Sunday, May 31, 2015

Topic: When You See the Doctor (in the emergency room)

When You See the Doctor (in the emergency room)


In most health care settings, your time with the doctor will be limited. This is especially true of the emergency department, where the goal is to address your immediate crisis and help make you stable until you can see your regular health care provider.

Be prepared to briefly describe your current pain problem. Include:

Location of your pain;



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Topic: What Not to Expect (from the ER if you are a pain patient)

What Not to Expect (from the ER if you are a pain patient)


The ED is designed to take care of urgent, short-term problems and to stabilize patients so that they can see their own health care providers in the morning or in a few days. The ED is not able to do these things:

Diagnose long-term problems and provide a treatment plan;



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Topic: What to Expect (from the ER as a pain sufferer)

What to Expect (from the ER as a pain sufferer)


The emergency department is meant to provide treatment for sudden, extreme, or unstable illnesses or accidents. It cannot take the place of regular care from a family doctor or pain specialist. But it can help you get through those times when your pain breaks through or you have some other critical event.



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Topic: Preparing for an Emergency Department Visit

Preparing for an Emergency Department Visit


If it is possible, go to the emergency department of the hospital that your doctor is affiliated with. This will allow the ED staff to get access to your medical records, which can be very helpful. You can make the process go more smoothly if you come prepared. When you are in crisis, you may not be able to think clearly, so it’s a good idea to have this information ready in an envelope or folder you can just grab on your way out the door.



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Topic: Going to the ER (as a pain patient)

Going to the ER (as a pain patient)


Almost everyone who lives with pain has been to the emergency room at some time. You may have gone because your pain was out of control and you could not reach your own health care team. You may have gone because you feared that your pain was a sign of a new medical problem. You may have gone because you have no insurance. Or your own doctor may have sent you there.



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Saturday, May 30, 2015

Topic: Prevention (for migraines)

Prevention (for migraines)


Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of migraines. One or more of these suggestions may be helpful for you:



Avoid triggers

If certain foods or odors seem to have triggered your migraines in the past, avoid them.



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Topic: Alternative medicine (migraines)

Alternative medicine (migraines)

Nontraditional therapies may be helpful if you have chronic migraine pain:

Acupuncture
In this treatment, a practitioner inserts many thin, disposable needles into several areas of your skin at defined points. Clinical trials have found that acupuncture may be helpful for headache pain.
Biofeedback

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Topic: Lifestyle and home remedies (for migraines)

Lifestyle and home remedies (for migraines)


Self-care measures can help ease the pain of a migraine headache.

Try muscle relaxation exercises. Relaxation may help ease the pain of a migraine headache. Relaxation techniques may include progressive muscle relaxation, meditation or yoga.

Get enough sleep, but don't oversleep. Get an adequate amount of sleep each night. It's best to go to bed and wake up at regular times, as well.



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Topic: Treatments and drugs (for migraines)

Treatments and drugs (for migraines)




Migraines can't be cured, but doctors will work with you to help you manage your condition. A variety of medications have been specifically designed to treat migraines. In addition, some drugs commonly used to treat other conditions also may help relieve or prevent migraines. Medications used to combat migraines fall into two broad categories:



Pain-relieving medications

Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun.

Preventive medications

These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines. Choosing a strategy to manage your migraines depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions. Some medications aren't recommended if you're pregnant or breast-feeding. Some medications aren't given to children. Your doctor can help find the right medication for you.



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Topic: Tests and diagnosis (for migraines)

Tests and diagnosis (for migraines)


If you have migraines or a family history of migraine headaches, your doctor trained in treating headaches (neurologist) will likely diagnose the condition on the basis of your medical history, a review of your symptoms, and a physical and neurological examination.

Your doctor may also recommend a variety of tests to rule out other possible causes for your pain if your condition is unusual, complex or suddenly becomes severe.

Blood tests

Your doctor may order blood tests to test for blood vessel problems, infections in your spinal cord or brain, and toxins in your system.



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Topic: Preparing for your appointment (for migraines)

Preparing for your appointment (for migraines)


You're likely to start by seeing your primary care provider, but you may be referred to a doctor trained in evaluating and treating headaches (neurologist). Because appointments can be brief, and because there's often a lot to talk about, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

Write down symptoms you're experiencing, even if they seem unrelated to your migraines. Write down key personal information, including any major stresses or recent life changes. Make a list of all medications, vitamins or supplements that you're taking. It's particularly important to list all medications, as well as the dosages you have used to treat your headaches.

Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.



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Topic: Risk factors (for migraines)

Risk factors (for migraines)

Several factors make you more prone to having migraines.

Family history

Up to 90 percent of people with migraines have a family history of migraine attacks. If one or both of your parents have migraines, then you have a good chance of having migraines too.

Age

Migraines can begin at any age, though most people experience their first migraine during adolescence. By age 40, most people who have migraines have had their first attack.



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Topic: Migraine Causes

Migraine Causes


Although much about the cause of migraines isn't understood, genetics and environmental factors appear to play a role. Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway. Imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system — also may be involved. Researchers continue to study the role of serotonin in migraines.  Serotonin levels drop during migraine attacks. This may cause your trigeminal system to release substances called neuropeptides, which travel to your brain's outer covering (meninges). The result is headache pain.



