (Priscilla Wear and Jill Cowen) as well as a very brief fling with Marlene Dietrich (who was 15 years older than JFK).  The list of beautiful women bedded by JFK goes on and on (Browne, 2018).

Having said that, JFK had no intention of ever leaving Jackie Kennedy (née Bouvier), his elegant wife and devoted mother of their 2 beautiful children.

image.jpeg

JFK and his future wife, Jacqueline Bouvier (1953)

http://time.com/4793898/john-f-kennedys-call-leadership/

Given that further details of JFK’s love life are outside the scope of this blog post, let’s move on …

JFK’s Ever Constant Companion – Severe Back Pain, His Back Brace and His Assassination

It has oft been said that if JFK had not suffered from severe back pain, he may never have entered politics in the first place.  JFK’s back pain followed him everywhere, like a dark shadow.

In 1940, JFK failed the physical exams for both the Army and the Navy due to his back pain.

JFK’s severe back pain left him with no other option but to enter politics.

And it was severe back pain that ultimately forced him to wear an orthopedic brace on a daily basis.  Made of cloth with metal rod inserts, JFK’s canvas corset back brace helped support his back that was in constant, unbearable pain.

Ironically, the brace that supported his back was likely the same brace that contributed to his death on 22/11/63 in Dallas, Texas.  Specifically, his back brace prevented JFK from immediately slumping after the first bullet passed though his lower throat and neck.  Instead, JFK’s brace forced his body to remain erect, despite being shot at twice.

‘Thanks’ to his back brace that kept him in an upright position , JFK  remained visible and highly exposed to his assassin.  Like a sitting duck, JFK was in the assassin’s direct line of fire.  Sadly, when the 2nd bullet hit his head, JFK had absolutely no chance of survival.

It was suggested that if JFK had not worn his brace during the assassination, he may have slumped into his chair.  As such, he may have received ‘only’ one bullet to his neck (and not 2 bullets – one to his neck and a second one to his head).  As such, JFK may have slipped away from harm’s way of another bullet.  Thus, it may have been possible to save JFK’s life.

Sadly, despite valiant efforts to try to save his life in hospital, JFK died within half an hour of being shot at twice.

Much has been written about what the world might have been like today if JFK not been fatally shot in Dallas, Texas, on 22 November 1963.  The fact is that no one will never know for sure.

What is finally being revealed is the degree of JFK’s excruciating back pain.

Quoting Dr. Kelman, Internal Medicine and Physiology Specialist,

‘The most remarkable thing was the extent to which Kennedy was in pain every day of his presidency’ (

Summary 

Severe and ongoing back pain framed JFK’s entire political career from start to finish.  Excruciating back pain affected JFK non-stop since his early years at Harvard until the day he was shot.

It was his severe back pain that led JFK into politics in the first place.  This is because back pain prevented JFK from pursuing other career options. 

In all likelihood, it was severe back pain, and in particular, his back brace for his back pain, that shortened his time as USA’s 35th president and that took him straight into his grave at the tender age of only 46.

As one of the most charismatic and beloved US presidents in recent times, JFK enjoyed many accomplishments during his 1000 days as ‘the most powerful defender of freedom on earth’.

JFK played a huge role in defusing the Cold War between Washington and Moscow by successfully minimising conflict between Cuba and the US in October 1962.  In so doing, JFK played a huge role in preventing a nuclear war at a time when the entire world was at the brink of World War III.  The Soviet missile bases in Cuba were dismantled shortly after the Cuban Missile Crisis ended.  

JFK also founded the Peace Corps, initiated the nuclear test ban treaty and supported the space program (Allison, 2012).

JFK’s Quotes

A review of JFK’s quotes reveals an intelligent man who longed for peace, harmony, freedom, stability, tolerance and justice for mankind.

Here is a sample of JFK’s more famous quotes:

‘… Let every nation know, whether it wishes us well or ill, that we shall pay any price, bear any burden, meet any hardship, support any friend, oppose any foe to assure the survival and the success of liberty. …

… My fellow Americans, ask not what your country can do for you, ask what you can do for your country. …’

(Inaugural Address, 20 January 1961)

‘… For in the final analysis, our most basic common link is that we all inhabit this small planet. We all breathe the same air. We all cherish our children’s futures. And we are all mortal.’

JFK’s above speech is here:

 

‘As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.’

‘If we cannot now end our differences, at least we can help make the world safe for diversity.’

‘Geography has made us neighbors. History has made us friends. Economics has made us partners, and necessity has made us allies. Those whom God has so joined together, let no man put asunder.’ 

‘We are not here to curse the darkness, but to light the candle that can guide us through that darkness to a safe and sane future.’

‘Once you say you’re going to settle for second, that’s what happens to you in life.’

‘If a free society cannot help the many who are poor, it cannot save the few who are rich.’

‘Conformity is the jailer of freedom and the enemy of growth.’

Above quotes sourced from:  https://www.brainyquote.com/authors/john_f_kennedy

The next citation is quoted from JFK’s best-known international speech.  This powerful speech was translated into German for the 400,000 people who came out to welcome JFK to West Berlin on 26 June 1963.  Considered JFK’s most famous anti-communist speech, it delivered a message of solidarity to West Berlin at the height of the Cold War:

‘… Lass’ sie nach Berlin kommen.  Let them come to Berlin.

Freedom has many difficulties and democracy is not perfect, but we have never had to put a wall up to keep our people in, to prevent them from leaving us. … for [The Berlin Wall] is … an offense against humanity, separating families, dividing husbands and wives and brothers and sisters, and dividing a people who wish to be joined together. …

All free men, wherever they may live, are citizens of Berlin. And therefore, as a free man, I take pride in the words,

‘Ich bin ein Berliner!”

berlin_mack976.jpg

JFK’s ‘Ich bin ein Berliner’ speech (26 June 1963)

Source:  https://www.bbc.co.uk/news/magazine-23029697

http://www.let.rug.nl/usa/presidents/john-fitzgerald-kennedy/ich-bin-ein-berliner-speech-1963.php

Details of JFK’s Severe Back Pain Including 4 Back Operations:

Corticosteroid Treatments During JFK’s Youth

JFK received corticosteroid treatments for intestinal ailments as well as countless treatments for other medical issues throughout his childhood.  These ongoing corticosteroid treatments may have contributed to JFK’s back problems and other medical problems.

Back Injury During Football at Harvard University (1937)

JFK’s back issues and pain may have started in his early 20’s after he suffered a spinal injury while playing football at Harvard University in 1937 (Donald, 2017).

Solomon Islands Boat Collision (1943)

As a 26-year-old lieutenant, JFK was in charge of a crew of 12 on a Navy patrol boat called PT-109 in the Solomon Islands.  On 2 August 1943, JFK’s boat sank after being rammed and cut in half by a Japanese destroyer.  Two (2) crew members died during gas tank explosions.

JFK led all 10 survivors to the safety of a neighbouring island after a 5-hour swim for 5km in the South Pacific Ocean.  JFK also towed a seriously burned sailor by clenching the strap of the injured man’s life vest between his teeth while swimming.

