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Letters to the Editor: Central Sensitization, Microglia Modulators, Supplements

July/August 2015

Central Sensitization

While on a flight back from the recent pain meeting in Washington, DC, I read the April 2015 edition of Practical Pain Management. I am writing to say that your task force’s work and report on central sensitization was absolutely fabulous.1

As an advocate and a person who lives with fibromyalgia, I identified with everything in the report and can hardly wait to recommend it to others. Thank you very much for articulating scientifically what millions of us experience and have been unable to convey. I wanted to express my appreciation for your group’s work and report.

I hope to understand how brain mapping can be presented as part of the central sensitization diagnosis. In a search to locate ways to engage chronic pain patients more in their self-management (what happens between clinical visits), I’m considering how Dr. Norman Doidge’s pain treatment using visualization through self-forcing a focused concentration during pain in specific parts of the brain may be helpful.

Jan Chambers


National Fibromyalgia & Chronic Pain Association

Dear Jan,

Thanks for your kind words about the consensus report on centralized pain. In my opinion every pain practitioner should know how to explain chronic pain and interview patients to determine if they have it.

Please keep up your fine work.

Forest Tennant, MD, DrPH

Microglial Modulators

In the Editor’s Memo on Microglial Modulators2 and the discussions of tetracycline usage for refractory pain,3 it needs to be mentioned that this class of medication may cause a pseudotumor cerebri (idiopathic intracranial hypertension) disorder.

Pressures can get quite high, at times requiring shunting. This can be especially problematic for patients with pre-existing headaches/migraines.

If tetracyclines are used, careful ophthalmologic monitoring is essential.

Love PPM, each issue has useful information for me.

Daniel J. Lacey, MD, PhD


Dayton Children’s Hospital

Dear Dr. Lacy,

Thank you. Your information is new to me. It raises the question in my mind about non-analgesic, ancillary medications. For example, are the tetracyclines safe if used only 5 days a week? The concept of “drug holidays” may apply here.

Forest Tennant, MD, DrPH

Amino Acid Supplements

I read Practical Pain Management’s Guide to Dietary Supplements Most Commonly Used in Pain Management,4 and tried the amino acid supplementation recommendations on the website and they did in fact help me to spend less time in bed with less pain and therefore need less pain medication. Would you please tell the author how much I appreciate his sharing the information. I really appreciate the help— and have started to enjoy life a little bit more.

Marie L. Burnett

Pain Patient

Hypnosis and Biofeedback

I have read with great interest the article on “Hypnosis & Biofeedback” by Cosio and Lin.5 They referred to several recently published articles about the use of biofeedback in pain management. I would like to point out that I coauthored an article on the use of biofeedback in the management of rheumatoid arthritic pain.6 This article should be of great interest to your readers, and I would appreciate your bringing it to the attention of your readers.

Xuan T. Truong, MD, PhD

Dunlap, Illinois

The Benefits of Acupuncture

I wanted to respond to the Editor’s Memo on “Acknowledging the Failure of Standard Pain Treatment.7 It was not until an internship at Guang Zhao Hospital of Traditional Chinese Medicine (TCM) in 1998 that I saw first-hand what was possible with this form of natural medicine. I continue to return to China regularly, to learn and practice in an environment that effectively treats 10,000 patients a day.

In 2011, I was invited by Maria Torres, MD, Chair of the Pain Clinical Systems for Cook County Health & Hospital Systems (CCHHS), Chicago, Illinois, to add acupuncture services to their interdisciplinary team. My interns and I regularly use acupuncture to treat up to 35 patients a day, to reduce pain and drug dependence, and restore function in full partnership with the pain medicine physicians.

This integrated model works more times than it does not—with no side effects and a nickel’s worth of needles. It has spread like the proverbial 100th monkey to Cleveland Clinic, Mayo Clinic, Henry Ford Hospital, Harvard and Stanford Hospitals—to name just a few.

“Adopt or die” applies not just to species survival, but to the medicine used for it as well. TCM has been adapting to serve those in pain for over 5,000 years. It was Buddha who said, “pain is inevitable, suffering is optional.”

Frank Yurasek, PhD, LAc

Oak Park, Illinois

Last updated on: August 11, 2015
First published on: August 1, 2015