What’s Normal Now?

By Pat Akerberg, Guest Columnist

Trying to define what’s normal under any set of circumstances is tricky at best.  But whenever your personal version of normal has been hurled about and ripped apart by a medical tsunami, any sense of normalcy shatters.

Whether newly diagnosed or living with a progressive disorder, once our previous sense of normal falls apart, every unusual medical issue, complication or symptom that happens now begs the question: “Is this normal?”

That began in 2009 for me when trigeminal neuralgia (TN) hit. Then after a brain surgery to supposedly fix it failed miserably, my fragile normal collapsed like a house of cards. The disabling complications and surgical damage done forced me into premature retirement.

As my circumstances rapidly devolved, people tried to comfort me by defining the extreme changes in my world as my “new normal.” That likely comforted them more than it did me.

I’ve always bristled at the term “new normal” since TN struck. Why? Because “new” implies positive connotations of something fresh, without defects or problems. And the word “normal” suggests a typical or ordinary state that you can fit into.

Sounds nice. However, trying to characterize a rare, debilitating medical disorder or painful condition as orderly is like trying shove a distorted square peg into a round hole. Plus, a progressive neurological disorder like TN doesn’t offer some future state free from a flawed quality of life. When the nerve damage invariably progresses, complications follow. 

Medical Reality

That’s why I prefer to term my changing circumstances as my “medical reality” instead.  That descriptor fits my state of affairs better. 

When my medical reality changed dramatically, I initially started questioning whether the limitations I was experiencing might fit some other version of normal out there.

Examples of my questions follow. No doubt you have your own. I wondered if it was normal to:

• Cancel plans and miss important occasions because my pain is so unpredictable

• Family and friends to focus on how I look (“You don’t look sick”) versus the invisible suffering I endure

• Watch some of them drift away when I wasn’t getting better

• Find myself having to explain or defend my medical reality more than I’d like

• Have occasional “brain fog” that causes me to question myself

• Become exhausted dealing with constant pain and lack of sleep

• Need more help with some things when I never did before

• Have priorities, interests, motivations or some facets of my personality change

• Question how relevant I am or indulge in pity parties on bad days

I can attest that these questions can dig deep at the identity level. From my experience, the best answers to them don’t just pop up readily either. Instead you have to live into them – so they are believable… so they are yours. Making them yours is the point.

It helps if you are able to connect with others who share your medical reality. Then you can share, compare notes and support each other.

Hard Won Answers

At times even your own medical professionals may not be able to answer what might constitute normal in your case. Though they may have familiarity with your diagnosis, how it plays out may vary widely from person to person.

Working with a qualified counselor or therapist can also go a long way towards discovering what is true for you.  It helped reinforce that I’m the one who has my best answers.

These are two of my hard-won answers that work for me when I get frustrated by limitations:

1. It is what it is… for now.

2. When I can, I do. When I can’t, I don’t.

After a period of wrestling with a former healthy version of normal and a medically altered one, a personal clarity emerges – normal has become medically relative. 

What’s normal for your unique medical circumstances isn’t relative to anyone who doesn’t share that same medical reality.  And vice versa.

Eventually I concluded that it wasn’t helpful to question my altered state or try to measure up to an old paradigm of normal. That shift in mindset translated to permission to pursue a host of ways for me to compensate, accommodate and re-frame my daily living to better fit my medical reality.

The strategies that took shape from that shift are geared towards improved functioning and minimizing stress.  They lead to more realistic plans or expectations and pinpoint the kinds of help you may need.

Self Preservation Skills

As you work your way through normalcy questions into ways to redefine them, my experience has been that a more formidable self takes shape – one better skilled at self-preservation. Progress to that end doesn’t necessarily follow a linear or predictable fashion. 

The good news is that you learn to shift focus toward what’s within your control – and away from what isn’t. From this more fitting “work-arounds” emerge.

These proactive countermeasures act like seeds that create fertile ground for hope to take root.  While hope may not be a strategy on its own, it often provides the intangible fuel to press on.

One thing is certain – judging yourself as coming up short compared to some phantom reality definition of normal adds no positive value to your life.  

So, rather than submitting to bogus notions that medical deficits can reduce the measure of your humanity, give yourself kudos instead as your spirit and determination prevail over them. 

Pat Akerberg suffers from trigeminal neuralgia, a rare facial pain disorder. Pat is a member of the TNA Facial Pain Association and serves as a moderator for their online support forum. She is also a supporter of the Trigeminal Neuralgia Research Foundation.