The men were rescued from the South Pacific island several days later after JFK sent a coconut shell seeking help.

The strong impact during the Navy patrol boat’s collision (likely) further aggravated JFK’s lower back pain.

JFK was later awarded a Purple Heart and the Navy and Marine Corps Medal for his ‘extremely heroic conduct’ in the Solomon Islands.

A movie called ‘PT 109’ was released in June 1963, only 5 months before JFK was assassinated in Dallas, Texas.

https://www.imdb.com/title/tt0057393/

Four (4) Back Surgeries During 1944 to 1957 

Overview

JFK underwent 4 back surgeries during 1944 to 1957.

Specifically, JFK had an unsuccessful discectomy operation in 1944, less than a year after his boat collision.

Ten years later, JFK underwent a failed spinal fusion via metal plate implant.

Sadly, both spinal operations led to even more pain and complications, with the second surgery almost leading to JFK’s death.

A 3rd back operation was done to remove the metal plate that had been unsuccessfully implanted only months earlier.

A 4th and final back operation was done in 1957 to drain and surgically remove an abscess that had formed along the surgical scar on JFK’s lower back.

Details below.

JFK’s 1st Back Surgery (23 June 1944)

JFK underwent his first spine surgery involving a left L4-L5 laminotomy* and L5-S1 discectomy** on 23 June 1944.

Two (2) weeks later, JFK’s excruciating back pain returned, together with severe muscle spasms in his lower back while walking.

Highly disappointed with the results of this back operation, JFK wrote:

‘In regard to … my operation … I think the doc should have read just one more book before picking up the saw’ (Pait & Dowdy, 2017).

JFK relied on crutches, wore a back brace, had daily physiotherapy and took pain medication for the next 10 years (when not in public) (Staedter, 2011; Volpe, 2017).

JFK’s 2nd ‘Promising’ Back Surgery … The One That Nearly Killed Him (21 October 1954)

Overview

In 1954, JFK (by now a Senator) was advised that a sacroiliac and lumbosacral fusion surgery might stabilise his lower back.  Specifically, a spinally-implanted metal plate would fuse his vertebrae together.

On the other hand, if he chose not have lumbosacral metal implant and fusion surgery, JFK could end up in a wheelchair for life.  

Due to his never-ending back pain, JFK decided to go ahead with the lumbosacral fusion surgery.  In his mother’s words,

‘Jack … told his father that even if the risks were fifty-fifty, he would rather be dead than spend the rest of his life hobbling on crutches and paralysed by pain.’

(Pait & Dowdy, 2017).

Guess what happened anyway?

After his ‘promising’ back operation, JFK still spent most of his short life hobbling around on crutches, paralysed by pain, only to be ruthlessly shot dead by a crazy gun man.

As he once stated, ‘Life is unfair.’  

Details of the 2nd ‘Promising’ Back Surgery

Although radiographs showed that the (previously operated on) L5–S1 disc was significantly reduced by ~70%, there were no compression fractures nor congenital abnormalities in the vertebrae bone.  

Nevertheless, on 21 October 1954, the renowned Dr. Philip Wilson Sr surgically attached a curved metal plate onto the spinous processes*** on JFK’s vertebrae.  Made of a cobalt-chromium alloy, the metal plate was affixed via 3 transverse locking bolts (plus some wire).  Once firmly secured into position, the metal plate stretched from L5 in the lower back to S2 in the sacrum****.

This metal plate was also called a Wilson plate by its developer, being none other than JFK’s orthopedic surgeon, Dr. Philip Wilson Sr.

(See paper by Pait & Dowdy, 2017 that includes images of a Wilson plate.)

Disastrous Post-Surgery Results Including Septicaemia, Staphylococcal Infection and Coma

Immediately following back fusion surgery on 21 October 1954, JFK knew something had seriously gone wrong.  JFK’s medical issues including back pain went from bad to worse. 

JFK developed high temperatures, urinary tract infection and septicaemia before falling into a coma.

A priest was urgently called to his bedside to deliver the last rites of the church.  Those nearest and dearest to JFK were no longer confident that he would survive.

When JFK finally did awaken from his coma, a serious staphylococcal infection had developed at the site of incision.

Quoting JFK’s friend (in italics), there was an ‘open, gaping, very sickly looking hole’.

Quoting another friend, ‘the area where they cut into his back never healed.  It was oozing blood and pus all the time.  It must have been painful beyond belief … It was an open wound that seemed to be infected all the time.  And now and then a piece of bone would come out of the wound.  His pain was excruciating’ (Pait & Dowdy, 2017).

Meanwhile, public awareness of JFK’s post-operative dramas was kept to an absolute minimum.

Survive he did … but only just (Pait & Dowdy, 2017).

JFK’s 3rd Back Surgery (10 February 1955)

It would be another 6 – 7 months before JFK was finally able to return to his duties as a Senator in May 1955.

However, prior to returning to work, JFK had to endure yet another back operation.  This 3rd back operation was done to surgically remove the Wilson plate that had been implanted only months earlier.  Sadly, a life-threatening abscess had formed around this metal plate.

Post-3rd Back Surgery

JFK remained heavily medicated throughout failed back surgery in 1954 and the follow-up surgery in 1955 (that reversed its disastrous results).  JFK was hospitalised no less than 9 times during the next 2 years.  Needless to say, JFK’s severe back pain continued to haunt and torture him.

JFK continued to wear his back brace and use his crutches (the latter, when not in public view).

JFK received alternative treatments including multiple hot baths daily, swimming, massage therapy, muscle strengthening exercises including lifting weights and heat therapy.  JFK also commenced procaine trigger point injections for myofascial pain (more later).

JFK’s 4th and Final Back Surgery (13 September 1957)

A large Staphylococcus aureus-induced abscess was discovered on JFK’s lower back along the site of the surgical scar almost 3 years after his disastrous back surgery in 1954.  This abscess had to be drained and surgically removed during a 4th and final back surgery in 1957 (Dallek; Baggaley, 2017; DeCosta-Klipa, 2017; Pait & Dowdy, 2017; Volpe, 2017).

A PHILOSOPHICAL QUESTION ABOUT ‘THE ELEPHANT’ IN THE WHITE HOUSE (aka JFK’s CHRONIC BACK PAIN)

Prelude to a Philosophical Question

Why did JFK have to hide his suffering due to severe back pain from the media and the voters?

Quoting historian David Nasaw,

[Voters] largely knew nothing of his illnesses and chronic pain … They were instead presented with the portrait of a superbly healthy young man, an athlete, a veteran, a smiling, affable, dynamic, energetic, youthful, handsome American with a smiling, healthy, athletic wife, parents, brothers, and sisters.’  

Quoting Justin T. Dowdy, MD,

‘The most surprising finding … was the overall amount of severe pain JFK endured throughout his short life and, frankly, how he was able to hide his pain and medical ailments from the general public so well’ (Science Daily, 2017, for Pait & Dowdy, 2017).

