Trump Administration Promises Relief to Patients

By Pat Anson, Editor

A spokesman for the Trump administration pledged this week that the Department of Health and Human Services (HHS) would provide relief to patients who are "being harmed by the status quo.”

Matt Lloyd, a former top aide to Vice President Mike Pence, recently assumed the job of chief spokesman for HHS, the federal department that oversees the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services (CMS).

Lloyd made his comment in an unusual statement emailed to reporters after CMS released a report Friday that showed the number of Americans who signed up for insurance during Obamacare’s annual enrollment period had fallen to 9.2 million. That’s down from 9.6 million the year before.  

“Obamacare has failed the American people, with one broken promise after another. As noted in the report today from CMS, premiums in the ACA marketplace have increased 25 percent while the number of insurers has declined 28 percent over the past year,” Lloyd said.

MATT LLOYD

“We look forward to providing relief to those who are being harmed by the status quo and pursuing patient-centered solutions that will work for the American people.”  

Ironically, Lloyd made his statement two days after CMS invited public comment on the agency’s plans to have Medicare adopt the CDC’s opioid prescribing guidelines – a move that could affect thousands of patients who use opioids for pain relief. The CDC guidelines are voluntary and only intended for primary care physicians, but CMS wants to apply them to all doctors who prescribe opioids for non-cancer pain. A strict daily limit on opioids would also be set at 90 mg of a morphine equivalent dose.

Doctors and patients who don’t follow the proposed CMS policy could face punitive action, such as being dropped from Medicare coverage and insurance networks. CMS has estimated that over 15,000 Medicare beneficiaries who receive high doses of opioids for pain relief could be impacted  

CMS contracts with dozens of private insurance companies to provide health coverage to about 54 million Americans through Medicare.

The agency’s “Opioid Misuse Strategy” was developed during the final months of the Obama administration, but could be quickly adopted by the new administration.  CMS is only accepting public comments on its proposals until March 3 and plans to publish the final rules by Monday, April 3, 2017.

Comments on the CMS rule change should be mailed to:  AdvanceNotice2018@cms.hhs.gov.

Comments can be emailed to Matt Lloyd at: Matt.Lloyd@hhs.gov.

Medicare Planning to Adopt CDC Opioid Guidelines

By Pat Anson, Editor

The Centers for Medicare and Medicaid Services (CMS) has announced plans to fully implement the opioid prescribing guidelines released by the Centers for Disease Control and Prevention, which recommend that doctors not prescribe opioid medication for chronic non-cancer pain.

CMS is taking the CDC’s voluntary guidelines one step further, however, by mandating them as official Medicare policy and taking punitive action against doctors and patients who don’t follow them.

“When CDC released its guideline, I predicted that policymakers and payers would quickly move to convert CDC's voluntary recommendations into mandatory regulations, and my prediction appears to be coming true, both with CMS and with private payers,” said Bob Twillman, PhD, Executive Director of the Academy of Integrative Pain Management.

As Pain News Network has reported, CMS is adopting a “Big Brother” approach to fighting opioid abuse by developing a strategy that will encourage pharmacists to report doctors who may be overprescribing opioids and patients who may be abusing them. Information about these “potential opioid overutilizers” would be shared with insurance companies, which would be empowered to “prevent opioid overuse at point of sale at the pharmacy.”

CMS contracts with dozens of private insurance companies – known as sponsors -- to provide health insurance to about 54 million Americans through Medicare and nearly 70 million in Medicaid.

“To address the opioid epidemic, CMS has implemented a medication safety approach by which sponsors are expected to reduce beneficiary overutilization of opioids and maintain access to needed medications,” the agency said in a statement.

Saying it wanted to “better align” its policies with the CDC guidelines, CMS is proposing a daily ceiling on prescribed opioids at 90 mg morphine equivalent dose (MED). Any dosage above that level would be considered excessive. Patients who receive opioids from more than 3 prescribers and more than 3 pharmacies during a 6 month period would also be red-flagged.

Insurers would be expected to police pharmacies, doctors and patients who do not follow CMS policies, potentially dropping them from Medicare coverage and their insurance networks.

“Under the Part D opioid overutilization policy, sponsors are expected to implement appropriate plan-level claim controls at POS (point of sale) for opioids, use improved retrospective drug utilization review to identify beneficiaries at high risk for an adverse event due to opioids, and perform case management with the identified beneficiaries’ prescribers followed by beneficiary-specific POS edits to prevent Part D coverage of opioid overutilization,” CMS said.

Such a policy change would have a sweeping impact throughout the U.S. healthcare system because so many insurers and patients are involved. The Veterans Administration is the only other federal agency to adopt the CDC guidelines – and many veterans have complained that they are no longer able to obtain adequate pain relief at VA facilities.

Critics of the CMS strategy say it is even more draconian than the CDC guidelines, which are intended only for primary care physicians.

“CDC's ‘soft limit’ of 90 MED in treating chronic pain was a recommendation aimed at treatment of some people with chronic pain by primary care specialists. CDC stated that all of its recommendations were voluntary, and in this case, further provided prescribers with the option to use a higher dose if indicated by a careful risk/benefit analysis,” Twillman said in an email to PNN.

“In light of these limitations, it seems inappropriate for CMS to ask Part D providers to institute opioid dosing limits for people with pain who don't have cancer or are receiving hospice care, and for all prescribers, both primary care and specialists. 

Strategy Developed by Insurance Industry

The agency’s proposed “Opioid Misuse Strategy” was released publicly in early January.  It closely follows a 62-page “white paper” prepared by the Healthcare Fraud Prevention Partnership (HFPP), a coalition of private insurers, law enforcement agencies, and federal and state regulators formed in 2013 to combat healthcare fraud. 

The white paper, however, goes far beyond fraud prevention by recommending policies that will determine how a patient is treated by their doctor, including what medications should be prescribed. 

The number of Medicare patients who “overutilize” opioids is relatively small – just 15,651 beneficiaries in 2015 – which represents just 0.13% of Part D opioid users.

CMS is seeking public comment on the proposal in its 2018 Advance Notice and Draft Call Letter, which outlines a number of other changes the agency is making to its Medicare Advantage and Part D prescription drug programs. Comments will be accepted through March 3rd, with final versions published on April 3, 2017.

Comments can be emailed to: AdvanceNotice2018@cms.hhs.gov. 

When Will Doctors Speak Out for Their Pain Patients?

By Michael Thompson, Guest Columnist

I am a retired clinical social worker and a licensed chemical dependency counselor.

I had to retire about six years ago, at age 62, when my rotator cuffs started shredding on a chronic basis.  I also have osteoarthritis in both knees and peripheral neuropathy with severe pain in both feet and hands.  It’s been several years since I was able to wear shoes.   

I have also been diagnosed with Chronic Regional Pain Syndrome, which just means we don’t know what the problem is but were just going to call it blah, blah, blah.  That’s medicine for you – an art, not a science.

