Yoga Reduces Chronic Pain of Arthritis

By Pat Anson, Editor

A few weeks of yoga can significantly improve the health and mental well-being of people suffering from the two most common forms of arthritis, according to a new study at Johns Hopkins University.

Researchers found that 8 weeks of yoga classes reduced pain and improved the energy, mood and physical activity of patients with rheumatoid arthritis or knee osteoarthritis. The study, published in the Journal of Rheumatology, is believed to be the largest randomized trial to examine the effect of yoga on the physical and psychological health of arthritis sufferers.

"There's a real surge of interest in yoga as a complementary therapy, with 1 in 10 people in the U.S. now practicing yoga to improve their health and fitness," said Susan Bartlett, PhD, an adjunct associate professor of medicine at Johns Hopkins and associate professor at McGill University.

"Yoga may be especially well suited to people with arthritis because it combines physical activity with potent stress management and relaxation techniques, and focuses on respecting limitations that can change from day to day."

Rheumatoid arthritis (RA) 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 1% of adults worldwide suffer from RA.

Knee osteoarthritis (OA) is even more common and affects over 250 million people worldwide. Nearly 40 percent of Americans over the age of 45 have some degree of knee OA, which causes thinning of cartilage and progressive joint damage.

Johns Hopkins researchers recruited 75 sedentary adults with either knee osteoarthritis or RA. Participants were randomly assigned to either a wait list or eight weeks of twice-weekly yoga classes, plus a weekly practice session at home. Their physical and mental well-being were assessed before and after the yoga sessions by researchers who did not know which group the participants had been assigned to.

Those doing yoga reported a 20% improvement in pain, energy levels, mood and physical function, including their ability to complete physical tasks. Walking speed also improved to a lesser extent, though there was little difference between the groups in tests of balance and upper body strength. Improvements in those who completed yoga were still apparent nine months later.

"For people with other conditions, yoga has been shown to improve pain, pain-related disability and mood," said Clifton Bingham III, MD, associate professor of medicine at Johns Hopkins University School of Medicine and director of the Johns Hopkins Arthritis Center.

"But there were no well-controlled trial of yoga that could tell us if it was safe and effective for people with arthritis, and many health professionals have concerns about how yoga might affect vulnerable joints given the emphasis on changing positions and on being flexible. Our first step was to ensure that yoga was reasonable and safe option for people with arthritis.”

Participants were screened by their doctors prior to joining the study, and continued to take their regular arthritis medication. Instructors in the yoga classes also had additional training to modify poses to accommodate people with limited physical ability.

“Find a teacher who asks the right questions about limitations and works closely with you as an individual. Start with gentle yoga classes. Practice acceptance of where you are and what your body can do on any given day," Bingham said.

CDC: Opioids ‘Not Preferred’ Treatment for Chronic Pain

By Pat Anson, Editor

New draft guidelines by the Centers for Disease Control and Prevention (CDC) would – if adopted -- sharply reduce the prescribing of opioids for both chronic and acute pain in the U.S. The proposed guidelines may also trigger a turf battle between the CDC and the Food and Drug Administration over which agency has primary responsibility for the safe prescribing of medication.

In an unusual online “webinar” held by the CDC, the agency today unveiled a dozen draft guidelines for physicians to follow when prescribing opioids. The first recommends “non-pharmacological therapy” as the preferred treatment for chronic non-cancer pain, and states that opioids should only be prescribed if the benefits of reducing pain outweigh the risk of addiction and overdose.

Other guidelines recommend urine drug testing of patients both before and during opioid use, and that smaller doses and quantities be prescribed. Only “three or fewer days” supply of opioids is recommended for most types of acute pain. The guidelines also recommend that benzodiazepines not be prescribed concurrently with opioids.

Pain patients listening to the webinar expressed alarm over some of the recommendations.

“I would caution the CDC that putting these dosage limits in here would cause problems for patients,” said Marjorie. “These recommendations have severe ramifications.”

“I have been on and off opiates for a few years. I do not have cravings for opiates. I am not addicted to opiates. I do think there has been a demonization of opiates among the medical community, as well as the CDC possibly and definitely the DEA,” said Chardonnay. “How do you decide which patients to continue, that really get benefits from this, and how do you decide which patients take them to get high?”

The CDC took comments about the guidelines during the webinar, but refused to answer any questions about them. The agency said it would finalize its guidelines in early November to submit to the Department of Health and Human Services, with the goal of publishing them in January, 2016.

The CDC’s guidelines were not publicly available before the webinar, there was little advance notice about it, and there were numerous technical problems for some people who tried to participate online. There were so many complaints about lack of access to the webinar, the CDC said it would hold a second one tomorrow.

While the CDC recorded the webinar, it is not making it available for people to watch or listen to afterwards. The draft guidelines, outlined below, will also not be available on the CDC’s website.

(Update: PNN has obtained a transcript of the webinar through the Freedom of Information Act. You can see the transcript by clicking here.)

CDC Draft Guidelines for Opioid Prescribing

1. Non-pharmacological therapy and non-opioid pharmacological therapy are preferred for chronic pain. Providers should only consider adding opioid therapy if expected benefits for both pain and function are anticipated to outweigh risks.

2. Before starting long term opioid therapy, providers should establish treatment goals with all patients, including realistic goals for pain and function. Providers should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety.

3. Before starting and periodically during opioid therapy, providers should discuss with patients risks and realistic benefits of opioid therapy and patient and provider responsibilities for managing therapy.

4. When starting opioid therapy, providers should prescribe short-acting opioids instead of extended-release/long acting opioids.

5. When opioids are started, providers should prescribe the lowest possible effective dosage. Providers should implement additional precautions when increasing dosage to 50 or greater milligrams per day in morphine equivalents and should avoid increasing dosages to 90 or greater milligrams per day in morphine equivalents.

6. Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, providers should prescribe the lowest effective dose of short-acting opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three or fewer days will usually be sufficient for non-traumatic pain not related to major surgery.

7. Providers should evaluate patients within 1 to 4 weeks of starting long-term opioid therapy or of dose escalation to assess benefits and harms of continued opioid therapy. Providers should evaluate patients receiving long-term opioid therapy every 3 months or more frequently for benefits and harms of continued opioid therapy. If benefits do not outweigh harms of continued opioid therapy, providers should work with patients to reduce opioid dosage and to discontinue opioids when possible.

