New Neuro-Stim Device Lessened Abdominal Pain in Adolescents

I found this article and I thought it was really interesting. It might be a viable, possible treatment for people with gastroparesis. I am not familiar with it, so I apologize for the long article, but I wanted to share it and add it to my blog so that I can reference it later. It makes me happy that doctors are trying to find different treatments to help with gastroparesis and abdominal pain. It is a good step in the right direction. It will also help with pain from fibromyalgia and possibly for migraines as well. I know that it does not work for everyone.
However, I wanted to share the article anyway, to keep it in once place in my blog. Even though it may not work for everyone, I thought it was worth sharing and worth documenting in my blog for future research. The article is below.

"Electrical nerve stimulation introduces a potential non-pharmacologic treatment to address pain in adolescent patients who present with functional gastrointestinal pain disorders.
By Megan Garlapow, PhD With Adrian Miranda, MD, and Gary W. Jay, MD

Administering percutaneous electrical nerve field stimulation (PENFS) with Neuro-Stim, a FDA-cleared device manufactured by Innovative Health Solutions, in an adolescent population whose primary complaint was gastrointestinal pain, appeared to lessen subjective pain scores, according to findings published in The Lancet Gastroenterology and Hepatology.

The researchers were able to demonstrate that abdominal pain—the primary efficacy outcome of a difference from baseline to treatment—improved significantly in patients who underwent PENFS applied to the ear, as compared to those who had the sham treatment.1 The PENFS device must be applied by a licensed clinician.

Source:https://i.pinimg.com/736x/d7/3e/c6/d73ec617c2c77f196837e11f34305ff7--vagus-nerve-damage-electro-shock.jpg




Nerve stimulation device lessens gastrointestinal pain in teens; Efficacy Achieved Using Neuro-Stim for Gastrointestinal Pain


A randomized clinical trial in which 115 pediatric patients, ranging in age from 11-18 years old, who presented with abdominal pain related to a functional gastrointestinal (GI) disorder were treated at a single, out-patient clinic in the midwest.1

'We had heard about similar [favorable] results in other chronic pain conditions, but most results were from anecdotal reports,' said senior author Adrian Miranda, MD, a pediatric gastroenterologist and associate professor at the Medical College of Wisconsin in Milwaukee, 'We had to carry out a randomized controlled trial to properly assess the findings,' for GI pain.

More importantly, our preclinical studies demonstrated a reduction in the firing of neurons in the amygdala and spinal cord using the same technology,2 Dr. Miranda told Practical Pain Management, 'These central areas have been proposed by many to play a critical role in the development and maintenance of chronic pain.'

Functional abdominal pain disorders are a group of conditions, such as irritable bowel syndrome, abdominal migraine, and functional abdominal pain syndrome, in which pain is typically the most prominent complaint and symptoms are not caused by other conditions.




Study Design and Methodology

Patients were enrolled in the trial between June 2015 and November 2016. Researchers administered the non-invasive PENFS procedure via the external ear (n = 60) or a sham with no electrical stimulation (n = 55) for four weeks. The procedure was initiated with the intent to modulate central pain pathways. Patients were randomized equally to each arm with stratification based on sex, and presence or absence of nausea. Patients, caregivers, and researchers were blinded to allocation by group.

An outcomes analysis included 57 patients in the PENFS arm and 47 patients in the sham group after patients were excluded for discontinuation of treatment or for having organic disease.1

The primary efficacy endpoint—change in baseline reported abdominal pain—was assessed with the Pain Frequency Severity Duration Scale (PFSD), a subjective tool used to derive a quantifiable pain score in these young participants.1 The researchers used PFSD scores to assess improvements from the worst abdominal pain score as well as from a composite abdominal pain score.




Reduced GI Pain Was Sustained Following Neurostimulation

After three weeks of treatment, patients in the PENFS arm experienced a greater decrease in worst pain compared with patients in the sham arm (median score PENFS 5.0, IQR 4.0 - 7.0; sham 7.0, 5.0 - 9.0). The least-square means estimate of change in worst pain was 2.15 (95% CI: 1.37 - 2.93, P < .0001).1 Median composite scores of PFSD also decreased significantly in the PENFS arm, from 24.5 (IQR 16.8-33.3) to 8.4 (3.2-16.2), compared to the sham arm, which went from 22.8 (8.4-38.2) to 15.2 (4.4-36.8).1 Both worst pain and composite pain effects were reported for a median of 9.2 weeks during follow-up.1 The median worst pain was 2.0 points lower at follow-up in the PENFS arm but only 0.5 points lower in the sham arm (P < .0001). In addition, median composite pain at follow-up was 12.5 points lower in the PENFS arm compared to 6.0 points lower in the sham arm (P=.018). 'I know that ultra-high frequency can cause specific neurochemical changes that decrease pain,' said Dr. Gary W. Jay, MD, a clinical professor in the Headache Division in the Department of Neurology at the University of North Carolina, Chapel Hill. 'While I can at least get some idea as to why the reported pain decreased from this study, we don’t know what the parameters of electronic stimulation were, and they’ve done no testing other than filling out subjective forms, Dr. Jay told Practical Pain Management. Need for Further Understanding of Longterm Benefits