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.

Cannabis Effective in Treating Fibromyalgia

By Pat Anson, PNN Editor

Cannabis significantly reduces pain and improves quality of life for patients with fibromyalgia, according to Israeli researchers who conducted one of the first studies to look at the effectiveness of cannabis in treating fibromyalgia.

Nearly 300 patients diagnosed with fibromyalgia completed the 6-month study at a Tel Aviv clinic. Participants suffered from fibromyalgia symptoms for a median length of seven years and nine out of ten reported constant daily pain. Fibromyalgia is characterized by widespread body pain, fatigue, poor sleep, anxiety and depression. Standard treatments for fibromyalgia often prove to be ineffective.

"It is commonly accepted that chronic pain can be treated with cannabis, but there is scarce evidence to support the role of medical cannabis in the treatment of fibromyalgia specifically," says Lihi Bar-Lev Schleider, head research scientist at Tikun Olam, a cannabis producer that sponsored the study.

Patents began with a low dose of cannabis every 3-4 hours that was gradually increased until it had a therapeutic effect.

Participants were treated with two Tikun Olam strains of cannabis; the high-THC “Alaska” strain and the high-CBD “Avidekel” strain, which has virtually no THC.  Both strains are available as a tincture, topical oil or for use in a vaporizer.

Over 80 percent of the patients reported at least moderate improvement in their pain. At the start of the study, the median pain level for patients on a 1 to 10 scale was 9, but after six months the median pain level was reduced to 5.

In addition to lower pain intensity, nearly 93 percent of patients said they slept better and about 80 percent said there was improvement in their depression. Nearly two-thirds said their quality of life was good or very good. Appetite and sexual activity also improved.

The most common side effects were relatively minor, including dizziness, dry mouth and gastrointestinal symptoms.

“Our data indicates that medical cannabis could be a promising therapeutic option for the treatment of fibromyalgia, especially for those who failed on standard pharmacological therapies. We show that medical cannabis is effective and safe when titrated slowly and gradually,” researchers reported in the Journal of Clinical Medicine.

“Considering the low rates of addiction and serious adverse effects (especially compared to opioids), cannabis therapy should be considered to ease the symptom burden among those fibromyalgia patients who are not responding to standard care.”

During the study, about one out of five patients either stopped or reduced their use of opioid pain medication or benzodiazepines while taking cannabis.

Medical marijuana has been legal in Israel since the early 1990s. A recent survey found about 27 percent of Israeli adults have used cannabis in the past year, one of the highest rates in the world.

Teaching Children How to Cope with Pain

By Dr. Lynn Webster, PNN Columnist

Summer is upon us and so is trauma season. Emergency room visits for children with traumatic injuries can double during the summer. Potential injuries range from insect and animal bites to serious bicycle and ATV injuries.

This means parents will be on the front line, triaging each event to determine which injury needs medical treatment and which requires "only" emotional support.

A mother recently asked newspaper advice columnist Amy Dickinson about the best way to handle her toddler's pain. The mother was seeking suggestions from a stranger because she disagreed with her husband’s approach. She wanted to learn the "right" way to respond to her child's injuries.

The mother said she felt the need to provide the hurt child with ice packs and hugs, regardless of the extent of the injury, because that felt nurturing and productive.

On the other hand, the father thought his wife was making too big of a deal out of their child's pain. He believed that coddling children deprived them of the opportunity to grow into self-sufficient, resilient adults.

The columnist advised the mother that "tender gestures are an important part of parenting." Show your children that you care about their pain, Dickinson suggested, but don't turn each incident into a melodrama.

The mother's question grabbed my attention, because treating a child's pain is an omnipresent issue with far-reaching implications. By the time they reach age five, children have developed the way they will address adversity for the rest of their lives. Obviously, how a parent responds to a child’s injury -- their attitudes and behaviors -- is part of the culture that helps children form that foundation.

Options in Soothing a Child’s Pain

An overly doting, anxious parent can reinforce a hyperbolic response to pain that has little to do with the actual injury. A small "ouchie" can become a catastrophic event, and that may contribute to learned anxiety and the perception of greater pain.

On the other hand, ignoring an injury can lead to more aggressive attention-seeking behavior. Children need to know that an empathetic adult cares, even if the injury is relatively minor. Feeling safe positively influences a child's experience of adversity.

