Advances in Treatment Options for Chronic Pain

Chronic pain is a difficult condition to diagnose and manage, especially since most diagnostic measures are subjective and treatment varies from patient to patient. A key to diagnosing and treating chronic pain is to have a strong understanding of the different diagnostic tools and treatment options available. It is also important to understand what exacerbates the condition and adverse effects associated with treatment.

Steven Stanos, Jr., DO, of the Center for Pain Management, Rehabilitation Institute of Chicago in Illinois, moderated an afternoon session at the 2013 American Academy of Pain Medicine annual meeting, held April 12-14 in Fort Lauderdale, FL, that highlighted diagnostic and treatment options for chronic pain. The session also provided insight into deficiencies in testosterone associated with opioid treatment as well as the link between smoking and chronic pain.

During the session, Venu Akuthota, MD, of the Spine Center at the University of Colorado Hospital in Aurora, discussed the use of exercise as medicine for spinal pain disorders. Akuthota presented three cases studies and explained the appropriate exercise treatment options for those cases. He provided insight into the types of patients with chronic pain that need stability, including younger patients, those with good flexibility, patients with a positive segmental prone instability test, and those with aberrant movement. He also outlined characteristics of patients who would likely require manual therapy based on neural (dural) tension tests (slump test) and S1 joint maneuvers. Overall, based on these cases, Akuthoka recommended that physicians individualize an exercise regimen depending on the patient.

James Atchison, DO, of the Center for Pain Management Rehabilitation Institute of Chicago in Illinois, provided insight into new sacroiliac joint (SIJ) interventional procedures. Atchison walked through the types of maneuvers as well as SI injections. Types of maneuvers included compression belts (which have shown little efficacy), kineslotaping (the efficacy of which remains unclear) and manipulation (not effective). SI injections have been somewhat effective in clinical testing. Diagnostic blocks, corticosteriod injections, and botox appear to work for short periods of time but do not provide long-lasting pain relief. Atchison concluded his discussion with some insight into cool radiofrequency.

W. Michael Hooten, MD, of the Mayo Clinic in Rochester, Minnesota, further expanded upon the link between smoking and pain. Hooten discussed whether smoking could lead to the onset of pain, whether smoking was associated with pain severity, and the link between smoking and opioid use. While smoking has been linked to chronic pain, Hooten and colleagues found that smoking does not cause chronic pain. In addition, smoking was not associated with increased pain severity. However, depression appears to have mediated the relationship between smoking and pain as well as smoking and pain severity. The investigators found that smoking was directly associated with opioid use.

In another presentation, Gerald Malanga, MD, of Overlook Hospital Pain Center in Summit, NJ, discussed recent data on the use of platelet rich plasma (PRP) for the treatment of chronic pain. Malanga discussed the conditions that would most benefit from PRP and those where PRP would unlikely provide benefit. While PRP appears to be effective in treating tendon issues, it is not as effective in treating pain associated with muscle ailments. Further studies are needed for the use of PRP in joints as well as in osteoarthritis, but early results appear to be promising.

In the last presentation of the session, Bill McCarberg, MD, of the Elizabeth Hospice Neighborhood Healthcare in Escondido, CA, discussed how chronic opioid treatment could result in low testosterone levels. While many physicians and patients do not treat testosterone deficiency, treatment is important, as it is an independent risk factor for hypertension and coronary artery disease. Low testosterone levels are very common in patients with chronic pain taking opioids and should be something that physicians are more aware of and treat.