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Topic: Migraine Definition and Symptoms

Migraine Definition and Symptoms

Definition

A migraine headache can cause intense throbbing or a pulsing sensation in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down. Some migraines are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots, or tingling in your arm or leg. Medications can help reduce the frequency and severity of migraines. If treatment hasn't worked for you in the past, talk to your doctor about trying a different migraine headache medication. The right medicines, combined with self-help remedies and lifestyle changes, may make a big difference.



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Friday, May 29, 2015

Topic: 6 Rheumatoid Arthritis Mistakes to Avoid

6 Rheumatoid Arthritis Mistakes to Avoid

You do your best to live a full, active life with rheumatoid arthritis (RA). But do you recognize any of these common missteps? If they sound familiar, it’s not too late to get back on track.
1. Not Seeing a Rheumatologist
 Your regular doctor may have diagnosed your RA. It’s still a good idea to see a specialist, too. Rheumatologists are doctors who are experts in treating RA and other types of arthritis. A rheumatologist will have the most training in the medicines that treat RA and in finding the right ones for you. If you don’t have one, ask your primary care doctor for a referral.

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Topic: Communicating with healthcare professionals

Communicating with healthcare professionals


Most of the people that we talked to felt that a good relationship with their GP was crucial and many said that their GPs were supportive, enthusiastic and took a genuine interest in their pain. People valued GPs who gave them their full attention, listened to and understood how pain was affecting their life, made helpful suggestions for treatment and referred them when necessary.



Some felt that it was important to work in partnership with their doctor to find the most effective ways of managing their pain. Good partnerships were felt to be ones where they could discuss their current and potential treatments as well as complementary approaches that they had heard about.



It was particularly helpful when the GP followed up on this and found out more information. A woman explained that her GP was happy to discuss new treatments with her and felt it was important to keep him informed about the complementary approaches that she was trying.



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Topic: Sleep, stress and environmental factors

Sleep, stress and environmental factors


Chronic pain can vary from day to day and can sometimes flare-up dramatically (see also 'Coping with flare-up'). Those we talked to explained how pain could affect their sleep patterns. They also discussed the impact that fatigue and everyday stresses had on their pain. Pain could also be affected by other illnesses and environmental factors such as temperature.

Living with pain and coping with daily life can be tiring and many people that we talked to complained of fatigue. Getting to sleep and being disturbed at night were big issues for most people. Lack of sleep could often lead to increased pain.

Some found that taking sleeping tablets or pain medication at night was helpful while others preferred to use relaxation techniques (see also 'Pain management' relaxation and distraction'). Having a good bed was important and several people said that their electric blankets were “indispensable”.



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Topic: Coming to terms with pain

Coming to terms with pain


Many of the people that we talked to felt that coming to terms with the reality that pain is likely to be a permanent part of their life was a vital process in living life with chronic pain. The alternative was thought to be pointless anger, aggression and bitterness that could ruin the person's life and destroy their most important relationships.



Some people said that they were still struggling to come to terms with their pain and move on with life. Some people contrasted coming to terms with living with pain with their early and optimistic belief that they could and should 'fight' the pain. Others talked about not letting pain rule or ruin their life anymore.



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Topic: Pain management: pacing and goal setting

Pain management: pacing and goal setting


Chronic pain can change the way that people live their lives and carry out their daily activities. For example many people found that they could no longer perform certain tasks without experiencing increased pain and fatigue. This could lead to them becoming increasingly inactive, or catching up on jobs when they had a good day, which then lead to a flare-up of pain and the need to rest up for a few days (see also 'Coping with flare-up').



Many of the people that we talked to had learned techniques to manage their activities, minimize their pain and help prevent flare-ups. Usually these techniques had been learned on NHS Pain Management Programs through healthcare professionals, or support groups, but others had learned through the Internet or books (see also 'Learning about pain management'; 'NHS pain management programs').



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Thursday, May 28, 2015

Topic: FACING SERIOUS ILLNESS (Questions to Ask Your Doctor)

FACING SERIOUS ILLNESS (Questions to Ask Your Doctor)


By exercising your right to ask pertinent questions early in your relationship to your physician, you can find out if he or she is prepared to communicate with you in the way that you expect. If not, you can decide if you should seek another physician with whom you can have a more comfortable relationship. The following questions can help you talk to your physician.

Questions About Your Specific Illness

•How will this illness and its treatments likely affect my family and me?



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Topic: Chronic Pelvic Pain Syndrome in Men (CPPS) or Bacterial Prostatitis

Chronic Pelvic Pain Syndrome in Men (CPPS) or Bacterial Prostatitis


Chronic pelvic pain is the most common reason for men under 50 to visit a urologist. Yet it is very poorly understood. Doctors have called it prostatitis (say: pros-tuh-TIE-tis) for many years, mainly because when the doctor does the exam on a man with this condition, the prostate is very tender. “-itis” means inflammation. When you look at samples of an affected prostate under the microscope, there is no inflammation (swelling), so prostatitis is not a very good name. We have also traditionally treated this condition with antibiotics. It turns out that there are very rarely any bacteria involved, either.



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Wednesday, May 27, 2015

Topic: Do you feel that your doctor's are able to minimize your discomfort and pain caused by your condition?

Do you feel that your doctor's are able to minimize your discomfort and pain caused by your condition?



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Sunday, May 24, 2015

Topic: Psychological Approaches for Insomnia

Psychological Approaches for Insomnia


Among the most common psychological techniques used to help with sleep problems are relaxation training, meditation, hypnosis, and cognitive restructuring. These techniques are similar to those used for stress management as well as chronic pain management, and rely on a common set of skills: 

Deep muscle relaxation

Focus elsewhere rather than on the pain

Visual, sound, or other relaxing sensory imagery

Distancing oneself from the chronic pain

These skills, coupled with the deep breathing technique discussed next, can be very beneficial in improving sleep and decreasing the perception of pain by retraining the brain. Many of these skills are coupled with exercise in techniques such as yoga and Tai Chi.