Dr. Miranda shared some additional information on how persistent this therapy might be at reducing abdominal pain.

'I have patients whose symptoms have resolved and are six months out of treatment while others have recurrence at five months,' he said, 'and it may be that a second treatment is needed for those who have recurrence, or perhaps a longer initial trial of six weeks would be required to prevent relapse.'

'It’s too early to tell, and certainly longitudinal studies need to be done,' Dr. Miranda said, 'Perhaps in the future, this therapy can be combined with imaging techniques to better predict the phenotype that will respond to treatment.'

Dr. Jay concurred with the need for imaging studies, particularly as PFSD is susceptible to issues surrounding subjective measurements. Objective, physiological measurements could yield meaningful insights into the biological basis of the results achieved in this study, according to Dr. Jay. He also noted that the study did not provide sufficient detail about the methodology used to employ electrical stimulation.

'The researchers are not giving us any parameters of what they are doing, and they are also not looking at whether there are any physiological changes occurring,' said Dr. Jay. 'You would want to do functional MRIs to see exactly what is this stimulation is doing.'




Conclusions and Future Directions

Dr. Miranda expects transcranial electrical stimulation to hold promise for additional pain disorders.

'I think we have just started to uncover the possibilities of neuromodulation, using peripheral electrical stimulation. The implications for this type of non-invasive neuromodulatory therapy holds promise beyond just functional pain disorders, in my opinion,' said Dr. Miranda, 'and if you think about the central mechanisms that are involved in chronic pain, there is really no reason why this technology couldn’t be applied to many pain disorders.'

Dr. Jay agreed that neuromodulatory electrical stimulation has the potential to improve other disorders characterized by pain.

'Given that some of the animal studies show amygdala or limbic system involvement secondary to the stimulation, which would make sense in certain disorders, I would want to see trials that at this aspect. The limbic system is very highly incorporated into another so-called functional pain syndrome, fibromyalgia,' he told Practical Pain Management.

Dr. Miranda explained the need for creating distinct therapeutic regimens for individual patients and emphasized the importance of understanding which components could form the foundation for such a regimen, including pharmacotherapy, physical reconditioning, and neuromodulation.

'We need to figure out who our responders are for each treatment and tailor our approach for each patient. There is not one treatment that will work for all patients,' said Dr. Miranda. 'Yet we don’t always discuss these components of treatment with our patients because of time constraints, lack of resources, or issues with insurance coverage,' Dr. Miranda said.

The American Neurogastroenterology and Motility Society funded this research. The authors have no other disclosures.



Sources
Kovacic K, Hainsworth K, Sood M, Chelimsky G, Unteutsch R, Nugent M, Simpson P, Miranda A. Neurostimulation for abdominal pain-related functional gastrointestinal disorders in adolescents: a randomised, double-blind, sham-controlled trial. Lancet Gastroenterol Hepatol. 2017;S2468-1253(17:)30253-30254.
Babygirija R, Sood M, Kannampalli P, Sengupta JN, Miranda A. Percutaneous electrical nerve field stimulation modulates central pain pathways and attenuates post-inflammatory visceral and somatic hyperalgesia in rats. Neuroscience. 2017;25;356:11-21."

I have another article that I have researched and written on the vagus nerve. You can find it here: http://www.emilysstomach.com/2016/07/information-about-vagus-nerve.html

There is another article I wrote about the vagus nerve stimulator, which can be found here: http://www.emilysstomach.com/2017/06/the-vagus-nerve-stimulator.html

A Doctor's Advice to those with Chronic Illness

My friend Tanya recently shared an article that I wanted to re-post. It's a great read! I was actually sitting in the middle of my floor, in my bathroom, crying, because pain and nausea keep hitting me in waves. I woke up gagging and vomiting from horrible night terrors that continued when I went back to sleep to round out my four hours of sleep last night. I saw this article and read it.

