Pain Management

Posted on Diabetes, Pain Management

Rice U. students engineer socks for on-the-go neuropathy treatment

insole


Top view of a smart insole containing transcutaneous electrical nerve stimulation (TENS) fabric electrodes and a circuit board to control the electrical signals. CREDIT Photo by Jeff Fitlow/Rice University

Need a little spring — or buzz — in your step? A wearable electrical stimulation and vibration therapy system designed by Rice University engineering students might be just what the doctor ordered for people experiencing foot pain and balance loss due to diabetic neuropathy.

Rice engineering students in the StimuSock team — Abby Dowse, Yannie Guo, Andrei Mitrofan, Sarah Park and Kelly Xu — designed a sock with a smart insole that can deliver both transcutaneous electrical nerve stimulation (TENS) and vibration therapy that block pain signals to the brain and provide haptic feedback to help with balance issues, respectively.

According to the Centers for Disease Control and Prevention’s 2022 estimates, over 37 million people in the U.S. suffer from diabetes. About half of them will develop some form of diabetic neuropathy, a type of nerve damage that occurs most often in the legs and feet.

The StimuSock team sought to combine the best aspects of existing therapies into a single, user-centered design.

“Existing products or devices used to treat the symptoms of diabetic neuropathy are either pharmaceuticals or large at-home vibration devices users stand on,” Dowse said. “But none of them can both treat pain and improve balance, which our device aims to do by combining the TENS and the vibrational therapy in one wearable, portable, user-controllable and easy-to-use device.”

A lot of the team’s effort went into making the device as low-profile as possible.

“The intent is for the patient to be able to wear the device for the whole day,” Guo said. “Even when everything’s off and they don’t want the electrostimulation or haptics effect, they can still wear their device. … You don’t want it to look like you’re wearing an ankle monitor.”

Patients use a smartphone app to control the type, intensity and duration of the desired therapeutic stimulus. The system also allows users to target a specific area of the foot.

“We have three regions: one in the front of the insole, one in the middle and one at the back,” Park said. “Our aim is to allow patients to be able to control both the amplitude of the vibration and the location where it’s delivered. Some patients might only want vibration at the front of their feet and some only at the back.”

Mitrofan said the team anticipates the device’s final form will have sufficient battery life to provide the recommended maximum of four 30-minute sessions of TENS therapy per day and operate on standby the rest of the day.

Posted on Pain Management

E-health reduces patient pain and opioids in a clinical study. Would you use such a service? If so, why?


E-health reduces patient pain, opioids in clinical study

An online “e-health” program helped more people with chronic pain reduce their opioid medications and pain intensity than a control group that had only regular treatment in a recent clinical study.

In the study published in the journal Pain, about 400 participants who had been prescribed long-term opioid treatment for their pain were divided into two groups: one received treatment as usual and another received treatment and access to a self-guided, e-health program. Of the e-health group, more than half, 53.6%, were able to reduce their opioid medications by 15% or more after six months compared to 42.3% of patients in the control group.

“These were very encouraging findings: not only were they reducing opioids but also their pain was not becoming worse,” said Washington State University nursing associate professor Marian Wilson and the study’s lead author. “Some people are hesitant to stop their opioid medication because they fear their pain will increase, but we found that at least on average in this population, they could reduce their opioids a bit and not have increased pain symptoms.”

An estimated 50 million people in the U.S. have chronic pain and about 18 million are prescribed long-term opioid treatment. Since opioid use risks include addiction and even accidental death, researchers are searching for alternatives to help these patients.

At the start of this study, all the participants rated their chronic pain at an average intensity of 5 or 6 on a 0 to10 point scale with 10 being the most extreme pain. Chronic pain can arise from a range of conditions that have no cure, and the study participants had a range of diagnoses including arthritis, back pain, fibromyalgia and migraines.

At the end of the study, 14.5% of the e-health group reported that their pain was reduced by 2 points or more. Only 6.8% in the control group had the same level of pain decrease. The researchers also observed the patients improved their pain knowledge, confidence managing pain and coping skills.

For this study, the researchers used a psychologist-designed e-health program, called Goalistics Chronic Pain Management. This self-guided course aims to help people manage their own pain and its many impacts on their lives. The program contains a mix of pain tracking tools, cognitive therapy, exercise tips and relationship advice as well as information about opioid use and risks.

The program provides content similar to what a patient might receive from a psychologist who specializes in pain, a treatment that isn’t easily accessible for everyone, said Wilson.

While similar programs exist, the researchers chose this one because it is widely available in the U.S. and delivered fully online. Wilson also tested the Goalistics program in previous research providing preliminary data for this study’s large, randomized trial.

Since pain is such an individualized experience, the authors argue that patients can benefit from self-management programs so they can track their pain levels and experiment with different strategies.

 “The idea is to put the patient in the driver’s seat because we can give them a prescription for opioids, and that will work for a little while, but over time for chronic pain, it’s not usually going to be the solution to fix all their troubles,” she said.

Wilson added that chronic pain patients often have mood, social and physical functioning issues that also need attention.

The findings provide more evidence that online self-management programs are beneficial for chronic pain patients, and a variety of agencies, including the Centers for Disease Control and Prevention, support their widespread use.

