Kratom Supporters Rally at White House

By Pat Anson, Editor

Hundreds of protestors chanting “kratom saves lives” and “I am kratom” rallied in front of the White House today, hoping to turn their passion for an herb into a movement that stops the Drug Enforcement Administration from making kratom illegal.

“This stuff saved my life. It gave me my life back,” said one protestor.

Kratom comes from the leaves of a tree that grows in southeast Asia, where it has been used for centuries as a natural medicine. In recent years, kratom has grown in popularity in the United States, where it is made into teas and supplements as a treatment for pain, depression, anxiety and addiction.

All of that may change on September 30th, when the DEA plans to schedule the two main active ingredients in kratom as Schedule I controlled substances -- alongside heroin and LSD. That would effectively make the sale and possession of kratom a felony.

Under its emergency scheduling order, the DEA invited no public comment and held no public hearings.

“Stop this ban immediately. You’re trying to protect your jobs. You’re not trying to save Americans,” said Ryan Connor, a military veteran who lost a sister to a heroin overdose. “If you take away this herb, more and more people are going to die."

Connor said he uses kratom to treat his own opioid addiction.

image courtesy american kratom assn.

“I’ve been on every opioid under the sun. I was on Suboxone. I was told it was a cure for addiction, but it did not cure my addiction. In fact, it made it worse. I used kratom to get off Suboxone. It was painless. I had zero side effects from it. And I think as Americans we have the right to choose our health over getting poisoned by pharmaceuticals,” Connor said.

In a notice published in the Federal Register, the DEA said an emergency scheduling of kratom was necessary because it has no approved medical use. The DEA claimed the herb was being used recreationally for its "psychoactive effects" and as a substitute for heroin.

The Centers for Disease Control and Prevention also issued a report last month calling kratom "an emerging public health threat." The agency said there were 660 calls to U.S. poison control centers about kratom in the last six years. About 8 percent of the calls involved a life threatening condition. One death was reported.

courtesy patti belmont

Kratom supporters say the death was more likely caused by prescription drugs and that kratom actually saves lives.

“It changed my life. It rescued me from a very severe addiction to narcotics. It took me out of a home and bed-bound existence. It gave me the energy and pain control that I needed,” said Susan Ash, who founded the American Kratom Association, which organized the rally outside the White House.

“We want a regular scheduling process that involves public comment and the best available science, and not just a note from the CDC that said they got all of 660 calls to poison control when they’re getting three to four million calls a year. How do 660 calls make an emerging public health threat?”

Kratom supporters have gotten over 120,000 signatures on an online petition asking the Obama administration to stop the DEA from scheduling kratom as a Schedule I substance. Under its "We the People" petition rules, the administration promises to "take action" on a petition within 60 days if supporters are able to gather at least 100,000 signatures.   

According to the website whpetitions.info, the average response time for a successful White House petition is well over 100 days – not 60 days. Six petitions -- including the kratom petition -- are currently waiting for a response.

Meanwhile, the Center for Regulatory Effectiveness (CRE), a government watchdog group, has asked the DEA to postpone the scheduling of kratom.

In a September 12 letter to acting DEA Administrator Charles Rosenberg, a CRE official pointed out that the National Institutes of Health has conducted research to explore the therapeutic value of kratom as a treatment for chronic pain and substance abuse.

“The research was so well conducted and received by the scientific community that the aforementioned institutions applied for a patent. How much more additional evidence is needed to demonstrate that the DEA has acted arbitrarily in issuing a ban on kratom?” asked Jim Tozzi, a member of the CRE Board of Advisors.

“In short, without going through a notice and comment process, DEA is obviating another agency’s research that was conducted with appropriated funds. With its action, DEA is also obviating the progress and promise of kratom research to boosting the American bio-sciences industry.”

Tozzi’s letter said the DEA’s “rush to judgement” may have violated the federal Data Information Quality Act and was a “clear and flagrant abuse of discretion.”

He asked the DEA to extend the effective date for scheduling kratom to July 1, 2017, to allow for public comment and a peer review of the science behind the agency’s decision.

Half of Patients Have Trouble Getting Pain Meds

By Pat Anson, Editor

A new survey of chronic pain patients found that over half – 56 percent -- have experienced problems getting access to opioid pain medication, either from a pharmacy or their own doctor. Nearly half of the patients surveyed also said they have contemplated suicide.

“Access continues to be a problem and a growing problem for patients living with chronic pain,” said Jeff Dayno, MD, chief medical officer for Egalet, a pharmaceutical company that conducted the survey along with the American Chronic Pain Association (ACPA).

The online survey of over 1,000 patients was conducted in 2015, before guidelines were issued by the Centers for Disease Control and Prevention that discourage primary care physician from prescribing opioids for chronic pain. Although the guidelines are voluntary, they’ve had a chilling effect on many doctors and pharmacists since their release in March.  

“General practitioners who don’t have as much experience are having somewhat of a knee jerk reaction. Either they’re not prescribing opioids at all or taking a very cautious approach,” said Dayno.

“The broader medical community is backing away from the more effective type of pain medications and opioids specifically, even at the pharmacy level in terms of stocking them and having them available.”

Nearly two-thirds of patients (63%) said their pharmacy carries only a limited supply of pain medication. And nearly four out of ten patients (39%) said their physician no longer prescribes pain medication.

“Since the push to combat prescription medication abuse has risen, so have the number of calls we have received from individuals expressing their frustration about accessing their prescription medications,” said Penney Cowan, founder of the ACPA. “The study found that access really is an issue for individuals; they struggle to find doctors who are willing to treat them, and pharmacies that stock their medication.

“For individuals living with chronic pain, access to medication is vital to functioning in their everyday lives. Doctors would not withhold prescriptions from patients with other medical conditions such as diabetes or heart disease. What’s startling is the high percentage of individuals who have contemplated suicide.”

Forty-seven percent of the survey respondents said they’ve had thoughts of suicide.

“The statistic around patients contemplating suicide, we’ve seen numbers like that in the literature before. And that’s a very concerning and frightening aspect of the impact of limited access to effective pain medications,” said Dayno, who believes the number of patients complaining about access would be even higher if the survey was conducted today.

When asked by Pain News Network if he thought the CDC even considered suicides and other negative consequences on patients when it was drafting the guidelines, Dayno said no.

