Why Doctors Don’t Do What Works

By Barby Ingle, Columnist

Let’s examine infusion therapies. There are multiple types, including intravenous ketamine, plasma, stem cell, immunoglobulin and lidocaine.

I have tried many of these and know from personal experience that they can work. I have also been by the side of friends who have undergone infusions with great success, including some who have gone into remission.

Infusion therapy is being performed for patients with all kinds of neuropathy conditions and it helps many recipients. It is just hard to find a doctor who will perform infusions for anything outside of IV-chemotherapy for cancer patients. Why?

Right off the bat, let’s consider costs. In the case of intravenous immunoglobulin, it is very expensive to make, so insurance companies fight it a lot and that discourages doctors from offering it.

IV-lidocaine offers some relief, but is short lasting. In the case of IV-ketamine, it is an inexpensive drug and insurance companies are covering it in many cases, depending on documentation and the protocol being used.

I know that many doctors are underpaid. They are getting cutback by insurance companies and on treatment reimbursements with Medicare. Malpractice insurance rates are very high and many doctors still have thousands of dollars in student loans to pay. Those that have their own practice make less because of the overhead costs of location and staffing.

As a former business owner, I see the valid points the doctors are making. As a patient, I wish I could fix these reasons so that more patients could be helped.

Since learning about IV therapies myself back in 2007, I started asking around for names of doctors who are performing them as viable treatment option for chronic pain diseases. What I found was that the list was very small. I started asking questions of pain doctors specifically. I did not do this as “patient Barby,” but as director of the International Pain Foundation.

Some of these doctors have seen me over the past 10 years go from “wheels to heels.” They cannot believe their eyes when they see me now. Yet they still give reasons and obstacles for not wanting to offer infusion treatments.

Many have very small offices. Even at pain management and surgical facilities, the patient takes up a spot in the recovery room or infusion room for half a day. That becomes prohibitive for doctors to deal with because it cuts down the number of patients they can treat and the amount of money they can make.

In medical school, doctors have to choose a specialty. They get general studies that include a little info on this and a little on that, but unless a doctor is interested in studying the specialty that includes your condition, they may not have ever heard of it. Even if they did study your particular condition, they may have gotten only four hours of training on it.

Looking at it from the other side, doctors do have little time for treating patients, and they have required continuing education hours that they also have to fit in. Some tend to stick to classes that reflect their area of interest, so they are not getting a wide variety of knowledge that, as patients, we tend to believe occurs. I learned the hard way that doctors are not created equal. If an illness or condition is not their specialty, they do not invest in it.

When you have an IV-ketamine infusion, a certified nurse needs to be present and monitor you the entire time. He or she can’t just come and go. Taking one staff member away for four hours at a time increases a doctor’s overhead expenses. Most doctors could not survive this type of set up. They need to see more patients.

Not only are you taking vital staff away when getting an IV infusion, you are using space. If you are taking up a chair in the recovery room at a doctor’s facility for hours, the doctor is unable to fill that chair with other paying patients. Not just paying patients, but patients who also need help, just as much as you do.

When insurance companies start to compensate doctors appropriately for IV therapies, it will resolve many of these issues and more doctors will offer infusions. I pray that it becomes widespread as an option.

In 2007, I was at a medical conference where Dr. Robert Schwartzman was speaking on infusion therapy and he said, “It will soon be the standard treatment for RSD patients.”

“Soon” in medical terms can often be 8 to 10 years. It is about time that we get better access to proper and timely care.

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

More information about Barby can be found at her website.

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

Californians Busted for Selling Fake Painkillers

By Pat Anson, Editor

Three people have been arrested in San Francisco in what appears to be a widening investigation into sales of counterfeit pain medication.

Federal prosecutors say 39-year old Kia Zolfaghari and his wife, Candelaria Dagandan Vazquez, ran an illegal fentanyl pill manufacturing operation out of their San Francisco apartment. The pills were disguised to look like oxycodone.

The couple, along with King Edward Harris II of Oxnard, were arrested Friday in an undercover sting operation.

“The complaint alleges that Zolfaghari sold over 1,500 fentanyl-laced pills, over the course of six transactions, to a confidential source working with law enforcement.  The complaint further alleges that Harris, 34, of Oxnard, brokered these narcotics sales in a series of recorded calls with the confidential source and hand-delivered two of those purchases to the confidential source,” the U.S. attorney’s office said in a statement. 

“Zolfaghari also sold the fentanyl-laced pills to customers through an online marketplace.  The complaint alleges that Zolfaghari’s wife, Vazquez, 38, of San Francisco, conspired with him to carry out his drug trafficking operation, and delivered packages of pills for mailing, purchased packaging supplies, and accepted payments for narcotics via her bank account.”

Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine and can be lethal in very small doses.

It is prescribed legally to treat severe pain, but is also being manufactured illegally and sold on the street.

Fentanyl pills disguised to look like painkillers such as oxycodone and Norco are increasingly being found in the U.S. and Canada. Fake pain pills are blamed for at least 14 deaths in California and 9 in Florida.  Some pills were purchased off the street by pain patients who were unable to get prescription medication through a doctor.

Massachusetts and Rhode Island recently reported an “alarming” rise in fentanyl overdoses. Over half the opioid overdose deaths in those states are now blamed on illicit fentanyl, not prescription pain medication.

A Minnesota medical examiner this month also blamed fentanyl for the accidental overdose of pop icon Prince. It’s not known if the fentanyl involved in Prince’s death was prescribed legally or obtained through other sources..

A Canadian couple were charged Friday with running an illegal fentanyl pill operation in British Columbia. Leslie John McCulloch and Rebekka Rae White were arrested in March after the Royal Canadian Mounted Police raided a warehouse in West Kelowna, B.C. and found pill producing equipment. The couple is currently out on bail.

Fentanyl is blamed for over 170 overdose deaths in B.C. alone so far this year.

The fentanyl scourge has become so serious that the U.S. Drug Enforcement Administration has released a training video warning law enforcement officers that they could die just by handling a small amount of the drug.

The video features two New Jersey police officers who inhaled powdered fentanyl while collecting the drug as evidence during a raid. “I thought that was it. I thought I was dying. It felt like my body was shutting down,” said one detective.

In the video, acting DEA Deputy Administrator Jack Riley warns officers to avoid testing suspect fentanyl on the scene and to even keep their police dogs away from the drug because it is just too dangerous.To watch the video, click here.

Pain Patients Need a Champion

By Pat Akerberg, Columnist

As the national debate shines a spotlight on the opiate addiction and overdose problem, the divide widens between how the CDC/FDA/DEA and chronic pain sufferers see it. 

