Beyond opioids: moving towards evidence-based interventions for chronic pain

During the late 1990’s the idea that pain was being undertreated gained traction, leading to the coining of pain as the 5th vital sign. [1] Alongside this new understanding, pain was given status as a human rights issue. This meant that the denial of pain medication became the denial of a person’s human rights. At the time, opioids had been prescribed for acute pain and cancer pain. However, one publication in a major medical journal stating opioids as safe for chronic pain patients (based on unverified research) changed prescriber attitudes.[2] Subsequently opioids were being prescribed to anyone in ‘pain’. To further lay the groundwork for an opioid crisis, governing agencies began to use patients’ pain control as a measure of the hospital’s success.2 The funding and government reimbursement of hospitals depended on their success and thus the pressure to prescribe opioids for pain was significant.

It is now 2019 and we have a definitive evidence-base proving that long-term opioid therapy has little to no benefits for chronic pain patients, instead being fraught with risks of misuse, dependency and overdose. While opioids can play a useful role in acute pain, cancer pain and in a palliative care setting, the evidence suggests that long-term opioid use decreases quality of life and provides unsustainable pain relief as the body becomes tolerant to the substance. Regardless of the undeniable harms of addiction, opioid use is an “independent risk factor for depression, and in some patients can paradoxically worsen pain”. [3] This worsening of pain is called opioid induced hyperalgesia. It is now understood that classical opioids (e.g. codeine, morphine, oxycodone, fentanyl) activate a neuro-immune response which amplifies the transmission of pain signals in the spinal cord and brain. These medicines can provide short-term relief whilst slowly making overall pain experience worse over time.

Furthermore, pain is now understood as a biopsychosocial experience, meaning it comprises of biological, psychological and social factors. To suggest a one-size-fits-all approach to managing pain is to neglect vital contributing factors to that person’s pain. Yet, chronic pain is still one of the most cited reasons for opioid prescriptions, reflecting a time-poor and overburdened medical system where pressures for quick fixes are strong. Alarmingly, the opioid crisis is growing in Australia, as the rates of opioid related deaths have almost doubled between 2007 and 2016 (from 3.3 to 6.6 per 100,000), with more than three-quarters of these deaths involving prescription drugs. [4]

Given the current opioid epidemic, it is critical that the medical field utilises opioid-sparing therapies that are effective and evidence-based for the long-term relief of chronic pain. At this time, many innovative and effective therapies are available at Metro Pain in alignment with each patients’ pain management plan. Our treating teams are multidisciplinary and can address and relieve pain from biological, psychological and social aspects to help our patients live better. Treatment options such as nerve blocks and neuromodulation (a therapy in which electrical currents interrupt pain signals) have been revolutionary in how we view and treat chronic pain globally.

While there are many novel and innovative treatments that are proven and more effective than opioids for long-term chronic pain relief, the epidemic is likely to continue for now. Unfortunately, until these treatments become affordable and accessible on a larger scale we will continue to see overburdened medical systems opting for quick-fix solutions to the long-term detriment of society and people suffering chronic pain.

These reasons amongst others, drive our passions at Metro Pain Group to find better ways than prescribing pills to help our patients suffer less, function more and live better.

If you would like your current pain management plan reviewed, or for more information, please fill out the form below:

 

References:

[1] Morone, N. E. and Weiner, D.K. 2013. Pain as the 5th vital sign: exposing the vital need for pain education. Clinical Therapeutics, 35(11), pp. 1728-1732.
[2] Rummans, T.A., Burton, C.M and Dawson, N. 2018. How good intentions contributed to bad outcomes: The opioid crisis. Mayo Clinic Proceedings, 93 (3), pp. 344-350.
[3] Juurlink, D.N. 2017. Rethinking “doing well” on chronic opioid therapy. Canadian Medical Association Journal, 189 (39), pp. E1222-3
[4] Roxburgh, A., Dobbins, T., Degenhardt, L and Peacock, A. 2018. Opioid-, amphetamine-, and cocaine-induced deaths in Australia: August 2018. Sydney: National Drug and Alcohol Research Centre.

 

Pain Management Inquiry

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    At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. The suitability of our procedures varies from patient to patient. If you would like to find out if this or other treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

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Best Practices for Dorsal Root Ganglion Stimulation

drg stimulation

Dr Paul Verrills, in collaboration with other world leaders in neuromodulation, has recently published, The Neuromodulation Appropriateness Consensus Committee on Best Practices for Dorsal Root Ganglion Stimulation (DRG). The Neuromodulation Appropriateness Consensus Committee (NACC), which Dr Paul Verrills is a member of, reconvened to develop this article to provide other doctors worldwide with guidance for the best practice and use of DRG stimulation in the treatment of chronic pain syndromes.  Clinicians who choose to follow these recommendations may improve safety and treatment outcomes for patients living with chronic pain, where such treatments could prove beneficial.

