Kratom Petition Reaches Goal, But Now What?

By Pat Anson, Editor

Supporters of a citizens' petition that calls on the Obama administration to reverse a decision that will make the sale and possession of kratom illegal have reached their goal of 100,000 signatures.

But the move is largely symbolic and will probably not prevent the Drug Enforcement Administration from classifying kratom as a Schedule I controlled substance at the end of the month.

The DEA filed notice in the federal register last week for an emergency scheduling of mitragynine and 7-hydroxymitragynine, the two main active ingredients in kratom, which comes from the leaves of a tree that grows in southeast Asia.

Kratom is used in teas and supplements as a natural treatment for pain, depression, anxiety and other medical conditions. The DEA claims kratom is also used recreationally for its "psychoactive effects" and has even been used as a substitute for heroin. Kratom supporters say its no stronger than a cup of coffee.

Under its "We the People" petition rules, the Obama Administration promises to "take action" on an issue whenever supporters are able to gather at least 100,000 signatures online within 30 days.

"We will do our best to respond to petitions that cross the signature threshold within 60 days, however, depending on the topic and the overall volume of petitions from We the People, responses may be delayed," the White House says in a statement on its website.

According to the website whpetitions.info, the average response time for a successful petition is 118 days. Six petitions -- including the kratom petition -- are currently waiting for a response.

Barring a last minute legal challenge, the DEA scheduling of kratom as a controlled substance, alongside heroin, LSD and marijuana, will begin September 30.

"This may go into effect before we get a response from the White House," says Susan Ash, founder of the American Kratom Association, a volunteer organization of kratom users. "That's one of the reasons why we are doing our rally September 13th in front of the White House, so that we can bring this issue to their attention prior to them being required to give us a response."

The Obama administration began hosting "We the People" petitions on the White House website in 2011. Although the petitions have been criticized as a public relations gimmick, some have resulted in federal action, such as legislation allowing consumers to use their mobile devices on any network they choose.

At other times, however, the White House response to a petition has been a statement that only reaffirms current policy. That was the case in 2011, when petitioners asked the administration to legalize marijuana.

"Like many, we are interested in the potential marijuana may have in providing relief to individuals diagnosed with certain serious illnesses," wrote Gil Kerlikowske, Director of the Office of National Drug Control Policy, in the official White House response to the petition.

"That is why we ardently support ongoing research into determining what components of the marijuana plant can be used as medicine. To date, however, neither the FDA nor the Institute of Medicine have found smoked marijuana to meet the modern standard for safe or effective medicine for any condition."

The DEA is taking a similar stance on kratom, saying it has no medically accepted use.

Don’t Let the Media and Medical Profession Fool You

By Richard Oberg, MD, Guest Columnist

Chronic pain patients, like my wife, myself and others with abominable mistreatment, continue to lose the care they need while nothing is being done to address the real issues.

Drug abuse is up, young people are dying and the main culprits aren't prescription drugs, but something much more difficult to control. Heroin and illicit fentanyl, major causes of the increasing deaths, are becoming more widely available and, unfortunately, both of them are opioids.

The media routinely spouts about these “opioid deaths” while implying that prescription pain medication is what caused healthy people to take these illegal drugs. Why? Because they say so, that's why.

As with the recent 60 Minutes nonsense, they embellish the death of some high school quarterback, have a room full of grieving parents who say they had no idea their kids were drug addicts, add the fear that this can happen to you, and we the patients get to bear the brunt of this misdirected insanity.

The CDC addictionologist lobby and other federal agencies seem to have hoodwinked everyone into blaming chronic pain patients for this national problem. This is obvious and evident from countless stories of patient abuse no one seems to want to hear. The word is “scapegoat” and not a single person in power is responsible for anything – only we the patients are.

The CDC, government agencies and, quite frankly, the majority of physicians are NOT well-intended on this issue. They created this patient crisis that could have been avoided.

Don't let the medical profession that I was a part of for nearly four decades fool you. Physician sub-specialty organizations now exist for the benefit of physicians, not patients, and are mostly about maintaining control and money. Had these organizations stood up to defend patients against the CDC, and the ridiculous addictionology cohort of psychiatrists and anesthesiologists grooming their financial turf, we wouldn't be here right now. But they didn't, and a majority of physicians say they actually support the guidelines.

Don't buy the “they made me do it” line. It is misdirected nonsense, just as eliminating the pain scale to prevent any accountability is. Physicians don’t like accountability.

Inevitably, doctors still willing to write prescriptions for pain meds will attract greater numbers of chronic pain patients – and become easy prey for the DEA or their physician colleagues who don’t approve. Some of these doctors will become outliers in medical associations whose members tell them to stop because they don’t want to see or treat patients like us.

Why doesn't anyone ask where all the patients of physician practices that are being shut down go to? It's because no one in power cares, that's why. And then there’s the sheer ignorance or bigotry of many physicians who profess to be “pain management experts.”

The American Medical Association (AMA) once represented 75% of all licensed physicians and supported the best care for patients. 

Today, membership in the AMA has declined to just 15-20% of physicians, as subspecialty organizations gained power and patient care became driven by those isolated subspecialties. 

These organizations support the flow of wealth to their specialties better than the AMA ever could.  With increasing specialization, patient care became highly fragmented for those with complex diseases, yet there was no attempt or incentive to coordinate care. It became every patient for himself.

It is extremely rare to non-existent for a physician specialist to actually speak to another physician about your care, nor is much if any time spent reading another doctor’s evaluations. It’s just not fiscally expedient with current healthcare models. That is why you’re “re-evaluated” by every new specialist you see and have to reprove your illness over and over, often to skeptical stares.

The major problem with this is that subspecialties often “evaluate” you beyond their competence. For example, a rheumatologist is vastly superior to a psychiatrist if you have an autoimmune disease, but if you’re depressed and miserable because of an undiagnosed autoimmune disease and enter the care of a psychiatrist, the odds of ever getting an appropriate diagnosis are nil. Worse, they can make your life hell.

It’s just not what they do -- they make you fit their model – not the other way around. Whenever you get into the care of some subspecialist unlikely to have any idea what’s wrong with you, it inevitably leads to biases against you because physicians are just as bigoted about what they don’t understand as anyone else.

