Clinical research of Opioid Therapy for Chronic Pain

Opioid pain medications like OxyContin, Vicodin, hydrocodone, oxycodone, Duragesic, fentanyl, morphine, etc., are considered to be one of the most potent analgesics. These medications may be available in a variety of forms like tablets or liquids to be taken orally or may also come as opioid injections or patch administrations. These drugs are used to treat moderate to chronic symptoms of pain. Since opioids have narcotic properties, serious side effects may result if used incorrectly. Seek the help of reputable doctors like San Diego pain management doctors for use of opioid medications.

Opioid Therapy for Chronic Pain

What is the mechanism of working?

Clinical research on opioid therapy for chronic pain

All compounds that bind to opiate receptors are referred to as opioids. Opioids can be derived from naturally occurring opiates like heroin from morphine or be artificially synthesized in the laboratory like fentanyl and methadone. Opioids bind to opioid receptors which are widely distributed. The receptors responsible for pain modulation are located in cells of both the central and peripheral nervous systems. The opioid drugs compete with the endogenous endorphins of the body in binding to these receptors. Such binding suppresses the strength of the pain stimulus which reaches the brain. This results in decreasing your sensation of pain.

Clinical research on opioid therapy for chronic pain

Starting from the 20th century, a number of major advances have been made in the use of opioids for chronic pain management. These included the attempts to control opioid distribution by several countries, the discovery of endogenous opioids and the recognition that opioids can be effectively used in alleviating the symptoms of pain. There was also a huge controversy surrounding the long term use of these drugs as professionals believed it could lead to addiction and misuse of these narcotics. However, since the 1990’s, the popularity of opioid medications and its involvement began to rise gradually and this trend continues till this date. Unfortunately, the rise in medical use of this class of drugs has been accompanied by an increase in its non-medical abuse. Still, according to reports by pain specialists, chronic pain can be handled quite effectively using opioid medications. Studies have been conducted to compare the efficacy of opioid pain medications versus that of the non-opioid ones and it has been found that ‘weak’ opioids are not as effective as the relatively ‘stronger’ ones. Some reports also show little or no evidence in support of these pain medications in treating back pain.

Side effects

Opioid medications are not available as ‘over the counter’ drugs at pharmacies and need to be prescribed by a doctor for purchase. It is the sole responsibility of your doctor to regulate the dosage of the medication. Opioids may be administered by registered practitioners like San Diego pain management doctors at regular intervals over a period of many days to treat chronic pain or as a single dose to treat a sudden flare of pain. Some of the common side effects of opioid medications include:

  • constipation, nausea and vomiting
  • drowsiness
  • opioids can be dangerous if used with alcohol, sleeping pills, antidepressants or antihistamines
  • opioid dependence or addiction leading to withdrawal symptoms when attempting to overcome addiction.

Occipital Nerve Block Injection by Pain Doctors San Diego

What is an occipital nerve block?

An occipital nerve block is a type of injection by pain doctors San Diego using steroids or other medications around the occipital nerves which are located on the back part of the head, right above the neck.
Occipital Nerve Block San Diego

What does the occipital nerve block do?

The occipital nerve block is a type of steroid injection used to reduce swelling or inflammation of tissue around your occipital nerves. This can help to reduce pain and any other symptoms which might be caused by inflammation or irritation in your nerves or surrounding structures. In many cases, headaches in the back part of the head, including tension headaches and regular migraines can be alleviated with the use of occipital nerve block

How long does the process take?

This process takes a few minutes at a pain clinic in San Diego for the actual injection.

What is injected?

With an occipital nerve block, the injection contains a local anesthetic used to numb the pain and a steroid medication intended to allow the anesthetic to work for a longer period of time.

Does this process hurt?

Occipital nerve stimulator San DiegoThe occipital nerve block involves a large needle which is inserted by a pain doctor in San Diego into your deeper tissue. It is this which causes the most amount of pain for patients. The skin and the deeper tissue through which the occipital nerve block will be inserted are numbed though, before the procedure, using a local anesthetic. This will help to alleviate any discomfort felt during the procedure. In this case, patients do not require general anesthesia, but rather, they use the local anesthetic.

