Anxiety Is a Symptom, Not a Diagnosis

By Dr. David Hanscom, PNN Columnist

Every living creature on this planet survives by avoiding threats and gravitating towards rewards. The driving force is staying alive and survival of the species. This is accomplished by the nervous system taking in data from the environment through each body sensor and analyzing it.

The first step in this process is for your brain to define reality. A cat is a cat because your brain has unscrambled visual signals and determined the nature of the animal. A cat’s meow is analyzed from the auditory receptors. Your nervous system then links the two inputs together to associate the sound as one that emanates from a cat.

The reason why I am presenting the obvious is to make the point that nothing exists without your brain gathering data, unscrambling it and determining what is.

One of the responsibilities of the central nervous system is to maintain the delicate balance of the body’s chemistry. There are numerous chemicals to keep track of. When there is a threat, hormones will be secreted that increase your chances of survival.

Some of the core response hormones are adrenaline, noradrenaline, endorphins, histamines and cortisol. I won’t list the effects of each of these survival hormones, but the net result is an increased capacity to flee from danger.

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All of these allow you to leap into action, but what compels you to do so? It is a feeling of dread that we call anxiety. It is so deep and uncomfortable that you have no choice but to take action.

Anxiety is a symptom, not a diagnosis, disease or disorder. Therefore, it isn’t treatable by addressing it as the problem. Once you understand anxiety is only a warning mechanism, you can address the causes of it.

The Curse of Consciousness 

The universal problem of being human is what I call the “Curse of Consciousness.” Recent neuroscience research has shown that threats in the form of unpleasant thoughts are processed in a similar area of the brain as physical threats and with the same chemical response.  

This curse is that none of us can escape our thoughts, so we are subjected to an endless hormonal assault on our body. This translates into more than 30 physical symptoms and many disease states, including autoimmune disorders and intractable pain. The worst symptom is relentless anxiety.  

In my personal experience and working with thousands of pain patients, it is the mental pain -- manifested by anxiety – that becomes intolerable. Anxiety is the essence of human suffering and physical pain is the final insult.  

Since this unconscious survival mechanism has been estimated to be a million times more powerful than your conscious brain, it isn’t responsive to rational interventions to manage or control it. Without anxiety that is unpleasant enough to compel you take action, you wouldn’t survive. Neither would you survive without the drive to seek physiological rewards. 

Direct Your Own Care

Try to view anxiety as the fuel gauge in your car. It lets you know that you are being threatened. Whether the threat is real or perceived doesn’t matter. But you have to allow yourself to feel it before you can understand and deal with it.  

If anxiety is the measure of your body’s survival hormones, then the only way to decrease it is to lower them. This can be accomplished directly through relaxation techniques or by indirectly lowering the reactivity of your brain to dampen the survival response.  

This is accomplished by stimulating your brain to rewire so the response to a threat results in a lower chemical surge and is of shorter duration. The term for this is “neuroplasticity.” Your brain changes every second with new cells, connections and myelin. 

By not wasting energy trying to treat or solve your anxiety, you now have the energy to pursue a new path with a remarkable surge in energy, life forces and creativity.   

How is this accomplished? Learning tools to calm and rewire your nervous system is the core of the Direct your Own Care (DOC) project. These approaches have been known for centuries, but have been buried under the weight of modern information overload and the rapid pace of life.  

DOC is a four-stage process for you to understand the nature of your pain and relevant issues that allows you to figure out your own version of a solution. The clarity you get will help you connect to your own capacity to heal by developing skills to auto-regulate your body’s chemistry from anxiety to relaxed.  

Success in learning to adjust your body’s chemical makeup is based on awareness and openness to learning so change can occur. It is remarkably simple and consistent. Join me in living your life in a manner that you could not conceive was possible – even better than before you were crushed by pain. 

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Dr. David Hanscom is retired spinal surgeon who has helped hundreds of back pain sufferers by teaching them how to calm their central nervous systems without the use of drugs or surgery.

In his book Back in ControlHanscom shares the latest developments in neuroscience research and his own personal history with pain.

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.

How West Virginia Became the Epicenter of the Opioid Crisis

By Douglas Hughes, Guest Columnist 

Aggressive promotion by the distributors of OxyContin, the best pain medication ever formulated (when properly used), led to excessive prescribing by West Virginia doctors. 

This caused a methamphetamine drug problem in the state to morph into a prescription opioid epidemic, mostly due to unused opioids squirreled away in medicine cabinets.  Adolescents ignored by their guardians had complementary party favors of these excess opioids. This is why so many families were affected. 

After a few years of this, once the addiction problems were exposed, the excess prescribing stopped. Those desiring to misuse OxyContin went to pain clinics and lied to receive more.  Since we don’t have tachometers on our foreheads to gauge real subjective pain, lying to doctors was effective for many to get drugs to abuse.  

Not wanting to assist pain specialists and willing to deny legitimate intractable pain treatment, the West Virginia legislature passed the “Chronic Pain Clinic Licensing Act.”

When implemented on January 1, 2015, the goal to deny licenses to a dozen new and existing pain clinics was achieved. This left only pills being hoarded in medicine cabinets, which were quickly depleted.  

