100 Million Pain Pills Unused After Dental Surgery

By Pat Anson, Editor

Over half the opioids prescribed to patients following dental surgery go unused, according to a small study by researchers who say the leftover pills could be abused or stolen by friends and family members.

Researchers affiliated with the University of Pennsylvania’s Perelman School of Medicine and School of Dental Medicine followed 79 patients who had their wisdom teeth removed or some other type of surgical tooth extraction. Seventy-two of them were given opioid pain medication after the surgery.

On average, patients received 28 opioid pills and – three weeks later -- had 15 pills (54%) leftover. Only five patients used all of the prescribed pills.

From that small sample, researchers project that as many as 100 million excess pain pills are prescribed annually by dentists.

 “When translated to the broad U.S. population, our findings suggest that more than 100 million opioid pills prescribed to patients following surgical removal of impacted wisdom teeth are not used, leaving the door open for possible abuse or misuse by patients, or their friends or family,” said lead author Brandon Maughan, MD, an emergency physician and health services researcher at The Lewin Group, a health policy consulting firm.

“Given the increasing concern about prescription opioid abuse in the United States, all prescribers – including physicians, oral surgeons and dental clinicians – have a responsibility to limit opioid exposure, to explain the risks of opioid misuse, and educate patients on proper drug disposal.”

Twenty-four hours after surgery, patients in the study reported an average pain score of 5 out of 10 while taking pain medication. By the second day, more than half (51%) reported a low pain score (0-3 out of 10), and by the fifth day, almost 80 percent had a low pain score.

“Results of our study show within five days of surgery, most patients are experiencing relatively little pain, and yet, most still had well over half of their opioid prescription left,” said co-author Elliot Hersh, DMD, a professor in the department of Oral & Maxillofacial Surgery and Pharmacology at Penn Dental Medicine.

“Research shows that prescription-strength NSAIDs, like ibuprofen, combined with acetaminophen, can offer more effective pain relief and fewer adverse effects than opioid-containing medications. While opioids can play a role in acute pain management after surgery, they should only be added in limited quantities for more severe pain.”

The study, published in the journal Drug and Alcohol Dependence, also found that drug disposal kiosks in pharmacies and small financial incentives may encourage patients to properly dispose of their unwanted pain medication.

Patients in the study received a debit card preloaded with $10. If they completed surveys assessing their pain and medication use after surgery, they received an addition $3 credit on the debit card. Patients who completed a follow-up health interview received an additional $10.

Patients were also provided with information about pharmacy based drug disposal programs, which led to a 22% increase in the number of patients who had either disposed or planned to properly dispose of their leftover opioids.

“Expanding the availability of drug disposal mechanisms to community locations that patients regularly visit – such as grocery stores and retail pharmacies – may substantially increase the use of these programs,” Maughan said.

Reducing the excess prescribing of opioids for acute pain is one of the goals of the Centers for Disease Control and Prevention. The CDC's prescribing guidelines state that three days or less supply of opioids “often will be sufficient” for acute pain caused by trauma or surgery, and that 7 days supply “will rarely be needed.”  Those guidelines, however, were developed for primary care physicians, not dentists.

Negative Thoughts About Sleep Make Pain Worse

By Pat Anson, Editor

Negative thoughts about pain and not being able to sleep can worsen chronic pain conditions like fibromyalgia, arthritis and back pain, according to British researchers.

“Pain-related sleep beliefs appear to be an integral part of chronic pain patients' insomnia experience,” said Nicole Tang, a psychologist in the Sleep and Pain Laboratory at the University of Warwick. "Thoughts can have a direct and/or indirect impact on our emotion, behaviour and even physiology. The way how we think about sleep and its interaction with pain can influence the way how we cope with pain and manage sleeplessness.”

Tang and her colleagues developed a scale to measure beliefs about sleep and pain in chronic pain patients, along with the quality of their sleep.

The scale was tested on four groups of patients suffering from long-term pain and bad sleeping patterns, and found to be a reliable predictor of future pain and insomnia.

"This scale provides a useful clinical tool to assess and monitor treatment progress during these therapies," said Esther Afolalu, a graduate student and researcher at the University of Warwick. 

university of warwick

"Current psychological treatments for chronic pain have mostly focused on pain management and a lesser emphasis on sleep but there is a recent interest in developing therapies to tackle both pain and sleep problems simultaneously."

Researchers found that people who believe they won't be able to sleep because of their pain are more likely to suffer from insomnia, thus causing more pain. The vicious cycle of pain and sleeping problems was significantly reduced after patients received instructions in cognitive-behavioural therapy (CBT), a form of psychotherapy in which a therapist works with a patient to reduce unhelpful thinking and behavior.

The study, published in the Journal of Clinical Sleep Medicine, is not the first to explore the connection between pain and poor sleep.

A 2015 study published in the journal PAIN linked insomnia and impaired sleep to reduced pain tolerance in a large sample of over 10,000 adults in Norway. Those who had trouble sleeping at least once a week had a 52% lower pain tolerance, while those who reported insomnia once a month had a 24% lower tolerance for pain.

A Pained Life: Swim at Your Own Risk

By Carol Levy, Columnist

I swim at my local YMCA. A new pool just opened and there are no flags or indicators showing when a swimmer is close to the end of the pool.

I can only do a backstroke. Not knowing where the wall is can be dangerous. I had already hit my head once miscalculating where I thought the wall was.

“I wish they had something as a warning that we are close to the wall,” I said to Jennifer, one of the lifeguards.

“Well, don't swim on your back. Then you can see it yourself,” she replied.

“I would love to, but because of my neck situation I can't swim on my stomach,” I explained.

Jennifer responded strangely: “Wah, wah, wah.”

I looked at her in surprise. Usually she is sweet and kind.

“My neck is held together with 12 pins and 2 clamps,” I told her. “I can't swim on my stomach. The posture and head movements for breathing are impossible for me.”

“Wah, wah, wah.”

“Jennifer, my entire neck is held together with metal. That's all that holds it up,” I said, starting to feel angry and frustrated.

“Wah wah wah. Wait! What if you used a snorkel?”

Her suggestion ignored what I had said about why I couldn't swim on my stomach.

There is another reason I can’t use a snorkel: I have a phantom touch-induced discomfort in my face. But that was more then I wanted to explain. And the explanation would require more explanation to explain what I was trying to explain.

On the other hand, my facial paralysis is very visible. The left eyelid is almost always swollen. As soon as someone sees me they know something is wrong.

“I can't keep my head in the water,” I said. “My eye doctor told me I shouldn't even be in the pool.”

Jennifer's response was quick and easy: “Oh I'm sorry. I didn't realize. That definitely would be a bad idea.”