I forget sometimes that sometimes, as our own advocates, that we can come on too strongly to doctors. I definitely don't want to intimidate anyone, I just want help - as I imagine many chronically ill people feel. I think as someone who is chronically ill, we tend to give up on doctors before we even meet them because of past experiences with other doctors, specialists, etc. If you're like me, you've seen too many doctors to count. But, this doctor's advice brought me back down to Earth. I'm probably guilty of doing some of this so I wanted to share this article with everyone.

"A Letter to Patients with Chronic Illness
by: Dr. Rob BLOG LINK: HERE

Dear Patients:

You have it very hard, much harder than most people understand. Having sat for 16 years listening to the stories, seeing the tiredness in your eyes, hearing you try to describe the indescribable, I have come to understand that I too can’t understand what your lives are like. How do you answer the question, “how do you feel?” when you’ve forgotten what “normal” feels like? How do you deal with all of the people who think you are exaggerating your pain, your emotions, your fatigue? How do you decide when to believe them or when to trust your own body? How do you cope with living a life that won’t let you forget about your frailty, your limits, your mortality?

I can’t imagine.

But I do bring something to the table that you may not know. I do have information that you can’t really understand because of your unique perspective, your battered world. There is something that you need to understand that, while it won’t undo your pain, make your fatigue go away, or lift your emotions, it will help you. It’s information without which you bring yourself more pain than you need suffer; it’s a truth that is a key to getting the help you need much easier than you have in the past. It may not seem important, but trust me, it is.

You scare doctors.

No, I am not talking about the fear of disease, pain, or death. I am not talking about doctors being afraid of the limits of their knowledge. I am talking about your understanding of a fact that everyone else seems to miss, a fact that many doctors hide from: we are normal, fallible people who happen to doctor for a job. We are not special. In fact, many of us are very insecure, wanting to feel the affirmation of people who get better, hearing the praise of those we help. We want to cure disease, to save lives, to be the helping hand, the right person in the right place at the right time.

But chronic unsolvable disease stands square in our way. You don’t get better, and it makes many of us frustrated, and it makes some of us mad at you. We don’t want to face things we can’t fix because it shows our limits. We want the miraculous, and you deny us that chance.

And since this is the perspective you have when you see doctors, your view of them is quite different. You see us getting frustrated. You see us when we feel like giving up. When we take care of you, we have to leave behind the illusion of control, of power over disease. We get angry, feel insecure, and want to move on to a patient who we can fix, save, or impress. You are the rock that proves how easily the ship can be sunk. So your view of doctors is quite different.

Then there is the fact that you also possess something that is usually our domain: knowledge. You know more about your disease than many of us do – most of us do. Your MS, rheumatoid arthritis, end-stage kidney disease, Cushing’s disease, bipolar disorder, chronic pain disorder, brittle diabetes, or disabling psychiatric disorder – your defining pain - is something most of us don’t regularly encounter. It’s something most of us try to avoid. So you possess deep understanding of something that many doctors don’t possess. Even doctors who specialize in your disorder don’t share the kind of knowledge you can only get through living with a disease. It’s like a parent’s knowledge of their child versus that of a pediatrician. They may have breadth of knowledge, but you have depth of knowledge that no doctor can possess.

So when you approach a doctor – especially one you’ve never met before – you come with a knowledge of your disease that they don’t have, and a knowledge of the doctor’s limitations that few other patients have. You see why you scare doctors? It’s not your fault that you do, but ignoring this fact will limit the help you can only get from them. I know this because, just like you know your disease better than any doctor, I know what being a doctor feels like more than any patient could ever understand. You encounter doctors intermittently (more than you wish, perhaps); I live as a doctor continuously.

So let me be so bold as to give you advice on dealing with doctors. There are some things you can do to make things easier, and others that can sabotage any hope of a good relationship:


Don’t come on too strong – yes, you have to advocate for yourself, but remember that doctors are used to being in control. All of the other patients come into the room with immediate respect, but your understanding has torn down the doctor-god illusion. That’s a good thing in the long-run, but few doctors want to be greeted with that reality from the start. Your goal with any doctor is to build a partnership of trust that goes both ways, and coming on too strong at the start can hurt your chances of ever having that.

Show respect – I say this one carefully, because there are certainly some doctors who don’t treat patients with respect – especially ones like you with chronic disease. These doctors should be avoided. But most of us are not like that; we really want to help people and try to treat them well. But we have worked very hard to earn our position; it was not bestowed by fiat or family tree. Just as you want to be listened to, so do we.