“I don’t think that dimension was clearly considered in the guidelines. I think it was much more of an evidence based, clinical approach on the pain management side. But the impact of potential barriers to access to these medications was not factored in to that assessment as part of the CDC guidelines,” he said.

A noted expert on pain management says he’s also seen “anecdotal reports” of primary care physicians and pain management specialists dumping pain patients since the CDC guidelines came out.

“I think some doctors are increasingly uncomfortable with continuing to prescribe what has been a higher dose of opioids, uncomfortable with the scrutiny that they’ve gotten, and as a consequence they are discharging patients from clinics, urging them to find care elsewhere,” said Sean Mackey, MD, Chief of the Division of Pain Medicine at Stanford University.

Study Finds Link Between Weather and Chronic Pain

By Pat Anson, Editor

There may be something to the old adage about “feeling under the weather.”

Early results from a smartphone-based weather study in the UK show that rain and lack of sunshine have an impact on how we perceive pain.

Over 9,000 people are participating in The University of Manchester’s Cloudy with a Chance of Pain project,  using a special app to record their daily pain levels.  

The app also captures hourly weather conditions using the phone’s GPS, giving researchers the ability to compare the pain data with real-time local weather.

Researchers reviewed data from participants in three cities – Leeds, Norwich and London – and found that as the number of sunny days increased from February to April, the amount of time participants spent in severe pain decreased.

Conversely, when the weather turned rainy and cloudy in June, the amount of time spent in severe pain increased.

The 18-month study is only half complete and researchers are still looking to recruit as many people as possible who are willing to track their symptoms.

“If you are affected by chronic pain, this is your chance to take do something personally – and easily – to lead to a breakthrough in our understanding of pain,” said lead investigator Will Dixon, a professor of Digital Epidemiology at The University of Manchester’s School of Biological Sciences.

The Greek philosopher Hippocrates in 400 B.C was one of the first to note that changes in the weather can affect pain levels. Although a large body of folklore has reinforced the belief that there is a link between weather and pain, the science behind it is mixed.

A 2014 study in Australia found that low back pain is not associated with temperature, humidity and rain.  A 2013 Dutch study also concluded that weather has no impact on fibromyalgia symptoms in women.

“Once the link is proven, people will have the confidence to plan their activities in accordance with the weather. In addition, understanding how weather influences pain will allow medical researchers to explore new pain interventions and treatments,” says Dixon.

People with arthritis or chronic pain who are interested in joining the Cloudy with a Chance of Pain project – and who have access to a smartphone – can download the app by clicking here. You need to be at least 17 and live in the UK.

Participants are encouraged to record their pain symptoms daily until the project ends in January.  Researchers hope to use data to develop “pain forecasts” based on weather predictions.

Waiting for Santa in the ER

By Emily Ullrich, Columnist

Some of you may have noticed I’ve been silent for a while. I’ve been shirking my duties to the pain community because I am so fed up that it all seems futile.

I’ve been struggling with feelings of defeat and guilt at my unusual inability to muster the courage to continue. I have been deeply introspective and, for once, I’ve had no words for the profound emotional disenchantment that one experiences when they realize that most doctors really don’t care.

My mother tells the following story about me when I was a little girl, and it struck me that this feeling I have today is the same one I had when I realized there was no Santa Claus.

She says that I essentially disassembled the entire house of cards that kids are brought up believing in. She says I was lying in bed when I asked her if Santa was real. She attempted an explanation that Santa was the spirit of Christmas and that he wasn’t an actual person, but that his essence was within all of us. According to her, I went on to ask if there was an Easter bunny, a tooth fairy, or even a God.

A few years later, I left the sheltered life of Montessori school, where creativity was valued, analytical thinking promoted, and social interactions remained innocent. I entered public school in the midst of puberty. Despite my many futile attempts at preppy mall fashion, and rehearsed and repetitive social coolness, I could not blend in.

To my dismay, my quirky, outside-of-the-box thinking betrayed me daily. I became the weird, socially awkward, politically and culturally over-saturated smart girl, wearing the body of a 6-foot tall woman.  As a writer, these experiences have given me a unique lens through which to view life and are now the things I pride myself in.

As a chronically ill patient, I have been thrown right back into the post-traumatic stress of that time, my intellect and strong personality are not seen as behaviors of a good patient. I feel l have to be a fake to get the care that I need. I feel this sensation washing over me every time I have a doctor’s appointment, surgery, procedure or hospital stay.

I’ve written before about the inhumanity and cold, cruel treatment I have received more times than I care to remember. I am aware that there are doctors and nurses who do care and actually want to help, and I have been blessed more than a few times with having these amazing people as my caregivers.

But if I am truly honest, more often than not, these gems of humanity are not the ones we patients get.

I understand that they’re at work, doing a job, and they have to do more for us than the usual patient. Some are also jaded, uninformed, insensitive and, frankly, shouldn’t be in this line of work.

When a patient’s life, health, and attitude are psychologically and sometimes physically neglected, disrespected, and infused with negativity, it’s scarring. It plays over and over in your head. Although it’s really hard to control my temper and emotions in this situation, I do my best. It’s not natural for me. I am opinionated and strong-willed.

I’ve learned the hard way that when I act how I feel like acting, my care gets even worse. I always wonder what I could have or should have done differently to make the situation better.

I know that I am probably coming across as very negative, but there is one thing that I know about myself -- when I am at my worst, I am often at my best. What I mean is, I want to make others around me comfortable, and the more serious a situation is, the more I try to bring levity and positivity. I try to make people feel at ease, to laugh, and to know that I am grateful for their help. I make a point of being very polite to my caregivers, even when I’m frustrated with them, and I make a point to ask how their day is, even if they haven’t asked about mine. This leads me to my most recent hospital stay.

My Latest Trip to the ER

I went to the emergency room because my home healthcare nurse demanded it after noticing that my arm with a PICC catheter line was very red and inflamed. As usual, the ER doctor treated me like I was there for fun. Because waiting for 6 hours in a room full of sick people and being treated like crap is everybody's idea of a good time!

It turned out that I had pulmonary embolisms -- blood clots in my lungs -- a life-threatening condition which frequently causes stroke or heart attack. The doctor scolded me that I should "take this seriously," as though I got the clots from doing some sort of illicit behavior and was obviously careless about my health. I wonder if it ever occurred to him that maybe I was taking it seriously -- by going to the damned ER!