I am allergic to non-steroidal anti-inflammatory pain medication.  The last time I took naproxen, my blood pressure (which is normally high) dropped to 80/50.  I literally saw the pearly gates.  I ended up in the hospital for about a week. 

To put it lightly, my genes are rotten.  Everything seems to be breaking down in the latter years of my life and it all hurts. 

For about six years I was on a relatively high dose of opioid pain medication. Life wasn’t great, but it was pretty good.  I was able to play golf and work out three times a week in a physical therapy program.  I could work in the yard and around the house. Despite all of my multiple medical problems, I had an acceptable quality of life. 

MICHAEL THOMPSON

Then last year the CDC guidelines for opioid prescribing came out. My pain specialist freaked out and abruptly informed me that in order to keep the DEA from her door, she was going to have to reduce the amount of opiate medication she was prescribing for me.  My dose was cut in half.

In less than a month, I cratered.  I was in such intense pain 24 hours a day that I couldn’t sleep.  I couldn’t function.  My quality of life went from decent to nonexistent.  I was no longer able to work out and gained a good deal of weight. I couldn’t walk across the room because of extreme pain.  I spent my time at home waiting until it was time to take my next dose of medication. 

I tried changing my schedule, so that instead of taking a pill every six hours I would take one when I really needed it for severe pain. That seemed to work better, but I wound up taking more pills than I should and came up short at the end of the month. I was left for 48 hours with no medication at all. 

Even though I had never abused my medication, my pain doctor refused to help me out with an early refill, saying that it was just too bad and that the DEA would not let her write a new script even a half a day before it was due.  

I was stunned, though I should have known better.  For two days I thought I was going to die.  It wasn’t just the withdrawal. It was the unmasked intense pain. 

I worked for a time early in my career with an addiction physician who taught me that chemical dependence was a lot easier to treat than chronic pain, because of the all-consuming nature of pain.  He told me that with addiction you might wish you were going to die, but with the strain that untreated pain puts on the body, you might actually die.  After experiencing both, I can vouch for the truth of his words.

Needless to say, I have not made that mistake again.  Since that time I have maintained a strict regimen, even if that meant that I would have to white knuckle the last few hours before the next dose is due.

When I saw my doctor last month, she told me that the DEA had instructed her that she could not prescribe more than three pills a day to any of her patients.  Next time I see her, she will reduce me to four pills a day.  The month after that, she will only prescribe three a day. 

I don’t know what I am going to do when that happens.  It terrifies me.  I have never considered suicide as an option, but when a person is without hope that things will improve and they face intense grinding pain 24/7, I can understand how some people might find suicide appealing.  As a therapist, I never thought that I could understand that kind of thinking, but I do.

I asked for a referral to a psychiatrist because of her suggestion that with their advanced training, they might be able to prescribe more medication or a different opiate that works better. 

The psychiatrist I was referred to was the CEO of a local rehab program.  When he discovered that I was retired and on Medicare, and that I didn’t have a generous insurance package for rehab, his manner changed abruptly.  He treated me like I was a med seeking (which I was) and stone cold junky (which I was not). 

After an extremely presumptuous and rude exchange (it was clear that he was trying to impress his two cute interns and to show them just how you handle addicts), I informed him that I just did not feel that we were a good fit and left. 

It was clear that he knew nothing about my background or my history. And when he found out I didn’t have insurance money to feed his program, he lost interest in finding out anything about me.  I pity his patients and his employees. 

My next step was to seek a second referral. The doctor I was sent to was another pain specialist, who informed me that she was only prescribing two pills a day to her current patients, and so I should stay with my current provider.

I don’t know whether the issue has been a poor roll out of the CDC guidelines or if doctors aren’t reading them correctly and feel it’s better to be safe than sorry – even if that means leaving their suffering patients in the lurch. 

Either way, it’s a hell of a way to run a railroad and a lousy way to practice the healing arts.  Leaving so many people in agony is criminal.  For a doctor to do this, they might as well sell insurance for all the good they are doing their patients. What happened to the Hippocratic Oath?

I have to confess.  I am getting desperate.  With the level of pain and stress I am under, my health is breaking down. I can understand why some might consider suicide as a real option as an alternative pain solution. 

The CDC needs to consider how this will affect the aging population, for whom opiate medication may be the only path to a decent quality of life during their later years.  I mean, what are they afraid of? Lines of aging junkies sitting in the gutter with a needle in their arm? 

It is interesting to note that none of this is affecting the addict population, other than to increase the number of people seeking pain relief on the black market.  Addicts will always find a way.  Legitimate seniors with palliative and end-of-life pain concerns, and others with legitimate pain needs, have nowhere else to turn. 

Medicine is failing us. This is medicine by law enforcement. Scare the doctors and the problem will go away.  If the DEA is frightening doctors with the loss of their license, the CDC needs to step in and call off the dogs.

I just hope this communication to my pain doctor comes before I die from complications of intense pain.  What a way to go. Death by good intentions, but poor communication.

Who speaks for us, if not the doctor?

Michael Thompson lives in the Dallas, Texas area.

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.

Flu and NSAIDs Increase Heart Attack Risk

By Pat Anson, Editor

With the cold and flu season in full swing, many people take over-the-counter pain relievers like Advil and Aleve to ease their aches and pains, and to help them sleep.

What many don’t know is that they may be increasing their risk of a heart attack.

In a study of nearly 10,000 people hospitalized in Taiwan after a heart attack, researchers found that patients who took non-steroidal anti-inflammatory drugs (NSAIDs) during an acute respiratory infection tripled their risk of an acute myocardial infarction (heart attack).  The study was published in the Journal of Infectious Diseases.

Respiratory infections and NSAIDs were both already known to raise the risk of cardiovascular problems, but this was the first time they were studied together.  

"Physicians should be aware that the use of NSAIDs during an acute respiratory infection might further increase the risk of a heart attack," said lead author Cheng-Chung Fang, MD, of National Taiwan University Hospital.

“This approach should raise clinical concern because NSAIDs use during ARI (acute respiratory infection) episodes is highly common in real-world practice.”

Fang and his colleagues found that using NSAIDs while having a respiratory infection was associated with a 3.4-fold increased risk for a heart attack. The risk was 7.2 times higher when patients received NSAIDs intravenously in the hospital.

Another commonly used pain reliever, acetaminophen, which eases pain in a different way than NSAIDs do, was not evaluated in the study. But researchers say it may be a safer alternative, at least in terms of cardiac risk, for relief from cold and flu symptoms.

NSAIDs are widely used to treat everything from fever and headache to low back pain and arthritis. They are found in so many different over-the-counter products -- such as ibuprofen, Advil and Motrin -- that many consumers may not be aware how often they use NSAIDs. 

In 2015, the U.S. Food and Drug Administration ordered warning labels for all NSAIDs to be strengthened to indicate they increase the risk of a fatal heart attack or stroke. The revised warning does not apply to aspirin. The FDA said people who have a history of heart disease, particularly those who recently had a heart attack or cardiac bypass surgery, are at the greatest risk.