8. Before starting and periodically during continuation of opioid therapy, providers should evaluate risk factors for opioid-related harms. Providers should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid-related harms are present.

9. Providers should review the patient’s history of controlled substance prescriptions using state Prescription Drug Monitoring Program data to determine whether the patient is receiving excessive opioid dosages or dangerous combinations that put him/her at high risk for overdose. Providers should review Prescription Monitoring Program data when starting opioid therapy and periodically during long-term opioid therapy (ranging from every prescription to every 3 months).

10. Providers should use urine drug testing before starting opioids for chronic pain and consider urine drug testing at least annually for all patients on long-term opioid therapy to assess for prescribed medications as well as other controlled substances and illicit drugs.

11. Providers should avoid prescribing of opioid pain medication and benzodiazepines concurrently whenever possible.

12. Providers should offer or arrange evidence-based treatment (usually opioid agonist treatment in combination with behavioral therapies) for patients with opioid use disorder.

The CDC said the guidelines were developed after a series of meetings with a “core expert group” and “independent peer reviewers” that the agency did not identify by name.

CDC officials have long been critical of opioid prescribing practices and have repeatedly cited a study that claims over 16,000 Americans are killed annual by overdoses linked to pain medications.

"If the evidence of their guidelines are of the quality of their research on opioid overdoses, then we are in big trouble. They claim they will be using evidenced based material in forming these guidelines, however they have never shown any desire to correctly evaluate evidence for its strength and value,” said Janice Reynolds, a retired nurse and longtime activist in the pain community.

“I am sure their information came from addiction disease doctors who have an arrogance based model of practice and many don’t care about pain management.  Much of their information comes from PROP."

PROP (Physicians for Responsible Opioid Prescribing) is a controversial organization that has lobbied Congress and criticized the FDA for not doing more to limit access to opioids. A link to PROP literature recommending “cautious, evidence-based opioid prescribing” can be found -- unedited -- on the CDC’s website.

“The CDC knows nothing about pain management and possibly less about pharmacology, so why should anyone listen to them?” asked Reynolds. “Their complaints against opioids only increases the misery of people with pain and does little to prevent deaths as most people with an addiction to prescription medications obtain their meds not by legitimate prescriptions.”

According to the National Institutes of Health, only about 5% of patients taking opioids as directed for a year end up with an addiction problem.

The CDC does not normally get involved in setting guidelines for prescription drugs, a responsibility that falls on the FDA – which regulates drugs and determines which ones can be used to treat medical conditions. A spokesman for the FDA who handles opioid issues told Pain New Network he was unaware the CDC was drafting its own opioid guidelines.

How I Finally Took Myself Off Cymbalta

By Crystal Lindell, Columnist

To be fair, the first time I took myself off Cymbalta, it was less of a “took myself off” situation and more of a “I ran out of medication and money, and couldn’t get my refill for a few days so I just thought I’d skip a few doses” situation.

But it turns out that going off that stuff cold turkey is seriously hell. It made me dizzy and nauseous, and basically electrocuted my brain every few minutes with something called “brain zaps.” When I finally realized that all of this was because I didn’t refill my prescription, I went to the pharmacy, got another dose, and about a day later, got my brain back.

Except I didn’t really get my brain back, because Cymbalta essentially turns your brain off.

Being on Cymbalta, which is now available as a generic called duloxetine, made me so tired that 16 hours of sleep felt like I just pulled an all-nighter. It killed my sex drive. It canceled out all my creative thoughts. And it basically made me feel like I was living in a London fog every day. I could sort of see the world, but not really. Also, it made me gain 30 pounds.

So, to sum up, Cymbalta really sucks.

The worst part about this whole thing though isn’t the side effects. It’s that my doctor originally put me on Cymbalta to help with my chronic pain, but it actually did nothing at all to help that.

Although I will admit that it did curb all those suicidal thoughts that I was having because I wasn’t on enough pain medication and I thought I was going to feel like a semi-truck was crushing my ribs all day, every day, for the rest of my life.

But eventually I did get on the right mix of pain meds, and I realized my future wasn’t quite as bleak as I had thought. And so, even after that horrible experience of kind-of, accidentally going off Cymbalta last winter, I decided that I really wanted to go off it completely. And I thought maybe I’d just try the cold turkey thing again.

And before you’re all, “OMG!! You are an idiot!! Why would you ever take yourself off a drug like that cold turkey?” There are three things you should know:

1. I’ve had doctors, including one at the freaking MAYO CLINIC, tell me before to go off all sorts of drugs cold turkey, including sleeping pills, antidepressants, and opioids. So I got the impression that all this business about not going off certain drugs cold turkey is more of a suggestion than a recommendation.

2. My doctor never told me NOT to go off Cymbalta cold turkey. Ever. Not one time. Not even in passing as he shook my hand at the end of the appointment. Not even when I told him I was thinking about going off the drug and he shut me down by saying, “Just stay on it. It’s probably doing more than you think.” I also live in a really small town, with one small pharmacy, and they never gave me any sort of information when I picked up my prescription telling me about the side effects of going off it cold turkey.

3. (And probably most important) The dosing is such that going off Cymbalta cold turkey is kind of your only option. As far as I can tell, the lowest dose is 20 mg and it only comes in capsules, so you can’t just cut them into smaller and smaller pieces until you’ve weaned off it. After you're on the smallest dose, there’s no choice but to go cold turkey.

Also, honestly, I really did think the withdrawal symptoms would subside after maybe a day. I was wrong. After about a week, I couldn’t take it anymore and I went back on Cymbalta.

I really, really wanted off this drug though, so I decided to call Dr. Google. And I found out that some people were just opening the capsules and pouring a little more out each day until they got down to nothing. I decided to do the same thing. And, while it ended up taking me a few months of meticulously opening the capsules and eyeing it every day, I finally got completely off Cymbalta. And I was lucky enough to avoid most of the side effects that I experienced when I went off it cold turkey.

When I confessed all this to my doctor though, I’m pretty sure he A) Totally did not believe me about the brain zaps, and B) Was secretly judging me for my methods — especially since the makers of Cymbalta explicitly say you should not open the capsules.

I've written before about how horrible Cymbalta is though, and how people are actually suing Eli Lilly, the makers of the drug, because they’ve been kind of shady with how they portray the withdrawal symptoms.