In actual fact, JFK would scream out in pain during injections of procaine (up to 8 injections at a time) to numb the muscles deep inside his painful back.  JFK literally had 100’s, if not 1,000’s, of procaine injections from 1955 to 1961 (Pait & Dowdy, 2017).

JFK would take up to 8 different kinds of medication a day including a wide assortment of painkillers (e.g. codeine, Demerol, narcotics, methadone, ethyl chloride spray, methamphetamine derivatives, hydrocortisone, anti-anxiety drugs, stimulants (Ritalin), sleeping pills and hormones).  The list goes on and on.

JFK could not even put a sock or a shoe on his left foot without assistance.

Despite desperately wanting to, JFK could not even pick up his own children.

While JFK never complained openly about his back pain, he once stated (as already noted), ‘Life is unfair.’  

Despite JFK also adding, ‘Some people are sick and others are well’, the latter was usually suppressed in media. 

Instead, the public was led to believe that JFK’s back problems were caused by war injuries suffered while in the line of heroic duty when his boat, PT-109, was sunk in World War II.

Meanwhile, at least 10 boxes of X-rays were done in a desperate attempt to find the true cause for JFK’s back pain (DeCosta-Klipa, 2017).

 

Without a shadow of a doubt, JFK was the most powerful man in the free world from 1961 until his cold-blooded assassination in 1963.  JFK remains one of the most influential and popular presidents in American history.

Not only are 100’s of places in the US named after JFK, but 72 streets and locations in (West) Germany also received Kennedy’s namesake following his death.  Many other countries in the world also renamed streets, parks, schools and other places after JFK.

By renaming places and streets after him, JFK’s memory lives on forever (Kirk et al, 2013; Milbradt, 2017, in German).

A Philosophical Question

Would public knowledge of his severe and ongoing back pain have diminished, and even nullified, his chances of being voted as the US’s 35th president?

If yes, why??

How far have we come today?  Are today’s leaders ‘allowed’ to admit to suffering from chronic pain (if any)? Or would this be viewed as a sign of weakness that could only lead to career suicide?

On the other hand, what would happen if our great leaders were ‘allowed’ to openly discuss any sufferances due to chronic pain?  

Wouldn’t this lead to greater awareness of the problem of pain in our global community?

If yes, wouldn’t this lead to increased allocation of resources for pain research?  

If yes, wouldn’t this be a good thing for humanity?

I hope you enjoyed today’s blog post on President Kennedy and his severe back pain.

Sabina Walker, Blogger of Pain Matters (in WordPress)

 

KEY

* Laminotomy involves the surgical removal of a large part of the lamina (i.e. normal bone) from the vertebra.  This enables the surgeon to access the herniated disc.

** Discectomy involves the surgical removal of the herniated disc in the spine.

*** Spinous processes are bony projections (ridges) off the back of each vertebra that can be felt through the skin.

**** The sacrum is the triangular bone at the bottom of the spine.

REFERENCES

MEDIA

(1) Dallek, Robert. The Medical Ordeals of JFK. The Atlantic.

https://www.theatlantic.com/magazine/archive/2013/08/the-medical-ordeals-of-jfk/309469/

(2) DeCosta-Klipa, Nik. JFK had 5 brushes with death before that open-air Dallas car ride. Boston (22 May 2017).

https://www.boston.com/news/history/2017/05/22/jfk-had-5-brushes-with-death-before-that-open-air-dallas-car-ride

(3) Altman & Purdum. In J.F.K. File, Hidden Illness, Pain and Pills. 

https://www.nytimes.com/2002/11/17/us/in-jfk-file-hidden-illness-pain-and-pills.html?ref=oembed

(4A) Evans, Stephen. John F Kennedy: How ‘Ich bin ein Berliner’ gave a city hope. BBC News (25 June 2013).

https://www.bbc.co.uk/news/magazine-23029697

(4B) John Fitzgerald Kennedy – Ich bin ein Berliner Speech, June 26, 1963.

http://www.let.rug.nl/usa/presidents/john-fitzgerald-kennedy/ich-bin-ein-berliner-speech-1963.php

(5) Volpe, Kristin Della. John F. Kennedy’s Chronic Back Pain Conflicts Revealed. Spine Universe (27/12/17).

https://www.spineuniverse.com/conditions/chronic-pain/john-f-kennedy-s-chronic-back-pain-conflicts-revealed

(6) Staedter, Tracy. How John F. Kennedy’s Back Pain Affected His Life and Death. Live Science (11 July 2017).

https://www.livescience.com/59764-john-f-kennedy-back-pain-affected-life-and-death.html

(7) Baggaley, Kate. Why doctors are still studying JFK’s chronic back pain – Did his back trouble help kill him? Popular Science (18 July 2017).

https://www.popsci.com/why-are-doctors-interested-in-jfks-back-pain

(8) Allison, Graham. 50 years after Cuban missile crisis: closer than you thought to World War III. The Christian Science Monitor (

https://www.csmonitor.com/Commentary/Opinion/2012/1015/50-years-after-Cuban-missile-crisis-closer-than-you-thought-to-World-War-III

(9) John F. Kennedy. History.

https://www.history.com/topics/us-presidents/john-f-kennedy

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Patching up Pain with a Lidocaine 5% Patch

Dear Pain Matters readers,

Treatment via a lidocaine 5% patch may offer significant pain relief for patients including cancer patients with focal nerve pain.

Specifically, patients with severe and localised nerve pain including one of the following painful conditions may benefit from a lidocaine 5% patch that topically delivers lidocaine:

  • Postherpetic neuralgia and herpes zoster (shingles);
  • Non-diabetic and diabetic peripheral neuropathy;
  • Trigeminal (orofacial) neuropathic pain;
  • Erythromelalgia;
  • Chronic low back pain (Hines et al, 2002);
  • Post-surgical neuropathic pain (e.g. following surgery for cancer or otherwise); and
  • Neuropathic pain directly attributable to cancer.

Lidocaine works by blocking sodium channels including Nav1.7 that underlie many nerve pain conditions (and other mechanisms).  The release of very small amounts of lidocaine transdermally via the patch ensures that motor and cardiac functions remain unaffected.

While topical lidocaine patches leads to pain relief in 29%-80% of treated patients, likely via small-fiber block, it is not clear why lidocaine patches may work better in some patients than in others (Krumova et al, 2012).

The topical lidocaine patch, measuring 10 cm X 14 cm, should only be applied on top of unbroken skin and where the pain is the greatest.  Patches should only be used by patients who are not allergic to local anaesthetics including lidocaine and who are not sensitive to the adhesive material itself.

The recommended maximum daily dose is 3 patches worn simultaneously for 12 hours at a time.  Since the lidocaine patch can only be worn for 12 hours at a time each day, other pain medications may be necessary, especially during sleep.

Lidocaine 5% Patch Treatment for Severe Chronic Pain – Successful Cases

Four Patients with Severe Low Back Pain

Four (4) patients aged 30 to 64 had successful lidocaine 5% patch treatment for severe low back pain as well as leg pain, foot pain (including CRPS, left foot) and/or neck pain.  Their pain included burning and stabbing nerve pain.  Specifically:

(1) A 53-year old woman had severe low back pain since a motor vehicle accident in July 2000.  She also endured right leg pain and some right foot numbness.  The patient said that the lidocaine 5% patch treatment ‘helped about 80%’.

