Advanced Therapeutics in Pain Medicine

Description

Chronic pain places a tremendous burden on both the patient and the healthcare system. The use of opioids to address pain has resulted in negative impacts. As practitioners work to undo the current opioid crisis, options to manage pain need a new approach. Advanced Therapeutics in Pain Medicine offers pioneering approaches to this intransigent problem providing a functional medicine approach toward treating pain. This book is dedicated to the advancement of non-opioid therapeutic options that offer real progress in reaching a future of better pain management. With an emphasis on pathophysiology, chapters review various types of pain and propose comprehensive treatment plans. These include manual therapies, novel pharmacologic and plant-based approaches, hormonal effects on pain pathways, as well as psychological and lifestyle interventions. Features · Written by a multi-discplinary team, the book provides clinicians with multiple non-opioid treatment considerations. · Enables practitioners to shift from a “one size fits all’ treatment approach toward individualized patient care. · Includes case studies to help educate the provider on how to implement treatment plans in practice. Written by a team of physicians, pharmacists, psychologists and researchers, this important book offers a much needed step forward in optimizing pain care and benefits practitioners who care for patients experiencing chronic pain. Cover Half Title Title Page Copyright Page Contents Preface Editors Contributors Chapter 1 Physiology of the Pain System Peripheral System Axons Central System Spinal Cord Dorsal Horn Excitability Supraspinal Modulation Spinothalamic Tract Brain Considerations Other Considerations References Chapter 2 Neuro–Endocrine–Immune Dysfunction in the Chronic Pain Patient Peripheral Sensitization Mast Cells Peripheral Sensitization Endocrine and Inflammation Autonomic Nervous System and Inflammation More on Peripheral Sensitization DRG Central Sensitization Dorsal Horn Modulation Brain Endocrine System Mitochondria Leptin and Ghrelin Conclusion References Chapter 3 The Opioid Epidemic Opioid Overview Opioid Failure NMDA Pathway Non-NMDR Pathways Genetic Implications Glial Cells Hyperalgesia Endocrine Disruption Autonomic Nervous System References Chapter 4 Endogenous Cannabinoid Receptors and Medical Cannabis Historical Considerations and Clinical Precedent Maintaining Physiologic Balances The Roles of Receptors and Their Ligands A Master Regulatory System’s Mechanism of Action The Ubiquitous Endocannabinoid System Plant-Derived Molecules Engage Endogenous Receptors The Effects of Bioactive Cannabis Plant Chemicals Lead to the Discovery of Receptors and Endocannabinoids Cannabis Modulates Opiates as Endocannabinoids Modulate Endorphins Chemical Complexity of the Cannabis Plant Δ-9 Tetrahydrocannabinol (THC) and Cannabidiol (CBD) FDA Approval of CBD as a Medicine Additional Bioactive Chemical Components in Cannabis Research: Evidenced-Based Data vs. Anecdotal Experiences Institutes of Medicine (1999) National Academies of Sciences, Engineering, and Medicine (2017) Education: Clinical Rationale to Cannabinoids Used as Medicine A Concept Model Describing the Roles of Endocannabinoids Clinical Considerations of Cannabinoid Medicines Dosing Guidance Paradoxical Dose-Dependent Effects on Pain Routes of Administration Risks and Contraindications Contaminants and Testing Contemporary Cannabis and Its Medicalization Legal Status and Accreditable Practice Standards Future Developments The Contemporary Clinician’s Responsible Role References Chapter 5 Sex Hormones and Pain Control Introduction Sex Hormones in Women Sex Hormones in Males Pregnenolone in Women and Men Adrenal Hormones in Women and Men The Effects of Pain on Sex Hormones Hormones and Pain Control Opioid Suppression of Hormones Conclusion References Chapter 6 Managing Pain in the Presence of Autoimmune Disease Etiology of AD and Immune System Dysregulation Genetics and Terrain Plus Environmental Triggers Losing the Immune System Set Point Diagnostic Testing Bloodwork Bloodwork: Interpretation Blood Work: Treatment Salivary Cortisol Salivary Cortisol: Testing Salivary Cortisol: Interpretation Salivary Cortisol: Treatment Diagnostic Stool Analysis Digestive Stool Analysis: Testing Digestive Stool Analysis: Interpretation Digestive Stool Analysis: Treatment Provocative Heavy Metal Test Provocative Heavy Metal: Testing Heavy Metal: Assessment Heavy Metal: Treatment Food Sensitivity Test Food Sensitivity Test: Testing Food