Summary: Ketamine is an anesthetic and can also reduce pain sensation. However, its use to treat depression is new. Studies show that few ketamine infusions can provide prolonged relief from depression. However, some doctors have raised concerns regarding the risk of ketamine abuse. Fortunately, a new study in rodents shows that ketamine is not addictive. It does cause an increase in dopamine. However, any such upsurge is short-lived and thus does not appear enough to cause addiction.

Ketamine is an anesthetic, and it is also known to help with pain. However, its use in managing depression is new. There is significant interest in ketamine treatment for depression as the studies show that it may help provide prolonged relief, unlike traditional antidepressants.

However, conversely, it is no secret that ketamine is also a club drug, a substance of abuse. It causes euphoria at higher dosages. Therefore, doctors worry that its frequent use may put their patients at risk, and many might become addicted to it. 

But some experts think that though it is psychotropic, it does not appear addictive. After all, it has been available for a long time, and there are not many people addicted to ketamine. Now, a new study shows that though it may stimulate the reward pathway, it also affects some other brain pathways that help prevent ketamine abuse.

Addiction vs. Dependence

Before discussing the risk of addiction further, it is vital to understand that addiction and dependence are two different things. Addiction is when one seeks a substance despite its negative health consequences. Addiction is a kind of behavioral disorder. For instance, opioid addiction treatment is carried out when abuse of opioids begins to produce negative effects on the body.  

Dependence, on the other hand, causes withdrawal syndrome on discontinuation of the use of the substance. In addition, dependence often causes severe physical signs. Drugs that cause dependence may affect most people who use them regularly.

Although most people may become dependent on some substances after their prolonged use, the same is not true for addiction. Studies show that only some people become addicted. Moreover, addiction only affects a small number of people.

For example, studies show that only one-fifth of cocaine users are really addicted to it. And for opiates, this rate is about 30%. In a recent study, researchers tried to understand the risk of addiction to ketamine.

Ketamine has a short-lived impact on the reward pathway

Generally, people get addicted to substances as they increase the levels of the pleasure molecule dopamine. For example, cocaine can boost the brain’s dopamine level for a long time. However, after some time, it would start falling, and thus a person would seek the drug to increase dopamine level again.

In the new study, researchers used a special device that allowed mice to self-administer ketamine. They found that it increased dopamine levels in mice, so they repeated the self-administration. However, they found dopamine levels elevated due to ketamine also falling quite quickly, unlike many other drugs of abuse.

Ketamine also seems to have the effect that prevents reward pathway stimulation

Researchers wanted to know why, unlike other drugs of abuse, ketamine treatment for depression causes such a short-lived increase in dopamine levels. They found that ketamine increased dopamine by inhibiting NMDA receptors. However, it also modulated other receptors, called the D2 receptors, that act as a brake on the rapidly increasing dopamine. 

Hence, they found that it is this dual mechanism that helps prevent permanent changes in the brain, unlike other drugs. Therefore, ketamine does not cause long-term behavioral changes. The increase in dopamine levels is for such a short time that it is not enough to cause addiction. The researchers concluded that there is almost zero addiction risk of ketamine in rodents.

Of course, these are still early findings. Nonetheless, it provides the basis for further studies. There is a need to find out if this is also true for humans. Considering that quite often, what works in rodents also works in humans, it is likely that it does not cause addiction. Even if it does cause, any such effect is probably quite low.

Summary: Many people are living with chronic pain and need opioids to manage their condition. However, if, for some reason, they need to find a new physician, it becomes very difficult. People find it hard to find a physician who is ready to prescribe opioids for their chronic pain. A new survey of 452 primary clinics confirms that almost half of all clinics in the US do not want to take patients who use opioids to manage their pain. There are worries that they might have legal problems. They also think that patients must be abusing opioids leading to some serious opioid addiction. However, even if the patient is abusing opioids, it is not the reason to refuse care, as refusal may result in patients turning to illicit drugs.