Is it an opiate problem alone that can be regulated or a pain management problem that needs to be addressed? The government and pain patients are both fighting to preserve life, but their vantage points on the risks and benefits of opioids are very different. 

As protectionists, our Goliath-like government agencies are reacting to tragic deaths caused by opioid overdoses with a "War on Drugs" approach. They have mobilized around a clear direction, ownership, and action plan – stringent prescribing guidelines that force physicians and pharmacists to curtail and deter patient access to these medications. 

But for millions of chronic pain sufferers, protective of their own survival, those guidelines now put them at risk of their pain being undertreated or untreated.  

Already marginalized by chronic pain, they can’t afford to lose more quality of life or the will to press on if the benefits of those medications are abruptly taken away. The human right of self-preservation and the oath to do no harm are at issue.  

Even though pain sufferers are unified in their opposition to many of these measures, without a clear direction or representation they haven't had any influence. Their input has been largely excluded by the government’s closed process, a top-down stance many view as misguided and cruel. 

With sporadic grassroots efforts, pain patients are pushing back -- sporadic because many are already overwhelmed trying to cope with their medical challenges.

When people who are affected by a blanket change push back, it’s because something was sorely missed by the change drivers.  The guidelines weren't communicated well, didn’t include input from the people affected, and minimized issues that could have many serious unintended consequences. Many in the pain community feel betrayed and abandoned.

While the David-like courage and bravery of patients moves me, I’m also one of many frustrated chronic pain sufferers concerned about making headway without a proactive approach. 

Maybe it’s time we borrow from the best change management practices used successfully in business.  These practices effectively mobilize the energies of those needed to make change happen.  Progress occurs only when several key factors are fully defined to get from “current reality” to “future state." Those critical factors involve:

1. A clear definition of our unmet pain management needs
2. A realistic assessment of our current pain management reality
3. A compelling vision for future pain care  
4. A transition plan to get there

When any one of these critical success factors falls short, no amount of reactionary rhetoric or emotional expressions from us will substitute for our own proactive pain management platform.  Our efforts to fight back will sputter up against a bureaucratic wall. 

The deficiencies in the change approach our regulators took frustrated our expectations that we’d be heard and understood, with empathy and dignity.

Expectations can backfire if they’re unrealistic.  When they operate unchecked, it means that we have assumptions, predictions, and underlying beliefs that something will happen or play out the way we hope and need them to. We’re attached to an outcome when we hold onto those expectations. 

But life isn’t perfect and systemic change doesn’t happen overnight.  Eventually we are bound to have an experience like this one in which the gap between our expectations and reality results in a disappointing thud.  A self-help quote describes that occurrence well: “expectations are the partner of disappointment.”

Trying to change their hearts and minds about us, we’ve worked to convince the regulatory, profit-seeking, and career promoting stakeholders that we’re credible and responsible, not addicts or malingerers.

But the more dramatic our attempts have been, the more we’re viewed skeptically. Taking that personally, we feel misunderstood, thrown to the wolves and without impact.  In self-defense, sufferers continue to dial up reactionary and passionate protests, hoping regulators will someday see that their guidelines don’t solve our pain management needs.  

Since hope alone isn’t a strategy, we should redirect our energies and stop giving our power away while emotionally bargaining over the legitimacy of our pain management concerns. We also need to stop seeking compassionate understanding and consideration from entities ill equipped and unlikely to offer them. 

The “recovery” community sums up that advice as, “you don’t go to a hardware store expecting to buy bread.”  Better to save our hopes for our families, friends, and support groups where the odds favor us. 

Likewise, in the context of systemic change regarding chronic pain management, our expectations have a better shot of being met by a credible coalition that represents us.  

First and foremost, a strong change initiative needs a champion who owns the challenge and drives a clear and comprehensive change management platform that sets the conditions for success.  Without that credible representation, we have no seat at the table, nor any accountability.

Our very real pain management needs present a clear role for advocacy groups to step up and represent.  There’s no shortage of would-be sponsors for us to recruit.  Pain Pathways estimates there are 21 pain advocacy groups, along with 39 other disease related advocacy groups. 

The arrow of purposeful action and accountability points to an urgent unmet need – a coalition willing to champion a change agenda that best represents our interests, including ways we can champion and support it. 

The regulatory agencies have their plan with solid representation.  Let’s face it, without our own platform we sit in pain, frustratingly sidelined.

Let’s regroup and start shopping elsewhere for bread.

Pat Akerberg suffers from trigeminal neuralgia, a rare facial pain disorder. Pat is a member of the TNA Facial Pain Association and is a supporter of the Trigeminal Neuralgia Research Foundation.

Pat draws from her extensive background as an organizational effectiveness consultant who coached and developed top executives, mobilized change initiatives, and directed communications.

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.

Migraines Linked to Low Levels of Vitamin D

By Pat Anson, Editor

Low levels of Vitamin D have been associated with fibromyalgia, rheumatoid arthritis, multiple sclerosis and other chronic pain conditions. And new research suggests the “sunshine vitamin” may play a role in preventing migraines.

Researchers at Cincinnati Children's Hospital Medical Center found that a high percentage of children, teens and young adults with migraines appear to have mild deficiencies in vitamin D, riboflavin and coenzyme Q10. The latter is a vitamin-like substance found in cells that is used to produce energy for cell growth and maintenance.

"Further studies are needed to elucidate whether vitamin supplementation is effective in migraine patients in general, and whether patients with mild deficiency are more likely to benefit from supplementation," says Suzanne Hagler, MD, a Headache Medicine fellow in the division of Neurology at Cincinnati Children's Hospital Medical Center. She presented her findings at the annual meeting of the American Headache Society in San Diego.

Hagler studied a database of patients with migraines who had their blood levels checked for vitamin D, riboflavin, coenzyme Q10 and folate, all of which have been linked to migraines in previous and sometimes conflicting studies.

Many of the patients were put on migraine medications and received vitamin supplementation, if their blood levels were low. Because few received vitamins alone, the researchers were unable to determine if vitamin supplements by themselves were effective in preventing migraines.

Hagler found that girls and young woman were more likely than boys and young men to have coenzyme Q10 deficiencies. Boys and young men were more likely to have vitamin D deficiency. Patients with chronic migraines were more likely to have coenzyme Q10 and riboflavin deficiencies than those with episodic migraines.

Vitamin D helps control levels of calcium and phosphate in the blood and is essential for the formation of strong bones and teeth. Vitamin D also modulates cell growth, improves neuromuscular and immune function, and reduces inflammation

Sources of Vitamin D include oily fish and eggs, but it can be difficult to get enough through diet alone. Ultraviolet rays in sunlight are a principal source of Vitamin D for most people.