The attitude of most that my wife and I have encountered (despite both of us being physicians) suggests that most subspecialists get their information from the nightly news rather than medical journals outside of their specialty. Neurosurgeons think opioids are bad because that’s what they’ve heard. And they’d rather believe that than have you tell them otherwise.

From our point of view, it’s would almost be comical if it wasn't so infuriating.

Often, chronic pain patients are not sick enough to warrant hospital care (following acute care protocols), yet are too ill to be seen by outpatient physicians who aren’t reimbursed enough to spend additional time figuring you out or interacting with your other physicians.

And there are plenty of “well patient” visits providing better income – so why bother?

If this sounds bad, it’s because it is. For those who like their anesthesiologist pain care person, good for you. Many of us aren’t so fortunate. And someday you might not be either.

I’m not sure how much worse this will get, with patients losing access to opioids or seeing their doses cut, while overdose death rates continue to rise -- refuting CDC wisdom. Taking meds from chronic pain patients isn’t going to fix a problem caused by healthy people with illegal intentions.

Maybe some powerful mainstream media source will actually ask someone in power what's going on and not settle for anything other than a straight answer. But I wouldn’t hold my breath.

Take the unfortunate demise of Prince and how it has been reported. Whenever someone with career-induced injuries attempts to defeat aging by taking illicit opioid pain medication to continue performing 20 year old moves on a 57-year old body, bad things will result. It shouldn’t be rocket science to figure that out, yet I don’t recall a single media source saying that.

Instead, Prince has become another idiotic reason legitimate patients shouldn’t get opioid pain care – all because he intentionally misused it to extend his career. Because of the actions of a few, the vast majority will suffer. Not exactly stellar for the most expensive healthcare system in the world, is it?

Richard Oberg, MD, is disabled by psoriatic arthritis and no longer practices medicine. Dr. Oberg receives no funding from pharmaceutical companies. 

Pain News Network invites other readers to share their stories with us.  Send them to:  editor@PainNewsNetwork.org. 

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

Miss Understood: A Mother’s Greatest Fear

By Arlene Grau, Columnist

As a mother your main goals are to raise your children to lead happy lives, to always love them, and to keep them safe. I want to see my children excel and get a lot further in life than anything I've ever dreamed of.

Although I have many hopes and aspirations for my two daughters, my worst fear is always lingering in the back of my head.

What if I cursed one of my daughters with a genetic predisposition for an autoimmune disease? What if they develop arthritis or lupus? I could never forgive myself if I knew they were meant to endure the suffering I've lived through.

I would give anything if they would never have to worry about seeing a medical specialist, or needing infusions, blood draws and painkillers just to get by. They already see a pain sufferer’s life through a child’s point of view and that alone is very difficult to handle for a 5 and 9-year old. But burdening them with this lifestyle would be cruel in and of itself.

I'd like to think that I could handle any amount of pain you throw at me. I'll shed some tears and break down a bit, but I think of myself as a genuinely strong individual. However, if you involve my children, then all bets are off and I become vulnerable.

When my oldest daughter was born I suffered from preeclampsia (high blood pressure) and she was born prematurely. She weighed just 4.6 lbs. at birth and was in the neonatal intensive care unit for two weeks.

The day after I was discharged, I was back at her bedside from the time visiting hours began until it was time to go home. She ended up needing surgery at 8 weeks and it was the worst experience I've ever been through.

I can remember how much I wanted both my girls to come home from the hospital with me so I can just love and protect them. My desire for children was always about how much I wanted a family, but I never stopped to think about the possibility of passing down an autoimmune  disease. Now anytime my kids tell me their back or hands hurt, I subconsciously think that it might be arthritis.

I think I may always feel that way. Not only because I'm blaming myself for any pain they may be feeling, but because I know that these diseases do not discriminate against any age group.

Arlene Grau lives in southern California with her family. Arlene 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.

Senza Stimulator Rated More Effective Long Term

By Pat Anson, Editor

A two-year study of an innovative spinal cord stimulator shows the device is more effective at relieving chronic back and leg pain long term than traditional stimulators.

The Senza HF10 spinal cord stimulator uses high frequency pulses of 10,000 Hz to mask a patient’s perception of pain. Traditional stimulators typically use lower frequencies at 40 to 60 Hz.  

Spinal cord stimulators (SCS) are often considered the treatment of last resort for chronic back and leg pain, because the devices have to be surgically placed near the spine and connected to batteries implanted under the skin. The devices send electrical impulses into the spine to mask pain.

In a study of 171 patients with implanted SCS devices, 76% of those with back pain and 73% with leg pain had pain relief after 24 months with the Senza HF10. That compares to about 50% of the patients implanted with a traditional stimulator.

image courtesy nevro

The Senza stimulator is made by Nevro Corp. (NYSE: NVRO) a medical device company in Redwood City, California.

"By demonstrating a significant and durable decrease in back and leg pain over a two-year period, Nevro's HF10 therapy represents an important and evidence-based advance in pain medicine,” said Leo Kapural, MD, the lead author and principal investigator of the study, which is published in the journal Neurosurgery.  

“Extending comparative safety and efficacy outcomes from 12 to 24 months provides physicians, patients, and payers with rigorous evidence demonstrating the durability of SCS in treating chronic pain.”

The Senza SCS was approved by the Food and Drug Administration last year. It has been available in Europe and Australia for several years.

Nevro says the HF10 stimulator is the only SCS therapy that provides pain relief without paresthesia -- a tingling or buzzing sensation that lower-frequency stimulators use to help mask pain signals. Some patients have found paresthesia uncomfortable.

MarketsandMarkets, a market research firm based in Dallas, estimates the global market for spinal cord stimulators and other neuromodulation devices could reach $6.8 billion by 2017.

Should the DEA Ban Kratom? Take Our Survey

By Pat Anson, Editor

A natural supplement that most Americans are not familiar with is suddenly being thrust into the national spotlight and debate over opioid addiction.

Nearly 70,000 people have signed a White House petition and many are planning to attend a rally next week in Washington DC to protest plans by the DEA to classify a kratom as an illegal narcotic.

