Dr. Gatell On Pain Management Topics: An Overview!
Here are some pain management topics that may be helpful to you and your local doctors - Please make copies of them.
Also, I found that 98% to 99% of my patients with chronic intractable pain have some degree of underlying fibromyalgia that is very responsive to Dr. St. Amand's Guaifenesin Therapy - see www.fibromyalgiatreatment.com .
However, because the Guaifenesin Therapy makes symptoms worse before getting better, I have been able to modified Dr. St. Amand's Guaifenesin Therapy for patients with severe chronic pain by using adequate pain management treatments with drug and non-drug modalities.
Fibromyalgia, seems to me to be a migraine of the body, causing pain all over, especially when the patient is agitated or extremely emotional. This is supported by the following observations:
In my medical practice for chronic pain, it seems that only 1 to 2 % percent have "pure" nerve injuries with no fibromyalgia, while approximately 30% of my patients with fibromyalgia have some residual nerve injuries. Furthermore, maybe only 30% of this large group with fibromyalgia have some form of permanent nerve damage as result of un-necessary back surgery - the so-called "Failed Back Surgery Syndrome (FBSS)."
Recent, medical studies demonstrate that the real clinical improvement of patients with presumed FBSS may be related more to chronic depression (and perhaps chronic anxiety) versus any actual epidural spinal nerve scaring from surgery ( see References 1 to 8 below). And, most of the poor outcomes in spinal surgery ( e.g. FBSS) may be correlated more to chronic life-long traumatic events (stressors) with depression from difficulties - some with problems starting as early childhoods (see Ref 9 to 13 below).
There is no doubt the chronic pain in Fibromyalgia is very real and can be severe enough to have a patient spend most days in bed or in a wheelchair. And, I do believe that Fibromyalgia pain and its complications, is a genetic problem associated abnormal energy production as described by Dr. St. Amand ( see www.fibromyalgiatreatment.com ), and certainly not "all in your head."
I usually explain to patients that fibromyalgia, or Fibromyalgia-RSD, results in generalized chronic pain, due to a heightened nervous system affecting the brain and the spinal cord. This hyper-excitability usual allows patients with fibromyalgia to feel pain easier (a lowers pain threshold), and causes irritability of the brain itself, leading to anxiety and depression.
I further explain that 1/3 of the problem is purely the body's genetic makeup and runs in families, with females affected more than males ( approx. 5 to 1); the other 1/3 has to do with our psychology on how we handle stresses in our lives based n past experiences; and the last 1/3 has to do with how the genetic changes of the body affects the brain, causing migraines, irritability, insomnia, chronic daily fatigue, anxiety, depression and finally muscle and tendon aches and further pains of fibromyalgia from lack of the restorative stage 4 sleep.
This complex interactions of 1/3 body, 1/3 mind-body and 1/3 mind becomes a viscous cycle, until all levels are treated together in a holistic medical manner.
Most patients, see many primary care and medical specialists (e.g. Rheumatologist, Neurologist, Orthopedic Surgeon, Neurosurgeon, Psychiatrist, Endocrinologist, etc.), before finding a Fibromyalgia Doctor or a Chronic Pain Doctor that really understand Fibromyalgia and treats with Dr. St. Amand' Guaifenesin Therapy - see Guaifenesin Doctor List on www.fibromyalgiatreatment.com or www.guaidoc.com .
I have written extensively in weekly section of the "Ask the Doctor" of www.pain.com/drfiles/default.cfm and my old answers can be found in the "Doctor's Files" at www.pain.com/drfiles/drfiles.cfm under the topics of "Fibromyalgia" and "RSD" or Reflex Sympathetic Dystrophy. These files contain many of my answers to questions based on clinical experience and research on conditions of Fibromyalgia and Reflex Sympathetic Dystrophy (RSD), which I have found to be closely inter-related in patients in intractable chronic pain.
So, cheer up, there is hope ! You can live with adequate pain control once your doctor have used a more integrated, multidisciplinary or holistic medical approach.
Unfortunately, you can thank your local drug-addicts and drug-dealers for making it difficult for legitimate patients in chronic pain from obtaining help from medical doctors, as well as, "medical doctors" who illegally sell addicting drugs for a profit instead of practicing medicine. As you probably know, it has led many legitimate patients in chronic pain to "seek drugs" illegally creating "pseudo-addicts" and "pseudo-addiction" as previously described by several investigators (see References 14 through 17 below).
I pray that our Government, through the Drug Enforcement Agency (DEA) and involved Medical Communities, will eventually find a way to protect patients in chronic intractable pain and their local doctors from the real criminals.