He then launched into a lecture about the evils of pain medications, and even alluded to the doctor’s oath to "first do no harm," insinuating that the doctor who prescribed my pain medicines (who happens to be the kindest, most compassionate and knowledgeable doctor I’ve ever had) was not helping me, but harming me.

He assessed all of this in two minutes of talking at me, not to me, and without any idea of the myriad health conditions I live with. Sick, and even sicker of dealing with this re-run of the C+ med student-come-doctor with a God complex, I mustered the energy to stand up for myself. I argued that this was probably not the best time for a discussion about changing or completely discontinuing my medications, seeing as I had pulmonary embolisms to worry about, and a pain doctor whose specialty it is to deal with that was not present.

God forbid, I had challenged his almighty ER doctor knowledge and here's where it got good.

He decided to un-diagnose my Reflex Sympathetic Dystrophy (RSD) -- an extremely painful and complicated condition I was finally diagnosed with after two years of surgery, doctors’ visits, and being told there was nothing wrong with me that a knee joint replacement and antidepressants wouldn’t fix.  

Then I spent three days in a hospital being run through a battery of tests and a whole team of doctors had agreed on my diagnosis of RSD.  It’s an illness that I take medications for, have physical therapy for, use a cane for, and which you can tell I have just by looking at my knee -- which he never did.

"You don't have RSD," he said. Based on what? Maybe the fact that I wasn't screaming and writhing in pain, as he thought I should be?  

"Did a neurologist diagnose you?" he asked. I explained that I spent days in the hospital having a battery of tests and a number of different specialists all agreed that I have RSD. Again, he asserted his disbelief, without ever looking at my knee!

Begrudgingly, he admitted me to the hospital, as though I intentionally manifested blood clots in my lungs just so I could hang out with his charming self. He also lectured me further about the gravity with which I should treat this situation.

I wonder since if he has ever thought about this interaction with me, and in any small way realized the hypocritical irony that his entire discussion was loaded with.  

I can't stop thinking about what happened. Or where Santa went to.

Emily Ullrich suffers from Complex Regional Pain Syndrome (CRPS), Sphincter of Oddi Dysfunction, Carpal Tunnel Syndrome, endometriosis,  Interstitial Cystitis, migraines, fibromyalgia, osteoarthritis, anxiety, insomnia, bursitis, depression, multiple chemical sensitivity, and chronic pancreatitis

Emily is a writer, artist, filmmaker, and has even been an occasional stand-up comedian. She now focuses on patient advocacy for the International Pain Foundation, as she is able.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Can 3-D Sound Technology Silence Chronic Pain?

By Pat Anson, Editor

Cognitive behavioral therapy. Mindfulness meditation. Acupuncture. Massage. Yoga.

The list goes on and on.

You name it and most chronic pain patients have probably already tried some type of alternative treatment for pain relief. Many give up after a short trial period or simply can't afford to continue treatment.

But there's an innovative and inexpensive new way to treat chronic pain -- a CD that uses binaural sound technology to help listeners relax and "deamplify" pain signals. Think of it as a three-dimensional (3-D) stereo sound that reaches parts of your brain that regular sound can't.

"It's so easy. Anyone can pop in a CD and listen to it. The trick is to use it over time because when you use it regularly, you're training your brain away from pain, says Beth Darnall, PhD, a pain psychologist, clinical associate professor at Stanford University, and author of The Opioid-Free Pain Relief Kit: Ten Simple Steps to Ease Your Pain.

In addition to several practical tips at relieving pain, the book comes with a 20-minute CD that Darnall narrates using binaural technology, which she says is the "gold standard" in psychology for treating post-traumatic stress disorder (PTSD) and anxiety.  Darnall believes her CD is the first to use binaural sounds to treat chronic pain.

"The person just puts on headphones and I walk them through a total body progressive relaxation. Layered behind my voice are tones that go in one ear and in the other ear, in rapidly alternating sessions," Darnall told Pain News Network while attending PainWeek, a week-long conference in Las Vegas for pain management practitioners. 

"Most people will not perceive these tones, but your brain perceives them. This is called binaural technology and what it does is stimulates the different hemispheres of your brain in rapid alternating secession."

Wearing headphones is the key to making binaural technology work. So is listening to the CD at least twice a day. Darnall says it works in a way similar to cognitive behavioral therapy -- by "calming"  the brain and quieting the constant barrage of pain signals it is receiving.

BETH DARNALL, PHD

"Its only when you use headphones that the binoral works because the tones are going in one ear and in the other. And they're talking directly to your nervous system," explains Darnall.. "Even if you don't hear it, they're there.

"When you use it regularly, you're training your brain away from pain. You're literally retraining your neural networks to a calmer -- I don't want to say pain free --  state that helps people de-amplify. You're basically dampening the pain processing over and over again. And so over time your brain is less likely to go straight to the pain and amplification. You keep things at a calmer level where you have less pain and less distress."

You can click here to download an mp3 file and listen to a sample one-minute recording from the CD.

"We have observed is that it is very effective for pain," says Darnall, who recommends that users not be driving, doing chores or be engaged in anything else while listening to the CD.

"Sit. Close your eyes. Be present because we really want to induce a total body state ofdeep relaxation. If you're multi-tasking and doing other things, you're not fully relaxed."

Darnall recommends other relaxation techniques in her book to help people reduce stress and sleep better -- techniques she says can help reduce the need for opioid medication. She says listening to the CD will help enhance that process, but like any alternative treatment it takes time and effort to make it work.

"Most people with chronic pain, have been living with pain so long, if you listen to this once or twice, you're not going to scratch the surface. But over time we can train the whole nervous system away from pain," she said.

Kratom Petition Reaches Goal, But Now What?

By Pat Anson, Editor

Supporters of a citizens' petition that calls on the Obama administration to reverse a decision that will make the sale and possession of kratom illegal have reached their goal of 100,000 signatures.

But the move is largely symbolic and will probably not prevent the Drug Enforcement Administration from classifying kratom as a Schedule I controlled substance at the end of the month.

The DEA filed notice in the federal register last week for an emergency scheduling of mitragynine and 7-hydroxymitragynine, the two main active ingredients in kratom, which comes from the leaves of a tree that grows in southeast Asia.

Kratom is used in teas and supplements as a natural treatment for pain, depression, anxiety and other medical conditions. The DEA claims kratom is also used recreationally for its "psychoactive effects" and has even been used as a substitute for heroin. Kratom supporters say its no stronger than a cup of coffee.

