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