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Topic: Practicing Good Sleep Hygiene

Practicing Good Sleep Hygiene


There are a wide variety of different techniques and sleep aids that promote a normal, high quality night's sleep leading to full alertness and energy during the day. Just as one might practice good dental hygiene to keep teeth and gums in good shape, "sleep hygiene" is designed to keep sleep healthy and restore energy for the following day's activities.

Sleep hygiene involves engaging in a number of practices and behaviors that improve sleep. As chronic pain develops, it is not uncommon for patients to develop bad habits relative to sleep hygiene without even realizing it. An example of poor sleep hygiene habits includes such things as varying the time that one goes to bed and awakens in the morning, taking naps during the day, engaging in stressful activities such as paying bills while laying in bed, staying in bed most of the day, among other things. Good sleep hygiene habits include the following:



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Topic: Addressing Pain and Medical Problems Disrupting Sleep

Addressing Pain and Medical Problems Disrupting Sleep


When addressing a sleep problem associated with chronic pain, it is important to be sure that the patient is getting the best possible treatment for their back pain and within a multidisciplinary approach. Many of the treatments aimed at improving a chronic pain sufferer's sleep-wake cycle can also be helpful in the treatment of the chronic pain overall, and vice-versa.

Another step in improving sleep is to thoroughly investigate other possible medical problems (other than the pain) that might be contributing to the sleep disorder. Some of the common medical problems associated with poor sleep include:



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Topic: Pain and Sleeping Problems Need to be Treated Together

Pain and Sleeping Problems Need to be Treated Together


A sleeping disorder associated with chronic back pain should always be addressed as part of a multi-disciplinary, chronic pain treatment approach.

As with any symptom of a chronic pain syndrome, one should not attempt to treat the sleep disruption in isolation without taking into account proper treatments for the chronic back pain problem that is part of the cause of the sleeping problems. Many behavioral and psychological approaches to chronic pain treatment will also help with the symptoms of sleep disorder, and one should not be too quick to rush to medication solutions for insomnia.



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Topic: Chronic Pain and Insomnia: Breaking the Cycle

Chronic Pain and Insomnia: Breaking the Cycle

Patients suffering from chronic pain often find that their problems are compounded by the additional difficulties that come with insomnia and sleeping disorders. Of those who report experiencing chronic pain (about 15% of the general U.S. population and 50% of the elderly), approximately 65% report having sleep disorders, such as disrupted or non-restorative sleep.

Back pain is the most common type of chronic pain problem, and is the most prevalent medical disorder in industrialized societies. Not surprisingly, individuals with chronic back pain problems frequently report significant interference with sleep.

In a recent study, it was found that approximately two-thirds of patients with chronic back pain suffered from sleep disorders. Research has demonstrated that disrupted sleep will, in turn, exacerbate the chronic back pain problem. Thus, a vicious cycle develops in which the back pain disrupts one's sleep, and difficulty sleeping makes the pain worse, which in turn makes sleeping more difficult, etc.



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Friday, May 15, 2015

Topic: Multiple Sclerosis

Multiple Sclerosis


Multiple sclerosis is referred to as an autoimmune disease. The general theory for the development of MS is that a genetically damaged immune system is unable to distinguish between virus proteins and the body’s own myelin and so produces antibodies that attack. In other words, the body becomes allergic to itself, a condition known as autoimmunity.

Autoimmunity may develop when the body's immune system is damaged by genetic or environmental factors or both, causing it to attack its own tissues. In the case of MS, the immune system attacks the tissues that make up myelin:

•Myelin is made from layers of cell membranes that are produced in the brain and spinal cord by specialized cells called oligodendrocytes. The destruction of this myelin sheath during the disease process is the hallmark for multiple sclerosis.

•The myelin coat is distributed in segments along the axons, the long filaments that carry electric impulses away from a nerve cell.



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A Pacemaker For Pain Peripheral Nerve Field Stimulation

A Pacemaker For Pain
Peripheral Nerve Field Stimulation


People with chronic, intractable back pain know exactly what they need relief directly where it hurts. Peripheral nerve field stimulation (PNFS), the newest weapon against back pain for people who are finding no relief from conventional treatment, does just that, says Dr. Eugene Lipov, who is Director of Research, Alexian Brothers Hospital Network Pain Program.

Electrical leads are placed just under the skin at the source of the pain, and the area is stimulated by a feed of electricity from an implanted power pack. Patients feel their pain replaced by a slight tingle. 

This is an exciting evolution of the dorsal column stimulator for the spine, which has been in clinical use for the last 20 years. Where the previous stimulator was placed in the spinal canal right behind the spinal chord, this is placed at the site of pain, making it very effective for lower back pain and rendering it essentially free of complications.



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Topic: Actiq (oral transmucosal fentanyl citrate)

Actiq (oral transmucosal fentanyl citrate)
WARNING: IMPORTANCE OF PROPER PATIENT SELECTION, DOSING, and POTENTIAL FOR ABUSE

Reports of serious adverse events, including deaths in patients treated with ACTIQ® have been reported. Deaths occurred as a result of improper patient selection (e.g., use in opioid non-tolerant patients) and/or improper dosing. The substitution of ACTIQ for any other fentanyl product may result in fatal overdose.

