Often, chronic pain is invisible to those on the outside, which can make interactions difficult, especially when it flares without warning. This can include anything from arthritis or fibromyalgia to lyme disease. Just because others can’t see it doesn’t mean you don’t feel it.

We’ve put together a guide on how to travel if you’re living with chronic pain – which can be tension headaches, back or hip pain, knee replacements, and complications from surgery. We’ll cover what to pack, questions to ask, and much more.

Before the Trip: How to Pack for Travel When You Suffer From Chronic Pain

Giving yourself extra time to pack for traveling when you have chronic pain will help you prepare for your journey, and reduce stress because you’ll know you have everything you need to manage it.

Be sure to fill your prescriptions well before your trip, and have enough with you for the duration of your time away. Pack them in your carry-on bag (never in your checked luggage!) and put it within quick reach. Consider taking a small bag to carry with you throughout your entire journey, so they’ll always be close at hand.

Pack other helpful items like a heating pack, a neck pillow for long flights or train rides, and a good pair of shoes if you plan to do a lot of walking or sightseeing on your trip. Bring along a note from your doctor explaining your condition, and a list of the medications you’re taking, in case you need to show it for medical assistance or to get through the TSA checkpoint at the airport.

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The observations add to previous studies suggesting that “progressive exercise training markedly decreased diabetes associated neuropathic pain,” write Yu-Wen Chen, PhD, of China Medical University, Taichung, Taiwan, and colleagues. The link to Hsp72 offers a clue as to how exercise can prevent or slow the development of neuropathy—a major complication of diabetes.

Exercise Reduces Diabetic Nerve Pain in Rats
Neuropathic pain is a common and difficult-to-treat type of pain related to nerve damage—most commonly caused by diabetes. Affecting about half of patients with diabetes, diabetic neuropathy causes symptoms such as numbness, tingling, or pain in the arms and legs.

Dr Chen and colleagues examined the effects of exercise on neuropathy caused by chemically-induced diabetes in rats. For a few weeks after induction of diabetes, some animals were assigned to a progressive treadmill exercise program.

Within two weeks, the diabetic rats that did not exercise showed signs of diabetic neuropathy, based on observable pain behaviors. These included abnormal responses to temperature and pressure (thermal and tactile hypersensitivity)—both characteristic of neuropathic pain.

“In contrast, diabetic rats undergoing exercise demonstrated delayed progress of tactile and thermal hypersensitivity,” Dr Chen and colleagues write. The reduction in painful diabetic neuropathy was associated with lesser increases in blood glucose levels after induction of diabetes.

Previous studies have suggested that neuropathic pain may be related to expression of certain inflammation-promoting cytokines—such as tumor necrosis factor-alpha and interleukin-6—which might be reduced by exercise. In the new experiments, expression of TNF-alpha and IL-6 in nerve tissue were significantly increased after induction of diabetes, with no difference for exercising versus non-exercising animals.

Findings Suggest Role of Heat Shock Protein
However, diabetic rats assigned to exercise showed increased expression of Hsp72 in nerve tissues. Hsp 72 is one of a family of heat shock proteins that play essential roles in protecting against cellular damage caused by various types of stress (including heat stress). Previous experiments have shown protective effects of Hsp72 in other conditions, including neuropathy caused by mechanical nerve injury.

Exercise is commonly recommended for patients with various types of chronic pain, and is routinely prescribed as part of treatment to control diabetes. A growing body of evidence suggests that exercise may also have beneficial effects in reducing painful diabetic neuropathy.

The new study provides support for the concept that exercise can slow the progression of diabetic neuropathy. In the animal experiments, exercise had short-term effects on abnormal responses to pain and temperature, although long-term responses were unchanged.

The study also adds new evidence that exercise may protect against diabetic neuropathy by suppressing induced blood sugar levels while increasing expression of Hsp72 in nerve tissues. The results may present new opportunities for developing new, nondrug approaches that can “delay or protect against the development of diabetic peripheral nerve complications,” Dr Chen and coauthors conclude.