I was flabbergasted. She dismissed my neck issues even after I explained the situation. But I was astounded by how quickly she capitulated when I said my eye is the problem.

Oh, I get it. The eye she can see. It is not something she needs to understand. All that matters is that it is visible and obvious. My neck, on the other hand, is not.

The conversation with Jennifer was the perfect embodiment of the visibility/invisibility issue we all face. At what point do we decide it is not worth the explanation, the struggle to let ourselves and our truth be heard?

Too often I feel like my integrity is being questioned by two people.

The first person is the one who refuses to listen and accept.

The second person is me, because I am too often forced to lie.

I don't want to lie. I don't like to lie. I like to think my word is my bond. But, sometimes it is just easier to break that bond with yourself then struggle to explain and be heard.

Add one more pain to the list.

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.

Survey: Kratom ‘Very Effective’ for Chronic Pain

By Pat Anson, Editor

Chronic pain sufferers often struggle to find a treatment that works. Opioids dull the pain, but come with the risk of addiction; drugs like Lyrica and Cymbalta can have unwelcome side effects; over-the-counter pain relievers often don’t work for severe pain; and alternative treatments like massage and acupuncture are not always covered by insurance.

So people experiment and try different things – often settling for something that just takes the edge off their pain.

That brings us to kratom, an herbal supplement largely unknown to most pain patients and their doctors. At a recent pain management conference attended by thousands of practitioners, I could find only a handful of doctors who’d even heard of kratom. I’ll confess I didn’t know much about it myself until a few months ago.

Maybe we should all start paying more attention.

In an online survey of 6,150 kratom consumers by Pain News Network and the American Kratom Association, nine out of ten said the herb was a “very effective” treatment for pain, depression, anxiety, insomnia, opioid addiction and alcoholism.

Less than one percent said it did not help.

This was not a scientific study by any means on the safety and efficacy of kratom. It was an online survey of self-selected kratom consumers, many of them quite upset that the U.S. Drug Enforcement Administration is planning to make the sale and possession of kratom illegal, perhaps as soon as the end of the month.

In a 21-page notice published in the Federal Register, the DEA said kratom does not have "an approved medical use” and “is misused to self-treat chronic pain.”

WAS KRATOM EFFECTIVE IN TREATING YOUR PAIN OR MEDICAL CONDITION?

The agency cited no studies to support its claim that kratom was being “misused” to treat pain, so we decided to ask the people who actually use it:

"Honestly, I was blown away at how good it was for my pain and also had the benefit that it lifted my mood, which was important because of the depression I had been experiencing from the chronic pain."

"This natural approach to pain management has allowed me to work full time as a school teacher and be an actively involved mom. These are things I never thought I would be able to have in my life as a result of debilitating pain from a neurological condition for which there is no medical cure."

"I have acute chronic migraines that, unmedicated, result in pain that is completely debilitating, and at times have landed me in the emergency room with stroke symptoms. Multiple doctors have okayed my use of kratom for pain management, as over-the-counter medicine simply does not work and I cannot take opiates."

"My wife has fibromyalgia and has taken kratom for more than 12 years with no adverse effects. Prior to finding kratom, she had tried all of the medication that was prescribed to her. The prescription medication either didn't work, or the side effects outweighed the benefits. Kratom has been a godsend for my wife and has allowed her to function as a mother of 4 children for more than a decade."

"I have been living with chronic pain from multiple reconstructive foot surgeries for 20+ years. Kratom not only effectively treats my pain, but it enabled me to tell my doctor that I no longer wanted my monthly tramadol prescription."

What pain conditions does kratom work best on? Again, this is not a scientific study, and we don’t have a lot of data for certain conditions. For example, 100% of the people who used kratom for cancer pain said it was “very effective” for them, but we only had 27 respondents who identified cancer as the primary reason they used kratom.

On the flip side, over 1,700 respondents said they used kratom for back pain, so the data is probably more reliable for them. And 92% said kratom was very effective for back pain.  

Percentage Who Rated Kratom “Very Effective” for their Pain Condition

powdered kratom

• 100% Cancer
•   97% Multiple Sclerosis
•   94% Irritable Bowel Syndrome
•   93% Migraine
•   93% Fibromyalgia
•   92% Rheumatoid Arthritis
•   92% Back pain
•   92% Acute Pain
•   91% Lupus and other autoimmune diseases
•   90% Osteoarthritis
•   90% Neuropathy
•   88% Trigeminal Neuralgia
•   79% RSD or CRPS
•   76% Ehlers Danlos syndrome   

Quite a few people said they use kratom for pain conditions we didn’t ask about or discovered that it helped them feel better in unexpected ways:

"I tried kratom for many things and it has worked for all. Toothaches, back and knee pain, sore joints and ligaments, flu symptoms, and insomnia."

"I have had very little back pain since I starting taking kratom to treat it. Three side effects I didn't expect is that it eliminated my restless leg syndrome, reduced my blood pressure to a normal level and significantly reduced my overall cholesterol levels."

"I have found so much relief for my ulcerative colitis and carpal tunnel syndrome from this plant that I fear how my body will respond when I no longer have it."

"I use kratom for severe TMJ disorder and sacroiliac joint dysfunction. I am also a recovering addict, and kratom has helped me stay clean and be the best 4th grade teacher I can be. If I hadn't had kratom to help ease chronic pain and the urge to use, I wouldn't be doing my dream job. I'd probably be in jail without a job, divorced, and possibly even dead."

"Kratom without a doubt helps any part of my body to not be in pain. Not only does it help with pain, it helps with my depression and it helps me get to sleep very easily."

Many also have strong feelings about allowing drug companies to use kratom in pharmaceutical products, which would require approval from the Food and Drug Administration. 

Seven out of ten kratom consumers are opposed to that idea, believing drug makers have conspired with the DEA to make kratom illegal.

"This is big pharma using the DEA to eliminate an all-natural herb that is taking a bite out of their drug selling profits."

"Everyone knows all this has to do with the DEA and big pharma being in each other’s back pockets. Money is the root of all evil and here it shows again."

"I feel that the pharmaceutical companies are behind this. People are weaning themselves from their addictions and those that don't end up overdosing requiring Narcan. That is a lot of money they stand to lose."

"If pharmaceutical companies produce kratom, the cost will probably triple. There will be tremendous red tape in even getting the drug from a doctor."

SHOULD DRUG MAKERS BE ALLOWED TO PRODUCE AND MARKET KRATOM?

To see the complete survey results, click here.

Meanwhile, lobbying efforts continue by the American Kratom Association to get the DEA to postpone its decision to classify the two active ingredients in kratom as controlled substances. Two congressmen, Rep. Mark Pocan (D-Wisconsin) and Rep. Matt Salmon (R-Arizona) are circulating a letter on Capitol Hill urging the DEA to delay enacting its order.

