Pets Help Take Our Minds Off Pain

By Pat Anson, PNN Editor

Pets make good companions, keep their owners physically active and help us enjoy life. But did you know that pets can also help take our minds off pain?

That’s one of the findings from a new National Poll on Healthy Aging conducted by AARP and the University of Michigan Institute for Healthcare Policy. Researchers surveyed over 2,000 American adults aged 50 to 80, who answered a wide range of questions online about the health benefits of pet ownership.

Companionship, social connection and physical activity were positive side effects of pet ownership for many poll respondents.

People said their pets helped them enjoy life (88%), make them feel loved (86%), help reduce stress (79%), keep them physically active (64%) and help them cope with physical and emotional symptoms (60%), including taking their mind off pain (34%).

For those who said their health was fair or poor, pet ownership offers the most benefits. More than 70 percent of those older adults said their pet helps them cope with physical or emotional symptoms, and nearly half (46%) said their pets help distract them from pain.

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"Relationships with pets tend to be less complicated than those with humans, and pets are often a source of great enjoyment," says Mary Janevic, PhD, an assistant research scientist at the U-M School of Public Health. "They also provide older adults with a sense of being needed and loved."

More than half of those who owned pets said they did so specifically to have a companion and nearly two-thirds said having a pet helps connect them to other people.

"We have long known that pets are a common and naturally occurring source of support," says Cathleen Connell, PhD, a professor at the U-M School of Public Health. “Although the benefits of pets are significant, social connections and activities with friends and family are also key to quality of life across the lifespan. Helping older adults find low cost ways to support pet ownership while not sacrificing other important relationships and priorities is an investment in overall mental and physical health."

While pets come with benefits, they can also bring concerns. Nearly one in five older adults (18%) said having a pet puts a strain on their budget. Some owners even put their animals' needs ahead of their own health.

"For people living on a fixed income, expenses related to health care for pets, and especially pets that have chronic health issues, can be a struggle. Older adults can also develop health problems or disabilities that make pet care difficult," said Janevic.

"More activity, through dog walking or other aspects of pet care, is almost always a good thing for older adults. But the risk of falls is real for many, and six percent of those in our poll said they had fallen or injured themselves due to a pet," said poll director Preeti Malani, MD. “At the same time, given the importance of pets to many people, the loss of a pet can deal a very real psychological blow that providers, family and friends should be attuned to."

More than half of older adults (55%) reported having a pet. Among pet owners, the majority (68%) had dogs, 48% had cats, and 16% had a small pet such as a bird, fish, or hamster.

Over half of pet owners (53%) reported that their pets sleep in their bed. Dog lovers are often told that’s a bad idea, but a recent study found an "overwhelmingly positive" response from owners who say they slept better with their dogs.

Study: Alcohol Relieves Fibromyalgia Pain

By Pat Anson, PNN Editor

Another study is adding to a growing body of evidence that alcohol is an effective – yet risky – way to treat chronic pain.

Researchers at the University of Michigan surveyed over 2,500 patients being treated at a university pain clinic about their drinking habits, pain severity and physical function. Participants were also assessed for signs of depression and anxiety. About a third of the patients were diagnosed with fibromyalgia (FM), a poorly understood disorder characterized by widespread body pain, fatigue, insomnia, headaches and mood swings.

Researchers, who recently published their study in the journal Pain Medicine, found that patients who were moderate drinkers had less pain and other symptoms than those who did not drink alcohol.

“Female and male chronic pain patients who drink no more than 7 and 14 alcoholic drinks per week, respectively, reported significantly lower FM symptoms, pain severity, pain-related interference in activities, depression, anxiety and catastrophizing, and higher physical function,” said lead author Ryan Scott, MPH, of UM’s Chronic Pain and Fatigue Research Center.

“These findings suggest that chronic pain patients with a lesser degree of pain centralization may benefit most from low-risk, moderate alcohol consumption.”

According to the Mayo Clinic, moderate alcohol consumption for healthy adults means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.

