The Magic Combination for Pain Relief

Barby Ingle, Columnist

There is no cure for most chronic pain disease, but progress is being made in finding the underlying process that causes it. If we can understand that process, then options to cure chronic pain may come about more rapidly.

The earlier we catch and properly treat what is causing the pain, the better the chances for controlling the pain or putting it into remission. If the symptoms progress and are incorrectly treated or not treated at all, then issues become more complex and invasive.

It is important to learn about the types of treatments available to you, either through insurance coverage or cash pay. Treatment options include physical therapy, medication, orthopedic surgery, invasive surgery, non-invasive procedures, naprapathy, stem cell therapy, infusion therapy, and literally hundreds of other options.

Patients should look for ways to control and minimize their pain and discomfort to the greatest extent possible. Coping skills will develop out of necessity. However, sometimes we need to speak to someone outside of our circle for a different view. Psychological counseling may become necessary. It is okay to ask for help when needed.  

Goal creation and treatment plans should also include drug management, family/social adjustment, improvement of the patient's quality of life and psychosocial functioning, and increasing mobilization or range of motion through physical therapy.  

Many chronic pain patients consider these milestones for a successful treatment plan:

• Ability to achieve a full night’s sleep repeatedly
• Ability to perform physical therapy with improved muscle strength
• Decreased need for opioids
• Diminished depression
• Diminished swelling
• Improved thinking
• Increased stamina
• Lowered pain levels

It is important to treat the underlying symptoms, even if it means turning to surgical intervention in some cases. Depending on how well you respond to the various options, a progression of treatments may be used by your providers and yourself as an engaged and empowered patient. Setting goals and a timetable that is reasonable can be done with your providers.  But remember, you as the patient need to play an important and vocal role in creating the plan.

Treating your chronic pain begins with patient awareness. On my good days, I try a few new activities and increase the amount of physical activity, as I am able. By doing this, I have seen an increase in my body functioning, range of motion, muscle strength, improved balance and posture. I’ve also found that if an activity just takes the edge off my pain, it helps restore cognitive and physical function.

When my pain increases, I find myself slouching more. Becoming aware of yourself and your environment increases your chances of successful treatment and a better quality of life. Get involved in movement training. This can include walking for two minutes at a time or, if you’re ambitious, a mile.

Do what you can do at your level. It will be different for all of us. Moving will improve your health, the function of your body, and also helps with constipation and gastrointestinal issues. Movement increases your blood circulation, which helps with atrophy and can decrease hypersensitivity.

When most people think of physical therapy they think of machines, weights and treadmills. However, I’ve learned that there are many types of physical therapies that are more in line with what we can handle. They include biofeedback, hot compresses, elevation, massage, range of motion exercises, and hydrotherapy.

There is some thought that physical therapy is painful and does not help. But if you find the right combination of medication, counseling and physical therapy, you’ll have a better chance for pain relief and staying on track with your treatment plan. Again, it comes back to surrounding yourself with a team of doctors, caretakers, friends and family supporters that have the willingness and education to support you.

The good news is that no matter how long you have had chronic pain, you can be helped in some way -- if you stay active, avoid unnecessary surgical procedures, can change medication when appropriate, and improve your nutrition and posture habits.

There are hundreds of treatments you can use to help lower and control your pain. What the magic combination is will be different for each of us and we must find what works for us individually.

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 at 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.

New CDC Overdose Study Reduces Role of Pain Meds

By Pat Anson, Editor

The Centers for Disease Control and Prevention has quietly released a new report showing that illegal drugs like heroin, cocaine and fentanyl are responsible for more drug overdose deaths in the United States than opioid pain medication.

The report not only underscores the changing nature of the nation’s overdose epidemic, but undermines some of the rationale behind federal efforts to limit the prescribing of pain medication and public statements used to justify them.

In 2010, for example, the study found that oxycodone was the top drug involved in overdose deaths. But by 2014, the painkiller was ranked third, behind heroin and cocaine.

The anti-anxiety drug alprazolam, more widely known by the brand name Xanax, was ranked as the nation’s fourth deadliest drug; while the synthetic opioid fentanyl -- most of it probably illicit -- was ranked fifth and fast gaining ground.

Deaths linked to oxycodone and other prescription pain medications – although still significant, at about 16,000 a year -- remained relatively stable, even as the total number of drug overdoses increased by 23 percent, from 38,329 deaths in 2010 to 47,055 in 2014.

One of the CDC’s stated reasons for releasing its opioid prescribing guidelines earlier this year was that “the death rate associated with opioid pain medication has increased markedly,” a statement that now appears to be factually wrong, in light of the new study.

This online statement in a CDC analysis of overdoses also appears incorrect: "Prescription opioids continue to be involved in more overdose deaths than any other drug."

Both statements came from the CDC's National Center for Injury Prevention and Control. It was a different part of the agency, the CDC’s National Center for Health Statistics that arrived at this new evidence, after collaborating with the FDA in developing an enhanced method to study overdose deaths that allowed them to identify specific drugs.

The old method used by the CDC relies on death certificate codes, known as ICD codes, which can broadly categorize an overdose as “opioid related” without ever determining what the drug was, if it was legal, or even if it was the cause of death.

Using new software, researchers scanned the actual text in hundreds of thousands of death certificates, including notes written by coroners about the cause of death and other significant factors involved in an overdose.

“The literal text analysis method… leverages existing information on the death certificates for statistical monitoring of drug-involved mortality deaths. Assessments conducted during the methods development process demonstrate that these methods have high accuracy in identifying the drugs mentioned and involved in mortality as well as the corresponding deaths,” the researchers said in an analysis of the new method.

2014 OVERDOSE DEATHS BY DRUG

Source: CDC and FDA

The study, which covered overdoses from 2010 to 2014, found that many deaths involved multiple drugs or alcohol. Over three-quarters of the deaths involving oxycodone and hydrocodone, for example, involved other substances. Alcohol was involved in 15 percent of all drug overdoses. 

Anti-anxiety drugs like alprazolam (Xanax) and diazepam (Valium) were also involved in many deaths. Alprazolam was involved in about a quarter of the overdoses involving hydrocodone (26%), oxycodone (23%) and methadone (18%). The FDA recently expanded warning labels on all opioids and benzodiazepines, including alprazolam and diazepam, to discourage doctors from prescribing them together.

“The combinations of drugs in drug overdose deaths are important to consider when interpreting the study findings. Importantly, the most frequently mentioned drugs involved in drug overdose deaths were often mentioned with each other. For example, heroin and cocaine were involved concomitantly in more than 2,000 deaths. Another pair, oxycodone and alprazolam, were involved concomitantly in more than 1,000 deaths,” the report found. 

While the textual analysis of death certificates is an improvement over previous methods, researchers admit it still has flaws. It cannot distinguish between prescription fentanyl and illicit fentanyl; some deaths that refer to morphine may actually involve heroin; and some deaths classified as “unintentional” may have actually been suicides.  

It also cannot distinguish between the recreational use of a medication obtained illicitly and the medical use of a prescription by a legitimate patient.

Many pain sufferers believe they have been unfairly penalized by the CDC’s opioid prescribing guidelines as part of an effort to keep pain medication away from addicts and recreational users. Since the guidelines were released, many physicians have stopped prescribing opioids or sharply reduced the dosage, even if a patient has safely used the medication for years. 