“We hope to see a lot of congressmen and women sign onto this,” says Susan Ash, founder of the American Kratom Association. “The letter asks that the director of the Office of Management and Budget and the acting director of the DEA delay a final decision on the placement of kratom as a Schedule I substance, provide ample time for public comment on this significant decision, and resolve any other inconsistencies with other federal agencies.”

A similar letter is being prepared by a law firm hired by the American Kratom Association. Ash told PNN it’s possible the DEA will not formally act on the scheduling of kratom until well after September 30.   

“When we’ve looked back at some of the other emergency scheduling processes that have happened, we have found that they will say it’s going to happen in 30 days, but it’s usually a few weeks after that. That’s just what’s happened historically. We don’t think September 30 is essentially a firm date, just based on history, but we are prepared in case it is.”

Ash said her organization would seek a restraining order from a judge if the emergency scheduling is implemented by DEA.

Kratom Users Say Ban Will Lead to More Drug Abuse

By Pat Anson, Editor

Kratom is a safe and surprisingly effective treatment for chronic pain and a wide variety of medical conditions, according to a large new survey of kratom consumers. Many say banning the herbal supplement will only lead to more drug abuse and worsen the nation’s opioid epidemic.

The online survey of 6,150 kratom consumers by Pain News Network and the American Kratom Association was conducted after plans were announced by the U.S. Drug Enforcement Administration to classify two chemicals in kratom as a Schedule I controlled substances. Unless the scheduling is postponed, the sale and possession of kratom could become a felony as early as September 30.

The survey findings dispel the myth that kratom is used recreationally like marijuana by people who only want to get “high” or intoxicated. The vast majority say they use the herb in teas and supplements solely to treat their medical conditions.

Asked what was the primary reason they used kratom, over half (51%) said they used the herb as a treatment for chronic pain, followed by anxiety (14%), depression (9%), opioid addiction (9%) and alcoholism (3%). Less than two percent said they used kratom recreationally or out of curiosity.

WHAT IS THE PRIMARY REASON YOU USE KRATOM?

“The survey tells us exactly what we’ve been trying to tell the DEA, lawmakers and the general public. The average kratom consumer is nothing like we are being portrayed as,” says Susan Ash, founder of the American Kratom Association.

“The average kratom consumer is a man or woman in their 40’s, 50’s or 60’s, who is primarily looking for alternatives to pharmaceutical drugs that either didn’t work for them or had side effects that were unbearable. The survey clearly shows the majority of people are using kratom to manage chronic medical conditions.”

Nine out of ten patients (90%) said kratom was very effective in treating their pain or medical conditions.

Asked if they get high from using kratom, three out of four consumers (75%) said no and 23% said “a little.” Only about 2 percent said they get high from using the herb. Many likened the stimulative effect of kratom to a strong cup of coffee.

"I only take enough kratom to take the edge off. I never get high like I did on pills or marijuana. Just a clearer state of being with some pain relief."

"It's not possible to get high from kratom as that's not what it does. It is in the same family as coffee and acts just like coffee."

"It elevates my mood, gives me energy and helps with the pain."

"I was stable at all times with kratom. Sound minded and alert. In no negative way did it affect my ability to function. If anything, it improved that and my overall happiness in life."

CAN YOU GET "HIGH" FROM KRATOM?

While the DEA maintains that kratom poses “an imminent hazard to public safety” and has been linked to several deaths, the vast majority of kratom consumers believe it is safe to use.

Ninety-eight percent said kratom was not a harmful or dangerous substance and 95% said banning the herb will have a harmful effect on society.

Many have strong feelings about what will happen if kratom is made illegal.

"I believe this is incredibly harmful to the thousands of people who have been able to find relief from a huge variety of issues, but especially those treating an opioid addiction. Those people will be forced back to opiates."

"I believe that the ban on kratom will trigger the biggest uptick in opiate-related deaths that we've seen in decades."

"Banning kratom will in no way protect society from an imminent health hazard, but actually push society further into the deadly opiate epidemic that plagues America today."

"It will kill people if they make kratom Illegal."

"We must utilize every tool possible to combat addiction to dangerous drugs, and banning kratom is like cutting off your nose to spite the face: stupid and unproductive."

WILL BANNING KRATOM BE HELPFUL OR HARMFUL TO SOCIETY?

Given a variety of scenarios on what could happen if kratom becomes illegal, two out of three respondents (66%) said kratom consumer would be more likely to become addicted and overdose on other substances.

Over half (52%) predicted that kratom users would be more likely turn to illegal drugs such as heroin and illicit fentanyl.

Half (51%) also said kratom consumers would be more likely to consider suicide.

Asked what they would do personally if kratom is banned, one out of four (27%) said they would seek to buy kratom on the black market – indicating that many are willing to risk being charged with a felony rather than give up kratom. Less than a third (30%) said they would not buy kratom on the black market.

"Making kratom illegal isn't going to stop people from buying and taking kratom."

"People who want kratom bad enough will find it and keep using it."

"I believe kratom consumers are likely to try multiple strategies, but most likely they will go back to whatever they used prior to kratom and there will likely be a black market for illegal consumption because none of these other options can compete with the efficacy of kratom."

"We will all be forced to go back on the very drugs that kratom helped us get off of! It will kill a whole lot of people! It will undoubtedly cause an increase in suicides, overdoses of illegal drugs like heroin and morphine."

"Banning this leaf is equivocal to signing the death certificates of many. You may as well be sticking the needle into many arms."

IF KRATOM BECOMES ILLEGAL, WOULD YOU SEEK TO BUY IT ON THE BLACK MARKET?

Susan Ash of the American Kratom Assocation estimates that between 3 and 5 million Americans have tried kratom. And she thinks the DEA’s attempt to ban the herb may have actually led more people to try it.

“Probably a quarter of a million have tried it since they put this notice out,” Ash said.

To see the complete survey results, click here.

Click here to see a report on the effectiveness of kratom in treating specific chronic pain conditions such as fibromyalgia, migraines and back pain.

Living with Chronic Pain After Being Labeled an Addict

By Patricia Young, Guest columnist

I am writing this article from the perspective of a patient who has chronic back pain and also an unwarranted, doctor-imposed label of “addiction.”

As most people can imagine, having both of these problems -- chronic pain and a substance use disorder -- can be very difficult for a healthcare provider to manage. Imagine though how harmful it is when someone is diagnosed or labeled as an addict and it is not an appropriate diagnosis.

The new polite wording for addiction is "chemical dependence," "substance use disorder" or "opiate dependence."

But these terms are not helpful either, since they have the same meaning to most healthcare professionals, as well as the general public.

To make matters worse, I was totally unaware that this diagnosis was ever made and it was never explained to me that it would be in my medical record. I want to share some of the problems this has caused me.