Danish researchers found that exposure to sunlight may delay the onset of multiple sclerosis (MS). Patients who spent time in the sun every day during the summer as teenagers developed the disease later in life than those who spent their summers indoors.

Low levels of serum vitamin D were found in over 1,800 fibromyalgia patients in a recent meta-analysis (a study of studies) published in the journal Pain Physician. Researchers at National Taiwan University Hospital found a “positive crude association” between chronic widespread pain and hypovitaminosis D.

Pain News Network columnist Crystal Lindell began taking Vitamin D supplements when her blood levels were found to be very low. Within a few months she was feeling better, exercising more, and losing weight. You can read Crystal’s story by clicking here.

The Untold Story About Opioids

By Jennifer Kain Kilgore, Columnist

Let’s discuss responsible opioid use.

There’s a hysterical firestorm burning across the nation regarding heroin, drug overdoses, opioids, and fentanyl. Much of this has been amplified and distorted by the media coverage. A lot of the terms used in front-page stories are scary and a lot of the numbers about people dying look threatening.

I can understand why people are concerned about addiction and overdoses. However, I want you to do something for me. I want you to humor me and allow your currently held convictions to be challenged.

Now, let’s pretend that heroin, overdoses, opioids, and fentanyl are separate issues for a moment.

Heroin overdoses are on the rise because it is cheap and easy to acquire. Heroin has become entangled with the chronic pain epidemic because many are said to have resorted to heroin when they could not access opioids, including some patients who are unable to get proper pain care.

Pain drives people to tremendous lengths, but the number of pain patients who go on to abuse medication is surprisingly low.

Still, the media often portrays pain patients as drug seekers.

Meanwhile, people are overdosing on fentanyl because it’s being mixed with other common street drugs. Three grains of fentanyl are considered a lethal dose, indicating its potency, and Mexican drug cartels have figured out that it’s much cheaper for their enterprise. It was a business decision that has led to many deaths.

Let’s pretend that the vast majority of chronic pain and illness patients are diligent and responsible. Let’s pretend all of these issues are separate. Let’s pretend that drug addiction and drug dependence are two different things.

I’m going to run you through my day as an opioid-dependent human being.

For your reference: I have chronic back and neck pain stemming from two separate car accidents. I broke my thoracic spine in four places, one of which healed incorrectly and calcified over a cluster of nerves. This means that every movement of my midsection feels like someone is hammering nails directly into my spine. The second car accident necessitated two cervical fusions. If I stretch my neck any more than necessary, I get headaches so intense that they send me back to bed.

Using a straight 1 to 10 scale, 1 being the best level of pain, 10 being the worst, I live my life at a constant 7/10. On good days I can get down to 5/10. So, imagine having someone standing behind you all day, every day, screaming into your ear and tasing you endlessly. That’s my typical day.

This is an example of what an opioid-dependent person looks like:

             7 am: I wake up. I’ll get dressed, put on my beloved Quell pain relief device (which, for the record, I bought myself during their Indiegogo campaign last year), and head downstairs for coffee. First I will drink UltraInflamX 360, an anti-inflammatory medical powder. It is expensive and lasts for 14 meals. If I don’t eat it, my esophagus is raw and painful because of eosinophilic esophagitis, an autoimmune condition that causes food-allergy-like responses, and GERD. Nobody is sure why I have these, except that all of the medications I take have the potential to destroy my gastrointestinal tract.

Then I take the following medications:

1. Tramadol (synthetic opioid)
2. Lyrica (nerve medication)
3. Duloxetine (antidepressant used off-label for pain control)
4. Prilosec (protects my GI tract and helps with GERD)
5. Multivitamin (always a good idea)
6. Calcium
7. Vitamin K2
8. Vitamin D3 (used to offset the bone-weakening properties of Prilosec)
9. Turmeric (anti-inflammatory properties) 

            7:30 - 8 am: I drink coffee and catch up on emails. Typically, I sit in my recliner chair with a body-length heating pad. Today I also have an ice pack on my neck because I didn’t sleep last night. Being in complete spasm will do that to you.

            8 am - 12 pm: I work. I had to leave my law firm at the end of 2015 because I could not physically handle an office job. Now I work from my recliner and telecommute part-time for a few different companies. I am trying to transition into our home office and use a kneeling chair. During these three hours I get up multiple times, stretch, do gentle yoga, and think about lunch.

           Noon - 1 pm: Lunch. I used to take another Tramadol at the four-hour mark, but lately I have been trying to hold off most of the day. It is important to note here that opioid-dependent patients occasionally test how long we can go without meds (if we feel up to it). We don’t like being dependent. That is why I constantly test my boundaries. These days I can make it to 6 pm without a second pill. On bad days, I need to take one pill every four to six hours -- which is actually what my doctor instructed.

           1 pm - 2 pm: I take a walk outside while listening to podcasts or audiobooks. Since I can’t hold books comfortably (my neck doesn’t like it when I look down), I listen instead.

           2 pm - 4 pm: I try to do some more work. This can be hit or miss depending on how much pain I have on any given day. If I am in too much pain, I stretch or watch television from the recliner.

          4 pm - 6 pm: Power-down time. I sit in the recliner and read interesting articles, look at the news, and find cute animals online. Some days I’ll wear a soft cervical collar to take stress off my neck.

          6 pm - 8:30 pm: My husband comes home and we spend time together.

          8:30 pm - 9 pm: My husband reads while I begin the very long process of getting ready to sleep. This includes taping Lidocaine patches on my back. I can only put on three at a time and I have a lot of real estate to cover, so I place them on the loudest areas for that specific day. Then I take the following medications:

1. Tramadol
2. Duloxetine
3. Lyrica
4. Methocarbamol (muscle relaxer)
5. Zyrtec (allergies) 

I also put Mederma on my cervical fusion scar in the hopes of making it fade. Then I sleep with two pillows under my knees so that my low back doesn’t keep me awake. When I sleep on my side, I keep a pillow between my legs. I have a cervical pillow for my neck. 

That’s it. That’s the extent of opioid dependence. I need opioids to get through the day, but my day is not focused around them. On bad days I occasionally take two Tramadol at once, which my doctor recommended if I’m having a lot of pain. The numbers of times I do that per month can be counted on one hand because I don’t want to abuse it and lose access.

Would I take something stronger if my doctor prescribed it? Absolutely. Having this pain and trying to live a normal life is like having someone screaming right in your ear all the time. It’s always there in the background, dictating every decision I make.