Under its "We the People" petition rules, the Obama Administration promises to "take action" on an issue whenever supporters are able to gather at least 100,000 signatures online within 30 days.

"We will do our best to respond to petitions that cross the signature threshold within 60 days, however, depending on the topic and the overall volume of petitions from We the People, responses may be delayed," the White House says in a statement on its website.

According to the website whpetitions.info, the average response time for a successful petition is 118 days. Six petitions -- including the kratom petition -- are currently waiting for a response.

Barring a last minute legal challenge, the DEA scheduling of kratom as a controlled substance, alongside heroin, LSD and marijuana, will begin September 30.

"This may go into effect before we get a response from the White House," says Susan Ash, founder of the American Kratom Association, a volunteer organization of kratom users. "That's one of the reasons why we are doing our rally September 13th in front of the White House, so that we can bring this issue to their attention prior to them being required to give us a response."

The Obama administration began hosting "We the People" petitions on the White House website in 2011. Although the petitions have been criticized as a public relations gimmick, some have resulted in federal action, such as legislation allowing consumers to use their mobile devices on any network they choose.

At other times, however, the White House response to a petition has been a statement that only reaffirms current policy. That was the case in 2011, when petitioners asked the administration to legalize marijuana.

"Like many, we are interested in the potential marijuana may have in providing relief to individuals diagnosed with certain serious illnesses," wrote Gil Kerlikowske, Director of the Office of National Drug Control Policy, in the official White House response to the petition.

"That is why we ardently support ongoing research into determining what components of the marijuana plant can be used as medicine. To date, however, neither the FDA nor the Institute of Medicine have found smoked marijuana to meet the modern standard for safe or effective medicine for any condition."

The DEA is taking a similar stance on kratom, saying it has no medically accepted use.

Don’t Let the Media and Medical Profession Fool You

By Richard Oberg, MD, Guest Columnist

Chronic pain patients, like my wife, myself and others with abominable mistreatment, continue to lose the care they need while nothing is being done to address the real issues.

Drug abuse is up, young people are dying and the main culprits aren't prescription drugs, but something much more difficult to control. Heroin and illicit fentanyl, major causes of the increasing deaths, are becoming more widely available and, unfortunately, both of them are opioids.

The media routinely spouts about these “opioid deaths” while implying that prescription pain medication is what caused healthy people to take these illegal drugs. Why? Because they say so, that's why.

As with the recent 60 Minutes nonsense, they embellish the death of some high school quarterback, have a room full of grieving parents who say they had no idea their kids were drug addicts, add the fear that this can happen to you, and we the patients get to bear the brunt of this misdirected insanity.

The CDC addictionologist lobby and other federal agencies seem to have hoodwinked everyone into blaming chronic pain patients for this national problem. This is obvious and evident from countless stories of patient abuse no one seems to want to hear. The word is “scapegoat” and not a single person in power is responsible for anything – only we the patients are.

The CDC, government agencies and, quite frankly, the majority of physicians are NOT well-intended on this issue. They created this patient crisis that could have been avoided.

Don't let the medical profession that I was a part of for nearly four decades fool you. Physician sub-specialty organizations now exist for the benefit of physicians, not patients, and are mostly about maintaining control and money. Had these organizations stood up to defend patients against the CDC, and the ridiculous addictionology cohort of psychiatrists and anesthesiologists grooming their financial turf, we wouldn't be here right now. But they didn't, and a majority of physicians say they actually support the guidelines.

Don't buy the “they made me do it” line. It is misdirected nonsense, just as eliminating the pain scale to prevent any accountability is. Physicians don’t like accountability.

Inevitably, doctors still willing to write prescriptions for pain meds will attract greater numbers of chronic pain patients – and become easy prey for the DEA or their physician colleagues who don’t approve. Some of these doctors will become outliers in medical associations whose members tell them to stop because they don’t want to see or treat patients like us.

Why doesn't anyone ask where all the patients of physician practices that are being shut down go to? It's because no one in power cares, that's why. And then there’s the sheer ignorance or bigotry of many physicians who profess to be “pain management experts.”

The American Medical Association (AMA) once represented 75% of all licensed physicians and supported the best care for patients. 

Today, membership in the AMA has declined to just 15-20% of physicians, as subspecialty organizations gained power and patient care became driven by those isolated subspecialties. 

These organizations support the flow of wealth to their specialties better than the AMA ever could.  With increasing specialization, patient care became highly fragmented for those with complex diseases, yet there was no attempt or incentive to coordinate care. It became every patient for himself.

It is extremely rare to non-existent for a physician specialist to actually speak to another physician about your care, nor is much if any time spent reading another doctor’s evaluations. It’s just not fiscally expedient with current healthcare models. That is why you’re “re-evaluated” by every new specialist you see and have to reprove your illness over and over, often to skeptical stares.

The major problem with this is that subspecialties often “evaluate” you beyond their competence. For example, a rheumatologist is vastly superior to a psychiatrist if you have an autoimmune disease, but if you’re depressed and miserable because of an undiagnosed autoimmune disease and enter the care of a psychiatrist, the odds of ever getting an appropriate diagnosis are nil. Worse, they can make your life hell.

It’s just not what they do -- they make you fit their model – not the other way around. Whenever you get into the care of some subspecialist unlikely to have any idea what’s wrong with you, it inevitably leads to biases against you because physicians are just as bigoted about what they don’t understand as anyone else.

The attitude of most that my wife and I have encountered (despite both of us being physicians) suggests that most subspecialists get their information from the nightly news rather than medical journals outside of their specialty. Neurosurgeons think opioids are bad because that’s what they’ve heard. And they’d rather believe that than have you tell them otherwise.

From our point of view, it’s would almost be comical if it wasn't so infuriating.

Often, chronic pain patients are not sick enough to warrant hospital care (following acute care protocols), yet are too ill to be seen by outpatient physicians who aren’t reimbursed enough to spend additional time figuring you out or interacting with your other physicians.

And there are plenty of “well patient” visits providing better income – so why bother?

If this sounds bad, it’s because it is. For those who like their anesthesiologist pain care person, good for you. Many of us aren’t so fortunate. And someday you might not be either.