Oddly, the CDC released this new study just a week after releasing its annual report on drug overdose deaths, which used the older, flawed method of analyzing overdoses.  Further adding to the confusion and questionable use of statistics, the White House Office of National Drug Control Policy and the CDC released three different estimates of the number of Americans that died of drug overdoses in 2015 (see “Opioid Overdose Statistics: As Clear as Mud”).  

The Surprise Gift Chronic Pain Gave to Me

By Jean Price, Guest Columnist

When illness or injury causes long term consequences and persistent pain, we often grieve for what we used to be and do before the pain. That's natural, because we've lost that particular "design" of ourselves that we knew and liked, even though we usually took it for granted.

Chronic pain sufferers don’t take anything for granted anymore, not with pain invading and diminishing our functioning, ability to work, care for ourselves, and be an active part of our families and friendships.  We want what we most likely won't have again. 

In life, natural aging is a lot like this too, only there is more time to adjust and it feels more like a natural process, not like something that has been ripped out of our hands.

At first, we spend a lot of time waiting to get well and wanting to be healed. To get better, get back on our feet, and rise above where we are. To be whole again. 

In the past, we usually recovered from ailments and injuries. But not when we cross that bridge into daily and life-limiting pain. In a sense, we aren't really "sick." We've just reached a new normal. There's no cure or any way to change us back.

I remember a long ago evening when my daughter was too slow to get up and help me set the table and get dinner ready. So I told her rather abruptly I didn't feel like doing it and really needed her help. She replied that she had a headache and didn't feel like it either, adding something that stopped me in my tracks.

"Mom, I'm sick tonight and you're not!" she said.

JEAN PRICE

It wasn't until later that night that I realized what she had meant with those few words. I had been to the doctor the day before and had a bruise the size of a dinner plate on my hip from an injection. I was starting into the second year of severe pain after a failed back surgery.  A surgery with devastating complications that resulted in a second surgery two weeks later; ending with multiple doctors’ appointments and a dozen courses of steroid treatments over the next year. It made me even sicker and still unable to lift my leg.

I really felt sick, yet this had gone on so long that my daughter didn’t see me as sick anymore. I was just being me, and my pain and disability was normal. For her, the old mom was already history.  For me, I truly expected that if I just worked harder, found the right doctor, and suffered through the right treatment, I'd get back to my old idea of normal.

And of course I haven't. Instead, I've been through many new normals, all of them feeling like a downward spiral.

Until I found there is actually a big upside to all of this:  I have become a better person.

It's taken a lot of work. Grief is a verb and requires work! And it has taken good support from others and much learning. Yet the current "new me" has some really special attributes.  She is more patient, more compassionate, more at peace with change, more generous to herself and others, has a much stronger and tested faith, and has more joy in the little things of life.

She is less angry, less judgmental, less serious, less hyper-responsible, more loving, less co-dependent, more forgiving, more trusting of herself, more self-affirming, gives better support to others, and basically is way more whole. Less functional, certainly, but more whole.

Odd, but it's true. When our bodies fail us, we can choose to keep growing our minds and spirits, and we can find important things in life that are still easy, even when we can't do much. We find that love and joy come in little, surprising packages just waiting to be seen. And we find that there is more to life than what we do. We aren't human doings, but rather human beings.

Even with pain, we can chose to be kind, loving, at peace, and better than we were. We are not our pain. We are worthy and wonderful creations, and still enhance this world.

Yes, I do miss what I used to be able to do, but I really don't miss the person I was. Not at all! Because I like the person I am now so much better. Probably because I have been tempered by all that I’ve been through, and enriched by all the people and blessings in my life.

Life is full of changes and each change brings loss; even the chosen changes or the more positive changes still have losses. Yet we don't have to lose ourselves in the process of pain.  We can become more and better.

It's a choice. One of the few things we do have control of. How we feel emotionally, how we react, and how we think of ourselves and the world.

Pain doesn't stop us from being ourselves, only we can do that to ourselves. And if we do, then we've really lost, because the special person we each are deserves to be part of this world, and can still contribute and find joy, despite pain.  

I think I'm living, breathing proof of this.  And I'm glad I don't really have the choice of giving up pain or giving up who I have become. Because as odd as it may sound, that would be a really tough choice.  

Jean Price and her family live in North Carolina. Her chronic back pain began with a herniated disk and escalated after major complications from surgery. Jean also suffers from rheumatoid arthritis and osteoarthritis, and is a breast cancer survivor.

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.

Is Fibromyalgia Like a Software Problem?

By Lana Barhum

Earlier this year, the British Pain Society released an interesting study on the development of a new method to help doctors better communicate with fibromyalgia patients about their pain and symptoms. 

That narrative, which takes the unusual approach of comparing fibromyalgia to a software problem in a computer, is geared towards motivating patients to focus on exercise and other lifestyle changes, as opposed to pain medication.

"This study provides evidence that a framework incorporating a computer based analogy provides an acceptable story that helps FM (fibromyalgia) patients understand their illness and motivates them to engage in evidence based lifestyle adaptations that enhance recovery," wrote lead author Michael Hyland, PhD, a professor of Health Psychology at Plymouth University in the UK.

Fibromyalgia is a poorly understood disorder characterized by deep tissue pain, fatigue, depression, mood swings and insomnia. The exact cause of fibromyalgia is unknown.

Because the diagnosis of fibromyalgia is difficult and sometimes controversial, many patients struggle to communicate with doctors about their symptoms, pain and treatment. Studies have shown exercise and psychological intervention can improve fibromyalgia symptoms, but many patients feel their pain is best treated with medication. They are often surprised when their doctors suggest non-medicinal treatment options. 

The fibromyalgia narrative developed at Plymouth University is designed to minimize that misunderstanding and assist in communication between patients and their doctors.  It encourages doctors to present the body as “as ‘a very, very clever computer’ where fibromyalgia is caused by a software rather than a hardware problem.”

If there are issues in the software, the computer (the body) can be reprogrammed to correct them.  Essentially, patients are offered an explanation for why they are ill, why the doctor cannot find anything wrong, and what can be done to intervene. 

The narrative was developed with the help of 15 fibromyalgia patients.  The patients said the initial model created by researchers “worked poorly” and was ambiguous, so the researchers modified the narrative to make it more understandable. 

"Under certain identifiable conditions, the body creates ‘stop signals’ that prevent damage and promote recovery. These stop signals include pain, fatigue, nausea and dizziness. If, for whatever reason, the person is unable to respond to those stop signals – that is, they do not stop what they are doing – then over time the stop signals increase and become fixed, and the body is sensitized to anything that creates a stop signal,” wrote Hyland.  

The narrative also provided a basis for exercise and psychological help as ways to correct the body's software.

A second group of 25 fibromyalgia patients evaluated the new model during a 7 week “body reprogramming intervention,” in which they were taught about relaxation techniques, mood enhancement, exercise, diet and lifestyle changes. Only patients willing not to take medication were included.   

Most patients said the intervention was very useful, calling it believable, informative and hopeful. Many also said they had implemented lifestyle changes once they knew the benefits.

“Very informative and so refreshing to find answers to problems I’ve had for over 14 years and wonderful to be able to self believe ‘It’s not in my head’ as I’ve self-doubted so many times,” wrote one patient.

