Response to Surgeon General’s Opioid Pledge

Pain Academy’s Response to Surgeon General’s Opioid Pledge: “Come to terms with chronic pain” – National Pain Report – September 30, 2016 by Ed Coghlan

Since the CDC Guideline on Opioid Prescribing was released what has rankled many in the pain community—doctors, patients and advocacy organizations alike – was the lack of options to opioid prescribing.

The Academy of Integrative Pain Management added its voice this week in criticizing the Surgeon General’s Opioid Pledge.  It coincides with an op-ed published in USA Today from AIPM’s immediate past president, Dr. Robert Bonakdar.

In the USA TODAY, Dr. Bonakdar wrote, while over-prescribing of opioids and lack of insurance coverage for non-pharmacological treatments are problems, what the Surgeon General really needs to address is more fundamental – in the US, we have difficulty dealing with chronic pain.   Continue reading

High costs curb doctors’ ability to find opioid alternatives

High costs curb doctors’ ability to find opioid alternatives – June 2016 

Ken Manning’s head is held up by two metal rods, four plates, and 17 screws in his neck. Since falling off a frame at a carpentry job in the early 2000s, he has had four surgeries.

The pain is still so bad that he sometimes “sees stars” or passes out. To cope with it, he has been prescribed opioid pain medication for more than a decade.

for someone with his level of pain, there are few other options.

Doctors are left in a predicament:

How do you shepherd someone like Ken Manning through a devastatingly painful injury, days of local pain after surgery, and then years of chronic pain without him becoming addicted to opioids and all while seeing him in the 15-minute intervals that most doctors are allowed with patients?

Some doctors are looking for alternatives to replace opioids, but there seem to be few viable options for acute pain, and chronic pain patients must often overcome significant financial barriers to access other treatments.

Acute pain — the severe but temporary kind you might feel if you broke a bone — can often be treated by over-the-counter drugs like Tylenol or Advil. But such drugs come with limits: take too large a dose over a period of time and you can end up with long-term problems like liver or kidney damage.

“The thing that makes opiates attractive is that they are infinitely titratable, meaning you can keep giving patients opiates until the pain is gone, within certain safety parameters,” MacDonald said.

Dr. Scott Sigman, the hospital’s chief of orthopedics, was an early adopter of Exparel, a non-narcotic anesthetic that can be injected during surgery and keep the affected area pain-free for two to three days. He also uses Ofirmev, an intravenous form of acetaminophen.

Exparel costs around $300 a dose while Ofirmev runs about $35 per dose, and most patients require four or more doses. Meanwhile, the average Vicodin prescription in the U.S. cost $5 in 2015, according to IMS Health data.

Since adopting Exparel, Lowell General Hospital has saved an average of $1,638 per knee-replacement patient, due in large part to shorter lengths of stay, a study of the hospital’s data found.

But for patients, especially those with chronic pain, innovative treatments are often either not covered by insurance companies or remain far more expensive than opioids.

Ken Manning has tried alternatives to opioids, from steroid injections that left lasted for months but left him anxious and nauseous, to a therapy called transcutaneous electrical nerve stimulation, or TENS.

His TENS machine required him to attach electrodes to his body and it worked, until he started sweating and the pads fell off. Now, he is working with a doctor at Boston Medical Center in the hopes of receiving TENS implants.

The hard truth for chronic pain patients is that there is usually no such thing as a cure, said Cindy Steinberg, national director of policy and advocacy for the U.S. Pain Foundation.

“To a person, the hundreds of people who have come to my groups over the years have had to see four or more physicians before they’ve been able to get help,” she said. It is often because insurance companies compensate doctors for 15-minute appointments, which is not enough time to build a comprehensive pain-management plan

People are Dying and the Government is Lying

OPINION: “People are Dying and the Government is Lying” – National Pain Report

Notes on a Telephone Conversation with Thomas Novotny,  US Assistant Secretary for Health and Human Services. By: Lana Kirby and Richard A. Lawhern, Ph.D.

On September 19, 2016, chronic pain advocate and activist Lana Kirby spent nearly an hour in a telephone conference with Thomas Novotny, the US Assistant Secretary for Health and Human Services.  