European researchers released an even stronger warning last year, saying there was no solid evidence that NSAIDs are safe.

Exactly how the pain relievers damage the heart is unclear, but a recent study on animals at the University of California, Davis found that NSAIDs reduced the activity of cardiac cells and caused some cells to die.

We Need to Admit Opioid Medications Are Dangerous

By Fred Kaeser, Guest Columnist

If chronic pain patients want continued access to opioid medications, we're going to have to admit they can be dangerous

There, I said it.

This has been bothering me for some time now, the apparent inability of many opioid medication users to admit that opioids can be dangerous. Read through the comments here at PNN or any other chronic pain forum and you'll hear a continuous drumbeat from many that opioids are safe when used for chronic pain. No ifs, ands, or buts.

The truth is no one really knows how safe or unsafe long-term opioid use is. No one knows because those studies have never been done.

But what many of us chronic pain patients do know is that popping a 10 mg oxycodone or its equivalent will pretty much do the job for us for a few hours or more.

And for many of us, it will do the job better than any other complimentary or alternative pain modality you can throw at us.

Of course, there are those who will tell us that opioid medications are dangerous. If you happen to be one of the 2.2 million people suffering from opioid medication addiction (OMA) you know they're dangerous. If you're one of the 4 million or so parents whose son or daughter suffers from OMA, you know they're dangerous. And if you're one of the nearly 30,000 parents whose son or daughter died last year from an opioid medication interaction, you really know they're dangerous.

So, opioid medications are dangerous – to them. But what about us chronic pain patients? If you are genetically predisposed to addiction, opioid medication is potentially dangerous to you. But even if you're not predisposed, opioid addiction is still possible. If the addiction rate is just 1% (which some believe), that means for the 11 million Americans who use opioid medication daily, they're dangerous for 110,000 of us. And if you believe the addiction rate is 10%, they're dangerous for 1.1 million of us.

Ever experience opioid withdrawal? Some of us have. How did you like going through that? Many would admit that was pretty dangerous. And if we didn't think it was, we sure thought that it sucked. And how about opioid medication misuse? Misuse our medications and risk respiratory distress or some other negative consequence? It can all be pretty dangerous.

Why do we need to admit opioids are dangerous?

Because to the average Joe and Jane America, we’ll seem pretty stupid if we don't. Policy makers and most of America have bought into the idea that opioids (legal and otherwise) pose a huge problem. If we don't jump on that bandwagon and work together to see how this problem can be effectively handled, we're only going to be left further behind. That train left the station and it isn’t coming back.

Continue to resist admitting that opioid medications can be dangerous, and all those that believe they are will continue to turn a deaf ear when we say we need them for pain relief. We only sound like the addict who is equally convinced that they need their drugs.

We can no longer afford to be seen as part of the problem. It is time that we are seen as part of the solution. And that starts with an open and honest dialog about the dangers of opioids, along with a similar dialog as to how chronic pain sufferers gain a quality of life when we take our medications responsibly -- which is the case the vast majority of the time.

We can argue that chronic pain patients should continue to have access to opioid medication, while at the same time agreeing that they can be dangerous and have created a problem for many in our society.

We can continue to lobby and fight for our right to adequate pain relief, while at the same time lend our efforts in the fight to minimize and reduce the horrors of addiction and death.

By doing so we will enhance our plight in the eyes of those that do not know what it is like to suffer daily the burdens of debilitating chronic pain.

By doing so we will be seen as reasonable and responsible in wanting to thwart the opioid problem. And even though we suffer, we are willing to fight for the greater good.

Most of us are pretty good at standing up and saying we deserve the medications that serve us so well. We can still do that when we also admit that they can be very dangerous.

Fred Kaeser, Ed.D, is the former Director of Health for the NYC Public Schools. Fred suffers from osteoarthritis, stenosis, spondylosis and other chronic spinal problems. He taught at New York University and is the author of What Your Child Needs to Know About Sex (and When): A Straight Talking Guide for Parents.

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

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

Lyrica and Cymbalta Advised for Diabetic Neuropathy

By Pat Anson, Editor

New guidelines by the American Diabetes Association for the treatment of diabetic neuropathy strongly discourage the use of opioids to treat nerve pain, while recommending pregabalin (Lyrica) and duloxetine (Cymbalta).

Nearly 26 million people in the United States have diabetes and over half have some form of neuropathy, which often causes a painful stinging or burning sensation in the hands or feet.  Nerve pain is often the first symptom that prompts people to seek medical care before getting a diabetes diagnosis.

Researchers at the University of Michigan led a group of internationally recognized endocrinologists and neurologists, and teamed up with the American Diabetes Association (ADA) to craft a new position statement on the prevention, treatment and management of neuropathy. The ADA last released a statement on diabetic neuropathy in 2005.

"Our goal was to update the document so that it not only had the most up-to-date evidence, but also was easy to understand and relevant for primary care physicians," said lead author Rodica Pop-Busui, MD, a professor of internal medicine at Michigan Medicine Division of Metabolism, Endocrinology and Diabetes.

"Treatment of neuropathy pain is specifically relevant because, unfortunately, there has been much overprescribing of narcotics for neuropathic pain."

Although opioids like oxycodone and tramadol are effective in relieving nerve pain, they are not recommended by the ADA as a first, second or even a third-line treatment.

“Despite the demonstrated effectiveness of opioids in the treatment of neuropathic pain, there is a high risk of addiction, abuse, sedation, and other complications and psychosocial issues even with short-term opioid use. For these reasons, opioids are not recommended in the treatment of painful DSPN (distal symmetric polyneuropathy) before failure of other agents that do not have these associated concerns,” the guideline states.

Instead of opioids, the ADA recommends either pregabalin (Lyrica) or duloxetine (Cymbalta) as an initial treatment for neuropathic pain. Gabapentin (Neurontin) can also be considered.

PNN readers often complain of side effects from all three drugs – such as depression, fatigue, nausea, headache and weight gain -- yet the ADA statement only vaguely warns that their “adverse effects may be more severe in older patients.”

"Lyrica did help with my nerve pain but the side effects were intolerable and the withdrawal was absolute hell," said Laura.  "I gained 20 pounds in a month and was even more of a zombie than when I was on gabapentin. I had no personality, no interest in anything, and had completely lost motivation to do anything."

"I have been on Cymbalta a couple of years. It has helped overall with depression, anxiety and pain. I also can't miss a dose or try to quit cold turkey," wrote Rebecca Williams. "I become very dizzy, nauseated, night sweats, crazy dreams, electrical zaps in my head. I don't know how I would ever get off of it because the withdrawal symptoms are unbearable."

The ADA guidelines recommend that physicians try different therapies to prevent or slow the progression of diabetic neuropathy, most of which focus on controlling high blood sugar (glucose), which can cause irreversible damage to small nerve fibers. Insulin, regular exercise and a low-calorie, low-fat diet can help regulate glucose levels.

To see the ADA’s recommendations, click here.