“This has been a revelation and has given our family ‘hope’ where we thought there was none,” wrote the mother of another patient. “This illness has not only affected my daughter but the whole of our family. We have spent years trying self help, but it felt like we were just stabbing in the dark.”

Hyland says hope is an important facet in finding solutions to chronic pain. 

"When patients have no explanation of their illness, they do not have a conceptual model of how and whether they will ever get better. Thus, providing patients with an illness narrative provides information not only about the route into the illness but also the route out,” he wrote.

Lana Barhum lives and works in northeast Ohio. She is a freelance medical writer, patient advocate, legal assistant and mother. Having lived with rheumatoid arthritis and fibromyalgia since 2008, Lana uses her experiences to share expert advice on living successfully with chronic illness. She has written for several online health communities, including Alliance Health, Upwell, Mango Health, and The Mighty.

To learn more about Lana, visit her website.

Chronic Pain Patient Abandoned by Doctor Dies

By Pat Anson, Editor

This will be the first Christmas that Tammi Hale spends without her husband Doug in over 30 years.

The 53-year old Vermont man, who suffered chronic pain from interstitial cystitis, committed suicide in October after his doctor abruptly cut him off from opioid pain medication.

“His primary care provider kept trying to wean him off his opioid therapy, which worked at higher doses,” says Tammi. “My husband ran out (of medication) early a few times, so the doctor cut him off completely one day. Six weeks later he took his life as no medical establishment would treat his chronic pain.”

We’re telling Doug Hale’s story, as we have those of other pain patients who’ve committed suicide, because their deaths have been ignored or lost in the public debate over the nation’s so-called opioid epidemic.  Patients who were safely taking high doses of opioids for years are suddenly being cutoff or tapered to lower doses. Some are being abandoned by their doctors.

“I believe it will get worse with time. The docs are simply more interested in not risking their licenses than in treating chronic pain,” Tammi wrote to Pain News Network in a series of emails about her husband’s death.

Depression and suicidal thoughts are common for many people living with chronic pain and illness. According to a recent survey of over a thousand pain patients, nearly half have contemplated suicide.

DOUG HALE

But the problem appears to have grown worse as physicians comply with the “voluntary” prescribing guidelines released in March by the Centers for Disease Control and Prevention, which have been adopted as law in several states. Many doctors now fear prosecution and loss of their medical licenses if they overprescribe opioids. Some have chosen not to prescribe them at all.

While federal and state authorities track the number of drug overdose deaths, no one seems to be following the number of patients who are dying by suicide or from cascading medical problems caused by untreated chronic pain. Some in the pain community call this “passive genocide.” Tammi Hale compares it to the Holocaust.

“The Nazis eliminated the sick and the weak first, right? Makes you wonder,” she says. “I realize my comments are harsh, but I believe the public needs to be aware of the dangers any one of us could be facing with this silent epidemic.”  

Doctor Insisted on Weaning

Doug Hale began facing a life with intractable chronic pain in 1999, after a surgery left him with interstitial cystitis, a painful inflammation of the bladder. According to his wife, Doug tried physical therapy, antidepressants, epidurals, nerve blocks, TENS, cognitive behavioral therapy, and several different medications before finally turning to opioids for pain relief. High doses of methadone and oxycodone for breakthrough pain were found to be effective.

But a few years ago, Doug’s primary care provider (PCP) started urging him to wean to a lower dose.

“The PCP insisted on weaning. Although Doug clearly had documented malabsorption issues, the PCP persisted on weaning. The pressure to wean was unbelievable,” says Tammi.

“It came to a head in May of 2016. The PCP gave Doug one month to wean completely from 120mg/day of methadone and 20 mg/day of oxy. We knew this was impossible.”

Tammi says Doug checked himself into a 7 day detox program, where he was weaned to 40 mg of methadone a day. The doctor agreed to prescribe that amount, but it was not enough to relieve Doug’s pain. He started taking extra doses. 

“He ran out a week early in late August. The PCP abandoned Doug, stating ‘I'm not going to risk my license for you. The methadone clinic can deal with you.’” 

But the methadone clinic refused to treat Doug because they saw him as a chronic pain patient, not as an addict. “Had he turned to street drugs they could have treated him, but because he didn't break the rules they couldn't help,” Tammi explained.

Doug tried to detox at home, which Tammi calls a “brutal” experience. On October 10th, after being turned down by other healthcare providers, Doug went to his former doctor one last time to beg for help and was refused. The doctor said again that he didn’t want to risk his license.

“Doug left the office still thrashing in pain and despondent,” Tammi recalls. “The next day, my dear, sweet thoughtful husband of 32 years; a father, son, brother, uncle, and friend, well loved by many, dragged a chair to a remote spot in our back yard. A spot we could not see from the house, the road, or by the neighbors. 

“He shot himself in the head to escape his pain. He made sure we could still live in our home and not be plagued by gruesome memories. I just wish the medical establishment had an ounce of the compassion that he did.” 

“Can’t take the chronic pain anymore. No one except my wife has helped me. The doctors are mostly puppets trying to lower expenses.”

— Doug Hale

“Can’t take the chronic pain anymore. No one except my wife has helped me,” Doug wrote in a suicide note. “The doctors are mostly puppets trying to lower expenses, and (do not accept) any responsibility. Besides people will die and doctors have seen it all. So why help me.”

Tammi says she has been comforted by an outpouring of love and support from her family, friends and community. Doug’s suicide surprised many.

“Doug did make vague references about suicide during the summer due to the desperation and pain. He was just such a tough guy, he survived so much that my reaction, and others after the fact, was no. Not Doug. He's like the bionic man. Too much of a warrior to give up,” said Tammi.

“At his memorial so many people commented on what an inspiration he was to them. To graciously bear the path of pain and his never-give-up attitude made them reevaluate their own daily issues. I guess you could say his legacy was love and to never quit.”

Tammi consulted with a medical malpractice attorney after Doug's death, who told her the chances of winning a lawsuit against the doctor were slim. The cost of legal action would have also been prohibitive, after so many years of dealing with Doug’s medical expenses.

Tammi and Doug may never get their day in court, but she is determined to share his story in the hope that patients, doctors and regulators learn from it.

“My promise to him was to share with others. He was thrown away like a piece of trash, but his life and the life of all humans is precious.  All patients deserve to be treated respectfully,” she wrote. “Hopefully some changes will come in time before the holocaust grows too much larger.”  

How to Ask Your Doctor About Medical Marijuana

By Ellen Lenox Smith, Columnist

If you are considering medical marijuana as an alternative treatment for your chronic pain or other medical issues, you might be uncomfortable about approaching your doctor.

There are so many stories circulating about patients being judged by their doctor or being labeled a “drug seeker” if they ask about marijuana, that many have chosen not to engage in a conversation they really wish to have.  

So, what can you do to make this as comfortable as possible?

First, take the time to understand your state’s medical marijuana law. Over half the states have now legalized medical marijuana, but the rules are different for doctors and patients in each state. Click here to see a summary of medical marijuana laws in all 28 states and Washington DC.

Here in Rhode Island, residents can approach any doctor -- not only in Rhode Island -- but in the adjacent states of Connecticut and Massachusetts. If you have no success with the doctors that treat you, then we have a few locations in Rhode Island that you can turn to. These specialty doctors evaluate your medical issues and can sign you on.  