Of the study participants, over half reported use of opioid medication, which carries serious risks when combined with alcohol. Perhaps for that reason, participants in the UM study drank less alcohol than the general population.

“People with chronic pain may drink less due to the stigma and because they are being told not to drink while on pain medication,” says Scott.

Moderate drinkers with chronic pain were more likely to be white, have an advanced degree and were less likely to use opioids. They reported less pain, lower anxiety and depression, and higher physical function.

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Researchers found that fibromyalgia patients who drank moderately reported decreased pain severity and depression, but alcohol had no effect on how widespread their pain was or other symptoms such as cramps, headache, fatigue, poor sleep and cognitive dysfunction.

Scott believes alcohol may stimulate the production of gamma-aminobutyric acid (GABA), a neurotransmitter in the central nervous system that reduces nerve activity. Alcohol and drugs such as gabapentin (Neurontin) that act on GABA typically have relaxing effects.

“Alcohol increases gamma-aminobutyric acid in the brain, which is why we could be seeing some of the psychiatric effects. Even though alcohol helped some fibromyalgia patients, it didn’t have the same level of effect,” said Scott. “You probably need much more GABA to block pain signals and that may be why we’re not seeing as high an effect in these patients.”

Over a dozen previous studies have also found that alcohol is an effective pain reliever. In a 2017 review published in the Journal of Pain, British researchers found “robust evidence” that alcohol acts as an analgesic.

“It could be a stepping stone to increased quality of life, leading to more social interactions,” says Scott. “Fibromyalgia patients in particular have a lot of psychological trauma, anxiety and catastrophizing, and allowing for the occasional drink might increase social habits and overall health.”

Pain App Lets Patients ‘Paint’ Their Pain

By Pat Anson, PNN Editor

There are dozens of mobile apps that can help chronic pain patients track their symptoms, send reports to doctors, get health tips and even keep tabs on the weather.

GeoPain, a free app recently launched by a University of Michigan startup, takes the technology a step further. Instead of just giving a single number on a pain scale of zero to 10, patients can “paint” their pain on multiple locations on a 3D image of the human body.

The app’s creators say visually mapping the pain gives doctors a better idea of the pain’s location, severity, it’s possible cause and the best way to treat it.

“We can dissect the pain with greater precision, in one patient or several, and across multiple body locations,” says Alexandre DaSilva, co-founder of MoxyTech and director of the Headache & Orofacial Pain Effort Laboratory at the U-M School of Dentistry.

“Whether the patient has a migraine, fibromyalgia or dental pain, we can measure whether a particular medication or clinical procedure is effective for each localized or spread pain condition. Geopain is a GPS for pain health care.”

Patients can also use GeoPain to show their doctors a visual recording of a pain flare long after the flare has ended.

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“What patients are responding to the most is the visual tracking of their pain over time. They have shared some great stories of how they can now cleary show doctors how their pain has changed, which helps give them credibility and speeds up treatment,” Eric Maslowski, MoxyTech’s co-founder and chief technology officer, wrote in an email to PNN.

“Many clinicians like the visual nature of the app and ease of use. What was surprising to us initially was their interest in it for documenting patient visits for insurance and liability.” 

The app was initially created to track pain in patients enrolled in studies on migraine and chronic pain at the University of Michigan. Research showed that GeoPain data directly correlates with opioid activity in the brains of chronic pain patients, suggesting it might be useful in clinical trials to measure the effectiveness of pain medication.

The free app is available at Google Play, Apple’s App Store and at GeoPain.com.

Older Americans Rarely Abuse Opioid Medication

By Pat Anson, Editor

Three out of four older Americans who are prescribed opioid pain medication say they take it less often or in lower amounts than prescribed, according to a new national poll. Only 6 percent said they took opioids more frequently or in higher doses than prescribed.

The online survey of over 2,000 adults between the ages of 50 and 80 was conducted in March by the University of Michigan's Institute for Healthcare Policy and Innovation.  The poll was sponsored by AARP and Michigan Medicine, U-M's academic medical center.

Nearly a third of those surveyed said they received an opioid prescription in the past two years, usually for arthritis, back pain, surgery or injury. About half of those had leftover medication.