OxyContin distribution was suspended to pharmacies in most of West Virginia in 2015. 

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These two efforts stopped most OxyContin prescribing and decimated legitimate disabled intractable pain sufferers in West Virginia, the state with the highest incidence of industrial and worker compensation injury cases. 

For the sake of argument, let’s estimate pain clinic patients were 50% legitimate pain sufferers and 50% abusers lying in order to get opioids.  Each of those twelve pain clinic closures turned a thousand or more patients onto the streets.  Some wanted to abuse, while others desperately sought to replace critical pain treatment denied to them by state law.  Some turned to street drugs as their answer. 

In 2015, West Virginia police departments reported that pain pills seized from drug arrests fell a remarkable 89 percent. The opioid crisis was shifting rapidly to heroin, as the drug sub-culture always does when a drug source changes. The prescription opioid epidemic in West Virginia essentially ended in 2015.  There was no memo from the CDC.

Those thousands of good and bad patients from pain clinics were both naive to the strength and use of heroin.  Dosing, once regulated by prescription, now was more lethal. Learning how to prepare and inject heroin without becoming infected, overdosing and dying was problematic. There were record overdose deaths in 2015, even though there were fewer pain pills. 

Counterfeit medication and heroin laced with illicit fentanyl appeared and record overdose deaths continued in 2016 and 2017 because there were so many inexperienced street drug users.  

Since 2015, West Virginia has wasted millions of dollars annually chasing imaginary diversion and investigating and prosecuting good physicians. This satisfied everyone except legitimate pain patients, who were left suffering and dying in their beds.  A suicide epidemic ensued.

West Virginia lacks a prevention component to their drug crisis response, which insured the re-occurrence of another epidemic. Apparently, we are satisfied with this catastrophe. May we have another?   

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Douglas Hughes is a disabled coal miner and retired environmental permit writer in West Virginia.

Do you have a story you want to share on PNN? Send it 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.

Lessons from ‘The United States of Opioids’

By Roger Chriss, PNN Columnist

Harry Nelson’s new book “The United States of Opioids: A Prescription for Liberating a Nation in Pain” looks closely and productively at the opioid overdose crisis. It comments on origins and causal factors, and offers pragmatic policy ideas for addressing it. The book is succinct and well-organized, designed for easy reading and reference.

Nelson starts with a dire description of addiction and overdose, calling the U.S. opioid crisis “American healthcare’s self-inflicted wound.” He then gives a brief history of opioids, explaining the three waves of the crisis, culminating in illicit fentanyl and “an increasing crackdown on physician overprescribing.”

Nelson touches on the history and science of opioids, then looks at causes of the crisis. These include not only Purdue Pharma and the Sacklers, but also drug distributors, retailers and health insurers. Institutional and regulatory failures on opioids are not ignored.

“The overarching problem when it comes to physician overprescribing has been insufficient training and education on how to prescribe opioids,” he writes. “The FDA approved these drugs and oversaw the data concerning the risks of their misuse, abuse, addiction, and overdose.”

But Nelson digs deeper, looking at the underlying social and cultural determinants that play into the longer term. He cites a 2018 University of Pittsburgh study that underscores that opioids are part of a broader trend in which abuse of multiple drugs and a rising drug overdose rate “that shows no signs of slowing, with sub-epidemics of different drugs over time.”

Unlike other books, Nelson writes in depth about how to address the crisis: “I believe that our attention should first be focused on a host of intersecting trends that point to suffering in America — parallel crises that include suicidality, anxiety, depression, and pain.”

He explores other options for pain management, from NSAIDs and nerve blocks to non-pharmacological techniques: “It is critical to push insurers and government programs to cover non-opioid treatment, even if it means spending more to achieve this priority.”

Nelson includes a whole chapter on cannabis and other alternative therapies for opioid addiction, in particular kratom and psychedelics. He is optimistic but tentative about cannabis: “Despite the potential to address health issues, consumers need to be cautious about both the claims and contents of cannabis products.”

He also looks at addiction treatment, including AA-type abstinence programs and medication-assisted therapy, and notes that “the biggest challenge in addiction treatment is the complexity of addiction itself.”

Nelson is highly critical of much of the response to the crisis to date: “When I think about the government and health system’s approach for taking on the opioid crisis, the thing that strikes me most is how much it feels tactical rather than strategic.”

Nelson condemns the rampant fraud and patient brokering in the recovery industry. But he also points out that addiction treatment itself needs improvement.

“We will know that addiction treatment has ‘arrived’ in terms of its integration into healthcare when we have relatively uniform professional and program licensure requirements from state to state — something seemingly decades away,” he wrote.

Nelson lists seven general recommendations for the crisis in his OPIOIDS acronym:

  • Outreach for prevention and early intervention

  • Physician improvements

  • Innovation in pain and addiction care

  • Overdose interventions

  • Interdiction off illicit opioids

  • Data analytics to better track the crisis

  • Strengthening access to addiction care

He emphasizes the value of harm reduction, improving social capital, and organizing prevention in schools and the workplace — instead of “stop gap” measures that do little beyond preventing fatal overdoses.

