Living on False Hope

By Carol Levy, PNN Columnist

I live on false hope. I think hope is what keeps many of us afloat. And when the medical community tells you, “I have nothing left to offer you,” false hope is all there is.

And then I open my email, and there is a story in KevinMD, a medical site that I trust. It’s about using ultrasound as a treatment for pain. My heart soars with anticipation. Maybe, maybe this time, the answer has arrived.

The headline, “Ultrasound shows promise as new pain treatment, targeting a specific brain region,” sets off a specific area of my brain. I feel the false hope lifting and true hope taking its place.

And then I read the article.

Just like too many other studies I have read, this is not research that can be applicable to many people. The researchers only used a sample population of 23 people. That is just too small a number to extrapolate out to the larger pain community.

I have had many brain surgeries for my trigeminal neuralgia, so I'm not put off by a treatment that targets the brain. But the author of the article wonders if stimulating areas of the brain with ultrasound could be used for nefarious purposes, such as torture. 

I was going to do research to see what other new ideas and treatments are out there. Then I realized I didn’t really want to know, because most of the research doesn’t pan out or involves too few people to take it seriously.

I want to read about research involving enough participants that there is real hope in what they found. A study that uses a large number of people and with results so positive that it may be a realistic treatment option.

So far, I haven’t seen that. I know the pharmaceutical industry is working on non-opioid pain relievers, but I think the better way to go would be to find something that minimizes our pain. I'm afraid there may be no way to ever truly eradicate many painful conditions. 

Until I find a study involving hundreds or thousands of participants using a new pain treatment that actually works, is affordable, and has few side effects, I suppose false hope is better than none. 

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here. 

New Imaging Allows Doctors to Watch Spinal Cord During Surgery

By Pat Anson, PNN Editor

A new type of imaging technology could improve the effectiveness of spinal surgeries by allowing doctors to view high resolution images of the spinal cord during surgery.

The technology, known as fUSI or functional ultrasound imaging, is currently used to track neural activity in the brain. Researchers at the University of California Riverside (UCR) and University of Southern California say fUSI could also be used during back surgery to help doctors “see” the spinal cord in real time and how it responds to electrical stimulation. That could improve the success rate of spinal cord stimulators and other devices that use neuromodulation to dull pain signals.

“The fUSI scanner is freely mobile across various settings and eliminates the requirement for the extensive infrastructure associated with classical neuroimaging techniques, such as functional magnetic resonance imaging (fMRI),” lead author Vasileios Christopoulos, PhD, an assistant professor of bioengineering at UCR, said in a press release. “Additionally, it offers ten times the sensitivity for detecting neuroactivation compared to fMRI.”

Christopoulos and his colleagues reported in the journal Neuron that fUSI imaging was used on six people with chronic back pain who had partial laminectomies, a surgery that eases pressure on spinal nerves through the removal of bone or tissue. During the surgeries, clinicians also stimulated the patients’ spinal cords with mild electric signals to test the viability of fUSI.

Until now, it’s been difficult to assess whether a surgery for back pain is working because patients are asleep under anesthesia and cannot provide feedback on their pain levels. The motion caused by a patient’s heart and breathing may also interfere with MRIs and other imaging methods.

“These movements introduce unwanted noise into the signal, making the spinal cord an unfavorable target for traditional neuroimaging techniques,” Christopoulos explained. “With ultrasound, we can monitor blood flow changes in the spinal cord induced by the electrical stimulation. This can be an indication that the treatment is working.”

Images produced by fUSI are clearer and less sensitive to motion. It uses ultrasound waves to track the flow of blood in specific areas. Christopoulos likens it to a submarine that uses sonar to detect objects in the water.

“We have big arteries and smaller branches, the capillaries. They are extremely thin, penetrating your brain and spinal cord, and bringing oxygen places so they can survive,” he said. “With fUSI, we can measure these tiny but critical changes in blood flow.”

Spinal cord stimulators (SCSs) are invasive and have poor success rates. That’s why it’s customary for patients to go through a short trial period before having the devices surgically implanted. With improved monitoring of blood flow during surgery, Christopoulos hopes the success rate of SCSs will improve dramatically.

“We needed to know how fast the blood is flowing, how strong, and how long it takes for blood flow to get back to baseline after spinal stimulation. Now, we will have these answers,” Christopoulos said. “With less risk of damage than older methods, fUSI will enable more effective pain treatments that are optimized for individual patients.”

About 50,000 spinal cord stimulators are implanted annually in the U.S. The devices are often touted as an alternative to opioid pain medication, although a growing number of studies have questioned their safety and efficacy.

4 Oldies But Goodies That Relieve Back Pain

By Dr. Forest Tennant, PNN Columnist 

In our studies, we routinely review persons with adhesive arachnoiditis (AA), Ehlers-Danlos Syndrome, Tarlov cysts and Epstein Barr autoimmunity. Our bulletins have, for the last two years, focused on new discoveries such as autoimmunity, medicinal agents, spinal fluid flow exercises, MRIs and laboratory testing.  

It’s a little embarrassing, but we haven’t sufficiently emphasized that some older treatments can still bring a lot of relief.  

AA causes considerable imbalance and unusual stretches to the muscles, tendons, nerves, and joints in the back, hips and pelvis. Consequently, these tissues become sprained, strained and inflamed. Many “old-time” measures can heal these tissues and enhance comfort and mobility. Here is a short summary of four that will be around for a long time since they simply provide comfort and relief. 

1. Ultrasound: Several years ago, we started using ultrasound for AA. The theory is that it may break up adhesions. While this may or may not happen, ultrasound often provides immediate relief that can last days or weeks. Medications such as cortisone cream can also be administered during ultrasound, which boosts their effectiveness. There are now hand-held ultrasound devices that can be purchased for use at home. 

2. Epsom Salts: Foot baths with minerals are convenient and soothing. Epsom salt baths are generally believed to “pull out” or detoxify the body of excess electricity and toxins. They can be most helpful for burning feet sensations and stabbing pains in the legs. 

3. Heating Pad: Heat dilates blood vessels, which brings more oxygen to the treated area and promotes healing. Heat also relaxes muscles that may be in spasm. 

4. Transcutaneous Electrical Nerve Stimulation (TENS): Electrical currents act as an anesthetic on nerves and nerve roots. Pain in persons with AA may temporarily abate when an electric current is administered over the lower back. TENS can often break a flare.

The human body has remained unchanged for thousands of years. Remedies and treatments discovered long ago may still be applicable today. AA has many associated conditions including spinal fluid leaks, inflammation in tissues around the spine, muscle spasm, and radiating pain among others. Some “old-time” treatments may be a welcome adjunct to the 3-component medical protocols.

Forest Tennant, MD, DrPH, is retired from clinical practice but continues his research on the treatment of intractable pain and arachnoiditis. This column is adapted from an updated bulletin recently issued by the Arachnoiditis Research and Education Project. Readers interested in subscribing to the bulletins should click here.

The Tennant Foundation gives financial support to Pain News Network and sponsors PNN’s Patient Resources section.