The first time I thought something was wrong was when I found myself having severe eye pain. I called ahead to the emergency room to make sure they had an eye doctor available to see me and decided to go in when they said they did. Instead, I was examined by a physician’s assistant (PA) after he reviewed my medical records. He looked at my eye from a distance without using any diagnostic equipment, told me I had an infection, and gave me antibiotic drops for it. The eye drops only made the pain worse.

I thought it was odd since I had no eye drainage of any kind and never had such pain before with an eye infection. A few days later I learned I had a herpes sore in my eye. No wonder those eye drops didn’t work!

Not one medical doctor or PA had taken my pain seriously in the ER because I had been labeled as having “drug seeking” behavior. But I did not know that until much later.

At the time I was taking opioid pain medication prescribed by my doctor to treat chronic pain from a lower back injury and two back surgeries. Sometimes I have flare ups of severe pain in my left hip, groin and leg despite the prescribed opiate drugs.

I went another time to the ER in severe pain and was seen by another physician’s assistant. After looking at my medical record, the PA proceeded to tell me to get out of the ER as I lay there on a gurney. My husband and I had no understanding at the time why 3 security guards came and told me to get back in my wheelchair myself or they would pick me up and put me there.

My husband picked me up and we were escorted out the door. I was 59 years old, disabled and was no threat to anyone. It was at that point that I started to wonder what “red flag” was in my medical records to make them treat me like that.

Later I found out what that red flag was. A doctor had written down after one visit that I had a “history of addiction.” This was the first time I became aware of this. I really could not understand why since no medical person had ever said I may have this diagnosis or even mentioned the word “dependency” to me.

I later had to move to Florida from upstate New York because my disability made it hard to cope with harsh winter weather. After the move I had great difficulty finding a new primary care physician. I believe no doctor wanted me as a patient after they saw the diagnosis of “history of addiction.”

We all know how difficult it can be to deal with an individual with a drug addiction. It’s a diagnosis that follows people for a lifetime. Unfortunately, when it is made in error, it is very detrimental and can even be a factor in someone’s death. Not only can there be a huge physical ramification from a diagnosis of addiction, but it can do harm to a person’s mental and emotional health, as well as cause family problems. I know it has affected me that way. The diagnosis evokes many people to make judgements.

I had many angry responses from healthcare professionals in my times of real need. The ones that threw me out of the ER demonstrated their anger by tone of voice, gestures, and curtness. I felt hopeless leaving there and my husband was so stunned he had no words to say. It was a very dark time in my life that is difficult to forget.

It has been suggested to me that I now suffer with post-traumatic stress syndrome and anxiety. Doctors want me to take anti-hypertensive medications daily as a result. This very frustrating and damaging diagnosis has led me to distrust the very physicians I go to for help. My blood pressure is high in their offices but not at home.

I also wrestle now with the problem of feeling as if my reputation has been harmed. I am seen by doctors as untrustworthy and in denial since I disagree with the addiction diagnosis. The very medical system that I worked in for almost 35 years has now mislabeled me and treats me harshly at a time when I need care myself.

I strongly believe there needs to be more understanding within the medical community as well as the public arena about this problem. There is a definite difference between a physical dependence on a substance versus an addiction to it. An addiction diagnosis suggests that one has misused drugs and has a mental disorder.

I have been judged as one of those types of people and it’s wrong. I had many medical professionals come up to me and congratulate me for stopping my pain medication. I thought they were crazy. It was no mental feat to stop taking the drugs, but I must admit my body’s physical reaction was not good. That is normal for someone that has taken opioid pain medicine for a period of time.

It is time we stop hurting and stigmatizing pain patients in this manner. It just makes our pain worse and can even lead to serious mental health problems and in some cases suicide.

Please healthcare providers, make sure your diagnosis is made correctly. I believe that an addiction or dependency diagnosis should only be made by someone who is trained in addiction medicine and who specializes in treating addictive disorders.

Patricia Young lives in Florida.

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

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

Experimental Drug Reduces Migraine Days by Half

Pat Anson, Editor

An experimental injectable drug reduces the number of migraine days by 50 percent or more in patients who suffer from chronic migraine, according to the results of a new study released by drug makers Amgen and Novartis.

The Phase II study of AMG 334 -- also known as erenumab – involved 667 patients who suffered an average of about 18 migraine days per month.  A reduction of 50% or more in monthly migraine days was observed in four out of ten patients taking a 140 mg dose of erenumab. Patients taking a 70 mg dose had a 40% reduction in migraine days compared to a placebo drug. 

Significant improvements were also noted in quality of life, headache impact, disability, and pain interference compared to the placebo.

“Chronic migraine patients lose more than half of their life to migraines with 15 or more headache days a month, facing intolerable pain and physical impairment,” said Stewart Tepper, MD, a professor of neurology at the Geisel School of Medicine at Dartmouth. “As a neurologist, these findings are exciting because they demonstrate that erenumab could serve as an important new therapy option for reducing the burden of this often-disabling disease.”

Erenumab is not an opiate and falls under a newer class of medications – known as fully human monoclonal antibodies -- that target receptors in the brain where migraines are thought to originate.

“Erenumab is specifically designed to prevent migraine by blocking a receptor that is believed to have a critical role in mediating the incapacitating pain of migraine,” said Sean Harper, MD, executive vice president of Research and Development at Amgen, which is co-developing the drug with Novartis.

“The results from this global chronic migraine study are exciting because they support the efficacy of erenumab for a patient population that has had few therapeutic options.”

Results from two Phase III studies of erenumab for episodic migraine are expected later this year. If positive results are achieved, that could lead to a new drug application with the Food and Drug Administration.

"This is an exciting time in the treatment of chronic migraine, which has a profound impact on the lives of those who suffer from the disease," said Vasant Narasimhan, Global Head of Drug Development and Chief Medical Officer for Novartis. "These important data further support the efficacy of AMG 334 in patients who currently have limited therapeutic options."

Under its agreement with Novartis, Amgen holds sales rights for erenumab in the United States, Canada and Japan, while Novartis would sell the drug in Europe and the rest of the world.

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

Why I Prefer Kratom Over Pharmaceutical Drugs

By William Johnson, Guest columnist

I've experienced much of what's wrong with our healthcare system and can think of only one possible solution people can do for themselves when it comes to pain management, which leads to another matter as well.

Kratom works well for pain and you don't need a prescription to buy this centuries old remedy from Southeast Asia. Did I say buy? Yes I did, which leads to the other matter. The Drug Enforcement Administration is currently in the process of classifying the leaf from this tree into a Schedule I drug, meaning no one will be able to prescribe it, much less buy it inside the United States.