While most were cautious about their use of opioids, what they did with the leftover meds was cause for concern. The vast majority (86%) said they kept it in case they had pain again. Only 9% threw their opioids in the trash or flushed it down the toilet, and 13% returned it to an approved location.

"The fact that so many older adults report having leftover opioid pills is a big problem, given the risk of abuse and addiction with these medications," said Alison Bryant, PhD, senior vice president of research for AARP. "Having unused opioids in the house, often stored in unlocked medicine cabinets, is a big risk to other family members as well.”

The researchers suspect that many older adults fear that they will not be able to obtain pain medication when needed because of laws and guidelines that discourage opioid prescribing. Several states now mandate that initial opioid prescriptions for acute pain be limited to a few days’ supply.

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Ironically, while many older Americans may worry about losing access to opioid medication, nearly three out of four (74%) support restrictions on the number of days and pills that can be prescribed. And nearly half would support laws that require leftover medication to be returned.

The poll also found that doctors do not consistently warn patients about the risks associated with opioids. While 90% of those surveyed said their prescribing doctor talked with them about how often to take pain medication, only 60% were warned about side effects and less than half of the doctors cautioned patients about the risks of addiction and overdose or what to do with leftover pills.

A full report on the National Poll on Healthy Aging can be found by clicking here.

Fibromyalgia Linked to Overactive Brain Networks

By Pat Anson, Editor

Many fibromyalgia sufferers have been told that the pain is “all in their head.” New research indicates there may be some truth to that, and that overactive brain networks could play a role in the hypersensitivity of fibromyalgia patients.

Fibromyalgia is a poorly understood disorder characterized by deep tissue pain, fatigue, headaches, mood swings and insomnia. There is no known cause and successful treatments have been elusive.

In a lengthy study published in the journal Scientific Reports, an international team of researchers at the University of Michigan and in South Korea report that patients with fibromyalgia have brain networks primed for rapid responses to minor changes. This abnormal hypersensitivity is known as called explosive synchronization (ES).

"For the first time, this research shows that the hypersensitivity experienced by chronic pain patients may result from hypersensitive brain networks," says co-senior author Richard Harris, PhD, an associate professor of anesthesiology at Michigan Medicine’s Chronic Pain and Fatigue Research Center.

In ES, a small stimulus can lead to a dramatic synchronized reaction throughout the network, as can happen when a power outage triggers a major grid failure or blackout. Until recently, this phenomenon was studied in physics rather than medicine. Researchers say it's a promising avenue to explore in the quest to determine how a person develops fibromyalgia.

"As opposed to the normal process of gradually linking up different centers in the brain after a stimulus, chronic pain patients have conditions that predispose them to linking up in an abrupt, explosive manner," says first author UnCheol Lee, PhD., a physicist and assistant professor of anesthesiology at Michigan Medicine.

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The researchers tested their theory by conducting electroencephalogram (EEG) tests on the brains of 10 female patients with fibromyalgia. Baseline EEG results showed the patients had hypersensitive brain networks, and that there was a strong correlation between the degree of ES conditions and the self-reported intensity of their pain during EEG testing.

Lee's research team and collaborators in South Korea then used computer models of brain activity to compare the stimulus responses of the fibromyalgia patients to those of healthy ones. As expected, the fibromyalgia model was more sensitive to electrical stimulation.

"We again see the chronic pain brain is electrically unstable and sensitive," Harris says.

Harris says this type of modeling could help guide future treatments for fibromyalgia. Since ES can be modeled outside of the brain in computers, researchers can test for influential regions that transform a hypersensitive network into a more stable one. These regions could then be targeted in living humans using noninvasive brain modulation therapies such as transcranial magnetic stimulation, which is currently used to treat fibromyalgia and depression.

“We expect that our study may ultimately suggest new approaches for analgesic treatments. ES provides a theoretical framework and quantitative approach to test interventions that shift a hypersensitive brain network to a more normal brain network,” researchers reported. 