“The key to solving the opioid crisis lies in not being satisfied with tackling the overdose death issue, but in addressing two of the fundamental problems that got us here: the inadequate management of ongoing issues for people living with chronic pain, which overlaps with the second problem of people living with an opioid use disorder (OUD),” he writes.

Finally, Nelson gives a warning: “If we think about the opioid crisis as the ‘canary in the coal mine,’ it’s warning us that we need to address a much bigger, toxic set of problems.”

For all the book offers, it also has problems. Nelson overstates the number of people with opioid use disorder, misrepresents the complex nature of opioid initiation, and misconstrues the varied trajectory of heroin addiction. Most importantly, Nelson gives little attention to rising rates of cocaine and methamphetamine overdose deaths, and ignores that most overdoses involve multiple drugs.

“The United States of Opioids” offers a suite of tools and ideas for moving forward, a refreshing change from the many righteous rants or poignant laments about the crisis.

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Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

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.

Chronic Pain Patients in Alberta Revolt

By Marvin Ross, Guest Columnist

Last week the Chronic Pain Association of Canada issued a press release calling upon the Alberta health minister to investigate the College of Physicians and Surgeons of Alberta (CPSA) for “its unwarranted and secret cautioning and sanctioning” of doctors who prescribe opioid medication.

The press release came after a public meeting of pain patients in Edmonton organized by the group Help Alberta's Pain. Numerous patients showed up to complain about the poor quality of pain care in Alberta.

The meeting was so successful that the organizer, Tracy Fosum, told me that more meetings are being arranged in Edmonton, Calgary, Sherwood Park, Lethbridge and one in Northern Alberta.

An estimated 1.25 million Albertans suffer from chronic pain and 125,000 have long used opiate analgesics in order to function. In March, an Edmonton pain practice shutdown, throwing nearly 1,000 of these patients out of care.  

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“Thousands of Albertans with pain have lost specialist and primary care because the College of Physicians and Surgeons of Alberta has forced doctors to stop prescribing opiates. The province's pain specialists are retiring in large numbers, citing College intimidation,” Barry Ulmer, Executive Director of the Chronic Pain Association of Canada said in a statement.

In response, the CPSA issued a statement from Registrar Dr. Scott McLeod calling such claims “misinformation” and denying there was an exodus of pain physicians from the profession.   

“Many Albertans suffer with severe daily pain and need medical assistance to allow them to live productive lives with their family, friends and in the workplace. We understand the challenges these Albertans face and encourage physicians to work with their patients to find a sustainable solution,” McLeod said. “Responsible prescribing does not include abrupt discontinuation or tapering of opioids or abandoning patients who use opioids.”

McLeod said the CPSA has been successful in reducing overdoses and opioid prescriptions. Accidental overdose deaths in Alberta from prescription opioids have been cut in half, there has been a 20% decline in opioid prescribing since 2016, and 13% fewer patients received an opioid in 2018 compared to 2016.

Patients Denied Treatment

Tracy Fosum recently appeared on the Roy Green syndicated radio show to talk about her personal experiences as a long time chronic pain patient in Alberta. Suffering from what even I recognized as the classic signs of a heart attack, she went to a local Edmonton hospital. Staff were suspicious of Tracy because of her high opioid use and, after a cursory exam, suggested she go home and take some NSAIDs for what they decided were chest muscle spasms.

Later, Tracy went to another hospital emergency room, where she was forced to wait for six hours as, she contends, they mistook her for a drug seeking addict. While trying to convince them to do an EKG, she went into cardiac arrest and collapsed. Fortunately, Tracy survived but ended up with heart damage because she had to wait too long.

Meanwhile, the Ontario College of Physicians and Surgeons is in the process of revising their opioid prescribing guidelines. A new draft policy states: “Physicians must not taper patients inappropriately or arbitrarily. Physicians are reminded that it is not always possible or appropriate to taper below a specific dose, nor is it usually appropriate to suddenly or rapidly taper prescriptions.”

The proposed guideline also states that “arbitrarily refusing to prescribe these drugs in all cases and without consideration for the circumstances of the patient may lead to inadequate patient care.”

While this is a step in the right direction, the problem is that patients have little recourse other than filing a formal complaint if a doctor provides poor treatment. A formal complaint can take months to years to resolve and ruins a doctor/patient relationship.

I am personally familiar with one case where a chronic pain patient was refused care by a doctor unless she agreed not to take any opioid medication. That doctor was sanctioned for refusing a patient on narcotics and refusing to prescribe narcotics, but the sanction was simply “Don't do that. You cannot refuse.” That patient now has no doctor because no one will take her on.

The Colleges can revise their rules and recommendations all they want, but they also need to ensure that doctors adhere to them.

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Marvin Ross is a medical writer and publisher in Dundas, Ontario. He is a regular contributor to the Huffington Post.

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.

What ‘Rocketman’ Tells Us About Pain and Addiction

By Lynn Webster, MD, PNN Columnist

“Rocketman” is a new biopic about the legendary singer Elton John. The emotionally-driven musical fantasy takes some liberties with certain details of John's life, but it illuminates an essential truth: childhood trauma can lead to pain, addiction and other severe health problems.