“Studies show that between 50% and 78% of Cymbalta users experience antidepressant withdrawal symptoms after discontinuing the drug. Yet the drug label misleadingly states that Cymbalta withdrawal symptoms occur in only 1% to 2% of cases,” claims attorney Steven Gacovino, one of several lawyers suing Eli Lilly on behalf of patients.

That’s a pretty big difference. So maybe my doctor really didn’t know that it could be an issue for me to go off Cymbalta cold turkey and that’s why he never mentioned it. Or maybe he really did think it was helping me more than I realized. I don’t know.

I do know that I’m really glad I got off that drug. I also know that if any other chronic pain patient ever asks me my opinion about Cymbalta, I will definitely advise them against taking it for pain.

I just hope it’s not too late.

Crystal Lindell is a journalist who lives in Illinois. After five years of unexplained rib pain, Crystal was finally diagnosed with hypermobile Ehlers-Danlos syndrome.

New Wearable Devices for Chronic Pain

By Pat Anson, Editor

With opioid pain medications becoming harder to get and many patients looking for safer alternatives with fewer side effects, a growing number of companies are offering wearable “electrotherapy” devices for pain relief.

There’s the Cefaly headband for migraines, ActiPatch for sore muscles, AcuKnee for osteoarthritis, and the Quell nerve stimulator, which is designed to treat a range of chronic pain conditions. All are part of a fast growing $2.8 billion market for wearable medical devices.

“There’s a big problem brewing on the horizon. And that is the pain medications are being removed from the market, slowly but surely,” says Phillip Muccio, President and founder of Axiobionics, which has been making customized electrotherapy devices for 20 years.

“Electrical stimulation has a way of reaching into the body and interacting and coordinating what happens to the body. That’s why it a fascinating area of medicine because not a lot of things will do that, especially non-invasively and non-pharmacologically.”

Most of the new devices use a form of electrical stimulation to block or mask pain signals – a technique developed decades ago known as Transcutaneous Electric Nerve Stimulation (TENS).

Unlike the old TENS units, which are typically used for about 30 minutes, wearable devices are designed to be worn for several hours at a time or even while sleeping.

image courtesy of axiobionics

“TENS is like a short acting opioid. It’s basically only effective when it’s on,” said Shai Gozani, MD, President and CEO of Neurometrix. “If you’re going to deal with chronic pain, you have to have a wearable, chronically usable device, because pain can be two hours a day or it could be 24 hours a day. TENS devices historically haven’t been designed at all for wear-ability or continuous use.”

Neurometrix recently introduced Quell, an electrotherapy device that Gozani compares to a spinal cord stimulator. But instead of being surgically implanted near the spine like a stimulator, Quell is worn externally on the upper calf below the knee.

image courtesy of neurometrix

“We really look at spinal cord stimulation as the model. We’re trying to make that available but in a non-invasive, wearable way -- versus TENS devices which are really intended for local muscle stimulation. We don’t stimulate the muscles, we stimulate the nerve alone,” Gozani told Pain News Network.

“The upper calf has a lot of nerves. It’s comfortable. It’s discrete. So it meets the requirement to have a large segment of nerves to stimulate, but it’s also highly usable from a wear-ability perspective.”

A small study recently conducted by Neurometrix found that over 80% of Quell users had a significant reduction in pain and two-thirds were able to reduce the amount of pain medication they were taking.  Participants in the study had several different types of of chronic pain, including fibromyalgia, sciatica, neuropathy and arthritis.

When it comes to clinical studies, medical device makers have a clear advantage over pharmaceutical companies, which often have to spend years and tens of millions of dollars proving the safety and effectiveness of their drugs before they’re approved by the Food and Drug Administration. Device makers are held to a lower regulatory standard.

“Devices are approved by FDA basically for safety and not necessarily for efficacy. It’s a lot easier to demonstrate that with a device than if you have to demonstrate a new drug. You basically run one study or two and show that nobody got electrocuted by a TENS unit and you’re good to go,” said Bob Twillman, PhD, Executive Director of the American Academy of Pain Management.

Device makers can even get fast track approval from the FDA without any clinical studies -- if they say a new device is substantially equivalent to an older device already on the market.  Quell, for example, was given clearance by the FDA because of its similarity to Sensus, another Neurometrix device that's worn below the knee for pain relief.

A significant disadvantage for device makers is that most are not covered by public or private health insurers – meaning patients have to pay for them out of pocket. Three years ago, Medicare stopped covering TENS for low back pain, saying the technology was “not reasonable and necessary.”

The lack of reimbursement also makes many doctors unwilling to prescribe wearable devices and unfamiliar with the technology behind them, which stifles innovation.  For that reason, Neurometrix took an unconventional path and made Quell available without a prescription – bypassing insurers and doctors so it could market directly to consumers for $249 a unit.

“We thought it was imperative to get it over the counter. We wanted to make sure it was accessible to patients," said Gozani. "Wear-ability changes everything. Wear-ability is the game changer in terms of optimizing pain relief. I think it's huge."

The 7 Psychological Stages of Chronic Pain

By Jennifer Martin, PsyD, Columnist

Have you ever wondered if other people with chronic health conditions feel the same way you do?

Throughout my years with chronic pain and illness, along with the hundreds of patients I have counseled, I have found that, while everyone copes in their own way and experiences their condition uniquely, there are common feelings that most of us share.

When I first began counseling chronic pain patients, I often used Elizabeth Kübler-Ross’s “Five Stages of Grief” to help them understand what they were going through. 

But as time went on, I reflected on what I experienced with my own chronic conditions and also on my patients’. It seemed that these stages, while very helpful, didn’t fully explain the broad range of emotions that people with chronic illness experience. 

After all, Kubler-Ross developed them to explain the responses to grief and loss. Having a chronic illness can be viewed as a type of loss, but they were not developed specifically to explain the emotions of people experiencing chronic conditions.

I used Kübler-Ross’s stages as a model to develop the Seven Psychological Stages of Chronic Pain and Illness: 

1. Denial

In this stage, we are in a state of shock and refusal. We wonder how our life is going to change and how we are going to live with those changes. Denial and shock help us to cope and make survival possible.

This stage can be dangerous for people with chronic pain and illness because if they are in denial about their condition, they may not take the necessary steps to get themselves the treatment they need.

Example: “It’s not a big deal, it will go away” or “The doctor is wrong, I don’t have diabetes.”