Kratom comes from the leaves of a tree that grows in southeast Asia, where it has been used for centuries as a natural medicine. Only in recent years has kratom caught on in the United States – where the leaves are used in teas and supplements to treat pain, depression, anxiety and even addiction.

Since the DEA’s surprise decision was announced, many kratom supporters have written us saying that kratom is far more effective and safer than pharmaceutical drugs.

“I was amazed at the pain relief, energy, anxiety relief, and mood boost that it gave me,” wrote Connie Fuller, a high school teacher and mother of two who suffers from arthritis, fibromyalgia, back pain and other chronic conditions. “I still feel pain 24/7 but it’s quite tolerable most days and I gladly smile again. We MUST keep kratom legal so that I can keep my life.”

“I'm a kratom user of two years and my life has dramatically improved. I'm so scared about this. Not sure what I'm going to do. I don't want to be on pharmaceuticals again. But I don't want to be a criminal either,” said Jordan.

Is kratom really the “hazard to public safety” that the DEA says it is? Does it make people high? Where is the evidence that it actually works?

In an effort to answer some of these questions, Pain News Network has partnered with the American Kratom Association in an online survey to see why people use kratom, whether it is effective, and what they plan on doing if the sale and possession of kratom is criminalized by the DEA.  

(Update: The survey is now closed. The results will be released September 20)

“The CDC, DEA and other federal agencies, as well as the media, believe that we are nothing but a bunch of teenagers or young adults who are only using kratom on a recreational basis and are abusing it,” says Susan Ash, who founded the American Kratom Association. “That is simply not the case. Our members are largely people in their 40’s, 50’s and 60’s. We have a lot of soccer moms, firefighters, lawyers and lobbyists who are members. To paint a truer picture of the kind of people that are using this product medicinally, this survey will be helpful in showing that we’re not the kind of people that they think we are.”

The DEA notice published in the Federal Register last week will classify the two main active ingredients in kratom -- mitragynine and 7-hydroxymitragynine -- as Schedule I controlled substances, the same classification used for heroin, LSD and marijuana.

Although mitragynine and 7-hydroxymitragynine are alkaloids, the DEA took the unusual step of calling them “opioid substances,” even though they don’t originate from the poppy plant like other opioid pain medications. The DEA saidkratom has “a high potential for abuse” and was linked to several deaths.

“In the United States, kratom is misused to self-treat chronic pain and opioid withdrawal symptoms, with users reporting its effects to be comparable to prescription opioids. Users have also reported dose-dependent psychoactive effects to include euphoria, simultaneous stimulation and relaxation, analgesia, vivid dreams, and sedation,”  the DEA said.

“They did that on purpose,” says Ash. “They put ‘opioid’ in there to get sympathy from all of the Congress people already working on this issue, who will look at that Federal Register notice and say ‘Oh my God, another opioid.’ We need to ban it.”   

Another unusual aspect of the DEA action is that there was no public notice or comment period, as there usually is when a controlled substance is scheduled. It will become illegal to possess or sell mitragynine and 7-hydroxymitragynine – in other words, kratom itself – at the end of September.

“This emergency scheduling only gives people 30 days to come up with a solution. Most people can’t even get in to see their doctors in 30 days,” says Ash. “They’re putting tens of thousands of people in a position where they have to decide 'Do I go back to pharmaceuticals?' and 'Do I even have time to see my doctor?'

“We’re leaving people completely in the lurch that count on kratom for their health and well-being. People have been using kratom safely for years and these people are basically being told you need to cut off your use abruptly.”

Ash says the American Kratom Association is meeting with lawyers to pursue every possible legal avenue to stop or delay the DEA's scheduling process. She’s also hopeful that grassroots action, the rally in Washington, and the results of our survey will help educate the public and media about kratom’s benefits.  

What Alternative Treatments Work for Chronic Pain?

By Pat Anson, Editor

A review of over a hundred clinical trials has found that some alternative pain therapies such as acupuncture, yoga, tai chi, and massage are effective in treating chronic back and neck pain, osteoarthritis of the knee, migraine and headaches.

But only weak evidence was found that they might help people with fibromyalgia.

The review was conducted by scientists at the National Center for Complementary and Integrative Health at the National Institutes of Health (NIH). The study,  published online in the Mayo Clinic Proceedings,  was conducted to give patients and primary care providers better evidence on the effectiveness of non-drug treatments for chronic pain.

“One major goal for this study was to be as relevant as possible to primary care providers in the United States, who frequently see and care for patients with painful conditions. Providers need more high quality information on the evidence base for pain management tools, especially nondrug approaches,” said lead author Richard Nahin, PhD, an epidemiologist with NIH.

“Overall, the data suggest that some complementary approaches may help some patients manage, though not cure, painful health conditions.”

The scientists “found promise” in the safety and effectiveness of these treatments:

• Acupuncture and yoga for back pain
• Acupuncture and tai chi for osteoarthritis of the knee
• Massage therapy for neck pain  
• Relaxation techniques for severe headaches and migraine.

Though the evidence was weaker, the researchers found that massage, spinal manipulation, and osteopathic manipulation may provide some help for back pain. Relaxation approaches and tai chi might also help some people with fibromyalgia.

Mixed or no evidence was found that glucosamine, chondroitin, omega-3 fatty acids, and S-Adenosyl methionine (SAMe) are effective in treating chronic pain.

Each year Americans spend about $30 billion on alternative and so-called complimentary health treatments, even though few studies have been conducted on their effectiveness. The NIH researchers had to go back 50 years to find enough clinical studies to review. Many of the studies involved fewer than 100 people, which weakens the conclusions drawn from them. Some of the same studies were used by the Centers for Disease Control and Prevention as evidence for its opioid prescribing guidelines, which encourage "non-pharmacological" treatments for chronic pain.

“It's important that continued research explore how these approaches actually work and whether these findings apply broadly in diverse clinical settings and patient populations," said David Shurtleff, PhD, deputy director of National Center for Complementary and Integrative Health.

Make the Life that You Want

By Barby Ingle, Columnist

Lately I have been living my dreams, but at the same time realizing how much I have gone through over the years, especially the last two.

Before I got sick I was active, a go-getter, never quit and efficient. Nowadays, I am still as active as I can be, still setting goals and working towards accomplishing them, and trying to keep a positive attitude. But I am not efficient anymore. It’s a large change.