I hope that this "War Against Drugs" stops hurting legitimate patients in severe chronic pain and also any compassionate doctor(s) trying to help them regain some form of life again. This may also help prevent the problem of patients committing suicide to cure their under-treated intractable severe chronic pain and forcing many legitimate patients from becoming "drug seekers" or "drug addicts".
Perhaps, a national database of all prescribed potent narcotics, prescribing doctors and the pharmacies would help catch the real bad guys - the real drug addicts and/or drug dealers.
Sincerely yours,
John A. Gatell, M.D.
References:
1: Coskun E, Suzer T, Topuz O, Zencir M, Pakdemirli E, Tahta K. Related Articles
- Relationships between epidural fibrosis, pain, disability, and psychological factors after lumbar disc surgery.
Eur Spine J. 2000 Jun;9(3):218-23.
PMID: 10905440 [PubMed - indexed for MEDLINE]
2: Burchiel KJ, Anderson VC, Wilson BJ, Denison DB, Olson KA, Shatin D. Related Articles - Prognostic factors of spinal cord stimulation for chronic back and leg pain.
Neurosurgery. 1995 Jun;36(6):1101-10; discussion 1110-1.
PMID: 7643988 [PubMed - indexed for MEDLINE
3: Broggi G, Servello D, Dones I, Carbone G. Related Articles - Italian multicentric study on pain treatment with epidural spinal cord stimulation.
Stereotact Funct Neurosurg. 1994;62(1-4):273-8.
PMID: 7631081 [PubMed - indexed for MEDLINE]
4: Vendrig AA. Related Articles - Prognostic factors and treatment-related changes associated with return to work in the multimodal treatment of chronic back pain.
J Behav Med. 1999 Jun;22(3):217-32.
PMID: 10422615 [PubMed - indexed for MEDLINE
5: Riley JL 3rd, Robinson ME, Geisser ME, Wittmer VT, Smith AG. Related Articles - Relationship between MMPI-2 cluster profiles and surgical outcome in low-back pain patients.
J Spinal Disord. 1995 Jun;8(3):213-9.
PMID: 7670212 [PubMed - indexed for MEDLINE]
6: Sorensen LV. Related Articles - Preoperative psychological testing with the MMPI at first operation for prolapsed lumbar disc. Five-year follow up.
Dan Med Bull. 1992 Apr;39(2):186-90.
PMID: 1535307 [PubMed - indexed for MEDLINE]
7: Spengler DM, Ouellette EA, Battie M, Zeh J. Related Articles - Elective discectomy for herniation of a lumbar disc. Additional experience with an objective method.
J Bone Joint Surg Am. 1990 Feb;72(2):230-7.
PMID: 2303509 [PubMed - indexed for MEDLINE]
8: Thorvaldsen P, Sorensen EB. Related Articles - Psychological vulnerability as a predictor for short-term outcome in lumbar spine surgery. A prospective study (Part II).
Acta Neurochir (Wien). 1990;102(1-2):58-61.
PMID: 2137661 [PubMed - indexed for MEDLINE
9: Schofferman J, Anderson D, Hines R, Smith G, White A. Related Articles - Childhood psychological trauma correlates with unsuccessful lumbar spine surgery.
Spine. 1992 Jun;17(6 Suppl):S138-44.
PMID: 1385898 [PubMed - indexed for MEDLINE]
10: Poyhia R, Da Costa D, Fitzcharles MA. Related Articles - Previous pain experience in women with fibromyalgia and inflammatory arthritis and nonpainful controls.
J Rheumatol. 2001 Aug;28(8):1888-91.
PMID: 11508596 [PubMed - indexed for MEDLINE]
11: Katon W, Sullivan M, Walker E. Related Articles Medical symptoms without identified pathology: relationship to psychiatric disorders, childhood and adult trauma, and personality traits.
Ann Intern Med. 2001 May 1;134(9 Pt 2):917-25.
PMID: 11346329 [PubMed - indexed for MEDLINE]
12: Walker EA, Keegan D, Gardner G, Sullivan M, Bernstein D, Katon WJ. Related Articles
- Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: II. Sexual, physical, and emotional abuse and neglect.
Psychosom Med. 1997 Nov-Dec;59(6):572-7.
PMID: 9407574 [PubMed - indexed for MEDLINE]
13: Wolfe F. Related Articles - Fibromyalgia.
Rheum Dis Clin North Am. 1990 Aug;16(3):681-98. Review.
PMID: 2217965 [PubMed - indexed for MEDLINE]
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Heit HA. | Related Articles |
| 15: | Kowal N. | Related Articles |
| 16: | Weissman DE. | Related Articles |
| 17: | Weissman DE, Haddox JD. | Related Articles |
John A. Gatell, M.D.
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February 26, 2007, Angel Pain Relief Center. All rights reserved.