Advanced Therapeutics in Pain Medicine

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