(2) A 30-year old woman suffered low back pain, neck pain and right leg pain including burning and stabbing nerve pain.  She had a lifting and twisting injury in 1996.  The patient stated that her pain had dropped from ‘8’ to ‘5’ thanks to lidocaine 5% patch treatment.

(3) A 64-year old man suffered low back pain after a lifting injury in 1987.  He also suffered CRPS in his left lower leg and foot.  Lidocaine 5% patch treatment offered effective pain relief for his CRPS, left foot, and his painful lower back.  Furthermore, he was able to stop all other pain medication.

(4) A 50-year old woman suffered low back pain and right leg pain including aching and burning pain for 22 years.  Lidocaine 5% patch treatment offered effective pain relief.

There were no adverse effects resulting from lidocaine 5% patch treatment (Hines et al, 2002).   

A Young Patient With Episodic Erythromelalgia In Both Feet

A 15-year old Caucasian girl who suffered disabling pain during episodes of erythromelalgia in both feet derived complete pain relief almost immediately after applying lidocaine 5% patches to the top of both of her feet, both at rest and during almost normal levels of activity.  

m_dce10009f2-3.png

Post-lidocaine patch treatment, the young patient was able to run around the track at school, play soccer, return to her physical education class, march in the school band and walk around the shopping mall for almost an hour.  As long as she did not overdo her activities, she was able to obtain 100% relief during the 12 hours of lidocaine patch use, plus another 2-3 hours after patch removal.  The patient slept without the patches.

Whilst offering complete local pain relief and no side effects, the lidocaine patch was unable to prevent the other symptoms of erythromelalgia from occurring including bright red skin and over-heated feet following physical exertion.

m_dce10009f1.png

(Davis & Sandroni, 2002, including both images).

Two (2) Patients With Nerve Pain       

1st Patient – A 74-Year Old Female Patient With Herpes Zoster (Shingles)

Despite prompt treatment for a herpes zoster skin rash, a 74-year old woman developed stabbing and burning pain in her rash-affected area.  The patient was offered 2 lidocaine patches daily to cover the painful region.  Within 4 weeks treatment, the patient obtained 75% relief from pain caused by her herpes zoster skin rash.  Most of her systemic pain medications were stopped.

2nd Patient – A 56-Year Old Man With Severe Neuropathic Pain Syndrome Following Microsurgery For A Neuroma in Right Foot 

A 56-year old man suffered severe nerve pain shortly after microsurgery to his right foot due to an interdigital neuroma.  His painful symptoms included severe burning pain, mechanical hyperalgesia and allodynia, together with other symptoms.  As a result, he could no longer work, was unable to wear socks and shoes (only sandals) and withdrew from his family and friends.

After applying half of a lidocaine 5% patch daily onto his painful skin region, the patient reported positive results.  After 8 weeks of lidocaine patch treatment, the patient enjoyed an 80% reduction in overall pain levels and consequently returned to work.  There were no side effects and the patients was able to stop all other analgesics (Hans et al, 2010).

Trigeminal (Orofacial) Neuropathic Pain And Lidocaine Patch Treatment

A British study revealed that lidocaine 5% patch treatment led to improved pain levels in 12 of 14 trigeminal pain patients including oral surgery patients.  Nine (9) of the 12 patients were able to reduce or stop their intake of other pain medications.  Given that the majority (12/14) patients with trigeminal nerve pain benefited from lidocaine 5% patch treatment, further studies are warranted (Khawaja et al, 2013).

Cancer Patients And Lidocaine Patch Treatment

A large Australian study in a comprehensive cancer centre revealed that lidocaine 5% patch treatment had a ‘potent analgesic effect’ in 24 of 95 (25%) patients while another 23 patients (24%) reported a ‘partial effect’.  Given that almost half (47/95, or 49%) of all cancer patients with nerve pain benefited from lidocaine 5% patch treatment, further research is warranted (Fleming and O’Connor, 2009).

Current Study Involving Lidocaine Patch for Lower Limb Amputation Pain

A Belgium-based trial is currently recruiting up to 20 patients with pain following above- or below-knee amputation to assess the effectiveness of lidocaine patch treatment for peripherally-mediated phantom limb pain and/or stump scar hyperalgesia (Hatem, 2016).  Stay tuned for updates…

Summary

While lidocaine 5% patch treatment is expensive and there is a small risk of a skin rash, many patients with focal nerve pain obtain significant pain relief from the lidocaine 5% patch, a targeted peripheral analgesic that is non-addictive and safe for long-term use.  

Now that’s a good way to patch up pain!

Sabina Walker

Blogger, Pain Matters

REFERENCES

(1) Davis, Mark D P; Sandroni, Paola. Lidocaine Patch for Pain of Erythromelalgia; Arch Dermatol. Jan 2002;138(1):17-19

doi:10.1001/archderm.138.1.17

http://jamanetwork.com/journals/jamadermatology/fullarticle/478622

(2) Fleming JA, O’Connor BD.

Use of lidocaine patches for neuropathic pain in a comprehensive cancer centre.

(Utilisation des timbres de lidocaïne pour la douleur neuropathique dans un centre d’oncologie)

Pain Research & Management : The Journal of the Canadian Pain Society. 2009;14(5):381-388

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779156/#!po=28.7879

(3) Hans G, Robert D, Verhulst J, Vercauteren M. Lidocaine 5% patch for localized neuropathic pain: progress for the patient, a new approach for the physician. Clinical pharmacology : advances and applications. 2010;2:65-70

doi: 10.2147/CPAA.S9795

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3262358/

(4) Hines R, Keaney D, Moskowitz MH, Prakken S. Use of Lidocaine Patch 5% for Chronic Low Back Pain: A Report of Four Cases. Pain Med 2002; 3 (4): 361-365

doi: 10.1046/j.1526-4637.2002.02051.x

https://academic.oup.com/painmedicine/article-lookup/doi/10.1046/j.1526-4637.2002.02051.x

(5) Khawaja N, Yilmaz Z, Renton T. Case studies illustrating the management of trigeminal neuropathic pain using topical 5% lidocaine plasters. British Journal of Pain. 2013;7(2):107-113.

doi:10.1177/2049463713483459

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590123/#!po=23.6842

(6) Hatem, Samar; A Trial of Lidocaine Patch for Lower Limb Amputation Pain (Trial ongoing since 2016); Brugmann University Hospital

https://clinicaltrials.gov/ct2/show/study/NCT02696720?view=results

(7) Krumova EK1, Zeller M, Westermann A, Maier C. Lidocaine patch (5%) produces a selective, but incomplete block of Aδ and C fibers. Pain. 2012 Feb;153(2):273-80.

doi: 10.1016/j.pain.2011.08.020.

https://www.ncbi.nlm.nih.gov/pubmed/21995882

(8) Devers A, Galer BS. Topical lidocaine patch relieves a variety of neuropathic pain conditions: an open-label study. Clin J Pain. 2000 Sep;16(3):205-8.

https://www.ncbi.nlm.nih.gov/pubmed/11014393

(9) Many Other Lidocaine Patch/Pain Studies Can Be Found Here:

http://www.druglib.com/druginfo/lidoderm/abstracts/

Traditional Chinese Medicine (TCM) For Chronic Pain? Let’s Talk About Corydalis, A Traditional Chinese Herbal Remedy For Chronic Pain

Source of Featured Image:

Courtesy of Shutterstock

and

http://www.medicaldaily.com/chinese-poppy-plant-corydalis-works-chronic-pain-266215

Dear Pain Matters blog readers,

Is traditional chinese medicine (TCM) a treasure box that needs to be opened more fully??