This is responsible opioid use and what the majority of chronic pain patients go through, though many are prescribed stronger painkillers than I am and need to take them more frequently. Many have asked me how I survive with just Tramadol. The answer? I have to, because what happens if it’s taken away? Then I have nothing.

I’ve learned to live with this constant pain because of the current political climate. My doctor won’t prescribe anything stronger because he said that eventually it’ll lose its efficacy. I can understand that. But nothing is being done to help chronic pain patients besides demonizing us in the media and taking away our only options.

You can’t remove that sole option without having something to replace it. And no, I’m not talking about “deep breathing” and “positive visualization,” both of which have been recommended. I do both. I don’t do them in place of Tramadol. They complement Tramadol.

Congress is now contemplating an opioid tax to fund addiction recovery programs -- a noble goal, but this makes it even more difficult for chronic pain patients. Do you know how much of my household’s monthly budget is spent on medication? Too much. Far too much.

This is not healthcare. This is extortion.

Our healthcare system is already ruined. Doctors refuse to prescribe medication that patients legitimately need for fear of losing their licenses. Insurance companies try to get out of paying by making already expensive conditions even more expensive to treat. I am a very expensive person to keep alive and functioning. Many, many people have it worse than I do.

The government and the medical system cannot take away our right to live. That is what opioid medication is for us: our right to live without pain. We must be separated from the current hysteria. There are millions of us in the United States alone.

We are not the monsters here. We are human beings who suffer indescribable agony on a daily basis, and we deserve to be protected.

 J. W. Kain is an attorney in the Greater Boston area who also works as a writer and editor in her spare time.  She has chronic back and neck pain after two car accidents.

You can read more about J.W. on her blog, Wear, Tear, & Care.  

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

New Treatments Offer Hope to Migraine Sufferers

By Pat Anson, Editor

Findings from several new clinical studies could pave the way for new treatments that could someday prevent and lessen the severity of migraines.

Migraine is thought to affect a billion people worldwide and about 36 million adults in the United States, according to the American Migraine Foundation. Although there are many treatment options available, most migraine sufferers are not fully satisfied with their effectiveness.

Teva Pharmaceuticals (NYSE: TEVA) is developing a new injectable drug – called TEV-48125 – that is designed to be injected monthly in chronic migraine sufferers who have headaches at least 15 days per month.

"Chronic migraine affects about 1 percent of all adults, yet less than 5 percent of those people receive a correct diagnosis and appropriate treatment," said study author Marcelo Bigal, MD, of Teva Pharmaceuticals. "Most people who receive preventive medication for chronic migraine stop using them, and one reason for that is the drugs can take a long time to become effective.”

In findings published online in the journal Neurology, Bigal reported that TEV-48125 was effective in reducing the length of headaches three to seven days after the first injection. The drug contains an antibody that blocks the calcitonin gene-related peptide that plays a role in migraine pain.

Teva’s Phase II study involved 261 people with chronic migraine who were divided into three groups; one group received a monthly shot for three months with a low dose of TEV-48125, the second group received a high dose and the third group received a placebo shot. Participants then used an electronic diary to record the number and length of their headaches.

After one week, the average number of headache hours went down by 2.9 hours for people taking the placebo, 9.1 hours for people taking the low dose of TEV-48125 and 11.4 hours for those taking the high dose.

After two weeks, the number of days with moderate or severe headaches, fell by 0.8 days for patients getting the placebo, 1.3 days for the low dose and 1.5 days for the high dose of TEV-48125.

“If these results can be confirmed with larger studies, this could be exciting for people with migraine," said Bigal.

Amgen Injectable Migraine Drug

Amgen (NASDAQ: AMGN) and Novaratis (NYSE: NVS) are also developing a monthly injectable drug --- called erenumab – which contains an antibody that blocks a peptide receptor that is believed to transmit migraine pain signals.

In a Phase II study, 667 chronic migraine patients were injected with a placebo or two different doses (70 mg or 140 mg) of erenumab. At the start of the study, patients were experiencing about 18 migraine days per month.

Patients who received erenumab at either dose experienced an average 6.6-day reduction in migraine days, compared to a 4.2-day reduction in those who receive a placebo. Less than five percent of the  patients treated with erenumab had a side effect, such as injection site pain, upper respiratory tract infection and nausea.

Erenumab is currently under evaluation in several large global, randomized, double-blind, placebo-controlled trials to assess its safety and efficacy in migraine prevention. Amgen expects results from a Phase III study of erenumab in the second half of 2016. Depending on the findings, that could result in an early new drug application to the Food and Drug Administration.  

Clinical studies presented this week at the annual meeting of the American Headache Society also highlighted some promising new migraine treatments.

Alder BioPharmaceuticals presented data showing that a single injection of a drug called ALD403 reduces migraine for up to six months. In a recent Phase II study of patients with chronic migraine, ALD403 significantly reduced migraines by 75 percent in up to a third of patients. 

“A 75 percent reduction in migraine days for these patients means a reduction of 12 or more migraine days each month,” said Jeffrey T.L. Smith, MD, Senior Vice President at Alder. “This equates to giving patients back roughly two weeks of their lives after a single administration.”

Researchers at Montefiore Medical Center and Albert Einstein College of Medicine reported results from a placebo controlled study on the efficacy of ubrogepant in treating a single migraine attack. Patients who received ubrogepant reported a reduction in headache severity from severe or moderate to mild or none within two hours.

Ubrogepant is free of known cardiovascular risk and may provide an important treatment option for patients who suffer from cardiovascular disease. 

Migraine affect 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. About half of people living with migraine are undiagnosed.

Most Medical Marijuana Patients Benefit From Treatment

By Pat Anson, Editor

Over 90 percent of long term medical marijuana patients reported significant improvement in their pain and nausea while using cannabis, according to researchers at Israel’s Ben-Gurion University of the Negev.

Medical marijuana has been legal in Israel for over 10 years, but this was the first in-depth study of patients who have a cannabis prescription from Israel’s Ministry of Health.

"Although medical cannabis has been legal for a decade and is licensed to patients to relieve pain and other symptoms, there has been no information about the users themselves," said Pesach Shvartzman, a professor at Ben-Gurion’s Faculty of Health Sciences.

The study examined more than 2,000 cancer and non-cancer patients using medical marijuana. Almost all said they sought a cannabis prescription after trying conventional treatments that were ineffective. Patients were interviewed by telephone in the first three months of treatment and subsequently every four months for two years. 

Users reported that their pain, nausea, anxiety, appetite, and general feeling had improved. Fewer than one in 10 stopped using marijuana due to side effects or ineffectiveness after the first interview, and only six percent after the second interview.

About three out of four patients experienced minor side effects that included dry mouth, hunger, sleepiness or “high” sensations.