Most Americans already know that it is pretty hard to find a physician who would readily treat their chronic pain, especially if they are on opioids. People often have to call many clinics before getting an appointment or finding a physician ready to help them. However, this is not just an imagination of some patients. A new study now confirms that it is a significant problem for those living with chronic pain and requiring opioids for pain treatment. If they need to change their physician for some reason, they are in trouble.
The new study shows that almost half of all clinics in the US are hesitant to treat patients living with chronic pain if they are on opioids. In the new study carried out by researchers at the University of Michigan, researchers used a technique called “secret shopper.” In the study, one poses as a female patient living with chronic pain and taking opioids. Then, experts called 452 primary clinics in nine states to ask if they were taking new patients.

Finding medical care for those using opioids for their chronic pain is challenging

If the clinic said “yes, ” the person would say that she is covered by insurance and looking for a new healthcare provider to treat her chronic pain, as her earlier physician has retired or stopped prescribing opioids. So the researchers made two calls to each clinic and talked about one of the scenarios.

To the researchers’ amazement, 43% of all clinics said they would not prescribe opioids in both scenarios (early physician retirement or physician stopped prescribing opioids). Only about 32% said that their primary care providers (PCPs) might prescribe opioids in these scenarios. However, another 25% gave mixed signals.

Here it is clear that doctors are hesitant to take patients that are taking opioids, and they are rejecting them without even considering their health condition. The study also found that clinics were twice more likely to reject these patients if they said their doctor stopped prescribing them opioids for some reason. In such instances, clinics assume that a person might be having problems related to opioid misuse.

The study suggests that there is a significant challenge in finding the proper medical care for living with chronic pain. However, the chances of finding care for chronic pain are further reduced if there are some indications that a person may abuse opioids. Healthcare experts warn that such a kind of refusal may significantly increase the risk of a patient’s conversion to illicit substances.

Researchers went further to explore why some clinics are so hesitant to treat such patients. They said that it is due to new legal norms and fear that they may get into some kind of trouble for prescribing these drugs.

The study results are consistent with another study done in 2019, in which researchers also found that 40% of primary care physicians are highly reluctant to treat patients who need opioids for their chronic pain.

However, this discrimination against opioid users is incorrect and poses some significant problems. Therefore, this study aims to show the existence of so-called bias towards opioid users and poor healthcare access.

Health experts say that even if a person is using opioids for other reasons than pain management, they still need medical help. In fact, those addicted to opioids need greater medical assistance, and those are the patients that primary care physicians must be treating.

Summary: Since Purdue Pharma, the manufacturer of OxyContin, agreed to close their company by paying $8 billion in compensation, several other investigations and legal battles have begun. The Justice Department has filed a legal case against Walmart retail and wholesale for dispensing opioids without taking a good look at prescriptions, thus blaming it for having played a role in the opioid epidemic. However, Walmart disagreed, saying it could not come in between the doctor and patients and reported suspicious prescriptions to DEA. Ultimately, such legal battles might also impact patients who need opioids to control their chronic pains.

Since the opioid epidemic has come into the limelight, things have been changing fast. New regulations and prescription guidelines have been introduced by different stakeholders. However, due to pressures from various groups, multiple investigations have also begun, and so has the blame game.

Thus, the Department of Justice now alleges that Walmart has played a significant role in the opioid crisis. Moreover, the department says that Walmart’s retail chain and distribution unit are to be blamed for the epidemic.

The Justice Department says that Walmart did not pay adequate attention to many things, and thus they broke the law. They continued to dispense opioids to hundreds and thousands of people with invalid prescriptions and failed to report suspicious opioid orders. The department has filed a legal case against Walmart in the US District Court for the District of Delaware.

The department says that as the largest pharmacy chain, it has the means to prevent violations. However, they did not take appropriate measures.

However, Walmart has blasted the Justice Department for inventing some kinds of theories. They say that doctors prescribed, and Walmart pharmacies were bound to fulfill prescriptions. Therefore, Walmart cannot come in between the doctor and the patient.

However, the Justice Department did not agree with Walmart’s explanation, saying that Walmart knew that many of those prescriptions were not for true medical purposes. Not only that, but the Justice Department also blames Walmart for failing to report these issues to the Drug Enforcement Agency (DEA).