How is the process performed?

This process is performed at a pain clinic in San Diego with the patient either lying down or in the sitting position. The skin and any hair on the back of the head will be cleaned using antiseptic after which the injection itself will be performed.

What is to be expected after the occipital nerve block?

Immediately after the occipital nerve block you will feel as though your pain is entirely gone, but this is likely due to the anesthetic. This will wear off after a few hours. Once that is done, you may feel sore for a day or two, the result of the mechanical process used to insert the needle. One the third day you will begin to feel pain relief.

What can I do after the procedure?

After the occipital nerve block you should rest. Many patients are able to drive themselves home from the pain clinic San Diego but it is advised that patients remains in the resting area for several hours directly after the procedure before doing this. You might benefit from applying ice to the affected area. You are able to perform whatever activity thereafter that you can tolerate. Unless you had complications during the procedure you should be able to go back to work the day after the occipital nerve block. The most common problem immediately after is a sore feeling at the incision site.

How long will the medication last?

The medication in the occipital nerve block will begin to work after three days and the effects can last up to a few months.

Reflex Sympathetic Dystrophy (RSD) Treatment With Pain Doctor San Diego

Reflex Sympathetic Dystrophy (RSD) Treatment With Pain Doctor San Diego

What is Reflex Sympathetic Dystrophy (RSD)?

Reflex sympathetic dystrophy (RSD) is a condition that is characterized by a group of typical symptoms, including pain, tenderness, as well as a swelling associated with varying degrees of warmth and coolness, shiny skin, sweating, flushing, and discoloration. Reflex sympathetic dystrophy (RSD) is also referred to as, the shoulder-hand syndrome or complex regional pain syndrome. It is a term used to describe a form of Complex Regional Pain Syndrome (CRPS). There are two types of CRPS, Type I and II. Both of these conditions result in chronic pain; however, the main cause of pain is much different. Type I CRPS (Complex Regional Pain Syndrome), is initiated by an injury in the tissue where there is no nerve injury, while Type II CRPS refers to the incidences where a high-velocity impact such as that from a bullet wound is associated with nerve injury.

What are the Causes of Reflex Sympathetic Dystrophy (RSD)/CPRS?

Pain Clinics San DiegoThe major cause of RSD is not known, but the condition is known to occur as a result of malfunctioning of the sympathetic nervous system. The theories behind this include irritation and abnormal excitation of the nervous tissue, resulting to abnormal impulses alongside the nerves that affects the blood vessels and the skin. In most cases, RSD comes after a trauma attack, therefore, some of the conditions that may trigger RSD include; fractures, sprain, damage to the blood vessels or nerves, surgery and certain brain injuries.

What are the Symptoms of RSD/CPRS?

The onset of RSD symptoms may range from rapid to gradual as the condition does not display all the features. There are three stages of RSD together with their symptoms. These are;
Acute Stage: This occurs from three to six months. The patients will experience symptoms such as flushing, sweating, pain, burning sensation, swelling, blanching, and tenderness.
Dystrophic stage occurs from three to six months. The patients experience early skin changes of shiny and contracture with persistent pain.

Atrophic: may be long-lasting. The patient experience loss of motion and function of the part involved (hand or foot) and thinning of the fatty layers under your skin.

How is RSD Diagnosed?

Pain Medication Management San DeigoRSD is diagnosed as per the clinical features seen previously. Sometimes studying images (x-ray, MRI) or nerve conduction tests may be useful. The diagnosis process will be carried out by a San Diego pain clinic. Blood tests may be recommended by a pain doctor San Diego according to the signs and symptoms. Nuclear bone scanning may be used in this process. It will help show characteristic uptake patterns. Overall, diagnosis is thought to help prevent progression of the syndrome.

Is there Treatment for RSD?

Well, there may be no cure for this condition but there is a treatment for such. The objective of the treatment by a pain doctor in San Diego is to help relieve painful symptoms so that the patient can resume their normal activities. Response to treatment of RSD is successful in the earlier stages as compared to the later stages.
The most appropriate treatment include;
• Use of cool and moist applications to the affected areas
• Physical therapy that includes gradual exercises helps relieve contractures
• Medication for pain and inflammation
• Other treatments options include amitriptyline, pregabalin, and clonidine.
• For persistent symptoms, prednisone (cortisone) may be used but in high dosage.
• Treatments such as surgically interrupting the nerves of the nervous system may be used to ease pain.