Three-quarters of the patients smoked marijuana, while one in five used a vaporizer or cannabis oil.

Israel still considers cannabis a “dangerous drug” and it is not registered as a medicine. However, the Ministry of Health says “there is evidence that cannabis could help patients suffering from certain medical conditions and alleviate their suffering.”

There are over 20,000 registered marijuana users in Israel. About 50 new users are approved each week by the Health Ministry.

Ministry of Health regulations allow for medical marijuana to be used to treat cancer symptoms and to reduce the side effects of chemotherapy. Eight farms have Ministry of Health permission to grow cannabis for medicinal use, and four companies have permission to deliver cannabis to cancer patients.

The High Cost of Anxiety Drugs Gives Me Anxiety

By Crystal Lindell, Columnist

I recently got a new prescription for a drug that’s supposed to help with my anxiety — which is a debilitating mix caused by opioid withdrawal and what I would call a base level of anxiety that runs through my bones.

The ironic thing about what happened is that when I went to pick up the anxiety medication, the cost of the prescription nearly gave me an anxiety attack — right there at the pharmacy.

The co-pay was $65.

It gets worse. My doctor wanted to gradually move me up on the dose, so he had ordered some 10 mg pills and some 20 mg pills. The insurance company wanted me to pay $65 for EACH dose! That’s $130. 

We need to talk about co-pays. There’s this misconception in America that if you have health insurance, then you don’t have to really worry about medical bills.

But that’s so incredibly not true. 

Listen, I wish a $65 co-pay for medication was no big deal for me. I wish I could just whip out some hundos every time I stopped in the pharmacy and throw them around like confetti, but alas, I am not a rapper or a Kardashian. 

So when my insurance company tells me that the medication I am taking is “not preferred” and thus comes with a $65 co-pay, I cry a little inside. Especially since it’s a monthly prescription.

Add in a couple other meds ($25/month) and I’m looking at $90 a month for prescriptions. That’s literally an electric bill, or four tanks of gas, or about 10 percent of my rent. 

I asked the insurance company if I could appeal the fact that it’s not their preferred medication, seeing as how I had what I thought were very valid reasons. 

1)  I had a horrific reaction to the one that is preferred, and ended up in the ER.

2)  As a response to the horrific reaction to the other drug, my doctor ran genetic testing to see which meds would work best for me, and after a lot of consideration we decided on this one.

3)  This is the medication my doctor chose.

But the insurance company was basically like, “Umm, yeah, no you can’t appeal.” Something about how they do technically cover it, so there’s nothing to appeal.

They literally tried to tell me that my doctor should just prescribe one of the preferred meds, completely ignoring the fact that my psychiatrist had literally spent hours with me talking about all the pros and cons before he decided on this one.

And then they had the audacity to act like it was no big deal. But if it’s no big deal, why don’t they pay the $65 then?

My $65 co-pay is just one small example of all the ways people with insurance can still find themselves with mountains of medical bills. There’s also the $30 co-pay for every single doctor’s appointment, and the $2,500 deductibles you run into every time you’re in the ER.

I live paycheck to paycheck, and all the medicals bills can make it hard to breathe. In fact, it’s enough to give a girl an anxiety attack.

Crystal Lindell is a journalist who lives in Illinois. She loves Taco Bell, watching "Burn Notice" episodes on Netflix and Snicker's Bites. She has had intercostal neuralgia since February 2013.

Crystal writes about it on her blog, “The Only Certainty is Bad Grammar.”

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.

Rheumatoid Arthritis Drug Linked to Overdoses

Pat Anson, Editor

A drug that’s long been used to treat rheumatoid arthritis and other autoimmune diseases has been linked to dozens of deaths in the U.S. and Australia, mainly because patients have taken it daily rather than the recommended weekly dose, according to a new study published in the Medical Journal of Australia.

Methotrexate was originally developed and is still used for chemotherapy because of its ability to stop the growth and spread of tumors. Because it is also effective as an immune system inhibitor, low doses of methotrexate became a front line therapy for rheumatoid arthritis in the 1950’s. It is also used to treat psoriasis, lupus, sarcoidosis, and inflammatory bowel diseases such as Crohn’s.

Researchers say methotrexate is safe when taken once or twice a week, but the drug is so potent that accidental daily dosing can be lethal.

“The unusual dosing schedule of low dose methotrexate is associated with a risk that it will be prescribed, dispensed or administered daily instead of weekly,” said lead author Rose Cairns, PhD, of the NSW Poisons Information Centre in Australia.

“Used appropriately, methotrexate is considered safe and efficacious; accidental daily dosing, however, can potentially be lethal. Higher or more frequent doses can result in gastro-intestinal mucosal ulceration, hepatotoxicity, myelosuppression, sepsis and death.”

In a review of medication errors in Australia from 2004 to 2014, researchers linked methotrexate to 22 deaths, including seven cases in which erroneous daily dosing was documented. One patient took methotrexate for 10 consecutive days. Reasons for the errors included patient misunderstanding and incorrect packaging of the drug by pharmacists.

A similar study of medication errors in the U.S. over a 4 year period identified over 100 methotrexate dosing errors that resulted in 25 deaths. Over a third (37%) of the errors were attributed to the prescriber, 20% to the patient, 19% to pharmacists, and 18% to administration by a health care professional.

The researchers also found a “worrying increase” in the number of medication errors just in the past year.

“It is difficult to explain this increase, but the risk of methotrexate medication error may be increasing as the population ages. Older people may be at increased risk because of a range of problems that includes confusion, memory difficulties, and age-related decline in visual acuity,” said Cairns.

Cairns and her colleagues say more needs to be done by drug makers and health professionals to reduce the risk of methotrexate overdosing, such as clearer labeling, smaller sized packages, and distinctly colored tablets.

"Methotrexate use is likely to continue increasing as Australia's population ages, so that additional measures are needed to prevent these errors," the authors concluded.

Living My Retirement in Pain

By Marleina Hampton, Guest Columnist

At the age of 66, I never thought I would be living my retirement life in pain.

At age 13 I was diagnosed with scoliosis, a curvature of the spine. The choice was made that I would wear a cast from my collarbone to my pelvis in order to "hold" the spine straight. Surgery was not an option.

During my late 20's, my back started to bother me and by the time my 30's arrived, I was in pain after standing or sitting. When I moved to California in 1990, I started looking for ways to treat this pain that was getting steadily worse. I did physical therapy, epidurals, prolotherapy and every other office procedure known to man, without success.

In 2003 when the pain was so bad I wanted to die, I had my first back surgery, which gave me some relief. But it wasn't long before I was suffering again.