I find that many people who develop an autoimmune condition were overachievers prior to their illness. Did we run ourselves down? Did something in our past prevent us from healing? Or did we just draw the short straw of life?

At this point it doesn’t really matter to me. A life with chronic pain management is my reality. I didn’t do it so well in the beginning and looked for others to fix me. I didn’t take responsibility for creating my own oasis. It was too much just trying to get to the doctor’s office for appointments when not being able to drive.

It took a lot of years, but I got reorganized and also gave myself permission to not be perfect. I came to understand that I will be managing my chronic diseases until I pass away. I can still accomplish many things; it is just going to take me longer.

I was living my dream and it turned into a nightmare. Sound familiar? I began a battle of life and death literally and mentally. 

For those reading that are not familiar with my story, I have been battling chronic pain since 1997, first with endometriosis -- which resulted in a full hysterectomy and left oophorectomy.

Then in 2002, I developed Reflex Sympathetic Dystrophy (RSD), a progressive neuro-autoimmune condition that affects multiple systems in the body. Then came temporomandibular joint syndrome (TMJ), hypothyroidism, hypoglycemia, arthritis, gastroparesis and ischemia -- not to forget a loss of balance and coordination that seems to lead to falls and bone breaks. Because my immune system is weakened, if anyone around me is sick, I will soon be as well.  

I lost my physical abilities and was bed bound for years. I spent many years using a wheelchair just to get out of bed and leave the house. It took 3 years to get a proper diagnosis and another 4 years to get the proper treatment. I know firsthand how hard it is to continue looking for relief and answers; and then coming up against healthcare professionals who blow you off or do not believe what you are telling them.

I have learned the hard way that the healthcare system is not always what we are led to believe. I think that from childhood, we should be taught prevention, health responsibilities and health rights. With 1 in 3 Americans living with at least one disease that causes chronic pain, these are important life lessons. 

People look up to their doctors and put total faith in them. But it is important to remember that doctors study a particular practice of medicine. Just because they are a neurologist doesn’t mean they can treat diabetic neuropathy, multiple sclerosis, Lyme disease, or RSD. Each doctor gets a small variety of a medical field and finds a specialty that they love and work on with research and education.

Knowing this will help you get better healthcare. Don’t be afraid to ask questions about your doctor’s education and background. What is their specialty?

I know that there are far too many pain patients who experience something similar to my story. Although each of us is unique and living with our own variations of a chronic disease, having a shared knowledge of overcoming the challenges that we face can be helpful and encouraging.

I had to learn the hard way -- and now share my story to give hope and answers to patients, caregivers and healthcare professionals. I hope by speaking out about my journey it prevents it from happening to others. I enjoy hearing other patient’s stories as well, because it helps me see that I am not alone.

I have had many twists and turns through the medical system, and now encourage the importance of  positive thinking, standing up for ourselves, and improving our knowledge even in the worst of times. Let’s get back to dreaming about big, positive and happy lives.

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 on 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.

Outrage Over DEA’s Kratom Decision

By Pat Anson, Editor

Mitragyna speciose has some fans out there.

Tens of thousands of people who use kratom supplements – made from the leaves of the Mitragyna speciose tree that grows in southeast Asia – are furious over a decision by the U.S. Drug Enforcement Administration to classify two chemicals in kratom as Schedule I controlled substances, right alongside heroin, LSD and marijuana.

The DEA said the move is necessary because the two main active ingredients in kratom -- mitragynine and 7-hydroxymitragynine – are not approved as drugs and pose “an imminent hazard to public safety.” The DEA filed notice in the federal register that it plans to implement the decision at the end of the month and make kratom illegal, despite a growing public outcry.

“People are going to die because of this,” said James, one of dozens of Pain News Network readers who wrote to tell us that kratom supplements relieve their chronic pain, depression and anxiety, and also helps ease withdrawal symptoms from opioid and alcohol dependence.

“An herb that has killed no one is being banned. Many people will turn to more dangerous drugs, and others who are already addicted to opiates will not have the option of using kratom to quit,” James wrote.

“This is ridiculous! Did we learn anything from alcohol prohibition? It gave us illegal moonshine, bath tub gin and other dangerous concoctions that caused blindness and death,” wrote Bob Thompson.

“I know many people who have used and are still using kratom for pain and/or to get themselves off of drugs such as Suboxone and methadone,” said Jennifer. “It’s been a life saver for so many people, helping them have a better quality of life and not be dependent on the highly addictive crap like Oxycontin & hydrocodone. The DEA is such an evil empire.”

KRATOM SUPPLEMENTS

Many readers see a dark conspiracy behind the DEA’s action -- a scheme engineered by the pharmaceutical industry to eliminate a cheap competitor.

“I am pretty sure that the government wants to ban kratom to use it in pharmaceuticals later,” said Marlo.  “They want it for themselves so they can eventually charge large amounts of money (for a) prescription form after the police have ‘cleaned up the streets’ from it.“

“The government is doing everything they can to keep people on pharma drugs and away from natural supplements,” said Rachel. “I am so sick of big pharma, big government, a broken medical system and the loss of personal freedom to choose what is best for oneself.”

“This is unbelievable. Our government is straight up sinister,” wrote Dan. “To take a plant that is so benign, with very limited side effects, that helps people with pain management and that helps others get off of hard drugs, and to make it illegal in the same category as meth and heroin is criminal.”

Whether you buy into the conspiracy theories or not, the fact is thousands of law-abiding citizens who’ve been buying kratom online and in health food stores for years have been shocked into the sudden realization that after September 30 they could be at risk of arrest, fines and imprisonment for violating the Controlled Substance Act. 

In less than a week, over 50,000 people signed a WhiteHouse.gov petition asking the Obama administration to stop the DEA from scheduling kratom as a Schedule I narcotic.

The American Kratom Association has also threatened a lawsuit and is planning a march on the White House on September 13th.

Is the DEA listening?

A post on a DEA Twitter account Friday acknowledged the agency “has heard from 100s of #kratom supporters in the past 2 days about the proposed scheduling action; we thank you for the feedback.”