2. Pleading, Bargaining & Desperation

This is the stage where we want more than anything for life to be what it once was. We become fixed on anything that could make our illness and pain go away -- or anything that could give us some semblance of the life we once had. 

We may find fault in ourselves and what we think we could have done differently. We may even bargain with the pain or illness because we would do anything not to feel them anymore. Guilt is common when bargaining. 

Example: “Please just don’t let this ruin my life” or “If you make the pain go away, I promise I’ll be a better person.”

3. Anger

After we conclude that our pleading and bargaining is not going to change the diagnosis, anger sets in. 

Anger is a necessary stage of the healing process. Feelings of anger may seem endless, but it is important to feel them. The more you truly feel anger, the more it will begin to subside and the more you will heal.  Your anger has no limits and it may extend to your doctors, family, friends and loved ones.

Anger is often felt later on when the illness and pain progresses, or holds us back from doing the things we would like. 

Example: “This isn’t fair! I didn’t do anything to deserve this!” or “Just give me something that will make me feel better!”

4. Anxiety and Depression

Feelings of emptiness and grief appear at a very deep level.  This depressive stage feels as though it will last forever.  It is important to understand that this depression is not a sign of mental illness.  It is the appropriate response to a loss or a life-altering situation. 

We may withdraw from life and wonder if there is any point in going on.  Depression after a loss is too often seen as unnatural or something that needs to be snapped out of.  Being diagnosed with a chronic illness or experiencing chronic pain is a loss – a loss of the life you once had.

Having a chronic pain or illness may also bring up feelings of anxiety; anxiety about what the future holds, anxiety about not being able to live up to expectations, anxiety about social situations, anxiety about medical bills, etc.

Example: “I’m going to be in pain forever so why even bother?” or “I’m going to be in debt forever.  How am I ever going to pay off these medical bills?”

5. Loss of Self and Confusion

Having chronic pain or illness may mean giving up some key aspect of what made us who we were.  It may mean an inability to be physically active like we once were.  It may mean not being able to be as sociable as we would like or it may even mean giving up a career. 

You may wake up one day and not recognize the person you are now.  You may question what your purpose in life is now.  This stage may occur at the same time as anxiety and depression, or it may be separate.

Example: “I don’t even recognize myself anymore.” or “My career was my identity.  Who am I without that?”

6. Re-evaluation of Life, Roles and Goals

Having a chronic condition often means giving up a lot.  We are forced to re-evaluate our goals and futures.  We are forced to re-evaluate who we are as a husband, wife, mother, father, sibling or friend.  While we once had a successful career that gave us purpose, we may find ourselves beginning to question what we can do for work in the future and how we can contribute to our families. 

While we were once able to do it all, we are now re-evaluating what absolutely has to get done during our days and how we can accomplish these goals while still remaining in a positive mood.  Re-evaluating your life, roles and goals is a crucial first step in accepting your condition.

Example: “I may not be able to be a nurse anymore but maybe I could teach classes a couple times per week.” or “I can’t be as physically active with my husband anymore so what else can I do to show him I love him?

7. Acceptance

Acceptance is often confused with the idea of being “OK” with what has happened. This is not true.  Many people don’t ever feel OK about having to live with pain or an illness for the rest of their lives.

This stage is about accepting the reality of your situation and recognizing that this new reality is permanent. We will never like this reality and it may never be OK, but eventually we accept it and learn to live life with it. It is the new norm with which we must learn to live.

We must make adaptations and alterations to our lives. We must find new things that bring us joy.

Example: “I’m not going to let this define me. I will learn to deal with this the best I can.”

It's important to remember that these stages are not linear.  While some people begin in the denial stage, move through each stage and end with acceptance, many people jump back and forth throughout the stages.  I hope that these stages give some comfort to those who are experiencing chronic conditions.

Jennifer Martin, PsyD, is a licensed psychologist in Newport Beach, California who suffers from rheumatoid arthritis and ulcerative colitis. In her blog “Your Color Looks Good” Jennifer writes about the psychological aspects of dealing with chronic pain and illness. 

Jennifer is a professional member of the Crohn’s and Colitis Foundation of America and has a Facebook page dedicated to providing support and information to people with Crohn’s, Colitis and Digestive Diseases, as well as other types of chronic pain.

Zohydro 'Not a Public Health Risk'

By Pat Anson, Editor

Eighteen months after the introduction of Zohydro, there is little evidence the controversial painkiller is being abused or diverted, according to a new report from a nationwide drug monitoring program.

"Zohydro is not a public health risk and has shown little tendency to increase over the time it has been available," stated the report by the Researched Abuse, Diversion and Addiction-Related Surveillance System (RADARS). "The drug is either not desirable or unavailable for abuse."

The report covered the first quarter of 2015. RADARS monitors hundreds of hospitals, poison control centers and addiction treatment clinics in the U.S. to track the abuse, misuse and diversion of prescription drugs.

"Everyone thought this was going to be some horrible, horrible thing. And it didn't materialize that way," said Errol Gould, PhD, Director of Medical Affairs for Pernix Therapeutics, which bought the rights to Zohydro from Zogenix Inc. earlier this year.

"There have been very few reports of people checking into treatment centers and reporting Zohydro ER as the drug they were abusing. In the past 18 months I can tell you there have been less than 40."

There was a storm of controversy surrounding Zohydro when it was introduced in March 2014. The first single ingredient  hydrocodone painkiller sold in the U.S. was approved by the Food and Drug Administration over the objections of its staff and an advisory committee -- which warned there was a potential for Zohydro to be abused even more than other hydrocodone products.

Addiction treatment experts also predicted Zohydro would fuel a new wave of painkiller addiction and overdoses. The Governor of Massachusetts even declared a state of emergency and tried unsuccessfully to ban Zohydro sales in his state.

"All the media attention sort of scared people, so there weren't a lot of prescriptions written in the beginning," said Gould. "But now over time the prescription rate has picked up. But we're still not seeing diversion. The abusers already know what hydrocodone is like and they're not going out and looking for Zohydro when they can get other things that are more readily available to them."

Only about 1,600 prescriptions are being written for Zohydro each week, a tiny fraction of the 130 million hydrocodone prescriptions that are filled each year in the U.S. Prescribing of Zohydro is also closely monitored to keep it away from pain patients who might misuse or abuse it.