Acupuncture Effective in Treating Pain and Depression

By Pat Anson, Editor

Acupuncture can boost the effectiveness of medical care and lessen the severity of chronic pain and depression, according to a new study led by British researchers.

In a meta-analysis (a study of studies) of 29 clinical trials involving nearly 18,000 patients with chronic neck, lower back, knee or headache pain, researchers found that acupuncture significantly reduced the severity of pain when combined with standard medical care such as anti-inflammatory drugs.

Acupuncture is an ancient Chinese form of treatment that involves the insertion of fine needles into acupuncture points on the body. About four million acupuncture sessions are provided each year in the UK, about half of them for pain relief. The evidence to support such treatment has been limited.

"There has been a question mark for many years over whether policy and decision makers should or should not provide wider access to acupuncture,” said Hugh MacPherson, PhD, a professor of acupuncture research at the University of York.

“Our aim was to bring together data from high quality clinical trials and provide a robust evidence base that will help reduce this uncertainty and support commissioners and health professionals in making informed decisions backed up with research."

The study, published in the National Institute for Health Research (NIHR) Journals Library, found that the addition of acupuncture -- compared to standard medical care alone -- significantly reduced the number of headaches and migraine attacks and reduced the severity of neck and lower back pain.  Acupuncture also reduced the pain and disability of osteoarthritis, which led to patients using less anti-inflammatory medication to control pain.

The research team also conducted a new clinical trial for depression, in which 755 patients were provided with acupuncture, counseling or antidepressants. They found that both acupuncture and counseling significantly reduced the severity of depression, and that the benefits were sustained up to 12 months after treatment.

"In the largest study of its kind, we have now provided a solid evidence base to show that not only can acupuncture and counseling bring patients out of an episode of depression, but it can keep the condition at bay for up to a year on average," said MacPherson, who added that antidepressants don’t work well for more than half of patients.

Researchers admit the benefits of acupuncture are partially associated with a placebo effect, which has contributed to uncertainty about it's clinical effectiveness. However, when compared with sham acupuncture – in which fake needles are used or inserted in the wrong locations – they say “real” acupuncture provides substantially more pain relief.

“Our new data provides a significant step forward in treating chronic pain and managing depression, because patients and health professionals can now make decisions on acupuncture with more confidence. Not only is it more cost effective, but it reduces pain levels and improves mood levels, which could reduce over reliance on drugs that can sometimes result in unwanted side effects," MacPherson said.

Acupuncture is one of the most widely practiced forms of alternative medicine. As many as 3 million Americans receive acupuncture treatments, most often for relief of chronic pain. While there is little consensus in the medical community about acupuncture’s value, a large study in the Archives of Internal Medicine found that  “acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option.”

A Safe Way to Healthy, Restorative Sleep

By Ellen Lenox Smith, Columnist

For many of us suffering from chronic pain, coping with our medical issues can be physically and emotionally draining. Often, the lack of healthy sleep is the culprit.

Living with Ehlers Danlos syndrome (EDS) and sarcoidosis, I used to constantly wake up in the middle of the night with so much pain it was impossible to get any form of rest. When I was teaching, I somehow went for years trying to teach on “empty” due to a chronic lack of restorative sleep.

I remember having to cheat and use a seating chart to remember the names of my wonderful students, who were sitting right in front of me. These were students I had known, loved and taught for months. It was embarrassing, heartbreaking, and created a sense of loss and hopelessness.

Thankfully, those days are gone. I have gone from years of almost no quality sleep to being someone who goes to bed at night and wakes up in the morning feeling well rested. I don’t even remember any dreams, so I am getting the real REM sleep!

How did I do it? A teaspoon of oil made from medical marijuana. I take it before bedtime, mixed with a little applesauce or a small amount of food.

Within an hour, my body is ready for bed and sleep. 

For years I made this oil at home on top of the stove, but today enjoy using the Magical Butter machine. We find that oil made from the indica strain of marijuana works best for sleep. Directions for making the oil can be found on our website. 

I am now both a medical marijuana patient and a caregiver in the state of Rhode Island. Patients visit us with a variety of different illnesses, but the one thing they all have in common is lack of sleep. Without sleep, you lose hope and courage to move forward with your life. Each patient that has tried this oil has found that it gives them rest and hope.

Recently, a young woman and her husband came to our home. Living with both EDS and Chronic Regional Pain Syndrome (CRPS), she had a difficult life, but was hoping to find something to make it easier. We have the same pain doctor and he suggested she get in touch with us to learn about cannabis. 

The first night that she tried the oil, she slept for eight hours and was both thrilled and shocked. She said even her face looked calmer and more rested.  She is now happier, hopeful and has more strength to get through the day.

There was another patient sent to us who was a paraplegic in constant pain. He was angry, miserable and wished he hadn’t been given life-saving surgery after his accident. He was at a loss as to what to do to cope with the life he was now given. 

He tried the oil and was shocked what it did for him. From that point on, the desperate man who first called me and couldn’t even be understood due to his level of pain, was happy, laughing and finding some meaning in his difficult life. He later passed, but the oil gave him a better quality of life and a sense of purpose again.

We have seen one success after another of pain patients getting real quality sleep and rest. We have seen it work for cancer patients, and those suffering with post-traumatic stress disorder, multiple sclerosis, back pain, fibromyalgia, arthritis and other conditions.

For those of you who are caught up in opioid hysteria and can no longer get medication, I hope you take a moment and think about trying cannabis oil at night for rest. I have used it safely for a decade, since I am not able to metabolize even an aspirin or Tylenol, let alone any opiate. May you find the courage to try it and get the same results.

Ellen Lenox Smith suffers from Ehlers Danlos syndrome and sarcoidosis.  Ellen and her husband Stuart are co-directors for medical marijuana advocacy for the U.S. Pain Foundation and serve as board members for the Rhode Island Patient Advocacy Coalition.

For more information about medical marijuana or to contact the Smith's, visit their website.

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

Early Detection and Diet May Help Prevent Osteoporosis

By Pat Anson, Editor

The key to good bone health – and preventing fractures later in life – may lie in anti-inflammatory diets and earlier detection of bone loss, according to two new studies.

Researchers at the University of Michigan are studying new ways to identify women at risk of osteoporosis, a loss in bone density that raises the risk of fractures and disability. Breaking a bone in your spine or hip doubles your chances of developing chronic widespread body pain, especially if you are older.

"It's been considered a silent disease," says Karl Jepsen, PhD, associate chair of research and professor of orthopaedic surgery at Michigan Medicine. "One of the biggest challenges when you're looking at age-related bone fragility is to identify people who will fracture."

Jepsen is the lead author of a study published in the Journal of Bone and Mineral Research, which followed nearly 200 women for 14 years as they transitioned through menopause.

"Current identification for bone fragility takes place when the patient is around 65 years of age," Jepsen explains.

"We were hopeful that this study would give us an opportunity to identify those patients as early as 30 years before they fracture based on their bone traits. That means we would have an opportunity to intervene before the fracture happens, instead of after the fact."

