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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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declined substantially after an abuse-deterrent formula of OxyContin was introduced and the painkiller propoxyphene was withdrawn from the U.S. market in 2010, according to a new study published online in JAMA Internal Medicine.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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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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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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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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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



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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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