Read the article in Anesthesia & Analgesia

• Neurostimulation
• Targeted Drug Delivery
• MRI Labeling

Neurostimulation

Medtronic is continually advancing neurostimulation therapy with the latest technology.

AdaptiveStim™, exclusively available with RestoreSensor™, is a first-of-its-kind neurostimulation system that uses an accelerometer similar to what is used in smart phones and gaming devices to detect a change in position.

Only AdaptiveStim lets your patient go about their day without using their programmer to change stimulation settings.

It:

• Listens and senses when your patient changes position
• Learns from previous experience and remembers your patient’s last comfortable setting
• Responds and automatically adjusts stimulation to your patient’s optimal setting
• Records your patient’s objective data

Common uses for neurostimulation

• Post-laminectomy pain
• Failed back surgery syndrome
• Degenerative disc disease
• Herniated disc pain
• Complex regional pain syndrome
• Epidural fibrosis
• Arachnoiditis
• Peripheral causalgia

Benefits of neurostimulation

• An effective method of pain control for many patients when used as directed
• May reduce the consumption of oral pain medications
• Reversible—can be discontinued or, if desired by the patient, surgically removed
• Systems can be reprogrammed without surgery
• Patient can control the level of therapy within programmable limits
• Trial of therapy may help assess patient response

Screening test

A screening test provides an opportunity to assess the effectiveness of neurostimulation and gauge patient response without a long-term commitment. The trial offers an adjustment period and time to explore therapy parameters.

The goal of neurostimulation is at least a 50% reduction in pain. However, patient-specific goals may include less pain reduction but improved quality of life.

Risks associated with the use of neurostimulation

Neurostimulation may be associated with adverse events, and each person’s experience may vary. Surgical risks include infection, pain at the implant site, and bleeding into the epidural space. Device risks include corrective surgery, jolting or shocking, lead fracture, lead migration, or lead dislodgement, which may result in unfavorable stimulation or loss of therapy effect.

Targeted Drug Delivery

Potential applications for Targeted Drug Delivery

Since the first implantable drug pump was approved for the treatment of chronic pain more than 20 years ago, Medtronic Targeted Drug Delivery has been used to manage chronic pain in thousands of patients with conditions that include:

• Cancer pain
• Failed Back Surgery Syndrome (FBSS)
• Complex Regional Pain Syndrome (CRPS)
• Compression fractures from osteoporosis
• Postherpetic neuralgia
• Arachnoiditis
• Chronic pancreatitis
• Phantom limb pain

Benefits of Targeted Drug Delivery

Many people experience improvements in their pain symptoms and quality of life after receiving Medtronic Targeted Drug Delivery. Benefits may include:

• Significant (50 percent or greater) reduction in pain^12-14
• Improved ability to function and participate in activities of daily living^13,14
• Lower medication doses compared with oral medications, which may result in reduced side effects^4,6-10
• Fewer oral pain medication(s)^13,14
• Proven safe and effective when used as directed
• Reversible – therapy can be turned off as desired or surgically removed at any time
• Ability to undergo full-body MRI scans – FDA-approved for full-body scans; designed to resume programmed therapy after the scan
• The use of myPTM^®, which provides the patient with the ability to administer medication and maintain control over their therapy
• SynchroMed II is the most tested and experienced drug delivery system, offering unmatched:
  • Reliability, demonstrating 98 percent event-free therapy 48 months in more than 150,000 patients
  • Accuracy, with only 1 percent average flow-rate error in the clinical setting
  • Precision, as the only programmable drug delivery system with 99.7 percent repeatability from pump to pump

Screening test

A screening test is required to assess the effectiveness of Targeted Drug Delivery as a treatment option for chronic pain.

A trial can be performed using various delivery methods:

• Continuous epidural
• Continuous intrathecal
• Bolus epidural
• Bolus intrathecal

Patients who report at least a 50% reduction in pain may be candidates for long-term therapy.