The one negative for using these facilities is that there is a fee that must be paid upfront and you must return yearly to confirm your continued need for medical marijuana. A regular doctor’s appointment only means a co-pay, depending on your insurance.

Second, you want to approach a doctor you believe might be the most open to considering marijuana. How do you figure that out?

Some states require doctors to take a marijuana course before being allowed to sign for someone. Check and see if your doctor is on that list. If they are not, ask your state health department for a list of qualified doctors you can turn to. You can also ask other patients already in the program what success they had with your doctor or see if they know another doctor in the area who would be better. 

If you think your doctor might be open to this discussion, consider calling their office in advance and sound out where the doctor stands on marijuana before going in. If it sounds hopeless, then turn to a different doctor that treats you.

If your state has set up distribution centers or marijuana dispensaries, they may also be able to guide you to a doctor willing to sign you on, if you have no luck with your own personal doctors.

Third, when you finally approach the doctor, come to the appointment with some knowledge to share. Be ready to educate them. Google your health condition and medical marijuana to see if cannabis has been used to treat it. Feel free to use our website to download articles about the successful use of marijuana with your condition.

Dr. Stephen Corn has a wonderful website for doctors called “The Answer Page” where they can turn to for education on this topic and also submit questions they might have. I would encourage you to share the link with your doctor.

Be sure to share with your doctor what medications you have already tried to help cope with your condition. Explain why they have not worked for you. Remind them that they are not writing a script or prescription for marijuana, but simply confirming you have one of your state’s qualifying conditions for it.

Share with the doctor that you don’t expect them to guide you in how to administer marijuana, and that you will be educated at the dispensary or by a caregiver.

I know it feels intimidating to consider asking your doctor to support you, but if this is a possible solution for your life, take the time to prepare for the meeting and go for it.

There are risks involved with using marijuana without telling your doctor. They could be caught by surprise and discharge you if marijuana unexpectedly shows up in a drug test. That’s happened to some patients, even though the CDC specifically warns that “clinicians should not dismiss patients from care based on a urine drug test result because this could constitute patient abandonment and could have adverse consequences for patient safety.”

I have turned my life around with a simple teaspoon of a marijuana-based oil at night -- and had to be convinced by my own doctor to give it a try! Once I realized what this was doing for my quality of life, I had to share my success with others.  I hope that others may find this natural and safe option to be successful for them too.   

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis. Ellen and her husband Stuart live in Rhode Island. They are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana, visit their 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.

Can Gum Disease Cause Rheumatoid Arthritis?

By Pat Anson, Editor

Scientists have long suspected that pathogens and bacterial infections may play a role in the development of autoimmune diseases such as rheumatoid arthritis (RA). Now there is evidence that a bacterium associated with chronic gum infections may trigger an inflammatory response characteristic of RA, a discovery that could lead to new ways to treat and prevent the disease.

"This research may be the closest we've come to uncovering the root cause of RA," said Maximilian Konig, MD, a former Johns Hopkins University School of Medicine fellow now at Massachusetts General Hospital.

Rheumatoid arthritis is a chronic autoimmune disease in which the body’s own defenses attack joint tissues, causing pain, inflammation and bone erosion. About 1.5 million Americans and one percent of adults worldwide suffer from RA. There is no cure for the disease and treatments only focus on slowing its progression.

In a study of nearly 200 RA patients, Konig and his colleagues found that nearly half had antibodies against Aggregatibacter actinomycetemcomitans in their blood.  

The level of infection with the bacteria was similar in patients with periodontal (gum) disease, but quite different in healthy patients, only 11 percent of whom tested positive for A. actinomycetemcomitans.

An infection with A. actinomycetemcomitans appears to induce the production of citrullinated proteins, which are suspected of activating the immune system and driving the cascade of events leading to RA.

"This is like putting together the last few pieces of a complicated jigsaw puzzle that has been worked on for many years," says Felipe Andrade, MD, a senior study investigator and associate professor of Medicine at the Johns Hopkins University School of Medicine.

Andrade cautions that over half of the study participants with RA had no evidence of an infection with A. actinomycetemcomitans, which may indicate that other bacteria in the gut, lung or elsewhere could be involved. He says more research is needed to determine if there is a cause and effect relationship between bacteria and RA.

"If we know more about the evolution of both combined, perhaps we could prevent rather than just intervene," he said.

The Johns Hopkins study is published in the journal Science Translational Medicine.

Scientists have observed an association between periodontal disease and RA since the early 1900s, and have suspected that both diseases may be triggered by a common factor. In the last decade, studies have focused on a bacterium known as Porphyromonas gingivalis, which is found in patients with gum disease. However, research has so far failed to corroborate such a link.

Researchers in the current study found inflammation in the joints of RA patients that was similar to the inflamed gums of patients with periodontal disease, an inflammatory process known as hyper-citrullination.

Citrullination occurs naturally in everyone as a way to regulate the function of proteins. But in people with RA, the process becomes hyperactive, resulting in the abnormal accumulation of citrullinated proteins. This drives the production of antibodies against proteins that create inflammation and attack a person's own tissues, the hallmark of RA.

Few Differences in Fibromyalgia Between Men & Women

By Lana Barhum

Fibromyalgia is remarkably more common in women than it is in men, but when it comes to feeling its effects, there is little difference between the sexes, according to results of a new study published in the journal Pain Research and Management.

Fibromyalgia is a poorly understood disorder characterized by deep tissue pain, fatigue, depression and insomnia. As many as 90 percent of fibromyalgia cases are diagnosed in women.

The Al-Andalus Project consisted of 405 fibromyalgia patients and 247 non-fibromyalgia participants from southern Spain, the vast majority of them women. A significant limitation of the study is that only 73 men participated.

The researchers followed the groups for two years to see if gender-specific symptoms in the fibromyalgia patients existed. Participants were evaluated in several ways, including pain, lifestyle impact, fatigue, sleep issues, mental and emotional health, and cognitive performance.

In the fibromyalgia group, the men showed better working memory than women, whereas sleep latency (the length of time that it takes to go from full wakefulness to the lightest non-REM sleep state) was lower in the female participants. In the non-fibromyalgia group, the male participants showed higher pain thresholds in some areas, but not in others. 

The researchers found that some symptoms, including pain, in fibromyalgia men were worse than their non-fibromyalgia male peers. They believe the findings show that fibromyalgia might affect men more severely than women in tender point tenderness, mental health, and sleep latency, which contradicts earlier research on gender differences.

“Previous research has shown that fibromyalgia men present more severe limitations in physical functioning, social functioning, and health perception. However, we failed to find these differences between fibromyalgia women and men in the present study. Our results are consistent with other studies finding no gender differences in clinical key features in fibromyalgia," they wrote. 

It does still seem that the worst fibromyalgia symptoms, especially pain, affect females more severely than they do males, but the Al-Andalus researchers do not feel that is unique to fibromyalgia. 

"In the general population, women usually present greater pain sensitivity and lower pain threshold than men, which is in agreement with the results found in the nonfibromyalgia group of the present study," they wrote, noting that there is a difference in the way genders perceive and handle pain.