ACTIQ is indicated only for the management of breakthrough cancer pain in patients with malignancies who are already receiving and who are tolerant to around-the-clock opioid therapy for their underlying persistent cancer pain. Patients considered opioid tolerant are those who are taking around-the-clock medicine consisting of at least 60 mg of oral morphine daily, at least 25 mcg of transdermal fentanyl/hour, at least 30 mg of oral oxycodone daily, at least 8 mg oral hydromorphone daily or an equianalgesic dose of another opioid for a week or longer.



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Topic: Multiple ER Visits Linked to Risk of Prescription-Drug Overdose Death

Multiple ER Visits Linked to Risk of Prescription-Drug Overdose Death


THURSDAY May 14, 2015, 2015 -- Frequent visits to emergency departments appear to be a predictor of death from a prescription drug overdose, a new study finds.People with four or more ER visits in the past year were 48 times more likely to die of prescription drug overdose compared to those who visited an ER once or not at all, researchers found. With three visits a year, the risk of overdose death from a prescription drug was 17 times greater.

The study, by researchers at Columbia University's Mailman School of Public Health, was recently published online in the journal Annals of Epidemiology.



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Monday, May 11, 2015

Topic: Patient Satisfaction Scores Not Affected by Amount of Opioids Given in Emergency Room

Patient Satisfaction Scores Not Affected by Amount of Opioids Given in Emergency Room


Giving opioids to patients in the emergency room (ER) does not affect their satisfaction scores, according a retrospective analysis of medical records and Press Ganey patient satisfaction surveys.

Researchers matched the medical records and completed surveys of 4,749 patients seen in the ERs of two New England hospitals to determine if there is a link between the amount of opioids administered in the ER and Press Ganey scores—one of the most commonly used metrics for measuring patient satisfaction, according to the study authors. They also factored in other variables such as medication order, health insurance status, time of arrival to the ER, total length of stay and patient-reported pain levels. The researchers did not find any association between prescribing opioids and patient satisfaction scores.

“Based on these findings, the administration of opioids in the emergency department setting does not make patients more satisfied,” said study author Kavita Babu, MD, in a press release.

Administering opioids in the ER is a challenge to physicians because of the time constraints, concerns about safety and lack of familiarity with the patient, according to the researchers. However, because compensation is linked to patient satisfaction scores in some hospital settings, some physicians might feel pressured to prescribe opioids to keep these scores up.



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Topic: Many PCPs Are Dissatisfied With Care of Chronic Pain Patients

Many PCPs Are Dissatisfied With Care of Chronic Pain Patients


San Diego—Despite public policy emphasizing the importance of addressing chronic pain, primary care physicians report feeling unprepared and less than satisfied in managing patients with chronic pain, according to survey results presented at the 2006 annual meeting of the American Academy of Neurology.

Primary care physicians (PCPs) in general reported higher levels of satisfaction with the care of patients who had congestive heart failure, chronic diabetes or terminal cancer than with the care of patients who had chronic pain. Alcoholism was the only condition that PCPs felt less satisfied treating than chronic pain, explained lead investigator Thomas Chelimsky, MD, Associate Professor of Neurology at Case Western Reserve University School of Medicine, Cleveland.

The findings are based on results of a nine-question survey that assessed the attitudes, practices and confidence of 83 PCPs regarding the management of chronic pain. The respondents were in practice for an average of 14.4 years and were treating a mean of 21.3 patients with chronic pain each month.



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Topic: PACIF Procedure Targets Pain Source To Relieve Chronic Low Back Pain

PACIF Procedure Targets Pain Source To Relieve Chronic Low Back Pain


The PACIF procedure, which destroys or removes tissue in the suprapendicular area, might be a safe and effective way to treat common low back pain, a new study suggests.

Researchers from the Texas Tech University Health Sciences Center, in Lubbock, started developing the PACIF (Percutaneous Ablation, Curettage and Inferior Foraminotomy) procedure after noticing that the majority of their patients’ low back pain could be reproduced in the L4-L5 region of the spine. Epiduroscopy of the area suggested that the likely source of the pain was not the nerve roots or disks, and that it might be a “sensitization of a peridural membrane in the suprapendicular area of the lumbar vertebral.” The researchers found that targeting this membrane helped to relieve pain, even for some patients who had chronic pain for more than five years.

“If I take the epidural scope and find an area that is painful, push the scope all the way out of the neuroforamen, out of the inferior part of the neuroforamen, when the patients came back to my clinic, they would either be completely pain-free or have dramatically reduced pain,” said study author Hemmo Bosscher, MD.



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Topic: Antiepileptic Drugs Increase Suicide Risk

Antiepileptic Drugs Increase Suicide Risk

Drug regulators are warning clinicians that patients who take drugs to control epileptic seizures or to treat other conditions, such as chronic pain, may be at increased risk for suicide.

The FDA alert, issued in late January, covers all commonly used antiepileptic drugs. The agency said it will begin requiring makers of the medications to include the risk for suicide on the products’ labeling. The FDA acknowledged that no cause-and-effect relationship has been established between suicide and antiepileptic drugs and did not advise physicians to stop prescribing these medications (Table 1).