I’m not sure how much worse this will get, with patients losing access to opioids or seeing their doses cut, while overdose death rates continue to rise -- refuting CDC wisdom. Taking meds from chronic pain patients isn’t going to fix a problem caused by healthy people with illegal intentions.

Maybe some powerful mainstream media source will actually ask someone in power what's going on and not settle for anything other than a straight answer. But I wouldn’t hold my breath.

Take the unfortunate demise of Prince and how it has been reported. Whenever someone with career-induced injuries attempts to defeat aging by taking illicit opioid pain medication to continue performing 20 year old moves on a 57-year old body, bad things will result. It shouldn’t be rocket science to figure that out, yet I don’t recall a single media source saying that.

Instead, Prince has become another idiotic reason legitimate patients shouldn’t get opioid pain care – all because he intentionally misused it to extend his career. Because of the actions of a few, the vast majority will suffer. Not exactly stellar for the most expensive healthcare system in the world, is it?

Richard Oberg, MD, is disabled by psoriatic arthritis and no longer practices medicine. Dr. Oberg receives no funding from pharmaceutical companies. 

Pain News Network invites other readers to share their stories with us.  Send them to:  editor@PainNewsNetwork.org. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Miss Understood: A Mother’s Greatest Fear

By Arlene Grau, Columnist

As a mother your main goals are to raise your children to lead happy lives, to always love them, and to keep them safe. I want to see my children excel and get a lot further in life than anything I've ever dreamed of.

Although I have many hopes and aspirations for my two daughters, my worst fear is always lingering in the back of my head.

What if I cursed one of my daughters with a genetic predisposition for an autoimmune disease? What if they develop arthritis or lupus? I could never forgive myself if I knew they were meant to endure the suffering I've lived through.

I would give anything if they would never have to worry about seeing a medical specialist, or needing infusions, blood draws and painkillers just to get by. They already see a pain sufferer’s life through a child’s point of view and that alone is very difficult to handle for a 5 and 9-year old. But burdening them with this lifestyle would be cruel in and of itself.

I'd like to think that I could handle any amount of pain you throw at me. I'll shed some tears and break down a bit, but I think of myself as a genuinely strong individual. However, if you involve my children, then all bets are off and I become vulnerable.

When my oldest daughter was born I suffered from preeclampsia (high blood pressure) and she was born prematurely. She weighed just 4.6 lbs. at birth and was in the neonatal intensive care unit for two weeks.

The day after I was discharged, I was back at her bedside from the time visiting hours began until it was time to go home. She ended up needing surgery at 8 weeks and it was the worst experience I've ever been through.

I can remember how much I wanted both my girls to come home from the hospital with me so I can just love and protect them. My desire for children was always about how much I wanted a family, but I never stopped to think about the possibility of passing down an autoimmune  disease. Now anytime my kids tell me their back or hands hurt, I subconsciously think that it might be arthritis.

I think I may always feel that way. Not only because I'm blaming myself for any pain they may be feeling, but because I know that these diseases do not discriminate against any age group.

Arlene Grau lives in southern California with her family. Arlene suffers from rheumatoid arthritis, fibromyalgia, lupus, migraine, vasculitis, and Sjogren’s disease.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Senza Stimulator Rated More Effective Long Term

By Pat Anson, Editor

A two-year study of an innovative spinal cord stimulator shows the device is more effective at relieving chronic back and leg pain long term than traditional stimulators.

The Senza HF10 spinal cord stimulator uses high frequency pulses of 10,000 Hz to mask a patient’s perception of pain. Traditional stimulators typically use lower frequencies at 40 to 60 Hz.  

Spinal cord stimulators (SCS) are often considered the treatment of last resort for chronic back and leg pain, because the devices have to be surgically placed near the spine and connected to batteries implanted under the skin. The devices send electrical impulses into the spine to mask pain.

In a study of 171 patients with implanted SCS devices, 76% of those with back pain and 73% with leg pain had pain relief after 24 months with the Senza HF10. That compares to about 50% of the patients implanted with a traditional stimulator.

image courtesy nevro

The Senza stimulator is made by Nevro Corp. (NYSE: NVRO) a medical device company in Redwood City, California.

"By demonstrating a significant and durable decrease in back and leg pain over a two-year period, Nevro's HF10 therapy represents an important and evidence-based advance in pain medicine,” said Leo Kapural, MD, the lead author and principal investigator of the study, which is published in the journal Neurosurgery.  

“Extending comparative safety and efficacy outcomes from 12 to 24 months provides physicians, patients, and payers with rigorous evidence demonstrating the durability of SCS in treating chronic pain.”

The Senza SCS was approved by the Food and Drug Administration last year. It has been available in Europe and Australia for several years.

Nevro says the HF10 stimulator is the only SCS therapy that provides pain relief without paresthesia -- a tingling or buzzing sensation that lower-frequency stimulators use to help mask pain signals. Some patients have found paresthesia uncomfortable.

MarketsandMarkets, a market research firm based in Dallas, estimates the global market for spinal cord stimulators and other neuromodulation devices could reach $6.8 billion by 2017.

Should the DEA Ban Kratom? Take Our Survey

By Pat Anson, Editor

A natural supplement that most Americans are not familiar with is suddenly being thrust into the national spotlight and debate over opioid addiction.

Nearly 70,000 people have signed a White House petition and many are planning to attend a rally next week in Washington DC to protest plans by the DEA to classify a kratom as an illegal narcotic.

Kratom comes from the leaves of a tree that grows in southeast Asia, where it has been used for centuries as a natural medicine. Only in recent years has kratom caught on in the United States – where the leaves are used in teas and supplements to treat pain, depression, anxiety and even addiction.

Since the DEA’s surprise decision was announced, many kratom supporters have written us saying that kratom is far more effective and safer than pharmaceutical drugs.

“I was amazed at the pain relief, energy, anxiety relief, and mood boost that it gave me,” wrote Connie Fuller, a high school teacher and mother of two who suffers from arthritis, fibromyalgia, back pain and other chronic conditions. “I still feel pain 24/7 but it’s quite tolerable most days and I gladly smile again. We MUST keep kratom legal so that I can keep my life.”

“I'm a kratom user of two years and my life has dramatically improved. I'm so scared about this. Not sure what I'm going to do. I don't want to be on pharmaceuticals again. But I don't want to be a criminal either,” said Jordan.

Is kratom really the “hazard to public safety” that the DEA says it is? Does it make people high? Where is the evidence that it actually works?