However, Walmart did not agree with most of this, as it says there has been a failure at the end of regulatory agencies, including DEA. They say they have empowered their pharmacists to refuse to fill prescriptions if they find them doubtful or if the opioids were not prescribed for the right reasons. On its end, Walmart claims it has sent tens of thousands of investigative leads and blocked thousands of questionable doctors. However, DEA failed to act on these leads.

The Justice Department has been pursuing all the companies it deems responsible for the opioid epidemic. However, things changed after Purdue Pharma, the maker of OxyContin, pleaded guilty and agreed to pay more than $8 billion to close the company.

However, all these legal tussles and blame games are not good news for people living with chronic pain and struggling with opioid addiction. It means those who need opioids for chronic pain treatment would now struggle to get prescription refills and those seeking opioid addiction treatment may face difficulty as well.

There is no doubt that doctors and pharmacists should take extra care when prescribing and dispensing controlled substances. However, abuse of specific medications by some individuals should not result in the inaccessibility of these beneficial remedies for those who need them most, including those seeking chronic pain treatment or opioid addiction treatment.

It is true that the opioid epidemic has caused many issues. However, if opioids become difficult to get, many of those addicted to opioids will start using other substances. However, when it comes to people living with chronic pains, they have limited options, as in many cases, opioids are irreplaceable. Thus, if the industry becomes too hesitant to produce, pharmacies reluctant to dispense, and doctors unwilling to prescribe, millions of people would suffer from pain and other severe health issues.

Summary: Fibromyalgia is a common chronic disorder causing body aches, fatigue, tenderness in various body parts, depression, sleep disorders, and more. The condition is caused by certain changes in the brain that remain poorly understood by science. Doctors treat fibromyalgia using painkillers, antidepressants, and other medications, but the treatment is far from satisfactory. However, new studies suggest that psychedelics like psilocybin or LSD may help in chronic pain treatment, as they can help reset the brain, providing long-term relief in the condition.

Fibromyalgia is among the most complex disorders to diagnose and treat. Fibromyalgia causes widespread body aches. There are multiple areas of high pain sensitivity. Not only that, but it also causes fatigue, sleep disorders, depression, and more.

However, the condition is still poorly understood by science. That is why it remains a diagnosis of exclusion. Before confirming the diagnosis, doctors would generally exclude other well-known chronic health disorders causing similar symptoms like body aches and fatigue. Its diagnosis is mainly clinical, and there are no reliable biomarkers to confirm it. Nevertheless, it is among the common causes of chronic pain. What is worrisome is that its incidence is increasing.

There is no single drug therapy that would work for all. Thus, doctors would prescribe non-inflammatory drugs and anti-seizure medications, like gabapentin, and antidepressants, to treat the condition. However, the benefit from most of these drugs is far from satisfactory, and the risk of side effects from such treatments is high. Thus, there is a need to find safe medications to treat the condition.

In recent years, doctors have understood that fibromyalgia is caused by some brain changes causing hyperalgesia and fatigue. Thus, body tenderness in the condition is rather due to changes in the brain and not due to some local inflammation. Hence, it is vital to explore drug therapies that may help alter the brain’s working. Psychedelics are known to help reset the brain and provide prolonged benefits for many brain disorders. However, psychedelic therapy still remains largely experimental in various health disorders.

Now, one of the pharma startups has decided to explore the role of psychedelics in managing fibromyalgia. A California-based company called Tryp Therapeutics has partnered with the Chronic Pain & Fatigue Research Center at the University of Michigan Medical School for a phase 2 study regarding the use of psilocybin to treat fibromyalgia.

There are many reasons to consider psilocybin. It is the psychoactive compound found in “magic mushrooms” and is known to be relatively safe. Thus, researchers do not need to spend years generating pre-clinical data, and they also do not need to start with a phase 1 study, which mainly focuses on the safety of the compound and its humans. It is because there is already sufficient information about psilocybin, and its safety in humans is established to a degree. It has the potential of becoming the best treatment for fibromyalgia.

Of course, phase 2 studies are also about safety, but they are more extensive than phase 1 studies. Moreover, they also focus on efficacy at a safe time. Thus, the possibility of starting from the phase 2 study means much savings in both financial terms and timelines.