But the odds of the DEA reversing course appear slim. The agency’s announcement Tuesday in the Federal Register clearly states that a public notice and comment period usually required under Section 553 of the federal Administrative Procedure Act “do not apply to this notice.”

“The (DEA) Administrator finds that there is good cause to forgo the notice and comment requirements of section 553, as any further delays in the process for issuance of temporary scheduling orders would be impracticable and contrary to the public interest in view of the manifest urgency to avoid an imminent hazard to the public safety,” the notice states.

Is there a public safety hazard?

According to the Centers for Disease Control and Prevention, kratom poses an “emerging public health threat,” although the evidence cited by the CDC in a report last month seems almost laughable.  The agency said there was a grand total of 660 calls to U.S. poison control centers about kratom in the last six years. Less than 8 percent of the calls involved a major life threatening condition and only one death was reported – a person who ingested antidepressant and anticonvulsant medications in addition to kratom.

As an article in Forbes points out, those 660 calls to poison control centers pale in comparison to the 6,843 kids who swallowed laundry detergent packets in the first seven months of this year.

But some say the DEA’s action is long overdue.

“This is a necessary and welcome step, but unless it is followed with real enforcement and penalties for those who are selling (kratom) in coffee bars, on the internet, and elsewhere, it will be toothless,” said Dan Frabricant, CEO and Executive Director of the Natural Products Association, an industry trade group.

“Kratom is not an herbal supplement: it is addictive, harmful, and worse, it may be contributing to America’s opiate epidemic. We are eager to work with the authorities and our members to help turn the tide against Kratom and ensure that it is seen as what the DEA says it is, a schedule I illegal narcotic that has no place in health or wellness.”

Can anything stop the DEA?

“We have spoken with many people who have been advised by lawyers that the most effective way to combat this is by having each individual who has a care for this cause to contact your congressman,” the American Kratom Association said in a statement. “Congressional action is needed to show the lies and false science issued about this plant in order to protect big pharmaceutical company. It is important to call in a polite manner and just share your story in a positive way.”

Many Multiple Sclerosis Patients Misdiagnosed

By Pat Anson, Editor

Multiple Sclerosis (MS) is a chronic disease that attacks the body’s central nervous system, causing pain, numbness, difficulty walking, paralysis, loss of vision, and fatigue. Patients diagnosed with MS face enormous physical, emotional and financial challenges coping with a disease that cannot be cured.

Many also discover that they don’t actually have MS.

A new study published in the journal Neurology looks at 110 patients who were incorrectly diagnosed with MS when they actually suffered from more common and treatable conditions such as migraine and fibromyalgia.   

One third of the patients were misdiagnosed for a decade or longer, most took unnecessary and potentially harmful medication to treat a disease they didn't have, and some even participated in clinical trials for experimental MS therapies.

About a third suffered from “unnecessary morbidity” – morbid thoughts of death.

"Misdiagnosis of MS is common; patients may experience common MS symptoms, such as numbness and weakness with a variety of different conditions, many that are more common and less serious than multiple sclerosis," says the study's senior author Brian Weinshenker, MD, a neurologist at Mayo Clinic.

"With the advent of treatments for MS, many physicians feel pushed to reach an early diagnosis, and may be less strict than they should in requiring more specific symptoms or objective neurological findings before making a diagnosis of MS.”

Unlike other chronic illnesses, there is no specific biomarker or blood test for MS. The nerve damage caused by MS is also associated with a wide range of symptoms, many of which are also caused by other conditions such as Lyme disease, lupus, fibromyalgia, and Vitamin B12 deficiency.

Some diagnostic tests for MS, such as magnetic resonance imaging (MRI), can also be misinterpreted.

“Nonspecific MRI abnormalities that can mimic those of MS are very common in healthy individuals, and widespread use of MRI as a diagnostic tool increases the rate of misdiagnosis," said Weinshenker.

The 110 patients included in the study were identified by MS subspecialist neurologists at Mayo Clinic, University of Vermont, Washington University and Oregon Health & Science University.

Twenty two percent of the misdiagnosed patients actually had migraine; 15% had fibromyalgia; 12% had a nonspecific condition flagged by an abnormal MRI; 11% had a conversion or psychogenic disorder; and 6% had neuromyelitis optica spectrum disorder.

"This study suggests significant and long-term unnecessary risks for these patients," said lead author Andrew Solomon, MD, a neurologist at the University of Vermont College of Medicine. "While there may be different reasons for misdiagnoses by subspecialists and nonspecialists, this study suggests that we all make mistakes, and I think we can all do better.”

A previous survey of MS specialists found that more than 95% had seen at least one patient in the past year that was misdiagnosed with MS by another provider.

Some treatments for MS carry serious side effects. One drug, taken by 13 percent of the misdiagnosed patients in the current study, can cause a potentially fatal brain infection. Other patients suffered from the discomfort and inconvenience of daily injections; others experienced side effects from medications or lacked treatment for the conditions they actually had.

There are also enormous financial costs involved. The cost of medications to treat MS in the United States now exceeds $50,000 a year.

"Premature diagnosis of MS should be avoided," says Weinshenker. "When in doubt, physicians often can defer a diagnosis if it is not clear that there is a serious neurological problem or if a patient is stable. Physicians should request a second opinion when they are unsure but concerned that it might be harmful to delay a definitive diagnosis of MS."

Weinshenker and Solomon hope their study will encourage better education of clinicians on the proper use of MS diagnostic criteria and to further studies on how to recognize patients incorrectly diagnosed with MS.

Study Finds Link Between Chronic Pain and Anxiety

By Pat Anson, Editor

A new study helps explain why so many chronic pain patients also suffer from anxiety or depression.

Researchers at the University of Vermont discovered that the body releases the same neurotransmitter in response to stress as it does to chronic neuropathic pain. The findings, published in the journal Biological Psychiatry, could lead to the development of a new and safer class of medication that could treat both pain and anxiety.

In studies on laboratory mice, researchers found that pain signals and the PACAP neurotransmitter (pituitary adenylate cyclase activating polypeptide) share the same pathway to the brain - the spino-parabrachiomygdaloid tract - which travels from the spinal cord to the amygdala, where the brain processes emotional behavior.