Fast forward to 2012, I relented and had spinal fusion surgery at Cedars-Sinai Medical Center. My back is now fused from T10 to S1, with two titanium rods and 20 screws.

My doctor told me that I would be on some type of pain medication for the remainder of my life. I saw several pain management doctors and finally asked my primary care provider if he would take over my pain management.

MARLEINA HAMPTON

In 2015, my husband retired and we moved to Prescott, Arizona. Little did I know that my nightmare was just beginning! I couldn't find a doctor who would accept me as a patient!  Prescott has a high number of addiction recovery homes and the pain management doctors refuse to accept appointments without a referral.

I spent weeks trying to find a doctor and was told by medical professionals that they are not comfortable having me as a patient! Just recently, I drove almost 2 hours through rain, ice, and snow to see a pain management doctor in Phoenix. I thought I would receive a higher level of care in a larger city. But when he found out that I was not a candidate for epidurals, he said he wasn't comfortable having me as a patient. That his practice did not prescribe drugs!

In tears, I called my doctors in California and they too were appalled that I was being treated this way. Never in my life did I have a problem receiving medication.

I finally found a doctor who agreed to prescribe pain medication for me. Now I go in every month to pick up my prescriptions. I was told that my doctor continues to receive emails asking him to cut down on the number of opioid prescriptions he writes. He knows what my life would be like with pain medication and said he would fight for me.

If I should be denied pain medication, I will probably join the ranks of many before me who have taken their lives because they no longer can cope with the pain. Every month I wonder if this is the month that my doctor will get tired of the battle. This is not the retirement life I had imagined.

Marleina Hampton lives in Prescott, Arizona.

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 represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Canadian Province Adopts CDC Guidelines

By Pat Anson, Editor

Less than three months after their adoption in the United States, the CDC’s opioid prescribing guidelines are now being implemented in Canada.

The College of Physicians and Surgeons of British Columbia has released new professional standards and guidelines that are closely modeled after the CDC’s guidelines.

One key difference is that while the CDC’s guidelines are “voluntary” and intended only for primary care physicians, British Columbia’s standards of care are legally enforceable for all opioid prescribers because they set a “minimum standard of professional behaviour and ethical conduct.”

“The public health crisis of prescription drug misuse has developed in part due to the prescribing of physicians. The profession has a collective ethical responsibility to mitigate its contribution to the problem of prescription drug misuse, particularly the over-prescribing of opioids, sedatives and stimulants,” the college said.

"Every physician is professionally responsible for the prescription that they provide to a patient."

Like the CDC guidelines, the college discourages the prescribing of opioids for chronic pain, but goes even further by saying they should not be used to treat three specific health conditions: headaches, fibromyalgia and low back pain.

Opioids for acute pain should be limited to three to seven days’ supply, and when prescribed for chronic pain should be limited to only a month’s supply at a time. British Columbia physicians are also warned not to prescribe opioids concurrently with benzodiazepines and other anxiety medication.

Doctors are also cautioned to carefully document their reasons for increasing doses over 50 morphine milligram equivalents (MME) per day and to avoid increasing the dose to over 90 MME per day.

The British Columbia standards are more strict than Canada’s national guidelines, which have not been revised since 2010, “leaving them out of date with current research associated with taking painkillers,” according to The Globe and Mail.

“While Canada’s guidelines for opioid-prescription are expected to be updated in January, the death toll is mounting too quickly to wait,” said the Toronto Star in an editorial urging Ontario’s College of Physicians and Surgeons to adopt guidelines similar to British Columbia’s.

“B.C. has shown the way for other provincial regulatory bodies. Colleges across the country, including Ontario’s, should follow its example and set informed rules now. Injudicious prescriptions have already destroyed the lives of too many Canadians.”

Like the United States, Canada is one of the top opioid prescribing countries in the world and is struggling with an “epidemic” of addiction and overdoses. A growing number of deaths, however, can be attributed to illegal opioids such as fentanyl and heroin, and it remains in doubt whether restricting access to prescription opioids will lessen the problem or only make it worse by forcing legitimate patients to turn to the streets for pain relief.

As Pain News Network has reported, Canadian drug dealers are now selling counterfeit painkillers laced with fentanyl, an opioid that is more potent and dangerous than most pain medications.

The Star sees the problem differently, blaming doctors for Canada's opioid problem.

“It’s hard to believe that a large part of the blame for Canada’s latest drug-addiction crisis lies not with dealers, but with doctors. That is the conclusion of a growing number of health experts across the country who say our ballooning opioid problem can’t be solved until physicians stem the flow of prescriptions for the highly addictive painkillers,” the newspaper said in its editorial.

Pain Patients Sound Off on ‘Barbaric’ Treatment

By Pat Anson, Editor

We received a lot of feedback from this month’s PNN newsletter, which looked at the impact the CDC’s opioid prescribing guidelines are having on pain patients.

The guidelines – which discourage the use of opioids to treat chronic pain -- are voluntary and recommended only for primary care providers, yet pain patients say they are being widely implemented by physicians regardless of specialty. Many wrote to tell us they were being cutoff or weaned off opioids. Some were having trouble just finding a doctor willing to treat them.

I thought I’d share some of the comments with you, as well as some tips on what to do if your doctor drops you from their practice.

"My pain medications were reduced the very first appointment I had with my doctor after the CDC guidelines came down,” said Kathleen, who suffers from neck and shoulder pain.

“I have not had an increase in my pain medications in over 4 years and yet I was told that I may have hyperalgesia. I was told that the guidelines are going to cause insurance companies to reject payment for pain meds and that I was going to be weaned off, slowly, but weaned off.” 

“Do I believe suicide rates will increase due to these new guidelines? Absolutely.  ABSOLUTELY!”  wrote Karen, who suffers from Chronic Regional Pain Syndrome and other chronic conditions.

“For myself, I'd choose quality of life over quantity. And I think that's true for most people in chronic pain.  When the pain becomes too great, goes untreated and there's no hope in sight, I imagine death would be a welcome end.”

“All I know is they are trying to take my wife’s pain meds away because of a bunch of junkies is insane,” said one man. “They are forcing a lot of people in pain to turn to the streets. If we had an animal that we allowed to live in pain we would be fined or jailed for cruelty to an animal but according to our government it’s ok to do it to people. My wife said she won’t live like that. Wrong. So wrong.”

“I too have been told from my doctor that I'll no longer be receiving Rx narcotics from him. He said as a group they've decided not to prescribe to anyone but cancer patients,” wrote Peggy, who’s been taking opioids for almost 20 years. “There will come a time when I'm bed bound once again, not able to even cook, shower, care for myself because opioids are the only thing that work for me.”