Remember to keep your pain doctor in San Diego informed of any new symptoms and progress so that they can establish a proper treatment program for you. To learn more about RSD, schedule an appointment with your San Diego pain clinic today.

Trigeminal Neuralgia Diagnosed By Pain Management Doctors In San Diego

What is Trigeminal Neuralgia?

Trigeminal Neuralgia is a chronic pain condition or inflammation of the trigeminal nerve that causes facial pain. This condition is referred to as tic douloureux since the intense pain can cause patients to contort their face into a grimace causing the head to move away from the pain, a condition called a tic.
Trigeminal nerve sends impulses of pain, touch, pressure and temperature directly to the brain from areas such as the face, gums, jaw, forehead and around the eyes. The pain caused by trigeminal neuralgia is quite intense and may occur in few hours, minutes or seconds. The outcome can be months or years of attack but in some patients it can be fully controlled.

Trigeminal Neuralgia have been known to affect people of any age, but it is more common in people older than 60 years old. The effects are seen in the right side of the face five times more than the left side.

What Causes Trigeminal Neuralgia?

Headache treatment San DiegoIn the vast majority of the common cases, trigeminal neuralgia is caused by compression of the main nerve to the brain, trigeminal nerve. This nerve is the largest in the skull. This compression is caused by a nearby blood vessel pressing on the main nerve inside the skull.

What are the Symptoms of Trigeminal Neuralgia?

Trigeminal Neuralgia is characterized by a sudden, sharp, electric-like, or stabbing pain that may last for several seconds. The pain mostly occurs on the face and around the eyes, lips, nose, scalp and forehead. These symptoms can be transferred from one person to another by brushing the teeth, touching the face, putting on make-up, swallowing or even feeling just a slight breeze.

Being one of the most painful disorders, the pain is felt on one side of the jaw or cheek though different people experience pain at different times on both sides. The attack result to a sharp pain that may be repeated one after the other. This pain may come and go throughout the day lasting for days, weeks or months. The disorder may be seen to disappear for months or years. It is more frequent in women than men and in rare cases does it affect younger than 50 years of age.

How is Trigeminal Neuralgia Diagnosed?

In diagnosing this condition, your pain management doctor in San Diego will first take a history of the situation and perform a physical examination which should be normal. The main area of test is muscle weakness and presence of corneal reflex controlled by V1. V3 is in control of chewing, and there should be no existence of muscle weakness. When the cornea is touched, the eye should blink in response. The two discoveries must be normal if not, the treatment for trigeminal nerve should begin.

Some pain management doctors in San Diego may order for a Magnetic Resonance Imaging (MRI) to help in the diagnosis of other conditions that may cause trigeminal neuralgia. This disorder is diagnosed based on the description of the patient’s symptoms.

How can Trigeminal Neuralgia Be Treated?

Trigeminal Neuralgia is a long term condition. It can be managed through treatment to some degree. The first treatment to be administered by a pain clinic San Diego should be with an anticonvulsant medication (mostly used to treat epilepsy) called carbamazepine. This medication should be taken several times in a day, with an increase of the dose over the course of few days or weeks so that the medication can build up in your bloodstream.

Migraine Treatment San DiegoTrigeminal neuralgia can also be treated with antiseizure drugs including Neurontin (gabapentin) or Tegretol (carbamazepine). Other medication like Depakote and Klonopin may also be quite effective when used in combination with other drugs to achieve pain relief.

If the treatments turn out to be ineffective, neurosurgical procedures are available to relieve pressure on the nerves and also reduce the amount of sensitivity on the nerves. Some patients have shown successive or reduced pain with the help of medical therapies such as chiropractic treatment, acupuncture adjustments as well self-hypnosis.
Well, these treatment options will help you achieve the very best when relieving pain caused by trigeminal neuralgia. To learn more about them, contact a pain clinic San Diego today.