Table 1. Antiepileptic Drugs Associated With Suicide

Carbamazepine

Felbamate (Felbatol, MedPointe Pharmaceuticals)

Gabapentin

Lamotrigine

Levetiracetam (Keppra, UCB Pharma)

Oxcarbazepine (Trileptal, Novartis)

Pregabalin (Lyrica, Pfizer)

Tiagabine (Gabitril, Cephalon)

Topiramate

Valproate

Zonisamide



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Topic: Type of Chronic Pain May Affect Risk for Suicide

Type of Chronic Pain May Affect Risk for Suicide

Suicide is the 10th most common cause of death in the United States, and is often related to serious depression, alcohol or substance abuse, or a major stressful event. Given the high correlation between chronic illness and depression, it is not surprising that studies have found suicidal ideation, suicide attempts and suicide completions to be common in patients with chronic noncancer pain. Now, researchers believe that the type of chronic pain also may play a role in risk for suicide.

“About 20% [of patients with chronic pain] most likely have passing suicidal thoughts; 5% have active thoughts; and about 5% have a past history,” said Martin Cheatle, PhD, director of the Pain and Chemical Dependency Program at the University of Pennsylvania, Philadelphia. “So, it is a pretty significant problem.”

Recent research has now expanded its scope to determine what chronic pain conditions are most closely linked to suicide risk. A study conducted in Spain found that suicidal ideation is highly prevalent among patients with severe fibromyalgia, a disorder that is characterized by chronic pain, sleep disturbances and depression (Pain Pract 2014 Jan 17. [Epub ahead of print]). Of 373 patients with fibromyalgia, 179 (48%) reported suicidal ideation. Of those, 148 (39.7%) described what was considered to be passive suicidal ideation and 31 (8.3%) reported active suicidal ideation. Risk for suicide was more commonly related to symptoms of psychological distress (depression, anxiety, sleep quality, mental health) than to physical symptoms of the disease (pain, general health).



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Topic: People who experience acute or chronic pain are at increased risk for thinking about killing someone else and then killing themselves, according to a new study

People who experience acute or chronic pain are at increased risk for thinking about killing someone else and then killing themselves, according to a new study


People who experience acute or chronic pain are at increased risk for thinking about killing someone else and then killing themselves, according to a new study.

Previous research has found that pain patients are at increased risk for suicide, most likely because they’re more prone to depression. The current study is the first to link pain with thoughts of homicide–suicide.

“We found that about 4.4% of patients in rehabilitation for chronic pain had some ideation about homicide–suicide,” said co-author Daniel Bruns, PsyD, a psychologist practicing in Greeley, Colo. This was more than twice as many as in the control group.

The study, which was presented as a poster at the 2010 annual scientific meeting of the American Pain Society in Baltimore (Poster 144), included 2,264 people at 106 sites across the United States. Participants filled out the Battery for Health Improvement 2 (BHI 2) questionnaire and were asked to respond to a number of statements about suicide and violence, including, “If I was going to kill myself, I would take somebody else with me.”



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Topic: Suicide and Pain: Research Explores Links to Suffering, Acceptance, Burden

Suicide and Pain: Research Explores Links to Suffering, Acceptance, Burden

NATIONAL HARBOR, MD—Walking among his three clinical research posters at the recent annual meeting of the American Academy of Pain Medicine, pain expert David Fishbain, MD, stopped in his tracks and stated the obvious.

“As you can probably tell,” the Pain Medicine News editorial advisory board member said while waving at the three pieces of research he was involved in, “we are pretty interested in suicidality.”

That interest has spawned a series of studies on various psychological aspects of suicidality in pain patients from Dr. Fishbain and his colleagues from Florida’s University of Miami School of Medicine. The three works explore questions surrounding the effects of burden, acceptance and suffering on both pain and suicidality. The studies, presented in poster form at the AAPM meeting, also touch on specific predictors and screening strategies to assess for suicidality in a pain population.

The Burden of Burden



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Topic: OTC Pain Relievers

OTC Pain Relievers


Pain isn’t always chronic. To help manage acute pain episodes, there are a number of effective over-the-counter pain relievers. Here’s how to select the one that’s right for you.

Let’s say you’ve been suffering from significant joint pain for several days. What’s your first instinct in addressing it? Is it to schedule an appointment with a pain doctor, or is it to ask your physician for prescription pain medicine? If either of these scenarios popped into your head, you might be jumping the gun, says Kamal S. Ajam, MD, clinical assistant professor of anesthesiology at Wake Forest Baptist Health.



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Sunday, May 10, 2015

Topic: Opioid Dispensing and Overdoses Down Sharply

Opioid Dispensing and Overdoses Down Sharply

Dispensing of opioid pain relievers and painkiller overdoses both declined substantially after an abuse-deterrent formula of OxyContin was introduced and the painkiller propoxyphene was withdrawn from the U.S. market in 2010, according to a new study published online in JAMA Internal Medicine.
The study is another indication there has been a reversal in the growth of opioid prescribing – which has long been blamed for the so-called “epidemic” of prescription drug abuse. Last week another study was released showing that the painkiller hydrocodone was no longer the most-widely prescribed drug in the U.S.
Researchers analyzed claims from over 31 million members of a large national health insurer, and estimated that by 2012 total opioid dispensing declined by 19% and the overdose rate dropped by 20 percent. The drop in prescription opioid overdoses was partially offset by a 23% increase in overdoses due to heroin.

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Topic: Chronic Pain: Nobody Tells You How Hard It Is

Chronic Pain: Nobody Tells You How Hard It Is

Some days, I feel like I can finally lift my head above water. Like I can finally take a breath. Or better yet, a couple of deep breaths.