"Chronic pain and anxiety-related disorders frequently go hand-in-hand," says senior author Victor May, PhD, a professor of neurological sciences at the University of Vermont. "By targeting this regulator and pathway, we have opportunities to block both chronic pain and anxiety disorders."

May and his colleagues found that anxious behavior and pain hypersensitivity were significantly reduced when a PACAP receptor antagonist -- designed to block the release of the neurotransmitter -- was applied.

"This would be a completely different approach to using benzodiazepine and opioids - it's another tool in the arsenal to battle chronic pain and stress-related behavioral disorders," said May, who found in a previous study that PACAP was highly expressed in women exhibiting symptoms of post-traumatic stress disorder (PTSD).

May’s findings are important because anxiety and stress are currently treated with sedatives, benzodiazepines and other central nervous system (CNS) depressants. When taken with opioid pain medication, the combination of the drugs can lead to extreme sleepiness, respiratory depression, coma and death.

Yesterday, the U.S. Food and Drug Administration ordered new “black box” warning labels be put on all medications that contain opioids, benzodiazepines and CNS depressants, warning patients and physicians about the increased risk.

According to a 2015 study, over a third of the patients prescribed opioids for chronic musculoskeletal pain were given a sedative. And patients with a history of psychiatric and substance abuse disorders were even more likely to be co-prescribed opioids and sedatives.

FDA Expands Warning Labels on Opioids & Sedatives

By Pat Anson, Editor

The U.S. Food and Drug Administration is expanding the warning labels on all opioids and benzodiazepines – a class of anti-anxiety sedative that includes Xanax – because of the serious risk of overdose and death when the drugs are used together.

The FDA’s “black box” warning labels – the FDA's strongest warning – involve nearly 400 opioid analgesics, opioid-containing cough products, benzodiazepines and other central nervous system (CNS) depressants.  The risks associated with using the drugs simultaneously are fairly well-established and include extreme sleepiness, respiratory depression, coma and death.

The agency said the move is one of a number of steps the FDA is taking as part of its Opioids Action Plan, which is focused on policies “aimed at reversing the prescription opioid abuse epidemic, while still providing patients in pain access to effective and appropriate pain management.”

"It is nothing short of a public health crisis when you see a substantial increase of avoidable overdose and death related to two widely used drug classes being taken together," said FDA Commissioner Robert Califf, MD. "We implore health care professionals to heed these new warnings and more carefully and thoroughly evaluate, on a patient-by-patient basis, whether the benefits of using opioids and benzodiazepines – or CNS depressants more generally – together outweigh these serious risks."

In addition to benzodiazepines, other CNS depressants include sedatives, hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, and alcohol.

The new warning labels caution physicians to prescribe benzodiazepines or other CNS depressants “at the lowest effective dose” if a patient is already taking an opioid.  

The FDA said the number of patients who were prescribed both an opioid analgesic and benzodiazepine increased by 41 percent between 2002 and 2014, which translates to an increase of more than 2.5 million opioid analgesic patients receiving benzodiazepines.

From 2004 to 2011, the rate of emergency department visits involving non-medical use of both drug classes increased significantly, with overdose deaths involving the drugs nearly tripling.

Recent guidelines by the Centers for Disease Control and Prevention also urge doctors to use caution when co-prescribing opioids and benzodiazepines.

The prescribing of opioid pain medication in the U.S. has actually been in decline for several years, but the number of overdoses blamed on opioids – both legal and illegal – continue to rise. One explanation for that is that the co-prescribing of opioids and sedatives has not changed.

According to a 2015 study, over a third of the patients prescribed opioids for chronic musculoskeletal pain were given a sedative. And patients with a history of psychiatric and substance abuse disorders were even more likely to be co-prescribed opioids and sedatives.

In February 2016, the FDA received a citizen petition from the city of Baltimore and over 40 public health officials asking the agency to strengthen warning labels for opioids, sedatives and depressants. The FDA said it was already reviewing data on the simultaneous use of the drugs, but today’s action was a response to that citizen petition.

A Pained Life: Pennsylvania’s Opioid Law Ignores Us

By Carol Levy, Columnist

Recently I received an email update from my state senator. He wanted to let me know about  efforts in the Pennsylvania legislature to address the "opiate crisis.”

I have written before that I believe some of what has been proposed throughout the country makes sense, a prescription monitoring database, for instance. Much of what is being considered in Pennsylvania also makes sense to me:

• Labels on opioid prescription bottles warning of their addictive nature
• Written consent from parents in order for their children to receive prescription opioids
• A safe opioid prescribing curriculum in Pennsylvania’s medical schools to better educate future doctors about proper opioid prescribing practices
• Insurance plans to provide access and share the cost of abuse-deterrent opioids
• Mandatory reporting of all heroin and opioid overdoses where naloxone was administered
• Implementation of opioid prescribing guidelines developed by a state task force
• Healthcare providers to discuss the risks of opioid addiction and overdose with patients and to receive written consent from a patient before prescribing them

But there are two provisions of the law I find very concerning, one being a requirement that coroners and medical examiners report the death of any person resulting from a drug overdose.

One of the issues surrounding the reporting of deaths arising from opioids is that other medical conditions, such as the use of alcohol or illegal drugs, are often ignored and the death is counted as an opioid overdose.

That is not only poor research, but gives a false picture of what is the effectual cause of the death. Ignoring those other factors means ignoring other issues that the law needs to be addressing.

The second issue I have with the law is alarming: limiting the prescription of opioids to seven days. This ignores chronic pain sufferers and the long-term need for opioid medication, which is often our only or last available treatment.

The change we saw, in many states, was requiring a visit to the doctor for a new prescription every 6 months to needing one every 3 months. That was bad enough.  I recall needing to go only once a year, but that was in the 1970's and 80's.

If you have trouble moving, tolerating the weather or other issues, being forced to go see the doctor every three months is an issue. In addition, co-pays rise, insurance companies pay more for extra visits and may raise your rates as a result, and the cost to the state and federal government through increased Medicaid/Medicare billing soars.

I decided to research this. I found that New York State has imposed a 7-day limit on prescriptions, but the law contains exceptions for those with chronic pain or who are receiving hospice or palliative care for life threatening illnesses. Unfortunately, Pennsylvania legislators have decided to ignore those in chronic pain. The bill includes exceptions only for hospice and patients receiving palliative care.