"I think the growth has been slow. Most of that has been because of the prior perceptions. We fully expect that to change over time. It just takes time to change people's views and minds. We've had a bit of an uphill battle," said Doug Drysdale, President and CEO of Pernix. "The good news here from RADARS is that the product is not being abused. And I think that's very encouraging."

The biggest problem faced by Pernix going forward may not be the hysteria over Zohydro's introduction -- but competition from rival drug makers.

Purdue Pharma has introduced its own "pure" hydrocodone product -- sold under the brand name Hysingla ER. Hysingla is designed to be taken once a day, while Zohydro is meant to be taken twice daily for chronic pain. Both products are sold in abuse deterrent formulas that make them harder for drug abusers to snort or inject.

Until the introduction of Zohydro, most hydrocodone products on the market were combined with acetaminophen, which at high doses can cause liver damage. Hydrocodone combination drugs such as Vicodin, Lortab and Lorcet are the most commonly prescribed and abused painkillers in the U.S. In 2014 hydrocodone was reclassified by the Drug Enforcement Administration as a Schedule II medication to make it harder to obtain.

Montana Clinic to Reopen Without Doctor

By Pat Anson, Editor

A Montana health clinic that closed its doors last week will reopen on Monday, but without its owner -- who says he will not write opioid prescriptions for chronic pain patients because he is "paralyzed with fear" of being arrested.

"I don't think it's safe for me to continue seeing these patients until I get some reassurance that I can do it. I'm risking my well being by going in there.," said Mark Ibsen, MD, owner of the Urgent Care Plus clinic in Helena.

Ibsen says he left behind "tapering" prescriptions for opioids at lower doses to help wean patients off the drugs and prevent them from going into withdrawal.

"I have a couple who are upset and feel abandoned. And I have a lot of them who are upset and understanding," he said. "They've seen what I am going through. They've been watching me kind of deteriorate emotionally over the last few months. And I tell my patients I can't continue to do this, you've got to find someone else. This is dangerous for me."

image courtesy of mark ibsen

Ibsen fears being arrested like Dr. Chris Christensen, another Montana doctor who was recently charged with 400 felonies, including two counts of negligent homicide, in connection with the overprescribing of opioids. Ibsen himself was the target of a lengthy investigation by the Montana Board of Medical Examiners after he started treating some of Dr. Christensen’s former pain patients.

If he keeps writing prescriptions for opioids, Ibsen worries he'll be next.

"The DEA agents that met with me five different times will not meet with me again unless my lawyer is present. My only inference from that is that they have an open investigation. I haven't been able to confirm that , but you don't know that until they walk through the door and cuff you.  I have no idea, so I am paralyzed with fear," he said.

dr. mark ibsen

Pain News Network caught up with Ibsen in Las Vegas, where he is attending PAINWeek, the nation's largest conference for frontline practitioners in pain management. Ibsen hoped going to the conference would re-energize him, but found that many of the lectures focused on opioid abuse and diversion.--. the very subjects he's grown weary of.

"All I've seen is more evidence of hysteria," he said. "Prescription drug overdose is number 22 on the list of causes of death in America. And this so-called epidemic, I mean calling it an epidemic is insane."

Like Ibsen, other doctors around the country have also stopped writing prescriptions for opioids.

"Many of them with much less provocation than he's had," said Bob Twillman, PhD, Executive Director of the American Academy of Pain Management. "You worry you're going to lose your practice and lose your livelihood by doing something you don't intend to do. And the easiest way to do that is don't go there, don't prescribe."

Ibsen says he was prescribing opioids to about200 patients when he stopped. Some have gone to hospital emergency rooms seeking more medication, while others are in search of new doctors in a state where very few are willing to prescribe to new patients.

"My patients are now being shunned by other doctors and judged by the fact that they've seen me," Ibsen said. 

Pfizer Loses Lyrica Patent Case

By Pat Anson, Editor

A British judge has strongly rebuked Pfizer for making "groundless threats" against doctors and pharmacies in the UK to prevent them from prescribing or selling cheaper generic versions of  Lyrica for pain relief.

Judge Richard Arnold ruled against Pfizer in a patent protection case, saying emails and letters the U.S. drug maker sent to British healthcare providers were “calculated to have a chilling effect on the willingness of pharmacies to stock and dispense generic pregabalin.”

Pregabalin is the generic version of Lyrica, a blockbuster drug that generates over $5 billion in sales annually for Pfizer.

The company's patent on Lyrica for the treatment of epilepsy and anxiety expired last year, but a secondary patent for pain is good until 2017.  However, that didn't stop British doctors from prescribing pregabalin "off-label" for pain. According to Pharmalot, about 80% of UK patients on pregabalin are using it to treat pain -- amounting to about $386 million in lost Lyrica sales for Pfizer.

Arnold's ruling that doctors and pharmacists were not infringing on the patent does not impact Pfizer's patent rights outside of the UK. The company said it would appeal the decision.

“Our intention was only ever to communicate the existence and importance of our second medical use patent for the use of Lyrica in pain," Pfizer said in a statement. “With the benefit of hindsight and having navigated particularly challenging and complex legal issues, we wish we had been able to explain this better and sooner."

Ironically, Pfizer paid $2.3 billion dollars in 2009 to settle criminal and civil charges in the U.S. for the off-label marketing of Lyrica and other medications – the very sort of off-label use it was trying to stop in the U.K.

Lyrica is one of only three drugs approved by the U.S. Food and Drug Administration to treat fibromylagia. Although it is the most widely prescribed medication for fibromyalgia, many patients have written to Pain News Network warning about its side effects.

"I have memory loss and bad vision from Lyrica. Some of my memory will never be restored," said Dana.

"Lyrica made me fat, extremely fat, I was depressed on this drug too. No thanks," said Freda.

"I have tried Lyrica. I was falling on the floor. Could not walk without holding onto a cane," said Nancy. "It's time for researchers to find medications that are meant to treat Fibromyalgia, and not second or third off label uses of other meds that were never intended for FM. After 25 years, I'm really tired of waiting!"

A Pained Life: Waiting Can Be a Good Thing

By Carol Levy, Columnist

I am on an online "chat" with the cable company. I know this will be difficult -- my eye pain is made worse by having to read and type -- but it is just so darn difficult getting them on the phone.

The chat was going well, but it took what seemed like forever between responses from the representative. I was getting more and more frustrated and annoyed. 