The company will test synthetic psilocybin. Early studies suggest that psilocybin can alter neuroplasticity, alter many neural networks, and cause long-term changes in brain function. Hence, it is likely that it may help reduce hyperalgesia of central origin often found in those with fibromyalgia.

Everyone is very excited about the study, as its success may change how fibromyalgia is managed and may even affect how chronic pain treatment, opioid addiction treatment and depression management is carried out. But, of course, these are still early days, as the company is still only getting ready to file for phase 2 trials. Such a trial needs to enroll a few hundred people. However, for the US FDA to approve the drug for medical use, there would be a need for a phase 3 trial, which is much more extensive.

So, sure, there is still a way to go. Nevertheless, the news is exciting, as pharma companies have started looking beyond traditional painkillers or antidepressants to manage such conditions. Moreover, there is limited evidence that antidepressants work for fibromyalgia.

Even more interesting is that other pharma companies have also started exploring the role of psychedelics in managing fibromyalgia. Thus, another company, Mind Medicine, has announced that they are beginning their investigation regarding the use of LSD to treat chronic pain syndrome and get cluster headache relief.

To date, LSD and psilocybin are classified as Schedule 1 controlled substances; hence, they are not approved for any medical use. However, these studies may change all that.

Summary: Chronic pain is among the most common comorbidities in those being treated for opioid use disorder (OUD). However, a new study found that in most cases, doctors treating OUD do not pay sufficient attention to chronic pain management, resulting in higher opioid relapse. They also found that those treated with medications like methadone or buprenorphine had better pain relief and, thus, better treatment outcomes. Therefore, researchers recommend that doctors focus on managing comorbidities when treating OUD.

When we think of people living with OUD, we completely neglect that many of them live with severe chronic pain such as, neck pain, complex regional pain syndrome, etc. This poorly managed chronic pain may be related to poor treatment outcomes in many. Studies show that chronic pain is the most common comorbid condition in those living with OUD.

 

Recently, the Journal of Pain published a patient survey, finding that two-thirds of those treated for OUD reported that their chronic pain was not managed well. Even worse, 47% reported that their pain worsened over time, thus increasing the risk of opioid relapse.

 

The opioid crisis continues to be a significant health problem, and it is showing no sign of slowing down. Moreover, the coronavirus pandemic only increased opioid use disorder (OUD) and drug overdose-related deaths. This only underlines the need to pay more attention to the effective opioid addiction treatment.

 

Health experts say that the problem in tackling the opioid crisis is not just in lack of access to opioid treatment, which is true. Still, other factors make treatment more difficult and result in high relapse rates. In addition, most people treated with OUD have other comorbidities, with many living with mental health issues and chronic pain.

 

Although it is no secret that chronic pain and OUD are related health issues. However, it is unknown how ill-managed pain in those living with OUD may affect treatment outcomes for the condition. Health experts say that one of the problems is that treating doctors focus significantly on OUD, but less on comorbidities, especially issues like chronic pain.

 

In the new survey, researchers analyzed the data of 14,449 patients getting treated in 225 OUD treatment centers. They found that one-third of all the patients had significant chronic pain. Out of these patients, just one-third reported that their chronic pain was managed properly with pharmaceutical drugs. Moreover, almost half of all the patients said the pain was the primary reason for opioid relapse.

 

Researchers say this is a massive sample size, and they were amazed to see that so many patients are not being treated adequately for their chronic pain. Many of these patients have even used street drugs like heroin to manage their pain.

 

When researchers interacted with doctors treating OUD, they were often told that treating pain was not their priority or not within the scope of their practice.

 

Researchers say that there is a need to understand that pain is among the most significant causes of opioid relapse. Hence, effective treatment of OUD must include adequate pain relief.

 

The study had another unexpected finding related to opioid relapse. In the survey, 20% of those treated for OUD said that they would return to opioid use once they overcame their addiction. It means that treatments are not preparing them well for post-treatment life, and many of them still view opioid use as an option.