In an effort to answer some of these questions, Pain News Network has partnered with the American Kratom Association in an online survey to see why people use kratom, whether it is effective, and what they plan on doing if the sale and possession of kratom is criminalized by the DEA.  

(Update: The survey is now closed. The results will be released September 20)

“The CDC, DEA and other federal agencies, as well as the media, believe that we are nothing but a bunch of teenagers or young adults who are only using kratom on a recreational basis and are abusing it,” says Susan Ash, who founded the American Kratom Association. “That is simply not the case. Our members are largely people in their 40’s, 50’s and 60’s. We have a lot of soccer moms, firefighters, lawyers and lobbyists who are members. To paint a truer picture of the kind of people that are using this product medicinally, this survey will be helpful in showing that we’re not the kind of people that they think we are.”

The DEA notice published in the Federal Register last week will classify the two main active ingredients in kratom -- mitragynine and 7-hydroxymitragynine -- as Schedule I controlled substances, the same classification used for heroin, LSD and marijuana.

Although mitragynine and 7-hydroxymitragynine are alkaloids, the DEA took the unusual step of calling them “opioid substances,” even though they don’t originate from the poppy plant like other opioid pain medications. The DEA saidkratom has “a high potential for abuse” and was linked to several deaths.

“In the United States, kratom is misused to self-treat chronic pain and opioid withdrawal symptoms, with users reporting its effects to be comparable to prescription opioids. Users have also reported dose-dependent psychoactive effects to include euphoria, simultaneous stimulation and relaxation, analgesia, vivid dreams, and sedation,”  the DEA said.

“They did that on purpose,” says Ash. “They put ‘opioid’ in there to get sympathy from all of the Congress people already working on this issue, who will look at that Federal Register notice and say ‘Oh my God, another opioid.’ We need to ban it.”   

Another unusual aspect of the DEA action is that there was no public notice or comment period, as there usually is when a controlled substance is scheduled. It will become illegal to possess or sell mitragynine and 7-hydroxymitragynine – in other words, kratom itself – at the end of September.

“This emergency scheduling only gives people 30 days to come up with a solution. Most people can’t even get in to see their doctors in 30 days,” says Ash. “They’re putting tens of thousands of people in a position where they have to decide 'Do I go back to pharmaceuticals?' and 'Do I even have time to see my doctor?'

“We’re leaving people completely in the lurch that count on kratom for their health and well-being. People have been using kratom safely for years and these people are basically being told you need to cut off your use abruptly.”

Ash says the American Kratom Association is meeting with lawyers to pursue every possible legal avenue to stop or delay the DEA's scheduling process. She’s also hopeful that grassroots action, the rally in Washington, and the results of our survey will help educate the public and media about kratom’s benefits.  

What Alternative Treatments Work for Chronic Pain?

By Pat Anson, Editor

A review of over a hundred clinical trials has found that some alternative pain therapies such as acupuncture, yoga, tai chi, and massage are effective in treating chronic back and neck pain, osteoarthritis of the knee, migraine and headaches.

But only weak evidence was found that they might help people with fibromyalgia.

The review was conducted by scientists at the National Center for Complementary and Integrative Health at the National Institutes of Health (NIH). The study,  published online in the Mayo Clinic Proceedings,  was conducted to give patients and primary care providers better evidence on the effectiveness of non-drug treatments for chronic pain.

“One major goal for this study was to be as relevant as possible to primary care providers in the United States, who frequently see and care for patients with painful conditions. Providers need more high quality information on the evidence base for pain management tools, especially nondrug approaches,” said lead author Richard Nahin, PhD, an epidemiologist with NIH.

“Overall, the data suggest that some complementary approaches may help some patients manage, though not cure, painful health conditions.”

The scientists “found promise” in the safety and effectiveness of these treatments:

• Acupuncture and yoga for back pain
• Acupuncture and tai chi for osteoarthritis of the knee
• Massage therapy for neck pain  
• Relaxation techniques for severe headaches and migraine.

Though the evidence was weaker, the researchers found that massage, spinal manipulation, and osteopathic manipulation may provide some help for back pain. Relaxation approaches and tai chi might also help some people with fibromyalgia.

Mixed or no evidence was found that glucosamine, chondroitin, omega-3 fatty acids, and S-Adenosyl methionine (SAMe) are effective in treating chronic pain.

Each year Americans spend about $30 billion on alternative and so-called complimentary health treatments, even though few studies have been conducted on their effectiveness. The NIH researchers had to go back 50 years to find enough clinical studies to review. Many of the studies involved fewer than 100 people, which weakens the conclusions drawn from them. Some of the same studies were used by the Centers for Disease Control and Prevention as evidence for its opioid prescribing guidelines, which encourage "non-pharmacological" treatments for chronic pain.

“It's important that continued research explore how these approaches actually work and whether these findings apply broadly in diverse clinical settings and patient populations," said David Shurtleff, PhD, deputy director of National Center for Complementary and Integrative Health.

Make the Life that You Want

By Barby Ingle, Columnist

Lately I have been living my dreams, but at the same time realizing how much I have gone through over the years, especially the last two.

Before I got sick I was active, a go-getter, never quit and efficient. Nowadays, I am still as active as I can be, still setting goals and working towards accomplishing them, and trying to keep a positive attitude. But I am not efficient anymore. It’s a large change.

I find that many people who develop an autoimmune condition were overachievers prior to their illness. Did we run ourselves down? Did something in our past prevent us from healing? Or did we just draw the short straw of life?

At this point it doesn’t really matter to me. A life with chronic pain management is my reality. I didn’t do it so well in the beginning and looked for others to fix me. I didn’t take responsibility for creating my own oasis. It was too much just trying to get to the doctor’s office for appointments when not being able to drive.

It took a lot of years, but I got reorganized and also gave myself permission to not be perfect. I came to understand that I will be managing my chronic diseases until I pass away. I can still accomplish many things; it is just going to take me longer.

I was living my dream and it turned into a nightmare. Sound familiar? I began a battle of life and death literally and mentally. 

For those reading that are not familiar with my story, I have been battling chronic pain since 1997, first with endometriosis -- which resulted in a full hysterectomy and left oophorectomy.