Even some cancer patients are being weaned off opioids, as we learned from 64-year old Dan Hartsgrove, who was diagnosed with throat cancer last year.

“I suffer every day. Cannot eat or sleep due to the pain,” Dan wrote. “I have enough to deal with and no way in the world should be suffering in this manner. No one should. This whole opioid war is a failure and aimed at the wrong people.” 

Dan’s pain management doctor said he was taking “too much medication” and discharged him after Dan refused to have a pain pump installed. Even his chemotherapy doctor has lowered his dosage.

“It was fine for me to be allowed the poison of chemo and radiation, however I am allowed no relief from suffering daily,” said Dan.  “Where is the compassion? My wife had a friend who was 49 and had throat cancer, he was in so much pain he would put his head through his wall at night when he was trying to sleep. The doctors would not help control his pain and he committed suicide 2 years ago. This is barbaric.  I am slowly slipping away from this pain. I need to eat and just can't. Everybody thinks cancer patients are excluded from this war on opioids. NOT TRUE.”

A Florida woman who has been taking opioids for years for an autoimmune disease also says her doctor is trying to talk her into a pain pump.

“I currently have a kind and understanding pain management doctor who knows this is helping me but his office was raided last year by DEA agents and ever since then he has been afraid to prescribe,” she wrote.  “I feel I have been given a choice to get the pump or else. I shouldn't have to get something I don't want just to please the DEA and CDC. My doctor feels that by years end opioids will become less available at the pharmacy.”

“Now every snake oil salesman is pushing something to take the pain away. It’s all garbage. Opioids as a whole have been the gold standard for thousands of years when it comes to pain relief,” said Michael. “Take away the only thing that legitimately reduces our pain, then just kill us now, put us in jail or a psychiatric hospital. This is where we will ALL end up if this continues.”

“The last thing chronic pain patients need is to take less medication than they should because they're afraid of either being labelled addicts or even worse, having their medicine taken away without any notice,” said Doreen, who suffers from fibromyalgia and autoimmune diseases.

“My rheumatologist has told me I cannot ever stop taking the pain patches I'm on. I don't enjoy taking them, but it scares the hell out of me wondering what will happen when I get to that point! Please consider chronic pain patients when talking about cancelling the prescribing of opioids!! Where does this leave us?”

Tips for Dealing with Patient Abandonment

Patient advocate and fibromyalgia sufferer Celeste Cooper says she’s been “deluged” with complaints from patients who have been abandoned by their doctors.

“It’s important to understand what is happening. Physicians are caught in a quagmire of discontent. They are put in harm’s way by the DEA and other government agencies if they do prescribe opioids, and yet they run the risk of losing their license if they don’t treat their patient’s pain and it causes harm,” Celeste wrote on her website.

“When a patient is fired, the physician has an ethical obligation to ensure a patient’s care is uninterrupted or they are subject to the repercussions of patient abandonment. If a patient is harmed because they are abandoned, there may be grounds for a lawsuit.”

Celeste says it’s important to gather factual evidence to protect your legal rights, such as getting a written letter from the doctor stating their reasons for stopping your pain care. The physician is also obligated to provide copies of all relevant medical records.

If you have been harmed due to patient abandonment or changes in pain care, you could file a complaint against your doctor under the Ensuring Patient Access and Effective Drug Enforcement Act of 2016, which was signed into law in April.

Flood Congress with Phone Calls

Connie Raterink suggests another way pain patients can get their voices heard. In 1994 she was homeschooling her children when Congress was considering legislation that would have basically made home schools illegal. When attempts to amend the bill failed, home school advocates flooded their congressional representatives with phone calls.

“We literally shut down Congress that day. They couldn't make outgoing calls, and the only ones getting through were home schoolers. They couldn't even call their own staff within Congress!” Connie said. “They got the message, and immediately amended the bill. Over the few days involved with this, there were over one million phone calls made.”

Connie, who suffers from a severe form of osteoporosis, thinks the same approach could be used by pain patients.

“So, pick a date... get the message out.... there are 600 people in my Church alone that would call just on MY behalf,” she wrote. “Congress again needs to hear from us individually, but en masse. We need to tell them to get their noses out of our medical records, and let our doctors make the decisions for their patients, not Congress.”

To learn more about the home schoolers’ campaign, click here.

To sign up for our free monthly newsletter, click here.

Belbuca Effective in Treating Pain Long Term

By Pat Anson, Editor

A new opioid film designed to be taken orally twice a day significantly reduces pain and the need for breakthrough pain medication in patients with moderate to severe pain, according to a new clinical study by Endo International (NASDAQ: ENDP). The results of the Phase III study were released this weekend at the International Conference on Opioids in Boston.

Belbuca is the only analgesic formulation of buprenorphine in a sublingual film that is dissolved in the mouth and absorbed through the inner lining of the cheek.

Buprenorphine is an opioid classified as a Schedule III controlled substance, which means it has lower abuse potential than Schedule II drugs, a category that includes opioids such as hydrocodone. Buprenorphine is also used to treat addiction when combined with naloxone.

Over 400 patients with moderate to severe pain took Belbuca for 48 weeks after being titrated to find the most effective dose. During long term treatment, the average daily pain score was about 3 on a scale of 0 (no pain) to 10 (worst pain imaginable).

The need for daily rescue medication to relieve breakthrough pain decreased from an average of 3 tablets to 1.1 tablets.

"Many patients living with chronic pain require long-term treatment to control their suffering, so it is important that patients have options to manage their pain," said Martin Hale, MD, Medical Director of Gold Coast Research, one of the study's investigators. "These new findings support the safety and tolerability of treatment with Belbuca across a broad range of dosage strengths.”

About half of the patients (54%) experienced some type of side effect, including nausea, constipation, headache, vomiting and upper respiratory tract infection.

Belbuca was approved by the U.S. Food and Drug Administration in October 2015 for use in patients with pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatments are inadequate.

Belbuca utilizes a drug delivery system developed by BioDelivery Sciences (NASDAQ: BDSI). Because the oral film delivers buprenorphine into the bloodstream faster than pills or skin patches, lower doses are needed to treat pain. The film contains one-tenth to one-twentieth the amount of buprenorphine as Suboxone and other products that are used to treat opioid addiction.

Belbuca is available in seven different dosages, allowing physicians to titrate Belbuca to a tolerable dose that provides pain relief with fewer side effects. According to the Healthcare Bluebook, a 75mcg, 60-day supply of Belbuca should cost about $265.

5 Tips on Leaving Your Career Due to Health Issues

By Ellen Lenox Smith, Columnist

Leaving your career due to chronic pain and illness can be heartbreaking, but for some of us it’s a necessary step.