At this very moment, thousands are telling and retelling their stories about kratom, trying to save it from the axe of the DEA; how it saved their lives or helped them stop taking pharmaceutical drugs that have horrible side effects, such as Xanax, OxyContin, Klonopin, Paxil and many others.

I was unaware of this plant until three months ago, when I first began taking kratom. I was fed up with pain clinics, tired of being treated like a criminal, and tired of waiting for hours each month just to have a prescription renewed.

I was also tired of the adverse side effects from long term opiate use. Those include, but are not limited to, depression, lack of motivation, liver damage, and severe constipation. Sound familiar to anyone?

I've made some other discoveries along the way as well. My recent annual blood work to test liver function returned to normal for the first time in over a decade, after I contracted Hepatitis C at a dentist’s office.

william johnson

Not only that, while it relieved most of my pain from several conditions of the spine, ones I was told would require long term opiate use for the rest of my life, it also adequately treated the symptoms of Hepatitis C, like chronic fatigue, joint pain and a host of others common to those with this virus.

My doctor was amazed when he found out I was consuming kratom, a botanical he'd never heard of. He began to research it and concluded the same thing as I. Kratom is the most likely cause that my liver functions are normal. He's never seen this with any patient with such a high viral load, not to mention the Hepatitis-C, which also managed to give me stage three Cirrhosis.

Unheard of, you say? Needs more study, right?

Every kratom researcher to date has recommended more study on its potential benefits, but now the DEA comes along saying kratom presents an imminent danger to public health -- even though it cannot identify a single death associated with kratom use alone.

One of the points I'm hoping to make is that there are viable alternatives for pain sufferers that don't include dealing with the healthcare system. And because more patients are learning about kratom, costing the industry million upon millions of dollars, DEA has stepped in to ban kratom for its pharmaceutical buddies, using outright false information in the process.

For more on that, click here to see a letter to the DEA from the Center for Regulatory Effectiveness.

And if you haven’t already, sign the petition to the White House opposing the DEA action.

While we're not going to fix the influence money has on the healthcare industry in a day, a week or even years, one thing we can do is remove as much of our business from that industry as possible. If herbal remedies work as well or better, I strongly suggest we work to keep them legal. Western medicine doesn't have all the answers and it might serve the public interests if we begin to realize this.

William Johnson lives in Virginia. He is a retired urban planner, who advocates for organic farming and gardening.

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.

CDC: Prescription Opioid Abuse Costs $78.5 Billion

By Pat Anson, Editor

A new analysis by the Centers for Disease Control and Prevention estimates the total “economic burden” of prescription opioid abuse in the United States at $78.5 billion a year.

Researchers at the National Center for Injury Prevention and Control – the same agency that oversaw development of the CDC’s controversial opioid prescribing guidelines – analyzed economic data from 2013 associated with opioid abuse, including the cost of health care, lost productivity, substance abuse treatment and the criminal justice system.

“A large share of the cost is borne by the public sector, both through direct services from government agencies, but also through tax revenue that will be lost from reduced earnings. Also, the health care sector bears approximately one third of the costs we have estimated here,” wrote lead author Curtis Florence, a senior health economist at CDC.

Florence and his colleagues estimated that nearly two million Americans abuse or are dependent on opioids. Their study is published online in Medical Care, the official journal of the American Public Health Association.

 "More than 40 Americans die each day from overdoses involving prescription opioids. Families and communities continue to be devastated by the epidemic of prescription opioid overdoses.” said CDC Director Tom Frieden, MD, in a news release.

"The rising cost of the epidemic is also a tremendous burden for the health care system."

Exactly what that burden is is open to conjecture. The researchers admit that some of their data is flawed because they relied on death certificates codes – which often fail to distinguish between deaths associated with prescription opioids and those caused by heroin. Heroin users and prescription opioid users are essentially lumped together – even though heroin users are far more likely to enter the criminal justice system.

In addition, opioids associated with death were considered a sign of abuse even if multiple drugs were involved. No distinction was made if the deaths were accidental, intentional or undetermined.

“Our health care cost estimates used the definition of opioid abuse and dependence identified by ICD-9 diagnosis codes. This definition does not differentiate between prescription opioids and heroin,” said Florence. "We did not attempt to attribute costs to specific drugs if multiple types of drug abuse were reported. This could bias our results if the health care cost impact of abuse and dependence is different between prescription opioids and heroin, or if abuse of prescription opioids alone has a different effect from abuse of multiple drugs,”

The researchers also were unable to distinguish between the “nonmedical” use of opioids by someone who obtained the drugs illegally and those who obtained them legally through a prescription.  

“It is extremely difficult to measure all costs to society from an epidemic. In this case, there are many costs we were unable to measure, such as the reduction in quality of life of those who are dependent,” wrote Florence.

Despite these limitations, the CDC research team said their estimates should be considered by healthcare providers and regulators in deciding whether prescription opioids should be used to treat pain.

“In the ideal case, decision makers could use these estimates when weighing the benefits and risks of using opioids to treat pain, and evaluating prevention measures to reduce harmful use. However, at the present time a full accounting of both the benefits and costs of prescription opioid use is not available,” they wrote.

The CDC estimate of $78.5 billion as the annual cost of prescription opioid abuse is only a fraction of the total cost of chronic pain on society. Using data from 2008, researchers from Johns Hopkins University estimated that the economic cost of pain in the United States ranged from $560 to $635 billion annually.

The CDC’s opioid guidelines discourage primary care physicians from prescribing opioid for chronic pain. Although voluntary, anecdotal reports from patients and doctors suggest the guidelines are being widely adopted by many prescribers. Some states have even adopted the CDC guidelines as official policy or in legislation.

The CDC has released no estimate on the economic impact of its guidelines or on the reduction in quality of life for pain patients who are no longer able to obtain opioids.

‘Hope Is True’ Primed to be Pain Community Anthem

By Barby Ingle, Columnist

Even the tiniest spark of hope can get someone through the toughest moments in life – whether the challenges are physical, emotional or spiritual. Sometimes, all it takes is a song to help us feel better about ourselves.

Chronic pain affects one in seven globally, so it’s bound to affect you or someone you know. We need a way to have the voice of pain patients be heard so society will better understand our challenges and provide better support. That’s why the International Pain Foundation (iPain) developed the Music Moves Awareness project.

This month we released a new song and music video to shed some light on the daily challenges faced by the pain community. “Hope Is True” was created in collaboration with some of the brightest talent in the entertainment industry, including Ryan Young, William J. Fuller, The Silhouettes, Lynne Waggoner-Patton, Who is Emileigh Productions, Alex Geringas and Intellectric Media.

All funds raised from iTunes and other outlets through sales of “Hope Is True” will benefit iPain programs and the pain community. iPain is dedicated to shining a light on chronic pain, funding research and helping patients get better access to pain care. As we move forward, iPain will be using music -- particularly this new song -- to educate the world about chronic pain issues and their social, cognitive, physical, emotional, and developmental impact.