The government has acted as doctor in many other instances; such as women's health care, declaring some drugs illegal, and allowing certain medications and procedures while denying others. I understand that. There needs to be limitations and oversight.

But this is not oversight or limitation.  This is a frenzied and illogical response to an “epidemic” that is not caused or perpetuated by those of us with chronic pain, but is nevertheless being taken out on us.

Politicians who point at us and claim they are handling the crisis are ignoring the real culprits, which is those who abuse drugs illegally.

The question has to be asked. 

How in the world does this law address the opioid epidemic, as opposed to merely blaming and punishing those with chronic pain?

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.

DEA Banning All Sales of Kratom

By Pat Anson, Editor

The U.S. Drug Enforcement Administration has announced plans to ban all sales of kratom, a popular herbal supplement increasingly being used as an alternative to opioids for relieving chronic pain.

The DEA filed notice in the federal register that it plans to classify two opioid-like chemicals in kratom as Schedule I drugs under the Controlled Substances Act – the same classification given to heroin, LSD and marijuana. Kratom is currently considered a food supplement, not a drug, but the move would effectively prohibit all sales of kratom, which comes from the leaves of a tree grown in southeast Asia.

The founder of the American Kratom Association told Pain News Network that her organization may go to court to block the DEA from carrying out its plan.

"This honestly was a complete and total shock for those of us involved in this issue," said Susan Ash. "We're weighing all of our options right now and one option of course is to seek a temporary restraining order."

The two main active ingredients in kratom, mitragynine and 7-hydroxymitragynine, act on the same receptors in the brain as opioids do, but are not currently approved as drugs.

The DEA said it needed to classify them temporarily as controlled substances “to avoid an imminent hazard to public safety.”

“Available information indicates that these opioid substances, constituents of the plant kratom, have a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision,” the DEA said.

“Consequently, kratom, which contains the main active constituents mitragynine and 7-hydroxymitragynine, is an increasingly popular drug of abuse and readily available on the recreational drug market in the United States. Attempted importations of kratom are routinely misdeclared and falsely labeled. This is similar to other attempts to import controlled substances or substances intended to mimic controlled substances.”

Although the DEA refers to mitragynine and 7-hydroxymitragynine as "opioids," they are actually alkaline compounds that are believed to act on natural opioid receptors in the brain.

"They're not opioids. An opioid is a synthetic version of the poppy plant, so that's just completely wrong," said Ash. "They are novel substances that I really don't think you can define, quite honestly. There's nothing else like them in medicine or nature."

Although illegal in a handful of states, kratom is widely available online and in health stores, where it is sold as dried or crushed leaves, powder, capsules, tablets, liquids and gum. Users tout kratom's pain relieving benefits, and say it also reduces stress, depression and cravings for other drugs.  Recent policies that discourage the prescribing of opioid pain medication have increased interest in kratom as an alternative treatment.

Ash is a recovering opioid addict who uses kratom as a deterrent.

"I have no cravings for narcotics. No part of me ever desires to put narcotics back into my body because of kratom. There is no need because it works so well and it eliminates cravings," said Ash, who used the addiction treatment drug Suboxone for about a year while in recovery.

"I went off of Suboxone using kratom. There is no way I would ever put myself back on Suboxone. But where do I go for help with pain now?" she asked.

Ash first had an inkling that the federal government was preparing to take broader action against kratom when the Centers for Disease Control and Prevention issued a report last month claiming that kratom was "an emerging public health threat." The CDC cited kratom-related calls to U.S. poison control centers, which jumped from 26 calls in 2010 to 263 in 2015.

"I'm sorry, but I don't consider 263 calls to poison control an emerging public health threat. I don't think anyone does," said Ash. 

Few Kratom Studies

Although kratom has been used medically for hundreds of years, few studies have been done on its safety or to see how it actually works.

“Mitragyna speciose (kratom) has a psychostimulant effect like coca and a depressive effect like opium and cannabis, which seem to be contradictory. It is also reported that it is weaker than morphine, has a milder withdrawal syndrome compared to opioids, and is less harmful than cocaine,” is how one study explained it.

The Food and Drug Administration has been trying unsuccessfully to stop the importation and sale of kratom.  Last year the FDA issued an import alert that allows the agency to seize kratom supplements without even physically examining them.

Earlier this month, FDA agents seized more than 100 cases of products labeled as kratom in Grover Beach, California. The products are distributed by Nature Therapeutics Inc. under the name Kratom Therapy.  The FDA said the company was illegally selling kratom products as drugs to treat various medical conditions.

“The FDA will continue to take aggressive enforcement action to safeguard the public from harmful drug products illegally marketed as treatments for which they have not been studied or approved,” said Melinda Plaisier, the FDA’s associate commissioner for regulatory affairs.

The DEA says the ban on kratom chemicals would take effect at the end of September. Earlier this month, the agency also said it would not change the classification of marijuana as a Schedule I controlled substance.

Animal Studies Show Promise for Safer Opioids

By Pat Anson, Editor

Animal studies currently underway could hold the key to developing new opioid therapies that relieve pain without the risk of addiction, overdose and other harmful side effects.

Researchers at Wake Forest Baptist Medical Center in North Carolina have developed a pain killing compound -- called BU08028 – that relieves pain in monkeys without causing physical dependence. BU08028 is similar to buprenorphine, an opioid currently used to treat both pain and addiction.

"Based on our research, this compound has almost zero abuse potential and provides safe and effective pain relief," said Mei-Chuan Ko, Ph.D., professor of physiology and pharmacology at Wake Forest Baptist and lead author of the study published in the Proceedings of the National Academy of Sciences.

"This is a breakthrough for opioid medicinal chemistry that we hope in the future will translate into new and safer, non-addictive pain medications."

This study, which was conducted on 12 monkeys, targeted a combination of mu opioid receptors in the brain – the same receptors targeted in humans by existing opioid pain medication.

The Wake Forest researchers examined behavioral, physiological and pharmacologic factors and found that BU08028 blocked pain signals without the side effects of respiratory depression, itching or adverse cardiovascular events. In addition, the study showed pain relief lasted up to 30 hours in the monkeys and repeated administration did not appear to cause physical dependence.