The movie is generating some Oscar buzz, but it offers more to viewers who want to see how painful childhood experiences can adversely affect people when they become adults.

The film begins with the flamboyantly wealthy and gifted Elton John strutting down a hallway -- in full costume complete with a colorful headpiece from a recent stage show -- to his first Alcoholics Anonymous meeting.

He becomes the center of attention at the AA meeting when he begins to describe -- through flashbacks told, in part, through song and dance -- his childhood, which was devoid of love and acceptance.

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Elton John is a musical prodigy, but his talent couldn't save him from the harm caused by a father who rejected him and a mother who didn't protect him. As John told The Guardian, "My dad was strict and remote and had a terrible temper; my mum was argumentative and prone to dark moods. When they were together, all I can remember are icy silences or screaming rows."

As John remembers it, "The rows were usually about me, how I was being brought up."

How Childhood Trauma Affects Health

In her TED Talk, Dr. Nadine Burke Harris describes how childhood trauma can affect health over a lifetime — laying the foundation for seven out of 10 leading causes of death in the United States, including addiction and even suicide.

As Dr. Harris points out, our healthcare system treats childhood trauma as a social or mental health problem rather than as a medical issue. Doctors are trained to refer traumatized children to specialists rather than providing intervention and treatment themselves. But childhood trauma may lead to serious medical problems and can even reduce life expectancy by 20 years, according to a study published in the American Journal of Preventive Medicine.

The CDC’s Adverse Childhood Experiences Study (also known as the ACE Study) defined and examined this problem. The study acknowledged 10 types of childhood trauma, including verbal, physical, and sexual abuse; parental rejection and neglect; mental illness or incarceration of a family member; divorce; and substance dependence.

Of the 17,000 adults who participated in the study, two-thirds had experienced at least one of these childhood traumas. Eighty-seven percent had lived through more than one. The consequences of this can be staggering. People who experienced four childhood traumas were 2.5 times more likely to have pulmonary disease and hepatitis. And they were four times more prone to depression and had 12 times the risk for suicidality.

“Adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today,” says Dr. Robert Block, President of the Academy of Pediatrics.

Trauma Rewires the Brain

Adverse childhood experiences rewire the brain. The heightened response to stress that some children develop can affect the reward center of the brain and the executive functioning of the prefrontal cortex. It can also result in maladaptive behaviors associated with pain and addiction.

About a decade ago, Dr. Norman Doidge provided an understanding of how our brains have the capacity to change in his book, “The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science.”  His highly acclaimed research offers scientific hope that there is treatment for the adverse effects of childhood trauma and chronic pain.

Dr. Doidge describes neuroplasticity as the process through which an injured brain can heal itself. An example of this healing process was reported by National Public Radio's Patti Neighmond. It is called emotional awareness and expression therapy (EAET).

Developed in 2011 by psychologist Mark Lumley and Dr. Howard Schubiner, EAET combines talk therapy with cognitive behavioral therapy to change brains that have been structurally altered by trauma. The NIH’s Pain Management Best Practices Inter-Agency Task Force has recognized EAET as potentially beneficial to some people in chronic pain.

Preventing the Need for Drugs

“Rocketman” reflects more than the consequences of a single individual's traumatic childhood. It illuminates a broader social problem that sows the seeds for substance use disorders in adults. 

The approach we take to solving substance use disorders today is focused on treatment and law enforcement. Neither approach seems to be curbing the problem, which suggests the need for a better strategy. Long-term solutions to substance use disorders must include prevention. This means we need to understand what creates the demand for drugs.

Elton John’s story poignantly illustrates two of the causes of addictive behavior:

  1. Memories of pleasurable experiences are the reason drugs are repeatedly abused

  2. Memories of painful life experiences are commonly the genesis of drug initiation

There is compelling evidence that the trajectory of our mental and physical health begins with how we are treated as children. It may seem Pollyannish to say this, but our first line of defense is to love and accept our children, regardless of their gender identity, abilities or individual traits.

As “Rocketman” testifies, anything else can set children on the path to developing a substance use disorder and, in some cases, chronic pain. 

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Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. Lynn is a former president of the American Academy of Pain Medicine, author of the award-winning book “The Painful Truth” and co-producer of the documentary “It Hurts Until You Die.”

You can find him on Twitter: @LynnRWebsterMD.

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.

Why Do Doctors Keep Pushing Invasive Procedures on Me?

By Mike Emelio, Guest Columnist 

I'm not a cynical person by nature, but I'm seeing a very clear pattern with interventional pain management doctors. Why is it that every doctor I've seen who is certified in interventional pain medicine (at least 8 of them already) demonize opioid medication and insist on pushing their non-FDA approved injections, radiofrequency ablations, pain pumps and spinal cord stimulators? 

This approach is even more absurd when you consider the fact that invasive procedures tend to have low rates of efficacy and are known to create scar tissue and nerve damage, both of which can cause more pain.  

As if this weren't ridiculous enough, in spite of explaining to these doctors how epidural steroid injections not only didn't work for me, but robbed me of my life by tripling my pain and making my condition much worse (see “Disabled by the War on Opioids”), every single one of the doctors I've seen still tries to push more of those injections on me.  