In other words, should more research be done to scientifically explore the hidden treasures of TCM?  If we did this, would we find additional effective pain treatment options not yet offered by conventional medicine?

Consider this ancient, nonaddictive, Chinese herbal remedy for chronic nerve pain that may, at times, offer longer lasting pain relief than opiates:

The roots of a flowering poppy plant called Corydalis yanhusuo (C. yanhusuo; Corydalis) has been used for centuries as a Chinese remedy for chronic pain.  Corydalis is grown in China, Japan and Siberia.  The underground tubers from the Corydalis plant must be harvested, dried, ground, and boiled in hot vinegar before they can be used as a remedy for pain including headaches, back pain, menstrual cramps, chest pain and abdominal pain.

535S18a-i5.jpg

Source of photo showing Corydalis yanhusuo:  

http://www.nature.com/nature/journal/v535/n7611_supp/full/535S18a.html

In collaboration with Chinese scientists, University of California researchers have recently identified and isolated a key pain-relieving compound called dehydrocorybulbine (DHCB) in the roots of Corydalis.  Specifically, basic research showed that DHCB (extracted from the Corydalis tubers) reduced acute pain, inflammatory pain as well as injury-induced nerve pain.  The compound, DHCB, blocks dopamine D2 receptors.

More importantly, the DHCB does not interact with the morphine receptor.  As such, the effectiveness of DHCB will not weaken over time, nor will tolerance, addiction and drug dependence become issues (as often occurs with conventional opiate medicine including codeine and morphine).

Researchers felt that DHCB could offer some relief for low-level chronic pain without the risk of addiction or tolerance following repeated use (Zhang et al, 2014; Ingram, 2014).

Patient experiences with Corydalis yanhusuo extracts:

While not scientifically verifiable, the following (partially copied) user comments are interesting to read:

Refer:

User Reviews & Rating – CORYDALIS

http://www.webmd.com/vitamins-supplements/ingredientreview-415-CORYDALIS.aspx?drugid=415&drugname=CORYDALIS

Quoting comments from a disappointed pain patient:

Patient –

“I took my first capsule this morning and have felt tired, dragged out, strangely a little depressed and above all light-headed–dizzy enough to stumble and fall. If anything, my painful back, hips and knees hurt more today. Obviously I won’t take it again.

Quoting positive comments from people with chronic pain who use Corydalis:

Patient –

“…both knees replaced at the same time, and also suffer from frequent headaches.  I began using this product after my surgery and it has provided me with great relief!  ….easier on my GI system….Love Corydalis!  Been a lifesaver for me!

Patient –

“I have been taking 1-2 capsules a day.  It helps my joint pain considerably which I’ve had for 20 years….”

Patient –

“I have had severe knee pain for several years due to old sports injuries and have began using the Cordyalis 10:1 pills recently. The first day my pain was so subtle that I hardly noticed it at all. Stairs were a nightmare for me, but they are much, much easier to handle. I know that nothing can completely remove the pain I suffer from, but this is positively changing my quality of life!!

Patient –

“I have degenerative disc disease and get spinal headaches from intermittent neck pain. I was instructed by a Taiwanese doctor to take 20g boiled in water from 500cc down to 250cc (about 25 minutes on electric stove med-hi), straining out and discarding the root at the end. I found 20g was too much (I experienced worse spasms), tried 5g, and ended up using 10g per serving, up to twice a day. I found that taking it daily was less effective than taking as needed (was hoping to keep the pain away by taking daily.) When I first used it, it made me “high” like cough syrup. After a few servings, I no longer feel that. It’s probably the most effective thing I’ve taken for the pain (I will not take opioids, which tend to make me sick anyway.) …. The tea from root tastes horrible….”

Patient –

“I have had constant shoulder and neck pain for 2 yrs which also cause headaches and migraines. Muscle relaxers and fiorcet are my daily regimine but still constant pain that made me so tired and energy draining. Since using corydalis i have energy and no shoulder pain.

Patient –

“Has eased my intractable nerve pain.”

Patient –

“Female, 66 – for sciatica. I take the powder: premixed, in hot water – drink it fast so as to obscure the taste. Worked in 30 min. the first time taken. I take it 1/2 hr before eating dinner. I’ve learned to put Stevia in it – helps with the taste.”

Patient –

This stuff works, however, I have only taken it in the powdered form. It tastes terrible … Its hard to figure out dosages. I take two teaspoons per day on most days to augment my pain medication, hydrocodone. It dramatically extends the time the hydrocodone works and seems to add some additional relief. I am concerned about possible harmful effects and standardization of strengths of the herb……

[Blogger’s comments:

Based on above, is it possible that the effectiveness of certain conventional pain medication (in this case, hydrocodone) may be increased, and/or prolonged, through the use of Corydalis?  Further research is warranted.]   

Patient –

I have experience chronic low back pain for about 2 years. The pain is 24/7 and worsens with inactivity or excessive physical fitness. I purchased capsules. The serving size is 8 capsules and I only took 3 and felt amazing relief. I lifted weights today for my legs and shoulders then did 15 minutes of interval sprints and my back feels PHENOMENAL! For $15.99 it is worth the try!….

Patient –

“I have a bulging disk and pain 24/7, at times it feels like to torture. Corydalis has helped the pain a little so my pain level is 4 instead of 7 or 8.

Patient –

“I have had fibromyalgia for 25 years and now suffer spinal stenosis after car wreck 10 years ago. I have found acupuncture and this herb to help the pain and neurological problems.….”

A huge word of caution:

While DHCB is currently not available, TCM practitioners can offer Chinese herbal remedies/extracts that specifically include Corydalis yanhusuo extracts or roots/tubers (as they have already done for many centuries).  Corydalis extracts are also available in Chinese specialist stores and on-line.

However, in Dr Civelli’s words, “DHCB is present in low quantities, but it’s there” (Chia, 2014).

Thus, traditional Chinese remedies that include Corydalis yanhusuo extracts or tubers are certainly worth trying (after discussing with your GP first).  

Please discuss with your GP before deciding to undergo any TCM treatments and/or other alternative/complementary medical treatments (as well as post-TCM treatment, if necessary).