“It may be possible to convert an ES network to a non-ES network just by modulating one or two hub nodes. Indeed, transcranial magnetic stimulation and/or transcranial direct current stimulation may be improved by ‘targeting’ these sensitive hub nodes. The application of deep brain stimulation to critical nodes that could modify ES conditions is another therapeutic possibility that could be explored.”

The research was funded by the Cerephex Corporation, James S. McDonnell Foundation, and the National Institutes of Health

Teen Misuse of Rx Opioids at Historic Lows

By Pat Anson, Editor

Misuse of opioid pain medication by American teenagers is at an historic low, according to a nationwide survey that also found prescription painkillers have become increasingly harder for teens to obtain.

Nearly 44,000 students in 8th, 10th or 12th grade were questioned about their drug use in the University of Michigan’s annual Monitoring the Future (MTF) survey. Overall, the number of teens drinking, smoking and abusing drugs is at the lowest level since the 1990’s, although marijuana use spiked upward in 2017.

While the so-called opioid epidemic continues to make national headlines, misuse of prescription painkillers by teenagers has been steadily falling for over a decade.

The survey found that 4.2% of 12th graders used “narcotics other than heroin” in the past year, down from 9.4% in 2002.

Only 35.8% of high school seniors said the drugs were easily available in the 2017 survey, compared to more than 54 percent in 2010.

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“We’re observing some of the lowest rates of opioid use that we have been monitoring through the survey. So that’s very good news,” said Norah Volkow, MD, director of the National Institute on Drug Abuse. "The decline in both the misuse and perceived availability of opioid medications may reflect recent public health initiatives to discourage opioid misuse to address this crisis."

The misuse of the painkiller Vicodin continues a decade long decline, falling to 2.9% of high school seniors in 2017. That’s down from 10.5% of seniors in 2003. Similar declines were reported in the misuse of OxyContin.

Marijuana use by teenagers rose by 1.3% to 24 percent in 2017, the first significant increase in seven years.

“This increase has been expected by many,” said Richard Miech, lead investigator of the study. “Historically marijuana use has gone up as adolescents see less risk of harm in using it. We’ve found that the risk adolescents see in marijuana use has been steadily going down for years to the point that it is now at the lowest level we’ve seen in four decades.”

For the first time, the survey asked students about vaping.  Nearly 28 percent of high school seniors said they had used a vaping device in 2017. A little over half said the mist they inhaled was "just flavoring," about a third said they inhaled nicotine, and 11% said they vaped marijuana or hash oil.

After years of steady decline, binge drinking appears to have hit bottom. Nearly 17 percent of 12th graders said they had five or more alcoholic drinks in a row sometime in the last two weeks. That’s a lot, but it's down from 31.5% in 1998.

Study Advocates Guidelines for Postoperative Pain

By Pat Anson, Editor

Patients recovering from gallbladder surgery need only about a third of the opioid painkillers that are prescribed to them, according to a small new study that could lay the groundwork for new national guidelines on treating postoperative pain.

Researchers at the University of Michigan looked at prescribing data on 170 people who had their gallbladders surgically removed in a laparoscopic cholecystectomy and found that the average patient received an opioid prescription for 250mg morphine equivalent units. That's about 50 pills.

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But when the researchers interviewed 100 of those patients, the amount of opioid medication they actually took after their surgeries averaged only 30mg, or about 6 pills. The remaining pills were often left sitting in their medicine cabinets for years.

"For a long time, there has been no rhyme or reason to surgical opioid prescribing, compared with all the other efforts that have been made to improve surgical care," says lead author Ryan Howard, MD, a resident in the U-M Department of Surgery who began the study while attending the medical school.

"We've been overprescribing because no one had ever really asked what's the right amount. We knew we could do better."

When U-M surgical leaders heard about the findings, they gave Howard and his colleagues permission to develop a new prescribing guideline that recommended just 15 opioid pills for gallbladder patients.

Five months later, the average prescription for the first 200 patients treated under the guideline dropped by 66 percent -- to 75mg morphine equivalent units. Requests for opioid refills didn't increase, as some had feared, but the percentage of patients getting a prescription for “safer” non-opioid painkillers such as acetaminophen or ibuprofen more than doubled.