Keep your eggs in only a few baskets – find a good primary care doctor and a couple of specialists you trust. Don’t expect a new doctor to figure things out quickly. It takes me years of repeated visits to really understand many of my chronic disease patients. The best care happens when a doctor understands the patient and the patient understands the doctor. This can only happen over time. Heck, I struggle even seeing the chronically sick patients for other doctors in my practice. There is something very powerful in having understanding built over time.

Use the ER only when absolutely needed – Emergency room physicians will always struggle with you. Just expect that. Their job is to decide if you need to be hospitalized, if you need emergency treatment, or if you can go home. They might not fix your pain, and certainly won’t try to fully understand you. That’s not their job. They went into their specialty to fix problems quickly and move on, not manage chronic disease. The same goes for any doctor you see for a short time: they will try to get done with you as quickly as possible.

Don’t avoid doctors – one of the most frustrating things for me is when a complicated patient comes in after a long absence with a huge list of problems they want me to address. I can’t work that way, and I don’t think many doctors can. Each visit should address only a few problems at a time, otherwise things get confused and more mistakes are made. It’s OK to keep a list of your own problems so things don’t get left out – I actually like getting those lists, as long as people don’t expect me to handle all of the problems. It helps me to prioritize with them.

Don’t put up with the jerks – unless you have no choice (in the ER, for example), you should keep looking until you find the right doctor(s) for you. Some docs are not cut out for chronic disease, while some of us like the long-term relationship. Don’t feel you have to put up with docs who don’t listen or minimize your problems. At the minimum, you should be able to find a doctor who doesn’t totally suck.

Forgive us – Sometimes I forget about important things in my patients’ lives. Sometimes I don’t know you’ve had surgery or that your sister comes to see me as well. Sometimes I avoid people because I don’t want to admit my limitations. Be patient with me – I usually know when I’ve messed up, and if you know me well I don’t mind being reminded. Well, maybe I mind it a little.

You know better than anyone that we docs are just people – with all the stupidity, inconsistency, and fallibility that goes with that – who happen to doctor for a living. I hope this helps, and I really hope you get the help you need. It does suck that you have your problem; I just hope this perhaps decreases that suckishness a little bit.

Sincerely,

Dr. Rob"

I think this is amazing advice! I am guilty of putting up with jerks and avoiding doctors because of it. But, I hope this helps you in some way. It stopped me from crying earlier. <3

How to Make Good Decisions When You Have a Chronic Illness.

I found this article online and I thought it was worth sharing because it contains great information. I will edit it later with my own perspective added to it but thought it was important enough to share now.




How to Make Good Decisions When You Have a Chronic Illness
By Tom Robinson



Every day, all of us have lots of decisions to make. When you have a chronic illness, many of those decisions involve which providers to see, which treatments to try, and things like that. So they can affect whether you get better or worse and many other aspects of your quality of life. So you definitely want to make those decisions good ones.



But it is often hard to make good decisions, especially when you’re struggling with a chronic illness. However, no matter what you’re struggling with or what is going on in your life, it is still possible to make them. In this post, I’m going to share with you a way to do that which works well for me.



I have found, both in my own life and from coaching hundreds of people during the past 10 years, that one of the main things that makes it hard for us to make good decisions is our feelings, especially the unpleasant ones, such as sadness, rejection, fear, etc. We don’t like having those feelings, so without even thinking about it, we automatically make decisions that allows us to avoid them. But those automatic decisions can often have a negative effect on our health and our quality of life.



Knowing that, one of the ways I make better decisions is to think of my mind as a room with windows at both ends and think of my feelings as scents in the air that blows through it. Looking at feelings that way, I’ve found that if I just notice and observe them coming into my mind—the way I would notice and observe scents–without getting caught up in them, the window at the back of the room stays open, and they pass through. But when I get caught up in and dwell on those feelings, the window at the back of the room closes. And I end up making more and more bad decisions in an attempt to either avoid them or pretend they’re not there.



So as I’ve said, I make much better decisions when I just notice and observe my feelings. I know you will too. But there is another benefit—a very big one–that comes from allowing the unpleasant feelings to pass right through the room rather than reacting to them. The more we practice allowing those unpleasant feeling to pass right through, the more our ability to do so increases. I have found and seen that as it does, the more confident we become that we can handle the many challenges that we all experience in our lives. And with that confidence comes a deeper and deeper sense of peace.


The link to the article can be found HERE.