 

The study also found that those treated with OUD with medications had a higher success rate. Thus, those treated with buprenorphine and methadone reported better treatment satisfaction. It seems that one of the reasons for a greater success rate with these medications is that they also help with chronic pain treatment.

 

Thus, health experts say addiction treatment will only improve if different health specialists work together. Moreover, the coronavirus pandemic has shown that interdisciplinary collaboration using technologies like telemedicine is not that difficult.

 

Of course, researchers say that the study has also raised certain questions, like the role of opioids in pain management. As a result, the researchers suggest that the use of opioids for managing chronic pain should be limited.

 

Additionally, researchers say that one of the issues is that doctors often do not view chronic pain as one of the significant issues. They forget that this pain may be due to comorbidities like depression and mood disorders requiring treatment. If these comorbidities remain unmanaged, relapse is more likely.

 

Hence, researchers concluded that OUD should be treated by multi-specialist teams, including pain management, psychiatry, psychology, integrative medicine, and physical therapy. In addition, we should treat the patient as a whole and not merely focus on reducing pain numbers on a scale.

Summary: Chronic pain is challenging to treat. Many people living with chronic pain continue to suffer for months or even years despite medical treatment. Inadequate chronic pain opioid addictionology treatment has contributed to the opioid epidemic. One of the ways to overcome chronic pain is patient education. Teaching patients self-care will help manage pain and prevent its future episodes. However, doctors do not have time and motivation for patient education, as they are not reimbursed for it. The new digital system tries to overcome this gap in patient care by providing an education system to doctors. It is a system that can be integrated into any electronic health record. It uses intelligent algorithms, predictive analytics, and more. It also ensures fair compensation to the healthcare workers for patient education.

Chronic pain is among the leading causes of disability. US data shows that almost one-fifth of adults live with chronic pain, and about 8% have severe pain. In addition, poorly managed chronic pain is one of the reasons for the opioid epidemic in the US. Therefore, doctors need to frequently assess the pain scores of their patients and adjust treatment plans.
Clinicians should prescribe medications and support and coach patients in self-care. However, the problem is that doctors lack time and tools and are not reimbursed for better ongoing patient support.

Patient-centered addiction and chronic pain care

This model of care tries to close the existing gap in patient care. It provides telemedicine coaching to patients to manage chronic pain and reduce its risk. This approach also fulfills the current gap by reimbursing the health professionals for training patients in self-care through telemedicine.
Telemedicine care includes the following:

● Validated pain and risk assessment tools.
● Patient engagement platform containing digital lessons that are readily integrated into any electronic health record system. Based on the EHR, the program can provide personalized training to the patients. It can also help track outcomes remotely.
● Telemedicine coaching encourages patients to make lifestyle changes and thus helps them recover faster from pain.
● Remote monitoring dashboard that helps doctors track the progress being done by the patient.
● It also contains predictive analytics using artificial intelligence to predict long-term health outcomes.

Patient-centered transformative care

The critical thing about the program is that it is highly engaging and thus helps patients to make needed changes. It uses the following strategies:

● Create a well-structured pain management program, and provide tele-coaching to the patients. It focuses on the seven realms of a patient’s life; body, lifestyle, mind, emotions, spirit, environment, and social life.
● The program helps make shifts to patient-centered care, thus facilitating patient empowerment and greater engagement and hence improving the long-term outcomes.
● The program encourages shared decision-making so that the patient develops a better understanding of the condition, and this also results in shared responsibilities.
● It promotes support from family and friends, as they play a crucial role in reducing pain and managing addiction.
● It helps develop interactive content that is easy for patients to remember and thus incorporate into their life.
● Create a simple and doable action plan.

Studies show that more than fifty percent of cases of chronic pain cases still have pain even after a month. Even worse, many of them continue to experience pain for several years. This happens despite the best treatment. It appears that in many cases, the cause of this poorly managed chronic pain is the lack of self-management training for the patients.

Thus, transformative care can provide the right tools to the doctors for shifting to patient-centered care, providing healthcare workers with the necessary digital tools for this transformation, and assisting them with patient education.

Transformative care provides research-based tools that take a minimum time for the clinicians, help in remote monitoring, and have predictive data analytics. It also solves the issue of reimbursement by health plans.