The occasion for this interview was President Barack Obama’s declaration of the week as “Prescription Opioid and Heroin Epidemic Awareness Week.”     Continue reading

CDC Guidelines Contribute to the Cost of Addiction

3 Reasons the New CDC Guidelines May Contribute to the Cost of Addiction – The Painful Truth

In the September 13 issue of Vice, Maia Szalavitz challenges the myth that the U.S. can solve the opioid crisis by reducing the supply. 

Szalavitz is an informed and highly accomplished neuroscience journalist who applies common sense to the opioid epidemic. She says,

“If America really wants to reduce the death toll from its opioid crisis, we need to focus on reducing demand, not supply.”

The situation since then certainly has been chilling. In fact, it has become downright frigid, and the people who are suffering the most are the people who can least afford to: those with chronic pain.   Continue reading

Do Sit-Stand Desks Have a Role in Spine Care?

Do Sit-Stand Desks Have a Role in Spine Care? – Lead author Bethany Barone Gibbs, PhD, FAHA and A. Nick Shamie, MD Comment

Office workers who alternated between sitting and standing significantly increased the number of calories they burned without causing pain, according to a study published online ahead of print in Occupational Medicin

The increases in energy expenditure were relatively modest (7.8% increase with sit-stand desks and 11.5% with continuous standing), but may be sufficient to help people prevent weight gain when combined with other low-impact activities.

“Our acute study shows that standing or alternating [between sitting and standing] doesn’t cause any additional pain,” said lead author Bethany Barone Gibbs, PhD, FAHA.   Continue reading

Interventional Pain Management for Chronic Pain

Interventional Pain Management for Chronic Pain 7/18/16

Injections, Stimulation, Pain Pumps, and Other Treatments

For many people living with chronic pain, finding pain relief can be tough. A lot of trial and error is involved to find a pain treatment that works. Interventional pain management may help chronic pain patients cope with their pain.

what makes interventional pain management different is that it uses techniques, such as injections and radiofrequency rhizotomy, to directly [and invasively] address the source of your pain.

Some conditions interventional pain management techniques commonly treat include:   Continue reading

CDC’s own Study: Pot Legalization Decreases Use

CDC Study Shows Pot Legalization Dramatically Decreases Drug Use | By  Justin Gardner | Free Thought Project | September 8, 2016

In 2014, after Colorado legalized the recreational use of cannabis, we began hearing that teen use was declining – contrary to prohibitionist propaganda.

Real-world data were beginning to prove that the black market, created through government prohibition, is a prime driver of negativites associated with drugs.

Another study performed by Washington University School of Medicine, published in May of this year, found that teen use of cannabis has significantly decreased as states legalize cannabis.   Continue reading

FDA Advises Against Fluoroquinolone Antibiotics

FDA Advises Against Fluoroquinolone Antibiotic Use for Uncomplicated Infections

Serious side effects associated with fluoroquinolones generally outweigh the antibiotics’ benefits for patients with uncomplicated infections like sinusitis and bronchitis, the FDA announced.

The alert comes a year after the FDA convened an advisory committee to review the risk-benefit balance for fluoroquinolones.

The committee determined that the risk wasn’t worth the potential benefit for patients with sinusitis, bronchitis, and uncomplicated urinary tract infections, for which other treatment options exist.   Continue reading

Buprenorphine Used for Both Addiction and Pain

A Doctor Explains How Buprenorphine Is a “Stealth Medicine” for Both Addiction and Chronic Pain | TheInfluence by Lucinda Grande, MD

My new patient Marshall*, a pale 63-year-old man who lugged around a portable oxygen tank for his breathing problems, had been stuck on pain pills for years. 

A succession of medical treatments culminated eight years ago in prescriptions for daily use of oxycodone

It had worked well at first. But after a few years, he descended into a continuous state of opioid withdrawal.

This is certainly not a common reaction could indicate a genetic probelm with opioid metabolism.
Continue reading

Lawmakers urge DEA to reconsider ban of kratom

Lawmakers urge DEA to reconsider ‘hasty’ ban of opioid-like kratom – By Eric Boodman @ericboodman  September 23, 2016

When the Drug Enforcement Administration announced in late August that it would outlaw an opioid-like plant called kratom, the reaction was immediate.

Kratom sellers threatened legal action.

Over 130,000 people signed a petition to stop the ban. Some 400 users marched in front of the White House, with kids wearing shirts that said, “Kratom saved my mom.”

Now members of Congress are getting involved.   Continue reading