"It has been speculated that both peripheral and central nervous systems pathways might be involved in pain experiences; however, the mechanism underlying gender differences in pain remains misunderstood."

While the findings of the Al-Andalus Project do not support any significant gender differences in fibromyalgia and only offer some indication that fibromyalgia might affect men more severely with some symptoms, the researchers believe there’s a need to further understand why men and women perceive fibromyalgia pain and symptoms differently.

"Our results, then, suggest that fibromyalgia pain might be aggravated in men and, consequently, there might be gender-specific pain mechanisms in fibromyalgia," they said.

The Al-Andalus researchers believe further studies are needed that look at male and female fibromyalgia patients separately

“Given the low sample size of our sample, our findings should be interpreted as preliminary and future studies with a larger sample size of men might confirm or contrast the cut-off scores suggested in the present study," they wrote.

Lana Barhum lives and works in northeast Ohio. She is a freelance medical writer, patient advocate, legal assistant, and mother. Having lived with rheumatoid arthritis and fibromyalgia since 2008, Lana uses her experiences to share expert advice on living successfully with chronic illness. She has written for several online health communities, including Alliance Health, Upwell, Mango Health, and The Mighty.

 To learn more about Lana, visit her website.

An Open Letter to President-Elect Trump

By Percy Menzies, Guest Columnist

Dear President-Elect Trump,

You will soon have an extraordinary opportunity to save thousands of lives with one stroke of the pen! I am talking about reducing overdose deaths from opioid overdoses. How is this possible?

We have three highly effective medications for the treatment of opioid addiction, but they are grossly under-utilized, largely due to accessibility. Two of the three drugs used to treat opioid use disorder have restrictions that have no place when overdose deaths exceed 30,000 per year. These restrictions made sense at a different time, but these barriers are now inadvertently contributing to overdose deaths.

I am specifically talking about buprenorphine, the most widely used medication in the battle against the opioid epidemic. This medication, better known by its brand name Suboxone, is an opioid with a very safe profile. Its unique pharmacology makes it almost impossible to overdose.

There are barriers to the use of this medication which made sense 14 years ago, when heroin was not a public health issue, but today they are a hindrance to saving lives.

Buprenorphine is the only drug that requires physicians to complete eight hours of training and then apply to the Drug Enforcement Administration to obtain a special exemption to prescribe it. It gets worse. Physicians can only treat 30 patients with this medication in the first year, and then they must obtain permission from the DEA to increase the limit to 100 patients. The physician also has to keep clear records and can expect a visit from a DEA agent to look at the records. 

This is a major deterrent and way too few physicians have bothered to obtain the required exemption. Any physician who has a DEA license can prescribe an FDA-approved controlled substance without restriction, but they have to deal with this barrier to prescribe buprenorphine. 

These restrictions were put in place to prevent buprenorphine from joining the opioid “pill mills” when few anticipated heroin sweeping our cities and towns. At the present time, there is no strategy in place to cut off or curtail the supply of heroin, or heroin that is laced with super potent opioids like fentanyl. Deaths from prescription opioids are declining, while deaths from heroin and fentanyl are climbing. Indeed, prescriptions for opioids drugs have fallen between 12 -25%, but the overdoses deaths have not declined. 

Yes, buprenorphine is being diverted, but most experts believe that is due to the lack of treatment. Patients desperately seeking treatment are purchasing the drug on the streets. Many experts believe that if patients have expanded and easier access to buprenorphine, the diversion will drastically reduce and more patients will be in treatment and get away from heroin.

Several steps have been taken to address this catastrophic problem, but these steps are woefully inadequate. Expansion of the needle-exchange programs and the widespread distribution of the opioid overdose drug naloxone (better known by the brand name Narcan) are welcome and should be expanded, but they are at best palliative in nature. These measures do little to address the underlying addiction.

The federal government is increasing the patient limits for buprenorphine for selected specialists from 100 to 275, and will also allow nurse practitioners and physician assistants to complete the required training and obtain the DEA exemption to prescribe buprenorphine. These are welcome steps, but fall far short of the response required to expand treatment and reduce deaths. 

You got elected on a law-and-order platform and a promise to reduce the flow of heroin coming in from Mexico. Almost 50 years ago, Richard Nixon got elected on a similar platform.  He too faced an unprecedented public health epidemic of heroin addiction – one that is nowhere close to what we are facing today.  

President Nixon is remembered for taking a bold measure, which at that time was controversial. He initiated the opening of methadone clinics, which for the first time provided evidence-based treatment for heroin addicts. This measure reduced overdose deaths, protected society from criminal activity, and allowed these patients to become productive members of society.  For the first time in the dark and checkered history of our nation, addiction was treated as a chronic healthcare issue and not a criminal activity. 

Nixon went a step further to curb the supply of heroin coming into this country. He put political pressure on France to shut down the illegal labs processing Turkish-grown opium into heroin. Turkey also complied with the strong U.S. demand to curb the illegal cultivation of opium. Who can forget The French Connection, the thriller movie about this operation.

Mr. Trump, you have an extraordinary opportunity to lift the present restrictions on buprenorphine through executive order, to lure patients away from heroin and drastically reduce overdose deaths. Your action would provide increased treatment and not just palliative care.

Furthermore, you are in the best position to bring pressure on Mexico to eliminate the opium processing labs and drastically reduce heroin coming into this country.  An epidemic is best treated when effective treatment is combined with eliminating factors contributing to the spread of the epidemic. In this case, it is the supply of heroin.

This one single action will earn you the gratitude of tens of thousands of families terrified at hearing a knock on the door informing them of the death of a loved one. You will also earn the gratitude of millions of patients suffering from chronic pain, who have been needlessly cut off from prescription opioids because of the overreaction of regulators and many physicians.

You will be remembered in history for a bold action that saved a generation from succumbing to a man-made epidemic.

Percy Menzies, M. Pharm, is the president of the Assisted Recovery Centers of America, a treatment center based in St Louis, Missouri.

He can be reached at: percymenzies@arcamidwest.com

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.

Opioid Overdose Statistics: As Clear as Mud

By Pat Anson, Editor

We’ve written before about how confusing and muddied the statistics can be for overdose deaths from opioid pain medication. (see “Lies, Damned Lies, and Overdose Statistics”). Now the White House and the Centers for Disease Control and Prevention are adding to the confusion.

Last week a news release from the White House Office of National Drug Control Policy stated that 17,536 Americans died in 2015 from overdoses involving prescription opioids, a 4% increase from the year before.

This week the CDC reported in its Morbidity and Mortality Weekly Report that the number of overdoses involving painkillers was actually smaller.

“Natural opioids (including morphine and codeine) and semi-synthetic opioids (including commonly prescribed pain medications such as oxycodone and hydrocodone) were involved in more than 12,700 deaths in 2015,” a CDC news release said. The agency said that was a 2.6% increase from the year before.

We asked the CDC to explain the discrepancy and were given a third number

“Given the recent surge in illegally-made fentanyl, the CDC Injury Center is analyzing synthetic opioids (other than methadone) separately from other prescription opioids (natural, semi-synthetic, and methadone). Using this approach, the number of deaths involving prescription opioids was… 15,281 in 2015,” CDC spokesperson Courtney Leland said in an email.

“This number better reflects the deaths associated with prescription opioids given the changing nature of the epidemic and increasing surge of illicit opioids.”