My head spins every time I hear them try to sell me on more injections. Are they deaf, insane, just trying to make their wallets fatter, or all three?

On what planet does it make sense to do more of what made a thing worse

Ever since my life was ruined by those injections 5 years ago, I've been desperately trying to find a doctor who truly cares about my well-being and wants to help me. My search has been fruitless so far.  

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Sadly, it just keeps getting worse. The latest doctor I started seeing keeps pushing a pain pump on me. That is as absurd as it gets. Multiple doctors have told me that the reason those injections made my back pain worse is because they caused adhesive arachnoiditis or nerve damage – both of which can be made worse with invasive procedures.  

Why would any doctor push a pain pump on me? I could understand it for a patient with a history of drug abuse, but that is not the case with me. Not only do I have zero history of drug or alcohol abuse, but I have taken my pain meds responsibly for many years. Why should I submit to being put under anesthesia, cut open and have a device implanted in me, all which can have serious complications, when I can get the same medication in a pill that I took responsibly for many years? 

All of the surgeons say that my best option for improved quality of life is pain medication and staying as active and mobile as possible. Yet every interventional pain management doctor ignores their advice and pushes for injections, spinal cord stimulators or pain pumps. Why would they do that?  

It's simple.  According to my Medicare statements, a doctor makes about $75 per visit to write and maintain prescription medications. But with the injections, it's $1,000 and up!

Many times I've personally seen doctors perform unnecessary tests that pay them a lot of money and only for that reason. This is not just my opinion, as other doctors I've seen have confirmed this. Not all doctors are like this and I wouldn't even venture to say most, but the fact is there are plenty of them out there. 

I'm not saying any of this to bash doctors. I'm sharing this information in hopes that people take the time to get educated, be vigilant and be their own advocate when it comes to their healthcare. Doctors are only human. They're just as susceptible to flaws as anyone else. I can't impress enough on all of you to look out for yourselves and get second, third, fourth and even fifth opinions if needed.

If you think that sounds excessive, just think about what happened to me. They took away what was working for me and used a non-FDA approved procedure on me that wasn't even designed for what they were using it for. The end result was that it crippled me, robbed me of my ability to work, forced me into a life of poverty and disability, and took away my freedom, my dignity and my ability to properly care for myself. 

Simply put... It has devastated my life.

I don't post any this for sympathy. I am only trying to educate and inform people about what can happen if they put too much faith in doctors without doing some research. What happened to me is a prime example of just how essential it is that we patients be as proactive as possible, be our own advocates and protect ourselves. 

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Michael Emelio lives in Florida.

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.

Why Stem Cell Critics Are Wrong

By A. Rahman Ford, PNN Columnist

In a recent and rather lengthy New York Times article entitled “Stem Cell Treatments Flourish With Little Evidence That They Work,” authors Denise Grady and Reed Ableson do their absolute best to convince their readers that stem cell therapy (SCT) is based on strange, magical hocus-pocus, and its practitioners are all mad scientists. 

They portray stem cell clinics as shadowy castle dungeons lit only by the occasional lightning strike, and filled with glass beakers that froth with fluorescent-colored liquids.  The authors even use the phrase “unproven cell cocktails.”  That little piece of anti-SCT propaganda even scares me a little, and I’ve had SCT.

In the article, the authors trot out the same tired, empty and underhanded tropes that all articles of its ilk like to employ:

  • “no clear evidence that these treatments work”

  • “gotten way ahead of the science”

  • “no regulatory oversight”

  • “rogue clinics”

  • “scant data”

  • “not covered by insurance”

  • “high risk”  

  • “lack of solid medical evidence”

  • “snake oil”

A recent New Yorker article isn’t much different.  Both articles do contain some valid points, but those points are obscured by the scare tactics, fear-charged language and cherry-picked patient cases.

These SCT hit pieces appear from time-to-time, but rarely in publications with the broad readership of the New York Times and the New Yorker.  After reading so many of them over the years, I began to wonder – if stem cell clinics are flourishing, then isn’t that a tacit admission that the fear-mongering isn’t working? 

And if the fear-mongering isn’t working, why do they keep publishing these less-than-objective articles?  

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Maybe it’s because they feel like they are part of some consumer protection vanguard to protect Americans from sleazy medical charlatans.  Or maybe it’s because the scare tactics have failed and they have no idea what else to do. 

The fact is, as I wrote in a recent PNN column, the SCT tipping point appears to have been reached. The American public simply isn’t buying what the critics are selling. As many as 1,000 stem cell clinics are now operating in the United States, according to The Washington Post, which predicts the industry is “likely to flourish” despite a judge’s ruling that upheld the FDA’s authority to regulate — and stifle — the industry.    

The Basquiat Effect

But it gets even worse for the anti-SCT purveyors. They may be suffering from what I refer to as the Basquiat Effect.  Jean-Michel Basquiat was a graffiti-inspired painter, sculptor and musician who rose to prominence in the 1980s in New York City. 