When is she going to come back online so I can be done with this already? 

My reasoning was simple. The faster we can finish this, the sooner I am to no longer doing something that is causing me pain.

I was fuming. C'mon, C'mon!

And then it suddenly dawned on me -- the waiting is a good thing. Every minute or two between replies means I am not using my eye. It is free downtime, my eye getting a few minutes of reprieve.

How many times have you gone out with someone, maybe to shop for clothes or to buy groceries, and the other person stands there looking at items, wrestling with a decision:  "This one or that one? That one or this one?"

And how often do you get mad or upset? My body is hurting and the pain is growing. Please, enough already! Or maybe you even say it. 

What if, instead of letting the frustration or even the pain get to you, you take the opportunity to find a chair or lean against a counter? Or even say, "I need to leave the store. I'll go back and wait in the car." 

So often it feels like we have no options. It is an either/or situation -- either leave or let the pain take over.  Or feel like you are antagonizing the person you are with. 

But maybe there is a third choice. 

Instead of ending up upset because you could not get done what you came to do, or the person you came with is annoyed because your mood has turned foul and they "don't want to hear about your pain" anymore; maybe it is time to change our thinking.  

I am not one to dole out platitudes. I don't think we can make lemonade out of our pain-filled lemons. But just for this instance -- turn that frown upside down, as it were.

Take the frustration of waiting and give it a reason. 

Take the time to find a safe area, couch, counter, or a quiet fitting room and turn the negative of frustration into a positive time for yourself.  And a time-out for your body. 

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here.

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.

Blood Test Identifies Women Prone to Migraine

By Pat Anson, Editor

Researchers may have discovered a new marker for episodic migraine – lipids in the blood that regulate inflammation in the brain.

In a small study involving 88 women, researchers found that total levels of the lipids -- called ceramides or sphingolipids -- were significantly decreased in women with episodic migraine when compared to women without migraine. Episodic migraine is defined as less than 15 headaches per month. The women in this study had an average of 5.6 headache days a month.

"While more research is needed to confirm these initial findings, the possibility of discovering a new biomarker for migraine is exciting," said study author B. Lee Peterlin, DO, with the Johns Hopkins University School of Medicine. The study is published in Neurology,  the medical journal of the American Academy of Neurology.

Ceremides are bioactive lipids that may be involved in other neurological disorders, such as dementia and multiple sclerosis.

Women with migraine had approximately 6,000 nanograms per milliliter of ceramides in their blood; while women without headache had about 10,500 nanograms. Every standard deviation increase in total ceramide levels was associated with over a 92% lower risk of having migraine. Two other types of lipids, called sphingomyelin, were associated with a 2.5 times greater risk of migraine.

The researchers tested their theory by analyzing the blood of a random sample of 14 of the women. They were able to correctly identify those who had migraine and those who did not based on their lipid levels.

"This study is a very important contribution to our understanding of the underpinnings of migraine and may have wide-ranging effects in diagnosing and treating migraine if the results are replicated in further studies," said Karl Ekbom, MD, with the Karolinska Institute in Stockholm, Sweden, who wrote an accompanying editorial.

Ekbom noted there were limitations in the study. Only women were included, chronic migraine was not studiedm and an unusually high number of participants had migraine with aura

Migraine is thought to affect a billion people worldwide and about 36 million adults in the United States, according to the American Migraine Foundation. It affects three times as many women as men. In addition to headache pain and nausea, migraine can also cause vomiting, blurriness or visual disturbances, and sensitivity to light and sound.

Miss Understood: A Taste of Remission

By: Arlene Grau, Columnist

If you ask me to plan something, almost anything that requires me being somewhere on a certain day for any amount of time, I would have to decline because I never know how I'll be feeling on any given day.

Now ask me to plan a family vacation that would take me to Hawaii, where I would be 5 hours away from my doctor by plane – well, that would be insane.

However, I did just that and the results were better than expected.

I had my Rituxan infusion a month prior to leaving in hopes that it would kick in just before I left. My body, however, had a different agenda. I began feeling ill the week after my treatment. On top of that, I suffered a bad fall at home. I sprained my ankle, bruised my hip, and hurt my knee.

Instead of making progress, I was taking several steps backwards. I had tried to prepare my body for months and it was beginning to feel like it was all in vain.

But my husband and doctor didn't allow me to give up. My doctor prepared an emergency plan for me before I left. He prescribed backup antibiotics in case I became ill, started me on a temporary prednisone dosage, printed up my most recent patient summary (since I was taking so many medications with me), and gave me contact information for a rheumatologist in Hawaii in the event that I needed to be seen. He even called the other doctor ahead of time and told me to email him for anything.

Although my body wasn't completely ready, I felt like I had the tools necessary to handle any medical emergency I may have.

Now, I don't know if it was the simple fact that I removed myself from all the stressors in my life, but I felt so much better while I was in Hawaii during that one week than I have since I was first diagnosed with rheumatoid arthritis eight years ago.

My theory is that the change in climate helped with the inflammation I was suffering from. I know that when it's very cold and dry, I tend to flare up and feel very ill. And when it's really hot and the sun is pounding down on me, I feel my weakest and just as sick.

But out there I was met with humidity and sunlight that didn't feel like it was stripping away every ounce of energy I had.

I had one or two trying days; granted I was doing a lot more than I've ever done at home as far as activities and walking go. But I was extremely proud of everything I was participating in. I even got to enjoy my 30th birthday in Hawaii, one I never thought I would live to see.

I knew as soon as we got home that something was different because I woke up feeling like I had been hit by a truck. As quickly as the swelling and inflammation left, it returned. My insomnia is back and my migraines are more intense.

But I got taste of what remission might be like.

It was a great vacation with a bittersweet ending because, instead of dreaming about the visual paradise I was in, I'm left day dreaming about the physical paradise I felt -- the one that had less limitations and more of my old self.

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

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

Smoking Accelerates Multiple Sclerosis

By Pat Anson, Editor

Smoking is never a good idea for anyone – especially people in chronic pain -- but according to a new study it is particularly bad for multiple sclerosis patients, both before and after diagnosis.

Cigarette smoking is already a known risk factor for developing multiple sclerosis (MS), but in a first of its kind study published in JAMA Neurology, Swedish researchers found that continuing to smoke after diagnosis significantly accelerates progression of the disease.