Click here to view the abstract of the article.

 

World Arthritis Day

World Arthritis Day

Arthritis is a common chronic disease affecting people of all ages. In Australia alone, approximately 15% of the population have some form of arthritis, with osteoarthritis being the most common.

12 October marks World Arthritis Day. Help us raise awareness. If you are one of many who are affected by osteoarthritis, know that there may be options available.

For more information, please fill out the form below.

 

 


Osteoarthritis inquiry

  • DISCLAIMER

    At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. The suitability of our procedures varies from patient to patient. If you would like to find out if this or other treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

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Treatment for ongoing knee pain

treatment for ongoing knee pain

Do you experience knee pain that is worse in the morning, but improves as the day progresses?

 

Do you feel burning sensations, buzzing and numbness in your knees?

 

Do you experience severe pain that often wakes you up at night?

 

The knee is a complex joint. Ongoing knee pain from osteoarthritis can come from multiple sources. In 30% of cases, the pain does not actually come from the joint itself.1 The knee is surrounded by connective tissues, ligaments and bone which are all rich in nerves, and the likely source of pain. In some cases even nerves that well away from the knee area can also be common sources of pain.

At Metro Pain Group, we have a range of options available. With our unique approach, we offer treatment strategies for the long term reduction and management of pain.  Depending on the patient’s specific condition, we offer:

  • General advice
  • Medication management
  • Psychology and rehab
  • Delivery of injectables including steroids, hyaluron, PRP and stem cells
  • Recommendation of orthopaedic devices
  • Diagnostic procedures
  • Interventional treatments

 

If you are looking for options to relieve your pain and would like more information, please fill out the form below.

 

References:

1 Dieppe, P.A. and Lohmander, L.S., 2005. Pathogenesis and management of pain in osteoarthritis. The Lancet365(9463), pp.965-973.

 


Ongoing knee pain inquiry

  • DISCLAIMER

    At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. The suitability of our procedures varies from patient to patient. If you would like to find out if this or other treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

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September is Pain Awareness Month

Pain Awareness Month

Pain Awareness Month is a time when various organisations work together to raise public awareness of issues in the area of pain and pain management. The initiative was introduced by the American Chronic Pain Association under the Partners for Understanding Pain banner in 2001.

This year, the International Alliance of Patient Organizations and International Pain Management Network joins the initiative to bring pain to the forefront of the international community. Raise awareness by getting involved. Talk to your family, friends and healthcare team and help create greater understanding of pain.

neuropathic pain

What is neuropathic pain?

neuropathic pain

Neuropathic pain commonly presents as burning, pins & needles, numbness, electric shocks or itching. It has multiple causes including nerve injury, spinal cord damage and complications from shingles. Neuropathic pain can also arise following a surgical procedure.

Around 7–8% of adults experience pain that can be described as neuropathic, as well as one in four people with diabetes.  Managing neuropathic pain can be challenging. It is associated with impaired quality of life and is often poorly managed, partly because neuropathic pain is often unrecognised by healthcare practitioners.

At Metro Pain Group, we regularly treat patients with neuropathic pain. We offer advanced and evidence-based treatment measures in conjunction with multidisciplinary care.

For more information, please fill out the form below.

 

References:

Costigan, M., Scholz, J. and Woolf, C.J., 2009. Neuropathic pain: a maladaptive response of the nervous system to damage. Annual review of neuroscience32, pp.1-32.
Dworkin, R.H., O’Connor, A.B., Kent, J., Mackey, S.C., Raja, S.N., Stacey, B.R., Levy, R.M., Backonja, M., Baron, R., Harke, H. and Loeser, J.D., 2013. Interventional management of neuropathic pain: NeuPSIG recommendations. PAIN®154(11), pp.2249-2261.
Freynhagen, R. and Bennett, M.I., 2009. Diagnosis and management of neuropathic pain. Bmj339(b3002).
International Association for the Study of Pain. Epidemiology of neuropathic pain: how common is neuropathic pain, and what is its impact? Washington: IASP; 2014.
Smith, B.H. and Torrance, N., 2012. Epidemiology of neuropathic pain and its impact on quality of life. Current pain and headache reports16(3), pp.191-198.

 


Neuropathic pain inquiry

  • DISCLAIMER

    At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. The suitability of our procedures varies from patient to patient. If you would like to find out if this or other treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

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Workplace Injury

  • Is your workplace injury causing you pain?
  • Have you received a less than optimal outcome from your treatment?
  • Are you having challenges with obtaining approval for your pain treatment?