And what about the White House estimate?

“Their analysis of 17,536 deaths in 2015 was calculated by including any death that involved: opium; natural and semi-synthetic opioids; methadone; and unspecified narcotics (opioids). You would need to check with them about their rationale/methodology,” Leland explained.

In other words, the White House Office of National Drug Control Policy knowingly counted a number of overdoses caused by illicit opioids as prescription drug deaths.

All of these numbers may make your eyes glaze over, but they demonstrate an important point about the nation’s so-called opioid epidemic: No one really knows how bad it is.  Which is startling, because it’s an important national issue and Congress just voted to spend another $1 billion to fight it.

They may want to get their numbers straight first.

One thing the White House and the CDC do agree on is that overdoses from illegal opioids such as heroin and fentanyl are soaring, and deaths involving opioid pain medication appear to be leveling off.

The CDC reported many troubling statistics about opioid overdoses, which claimed over 33,000 lives last year:  

• Death rates nationwide from synthetic opioids such as fentanyl increased by over 72%
• Death rates from synthetic opioids more than doubled in New York (136%), Connecticut (126%) and Illinois (120%).
• Heroin death rates nationwide increased by nearly 21%
• Deaths rates from heroin jumped even more in South Carolina (57%), North Carolina (46%), and Tennessee (44%).

Perhaps the only bright spot was that deaths associated with methadone dropped by 9 percent, which the CDC attributed to lower methadone doses and less prescribing.

The agency still believes there is an “ongoing problem with prescription opioids” and that the number of overdoses may be undercounted.  

“Regardless of the analysis strategy used, prescription opioids continue to be involved in more overdose deaths than any other drug, and all the numbers are likely to underestimate the true burden given the large proportion of overdose deaths where the type of drug is not listed on the death certificate,” the CDC explains in a separate report.

Questionable Data

The CDC continues to rely on death certificate codes for much of its data, which many experts find troubling because the codes do not reflect the cause of death --- only the conditions that exist at the time of death.  In other words, somebody could die from lung cancer, but if a doctor used morphine to help ease the dying patient’s cancer pain, a box could be checked on their death certificate indicating opioids were present at the time of death. The CDC would consider that an “opioid involved” death.

Other factors that raise questions about the reliability of the CDC’s data:

• Overdose deaths were based on data from only 28 states “with high quality reporting”
• Wide variability in the expertise and training of local medical examiners and coroners who complete death certificates
• Nearly 1 out of 5 death certificates nationwide do not include any drug data
• Some heroin deaths may have been misclassified as prescription drug deaths
• Some overdose deaths may have been counted twice.

Critics also say there is a disturbing tendency by the CDC to “cherry pick” data to dramatize the harm caused by prescription opioids, without ever discussing their benefits. For example, the agency referred to a recent report from the DEA this way:

“The Drug Enforcement Administration referred to prescription drugs, heroin, and fentanyl as the most significant drug-related threats to the United States. The misuse of prescription opioids is intertwined with that of illicit opioids; data have demonstrated that nonmedical use of prescription opioids is a significant risk factor for heroin use, underscoring the need for continued prevention efforts around prescription opioids.”

The CDC does not mention that the DEA also found that the prescribing and abuse of opioid pain medication is actually in decline, that the number of admissions to treatment centers for painkiller addiction is falling, and that less than 1% of prescription opioids are diverted. Nor does the CDC mention that the DEA found a “massive surge” in the production of counterfeit pain medication made with illicit fentanyl, which is probably killing quite a few patients seeking pain relief.  

The CDC cites its own research to make the claim that it “did not find evidence that efforts to reduce opioid prescribing were leading to heroin overdoses.” But the DEA report said just the opposite: Some prescription opioid users are switching to heroin when they are no longer able to obtain medication:

“Some abusers, when unable to obtain or afford CPDs (controlled prescription drugs), begin using heroin, a cheaper alternative that offers similar physiological effects. With the successful reduction in availability of controlled prescription drugs, more users may shift to abusing heroin.”

This isn’t the first time the CDC has been accused of cherry picking data for public consumption. The same complaint arose when the agency released its opioid prescribing guidelines, many of which relied on “weak” or “very weak” evidence to support the contention that opioids should not be prescribed for chronic pain.

Recent research published in the journal Pain Medicine also took the agency to task for dismissing evidence that opioids could be used safely long term, while making no mention of the significant risks posed by non-opioid pain medication.

“No common nonopioid treatment for chronic pain has been studied in aggregate over longer intervals of active treatment than opioids. To dismiss trials as ‘inadequate’ if their observation period is a year or less is inconsistent with current regulatory standards,” wrote lead author Daniel Carr, MD, President of the American Academy of Pain Medicine and Program Director of Pain, Research, Education & Policy at Tufts University School of Medicine.  

“Basing therapeutic decision-making upon durations of published clinical efficacy or effectiveness trials does not support choosing any drug or nondrug therapy over another. In fact, the opening words of the first recommendation of the CDC… make no mention of the overwhelmingly strong evidence for significant morbidity and mortality risk from the most likely nonopioid alternatives to opioid therapy for chronic pain: NSAIDs, coxibs (cox-2 inhibitors), and acetaminophen.”

Although the CDC guidelines are “voluntary” and only intended for primary care physicians, many patients have reported that their chronic pain is going untreated or under-treated because they are no longer able to obtain opioids or their doses have been drastically lowered by their physicians. Other patients have been abruptly “fired” by doctors who no longer want to treat chronic pain because they fear prosecution for overprescribing opioids. Still other patients are contemplating or have committed suicide.

Where are the statistics about that?

FDA Designates CRPS Drug as ‘Breakthrough Therapy’

By Pat Anson, Editor

The U.S. Food and Drug Administration has designated an experimental drug as a potential breakthrough therapy for Complex Regional Pain Syndrome (CRPS), a chronic and disabling neurological disease for which there is no cure or treatment.

Neridronic acid was discovered by Abiogen Pharma, an Italian drug maker, and is jointly being developed with Grünenthal, a German pharmaceutical company.

The Breakthrough Therapy designation by the FDA came after the companies reported the results of a Phase II clinical trial showing a significant reduction in pain and symptoms of CRPS with neridronic acid treatment. The drug has already received fast track and orphan drug designations from the FDA.

The agency considers a new drug as a breakthrough therapy if it is intended to treat a serious condition and if preliminary clinical evidence demonstrates substantial improvement over current treatments. There are no current FDA approved treatments for CRPS, which is also known as Reflex Sympathetic Dystrophy (RSD).

"It is very encouraging to see that the FDA recognizes the urgent need for new treatments for patients with CRPS and has granted neridronic acid the status of a Breakthrough Therapy. This supports our efforts to develop an efficacious treatment option to these patients,” said Klaus-Dieter Langner, MD, Chief Scientific Officer of Grünenthal. “We are committed to working closely with the FDA to bring neridronic acid to patients with CRPS as fast as possible.”

In the Phase II study, neridronic acid or a placebo was administered intravenously to 464 patients with CRPS type 1, when the disease is in its early stages. The study ended in November.  

A previous study of 82 CRPS patients in Italy found that those who were treated with infusions of neridronic acid experienced significant and persistent reductions in pain.