Then in 2002, I developed Reflex Sympathetic Dystrophy (RSD), a progressive neuro-autoimmune condition that affects multiple systems in the body. Then came temporomandibular joint syndrome (TMJ), hypothyroidism, hypoglycemia, arthritis, gastroparesis and ischemia -- not to forget a loss of balance and coordination that seems to lead to falls and bone breaks. Because my immune system is weakened, if anyone around me is sick, I will soon be as well.  

I lost my physical abilities and was bed bound for years. I spent many years using a wheelchair just to get out of bed and leave the house. It took 3 years to get a proper diagnosis and another 4 years to get the proper treatment. I know firsthand how hard it is to continue looking for relief and answers; and then coming up against healthcare professionals who blow you off or do not believe what you are telling them.

I have learned the hard way that the healthcare system is not always what we are led to believe. I think that from childhood, we should be taught prevention, health responsibilities and health rights. With 1 in 3 Americans living with at least one disease that causes chronic pain, these are important life lessons. 

People look up to their doctors and put total faith in them. But it is important to remember that doctors study a particular practice of medicine. Just because they are a neurologist doesn’t mean they can treat diabetic neuropathy, multiple sclerosis, Lyme disease, or RSD. Each doctor gets a small variety of a medical field and finds a specialty that they love and work on with research and education.

Knowing this will help you get better healthcare. Don’t be afraid to ask questions about your doctor’s education and background. What is their specialty?

I know that there are far too many pain patients who experience something similar to my story. Although each of us is unique and living with our own variations of a chronic disease, having a shared knowledge of overcoming the challenges that we face can be helpful and encouraging.

I had to learn the hard way -- and now share my story to give hope and answers to patients, caregivers and healthcare professionals. I hope by speaking out about my journey it prevents it from happening to others. I enjoy hearing other patient’s stories as well, because it helps me see that I am not alone.

I have had many twists and turns through the medical system, and now encourage the importance of  positive thinking, standing up for ourselves, and improving our knowledge even in the worst of times. Let’s get back to dreaming about big, positive and happy lives.

Barby Ingle suffers from Reflex Sympathetic Dystrophy (RSD) and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics.

More information about Barby can be found on her website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Outrage Over DEA’s Kratom Decision

By Pat Anson, Editor

Mitragyna speciose has some fans out there.

Tens of thousands of people who use kratom supplements – made from the leaves of the Mitragyna speciose tree that grows in southeast Asia – are furious over a decision by the U.S. Drug Enforcement Administration to classify two chemicals in kratom as Schedule I controlled substances, right alongside heroin, LSD and marijuana.

The DEA said the move is necessary because the two main active ingredients in kratom -- mitragynine and 7-hydroxymitragynine – are not approved as drugs and pose “an imminent hazard to public safety.” The DEA filed notice in the federal register that it plans to implement the decision at the end of the month and make kratom illegal, despite a growing public outcry.

“People are going to die because of this,” said James, one of dozens of Pain News Network readers who wrote to tell us that kratom supplements relieve their chronic pain, depression and anxiety, and also helps ease withdrawal symptoms from opioid and alcohol dependence.

“An herb that has killed no one is being banned. Many people will turn to more dangerous drugs, and others who are already addicted to opiates will not have the option of using kratom to quit,” James wrote.

“This is ridiculous! Did we learn anything from alcohol prohibition? It gave us illegal moonshine, bath tub gin and other dangerous concoctions that caused blindness and death,” wrote Bob Thompson.

“I know many people who have used and are still using kratom for pain and/or to get themselves off of drugs such as Suboxone and methadone,” said Jennifer. “It’s been a life saver for so many people, helping them have a better quality of life and not be dependent on the highly addictive crap like Oxycontin & hydrocodone. The DEA is such an evil empire.”

KRATOM SUPPLEMENTS

Many readers see a dark conspiracy behind the DEA’s action -- a scheme engineered by the pharmaceutical industry to eliminate a cheap competitor.

“I am pretty sure that the government wants to ban kratom to use it in pharmaceuticals later,” said Marlo.  “They want it for themselves so they can eventually charge large amounts of money (for a) prescription form after the police have ‘cleaned up the streets’ from it.“

“The government is doing everything they can to keep people on pharma drugs and away from natural supplements,” said Rachel. “I am so sick of big pharma, big government, a broken medical system and the loss of personal freedom to choose what is best for oneself.”

“This is unbelievable. Our government is straight up sinister,” wrote Dan. “To take a plant that is so benign, with very limited side effects, that helps people with pain management and that helps others get off of hard drugs, and to make it illegal in the same category as meth and heroin is criminal.”

Whether you buy into the conspiracy theories or not, the fact is thousands of law-abiding citizens who’ve been buying kratom online and in health food stores for years have been shocked into the sudden realization that after September 30 they could be at risk of arrest, fines and imprisonment for violating the Controlled Substance Act. 

In less than a week, over 50,000 people signed a WhiteHouse.gov petition asking the Obama administration to stop the DEA from scheduling kratom as a Schedule I narcotic.

The American Kratom Association has also threatened a lawsuit and is planning a march on the White House on September 13th.

Is the DEA listening?

A post on a DEA Twitter account Friday acknowledged the agency “has heard from 100s of #kratom supporters in the past 2 days about the proposed scheduling action; we thank you for the feedback.”

But the odds of the DEA reversing course appear slim. The agency’s announcement Tuesday in the Federal Register clearly states that a public notice and comment period usually required under Section 553 of the federal Administrative Procedure Act “do not apply to this notice.”

“The (DEA) Administrator finds that there is good cause to forgo the notice and comment requirements of section 553, as any further delays in the process for issuance of temporary scheduling orders would be impracticable and contrary to the public interest in view of the manifest urgency to avoid an imminent hazard to the public safety,” the notice states.

Is there a public safety hazard?

According to the Centers for Disease Control and Prevention, kratom poses an “emerging public health threat,” although the evidence cited by the CDC in a report last month seems almost laughable.  The agency said there was a grand total of 660 calls to U.S. poison control centers about kratom in the last six years. Less than 8 percent of the calls involved a major life threatening condition and only one death was reported – a person who ingested antidepressant and anticonvulsant medications in addition to kratom.

As an article in Forbes points out, those 660 calls to poison control centers pale in comparison to the 6,843 kids who swallowed laundry detergent packets in the first seven months of this year.

But some say the DEA’s action is long overdue.