Risks associated with the use of Targeted Drug Delivery

The implanted pump and catheter are surgically placed under the skin. Surgical complications are possible and include infection, spinal fluid leak, and headache. Patients should not undergo the implant procedure if they have an active infection at the time scheduled for implant.

Once the infusion system is implanted, device complications may occur which may require surgery to resolve. Drug overdose or underdose can result because of these complications and have serious and even life-threatening adverse effects. Possible complications include the catheter or pump moving within the body or wearing through the skin. The catheter could leak, tear, kink, or become disconnected. The pump could stop because the battery has run out or because of failure of another part of the infusion system. Additionally, inflammatory mass has been reported at the tip of the catheter, which may lead to complications, including paralysis.

For additional safety information, please refer to the labeling provided with the device and the Important Safety Information at www.medtronic.com/chronicpain. Also it is recommended that patients discuss the benefits and risks of this therapy with their doctor.

MRI Labeling

Nearly 7 million head scans are performed each year in the US—1 every 4.6 seconds.

• Only Medtronic premium neurostimulators have FDA approved labeling for 1.5-Tesla MRI head scan
• Medtronic SynchroMed^® pumps have FDA approved labeling for 3.0-Tesla MRI full body scan

MRI procedures by anatomy

MRI head scans can diagnose several common conditions, including

• Stroke
• Brain tumor
• Cause of headache
• Multiple sclerosis
• Seizure
• Hearing loss

References

1. Medtronic Neurostimulation Therapy for Chronic Pain: Percutaneous Lead Implantation Guide. Minneapolis, MN: Medtronic, Inc.; 2008.
2. Medtronic Implantable Systems Performance Registry (ISPR) 2007 Annual Report: Protocol NSP0010-10000. Minneapolis, MN: Medtronic, Inc.; October 2008.
3. Medtronic Neurostimulation Systems for Pain Therapy Brief Summary. Minneapolis, MN: Medtronic, Inc.; February 2009.
4. Medtronic web site. Link: http://www.medtronic.com/patients/chronic-pain/device/drug-pumps/questions-answers/index.htm. Accessed: February 23, 2012.
5. Brogan SE. Intrathecal therapy for the management of cancer pain. Curr Pain Headache Rep. 2006;10:254-259.
6. Gerber HR. Intrathecal morphine for chronic benign pain. Best Pract Res Clin Anaesthesiol. 2003;17:429-442.
7. Nance P, Meythaler J. Intrathecal drug therapy. Phys Med Rehabil Clin N Am. 1999;10:385-401,viii-ix.
8. Ruan X. Drug-related side effects of long-term intrathecal morphine therapy. Pain Physician. 2007;10:357-366.
9. Smith TJ, Swainey C, Coyne PJ. Pain management including intrathecal pumps. Curr Pain Headache Rep. 2005;9:243-248.
10. Winkelmuller M, Winkelmuller W. Long-term effects of continuous intrathecal opioid treatment of chronic pain of nonmalignant etiology. J Neurosurg. 1996;85:458-467.
11. Onofrio BM, Yaksh TL. Long-term pain relief produced by intrathecal infusion in 53 patients. J Neurosurg. 1990;72:200-209.
12. Doleys DM, Brown JL, Ness T. Multidimensional outcomes analysis of intrathecal, oral opioid and behavioral functional restoration therapy for failed back surgery syndrome: a retrospective study with 4 years’ follow-up. Neuromodulation. 2006;9:270-283.
13. Deer T, Chapple I, Classen A, et al. Intrathecal drug delivery for treatment of chronic low back pain: report from the National Outcomes Registry for Low Back Pain. Pain Med. 2004;5:6-13.
14. Roberts LJ, Finch PM, Goucke CR, Price LM. Outcome of intrathecal opioids in chronic non-cancer pain. Eur J Pain. 2001;5:353-361.