At the time of this study, the e-health program had a monthly $30 fee. While relatively inexpensive compared to treatment by a pain psychologist, these types of programs are not covered by most insurance in the U.S. Other countries including Canada and Australia provide similar programs to patients for free, and Wilson is currently working on a project that aims to achieve greater access in the U.S.

Posted on Pain Management

Patients with chronic pain value empathic doctors who validate concerns and communicate clearly

Patient satisfaction with medical care for chronic low back pain: A pain research registry study
Patient satisfaction with medical care for chronic low back pain: A pain research registry study

Researchers measured the associations among process, outcomes and patient satisfaction within general medical care for chronic low back pain provided through an ongoing patient-physician relationship. They also used two models to measure factors associated with patient satisfaction, including studying a subgroup of participants experiencing chronic low back pain treated by the same physician for more than five years.

Among 1,352 participants, only physician empathy and communication were associated with patient satisfaction in the multivariable analysis that controlled for potential confounders. Similarly, in the subgroup of 355 participants, physician empathy and communication remained linked to patient satisfaction in the multivariable analysis.

Physician empathy and physician communication were strongly associated with patient satisfaction with medical care for chronic low back pain. Researchers argue that patients with chronic pain highly value physicians who are empathic and who make efforts to more clearly communicate treatment plans and expectations.

What is Known on This Topic: Despite medical advances in managing chronic pain experienced by millions of Americans, little research has been conducted on how patient-physician interaction impacts the process of delivering medical care for chronic low back pain and, ultimately, patient satisfaction.

What This Study Adds: Patients with chronic pain highly value empathic physicians who validate their concerns and often ill-defined symptoms, as well as physicians who make efforts to more clearly communicate treatment plans and expectations to patients.

Posted on Fibromyalgia, Pain Management

The Best Diet for Fibromyalgia and Other Chronic Pain Relief

The Best Diet for Fibromyalgia and Other Chronic Pain Relief | NutritionFacts.org


Anti-inflammatory diets can be effective in alleviating fibromyalgia and other chronic pain syndromes. The duo of inflammation videos I mentioned are Foods That Cause Inflammation and Which Foods Are Anti-Inflammatory?


Posted on Pain Management, Women's Health

March is Endometriosis Awareness Month – Endometriosis: how to diagnose and manage this complex condition

Endometriosis is a painful, complex condition affecting about 1 in 10 women of reproductive age, but it is poorly understood. A new clinical review published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.220637 provides an overview of the causes, diagnosis and management of endometriosis based on the latest evidence, to help clinicians and patients. The review is timely, as March is Endometriosis Awareness Month. Endometriosis, defined as the presence of endometrial-like tissue outside the uterus, is one of the most common gynecologic conditions. It is estimated to affect approximately 1 million women in Canada and an unknown number of gender-diverse people. It can cause chronic pelvic pain and organ damage, affect fertility and negatively impact quality of life. "Endometriosis can involve multiple organ systems and its symptoms are often chronic, which can affect work productivity, social life, intimate relationships and mental health considerably, and lead to substantial societal costs," writes Dr. Catherine Allaire, Department of Obstetrics and Gynaecology, University of British Columbia, and BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, with coauthors. Although laparoscopy with histopathologic confirmation has been considered the gold standard for diagnosis, to address the unacceptably long interval between symptom onset and diagnosis, recent guidelines note that a diagnosis can be made based on symptoms, physical examination and imaging. "Early recognition and diagnosis are key to providing timely treatment. Primary care providers can make a clinical diagnosis of endometriosis and start first-line medical management. Referral to a gynecologist for second-line hormonal therapy or surgery is important, when indicated," the authors conclude. "Reducing the delay to diagnosis and initiating treatment will help improve quality of life for the 1 million individuals affected by endometriosis in Canada," say the authors.

Endometriosis is a painful, complex condition affecting about 1 in 10 women of reproductive age, but it is poorly understood. A new clinical review published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.220637 provides an overview of the causes, diagnosis and management of endometriosis based on the latest evidence, to help clinicians and patients.

The review is timely, as March is Endometriosis Awareness Month.

Endometriosis, defined as the presence of endometrial-like tissue outside the uterus, is one of the most common gynecologic conditions. It is estimated to affect approximately 1 million women in Canada and an unknown number of gender-diverse people. It can cause chronic pelvic pain and organ damage, affect fertility and negatively impact quality of life.

“Endometriosis can involve multiple organ systems and its symptoms are often chronic, which can affect work productivity, social life, intimate relationships and mental health considerably, and lead to substantial societal costs,” writes Dr. Catherine Allaire, Department of Obstetrics and Gynaecology, University of British Columbia, and BC Women’s Centre for Pelvic Pain and Endometriosis, Vancouver, BC, with coauthors.

Although laparoscopy with histopathologic confirmation has been considered the gold standard for diagnosis, to address the unacceptably long interval between symptom onset and diagnosis, recent guidelines note that a diagnosis can be made based on symptoms, physical examination and imaging. 

“Early recognition and diagnosis are key to providing timely treatment. Primary care providers can make a clinical diagnosis of endometriosis and start first-line medical management. Referral to a gynecologist for second-line hormonal therapy or surgery is important, when indicated,” the authors conclude.

“Reducing the delay to diagnosis and initiating treatment will help improve quality of life for the 1 million individuals affected by endometriosis in Canada,” say the authors.