"To our knowledge, this is the only opioid-related analgesic with such a long duration of action in non-human primates," said Ko. “Given the decades-long effort aimed at developing abuse-free opioid analgesics, BU08028 represents a major breakthrough for opioid medicinal chemistry.”

Ko plans further animal studies on related compounds to see if they have the same safety profiles as BU08028. If those studies are successful, he hopes to begin studies on humans with the ultimate goal of getting FDA approval for a new class of opioid medication.

The research is funded by the National Institutes of Health and National Institute on Drug Abuse.

Rat Study Targets Peripheral Nerves

Another animal study is taking a different approach to pain relief – by targeting nerves in peripheral tissue – not the mu opioid receptors in the brain and spinal cord.

In findings published in Cell Reports, researchers at the University of Texas found that targeting delta opioid receptors on sensory neurons in the peripheral tissue of laboratory rats produces fewer side effects and with much lower abuse potential.

"Being able to increase the responsiveness of peripheral opioid receptor systems could lead to a reduction in systemic opioid administration, thereby reducing the incidence of side effects," says senior study author Nathaniel Jeske of the University of Texas Health Science Center at San Antonio.

One complication is that delta opioid receptors in peripheral tissues only become activated in the presence of inflammation. Because it has not been clear how to overcome this need for an inflammation trigger, the development of drugs that target peripheral nerves has been limited.

Jeske and his colleagues discovered a protein called GRK2 that binds to and prevents delta opioid receptors on rat sensory neurons from responding normally to opioids. But when those peripheral nerves were exposed to a natural inflammatory molecule called bradykinin, GRK2 moved away from the delta opioid receptors, setting off a biochemical reaction that restored the functioning of these receptors.

In addition, rats with reduced GRK2 levels in peripheral sensory neurons regained sensitivity to the pain-relieving effects of a drug that activates delta opioid receptors, and without the need for an inflammatory trigger.

The researchers hope to replicate the same findings using human tissues.

"By shedding light on how inflammation activates delta opioid receptors, this research could potentially lead to the development of safer, more effective opioids for the treatment of pain," said Jeske, whose work is funded by the National Institutes of Health.

Freedom: A Pain Patient’s Lost and Found

By Pat Akerberg, Columnist

Chronic pain takes away many things: our health, wealth, mobility, relationships and careers, to name a few. It’s not a stretch to consider our personal freedom as another major loss. 

Freedom is defined (according to Google) as the power to act, speak, or think as one wants without hindrance or restraint. And unrelenting pain is definitely a hindrance or restraint! 

Despite that harsh reality, there’s an implication that we still have some freedom of choice in how we react. But on those really bad days when it’s all a pain patient can do to get out of bed, the notions of freedom, choice, or power seem wholly non-applicable to us. 

Compared to being autonomous and independent, the setbacks or functional losses we experience threaten any determination or self rule we have left.  You would think that more than ever we’d err on the side of self care and triage. 

Instead, we can be unduly hard on ourselves.  Why?  We still desire to be productive in some way yet can’t be, causing guilt, frustration and even doubts about our purpose.

Even the NFL knows enough to sideline their injured players to PUP (physically unable to perform) status without shame or recrimination until they can function better.

To be kinder to ourselves, there’s an important freedom we can exercise.  We hold the power to choose how we look at freedom altogether. A more lenient twist would be to view it through the lens of the medically compromised.

That twist of perception provides us with 2 types of modified freedom.  One of them involves those things we are now “free from” and can do less of.  The other involves those that we are now “free to” do more of.   

Here are a few freedoms from certain things I have come to appreciate in my particular form of captivity with trigeminal neuralgia:

Type 1: Freedom From

• Attending obligatory, unappealing outings
• Taking all phone calls (talking is a huge pain trigger)
• Trying everything suggested as my cure-in-waiting
• Superficial small talk
• Grocery shopping, laundry, heavy cleaning or distance driving
• Strenuous physical exercise
• People who choose to judge my misfortune as an inferiority and their good fortune as superiority
• Unfulfilling, needy relationships
• Noisy, crowded places and boisterous people
• Educating people about my rare neurological condition, pain, etc.
• Being the initiator, mediator or helper at large

Here are some of my freedoms to. They’re permissions that I grant to myself:

Type 2: Freedom to

• Say no to outings, places, and activities that exact a painful price physically
• Avoid invasive treatments and lab rat experiments
• Express my views about the injustices surrounding inadequate pain care
• Avoid anything that demands my energy after 4 pm
• Not judge myself because mindfulness meditation, exercise, and other touted pain management strategies fell short for me
• Ask for what I need and want when help is offered
• Receive gratefully without guilt or the pressure to reciprocate if I can’t
• Cancel appointments/plans if I am unable to keep them
• Stay in my pajamas if I’m unable to do otherwise
• Practice comforting self-care: baths, massage, good books, TV binging, adult coloring books, sending note cards, and an occasional indulgent dessert
• Make an effort to look my best occasionally, even if it will work against me

It’s helpful to add to and review my list during my worst times to remind myself what freedoms I’m not missing or can give myself. 

Hopefully you’ll consider your particular Type 1 and Type 2 freedoms too and share some with us.  When we do that with each other, it expands our viewpoints and learning. 

After all, we’re each other’s “people,” the group we belong to now. And it takes our own to honestly understand the kind of work-a-rounds that we’re forced to come up with and the life quality compromises we endure.  We know how we can isolate or shield our loved ones when we’re plagued by fears, misgivings or unsettling worries.

I am telling both a lost and a found story about my modified version of freedom now.  It acknowledges that the freedoms I’ve lost have also given way to some new found gains. It’s not meant to suggest that any of this can reduce our pain or restore our undeniable losses, but at least it helps us see the glass isn’t rendered totally empty.

Sometimes it can take a revolution of sorts to hold onto to our freedom or mitigate our losses.  Mine started with giving myself permission to revolt against standardized one-size (that don’t fit all) ways of looking at important things like freedom. 

We can choose to replace any ill fitting lens with one that accounts for the unique and complex anomalies that happen to people just like us.

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.