 

If you answered yes, to any of the questions, Metro Pain Group can help.

  • We have a multidisciplinary team of Pain Doctors, Psychologists, Physiotherapists, Physician Associates and a Rehab Coordinator
  • Our Team can help you get back to doing what you love.
  • We can also act on your behalf when requesting approvals and other matters.

 

If your pain is a result of a workplace injury and would like to find out how we can help, please fill out the form below or contact 03 9595 6195:

Find out how we can help

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Advanced treatment for chronic headaches and migraines yields positive results

headaches and migraines

People who experience daily headaches and migraines often find that the pain hinders their day to day living. Their work, family and social life can also be affected when their pain is not well managed.

While there are many conventional treatments for headaches and migraines, some patients unfortunately do not get relief.  At Metro Pain Group we offer patients several options to alleviate headaches and migraines such as medications, physical and psychological treatments and procedures.

When conservative treatments have been unsuccessful, patients may seek alternative options.

In a long term study of 60 cases, Peripheral Nerve Field Stimulation (PNFS), a type of neuromodulation, has shown encouraging results. [i] Almost 70% of patients who underwent the procedure reported significant pain relief (>50%). [i]  Medication use was reduced for the majority of patients (83%) who were previously taking pain relief or prevention medication. Additionally, reductions in disability and depression were reported allowing patients to return to normal activity. [i]

As with any procedure, PNFS carries possible risks and side effects, however the treatment is reversible and can potentially bring relief to patients who have unsuccessfully tried other therapies.

If you are experiencing ongoing headaches and migraines and would like more information, please fill out the form below.

___________________

[i] Verrills P., Rose R., Mitchell B., Vivian D., Barnard A. 2013. Peripheral Nerve Field Stimulation for Chronic Headache: 60 Cases and Long-Term Follow-Up. Neuromodulation 2013; e-pub ahead of print. DOI: 10.1111/ner.12130

 

Headaches and migraines - more information

  • DISCLAIMER

    At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. The suitability of our procedures varies from patient to patient. If you would like to find out if this or other treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

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Would you like to find out more about the latest in pain treatments?

latest in pain treatments

Metro Pain Group has a wholly owned research subsidiary, Monash Clinical Research (MCR), who run clinical studies together with our doctors to help find new or improved treatments for patients suffering from chronic pain.

MCR is currently running several clinical trials, with more due to start later this year.

Some of the conditions being investigated include:

  • Failed Back Surgery Syndrome
  • Chronic Lower Back Pain
  • Chronic Leg Pain
  • Shoulder Pain

 

WorkCover/TAC/DVA and uninsured patients can also participate in some of these studies.

To find out more about our clinical trials, please fill out the form below and one of our research coordinators will be in touch.

 

Find out about the latest in pain treatments

  • DISCLAIMER

    At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. The suitability of our procedures varies from patient to patient. If you would like to find out if this or other treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

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Can Radiofrequency Neurotomy be repeated?

radiofrequency neurotomy

Radiofrequency Neurotomy (RFN) is a treatment used to bring relief to neck or back pain caused by facet joints. 1,2 The procedure is performed under fluoroscopy under sterile conditions in an operating theatre using mild sedation and local anaesthetic. Using a radiofrequency generator, the procedure involves placing a probe alongside the affected nerve. The probe is heated to 90 degrees Celsius. Pain signals are interrupted as a result which can bring pain relief for a long period until full nerve function recovers.

A small portion of patients may find that their pain is gone for good; however most patients may find that the effects are temporary and that the pain could return 6 to 18 months following the procedure. In such cases, the procedure can be repeated. Studies have found that patients who have previously responded well to the treatment are usually successful when they undergo subsequent treatments. 3

If you have previously had radiofrequency neurotomy and find that your pain is returning, please fill out the form below for more information.

References:
1 McDonald GJ, Lord SM, Bogduk N. Long-term follow-up of patients treated with cervical radiofrequency neurotomy for chronic neck pain. Neurosurgery 1999:45: 61-68
2 Dreyfuss, P., Halbrook, B., Pauza, K., Joshi, A., McLarty, J., & Bogduk, N. (2000). Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine, 25(10), 1270-1277.
3 Husted, D. S., Orton, D., Schofferman, J. and Kine, G. (2008), Effectiveness of Repeated Radiofrequency Neurotomy for Cervical Facet Joint Pain. Journal of Spinal Disorders & Techniques, 21(6):406-408. doi: 10.1097/BSD.0b013e318158971f.

 

Repeat RFN Inquiry

  • DISCLAIMER

    At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. The suitability of our procedures varies from patient to patient. If you would like to find out if this or other treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

  • This field is for validation purposes and should be left unchanged.
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