“This is a necessary and welcome step, but unless it is followed with real enforcement and penalties for those who are selling (kratom) in coffee bars, on the internet, and elsewhere, it will be toothless,” said Dan Frabricant, CEO and Executive Director of the Natural Products Association, an industry trade group.

“Kratom is not an herbal supplement: it is addictive, harmful, and worse, it may be contributing to America’s opiate epidemic. We are eager to work with the authorities and our members to help turn the tide against Kratom and ensure that it is seen as what the DEA says it is, a schedule I illegal narcotic that has no place in health or wellness.”

Can anything stop the DEA?

“We have spoken with many people who have been advised by lawyers that the most effective way to combat this is by having each individual who has a care for this cause to contact your congressman,” the American Kratom Association said in a statement. “Congressional action is needed to show the lies and false science issued about this plant in order to protect big pharmaceutical company. It is important to call in a polite manner and just share your story in a positive way.”

Many Multiple Sclerosis Patients Misdiagnosed

By Pat Anson, Editor

Multiple Sclerosis (MS) is a chronic disease that attacks the body’s central nervous system, causing pain, numbness, difficulty walking, paralysis, loss of vision, and fatigue. Patients diagnosed with MS face enormous physical, emotional and financial challenges coping with a disease that cannot be cured.

Many also discover that they don’t actually have MS.

A new study published in the journal Neurology looks at 110 patients who were incorrectly diagnosed with MS when they actually suffered from more common and treatable conditions such as migraine and fibromyalgia.   

One third of the patients were misdiagnosed for a decade or longer, most took unnecessary and potentially harmful medication to treat a disease they didn't have, and some even participated in clinical trials for experimental MS therapies.

About a third suffered from “unnecessary morbidity” – morbid thoughts of death.

"Misdiagnosis of MS is common; patients may experience common MS symptoms, such as numbness and weakness with a variety of different conditions, many that are more common and less serious than multiple sclerosis," says the study's senior author Brian Weinshenker, MD, a neurologist at Mayo Clinic.

"With the advent of treatments for MS, many physicians feel pushed to reach an early diagnosis, and may be less strict than they should in requiring more specific symptoms or objective neurological findings before making a diagnosis of MS.”

Unlike other chronic illnesses, there is no specific biomarker or blood test for MS. The nerve damage caused by MS is also associated with a wide range of symptoms, many of which are also caused by other conditions such as Lyme disease, lupus, fibromyalgia, and Vitamin B12 deficiency.

Some diagnostic tests for MS, such as magnetic resonance imaging (MRI), can also be misinterpreted.

“Nonspecific MRI abnormalities that can mimic those of MS are very common in healthy individuals, and widespread use of MRI as a diagnostic tool increases the rate of misdiagnosis," said Weinshenker.

The 110 patients included in the study were identified by MS subspecialist neurologists at Mayo Clinic, University of Vermont, Washington University and Oregon Health & Science University.

Twenty two percent of the misdiagnosed patients actually had migraine; 15% had fibromyalgia; 12% had a nonspecific condition flagged by an abnormal MRI; 11% had a conversion or psychogenic disorder; and 6% had neuromyelitis optica spectrum disorder.

"This study suggests significant and long-term unnecessary risks for these patients," said lead author Andrew Solomon, MD, a neurologist at the University of Vermont College of Medicine. "While there may be different reasons for misdiagnoses by subspecialists and nonspecialists, this study suggests that we all make mistakes, and I think we can all do better.”

A previous survey of MS specialists found that more than 95% had seen at least one patient in the past year that was misdiagnosed with MS by another provider.

Some treatments for MS carry serious side effects. One drug, taken by 13 percent of the misdiagnosed patients in the current study, can cause a potentially fatal brain infection. Other patients suffered from the discomfort and inconvenience of daily injections; others experienced side effects from medications or lacked treatment for the conditions they actually had.

There are also enormous financial costs involved. The cost of medications to treat MS in the United States now exceeds $50,000 a year.

"Premature diagnosis of MS should be avoided," says Weinshenker. "When in doubt, physicians often can defer a diagnosis if it is not clear that there is a serious neurological problem or if a patient is stable. Physicians should request a second opinion when they are unsure but concerned that it might be harmful to delay a definitive diagnosis of MS."

Weinshenker and Solomon hope their study will encourage better education of clinicians on the proper use of MS diagnostic criteria and to further studies on how to recognize patients incorrectly diagnosed with MS.

Study Finds Link Between Chronic Pain and Anxiety

By Pat Anson, Editor

A new study helps explain why so many chronic pain patients also suffer from anxiety or depression.

Researchers at the University of Vermont discovered that the body releases the same neurotransmitter in response to stress as it does to chronic neuropathic pain. The findings, published in the journal Biological Psychiatry, could lead to the development of a new and safer class of medication that could treat both pain and anxiety.

In studies on laboratory mice, researchers found that pain signals and the PACAP neurotransmitter (pituitary adenylate cyclase activating polypeptide) share the same pathway to the brain - the spino-parabrachiomygdaloid tract - which travels from the spinal cord to the amygdala, where the brain processes emotional behavior.

"Chronic pain and anxiety-related disorders frequently go hand-in-hand," says senior author Victor May, PhD, a professor of neurological sciences at the University of Vermont. "By targeting this regulator and pathway, we have opportunities to block both chronic pain and anxiety disorders."

May and his colleagues found that anxious behavior and pain hypersensitivity were significantly reduced when a PACAP receptor antagonist -- designed to block the release of the neurotransmitter -- was applied.

"This would be a completely different approach to using benzodiazepine and opioids - it's another tool in the arsenal to battle chronic pain and stress-related behavioral disorders," said May, who found in a previous study that PACAP was highly expressed in women exhibiting symptoms of post-traumatic stress disorder (PTSD).

May’s findings are important because anxiety and stress are currently treated with sedatives, benzodiazepines and other central nervous system (CNS) depressants. When taken with opioid pain medication, the combination of the drugs can lead to extreme sleepiness, respiratory depression, coma and death.

Yesterday, the U.S. Food and Drug Administration ordered new “black box” warning labels be put on all medications that contain opioids, benzodiazepines and CNS depressants, warning patients and physicians about the increased risk.

According to a 2015 study, over a third of the patients prescribed opioids for chronic musculoskeletal pain were given a sedative. And patients with a history of psychiatric and substance abuse disorders were even more likely to be co-prescribed opioids and sedatives.