Neridronic acid is currently being evaluated in a Phase III clinical trial. If successful, the drug could be the first FDA-approved treatment for CRPS, which is characterized by severe, burning pain that usually begins in the arms or legs after an injury or surgery. The pain often spreads throughout the body.

"Grünenthal is highly dedicated to improving the lives of patients with pain as well as rare diseases with limited treatment options. This is an area of high unmet medical need,” Gabriel Baertschi, CEO of the Grünenthal.

The company recently purchased Thar Pharmaceuticals, which is developing an oral form of zoledronic acid for the treatment of CRPS. That drug is also undergoing a Phase III study.

Neridronic acid is an investigational aminobisphosphonate. According to the Reflex Sympathetic Dystrophy Syndrome Association (RSDSA), bisphosphonates have been used for years overseas to treat CRPS.

“We need options and if this can help patients and encourage other medications and treatment options to come onto the market for CRPS’ers, it’s a great thing,” said Barby Ingle, who suffers from CRPS/RSD and is President of the International Pain Foundation.

“We saw with fibromyalgia and Lyrica that once it (fibromyalgia) had a medication designated it gained more awareness and acceptance in society, leading to better access to care. The same could happen with a CRPS designation for a medication, leading to greater treatments and a cure in the future.”

Can You Color Away Pain?

By Pat Anson, Editor

You might call Mary Hayes a pioneer in adult coloring. Millions of people like her have discovered that coloring a complex floral or geometric design is a great stress reliever.

But Hayes also colors to relieve her pain.

“I can't do a lot of activities, so I wanted something to do that would keep my mind active,” says Hayes, who has suffered most of her life from fibromyalgia, migraines, fatigue and other chronic illnesses.

“I played video games and worked puzzles, but I got tired of that.  I realized I was losing part of my physical self when my mind was engaged. So I started coloring.”

Hayes says she got strange looks when she first started asking for adult coloring books in book stores. That was before the “coloring craze” took off – first in Europe and then the United States.

Today, many craft, hobby and book stores keep a wide selection of adult coloring books. One colorist has sold more than 20 million of her books worldwide.

“I think of coloring as my therapy.  I've been able to express the way my pain makes me feel inside in a way that I cannot express in words,” says Hayes. “It not only engages the mind, it engages the body by adding some movement that could be compared to a yoga-like experience.

“When I'm sitting there and coloring, I'm thinking about what colors I want to use and what medium I want to use.  Time moves past so quickly.  I look up at the time and realize I haven't taken a pain pill in hours and that is an amazing feeling.  I think in a way it ties the brain up so tightly, it stops all those pain signals from breaking through.” 

Coloring not only provides pain relief, it’s turned Hayes into artist. Beautiful and complex designs – like the one she colored below – can often take days to complete.

Hayes started connecting with other colorists on Facebook, which is where Jack Plaxe discovered her. Plaxe retired from the world of finance several years ago, formed a company called Color 4 Fun, and started publishing adult coloring books as an avocation.  

“I’m having a good time working with artists around the world creating these books,” Plaxe told PNN. “I don’t have pain, but I color and it’s very, very relaxing. It’s stress relieving.”

Plaxe noticed that many of the colorists he met online suffer from chronic pain, which gave him the idea of publishing his latest book, Color Away the Pain. It features the artistry and personal stories of Hayes and four other colorists who suffer from chronic pain and illness.

“Many of them use coloring as a form of therapy for distraction from their pain. So I’m well aware of the benefit of coloring for people who are pain sufferers,” says Plaxe.

“We color our soul onto those pages.  We can run and be active in colors.  We can express our spirit and self with our personal style.  We are defined by our coloring style and not our disability,” says Hayes. 

“It feels so good to have someone tell someone about my artistry and not my disability.  I can show my work and not have to talk about my latest treatment.  Those things don't disappear, but they are not what defines me anymore.  I found out I have a real talent that I never knew existed.”

To see more of that talent and those of other artists, click here, here or here.

To find the hidden artist in yourself, you can buy a copy of Color Away the Pain from Amazon for $7.95. All royalties from sales of the book will go to the Chronic Pain Research Alliance.

Plaxe also has a Facebook page that offers free advice and instructional videos for beginners.

Color Away the Pain is featured along with several other pain-related books in PNN’s new “Suggested Reading” section.

Pain Relievers Linked to Hearing Loss in Women

By Pat Anson, Editor

Long-term use of acetaminophen and ibuprofen raises the risk of hearing loss in older women, according to a new study published in the American Journal of Epidemiology.

Researchers at Brigham and Women’s Hospital in Boston analyzed data from over 55,000 women between the ages of 48 and 73 enrolled in the Nurses’ Health Study, a long-term study that began in 1976.

They found that about 1 in 6 women who used ibuprofen or acetaminophen for at least six years suffered some degree of hearing loss. No such link was found in the women who used regular doses of aspirin.

“Although the magnitude of higher risk of hearing loss with analgesic use was modest, given how commonly these medications are used, even a small increase in risk could have important health implications,” said senior author Gary Curhan, MD, a physician in the Channing Division of Network Medicine at Brigham and Women’s Hospital.

“Assuming causality, this would mean that approximately 16.2 percent of hearing loss occurring in these women could be due to ibuprofen or acetaminophen use.”

Curhan noted the study was limited to mostly older, white women participating in the Nurses’ Health Study and that further investigation with larger and more diverse populations would be needed to better understand the connection between hearing loss and pain reliever use.

The researchers have previously published findings that indicate high frequency use of non-steroidal anti-inflammatory drugs (NSAIDS) and acetaminophen is associated with hearing loss in men and younger women. High doses of aspirin have also been associated with hearing loss.

The new study did not look at why the medications affect hearing, but previous research suggests the pain relievers affect blood and oxygen flow to sensitive parts of the ear that may compromise hearing.

About two- thirds of women in the U.S. over the age of 60 report some degree of hearing loss.

“Hearing loss is extremely common in the United States and can have a profound impact on quality of life,” said Curhan. “Finding modifiable risk factors could help us identify ways to lower risk before hearing loss begins and slow progression in those with hearing loss.”

Many people wrongly believe that over-the-counter pain relievers are relatively safe because they are available without a prescription. But studies have linked NSAIDs and acetaminophen to cardiovascular disease, hypertension, kidney problems and liver failure.

“I worry that people think NSAIDs and acetaminophen are completely safe, and that they don’t need to think about their potential (side effects),” Curhan told Time.  “But particularly for people who are taking them for chronic pain, I try to encourage them to look at why they are having the pain, not what they can take to try to treat the pain.”

Veterans More Likely to Have Chronic Pain

By Pat Anson, Editor

Nearly one out of ten U.S. military veterans suffers from chronic severe pain, according to an extensive new survey that found the prevalence of pain higher in veterans than nonveterans, particularly in veterans who served during recent armed conflicts.

The survey by the National Institutes of Health provides the first national estimate of severe pain in both veterans and nonveterans.

The prevalence of severe pain – defined as pain that occurs "most days" or "every day" and bothers the individual "a lot" – was 9.1% for veterans and 6.4% for nonveterans.

“Our analysis showed that veterans were about 40 percent more likely to experience severe pain than nonveterans,” said Richard Nahin, PhD, lead author of the analysis.