MS is a chronic and incurable disease which attacks the body’s central nervous system, causing numbness in the limbs, difficulty walking, paralysis, loss of vision, fatigue and pain. Symptoms begin with a series of irregular relapses, and after about 20 years MS worsens into a secondary progressive (SP) stage of the disease.

In a study of over 700 MS patients who continued to smoke after their diagnosis, researchers found that each additional year of smoking accelerated the time to SP conversion by 4.7 percent.  

Looking at it another way, the study found that patients who continued to smoke converted to SP faster (at an average age of 48) than those who quit smoking (at age 56).

“This study demonstrates that smoking after MS diagnosis has a negative impact on the progression of the disease, whereas reduced smoking may improve patient quality of life, with more years before the development of SP disease,” said lead author Jan Hillert, MD, Department of Clinical Neuroscience, Karolinska University Hospital Solna in Stockholm.

“Evidence clearly supports advising patients with MS who smoke to quit. Health care services for patients with MS should be organized to support such a lifestyle change.”

Getting MS patients to quit is important not only for patients, but for society as a whole because of the high cost of treating MS. Disease modifying drugs such as fingolimod and natalizumab, cost about $30,000 per year and are not always effective.

“This study adds to the important research demonstrating that smoking is an important modifiable risk factor in MS. Most importantly, it provides the first evidence, to our knowledge, that quitting smoking appears to delay onset of secondary progressive MS and provide protective benefit,”  said Myla Goldman, MD, of the University of Virginia, and Olaf Stüve, MD, of the University of Texas Southwestern Medical Center in an accompanying editorial in JAMA Neurology.

Previous studies have found that smoking increases your chances of having several types of chronic pain conditions.

A study of over 6,000 Kentucky women found that those who smoked had a greater chance of having fibromyalgia, sciatica, chronic neck pain, chronic back pain and joint pain than non-smokers. Women in the study who smoked daily more than doubled their odds of having chronic pain.

A large study in Norway found that smokers and former smokers were more sensitive to pain than non-smokers. Smokers had the lowest tolerance to pain, while men and women who had never smoked had the highest pain tolerance.

Visiting a Medical Marijuana Dispensary

By Ellen Lenox Smith, Columnist

Many people who are considering medical marijuana for pain relief are reluctant to visit a marijuana dispensary, fearing it might be in a bad part of town or that they may encounter some unsavory characters.

Since I am a home grower of marijuana, I felt it was best to visit a dispensary in my home state of Rhode Island to get a fresh, first hand view of what the experience is like. Through the kindness of Barbara Pescowolido at the Thomas C. Slater Compassion Center in Providence, this visit was made possible.

The first thing that I noticed was the professional layout that included informed, pleasant and knowledgeable employees who were there to greet me. There is 24 hour surveillance of the premises, a well-lit parking area, and a professionally trained security team.

I had to show to identification, which requires a Rhode Island medical marijuana patient or caregiver card,  and another form of ID, like a driver's license. After my information was put into the computer and confirmed, I was buzzed into the center. If a patient is not able to walk without assistance, he or she can be accompanied by a licensed caregiver, who would also be required to present credentials.

Every new patient is given an orientation session that includes a one-to-one educational conversation, and a folder of information to take home and review for future visits.The folder includes the different methods of ingesting marijuana, the concentrated forms available, their laboratory testing procedures, how to use your medicine sensibly, and a form that explains cannabis and the difference between sativa and indica plants.

There’s also a patient journal so you can record the type of marijuana you tried, how you ingested it, the date/time of taking, and the duration/effect. This is to help both the patient and staff make educated decisions on your next purchase.

Also included is a “Good Neighbor Agreement” the patient is to read and sign. You are expected to follow the guidelines to be able to continue using their services. They include:

• Not to smoke or consume marijuana on site or in the parking lot
• Refrain from using cellphones or cameras while in the building
• No minors allowed unless they are a patient and accompanied by a parent or legal guardian
• No minors left in your vehicle unattended while visiting the center
• No animals except guide/service animals are allowed inside
• Keep all medicine and money our of plain sight
• No weapons allowed.
• Do not invite individuals who are not patients or caregivers, unless special arrangements are made with management
• Do not throw litter in the parking lot or surrounding area
• Marijuana purchased in the center is not for resale. Any member found reselling will have their membership revoked
• Keep all conversations respectful and appropriate

New patients also learn about a wide range of free ancillary services, such as massage, reiki, hydrotherapy bed, cultivation, and classes on cooking and methods of consumption. There are also product showcases and live demo’s that include weekly open house tours, 1:1 consultations, loyalty rewards program, a community newsletter and a cannabis library/DVD section.

The next step for me was to take a number while relaxing in a tastefully designed waiting area. When you are called up to the counter, you get to work 1:1 with a knowledgeable patient advisor/employee.

A menu hangs over the counter sharing what medications are available. A variety of edibles, capsules, concentrates in syringes, flowers, exilers, and topicals are for sale.

This center has come up with a novel idea. For just $20, you can purchase a sampler packet that includes small samples of medicine that includes THC capsules, CBD capsules, elixir, a cookie, hard candy and gummy bears. This allows the patient to return home and try these different methods to decide what fits best for their needs.

The center is still not able to grow all that is needed to accommodate patients, so there are times customers return for a specific product to find it is not available. It is difficult for the center to have to rely on others growing for them, so their goal is to one day be totally self sufficient.

Patients are allowed to purchase 2 ½ ounces every fifteen days. Records are kept in a computer so that no one ever goes over that amount unintentionally or intentionally. You are able to check the center’s website for a "menu" of the current product being sold, but you are not allowed to purchase online.  

Prices presently range from $25 to $50 for an eighth of an ounce of product. Prices can fluctuate if the marijuana tests out to be stronger. All marijuana, either grown on site or purchased from growers, is tested and cleaned.

My experience there was pleasant and educational. For a closer look at the Thomas C. Slater Compassion Center, you can watch this short video the center has on YouTube:

Uploaded by Slater Center on 2015-06-09.

If you live in a state that allows medical marijuana, but does not permit you to grow your own or have a caregiver grow for you, then a dispensary like the one I visited can probably meet your needs. But each state has different laws and regulations for both patients and dispensaries, so your experience may differ from mine.

Visiting a dispensary and trying medical marijuana for pain relief could result in a significant improvement in your quality of life.

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.