Conclusion:

Increased funding and research into TCM including ancient Chinese herbal remedies for pain are warranted.

In particular, we need to expand research into Corydalis, and its key pain-relieving ingredient, DHCB (as well as research into other effective pain-alleviating remedies offered by TCM).

After all, the best approach is a global and unified approach to the global challenge of chronic pain.

Sabina Walker

REFERENCES

(1) Zhang et al; A Novel Analgesic Isolated From a Traditional Chinese Medicine; Current Biology (20 January 2014); 24(2): 117-123.

doi: 10.1016/j.cub.2013.11.039

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912990/

http://www.ncbi.nlm.nih.gov/pubmed/24388848

(2) Ingram; Pain: Identification of novel analgesics from traditional Chinese medicines; Current Biology (3 February 3 2014); 24(3): R114–R116.

doi: 10.1016/j.cub.2013.12.030

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3980722/

(3A) Plant Used in Chinese Medicine Fights Chronic Pain; Cell Press (2 January 2014).

http://www.eurekalert.org/pub_releases/2014-01/cp-pui122713.php

(3B) Zhang, Wang, et al; Chinese Herbal Compound Relieves Inflammatory and Neuropathic Pain; UCI News (2 January 2014).

http://news.uci.edu/press-releases/chinese-herbal-compound-relieves-inflammatory-and-neuropathic-pain/

(3C) Ericson, John; Chinese Poppy Plant, Corydalis, Works For Chronic Pain; Drugs (2 January 2014).

http://www.medicaldaily.com/chinese-poppy-plant-corydalis-works-chronic-pain-266215

(3D) Chia, Jessica; The Plant That Could Erase Chronic Pain; Prevention (2 January 2014).

http://www.prevention.com/print/health/health-concerns/chinese-remedy-corydalis-pain

(3E) Pain, Stephanie

Painful Progress

Nature (14 July 2016); 535, S18–S19

doi:10.1038/535S18a

http://www.nature.com/nature/journal/v535/n7611_supp/full/535S18a.html

(4) User Reviews & Rating – CORYDALIS

http://www.webmd.com/vitamins-supplements/ingredientreview-415-CORYDALIS.aspx?drugid=415&drugname=CORYDALIS

An Australian Woman With Chronic Back Pain, A Beautiful Neurosurgeon and A 3D-Printed Spine Implant (Plus Other Patients With Custom 3D-Printed Body Parts)

Source of Featured Image:

RMIT University

https://www.rmit.edu.au/news/all-news/2015/august/australias-first-3d-printed-spine-implant/

Dear Pain Matters blog readers,

Is this the title of a new science fiction novel??

“An Australian Woman With Chronic Back Pain, A Beautiful (Neurosurgeon’s) Mind and A 3D-Printed Spine Implant”

No, this is not science fiction….This really did happen!

Welcome to the futuristic world of 3D-printed body parts, and its potential role in reducing chronic pain!

Happily, for Amanda Gorvin, the future is now!

Amanda (38) had suffered persistent and crippling lower back pain for more than 30 years.  Amanda suffered shooting pains and countless sleepless nights due to a deformed lower back vertebra.  She had spent an entire adult life on antiinflammatories, ibuprofen, Nurofen, cortisone injections and physiotherapy.  Amanda’s lower back pain had affected her quality of sleep, resulting in only 3-4 hours sleep a night, as well as lethargy and exhaustion during her waking hours.  By now, her lower back pain adversely affected her social, sporting and sex life.  She was unable to dress herself without exerting a huge and painful effort.  As a result of her lower back pain that limited her physical activity, Amanda gained 30 kg in 5 years.

She finally had enough of her ‘bones rubbing’ in her lower back, causing excruciating pain every time she moved.  One night at 2AM, she dragged herself out of bed and crawled into the kitchen, crying out in pain.  At a loss what to do next, Amanda told her neurosurgeon, Dr Marc Coughlan, several days later, “Marc, I can’t do this anymore.”

Her neurosurgeon replied, “I’ve got this new thing.”

Dr Marc Coughlan and another surgeon collaborated with 3D implant company, Anatomics, and a team of scientists and engineers at RMIT University (Melbourne) to custom design a 3D-printed spinal implant for Amanda Gorvin.  Few international surgeons have done this procedure, and Dr Marc Coughan was the first Australian surgeon to attempt this.  His patient, Amanda, was Australia’s first patient to agree to this.

After explaining the risks to Amanda, Dr Marc Coughlan operated on 3 April 2015 to insert a custom 3D-printed spinal implant into her lower back.

In Dr Coughlan’s words (quoting):

“The beautiful thing when we put the implant in was that it felt like a key going into a lock.  I could actually feel it click into place.  It was so intrinsically stable, it was like a dream for a spinal surgeon.”   

marc 201x214

Dr Marc Coughlan, MBChB, FRACS, FCS

Source:

http://www.coastalneurosurgery.com.au/AboutUs.asp

After her 3D-printed spine implant operation, Amanda stated (quoting):

“I was back at work four weeks after the operation, back in the gym after six weeks,” she says. “I was breathing better, my mind was clearer, I felt lighter. It’s incredible how much influence the spine has on the rest of the body. I remember that pre-surgical pain and now I ­haven’t got one per cent of it. It’s nothing short of miraculous.” As she speaks, Gorvin becomes emotional and reaches for a tissue. “This has absolutely changed my life,” she says.”

376025-e6606ef0-418b-11e5-91d1-7a17ec48b9e9

Amanda Gorvin

Source:

http://www.theaustralian.com.au/news/special-features/d-printing-human-organs-it-suddenly-doesnt-seem-so-far-off/story-fnolgd60-1227482157233

Results like this simply speak for themselves….

Amanda has Dr Marc Coughlan, Neurosurgeon, to thank (for his beautiful mind).  Of course, the idea would not have materialized without the help of the 3D-printing team led by RMIT University Professor Milan Brandt and key staff at Anatomics.  The custom 3D-printed spinal implant literally erased Amanda’s lower back pain (that she had suffered for more than 3 decades).

OTHER PATIENTS WITH CUSTOM 3D-PRINTED BODY PARTS INCLUDING A TITANIUM HEEL, A PLASTIC SKULL AND A TITANIUM JAW JOINT

Len Chandler (71), recipient of a 3D-printed titanium heel:

A 71-year old former builder from Rutherglen, Victoria, Australia, Len Chandler, was facing amputation of his right leg below the knee due to rare cartilage cancer in his right heel.

Luckily, a surgically-implanted 3D-printed titanium heel (the first of its kind in the world) changed his fate for the better.

1421375683017_771

Len Chandler (above), together with replicas of his 3D-printed heel

Source:

China Daily Asia

http://www.chinadailyasia.com/asiaweekly/2015-01/16/content_15214917.html

After surgery for his 3D-printed heel implant, he stated (quoting):

“I’ve got no irritation or pain or anything from that.  It just fits perfect, I couldn’t asked for anything better.”