I feel like maybe I finally have this whole chronically sick thing figured out. And, finally, after being in pain for more than two years, I can focus on living the life I want to live. Like just maybe, this whole chronic pain thing isn’t going to win after all.

And then other days, like today, I wish I was dead.

Days when I wake up with an insane amount of pain in my ribs, and a migraine and I have to work because I’m genuinely afraid I’ll lose my job if I call in sick one more time.

Days when I hate my body so much, because it’s like a jail keeping me prisoner and holding me back from the life I once thought I was born to live. And days when I want to push myself, because that’s what I do, I push things, to the limits, and that’s how I have always lived my life.



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Topic: Living with chronic pain: How to balance mental health needs for social connections with your physical limitations

Living with chronic pain: How to balance mental health needs for social connections with your physical limitations


If you live with chronic pain, you know that the mere act of getting up in the morning and getting out of bed can be excruciatingly difficult. What I have found, in working with chronic pain patients is that often, there is an unhealthy interplay and cascade effect between chronic pain, depression and isolation. If you live in chronic pain, you might find it difficult to get to a social event and not going to such events increases social isolation which in turn increases depression. What’s worse is that experts are not quite sure yet how pain and depression are linked but posit that not only does pain lead to depression but depression and social isolation may exacerbate the subjective experience of physical pain. Chronic pain may be a catch-22 experience where multiple factors affect each other and the person who experiences the pain may not be very successful at finding their way out of the labyrinth of multi-dimensional suffering.



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Topic: Injectable Gel Could Help Knee Cartilage Heal

Injectable Gel Could Help Knee Cartilage Heal


With the number of knee replacement surgeries soaring in the United States, researchers at the University of Iowa are working on an injectable gel that could repair damaged cartilage and make many knee surgeries unnecessary.

"We are creating an [injectable, bioactive] hydrogel that can repair cartilage damage, regenerate stronger cartilage, and hopefully delay or eliminate the development of osteoarthritis and eliminate the need for total knee replacement," says Yin Yu, a graduate student at the University of Iowa (UI) whose study is featured in the journal Arthritis and Rheumatology.

Osteoarthritis (OA) is a joint disorder that leads to thinning of cartilage and progressive joint damage. Nearly 40 percent of Americans over the age of 45 have some degree of knee OA, and those numbers are expected to grow as the population ages.

About 600,000 knee replacement surgeries are performed annually in the U.S. – about twice the number performed 20 years ago. Recent studies have questioned whether many of the surgeries are appropriate.



UI researchers have previously identified precursor cells in healthy cartilage that can mature into new cartilage tissue – a surprising development given the long-held assumption that cartilage is one of the few tissues in the body that cannot repair itself.



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Topic: When Nobody Believes You

When Nobody Believes You


“It’s all in your head.”

“Your doctors are wrong.”

“You don’t really feel as bad as you say you do.”

“You must not really be in that much pain because you look fine.”

These words are far too common in the ears of chronic pain patients. They can make one feel isolated, alone, and as if nobody cares.

One of my patients told me the other day, “My husband doesn’t believe I’m in as much pain as I say I am. He thinks it’s all psychological.” 



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Topic: Americans Recognize Medical Value of Marijuana

Americans Recognize Medical Value of Marijuana

The perception of marijuana users as pot heads and lazy stoners may finally be changing to a new one: Patient. 

According to a new survey by the Pew Research Center, the medicinal value of marijuana is the #1 reason why a majority of Americans now favor its legalization.

The survey of 1,500 adults found that 53% favor legalization, a dramatic shift from a decade earlier when only 32% favored legalization.

When asked what was the main reason they support legalization now, 41% cited its medicinal benefits. Another 36% said marijuana was no worse than other drugs such as alcohol and cigarettes.

Nearly half of U.S. states have legalized medical marijuana and four states -- Colorado, Washington, Oregon and Alaska -- and the District of Columbia have passed measures to legalize its recreational use. The federal government still classifies marijuana as a Schedule I controlled substance with no accepted medical use, but in recent years has stepped back enforcement efforts in states where it is legal.



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Topic: A Pained Life: ER Protocols

A Pained Life: ER Protocols


When I read about people going to the emergency room to be treated for breakthrough pain, it is rare for anyone to say they felt they were well-treated. They tend to say they were disbelieved, looked at as a drug seeker, or the ER doctor did not give them enough meds to last until they could see their pain management doctor.



I have almost always replied, “Ask your doctor to send a protocol letter to the ER. Then if you have to go they will know what you have and how your doctor wants it treated.”



It occurred to me that it would be a good idea for me to query some ER's and see if this was in fact good advice.

After talking with one nurse, I did not feel it necessary to talk with any others.



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Friday, May 8, 2015

Topic: When Drug Tests Go Wrong

When Drug Tests Go Wrong


Robin Haas was driving to Disneyworld with her husband and three children in 2008 when their vehicle was rear-ended by a truck on a Florida highway. The accident left Robin with chronic back pain, and she had 17 surgeries over the next 11 months to repair her damaged spine.

It was only the beginning of her problems.

Last year Robin was kicked out of a pain management practice after two office urine tests failed to find any trace of the fentanyl patch she was wearing for pain relief – a red flag for physicians that a patient may be diverting a drug.

Initially, Robin says her doctor didn’t seem too concerned.

