Chronic Pain: A Disease of the Brain?

We need to understand the importance of the brain and patient's pain and try to take steps to figure out in an individual patient to what degree is the brain driving their pain and to what degree is the body driving their pain. Because in some sense, the treatments we use to target the brain are...

Central Sensitization and Ketamine Infusions

Unfortunately, central sensitization is one of those conditions that's really not very well understood by most practitioners. It's not something that's taught in medical schools, it's not even been something that's been focused on in residency or fellowship programs. So, what's central sensitization...

Interprofessional Education for Pain Practitioners

Interprofessional education is critically important, and accrediting organizations of schools of pharmacy, nursing, medicine, social work, and so forth, I have recognized this. So there's a move afoot to incorporate interprofessional education in all of our professional curricula. It's critically...

Getting the Most from POLST

Many clinicians still haven't heard about the concept of Physician Orders for Life-Sustaining Treatment or POLST. Some states call it POST or MOST. But they all basically mean the same thing. What we're trying to do is get patients to play an active role in the decision-making about their future...

Prescribing Buprenorphine for Chronic Pain

I think that buprenorphine actually should be one of the first line opioids. Pharmacologically, it's really a different animal. It's in the same kingdom, but just a different animal. Buprenorphine is available in two products that are specifically FDA approved for pain. Belbuca, which is the buccal...

Spinal Manipulative Therapy

The research has been interesting because obviously the debate hasn't been resolved, but it's becoming refined enough now that I think there are some key bits of information that we can get move on in future studies that will help improve clinical practice and help us understand what type of benefit...

Are Botulinum Toxins Effective as Pain Therapy?

The main mechanism of action of botulinum toxins that's been well established is the inhibition of the release of acetylcholine from the presynaptic terminals. This action caused in the affected organ, typically in most cases muscle, is the weakening of contraction of the muscle and that could be...

Pain and Depression: Looking Beyond the Disease

I think the essence of how to move forward in treating these comorbid conditions is to become more specific in how we define depression. It’s a word that is general, has a lot of different meanings, and when you think about it from a clinical perspective, there really are many different types of...

Managing Pain in Older Adults

There are some common pain complaints that you’ll see in the elderly, such as sacroiliitis or chronic low back pain that might be due to facetogenic osteoarthritis. These are conditions that we can see anywhere from 25% to 40% of patients, and even more so in the elderly. Looking at older patients...

Risk Management for Prescribing Clinicians

It is possible to provide the best care for a patient and protect yourself from criminal and civil liability. In fact, when you do one right, you do the other right as well. Typically you want to look for three things as a prescriber of any controlled prescription medication, opioid or otherwise...