A 22-year old Dutch woman, recipient of a 3D-printed near-entire plastic skull:

A Dutch woman (22) suffered from severe headaches, loss of vision and compromised motor coordination as a result of abnormal skull thickening.  Without drastic intervention, she was facing further brain function loss, ongoing severe headaches and an early death.

Her doctors surgically implanted a near-entire plastic skull, custom 3D-printed by Anatomics.  The operation was a huge success.  Three (3) months after her surgery, the woman’s severe headaches have disappeared and she fully regained her vision.

140327-science-3d-printed-skull_e8f32032da2f37a65e83ba184442e287.nbcnews-ux-600-480

Above, 3D-printed plastic skull

Source:

http://www.nbcnews.com/science/science-news/medical-first-3-d-printed-skull-successfully-implanted-woman-n65576

Richard Stratton (32), recipient of a 3D-printed titanium jaw joint:

Richard Stratton, a 32-year old Melbourne-based psychologist, received a 3D-printed prosthetic jaw implant on 23 May, 2015.

Part of his jaw had never grown properly ever since he was knocked in the jaw during childhood.  In fact, he was missing part of his jawbone including the left condyle (part of the temporomandibular joint, or TMJ).  This caused significant strain on the right side of his jaw and also left him with a crooked smile.

In recent years, he suffered sharp pain while moving his jaw, biting, chewing and eating and he also had painful headaches at night.  He was unable to fully open his mouth.

Dr George Dimitroulis (Oral and Maxillofacial Surgeon, St Vincent’s Hospital, Melbourne) designed a prosthetic jaw that included a 3D-printed titanium jaw joint implant and a 3D-printed plastic jaw joint (in collaboration with Dr Ackland and team, Department of Mechanical Engineering, The University of Melbourne).  The entire process from the initial design stage to the 5-hour operation took 3 years.

The plastic jaw TMJ is (likely) the first 3D-printed jaw joint in the world.

Quoting Dr Dimitroulis:

“The excitement was unbearable I think, just at the last minute we thought it just wasn’t going to fit in but it just slid in nicely.”

“It just clipped in.”

He has reason to be “very proud” that 3 years of hard work had resulted in such positive results.

7b57e551f0f7fcf6b2bcb1e2c5b5faa857feaf7cf02a1813a3445495ac4c.jpg

Above, Dr George Dimitroulis (Oral and Maxillofacial Surgeon, St Vincent Health)

Source:

https://pursuit.unimelb.edu.au/articles/the-jaws-of-life

One month after the post-surgery pain and swelling (that lasted a few days) subsided, Richard Stratton said he was able to open his mouth wider than before the surgery.  Several months later, he was chewing on both sides and eating normally.  His painful headaches at night also disappeared.

For more details, please view video by The University of Melbourne called:

‘When BioMechanics Colllides with Medicine’

Quoting Richard Stratton (several months after his operation):

“The joint has been working really, really well. It really has improved my quality of life.”

6536892-3x2-940x627.jpg

Above, Richard Stratton’s 3D-printed titanium jaw part (attached to a 3D printed version of his skull)

images.jpeg

Above, ‘Before Surgery’ (left) and ‘After Surgery’ – with surgical scar visible on jawline (right)

Source:

http://www.abc.net.au/news/2015-06-20/melbourne-man-receives-titanium-3d-printed-prosthetic-jaw/6536788

Patients with severe TMJ pain caused by jaw joint osteoarthritis, cancer, trauma or congenital abnormalities may benefit from 3D-printed titanium jaw joint implants.  Such implants may lead to complete restoration of jaw function plus significantly reduced/nil jaw pain.

SUMMARY

Here’s to the future that may include 3D-printed body implants to help reduce chronic pain!  Happily, for some, the future is already here!

Sabina Walker

REFERENCES

(1A) The Shape of Things to Come

Richard Guilliatt; The Australian (The Weekend Magazine) (pages 10-14); August 15-16, 2015

http://www.theaustralian.com.au/news/special-features/d-printing-human-organs-it-suddenly-doesnt-seem-so-far-off/story-fnolgd60-1227482157233

(1B) Surgeons Print Out 3-D Body Implant

Richard Guilliatt; The Australian (page 3); August 15-16, 2015

http://www.theaustralian.com.au/news/health-science/surgeons-print-out-3d-body-implant-for-spinal-operation/story-e6frg8y6-1227484209363

(2) Joint Effort Produces Australia’s First 3D Printed Spine Implant

RMIT University; August 17, 2015

https://www.rmit.edu.au/news/all-news/2015/august/australias-first-3d-printed-spine-implant/

(3) Anatomics

http://www.anatomics.com/company/news/

(4A) 3D Printing: Rare Cancer Sufferer, Len Chandler, Back On His Feet After Receiving Titanium Printed Heel
Lisa Tucker; ABC News; 22 Oct 2014

http://www.abc.net.au/news/2014-10-21/rare-cancer-sufferer-receives-3d-printed-heel/5830432

(4B) Close to the Bone
Karl Wilson (in Sydney, Australia); China Daily Asia; 16 January, 2015

http://www.chinadailyasia.com/asiaweekly/2015-01/16/content_15214917.html

(4C) World First Heel Implant at St Vincent’s Private Hospital Melbourne 7 News

(5) Medical First: 3-D Printed Skull Successfully Implanted in Woman
James Eng; NBC News; 27 March 2014

http://www.nbcnews.com/science/science-news/medical-first-3-d-printed-skull-successfully-implanted-woman-n65576

 

(6A) The Jaws of Life

Val McFarlane; The University of Melbourne; 24 September 2015

https://pursuit.unimelb.edu.au/articles/the-jaws-of-life

(6B) Titanium, 3D-Printed Prosthetic Jaw Implanted in Melbourne Man in Australian First Surgery

Stephanie Ferrier; ABC News; 22 Jun 2015

http://www.abc.net.au/news/2015-06-20/melbourne-man-receives-titanium-3d-printed-prosthetic-jaw/6536788

Ziconotide (Prialt) User Reviews – The Fine Line Between Maximizing Pain Relief and Minimizing Severe Adverse Effects

Source of Featured Image:

https://en.wikipedia.org/wiki/Conus_magus

Dear Pain Matters blog readers,

Many nerve pain sufferers say they have tried EVERYTHING, to no avail.

The good news is that some patients with severe, intractable nerve pain obtain pain relief following Ziconotide (Prialt) treatment (while, sadly, others don’t).

Ziconotide (Prialt) is synthesized based on the venom of a marine snail called Conus magus.

For further details on Ziconotide (Prialt), please refer to literature including a paper by McGivern (2007).  You are also welcome to go to my earlier blog post, here:

https://painmatters.wordpress.com/2014/11/10/ziconotide-prialt-for-nerve-pain-including-crps/

BRIEF ANALYSIS OF ‘PRIALT USER REVIEWS’

An internet site called ‘Prialt User Reviews’ offers a collection of patient reviews:

http://www.rxlist.com/script/main/rxlist_view_comments.asp?drug=prialt&questionid=fdb92576_pem

The ‘Prialt User Reviews’  show that Prialt treatment may be a ‘hit-or-miss’ treatment for many patients with severe nerve pain.  Thus, while some severe nerve pain sufferers obtained significant pain relief from Prialt (that outweighed its side effects), many others were worse off due to Prialt’s severe side effects.