“When it happened the second time, he said ‘Don’t worry about it. It’s happened with several of my patients with the fentanyl patches,’” Robin said



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Topic: Survey: Most Pain Patients Don't Abuse Painkillers

Survey: Most Pain Patients Don't Abuse Painkillers


Only a small percentage of chronic pain patients misuse or abuse their opioid painkillers, according to a wide ranging survey by the Partnership for Drug-Free Kids that also found a “disconnect” between patients and their doctors about opioid prescribing.



About one in ten pain patients (7% of chronic pain patients and 13% of acute pain patients) admitted misusing their opioid medications. Nearly half took longer to finish their prescriptions than directed – which was usually an effort to save the pain medication for another time.

More than one in ten (13% of chronic pain patients and 15% of acute pain patients) admitted using someone else's opiate prescription.



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Topic: Rheumatoid Arthritis Raises Risk of Heart Attack

Rheumatoid Arthritis Raises Risk of Heart Attack


Rheumatoid arthritis is a painful, disabling and incurable disease of the joints. But what many RA patients don’t know is that it also significantly raises their risk of a heart attack.



A new study by researchers in Mexico found that one quarter of patients with rheumatoid arthritis and no prior symptoms of heart disease could have a surprise heart attack. Their risk was higher even without cardiovascular risk factors such as smoking and diabetes.

“The condition nearly doubles the risk of a heart attack but most patients never knew they had heart disease and were never alerted about their cardiovascular risk," said Adriana Puente, MD, a cardiologist at the National Medical Center in Mexico City.



Rheumatoid arthritis is a chronic autoimmune disease in which the body’s own defenses attack joint tissues, causing swelling, inflammation and bone erosion. About 1% of adults worldwide suffer from RA.



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Topic: Researchers Develop New Painkiller from Lidocaine

Researchers Develop New Painkiller from Lidocaine


A fast acting pain reliever widely used to treat everything from itching to dental pain could be developed into a new medication that offers longer lasting pain relief.



"Because of its versatility and effectiveness at quickly numbing pain in targeted areas, lidocaine has been the gold standard in local anesthetics for more than 50 years," said George Kracke, PhD, an associate professor of anesthesiology and perioperative medicine at the University of Missouri (MU) School of Medicine.

"While lidocaine is effective as a short-term painkiller, its effects wear off quickly. We developed a new compound that can quickly provide longer lasting relief. This type of painkiller could be beneficial in treating sports injuries or in joint replacement procedures."



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Thursday, May 7, 2015

Topic: Chronic Illness Survival Guide

Chronic Illness Survival Guide


Learn about your condition:

The more you understand about what is wrong with you, the better prepared you will be when things go wrong. Remember to keep informed; information about conditions can change over time as more is learnt about it.

Teach your friends and family about your illness:

Not everyone is willing to learn, but the more your friends and family understand about your illness, the more supportive they will be. If you’re unsure how to teach them, show them some easy to follow websites about your condition, and leave them some light reading material (e.g. a simple pamphlet) to peruse in their own time. 



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Topic: Addiction to Narcotic Medications

Addiction to Narcotic Medications


Recent media coverage of narcotic medications and addiction has led to serious misconceptions about the role of such medications in treating chronic pain. The media's sensationalism of this issue has tragic repercussions for the more than 70 million Americans who suffer with chronic pain. The National Pain Foundation is concerned that such coverage, which reinforces misperceptions about narcotics, may lead to unnecessary withholding of these highly effective medications from patients who can benefit from narcotic treatment. The sensationalism also leads to reluctance on the part of patients to take such medications.

Confusion and misinformation surrounding physical dependence, tolerance, and addiction contribute to the already significant problem of the undertreatment of pain. Use of narcotics in the treatment of chronic pain rarely results in addiction. There are many options to treat chronic pain, ranging from medications, physical therapy, complementary therapies, psychological therapies, injections, and surgery. Narcotics are an effective option for treating pain for many individuals and can play a crucial role in pain control. 


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Topic: About Drug Addiction and Drug Abuse

About Drug Addiction and Drug Abuse


Both drug abuse and drug addiction can lead to many health problems. These problems vary depending on the type of drug abused. In general, drug abuse weakens the body's immune system, making it more difficult to fight off infection. People who abuse drugs often engage in risky behaviors, such as unsafe sex and sharing of needles. This makes them more likely to get sexually transmitted diseases, including HIV and hepatitis.



Abusing drugs can affect the way the heart works, including raising the risk for heart attack. Certain drugs, when abused, can damage the kidneys. Other drugs, including heroin, inhalants and steroids, can damage the liver.

All drugs that are abused affect the brain. This is because they cause a pleasurable or euphoric effect. Some drugs damage the brain or cause strokes or seizures. Drug abuse can interfere with memory and attention and can affect decision-making. Over time, the damage to the brain can result in paranoia, depression and aggression, the NIDA says.



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Both drug abuse and drug addiction can lead to many health problems. These problems vary depending on the type of drug abused. In general, drug abuse weakens the body's immune system, making it more difficult to fight off infection. People who abuse drugs often engage in risky behaviors, such as unsafe sex and sharing of needles. This makes them more likely to get sexually transmitted diseases, including HIV and hepatitis.



Abusing drugs can affect the way the heart works, including raising the risk for heart attack. Certain drugs, when abused, can damage the kidneys. Other drugs, including heroin, inhalants and steroids, can damage the liver.

All drugs that are abused affect the brain. This is because they cause a pleasurable or euphoric effect. Some drugs damage the brain or cause strokes or seizures. Drug abuse can interfere with memory and attention and can affect decision-making. Over time, the damage to the brain can result in paranoia, depression and aggression, the NIDA says.



