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We know that migraine is a neurological vascular headache and, more importantly, it’s a disease of the brain. That’s basically what we understand now from what we understand about migraine, and it is associated in a number of migraine patients with central sensitization. That means that the pain...
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Postoperative pain in older adults is probably underappreciated, in the sense that many clinicians are hesitant to treat with opioids due to the risk of respiratory depression. However, what we’ve learned is that the inadequate use of opioids actually can lead to greater pain postoperatively in...
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Because patients in palliative care are often on so many medications, the clinical picture’s always changing. Their organ function changes, they have low protein stores sometimes that affects the way drugs interact, and many patients have different distributions of enzymes. A lot of the major drug...
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The common adverse effects of opioid therapy include nausea and vomiting, and, of course, constipation. Sedation, also, although this could be the result of pain-induced sleep deprivation, and now that you’re treating the pain, they’re catching up on their sleep. Generally, that gets better over the...
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We have found that even subclinical levels of anxiety and depression can be important in terms of the experience of pain. Another factor that we spend a lot of time investigating in the pain research world is pain-related catastrophizing. It has a pervasive effect on people’s ability to manage pain...
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Diabetes can induce inflammation causing apoptosis, effecting major changes along the entire length of the GI tract down into the colon. Diabetic gastroparesis is the real culprit to the problem that we’re facing with GI pain in these patients. And so our goal is to try to help that symptom by...
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Another common pain syndrome that occurs in older adults is postherpetic neuralgia or shingles pain. This is something that I think is really underappreciated. Essentially, what we’re looking at is that when we’re young, many of us develop chickenpox. As we age, the varicella-zoster virus that...
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The use of marijuana in the treatment of pain conditions is certainly controversial. A number of states have permitted it but it continues to conflict with the federal statute, at least as it relates to the Controlled Substances Act. Now different states are doing it in different ways and so this...
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When you go to the textbooks, historically speaking, there was no mention of pain associated with neuromuscular disorders. Most--including Charcot-Marie-Tooth (which is a hereditary neuropathy) amyotrophic lateral sclerosis, most forms of muscular dystrophy--conditions were described as painless and...
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Low back pain plagues a lot of us, but as we age we’re more prone to the possibility. Low back pain can be caused by numerous different reasons, but mostly it’s due to musculoligamentous strain. Other things can cause it like facet joint problems in the spine, sacroiliac joint disease, piriformis...