Jepsen and his colleagues started following the women in 1996. Participants who enrolled had to be between 42 and 52 years of age and had at least one menstrual period in the previous three months. The women had bone density scans and other tests annually to measure changes in their bone mineral density.

Researchers found that the women experienced a wide variation in bone mineral content and bone area within the hip as they went through menopause, a finding that was unexpected.

"Our results were opposite to all expectations of how we assumed this would work," Jepsen says. "We found some women appeared to have hip bones that were increasing in strength during the menopausal transition while others seemed to be losing strength."

Jepsen said his study demonstrates that bone changes can be tracked individually in women during menopause, when treatment can begin earlier to prevent bone loss. Hormones and bisphosphonate drugs are currently used to help strengthen bones.

“Our goal is to use simple bone traits to identify those women that may benefit from early intervention when it comes to bone fragility, instead of the current strategy, which treats individuals after they have lost appreciable bone mass and strength," he said.

Anti-Inflammatory Diet Improves Bone Health

Anti-inflammatory diets -- which tend to be high in vegetables, fruits, fish and whole grains -- could boost bone health and prevent fractures, according to a study at The Ohio State University.

Researchers analyzed dietary data from over 160,000 women enrolled in the landmark Women's Health Initiative by assigning inflammation scores based on 32 foods that the women reported consuming. Researchers also looked at bone-mineral-density data from over 10,000 women and collected fracture data for the entire study group.

They found a correlation between high-inflammatory diets and fractures in post-menopausal younger than 63. Women with the least-inflammatory diets also lost less bone mineral density.

"This suggests that as women age, healthy diets are impacting their bones," said Tonya Orchard, an assistant professor of human nutrition at Ohio State's Food Innovation Center. "These women with healthier diets didn't lose bone as quickly as those with high-inflammation diets, and this is important because after menopause women see a drastic loss in bone density that contributes to fractures,"

The study, which appears in the Journal of Bone and Mineral Research, was observational -- meaning it does not definitively link diet to bone health. But it adds to a growing body of evidence that inflammation can increase osteoporosis risk.

"By looking at the full diet rather than individual nutrients, these data provide a foundation for studying how components of the diet might interact to provide benefit and better inform women's health and lifestyle choices," said Rebecca Jackson, the study's senior author and director of Ohio State's Center for Clinical and Translational Science.

Previous studies have connected high levels of inflammatory markers in the blood to bone loss and fractures in older women and men. The new findings suggest that women's bone health could benefit when they choose a diet higher in beneficial fats, plants and whole grains.

Pain Is Not That Simple

By Janice Reynolds, Guest Columnist

Let us stop talking about opioids for a moment and talk rather about pain. 

One of the unfortunate results of the phobia over opioids is that it has encouraged the belief that pain is a single and separate entity.  This way of thinking is being spread by the media, politicians and those who should know better, but don’t.  Pain is not that simple.

Pain affects the entire person and, when left untreated or undertreated, contributes to other health problems and can even lead to death. Acute and chronic pain can both exist in a cancer setting, as well as non-cancerous conditions.  The body does not know the difference.

What is different are the many different types and causes of acute and chronic pain.  There is also some crossover and intermingling.  Several different types of pain may exist at the same time, and acute pain can co-exist with chronic (notably as breakthrough pain).

It is usually easy to identify the source of acute pain, but there is no real evidence as to what “causes” chronic pain. We know there has been a change in neurons, which are no longer reporting a correct message to the brain. This poorly understood change is often permanent and not repairable.

People also respond differently to pain medications and therapies (what works for one may not work for another) and this is likely genetically linked. So a “study” which claims a certain medication doesn’t work for chronic pain or makes it worse has no basis in reality. There is no pain syndrome called “chronic pain.”

What is rarely talked about is the harmful effects of untreated pain. These effects are evidenced based, and can lead to increased suffering and fatal complications. Just with the cardiac system alone, pain can increase the heart rate, increase cardiac output, and contribute to heart attacks. Pain also affects the respiratory, musculoskeletal, endocrine, immune, gastrointestinal and nervous systems. Pain impairs wound healing.  

When left untreated or treated poorly, pain can also cause mental health problems, such as depression, suicide, insomnia, attention deficit, confusion, memory loss, and cognitive decline.  Many times these outcomes are blamed on medication, but pain is a much bigger impairment. Deaths are seldom evaluated to ascertain if pain was a contributing cause.

Stress has long been recognized as bad for your health.  It can worsen many illnesses and cause some as well.  We know that stress makes pain worse, but look at the amount of stress a person with pain faces almost every day in our society: losing access to a successful treatment, reading lies in the media, losing a provider, being treated like a criminal or drug addict, and so on.  This is not stress you can heal with exercise or meditation. It is relentless.

Pain may be an illness by itself, such as fibromyalgia, arthritis, headaches, interstitial cystitis, certain genetic conditions and more.  Pain accompanies many diseases or is part of their treatment: cancer, EDS, sickle cell anemia, lupus, post stroke pain, Parkinson’s, diabetes, alkalizing spondylitis, and so many more.

Pain could be a sudden onset of symptoms, such as kidney stones, gall bladder, disseminated shingles, or even an atypical heart attack. It may be the presenting symptom of other problems such as multiple myeloma, cancer metastases, ovarian cysts, torsion of the ovaries, testicles or intestines, and the list goes on. 

How many patients have died because the ER doctor hears the word “pain” and shuns them, refusing to see or treat them?  Or had a patient arrested because they refuse to leave?

Refusing to see someone in pain or denying them access to opioids or any treatment which works for them is malpractice. It certainly goes against the idea of “do no harm. ‘

The DEA has become a terrorist organization and many providers are afraid of it. “Evidence based practice” has also become a very loose term. The CDC opioid guidelines are not evidenced based.

Accusing only pain management doctors and patient advocacy groups of being influenced by the pharmaceutical industry is unethical as well, as the CDC, DEA and the addiction treatment industry also receive funding from pharma -- including support from drug testing companies.

Prescribing medication which is potentially more harmful than opioids, such as ibuprofen and acetaminophen, is also unscrupulous.  People with a history of ulcers and older adults are being told to take ibuprofen, even though ibuprofen causes 15,000 to 20,000 deaths a year when taken as prescribed. Ibuprofen was never meant for severe pain. 

People are being told they must do non-pharmacological interventions such as acupuncture, massage or physical therapy, even though they can’t afford it, it’s not covered by their insurance, or the therapy simply does not work for them.  Doctors insisting on an epidural steroid injection (which is not FDA approved) when it has not worked for someone in the past is also immoral.

There is a strong body of evidence that opioids work, no matter what an opiophobic or addiction treatment doctor will claim.

We have long fought against cook book medicine.  People with pain, whether acute or chronic, need to be considered in the whole, protected from harm, and treated with what is effective and affordable for them.  It is the ethical thing to do.    

Janice Reynolds is a retired nurse who specialized in pain management, oncology, and palliative care. She has lectured across the country at medical conferences on different aspects of pain and pain management, and is co-author of several articles in peer reviewed journals. 