“Younger veterans were substantially more likely to report suffering from severe pain than nonveterans, even after controlling for underlying demographic characteristics. These findings suggest that more attention should be paid to helping veterans manage the impact of severe pain and related disability on daily activities.”

The study is based on data from a survey of over 67,000 adults (6,647 veterans and 61,049 nonveterans) who responded to questions about the persistence and intensity of their pain. The vast majority of veterans were men (92%), while most of the nonveterans were women (56%). The survey did not identify any specific aspects of military service, including branch of the armed forces, years of service, or whether the veteran served in a combat role.

More veterans (65%) than nonveterans (56%) reported having some type of pain in the previous three months.  They were also more likely to have severe pain from back pain, joint pain, migraine, neck pain, sciatica and jaw pain.

Younger veterans (8%) were substantially more likely to suffer from severe pain than nonveterans (3%) of similar ages.

“These findings show that we still have much more to do to help our veterans who are suffering from pain,” said Josephine Briggs, MD, director of the National Center for Complementary and Integrative Health (NCCIH). “This new knowledge can help inform effective health care strategies for veterans of all ages. More research is needed to generate additional evidence-based options for veterans managing pain.”

Veterans Complain About VA Pain Care

The survey adds to the growing body of evidence that military veterans are more likely to suffer from physical and mental health issues, and that their problems are not being adequately addressed by the Veterans Administration, which provides health services to 6 million veterans and their families. According to a recent VA study, an average of 22 veterans commit suicide each day.

One of them was Peter Kaisen. In August, the 76-year old Navy veteran committed suicide outside a VA Medical Center in Northport, New York.  Kaisen’s widow told Newsday that her husband had chronic back pain, but VA doctors had told him there was nothing more they could do to ease his suffering.

According to a 2014 Inspector General’s study, more than half of the veterans being treated at the VA have chronic pain, as well as other conditions that contribute to it, such as depression and post-traumatic stress disorder.

In recent months, dozens of veterans have complained to Pain News Network that their treatment grew worse after the VA adopted the Centers for Disease Control and Prevention’s opioid prescribing guidelines, which discourage doctors from prescribing opioids for chronic pain.

“I am a Vietnam era veteran who has had testicular cancer, prostate cancer, hip joint cancer, and have been living with an inoperable spinal cord tumor,” wrote Tommy Garrett. “I cannot get the VA to prescribe OxyContin that civilian doctors have had me on for 17 years.”

“I received epidurals for 10 years and also I received pain medication for 6 years. The VA quit giving me epidurals and also took me off Vicodin,” said Mitch Kepner. “(Before) I was active and now I just lay around and do nothing wishing I was dead. I have no life, everything I do is a struggle. I don't want pity. I don't want compassion. I don't want (anything) from anybody. I just want Vicodin back so I can function.”

After several years of taking morphine to relieve pain from chronic arthritis, Vietnam veteran Ron Pence had his dosage cut in half by VA doctors – who want him to take Cymbalta, a non-opioid originally developed to treat anxiety. After reading about Cymbalta's side effects, Pence refused to take it.

“Why start something like that when what I was taking had no side effects for me and was working fine? I am sure the pills they are pushing will end in a lot more deaths and terrible disabilities and suffering,” wrote Pence in a PNN guest column.

“We are in one of the most advanced countries in the world medically, yet the doctors and politicians will not use that knowledge to ease pain and suffering. We have to find a solution.”

Quell Relieves Back Pain Without Medication

By Pat Anson, Editor

Like many people who suffer from chronic back pain, Greg Watson has tried a lot of different treatments, including physical therapy, soft tissue manipulation, chiropractic adjustments, trigger point injections and dry needling.

“I did trigger point injections with really big needles,” says Watson, whose back was broken in four places when his bike was hit by a car in 2011. “A lot of interesting ways of relieving pain by triggering an even bigger pain. Some of those things would work temporarily.”

Watson spent five days in the hospital after the accident, where he was “pumped full of morphine.” When he was finally released and sent home, the 45-year old Watson was determined to avoid taking more pain medication. That meant trying all of those alternative therapies, with little success, and living for years with intermittent pain that sometimes reached a 6 or 7 on the pain scale.

A friend recommended that Watson try Quell, a battery powered medical device worn below the knee that uses electric nerve stimulation to relieve pain throughout the body -- a therapy known as neuromodulation.

“I felt it and noticed something right away,” says Watson. “It feels a little bit like pins and needles, and it kind of comes in little waves or pulses. Very low amounts of electricity coming into you.”

It took a couple of days for Watson to feel some pain relief. The biggest improvement he noticed was that he slept better.  

“I would go home and put it on for a few hours and then be able to get a full night’s sleep without having to wake up with leg discomfort in the middle of the night,” said Watson, a city planner in Boston who is an avid runner and bicyclist.

neurometrix image

On bad pain days, Watson will wear the Quell device while sleeping or at work. But mostly he just wears it for a few hours at a time. Watson has found that he’s often able the get through an entire day without even thinking about his pain. 

“There are some days I get a bigger uptick in the amount of pain that comes from that old injury site. But when that’s the case, I just up-ramp the use of it a little more.”

Quell is made by NeuroMetrix (NASDAQ: NURO), which recently won approval for the device to be sold in the Europe Union.

It’s been available in the U.S. since the summer of 2015 and is FDA approved for the treatment of chronic pain.

Quell can be purchased without a prescription, but is not covered by insurance and costs $249 through the company’s website or on Amazon. 

PNN columnist Jennifer Kain Kilgore says Quell “worked brilliantly” in relieving her chronic neck and back pain.

But readers have had mixed results with the device.

“Very expensive, wasn't covered under my Medicare insurance. I tried it for a couple of weeks and simply didn't receive ANY pain relief for my low back and neck. None. I am very disappointed,” wrote one woman.

“I have been using Quell for a month now. I use it mainly at night for the pain that I experience in my hips and legs that keeps me from sleeping,” wrote Pam. “It actually has helped me to ditch the sleeping pills. It helps me fall asleep. I am elated.”

“I am on day 18 of my Quell device. It has eliminated the pain in my knees. No more Bengay, Australian Dream or Blue Emu Cream needed. The pain in my feet and hips has diminished greatly,” said Beth Flood. “It is not perfect, it is not a complete answer, but for what it does and the relief it has offered, it is well worth buying.”

NeuroMetrix recently announced that it was conducting a small clinical study of Quell in 60 adults with chronic low back pain at the Brigham and Women’s Hospital Pain Management Center. The three month study will compare a group of patients using Quell to patients using their “treatment-as-usual.” Participants in both groups will use a smartphone app developed by the Pain Management Center to help them document and manage their pain.

“This study will analyze the potential for Quell to reduce pain and improve quality of life in people suffering from chronic low back pain. We look forward to learning a great deal from this study,” said Shai Gozani, MD, President and CEO of NeuroMetrix in a news release.

In previous small studies of Quell in patients with arthritis, diabetic neuropathy, sciatica or fibromyalgia, over 80 percent said the device relieved their chronic pain and improved their overall health. The largest measured changes were in pain relief, along with improved sleep, general activity and walking ability.

Over two-thirds of the patients said Quell also reduced the amount of pain medication they were taking. That’s an important consideration for Greg Watson.

“Especially if you’re looking to avoid medication. That’s the absolutely most appealing thing about it to me,” he says.