To conclude, managing chronic pain is challenging, and patients continue to experience pain even several months after continued treatment. It appears that the leading cause is poor self-management of painful conditions by the patients, as doctors lack time and tools to educate the patients. Therefore, new transformative care digital tools try to fulfill this gap and thus help with better patient outcomes.

Summary: Despite a decline in opioid prescriptions, the opioid crisis continues. Opioid use disorder (OUD) and deaths due to opioid overdose continue to increase. Thus, researchers say that there is a need to develop a better understanding of opioid dependence and avoid oversimplification of the problem. So though an increase in opioid prescriptions initially fueled the crisis, later, other factors came into play, like pill mills and an increased supply of illegally produced opioids. 

The opioid crisis is not new, but it is not showing any signs of fading despite the best efforts of regulatory agencies and medical practitioners. What is worrisome is the upward trend of opioid overdose-related deaths, despite a significant decline in opioid prescriptions in the last few years. In addition, it appears that many are now procuring and using prescription opioids produced illicitly. 

Researchers think that if we want to counter this crisis, we need to understand the complex nature of the opioid crisis. Things are not as simple as they might appear. This crisis is not fueled much by opioid prescriptions by doctors to manage chronic pain. Instead, there are other factors like pill mills and “unscrupulous” physicians fueling opioid use disorder (OUD). This pathway that is fueling OUD exists outside the domain of chronic pain management. 

Though there are indeed many faces of the opioid crisis, and it is among the most complex health crisis causing physical and psychiatric health issues. Still, it is also worth understanding that the drug landscape is continually changing. Therefore, what researchers warn is against the oversimplification of the problem. 

For example, saying that the epidemic is solely fueled by opioids prescribed to manage chronic pain is just an oversimplification. On the contrary, studies show that when opioids are prescribed for managing chronic pain, very few patients abuse these drugs. Hence, opioids prescribed by doctors to manage chronic pain do not contribute much to OUD.

Similarly, initially, this factor played a role in OUD development since prescription drugs were cheaper options. However, this factor is not relevant anymore. Though pill mills continue to contribute to the crisis, they are not the only source.

It is true that initially, opioid prescription played a significant role in the opioid epidemic. The epidemic had a humble beginning, as the doctors wanted to help their patients living with chronic pain. Thus, they started prescribing opioids to many patients. However, soon opioid demand rose, and many started procuring these drugs from the illicit market. Due to high demand, the market got filled with illegal drugs. This also affected the market for illicit drugs as it shifted from heroin from Asia to illicitly produced fentanyl in Latin America.

However, researchers say we cannot blame pill mills and unscrupulous physicians alone. Many hospitals continue to prescribe opioids even for conditions with little benefit from opioid prescriptions. 

Since the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, opioid prescriptions have fallen. Nonetheless, opioid prescriptions remain relatively high in the US compared to other nations worldwide. In addition, studies now confirm that 90% of those living with OUD often use these drugs for non-medical reasons.

Though studies suggest that very few people prescribed opioids for chronic pain will ever develop OUD, this is still a significant number. Moreover, studies show that the number of people older than 50 seeking treatment for OUD has continuously increased. People of this age group are more likely to source opioids from physicians.

Similarly, it is still poorly understood why some individuals are more likely to develop OUD. Nonetheless, researchers think that there is no single explanation. Most of those who develop OUD are individuals who already have other psychiatric comorbidities apart from chronic pain. Thus, this group of people is more likely to develop OUD. Consequently, they not only keep using prescription opioids but are also pretty likely to buy illicit drugs.

To sum up, the researcher says that though specific techniques like using electronic health record notification and motivational interviewing along with opioid dependence treatment  may help reduce the risk of OUD, much work still has to be done to understand the causes of OUD.

It is our mission to bring real hope and transformational change to patients who would otherwise be consigned to a lifetime of medications for opioid addiction treatment, doctor’s visits, and suffering. We expose misaligned incentives and return the power of health to the individual. We believe empowered individuals change their communities. We use a combination of lifestyle intervention, medication management, and emerging scientific research to help our patients.  When you are ready or have questions, reach out.