SOME POSITIVE ‘PRIALT USER REVIEWS’ 

A patient with low back pain commented:

“I did not realise how much this new drug helped me until I had to come off of it for a short period of time.”

Another pain patient wrote:

“I developed a BAD reaction to this med, even though it worked great for my pain.  Now I have all kinds of allergies and having trouble finding a med that is as effective without side effects.

A pain patient with 2 spinal operations wrote:

“Since I’ve had the pump, the pain is no longer in my legs.  I will be ever thankful to that little snail and its ooze.  God bless researchers.” 

A patient with chronic pain for over 10 years had a positive experience with Prialt.  In her own words, “…since I have been on these meds, things have turned around for the good….I thank God every day that I have my life back….”

Another pain patient stated:

“This for me has been a “life changing” positive experience.  I have been on the drug well over six years with NO side effects whatsoever….This has changed my life for the better as I am now able to do volunteer work…I had my occipital nerves sectioned as well as steroid-induced osteoporosis, so totally endorse this drug for neuropathic pain.”

A cancer survivor with chronic pain stated:

“My pain was due to cancer which is now in remission.  My first pain clinic pushed me too hard to increase Prialt and side effects were bad!  I heard music and it felt like my teeth were melting!  I kept reducing my Prialt until it was mixed w/a narcotic and that combination made my pain level from a constant 9 … to a livable 5-7!  This is the lowest my pain level has been in 9 yrs! … I am finally pleased with my Prialt and my Life.  After 8 years of trying different combinations and Prialt Levels and 1 pump reposition and 1 pump replacement, I am finally able to Live.  I can meet my husband for lunch most days ….Yes, it took several years to get the level just right and the side effects lower, but it was totally worth it to finally have a more normal and happy life!”

SOME NEGATIVE ‘PRIALT USER REVIEWS’ 

A patient with CRPS (RSD) for 8 years stated that Prialt is thebest at relieving pain BUT it’s not worth the side effects I get….several bad experiences and I always stuck it out since the relief was so good.  It’s no longer worth it.  I have no life, hardly leave the house and spend most of the time talking to myself’.

A former user said This medicine did help my nerve pain (moderately) but the memory loss is horrible.  I lost 50 lbs in 6 months.  I can’t concentrate well, agitated, no motivation, have extreme anxiety……I started having a pungent perfumey-like smell constantly, which started to become an obsession…..led up to a full blown manic episode …no sleep….thoughts of not wanting to live anymore….border-line psychosis….I’ve been off this medication for over 2 weeks now but still suffer from some of these side effects…..”

A pain patient who unsuccessfully underwent a Prialt trial wrote:

“…I started an IT pump trial with Prialt…..and the med was increased slowly (started out with about 4 mcg/day.  Increased eventually to about 7 mcg/day).  With the first increase, my pain improved (decreased).  With each successive increase of Prialt, my pain increased and so did side effects.  I became extremely dizzy, nauseated (with vomiting), confused, lethargic, my vision blurred, and I was unable to do anything but lie in bed and wonder what Prialt was doing to my brain…..”

IS DOSAGE AN ISSUE?

I find it very interesting that nerve pain levels did improve in several patients following Prialt treatment, despite severe side effects (see above).

Is it possible that the intrathecally-administered (spinally-administered) dosages were simply too high for those who suffered severe side effects, post-Prialt treatment?

Would nerve pain patients benefit from lower Prialt dosages for longer periods (before deciding to increase dosages)?  

Consider this example:

A 59-year old female with severe pain due to chronic trigeminal neuralgia (TN) pain underwent a single-shot trial of intrathecal ziconotide.  To reduce any adverse effects, the ziconotide dosage was intentionally kept very low, at only 1 mcg.  The patient’s TN pain levels dropped from ‘9’ to ‘6’ (that, unfortunately, returned to her original pain levels of ‘9’, 4 hours-post-ziconotide).  As such, 1 mcg/day ziconotide was added to her intrathecal combination of morphine and clonidine.  At this low dosage, the patient reported significant relief from TN, and (importantly!) no side effects (Michiels et al, 2011).

According to Webster (2005), to minimise adverse effects while also maximising pain relief, initial dosages must be very low and titrated very slowly.  Thus, for many patients, there is a fine balance between minimal adverse effects and maximal pain relief (Webster, 2005).

Ongoing studies are warranted to ascertain why Prialt treatment offers pain relief (with minimal side effects) for some nerve pain patients, but not for others.

Many patients had to stop using Prialt due to extreme, horrific, and intolerable side effects that included severe mental impairment, psychosis, personality changes, memory loss, hallucinations, minor to severe swelling of joints, tremors, paranoia, pain, bad mood swings, problems with sleeping, hearing loud music 24/7, confusion, anxiety attacks, depression, suicide risk, severe sinus infection, slurring speech, severe neurological symptoms, vision problems, severe weight loss, burning skin/electric shock sensations and allergies.  NB It is not clear whether some of the aforementioned side effects were solely caused by Prialt and/or due to other unknown factors.  Further studies of Prialt’s side effects are warranted.

Many studies into other novel drugs are underway (more later).

Wishing all pain patients less suffering and more hope.

Sabina Walker

PS  Please read the entire Prialt Patient Information Including Side Effects sheet before deciding to use Prialt.

http://www.rxlist.com/prialt-drug/patient-images-side-effects.htm

Also (quoting):

“Patient Comments are not a substitute for professional medical advice, diagnosis, or treatment…..”

http://www.rxlist.com/script/main/rxlist_view_comments.asp?drug=prialt&questionid=fdb92576_pem

PPS  It is important to note that not all Prialt users will offer feedback (positive or otherwise).  Furthermore, human nature tends to focus on the negative, rather than on the positive.  It is possible that many who obtain pain relief from Prialt choose not to post comments, while others who suffered severe side effects due to Prialt may offer feedback (to help others).

REFERENCES

(1) McGivern; Ziconotide: a review of its pharmacology and use in the treatment of pain; Neuropsychiatr Dis Treat. 2007; 3(1): 69–85.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654521/

(2) RxList – The Internet Drug Index

Prialt User Reviews

http://www.rxlist.com/script/main/rxlist_view_comments.asp?drug=prialt&questionid=fdb92576_pem

(3) For more information on Prialt, please refer to:

http://www.rxlist.com/prialt-drug/consumer-uses.htm

http://www.rxlist.com/prialt-drug/patient-images-side-effects.htm

http://www.prialt.com

(4) Michiels et al; Trigeminal neuralgia relief with intrathecal ziconotide; Clin J Pain 2011; 27:352-354.

http://www.researchgate.net/publication/51052321_Trigeminal_neuralgia_relief_with_intrathecal_ziconotide

(5) Webster; Ziconotide in Complex Regional Pain Syndrome (2005)

http://rsds.org/ziconotide-in-complex-regional-pain-syndrome/