Janice has lived with persistent post craniotomy pain since 2009.  She is active with The Pain Community and writes several blogs for them. 

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.

Insurers Behind Medicare’s ‘Big Brother’ Opioid Policy

By Pat Anson, Editor

The insurance industry appears to have played a major role in the development of a new strategy by the federal government to combat the abuse of opioid pain medication.

As Pain News Network has reported, the plan calls on pharmacists to report suspicious activity by doctors who prescribe opioids to Medicare and Medicaid patients (see “Medicare Takes ‘Big Brother’ Approach to Opioid Abuse”). Individual profiles of patients, their behavior, and opioid use would also be created and shared among insurance providers.

The plan was outlined earlier this month by the Centers for Medicare & Medicaid Services (CMS) in the agency’s proposed “Opioid Misuse Strategy.” 

The CMS plan closely follows a 62-page “white paper” prepared by the Healthcare Fraud Prevention Partnership (HFPP), a coalition of private insurers, law enforcement agencies, and federal and state regulators formed in 2013 to combat healthcare fraud. 

The white paper, however, goes far beyond fraud prevention by recommending policies that will determine how a patient is treated by their doctor, including what medications should be prescribed.  It states that all physicians should follow the opioid prescribing guidelines released by the Centers for Disease Control and Prevention, even though the guidelines are voluntary and explicitly state they are not intended for all prescribers.

The white paper was drafted largely by insurance companies – called “Partner Champions” -- including Aetna, Anthem, Blue Cross Blue Shield, Cigna, Highmark, Humana, Kaiser Permanente and the Centene Corporation.

“These HFPP Partner Champions have committed themselves to the creation of an HFPP White Paper that describes the best practices for serious consideration by all healthcare payers and other relevant stakeholders to effectively address and minimize the harms of opioids,”  the white paper states.

“Through coordinated action, payers, including members of the HFPP, have the opportunity to dramatically influence and reduce opioid misuse in the U.S. Simple actions performed systematically across a large group of stakeholders can considerably decrease the toll of prescription opioid misuse and OUD (opioid use disorder) in the U.S.”

Physicians and Patients Left Out

No other stakeholders in healthcare, such as physicians, pharmacists, hospitals or patients, were involved in a “special session” of the HFPP last October that led to the drafting of the white paper.

“It’s concerning that CMS appears to have developed a policy proposal regarding opioid prescribing solely on the basis of advice from a group dominated by the insurance industry, without asking for input from affected healthcare professional groups,” said Bob Twillman, PhD, Executive Director of the Academy of Integrative Pain Management, an organization of physicians who specialize in pain care.

“We have to be mindful of the vested interests of insurance companies in this issue. Some advocates have argued that pharmaceutical manufacturers have wielded outsized influence in previous policy decisions, but there has been precious little focus on the influence of payers, which seems obvious in this case.”

CMS contracts with dozens of private insurance companies to provide health coverage to about 54 million Americans through Medicare and nearly 70 million in state-run Medicaid programs.

“Who exactly are the individuals who put this information together for CMS… and what is their true aim?” asks Ingrid Hollis, the mother of a chronic pain patient. “It looks to me like collusion between insurance companies and federal agencies to cut costs.

“Senior citizens and those disabled with progressive painful diseases or injuries deserve better treatment than this. To single this community out for draconian policies based on what looks like purely profit motives in the name of ‘harm reduction’ is inhumane. Who is truly being harmed here?”

“When they describe insurance companies involved in their efforts as ‘Champions,’ it calls to mind comic book and movie heroes like Superman.  Superman was noble, his motives pure.  I don't think of profit-conscious insurers as being noble or pure in motive,” said Anne Fuqua, a disabled nurse, pain patient and patient advocate. 

“Involving insurance companies in setting policies that directly or indirectly impact prescribing and/or reimbursement presents a conflict of interest.”

Stewards, Stockers and Demanders

Under the proposed CMS policy, information about doctors and patients who’ve been red flagged by pharmacists for suspicious prescribing would be shared through a CMS database with all insurers. The companies would then be empowered to “investigate provider and beneficiary behaviors that may be indicative of fraud or abuse.” Violators could be dropped from insurance networks or lose their coverage.    

The HFPP white paper goes further, recommending that insurers develop profiles of each patient and classify them in one of three groups based on their behavior:

1. “Stewards” (patients who follow guidelines)
2. “Stockers” (patients who stockpile unused medications)
3. “Demanders” (patients who ask for medication)

“Segmenting patients by intentions/behaviors with regards to opioid prescriptions could help payers better target messages and disseminate tailored communications that are most salient to the recipient,” the white paper states.

“For example, stewards may be those who are more likely to adhere to the CDC guideline and seek non-pharmacologic or non-opioid pharmacologic therapies for chronic pain and stockers may be those who are likely to ask for an opioid prescription/have received an opioid prescription for chronic pain in the past.”

A data analysis of patients and doctors, according to the white paper, could also be used by insurers to develop computer models to identify “problematic actors and schemes” and “deny payments for prescriptions that do not conform to general prescribing practices.”

“The HFPP strongly encour­ages collaborative efforts to develop and widely disseminate effective strategies to identify: patients at risk of opioid misuse or OUD, providers whose opioid prescribing patterns fail to comply with quality indicators (such as the CDC Guideline for Prescribing Opioids for Chronic Pain), and methods that are particularly ef­fective at preventing or treating OUD,” the white paper states.

But critics say the profiling of patients and doctors, as well as the sharing of data from prescription drug monitoring programs (PDMPs), amounts to an invasion of privacy.

“PDMP data contains some of the most sensitive health information that is produced.  When PDMPs were introduced, confidentiality protections were stressed and prescribers and pharmacists could review the information,” says Anne Fuqua.

“Now, CMS is discussing their plan to provide open access to insurers participating in their database.  They flip between arguments that this will help insurers make sure people get needed treatments for addiction and fraud detection.  It's clear that detection of fraud and conserving on drug costs is the primary focus.”

Non-Opioid Treatments Encouraged

Like the CDC guidelines, the white paper discourages the use of opioid pain medication, and recommends that over-the-counter pain relievers such as aspirin, acetaminophen and ibuprofen be used as an alternatives, as well as “non-pharmacological” treatments like cognitive behavioral therapy and chiropractic care. Addiction treatment drugs such as buprenorphine and methadone are strongly recommended for anyone showing signs of opioid use disorder.

“Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with non-pharmacologic therapy and non-opioid pharmacologic therapy,” the paper states.

Critics say the recommendations – and threats of sanctions against those who don’t follow them -- could interfere with the doctor-patient relationship.

"Proposals, like CMS' Opioid Misuse Strategy, aimed at combatting the prescription drug abuse crisis, while important, must be careful to not leave patients with a legitimate medical need without access to the treatments they and their doctors have determined are the best course of care,” the Alliance for Patient Access, a national network of physicians, said in a statement to PNN.