Basquiat’s work is laden with social and political commentary, with primordial figures, abstract arrangements and linguistic devices.  One of his more popular motifs was to write words and cross them out. 

Why did he do this?  As quoted from the documentary Jean-Michel Basquiat: Radiant Child, “I cross out words so you will see them more.  The fact that they are obscured makes you want to read them.”

One of Basquiat’s paintings recently sold for $110.5 million.  He was clearly on to something.

Put simply, the Basquiat Effect holds that the more one tries to hide something, the more the people they are trying to hide it from pay attention to it.  This effect becomes even more powerful after the phenomenon that is attempting to be hidden reaches it tipping point. 

Because the American public’s curiosity is already piqued, any mention of the phenomenon, regardless of context, compels the reader to look into it. The principle seems counter intuitive, but SCT critics may have provided a perfect example.  The New York Times and New Yorker articles may actually drive more people toward SCT rather than away. 

One of Basquiat’s trademark graffiti tags was “SAMO,” short for “Same Old.”  It essentially illustrated his disenchantment with the prevailing cultural orthodoxy and his intention to introduce something new, radical and revolutionary as a solution. 

In the same way, SCT is a radical response to the failures of medical orthodoxy. The “SAMO” pills and surgeries that exemplify the “treatment” approach to healthcare have given way to an expanding desire by the American people for procedures that actually “cure” chronic conditions and don’t just mask their symptoms.

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The best approach for the anti-SCT purveyors may be to join a pro-cure movement that is clearly succeeding despite their efforts.  Or, they can continue to publish their criticism.  Either way, stem cell therapy will flourish.

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A. Rahman Ford, PhD, is a lawyer and research professional. He is a graduate of Rutgers University and the Howard University School of Law, where he served as Editor-in-Chief of the Howard Law Journal. He earned his PhD at the University of Pennsylvania.

Rahman lives with chronic inflammation in his digestive tract and is unable to eat solid food. He has received stem cell treatment in China. 

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.

Should Postpartum Pain Control Be a Crap Shoot?

By Lynn Webster, MD, PNN Columnist

Anticipating the birth of my second grandchild should have been a purely joyous time. My daughter was about to become a mother for the second time. The miracle of life would unfold again in our family, as it does for thousands of families, every day, all around the world.

My daughter was scheduled to have a repeat cesarean section (I am sharing this story with her permission). The first operation was uneventful, apart from the fact that it produced my first, adorable grandchild.

However, this time I was concerned that my daughter’s post-op pain might not be adequately treated. Since her first C-section three years ago, the hospital system where she delivers has made a public commitment to reducing the amount of opioids prescribed for acute pain by 40 percent.

I worried that the hospital’s choice to lessen the amount of drugs prescribed, rather than focusing on patients' clinical needs, might mean my daughter's need for pain control would be unmet.

The idea of my daughter enduring inadequately treated pain haunted me, as it would any father, but as a pain specialist, it may have troubled me even more. I have seen the unspeakable suffering that insufficiently managed pain can cause. I also know that inadequately treated acute pain can lead to chronic pain.

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The thought that my daughter might be the victim of the hospital’s well-intended attempt to reduce opioid use was highly unsettling to me, but there was little I could do about it. Doctor or not, I could not be sure that my daughter would receive the individualized treatment she deserved after her surgery.

So, several weeks before her scheduled operation, I advised my daughter to talk to her surgeon. Specifically, I asked her to find out how her post-op pain would be treated.

The irony of the situation was not lost on me. This was the first time in my career as a pain specialist and anesthesiologist that I had to worry a family member might suffer from ineffectually managed post-op pain. It was humbling. I felt as impotent and powerless as any other bystander.

I know the hospital system is addressing the number of people who abuse drugs, and their response may well be appropriate in some cases. But my daughter isn’t contributing to the problem. Why should she have to pay the price for the inappropriate behaviors of others?

Pain control was no longer only a professional concern for me. It was now very personal.

My fear was reinforced by a June 3 The Wall Street Journal article by Sumathi Reddy, “The Push for Fewer Opioids for New Mothers. In it, Reddy describes the national effort to reduce the amount of opioids used postpartum. 

Of course, opioids should not be used if there are safer and more effective alternatives. But some hospitals are taking aggressive steps to eliminate the use of any opioids. As a result, the individual needs of a patient may be lost in an effort to tackle a public health problem.

Something seems out of kilter with that line of thinking. It reminds me of the adage of not seeing the forest for the trees.

The American College of Obstetricians and Gynecologists (ACOG) recently published new guidelines for treating postpartum pain. The guideline does not exclude the use of opioids from post-op pain control. In fact, the recommendation for opioid use seems to be logical and consistent with patient-centered care.

Fortunately, my daughter’s OB is an excellent and caring clinician. Her approach is patient-centered, and she provided my daughter -- cautiously -- with the necessary analgesics to help her manage her recovery. My daughter did not like the way the medication made her feel, but without it she would not have been able to care for her newborn. 

An ACOG recommendation specifically states that postpartum pain management should involve shared decision-making. My daughter needed to understand the risks and benefits of opioids before deciding whether or not to accept them to treat her pain. This approach worked for her. The mother of my new, healthy, precious grandchild deserved no less.