Sensitivity Test: Assessment Food Sensitivity Test: Treatment Treatment Based on Empirical Knowledge Rather Than Lab Results Case Studies Potential Testing Limitations Conclusion References Chapter 7 Fibromyalgia: A Comprehensive Perspective What Is Fibromyalgia? Microbiome Composition in Patients with Fibromyalgia Current Treatments for Fibromyalgia Medication Therapies Medications and Experimental Agents under Study for Fibromyalgia Low-Dose Naltrexone Dopamine Agonists Ambroxol NMDAR Inhibitors Antiviral/Cyclooxygenase Inhibitor Combination (IMC-1) Cannabinoids Herbals and Supplements 5-Hydroxytryptophan (5-HTP) S-Adenosyl-l-Methionine (SAMe) St. John’s Wort Magnesium Coenzyme Q10 Melatonin Panax Ginseng Ribose Vitamin D Acetyl l-Carnitine Capsaicin Turmeric Valerian, Chamomile, and Passion Flower Adaptogens Non-Drug Therapies Mind–Body Practices Conclusion References Chapter 8 A Functional Approach to Gynecologic Pain: Integrative Gynecology for the Non-Gynecologist Introduction Examination and Imaging Types of Pain Menstrual Pain during the Period: Dysmenorrhea The Ovarian Cyst Non-Menstrual Pain Infectious Causes Vulvar Pain Syndrome Conclusion References Chapter 9 Headache Disorders Migraine Diagnosis Pathogenesis Migraine Treatment New Thoughts on Treatment New Developments in Migraine Treatment Role of Opiates in Migraine Treatment Migraine and the Emergency Department Trigeminal Autonomic Cephalalgias Diagnosis Cluster Headache Treatment New Cluster Headache Therapies Indomethacin-Responsive TACS Chronic Paroxysmal Hemicrania Hemicrania Continua Indomethacin Treatment Other Potential Non-Indomethacin Treatments78 SUNCT Syndrome Other Less Common Primary Headache Syndromes Primary Exercise Headache1,82 Primary Cough Headache1,82 Primary Headache Associated with Sexual Activity1,82 New Daily Persistent Headache Secondary Disorders Mimicking NDPH Key Points in Regard to NDPH Summary References Chapter 10 Biotensegrity: Advancing Pain Diagnosis and Treatment by Rethinking Anatomy and Biomechanics Introduction Myofascial Pain as an Introduction to Understanding Chronic Pain and Sports Injury Not All Feedback and Control Are Neurologic The Case of a Bodybuilder with Degenerative Arthrosis An Advantage of Dynamic Ultrasonography Tensegrity: The Tension Is the Frame Biotensegrity-Based Anatomy and Biomechanics: A Summary Fascia as a Body-Wide Signaling Mechanism Clinical Application of Biotensegrity Principles in Pain Medicine: A Summary Biotensegrity-Informed History Biotensegrity-Informed Physical Exam The False Concept of Ligaments as the Only Controllers of PROM Biotensegrity-Informed Treatment Restoration of Tensional Integrity: Clinical and Tissue Improvements 3 Months Post-Procedure Conclusion References Chapter 11 Myofascial Trigger Points, Sensitization, and Chronic Musculoskeletal Pain: Evaluation and Management Summary Introduction Origin and History of MPS Chronic Musculoskeletal Pain and Sensitization: Implications for Evaluation and Treatments Aims and Objectives MPS, Sensitization, and Viscerosomatic Interactions The Role of the Limbic System Possible Physiological Mechanisms Clinical Evaluation of the MTrP and Sensitized Segments Principles and Methods of Treatment Treating the MTrP Beyond the MTrP: Spinal Segmental Sensitization Perpetuating Factors of MPS Conclusion A Case Scenario References Chapter 12 Mycotoxins and Tick-Borne Disease: Increasingly Common Causes of Unexplained Chronic Pain Lyme Disease History Epidemiology Pain as a Clinical Presentation Molecular Mechanisms of Pain in Lyme Disease Diagnosis of Lyme Disease Antibiotic Treatment of Lyme Disease Herbal Treatment of Lyme Disease A Note on Co-Infections Mycotoxin Illness Molecular Mechanisms of Pain in Mycotoxin Illness Environmental Diagnosis Patient Diagnosis Treatment of Mycotoxin Illness Pain Management in Environmentally Acquired Illness Summary References Chapter 13 Regenerative Medicine in Pain Management Introduction Mesenchymal Stem Cells Bone Marrow-Derived Stem Cells Adipose-Derived Stem Cells MSCs in Pain Management Neuropathic Pain Discogenic Pain Osteoarthritis or Inflammatory Pain Bone Marrow-Derived Stem Cell Studies in OA Adipose-Derived Stem Cell Studies in OA Allogeneic-Derived Stem Cells Cancer Pain Migraine Opioid Tolerance and Opioid-Induced Hyperalgesia Extracellular Vesicles References Chapter 14 Adenine Dinucleotide: Past, Present, and Future Introduction Historical Perspective on NAD+ What Is the Role of NAD+ in the Body? Current Clinical Applications of Intravenous NAD+ Basic Research into the Mechanisms