Medical marijuana is legal in 23 U.S. states and the District of Columbia, but is still technically illegal under federal law. Even in states where it is legal, doctors may frown upon marijuana and drop patients from their practice for using it.

Your Friendly Neighborhood DEA Snitch

By Steve Meister, Guest Columnist

A recent story out of the Southeast caught my eye. A local pain management doctor has been cut off by local pharmacies, or more precisely, the patients of that doctor have been cut off because local pharmacies are refusing to fill pain scrips written by that doctor.

In these instances, which I’ve seen some of my own doctor-clients’ experience, the pharmacies’ actions range from altruistic and concerned, to cowardly and hasty disassociation from a provider who may or may not have done anything wrong.

The doctor who was the subject of the news story does, admittedly, write many, many pain prescriptions, and perhaps he does deserve a close second look by pharmacists. Pharmacists, after all, have a very important job, not only to fill a prescription correctly and consider drug interactions, appropriate dosage, and medical necessity, but they also have a responsibility under federal law to double-check the legitimacy of the prescription to begin with.

This is especially true when it comes to pain prescriptions, and so says the DEA. Loudly, in fact. So loudly does the DEA make this pronouncement to pharmacists, that many times I have seen pharmacists inform on doctors just to get the DEA off the pharmacy’s back.

While a pharmacist can always say, perhaps legitimately, that he or she was righteously concerned about the sheer volume of pain scrips coming out of a certain doctor’s office, that same pharmacist might be getting visits from DEA agents.

The pharmacist knows from the get-go that “naming names” is often a good way to get the DEA to redirect its focus. So pharmacists name names. And then other pharmacists in the area get word, and cut off the same doctor or the doctor’s patients. A type of local hysteria takes over, and pretty soon, there are a lot of pain patients finding pharmacy counters off limits to them.

What happens to these patients? An excerpt from the recent news story gives you an idea:

“I didn’t have a real good feeling about cutting people off cold turkey, but in some cases it was warranted,” a local pharmacist said.

The pharmacist interviewed is admitting that an abrupt cut-off of one’s prescription drug dosage can force people to go “cold turkey,” without tapering off of powerful medication on which the patient may have become physically dependent or developed a tolerance. What does it mean when there’s no tapering off? It means a patient risks going into withdrawal, which can be very dangerous and which subjects innocent people to great physical and psychological agony.

According to prescribing and pharmacy practice guidelines, doctors and pharmacists SHOULD NOT subject patients to abrupt, 100% cut-off from opioid dosage, even if a patient is exhibiting signs of misuse. Medication is to be titrated down, patients provided with enough medication for a reasonable time to allow them to find another provider, or be referred to substance abuse treatment programs if necessary, and patients are NOT to be placed at unnecessary risk of going into withdrawal.

And when the DEA is breathing down your neck, Mr. Pharmacist? It’s OK to kick patients to the curb then? No, it’s not. The pharmacist interviewed in the story is actually violating prescribing guidelines and probably running afoul of rules of professional conduct. He is certainly not placing patient safety ahead of his own survival. And without doubt, he is not alone in his self-serving behavior.

Unfortunately, as is often the case, people who otherwise act with dignity and compassion in their professional lives fail to show courage in the face of government intimidation. It’s easier to name names.

Steve Meister is a criminal defense attorney and former prosecutor in Los Angeles.  He advises prescribers on how to comply with prescription criminal laws, and defends people accused of overprescribing narcotics.  

This column is republished with permission from Steve’s blog, Painkiller Law.

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.

Discovery Could Lead to Earlier RA Treatment

By Pat Anson, Editor

Scientists have discovered a new protein that regulates the severity of tissue damage caused by rheumatoid arthritis, a finding that could help identify RA patients earlier for more aggressive treatment.

The protein – known as C5orf30 – was found in DNA and biopsy samples from the joints of over 1,000 RA patients in the UK and Ireland.

"Our findings provide a genetic marker that could be used to identify those RA patients who require more aggressive treatments or personalized medicine," said Professor Gerry Wilson from the School of Medicine and Medical Science, University College Dublin, who led the research.

"They also point to the possibility that increasing the levels of C5orf30 in the joints might be a novel method of reducing tissue damage caused by RA".

Rheumatoid arthritis is a chronic autoimmune disease in which the body’s own defenses attack joint tissues, causing joint pain, inflammation and bone erosion. About 1.5 million Americans and 1% of adults worldwide suffer from RA.

"These exciting findings will prompt us to further explore the role of this highly conserved protein that we know so little about, and its significance in human health and disease,” said co-author Dr. Munitta Muthana from the Medical School at the University of Sheffield.

The study, funded by Arthritis Ireland and the University of Sheffield, is published in the journal PNAS.

It is estimated that 30% of patients with rheumatoid arthritis are unable to work within 10 years of onset of the disease. It affects more women than men, and often more severely. RA is most common between the ages of 40 and 70, but it can affect people of all ages, including children.

Although there is no cure for RA, new drugs are available to treat the disease and slow joint damage. Self-management of the condition by patients, including exercise, is also known to reduce pain and disability.

One of the biggest problems in treating RA is early diagnosis and treatment, which can reduce the amount of joint damage.  

"Treatments for arthritis have improved enormously over the last number of years. Thirty years ago, rheumatologists' waiting rooms were filled with people in wheelchairs. Today, that is no longer the case. The outlook for a person diagnosed with arthritis in 2015 is much brighter than it used to be,” said John Church, CEO of Arthritis Ireland.

British researchers recently said they were close to developing a blood test that could detect both RA and osteoarthritis in its earliest stages.

Osteoarthritis (OA) is a progressive joint disorder caused by painful inflammation of soft tissue, which leads to thinning of cartilage and joint damage in the knees, hips, fingers and spine.

Researchers at the University of Warwick’s Medical School identified a biomarker linked to both forms of arthritis. Diagnostic blood tests already exist for RA, but the newly identified biomarker could lead to one which can diagnose both RA and osteoarthritis.

“This discovery raises the potential of a blood test that can help diagnose both RA and OA several years before the onset of physical symptoms," said lead researcher Naila Rabbani, PhD.

Rabbani’s research focused on citrullinated proteins (CPs), a biomarker present in the blood of people with early stage rheumatoid arthritis. Patients with RA have antibodies to CPs and the Warwick researchers established for the first time that CPs levels also increase in early-stage OA.

That research is published online in Nature Scientific Reports.