The International Pain Foundation recently celebrated its tenth anniversary and the Music Moves Awareness program by hosting a premiere party for “Hope Is True” in downtown Los Angeles. Celebrities who came out in support included Christina Milian, Ally Hilfiger, Rachel Reenstra, After Romeo, Bret Lockett, Chris Caldovino, Gillian Larson, Billy Blanks Jr., Dre Davis, and many others.

It’s all about raising awareness. We have celebrities come to events like this to tweet about it and talk about it -- and then we turn the spotlight on patients and share their stories.

The Music Moves Awareness project is centered on empowering chronic pain patients to live the very best lives they can. We believe music has the power to make lives better and inspire those living with chronic pain to become engaged by being their own best advocate.

All of our educational events are free for the patients to attend. My dad started the foundation because it took three years to get a proper diagnosis for me. We figured if it happened to me, it’s probably happened to other people.

What started as a family project turned into a non-profit foundation. We’ve done pain expos, symposiums, and currently have a webinar series as a part of the Music Moves Awareness initiative. We also get the word out by distributing printed materials and recently launched our new magazine, iPain Living.

iPain supports the idea that chronic pain is a real and complex disease that exists either by itself or can be linked with other medical conditions. As a charity, we campaign for effective pain care through an array of treatment options, many of which are widely inaccessible. Chronic pain is an unrecognized public health crisis with devastating personal and economic impacts. Most importantly, we operate under the belief that allowing people to suffer with unmanaged pain is immoral and unethical.

Over the next 18 months, we’ll be releasing features about chronic pain patients, sharing their stories and putting the spotlight on them. Each patient has a different pain condition, different treatment options that they’re pursuing, and things that are going on in their lives. 

This will help the world learn more about chronic pain and give us all new hope. 

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.

Kratom Supporters Rally at White House

By Pat Anson, Editor

Hundreds of protestors chanting “kratom saves lives” and “I am kratom” rallied in front of the White House today, hoping to turn their passion for an herb into a movement that stops the Drug Enforcement Administration from making kratom illegal.

“This stuff saved my life. It gave me my life back,” said one protestor.

Kratom comes from the leaves of a tree that grows in southeast Asia, where it has been used for centuries as a natural medicine. In recent years, kratom has grown in popularity in the United States, where it is made into teas and supplements as a treatment for pain, depression, anxiety and addiction.

All of that may change on September 30th, when the DEA plans to schedule the two main active ingredients in kratom as Schedule I controlled substances -- alongside heroin and LSD. That would effectively make the sale and possession of kratom a felony.

Under its emergency scheduling order, the DEA invited no public comment and held no public hearings.

“Stop this ban immediately. You’re trying to protect your jobs. You’re not trying to save Americans,” said Ryan Connor, a military veteran who lost a sister to a heroin overdose. “If you take away this herb, more and more people are going to die."

Connor said he uses kratom to treat his own opioid addiction.

image courtesy american kratom assn.

“I’ve been on every opioid under the sun. I was on Suboxone. I was told it was a cure for addiction, but it did not cure my addiction. In fact, it made it worse. I used kratom to get off Suboxone. It was painless. I had zero side effects from it. And I think as Americans we have the right to choose our health over getting poisoned by pharmaceuticals,” Connor said.

In a notice published in the Federal Register, the DEA said an emergency scheduling of kratom was necessary because it has no approved medical use. The DEA claimed the herb was being used recreationally for its "psychoactive effects" and as a substitute for heroin.

The Centers for Disease Control and Prevention also issued a report last month calling kratom "an emerging public health threat." The agency said there were 660 calls to U.S. poison control centers about kratom in the last six years. About 8 percent of the calls involved a life threatening condition. One death was reported.

courtesy patti belmont

Kratom supporters say the death was more likely caused by prescription drugs and that kratom actually saves lives.

“It changed my life. It rescued me from a very severe addiction to narcotics. It took me out of a home and bed-bound existence. It gave me the energy and pain control that I needed,” said Susan Ash, who founded the American Kratom Association, which organized the rally outside the White House.

“We want a regular scheduling process that involves public comment and the best available science, and not just a note from the CDC that said they got all of 660 calls to poison control when they’re getting three to four million calls a year. How do 660 calls make an emerging public health threat?”

Kratom supporters have gotten over 120,000 signatures on an online petition asking the Obama administration to stop the DEA from scheduling kratom as a Schedule I substance. Under its "We the People" petition rules, the administration promises to "take action" on a petition within 60 days if supporters are able to gather at least 100,000 signatures.   

According to the website whpetitions.info, the average response time for a successful White House petition is well over 100 days – not 60 days. Six petitions -- including the kratom petition -- are currently waiting for a response.

Meanwhile, the Center for Regulatory Effectiveness (CRE), a government watchdog group, has asked the DEA to postpone the scheduling of kratom.

In a September 12 letter to acting DEA Administrator Charles Rosenberg, a CRE official pointed out that the National Institutes of Health has conducted research to explore the therapeutic value of kratom as a treatment for chronic pain and substance abuse.

“The research was so well conducted and received by the scientific community that the aforementioned institutions applied for a patent. How much more additional evidence is needed to demonstrate that the DEA has acted arbitrarily in issuing a ban on kratom?” asked Jim Tozzi, a member of the CRE Board of Advisors.

“In short, without going through a notice and comment process, DEA is obviating another agency’s research that was conducted with appropriated funds. With its action, DEA is also obviating the progress and promise of kratom research to boosting the American bio-sciences industry.”

Tozzi’s letter said the DEA’s “rush to judgement” may have violated the federal Data Information Quality Act and was a “clear and flagrant abuse of discretion.”

He asked the DEA to extend the effective date for scheduling kratom to July 1, 2017, to allow for public comment and a peer review of the science behind the agency’s decision.

Half of Patients Have Trouble Getting Pain Meds

By Pat Anson, Editor

A new survey of chronic pain patients found that over half – 56 percent -- have experienced problems getting access to opioid pain medication, either from a pharmacy or their own doctor. Nearly half of the patients surveyed also said they have contemplated suicide.

“Access continues to be a problem and a growing problem for patients living with chronic pain,” said Jeff Dayno, MD, chief medical officer for Egalet, a pharmaceutical company that conducted the survey along with the American Chronic Pain Association (ACPA).

The online survey of over 1,000 patients was conducted in 2015, before guidelines were issued by the Centers for Disease Control and Prevention that discourage primary care physician from prescribing opioids for chronic pain. Although the guidelines are voluntary, they’ve had a chilling effect on many doctors and pharmacists since their release in March.  