“Patient access can be impeded when physicians and patients feel threatened that they are being watched, may be reported, or their personal information shared by pharmacists and insurers. When that happens patients suffer and the physician-patient relationship, one based on trust, is strained.” 

“It should not be a surprise that insurance companies have been aggressively opposing the use of branded opioids. Their fiduciary responsibility is to their shareholders, not to patients,” said Lynn Webster, MD, past president of the American Academy of Pain Medicine. “Decisions by insurance companies are causing many patients to suffer. This is not right.”

“Patients and doctors don’t want insurance companies and other parties determining what is best for them.  Doctors have a medical degree, the experience, the knowledge and treatment plans are determined by the medical condition they are treating,” says Ingrid Hollis.

“They act in the best interest of the patient, and have pledged the Hippocratic Oath of ‘Do no harm.’ Can the same be said of the bean counters in the insurance industry? Insurance is interested in cost cutting and maximizing profits.  Doctors are trying to save lives.”

CMS has not said when it plans to implement its Opioid Misuse Strategy or if public hearings would ever be held on them. The agency has only said that in coming weeks it would release “statements reflecting the agency’s Medicare and Medicaid goals.”

The HFPP white paper was released publicly for the first time Tuesday on the CMS website, without any explanation of its broader meaning or impact on Medicare and Medicaid policies.

An HFPP infographic urging people "to fight healthcare fraud, waste and abuse" was also released on the government-run website, without any indication that it was largely developed by the insurance industry.

Spinal Cord Stimulators Reduce Opioid Use

By Pat Anson, Editor

Most patients who have a spinal cord stimulator significantly reduce their use of opioid pain medication one year after their implant, according to new industry-funded research.

In an analysis of private and Medicare insurance claims from 5,476 patients who received a spinal cord stimulator (SCS), opioid use declined or stabilized in 70 percent of the patients. Opioid use was higher among patients who had the stimulator removed.

The study, presented at the annual meeting of the North American Neuromodulation Society (NANS), was sponsored by Abbott (NYSE: ABT), a manufacturer of SCS systems and other medical devices.

"Given the epidemic of opioid addiction and abuse, these findings are important and confirm that spinal cord stimulation therapy can offer strong benefits for patients struggling with chronic pain," said Ashwini Sharan, MD, president of NANS and director of Functional and Epilepsy Surgery at Vickie and Jack Farber Institute for Neuroscience.

"Based on these results, we concluded it may be possible to improve outcomes by offering our patients spinal cord stimulation earlier, before opioid dependence and addiction can occur."

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

Some patients find the stimulators ineffective and have them removed. According to one study, only about half of patients who received a traditional SCS device have a 50 percent reduction in their back and leg pain.

New technologies have been developed to make the devices more effective, easier to recharge and to reduce complications such as paresthesia – a tingling or buzzing sensation.

And with government regulators and insurers discouraging the use of opioid pain medication, the medical device industry is urging patients and doctors to take another look at SCS devices.

X-RAY OF PATIENT WITH MEDTRONIC SCS DEVICE

"As our society has been seeking ways to stem opioid abuse and addition, our company offers treatment options that can reduce their exposure to opioid medication," said Allen Burton, MD, medical director of neuromodulation at Abbott in a news release. "Data like these are critical to helping us demonstrate that spinal cord stimulation can reduce exposure to opioids while giving patients comprehensive pain relief."

Abbot recently purchased St. Jude Medical, giving the medical device maker its first exposure to the SCS and neuromodulation market, which has an estimated value of $5.3 billion.

"Non-medical pain relief is a focus with attention on the dangers of pain medication and the need to find alternatives to reduce chronic pain," said Bruce Carlson, Publisher of Kalorama Information, a research firm that tracks the neuromodulation market. "Abbott builds on its cardiovascular device properties with this deal, and that is a big focus of press coverage.  St. Jude's impressive spinal cord offering should not be obscured in this transaction."

Pain Patients Sound Off on Opioid Cutbacks

By Pat Anson, Editor

In our last newsletter, we asked readers if their doctors had recently reduced or stopped prescribing opioid pain medication, and to share their stories with us.

We heard back from dozens of people, all of them angry and frustrated with the state of pain care and the government agencies that regulate pain medication in the U.S.

“We are disgusted with the DEA and uneducated callous physicians' war on chronic pain patients and their doctors. Suicides are skyrocketing and lives are being destroyed,” wrote Connie Potter, a registered nurse in New Mexico.  “The number of people I see whose lives are worthless and destroyed is appalling.” 

Connie said that her husband, who suffers from severe back pain, dystonia and fibromyalgia, is being prescribed about a third of the pain mediation he used to get.

“No one wants to give pain meds in southern New Mexico. My friend with acute MS (multiple sclerosis) has had his already pathetic meds dosages halved,” she said.

Many pain sufferers are being told by doctors that they are required to reduce or eliminate opioid prescribing, even though guidelines released last year by the Centers for Disease Control and Prevention are voluntary, not mandatory.

“I was told in November that as of January 1, 2017 my medication would be reduced by half because the government is mandating this across the United States,” wrote 46-year old Cindy, who has suffered from back and pelvic pain since childhood. 

“I am still trying to grasp how this could happen!  I am every doctor's dream patient. I do whatever they ask whatever they suggest - anything!  How the hell am I supposed to make it through a day of work when I can't sit? This is crazy!  Do I seriously not have any recourse?”

“These doctors don't give a s*** anymore, all they care about (is) lowering their opiates prescriptions, so they don't have to deal with the backlash from our stinking government,” said David Cole, who has perineural neuropathy.

“I've been using opioids for the last 14 years to control to my pain and manage my life,” wrote Eli. “Then came the infamous CDC 'recommendations' and in March of 2016 I was cut down 50% on my dosage. Was difficult to do it, and couldn't have pulled it off without the help of cannabis.”

Even though medical marijuana is legal in California, where Eli lives, most doctors don’t want to prescribe opioids to someone using cannabis. So he's been tapered again to a lower dose. And he may be on his last refill.  

“My life began falling apart when they cut my dose in half, and hasn't been the same since. I've grown much more dependent on help from others and can barely shop. This anti-opioid madness has got to stop," he says.

Treated Like Addicts

Many readers say they are tired of being treated like criminals or addicts.

“Being treated like an incompetent, drug seeking/selling, whiny and lazy hypochondriac by non-medical and/or elected individuals is not an issue I anticipated,” wrote Ellen Rames, who is disabled at the age of 65. “It feels like the eyes of judgment are on me every day. It shouldn't be this way.”

“Twenty five years of taking opioids without a problem and now I feel like criminal trying to get them,” said Kaye Ingram, a disabled coal miner. “I (am) just sick of being piss tested every month and being threatened.”

“I'm tired of being treated like a druggie or addict when I ask for relief,” said Mike Schmidt, who has chronic pain after 15 surgeries on his neck and back. At the age of 72, the retired drug and alcohol counselor says he’s not worried about addiction.

“I have always taken medication at the prescribed dosage or less,” says Schmidt.  “I found morphine to be an effective pain relief for me after trying different medications and not liking the side effects.”