Medical Disclaimer: Keep in mind that the content provided is not direct medical advice for patient care, but is provided for thoughtful discussion.

Summary: Chronic groin pain is a significant issue in those who have undergone surgery for an inguinal hernia. This often leads to patients blaming the mesh companies. It also causes prolonged distress and trauma to the patients. However, doctors often fail to treat such pains. Studies suggest that in many such instances, pain is due to some other underlying cause like low back pain or trauma, and only in small cases is it secondary to surgical intervention. Thus, doctors recommend careful history taking to identify the cause of this pain and suggest various treatments like Suboxone treatment. Additionally, experts also recommend exploring nontraditional treatments for chronic pain, like psychedelic-assisted psychotherapy.

 

In the annual meeting of the American Hernia Society, 2021, Doctor Brian P. Jacob discussed the significance of understanding chronic groin pain and finding its solution using innovative treatment methods.

 

Groin pain is a pretty common complaint among those living with inguinal hernia. Quite often, this hernia is treated using mesh repair. It is a relatively simple surgical procedure that provides instant relief in 70% of cases. However, experience shows that one-third of patients continue to experience pain. Quite often, they blame mesh for their continued pain, and doctors fail to understand the cause of such pain.

 

Dr. Jacob has multiple recommendations for surgeons and pain clinics for managing such pain. He also underlined the importance of understanding this pain. Since this continued pain after surgery is a source of significant distress. It makes patients quite angry, and they also go on blaming the mesh companies for their pain. Not only that, untreated patients undergo significant trauma, resulting in PTSD.

 

Surgeons must identify the cause of chronic pain

Dr. Jacob says that there are two sources of these chronic pain in those who had hernia surgery. The first and often overlooked cause of this chronic pain is some pre-existing condition in the patient, like a back issue or some other trauma. Unfortunately, doctors often fail to notice or identify these causes, and the patient continues to associate this pain with the surgery.

 

The second reason for such chronic pains is naturally the surgery itself, which means unintentional fault. Unfortunately, however, surgeons are often hesitant to accept that something has occurred due to the surgical procedure, and this negation only adds to the patient’s frustration.

 

There cannot be more frustrating for the patient than doctors failing to recognize the cause of pain. Thus, such patients have to tolerate this continuous chronic pain, and at the same time, they undergo severe emotional trauma. Worst in this situation is the fact that these patients largely remain untreated.

 

Thus, Dr. Jacob recommends that doctors accept that their patient is going through severe and chronic pain and focus on finding the solution. It is true that identifying the cause of such chronic pain is challenging. Nevertheless, they need to treat such patients. He particularly recommends focusing on alternative therapies

Alternative therapy for chronic groin pain

Dr. Jacob advocates exploring alternative treatments for chronic pain. This does not essentially mean supplements. It also means exploring uncommon approaches to pain management. The traditional way of pain management appears to mask the pain origins and provide temporary relief.

 

Unlike traditional painkillers or opioids, doctors must explore non-pharmacological therapies like meditation, mindfulness, yoga, pilates, and even psychotherapy. Dr. Jacob is also a proponent of psychedelic-assisted psychotherapy.

 

When it comes to psychedelic-assisted psychotherapy, this therapy mainly uses ketamine these days. Ketamine is proven to work, safe, and supported by many clinical studies. The results of ketamine-assisted psychotherapy are pretty promising.

 

However, Dr. Jacobs also favors exploring other ways of psychedelic-assisted psychotherapy. Among the other agents, psilocybin and MDMA are pretty promising. These medicines have excellent safety profiles and maybe even better than ketamine. Moreover, these therapies not only treat pain but also help overcome anxiety, depression, PTSD, and other severe mental health issues.

 

In short, Dr. Jacob strongly recommends taking a thorough history of patients with groin pains. The doctor should not assume that this pain is only due to an inguinal hernia. In many cases, other unidentified causes of groin pain remain undiagnosed. Additionally, in some cases, the cause of chronic pain could be a surgical procedure. In all these conditions, doctors must understand the patient’s pain and focus on treating chronic pain using various methods.