There was never a day in my life as a teacher that I didn’t love getting up and going to work, yet that career had to end due to the progression of Ehlers Danlos syndrome and sarcoidosis. I felt so lost and not sure who I would be without the career I had.

So, one day before retiring, I went for a walk at the Scituate Reservoir in Rhode Island with my dogs at the time, Corey and Carmel. I made the decision to not think about all the emotions entering my mind -- trying to push those negative thoughts away so I could de-stress. I only allowed myself to look and listen to nature.

Within minutes, I started to have words and thoughts come into my head. Before I knew it, I had to come home, sit at the computer and start writing. The first of what turned out to be over a hundred poems poured out of me. I always laugh when I share this experience, for I am not particularly into poetry.

This was the first of my eventual one hundred poems, which helped cleanse my emotions and prepare for announcing my need for retirement and a life with two progressive conditions:    

ELLEN LENOX SMITH

I Attended a Concert This Morning

It was that time to escape, to go for an adventure. We were attending a concert. All ten of our legs got into the car to begin the trip. No clues had been provided to us to prepare for what an impact this performance would have on the rest of our day.

We arrived, opened the door and got out, some of us more easily than others, and then shut the door off from life as we knew it…

It seems that we were late for the concert. It was already in progression. We knew when we arrived that we would have to follow the rules. We had to turn off everything from our lives; the cell, the TV, the radio, computer and most importantly, “the mind”.

We began to walk and quickly heard the concert. It felt loud and overwhelming at first. It felt crowded listening to it despite a lot of space provided. It was too much to hear, too much to absorb. And “the mind”, it wanted to come on, even though it knew it wasn’t invited. But it seemed to finally learn how to respect the rule.

As it cooperated, the concert began to take on a new dimension of sounds and feelings. It became soft, clearer, calmer and incredibly comforting. This concert became exceptional, being absorbed in every space of the mind and body.

And all that was needed to feel this was to just turn off everything else.

The concert never came to a close, but it was time we return to the car and journey back to home as we know and love it. But, we knew we had had an experience that gave us strength and renewal to our lives.

Corey, Carmel and Mom all took a moment to enjoy nature and listen to the truth of life. It was a concert that will never be forgotten. A lesson was learned, “turn it all off”, attend the concert of nature. It’s there for us all and is open at all times.

Looking back, I learned that writing about my emotions helped me face the changes that were happening to my life. It was a very cleansing process that I entered and I continue to do it.

Here are some tips if you are also dealing with the loss of your career:

1. Try writing down emotions that are swirling in your head. You will gain more than you might realize with this process. Many write to the US Pain Foundation for help and I respond to them, but often I do not hear back from them. I believe this is because they’ve cleansed their emotions by just writing down their story and frustrations.
2. Accept that you will have to redefine who you are. I was a teacher by profession, but have discovered I am still teaching, just in a different way.
3. Remember you are not alone for many have also had to face the loss of their career. Try to find comfort in knowing this. I talk to myself and say that if they can do this, so can I!
4. Mourn your losses. You are human and allowed to do this, but remember to move on from this loss too. You are more than your career. There are others things in life that will make you feel worthwhile and productive. It will take work to figure out what you will do next, but it is a worthwhile effort.
5. Try to not get stuck on “Why me?” Instead, try to find a way to move on with acceptance and grace for others to learn from. I always remind myself that although my four sons are now adults, they are still observing how I handle my life, including this process of letting go and redefining. I want to be remembered by them for trying, fighting and not giving up.

I know it is heartbreaking to have to step away from a career, especially if it is one you love. But you also have to remind yourself that you have one life to live, and you need to redefine yourself and find things that will bring meaning, joy and happiness back, despite the loss.

I know this is hard to do, but the effort will pay off in the end. Despite illness, you can discover new things about yourself and have a positive impact in life. Be strong, reach out for support and may you, too, discover there is life despite your huge loss.

Ellen Lenox Smith 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.

Ellen recently published her new book, “It Hurts Like Hell!: I live with pain -- and have a good life, anyway.”

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.

Fentanyl Blamed in Prince Overdose

By Pat Anson, Editor

A medical examiner has confirmed widespread speculation that opioids were involved in the accidental death of pop star Prince. The surprise was the type of opioid that was found in the singer's system.

“The decedent self-administered fentanyl,” Dr. A. Quinn Strobl, chief medical examiner for the Midwest Medical Examiner’s Office, wrote in his widely awaited report, which you can see by clicking here.

The report was released six weeks after Prince's death and only covered the manner and cause of death. All other information is considered private under Minnesota law.

The medical examiner’s report is likely to focus new attention on the so-called opioid abuse epidemic, which is routinely blamed on prescription opioids. Fentanyl is a potent opioid more powerful than morphine, and when prescribed the drug is generally only given to people in severe pain.

However, the report does not state whether the fentanyl that killed Prince was from a prescription or if it was illicit fentanyl obtained through other means.

Illicit fentanyl is an odorless white powder that is typically combined with heroin or cocaine to boost their potency. In recent months it has increasingly been found in counterfeit pain medication sold on the streets.  

Thousands of people have died from fentanyl overdoses in the U.S. and Canada, but because of the nature of the drug it’s impossible to tell whether it was prescribed legally and used for medical reasons or manufactured illegally and sold as a street drug.

“Toxicology tests used by coroners and medical examiners are unable to distinguish between prescription and illicit fentanyl. Based on reports from states and drug seizure data, however, a substantial portion of the increase in synthetic opioid deaths appears to be related to increased availability of illicit fentanyl,” said a recent report from the Centers for Disease Control and Prevention, which nevertheless still classifies all fentanyl overdoses as prescription drug deaths.

Massachusetts and Rhode Island recently reported a “significant increase” in fentanyl-related overdoses, with nearly 60% of the fatal overdoses in those states now attributed to fentanyl. Rhode Island health officials say the shift to fentanyl worsened when “more focused efforts were undertaken nationally to reduce the supply of prescription drugs.”  

Prince’s body was found in an elevator at his Paisley Park estate near Minneapolis on April 21. There was immediate speculation the singer was addicted to pain medication that he took for hip pain, but the only opioid ever mentioned was Percocet.  In the days before his death, Prince reportedly sought help from an addiction specialist in California.

The singer’s use of painkillers and how he obtained them are now the focus of a criminal investigation. No charges have been filed and a judge has sealed all records in the case.

According to search warrant that was accidentally released and obtained by the Los Angeles Times, Dr. Michael Todd Schulenberg, a family medicine practitioner, treated Prince on April 7 and 20, the day before his death.