“General practitioners who don’t have as much experience are having somewhat of a knee jerk reaction. Either they’re not prescribing opioids at all or taking a very cautious approach,” said Dayno.

“The broader medical community is backing away from the more effective type of pain medications and opioids specifically, even at the pharmacy level in terms of stocking them and having them available.”

Nearly two-thirds of patients (63%) said their pharmacy carries only a limited supply of pain medication. And nearly four out of ten patients (39%) said their physician no longer prescribes pain medication.

“Since the push to combat prescription medication abuse has risen, so have the number of calls we have received from individuals expressing their frustration about accessing their prescription medications,” said Penney Cowan, founder of the ACPA. “The study found that access really is an issue for individuals; they struggle to find doctors who are willing to treat them, and pharmacies that stock their medication.

“For individuals living with chronic pain, access to medication is vital to functioning in their everyday lives. Doctors would not withhold prescriptions from patients with other medical conditions such as diabetes or heart disease. What’s startling is the high percentage of individuals who have contemplated suicide.”

Forty-seven percent of the survey respondents said they’ve had thoughts of suicide.

“The statistic around patients contemplating suicide, we’ve seen numbers like that in the literature before. And that’s a very concerning and frightening aspect of the impact of limited access to effective pain medications,” said Dayno, who believes the number of patients complaining about access would be even higher if the survey was conducted today.

When asked by Pain News Network if he thought the CDC even considered suicides and other negative consequences on patients when it was drafting the guidelines, Dayno said no.

“I don’t think that dimension was clearly considered in the guidelines. I think it was much more of an evidence based, clinical approach on the pain management side. But the impact of potential barriers to access to these medications was not factored in to that assessment as part of the CDC guidelines,” he said.

A noted expert on pain management says he’s also seen “anecdotal reports” of primary care physicians and pain management specialists dumping pain patients since the CDC guidelines came out.

“I think some doctors are increasingly uncomfortable with continuing to prescribe what has been a higher dose of opioids, uncomfortable with the scrutiny that they’ve gotten, and as a consequence they are discharging patients from clinics, urging them to find care elsewhere,” said Sean Mackey, MD, Chief of the Division of Pain Medicine at Stanford University.

Study Finds Link Between Weather and Chronic Pain

By Pat Anson, Editor

There may be something to the old adage about “feeling under the weather.”

Early results from a smartphone-based weather study in the UK show that rain and lack of sunshine have an impact on how we perceive pain.

Over 9,000 people are participating in The University of Manchester’s Cloudy with a Chance of Pain project,  using a special app to record their daily pain levels.  

The app also captures hourly weather conditions using the phone’s GPS, giving researchers the ability to compare the pain data with real-time local weather.

Researchers reviewed data from participants in three cities – Leeds, Norwich and London – and found that as the number of sunny days increased from February to April, the amount of time participants spent in severe pain decreased.

Conversely, when the weather turned rainy and cloudy in June, the amount of time spent in severe pain increased.

The 18-month study is only half complete and researchers are still looking to recruit as many people as possible who are willing to track their symptoms.

“If you are affected by chronic pain, this is your chance to take do something personally – and easily – to lead to a breakthrough in our understanding of pain,” said lead investigator Will Dixon, a professor of Digital Epidemiology at The University of Manchester’s School of Biological Sciences.

The Greek philosopher Hippocrates in 400 B.C was one of the first to note that changes in the weather can affect pain levels. Although a large body of folklore has reinforced the belief that there is a link between weather and pain, the science behind it is mixed.

A 2014 study in Australia found that low back pain is not associated with temperature, humidity and rain.  A 2013 Dutch study also concluded that weather has no impact on fibromyalgia symptoms in women.

“Once the link is proven, people will have the confidence to plan their activities in accordance with the weather. In addition, understanding how weather influences pain will allow medical researchers to explore new pain interventions and treatments,” says Dixon.

People with arthritis or chronic pain who are interested in joining the Cloudy with a Chance of Pain project – and who have access to a smartphone – can download the app by clicking here. You need to be at least 17 and live in the UK.

Participants are encouraged to record their pain symptoms daily until the project ends in January.  Researchers hope to use data to develop “pain forecasts” based on weather predictions.

Waiting for Santa in the ER

By Emily Ullrich, Columnist

Some of you may have noticed I’ve been silent for a while. I’ve been shirking my duties to the pain community because I am so fed up that it all seems futile.

I’ve been struggling with feelings of defeat and guilt at my unusual inability to muster the courage to continue. I have been deeply introspective and, for once, I’ve had no words for the profound emotional disenchantment that one experiences when they realize that most doctors really don’t care.

My mother tells the following story about me when I was a little girl, and it struck me that this feeling I have today is the same one I had when I realized there was no Santa Claus.

She says that I essentially disassembled the entire house of cards that kids are brought up believing in. She says I was lying in bed when I asked her if Santa was real. She attempted an explanation that Santa was the spirit of Christmas and that he wasn’t an actual person, but that his essence was within all of us. According to her, I went on to ask if there was an Easter bunny, a tooth fairy, or even a God.

A few years later, I left the sheltered life of Montessori school, where creativity was valued, analytical thinking promoted, and social interactions remained innocent. I entered public school in the midst of puberty. Despite my many futile attempts at preppy mall fashion, and rehearsed and repetitive social coolness, I could not blend in.

To my dismay, my quirky, outside-of-the-box thinking betrayed me daily. I became the weird, socially awkward, politically and culturally over-saturated smart girl, wearing the body of a 6-foot tall woman.  As a writer, these experiences have given me a unique lens through which to view life and are now the things I pride myself in.

As a chronically ill patient, I have been thrown right back into the post-traumatic stress of that time, my intellect and strong personality are not seen as behaviors of a good patient. I feel l have to be a fake to get the care that I need. I feel this sensation washing over me every time I have a doctor’s appointment, surgery, procedure or hospital stay.

I’ve written before about the inhumanity and cold, cruel treatment I have received more times than I care to remember. I am aware that there are doctors and nurses who do care and actually want to help, and I have been blessed more than a few times with having these amazing people as my caregivers.

But if I am truly honest, more often than not, these gems of humanity are not the ones we patients get.

I understand that they’re at work, doing a job, and they have to do more for us than the usual patient. Some are also jaded, uninformed, insensitive and, frankly, shouldn’t be in this line of work.

When a patient’s life, health, and attitude are psychologically and sometimes physically neglected, disrespected, and infused with negativity, it’s scarring. It plays over and over in your head. Although it’s really hard to control my temper and emotions in this situation, I do my best. It’s not natural for me. I am opinionated and strong-willed.

I’ve learned the hard way that when I act how I feel like acting, my care gets even worse. I always wonder what I could have or should have done differently to make the situation better.