Interviews with 86 of the patients who received the smaller prescriptions showed they had the same level of pain control as those treated before -- even though they took fewer opioid painkillers. A new education guide for patients counseled them to take pain medication only as long as they have pain, and to reserve the opioid pills for pain that's not controlled by ibuprofen or acetaminophen.

"Even though the guidelines were a radical departure from their current practice, attending surgeons and residents really embraced them," said U-M researcher Jay Lee, MD. "It was very rewarding to see how effective these guidelines were in reducing excess opioid prescribing."

Researchers estimate that implementing the new guideline has kept more than 13,000 excess opioid pills out of circulation in the year since the rollout began. Their findings were published in JAMA Surgery.

U-M researchers have expanded on their efforts by developing prescribing guidelines for 11 other common surgeries, including hysterectomies and hernia repair. They believe the guidelines could serve “as a template for statewide practice transformation” and could be adopted nationally as well.   

It’s a common misconception that many patients become addicted to opioid medication after surgery. According to a recent national survey, one in ten patients believe they became addicted or dependent on opioids after they started taking them for post-operative pain. But a recent study in Canada found that long term opioid use after surgery is rare, with less than one percent of older adults still taking opioid pain medication a year after major elective surgery.

Another fallacy is that leftover pain medication is often stolen, sold or given away. The DEA says less than one percent of legally prescribed opioids are diverted.

Many patients are dissatisfied with the quality of pain care in hospitals. In a survey of over 1,200 patients by Pain News Network and the International Pain Foundation, 60 percent said their pain was not adequately controlled in a hospital after a surgery or treatment. And over half rated the quality of their hospital pain care as either poor or very poor.

Big Decline in Opioid Use by Marijuana Users

By Pat Anson, Editor

A new study has found that use of opioid pain medication declines dramatically when chronic pain patients use medical marijuana.

The small study by researchers at the University of Michigan involved 185 pain patients at a medical marijuana dispensary in Ann Arbor, who were surveyed in an online questionnaire about their use of marijuana and pain medications.

Nearly two-thirds (64%) reported a reduction in their use of prescription pain medications and almost half (45%) said cannabis improved their quality of life. Patients also had fewer side effects from marijuana than they did from opioids.

"We're in the midst of an opioid epidemic and we need to figure out what to do about it," said lead author Kevin Boehnke, a doctoral student in the School of Public Health's Department of Environmental Health Sciences. "I'm hoping our research continues a conversation of cannabis as a potential alternative for opioids."

Last week the Centers for Disease Control and Prevention issued new guidelines that recommend non-pharmalogical therapy and non-opioid drugs for chronic pain. The guidelines do not endorse medical marijuana as a pain treatment, but they do discourage doctors from testing patients for marijuana and from dropping them from their practices if marijuana is detected.

Currently, 23 states and the District of Columbia have legalized marijuana for medical purposes and four states allow it for recreational use.

The University of Michigan researchers found that patients with less severe chronic pain were more likely to report less use of opioids and a better quality of life.

"We would caution against rushing to change current clinical practice towards cannabis, but note that this study suggests that cannabis is an effective pain medication and agent to prevent opioid overuse," Boehnke said.

Researchers said their findings, published in the Journal of Pain, also suggest that overdose death rates would decline dramatically if marijuana was used more widely for pain relief.

“We are learning that the higher the dose of opioids people are taking, the higher the risk of death from overdose. This magnitude of reduction in our study is significant enough to affect an individual's risk of accidental death from overdose," said senior study author Daniel Clauw, MD, a professor of pain management anesthesiology at the U-M Medical School.

Previous research has found that opioid overdose rates declined by nearly 25 percent in states where medical marijuana was legalized. Another recent study of cannabis use by pain patients in Israel found a 44% reduction in opioid use.

One limitation of the current study is that it was conducted with people at a marijuana dispensary, who are more likely to already be believers in the medical benefits of marijuana.