All mothers across the world deserve the same level of care. I fear, in some cases, they may not be as lucky as my daughter. They may not receive the care they need, and the joy of giving birth may be superseded by the agony of unmanaged acute pain.

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Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. Lynn is a former president of the American Academy of Pain Medicine, author of the award-winning book “The Painful Truth” and co-producer of the documentary “It Hurts Until You Die.” He lives in Salt Lake City with his wife and now two granddaughters.

You can find him on Twitter: @LynnRWebsterMD.

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.

16 Key Findings about Arachnoiditis

By Forest Tennant, MD, PNN Columnist

We initiated the “Arachnoiditis Research Project” about 6 months ago. Our first goal was to pull together what we have learned to this point. While we continue to gather new information, this short report is an interim attempt to get our findings into the patient and practitioner communities.  

This report is not intended to be a formal protocol or guideline, but a way to pass on what we have found and determined during the course of our learnings.  Please keep in mind that research is neither static nor absolute.  In the future, newer findings will likely both clarify and expand upon our initial findings as presented in this report.    

Frankly, the response to the Arachnoiditis Research Project has been overwhelming. Each day we receive inquiries from patients and practitioners. Patients want help. Practitioners want to know what to do.

We have now reviewed over 300 MRI’s of Adhesive Arachnoiditis (AA) cases. We have received inquiries from 5 continents and over 17 countries. One thing is clear. The need to research and identify treatment for AA is here.  

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The goal of our research is to bring AA treatment to every community worldwide. How? By developing both diagnostic and treatment protocols that can be implemented by any medical practitioner in every community. Here is what we have learned so far:

16 Findings about Adhesive Arachnoiditis  

  1. Treatment efficacy is best achieved by the simultaneous administration of a three component medication program to suppress neuroinflammation, promote neuro-regeneration (nerve regrowth), and provide pain control to function. Medication for these three categories can be competently prescribed by any primary medical practitioner.  

  2. The most common cause of lumbar sacral AA is no longer dural puncture or trauma but intervertebral disc deterioration and spinal stenosis, which has forced cauda equina nerve roots to rub together causing friction, inflammation and adhesion formation.  

  3. Although there is no single symptom that uniquely identifies AA, there are a few symptoms that the majority of AA patients will usually have.  A simple 7-question screening questionnaire has been developed to help in identifying potential AA. If a patient answers “yes” to at least four of the seven questions in the test, they should immediately be evaluated by a physician to confirm the diagnosis.  

  4. A contrast MRI or high-resolution TESLA-3 or higher MRI can be used to visualize the cauda equina nerve roots and show abnormal swelling, displacement, clumping, and adhesions between clumps and the arachnoid layer of the spinal canal covering.  A greater number and larger size of clumps is generally associated with the most severe pain and neurologic impairments.  

  5. Some MRI’s are inconclusive or equivocal even though typical symptoms may be present.  In these cases, therapeutic trials of anti-neuroinflammatory drugs and pain control are warranted.  

  6. Spinal fluid flow impairment is common in AA patients and appears to be a cause of headache, blurred vision, nausea, and dizziness.  Obstruction or back-up of fluid can often be seen on an MRI.   

  7. Spinal fluid “seepage” throughout the damaged arachnoid layer and wall of the lumbar sacral spine covering is common and can be a cause of pain, tissue destruction and severe contraction that causes restriction of extension of arms and legs.  A physical sign of chronic seepage is indentation of tissues around the lumbar spine.  

  8. Pain due to AA appears to be a combination of two types: inflammatory and neuropathic (nerve damage).  It may also be centralized with what is called “descending” pain.  Proper pain control may require medicinal agents for all types.  

  9. There is currently no reliable laboratory test for the presence of active neuroinflammation, although certain markers (by-products of inflammation) such as C-Reactive Protein and myeloperoxidase may sometimes show in the blood.  Neuroinflammation may go into remission, but it may also act silently to cause progressive nerve root destruction.  

  10. Basic science and animal studies show the neuro-steroids (hormones made inside the spinal cord) have the basic functions of neuroinflammation suppression and neuro-regeneration stimulation.  Our observations clearly indicate that the patients who have improved the most have taken one or more of the hormones reported to reduce neuroinflammation and promote and support neuro-regeneration.  

  11. Patients who have had AA for longer than 5 years must rely on aggressive pain control to function and achieve recovery.  After a long period of untreated neuroinflammation, scarring of nerve roots is too severe for much regeneration to occur.  

  12. The drugs and hormones required for suppression of neuroinflammation and promotion of neuro-regeneration do not need to be taken daily to be effective and prevent side effects.  Medical practitioners have a choice of agents, and they can be competently prescribed by primary care practitioners.  We have found that three times a week dosing is usually quite sufficient.

  13. Persons who have developed AA without warning, trauma or chronic disc disease have often been found to have a genetic connective tissue disorder of which the most common are Ehlers-Danlos syndromes.  

  14. Cervical neck arachnoiditis is primarily a clinical and presumed diagnosis as there are no nerve roots to clump and observe on MRI.  The key MRI finding is spinal fluid flow obstruction and the major clinical symptom is extreme pain on neck flexing.  