I know that I am probably coming across as very negative, but there is one thing that I know about myself -- when I am at my worst, I am often at my best. What I mean is, I want to make others around me comfortable, and the more serious a situation is, the more I try to bring levity and positivity. I try to make people feel at ease, to laugh, and to know that I am grateful for their help. I make a point of being very polite to my caregivers, even when I’m frustrated with them, and I make a point to ask how their day is, even if they haven’t asked about mine. This leads me to my most recent hospital stay.

My Latest Trip to the ER

I went to the emergency room because my home healthcare nurse demanded it after noticing that my arm with a PICC catheter line was very red and inflamed. As usual, the ER doctor treated me like I was there for fun. Because waiting for 6 hours in a room full of sick people and being treated like crap is everybody's idea of a good time!

It turned out that I had pulmonary embolisms -- blood clots in my lungs -- a life-threatening condition which frequently causes stroke or heart attack. The doctor scolded me that I should "take this seriously," as though I got the clots from doing some sort of illicit behavior and was obviously careless about my health. I wonder if it ever occurred to him that maybe I was taking it seriously -- by going to the damned ER!

He then launched into a lecture about the evils of pain medications, and even alluded to the doctor’s oath to "first do no harm," insinuating that the doctor who prescribed my pain medicines (who happens to be the kindest, most compassionate and knowledgeable doctor I’ve ever had) was not helping me, but harming me.

He assessed all of this in two minutes of talking at me, not to me, and without any idea of the myriad health conditions I live with. Sick, and even sicker of dealing with this re-run of the C+ med student-come-doctor with a God complex, I mustered the energy to stand up for myself. I argued that this was probably not the best time for a discussion about changing or completely discontinuing my medications, seeing as I had pulmonary embolisms to worry about, and a pain doctor whose specialty it is to deal with that was not present.

God forbid, I had challenged his almighty ER doctor knowledge and here's where it got good.

He decided to un-diagnose my Reflex Sympathetic Dystrophy (RSD) -- an extremely painful and complicated condition I was finally diagnosed with after two years of surgery, doctors’ visits, and being told there was nothing wrong with me that a knee joint replacement and antidepressants wouldn’t fix.  

Then I spent three days in a hospital being run through a battery of tests and a whole team of doctors had agreed on my diagnosis of RSD.  It’s an illness that I take medications for, have physical therapy for, use a cane for, and which you can tell I have just by looking at my knee -- which he never did.

"You don't have RSD," he said. Based on what? Maybe the fact that I wasn't screaming and writhing in pain, as he thought I should be?  

"Did a neurologist diagnose you?" he asked. I explained that I spent days in the hospital having a battery of tests and a number of different specialists all agreed that I have RSD. Again, he asserted his disbelief, without ever looking at my knee!

Begrudgingly, he admitted me to the hospital, as though I intentionally manifested blood clots in my lungs just so I could hang out with his charming self. He also lectured me further about the gravity with which I should treat this situation.

I wonder since if he has ever thought about this interaction with me, and in any small way realized the hypocritical irony that his entire discussion was loaded with.  

I can't stop thinking about what happened. Or where Santa went to.

Emily Ullrich suffers from Complex Regional Pain Syndrome (CRPS), Sphincter of Oddi Dysfunction, Carpal Tunnel Syndrome, endometriosis,  Interstitial Cystitis, migraines, fibromyalgia, osteoarthritis, anxiety, insomnia, bursitis, depression, multiple chemical sensitivity, and chronic pancreatitis

Emily is a writer, artist, filmmaker, and has even been an occasional stand-up comedian. She now focuses on patient advocacy for the International Pain Foundation, as she is able.

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.

Can 3-D Sound Technology Silence Chronic Pain?

By Pat Anson, Editor

Cognitive behavioral therapy. Mindfulness meditation. Acupuncture. Massage. Yoga.

The list goes on and on.

You name it and most chronic pain patients have probably already tried some type of alternative treatment for pain relief. Many give up after a short trial period or simply can't afford to continue treatment.

But there's an innovative and inexpensive new way to treat chronic pain -- a CD that uses binaural sound technology to help listeners relax and "deamplify" pain signals. Think of it as a three-dimensional (3-D) stereo sound that reaches parts of your brain that regular sound can't.

"It's so easy. Anyone can pop in a CD and listen to it. The trick is to use it over time because when you use it regularly, you're training your brain away from pain, says Beth Darnall, PhD, a pain psychologist, clinical associate professor at Stanford University, and author of The Opioid-Free Pain Relief Kit: Ten Simple Steps to Ease Your Pain.

In addition to several practical tips at relieving pain, the book comes with a 20-minute CD that Darnall narrates using binaural technology, which she says is the "gold standard" in psychology for treating post-traumatic stress disorder (PTSD) and anxiety.  Darnall believes her CD is the first to use binaural sounds to treat chronic pain.

"The person just puts on headphones and I walk them through a total body progressive relaxation. Layered behind my voice are tones that go in one ear and in the other ear, in rapidly alternating sessions," Darnall told Pain News Network while attending PainWeek, a week-long conference in Las Vegas for pain management practitioners. 

"Most people will not perceive these tones, but your brain perceives them. This is called binaural technology and what it does is stimulates the different hemispheres of your brain in rapid alternating secession."

Wearing headphones is the key to making binaural technology work. So is listening to the CD at least twice a day. Darnall says it works in a way similar to cognitive behavioral therapy -- by "calming"  the brain and quieting the constant barrage of pain signals it is receiving.

BETH DARNALL, PHD

"Its only when you use headphones that the binoral works because the tones are going in one ear and in the other. And they're talking directly to your nervous system," explains Darnall.. "Even if you don't hear it, they're there.

"When you use it regularly, you're training your brain away from pain. You're literally retraining your neural networks to a calmer -- I don't want to say pain free --  state that helps people de-amplify. You're basically dampening the pain processing over and over again. And so over time your brain is less likely to go straight to the pain and amplification. You keep things at a calmer level where you have less pain and less distress."

You can click here to download an mp3 file and listen to a sample one-minute recording from the CD.

"We have observed is that it is very effective for pain," says Darnall, who recommends that users not be driving, doing chores or be engaged in anything else while listening to the CD.

"Sit. Close your eyes. Be present because we really want to induce a total body state ofdeep relaxation. If you're multi-tasking and doing other things, you're not fully relaxed."

Darnall recommends other relaxation techniques in her book to help people reduce stress and sleep better -- techniques she says can help reduce the need for opioid medication. She says listening to the CD will help enhance that process, but like any alternative treatment it takes time and effort to make it work.

"Most people with chronic pain, have been living with pain so long, if you listen to this once or twice, you're not going to scratch the surface. But over time we can train the whole nervous system away from pain," she said.