“It angers me to no end that I can't get decent sleep and that I spend most days in a chair because some people abuse medications that I legitimately need, and for which I have a proven record of responsible use,” said G.D. King, who has suffered from chronic back pain for over 25 years.

“Clearly I understand that the government doesn't want citizens dropping dead willy-nilly from overdoses.  But the fact that these deaths are the result of abusive and/or illegal activity for which I must pay a very steep personal price does not incline me toward sympathy for those who engage in these activities.”

Illegal activity is what some patients are considering to get pain relief.

“Pot isn't legal where I am so guess I'd have to break the law, or well, heck, since heroin is easier to get than a legitimate pain prescription, I guess that might be another choice.  Do these people have any common sense?” asked Donna.

Suicide is seen as an alternative by some.

“The government needs to get out of our doctor’s offices and our pharmacies and quit attempting to practice medicine by lumping all persons into the same category.”

“I feel that there needs to be more reporting on the suicide rate among chronic pain sufferers.  These people who are pushing for stopping opioid use to prevent overdose and death from opioids are only trading one form of death for another,” said Sam, a retired counselor who has worked with suicidal clients.  “I support euthanasia and the legalization of physician assisted suicide for the terminally ill, but I think it should also be allowed for those who suffer chronic pain that are not getting relief.”

Others believe the campaign against opioids is more about corporate profits, not healthcare or preventing addiction.

“This is strictly a dollars and cents issue, with the insurance companies not wanting to fulfill their contractual obligations. I know firsthand, as my insurer cut me off completely in 2016,” wrote Russ. “My family already is prepared that when I die because of their incompetence, the major lawsuits will begin unabated against any agency or company that was implicit in this conspiracy, and a conspiracy it is.

“The government needs to get out of our doctor's offices and our pharmacies and quit attempting to practice medicine by lumping all persons into the same category.”

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A Pained Life: The Hand of a Stranger

By Carol Levy, Columnist

I went to the Women’s March on Philadelphia Saturday. I am very politically minded.  I love doing these things. And each and every time, I have the same problem

I forget about the pain. I forget about the specifics, logistics and potential for pain.

I have trigeminal neuralgia, which causes severe pain on the left side of my face. It can be set off just by touch. I am also legally blind on that side.

It puts me in a precarious position. It is essential that I not let anyone get close enough to accidentally brush against my face. For me, the innocuous sign of an outstretched hand or arm is dangerous. And since I can't see on that side, I have no idea how close someone might be to touching and triggering the pain.

I did not expect the size of the crowd, which was estimated at 50,000 people. Small rallies are bad enough, but this one was so enormous that as soon as I left the train station and went towards the designated rally area, I was engulfed in a sea of people.

And I was petrified. Thousands of people were bearing in on me.

I tried to make my way through the mass of people. Everyone was very nice. “Excuse me. Excuse me,” I said.  Some moved, but some could not with the press of so many bodies.

image courtesy of philadelphia mayor's office

One woman smiled as I explained to her I was trying to reach the borders of the rally, so I would not be in the midst of so many people. For this kind of event it was an odd thing to say. She looked at me quizzically. I figured I had better explain.

I have learned to be hesitant about explaining my condition. My family has been nasty about the pain. Strangers, even friends and acquaintances, can and have been unpleasant about it. As way too many of us know firsthand.

This was a “'talk with the stranger in the next seat” moment. I would never see her again, so there was no risk in explaining and no worry if she didn't understand or could not care less. Plus, my need outweighed my concerns about how she might react.

Her reaction was unexpected. She put her arm around me and held out her hand. Taking mine in hers, she led us through a bastion of folks. When we got to an area less crowded, she let go and I continued on.

What a wonderful experience and for so many reasons, not the least of which was I said what I needed and I was heard.

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.

Even a Little Exercise Is Better Than None

By Pat Anson, Editor

We often hear from pain sufferers who say they’d like to exercise more, but can’t because their pain levels have left them bedridden or stuck on a couch. Others believe a workout at the gym will only make their pain worse.

But two new studies have found that you don’t need to be a gym rat to get the health benefits from exercise.

You may not even need to stand up!

Federal guidelines suggest a minimum of 150 minutes of exercise a week are needed to promote good cardiovascular health. But researchers at Northwestern University wanted to see if a lesser goal could improve overall health.

They measured the physical activity of 1,600 adults with osteoarthritis in their hips, knees or feet; and found that just 45 minutes of moderate physical activity a week improved their function and reduced pain

"We were interested in seeing what kind of physical activity might be beneficial to promote good function down the road,” said Dorothy Dunlop, a professor of rheumatology and preventive medicine at Northwestern University Feinberg School of Medicine.

“We found moderate-intensity activity rather than light activity, such as pushing a grocery cart, to be more valuable to promote future function."

Using sophisticated accelerometers to monitor movement, the researchers found that participants who engaged in moderate activity, such as brisk walking, for at least 45 minutes a week were 80 percent more likely to improve or sustain high future function.

The findings, published in the journal Arthritis Care & Research., were true for both men and women. The beneficial effects of the exercise were also long term. About a third of participants improved or had high function after two years.

"The federal guidelines are very important because the more you do, the better you'll feel and the greater the health benefits you'll receive," Dunlop said. "But even achieving this less rigorous goal will promote the ability to function and may be a feasible starting point for older adults dealing with discomfort in their joints.”

"Even a little activity is better than none," she added

Chair Yoga Relieves Pain of Osteoarthritis

A second study at Florida Atlantic University found that “chair yoga” is an effective way to reduce pain and improve quality of life in older adults with osteoarthritis.

As the name implies, the Sit-N-Fit Chair Yoga program was developed to help those who cannot stand during exercise or participate in traditional yoga. Chair yoga is practiced sitting in a chair or standing while holding the chair for support.

IMAGE COURTESY OF FLORIDA ATLANTIC UNIVERSITY

In a study of 131 older adults who have osteoarthritis, participants attended 45-minute chair yoga sessions twice a week for 8 weeks.

Researchers measured their pain, pain interference (how it affects one's life), balance, gait speed, fatigue and functional ability; before, during and after the sessions.

Compared to a control group enrolled in a health education program, the chair yoga group showed a greater reduction in pain, pain interference and fatigue during the sessions, as well as an improved gait. The reduction in pain interference lasted for about three months after the chair yoga program was completed.

"The effect of pain on everyday living is most directly captured by pain interference, and our findings demonstrate that chair yoga reduced pain interference in everyday activities," said Ruth McCaffrey, emeritus professor in FAU's College of Nursing and co-author of the study published in the Journal of the American Geriatrics Society.

"The potential impact of this study on public health is high, as this program provides an approach for keeping community-dwelling elders active even when they cannot participate in traditional exercise that challenges their balance," said co-author and principal investigator Patricia Liehr, PhD, a professor in FAU's College of Nursing.

Osteoarthritis is the most common form of arthritis and the leading cause of long-term disability in older adults. It affects about a third of Americans over the age of 65.