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Tuesday, May 5, 2015

Topic: A Brief History of the Drug War

A Brief History of the Drug War


Many currently illegal drugs, such as marijuana, opium, coca, and psychedelics have been used for thousands of years for both medical and spiritual purposes.

The Early Stages of Drug Prohibition

Why are some drugs legal and other drugs illegal today? It's not based on any scientific assessment of the relative risks of these drugs – but it has everything to do with who is associated with these drugs.



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Monday, May 4, 2015

Topic: Risk Evaluation and Mitigation Strategies (REMS)

REMS are requirements set by the Food and Drug Administration (FDA) for pharmaceutical manufacturers to help ensure that the benefits outweigh the risks for certain drugs. There are several components of REMS that can be used by the pharmaceutical industry, including one or more of the following:

Medication Guides or Patient Package Inserts

FDA-approved instructions for appropriate use and instructions for patients focused on avoiding serious adverse events

Communication Plans



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Topic: Risk Evaluation and Mitigation Strategies (REMS)

Risk Evaluation and Mitigation Strategies (REMS)


REMS are requirements set by the Food and Drug Administration (FDA) for pharmaceutical manufacturers to help ensure that the benefits outweigh the risks for certain drugs. There are several components of REMS that can be used by the pharmaceutical industry, including one or more of the following:

Medication Guides or Patient Package Inserts

FDA-approved instructions for appropriate use and instructions for patients focused on avoiding serious adverse events

Communication Plans



To read more, please click this link:

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Topic: Abuse Mitigation Programs & Policies

The Role of Government in Mitigating Opioid Abuse

Due to the complex issues surrounding opioid abuse and misuse, various national and state programs, policies, and laws have been put in place to help mitigate opioid abuse and misuse.



Prescription Drug Monitoring Programs (PDMPs)



PDMPs are in place in 49 states to help detect and reduce the risk of diversion and abuse of prescription drugs at the practice and retail levels. These state programs allow for the collection and analysis of prescription data. Proactive reporting through the use of PDMPs can help:



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Topic: Understanding Abuse & Misuse

Understanding Abuse & Misuse


More than 12 million people reported using prescription pain medications nonmedically in 2010.That number encompasses both abuse and misuse. The abuse and misuse of prescription pain medications were responsible for more than 475,000 emergency department visits in 2009, a number that nearly doubled in just five years. Further, opioid overdoses in particular are increasingly due to the abuse of prescription painkillers.



Abuse is a nonmedical use of a drug, repeatedly, or even sporadically, for the positive psychoactive effects it produces. The most common form of opioid abuse is swallowing a number of intact pills or tablets to achieve a feeling of euphoria. While this is the most widespread form of abuse, opioid analgesics can be abused in a number of ways:



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Sunday, May 3, 2015

Topic: Survey: Two-Thirds of Patients Unable to Get Hydrocodone



About two-thirds of pain patients say they were no longer able to obtain hydrocodone after the opioid painkiller was reclassified by the U.S. government from a Schedule III medication to a more restrictive Schedule II drug, according to the results of a new survey.



Many patients who had been taking hydrocodone at the same dose for years said their doctor would no longer prescribe the painkiller. Over a quarter (27%) said they had suicidal thoughts after being denied a prescription for hydrocodone.

The survey of over 3,000 patients was conducted online by the National Fibromyalgia & Chronic Pain Association (NFMCPA) and the findings presented this week at the annual meeting of the American Academy of Pain Medicine. An abstract of “Hydrocodone Rescheduling: The First 100 Days” can be found here.



Hydrocodone was rescheduled by the Drug Enforcement Administration in October of last year to combat an “epidemic” of prescription drug abuse. The rescheduling limits patients to an initial 90-day supply and requires them to see a doctor for a new prescription each time they need a refill. Prescriptions for Schedule II drugs also cannot be phoned or faxed in by physicians.

The reclassification quickly made a drug that was once the most widely prescribed pain medication in the country – at nearly 130 million prescriptions each year – to one of the hardest to get.



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Topic: Accepting Chronic Pain: Is it Necessary?


A patient of mine told me the other day, “I don’t think I will ever be able to accept my chronic pain. It has completely changed my life.” 



I think this is something that most people with chronic pain contend with at some point in time; wanting to hold onto hope that their diagnosis isn’t chronic or not wanting to come to the realization that they will have to live with the pain forever.



When most people hear the word “acceptance” they equate it with the notion that they should feel that it’s okay or it’s alright to have a chronic condition.  Many people don’t ever feel okay about having to live with pain or an illness for the rest of their lives. It is not something that is easy to get used to and it’s not fair.



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Topic: A Pained Life: Hey Handicap!



You may have seen a story in the news a few weeks ago about an Ohio woman with a prosthetic leg who left a note on the windshield of a car parked in a handicapped spot. The car had no handicapped ID, placard or license plate, so it appeared it was parked illegally, taking a place someone with a handicap (and proper ID) might have needed.

The owner of the car responded to the note in a very, very nasty way – leaving a note of her own:



“Hey handicap! First, never place your hands on my car again! Second, honey you ain’t the only one with ‘struggles.’ You want pity go to a one leg support group!” the note said.



There was no excuse for what she wrote. When a picture of the note was posted on Facebook, it went viral.

I abhor it when I see someone without proper ID parking in a handicapped spot. I have a handicapped license plate which allows me to park in the designated spots.



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