of NAD+ Effectiveness The Effect of Alcohol on NAD+ Levels and Markers for Inflammation and Oxidative Stress NAD+’s Effectiveness at Reducing Inflammation and Oxidative Stress Levels in Addiction Patients Intravenous NAD+ Infusion Reduces a Second Marker for Inflammation and Oxidative Stress in Addiction Patients Intravenous BR+NADTM Infusions Increase the NAD+/NADH Ratio in Alcohol Abuse Patients Intravenous BR+NADTM Infusions Increase the NAD+/NADH Ratio in Patients Addicted to Opiates Establishing Baseline NAD+ Levels Additional NAD Research, Inc., Partnership Studies Underway or Planned References Chapter 15 Ketamine Use in Pain Management Background Mechanism of Action Pharmacokinetics Pain Management with Ketamine Dosages and Routes of Administration Intranasal Intravenous Parenteral Ketamine Intranasal Ketamine Adverse Reactions Drug Interactions Contraindications Conclusion References Chapter 16 The Limbic System, Oxytocin, and Pain Management The Limbic System The Role of the Limbic System in Pain Perception Limbic System Retraining for Pain Management Oxytocin and the Limbic System Oxytocin and Pain Management Effect of Oxytocin on Pain via the Opioid and Cannabinoid Systems Human Studies of Oxytocin for Pain Oxytocin for Fibromyalgia Oxytocin and Headache Pain Duration of Oxytocin Treatment Pharmacokinetics Dosage and Administration Adverse Effects Conclusion References Chapter 17 Low-Dose Naltrexone: Immune and Inflammatory Mediator Extraordinaire Multiple Sclerosis Crohn’s Disease and Sarcoidosis Fibromyalgia Pain, Complex Regional Pain Syndrome, and Diabetic Neuropathy Cancer Autism Spectrum Conditions Wound Healing and Infection Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Discussion Conclusion References Chapter 18 Topical Pain Medications and Their Role in Pain Management Capsaicin Lidocaine Amitriptyline Gabapentin Baclofen Ketamine Clonidine Phenytoin Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Combination Therapy Conclusion References Chapter 19 Herbal and Supplement Use in Pain Management Capsicum Cat’s Claw Devil’s Claw Ginger Indian Frankincense (Boswellia) Limbrel (Flavocoxid) Turmeric Willow Bark Superoxide Dismutase Vitamin C Vitamin E Chondroitin Sulfate Glucosamine Sulfate Methylsulfonylmethane (MSM) S-Adenosylmethionine (SAMe) 5-Hydroxytryptophan (5-HTP) Magnesium Coenzyme Q10 Melatonin Ribose Vitamin D Acetyl l-Carnitine Vitamin B1 (Thiamine) Vitamin B12 Biotin Evening Primrose Milk Thistle (Silymarin) Feverfew References Chapter 20 PEA: A Novel Fatty Acid in the Treatment of Pain Pain, Endometrial Pain, Fibromyalgia, and IBS-Related Pain Parkinson Disease, Alzheimer Disease, and Brain Ischemia Traumatic Brain Injury and Spinal Cord Injury Glaucoma, Diabetic Retinopathy, and Diabetic Neuropathy Influenza and Common Cold Conclusion References Chapter 21 Lifestyle and Its Relationship to Pain Introduction What Matters Most? Partial Credit Example Side Bar Smoking and Tobacco Inflammatory Food and Pain Potato Fruit Juice Hydrogenated Oil Artificial Sweeteners Drinking Water and Chlorination Byproducts Stages of Learning Exercise Rest/Sleep Meditation Body Work Summary References Chapter 22 Developing Education and Treatment Protocols for Substance Use Disorders That Are Socially Responsible, Accountable, and Integrated: Recovery Engagement—Recognize and Treat Overview Scope of the Problem Recognition of SUD Symptoms and Patient Motivation Progression Tolerance Chronicity and Withdrawal Recognizing Levels of Impairment Identifying Emotional Dysregulation Depressive Episodes Depression Associated with Detoxification Suicidal Ideation Trauma Near-Death Experiences Diagnosis of SUD—DSM-5 Criteria for Substance Use Disorders Severity of Substance Use Disorders Placement Criteria for SUD (ASAM) Patient Intervention Protocols Unique to SUD Early Detection Understanding a “Moment of Clarity” Understanding Relapse Potential Understanding Patient “Reservations” Treatment Experience and Recovery Attempts Previous Treatment Experiences Recovery Attempts Aversion External Motivation Implications for Medical Professionals Summary References Chapter 23 Detoxification Strategies Introduction Traditional Addiction Accidental Dependence Genetics References Chapter 24 Naloxone Use in the Opioid Epidemic Naloxone Increasing Access to Naloxone Conclusion References Chapter 25 Psychological Intervention: Cognitive-Behavioral Therapy Introduction The Brain Cognitive-Behavioral Therapy Cognition Behavior Pediatric Considerations Development Relationships Academics References Index Taylor & Francis