  15. Only ketorolac among the anti-inflammatories, and methylprednisolone among the corticoids are routinely effective in AA.  Other anti-inflammatories and corticoids either do not cross the blood brain barrier or therapeutically attach to glial cell receptors.  

  16. Some seemingly unrelated compounds found to suppress microglial inflammation in animal and invitro studies also appear to have therapeutic benefit as neuroinflammatory suppressors in AA patients.  These include pentoxifylline, acetazolamide, minocycline and metformin.

The Tennant Foundation has also released an enhanced protocol for primary care physicians who treat AA patients. You can find the protocols and research reports on our website.

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Forest Tennant, MD, MPH, DrPH, has retired from clinical practice but continues his groundbreaking research on the treatment of intractable pain and arachnoiditis.

This report is provided as a public service by the Arachnoiditis Research and Education Project of the Tennant Foundation and is republished with permission. Correspondence should be sent to veractinc@msn.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.

Crackdown on Opioids and Benzodiazepines Ignores Their Benefits

By Roger Chriss, PNN Columnist

The overdose crisis is driving a lot of panicky policy to more closely regulate the prescribing of scheduled drugs, from oxycodone and other opioids to clonazepam and other benzodiazepines, which are used to treat anxiety.

A California doctor was recently accused of unprofessional conduct and could lose her license for prescribing “excessive amounts of opioid medications and benzodiazepines.” And a New Jersey doctor faces criminal charges for prescribing the so-called “Holy Trinity” of opioids, benzodiazepines and muscle relaxers.

The crackdown on opioids and benzodiazepines may help reduce overdose fatalities, but it also risks depriving people of beneficial drugs. Research is finding new benefits for familiar drugs that may slow diseases and improve quality of life.

In a recent Phase III clinical trial, a “novel” combination drug was shown to ease Charcot-Marie-Tooth disease. The drug – called PXT3003 -- provided “meaningful improvement” for people with a hereditary neuropathy that results in a progressive loss of sensation and motor function.

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This is a significant advance for people with Charcot-Marie-Tooth disease, which currently has no treatment. The FDA recently gave PXT3003 its “fast track” designation, which speeds the development of drugs for which there is an unmet medical need.

PXT3003 is a combination of three familiar drugs, naltrexone (an opioid receptor blocker), baclofen (a muscle relaxant), and sorbitol (an alcohol sugar). The how and why of this combination of drugs is not well-understood at present. The manufacturer Pharnext says there are “multiple main mechanisms of action” that improve nerve, muscle and immune cells.

In other words, research on existing drugs with known risk profiles has led to a novel treatment. Ordinarily, the use of an opioid and a muscle relaxant is regarded as clinically inadvisable and is actively counseled against in many prescribing guidelines.

Benzodiazepine Research

A similar outcome is occurring with long-term benzodiazepine therapy in congestive heart failure (CHF). An editorial in Psychotherapy and Psychosomatics reported that low-to-moderate doses of benzodiazepines “seem to be helpful in silent myocardial ischemia, angina, essential hypertension, and CHF, especially in patients with comorbid anxiety.”

This builds on research from Taiwan in 2014 showing that anti-anxiety medications are “associated with a decreased risk of cardiac mortality and heart failure hospitalization in patients after a new myocardial infarction.”

Long-term benzodiazepine therapy is already seen as important in the treatment of rapid eye movement sleep behavior disorder, a condition in which causes people to act out vivid and violent dreams, often injuring themselves or bed partners. Low-dose clonazepam therapy for months or even years turns out to be a highly effective treatment.

In the same fashion, benzodiazepines are used to treat stiff-person syndrome, a rare neurological disorder that causes extreme muscle rigidly and spasms that can make walking impossible. According to the National Institutes of Health, therapy to treat stiff-person syndrome includes “anti-anxiety drugs, muscle relaxants, anti-convulsants, and pain relievers.”

‘Political Interference’ in Medicine

But treatments for these disorders and the development of new regimens for other disorders may be impeded under current federal and state laws and guidelines. Recently a coalition of six physician groups called on state legislatures to end their “political interference” in the practice of medicine and the patient-physician relationship.

“The insertion of politics between patients and their physicians undermines the foundation of trust this relationship is built on and inhibits the delivery of safe, timely, and comprehensive care. Outside interference endangers our patients’ health by limiting, and sometimes altogether eliminating, access to medically accurate information and to the full range of health care,” the coaltion warned.

Physicians should never face imprisonment or other penalties for providing necessary care. These laws force physicians to decide between their patients and facing criminal proceedings.
— Coalition of physician groups

“Physicians should never face imprisonment or other penalties for providing necessary care. These laws force physicians to decide between their patients and facing criminal proceedings. Physicians must be able to practice medicine that is informed by their years of medical education, training, experience, and the available evidence, freely and without threat of criminal punishment.”

The statement was released by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, American Osteopathic Association and American Psychiatric Association.

As the past couple of years have shown, prescribing guidelines have a way of leading to blanket prohibitions. And a risk of blanket prohibitions is that we may miss important benefits.

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Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

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.