Children who have the emotional and cognitive ability to understand and determine their response to an injury generally suffer less. This is self-efficacy, and it allows the child to feel in control.

It's important to help children master their response to pain in age-appropriate ways. Of course, you comfort your pre-verbal children with a calm, measured voice and attitude. When children can communicate verbally, you can begin asking them whether their injury is a big one or small one. Then ask the children how they can make themselves feel better. This is how to nurture their resilience.

Accepting Pain

Experts who study why some people seem to handle pain better than others believe that acceptance plays a major role. There are two kinds of acceptance: acceptance with resignation and acceptance with resilience. 

Acceptance with resignation, or learned helplessness, steals hope more thoroughly than pain itself can do. A resigned person feels incapable of solving the problem and simply gives up.

Acceptance with resilience, on the other hand, makes it possible for a person to reinvent himself or herself to resolve the problem.

Children must learn how to accept pain with resilience so they can quickly, and without drama, move on from it. This requires a mutually caring relationship with the parent or guardian.

Big hurts, medium hurts, and small hurts may require different treatment, but not necessarily a different emotional response. Fundamentally, children must realize that everyday hurts are problems with solutions.

I recently watched my daughter instinctively demonstrate this behavior. My granddaughter, Gracie, fell and bumped her knee. The three-year-old began to cry. My daughter then asked Gracie: “is it a "big ouchie" or a "small ouchie?"

The question redirected Gracie’s attention. To my surprise, Gracie answered in a soft and shaky voice, “a small one.” Gracie received a hug from her mom and seemed to forget about the incident.

The Goal Is a Resilient Child

Pain is part of growing up. Parents cannot prevent injuries from occurring with their children, but they can model how to accept the injury with resilience.

To paraphrase Viktor Frankl, we have the power to choose our response to adversity. Relying on ourselves gives us control over our behaviors and happiness.

When parents can model self-efficacy without dismissing a child’s fears or insecurities; the result will be a resilient child who is able to experience pain as part of life, but not mistake it for life itself. 

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. Lynn is a former president of the American Academy of Pain Medicine, author of the award-winning book “The Painful Truth” and co-producer of the documentary “It Hurts Until You Die.”

You can find him on Twitter: @LynnRWebsterMD.

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.

Indonesia May Ban Kratom Exports

By Pat Anson, PNN Editor

A possible ban on the growth and export of kratom in Indonesia is raising alarm among kratom users in the U.S. and around the world.  About 95% of the world’s supply of kratom comes from Indonesia, where the herbal supplement has become a lucrative cash crop.

Kratom leaves are harvested from a tree that grows in southeast Asia, where it has been used for centuries as a natural stimulant and pain reliever. In recent years, millions of Americans have started using kratom to treat pain, addiction, anxiety and depression.

Kratom advocates say the U.S. Food and Drug Administration – which opposes the use of kratom for any medical condition – has been lobbying the Indonesian government to ban kratom farming. Current plans by the Indonesian Ministry of Health call for a 5-year transition period to allow kratom growers to shift to other crops.

“If this ban is allowed to go into effect, it will effectively end consumer access to kratom in the United States, and the FDA won’t have to do anything more to declare victory in the War on Kratom,” said C. M. “Mac” Haddow, a lobbyist for the American Kratom Association (AKA), a group of kratom vendors and consumers.

“Even if some black-market kratom gets into the United States after the Indonesian ban goes into effect, it will be so expensive that only the uber-rich will be able to afford it. And it will likely be extremely dangerous to consume because there will be no standards on growing, harvesting, and shipping.”

FDA Denies Involvement

An FDA spokesman said the agency has “inquired” about kratom in Indonesia, but denied making any effort to have it banned.

“The FDA has inquired to understand the current status of kratom under Indonesian law. However, the FDA has not advocated either formally or informally about a change in law in Indonesia or any other country relative to kratom,” the spokesman said in an email to PNN.

The AKA sent a delegation to Indonesia last month to meet with the Ministry of Health and other government officials. Among the attendees was Duncan Macrae, the founder of Kratom.com and one of the first commercial growers of kratom in Indonesia. Macrae told PNN the initial meeting went well.

“When we left Jakarta we were given the green light that there would always be a legitimate path to export kratom even though the Indonesian government will almost definitely regulate and make kratom illegal for domestic use in Indonesia,” Macrae wrote in an email. “Unfortunately, since there was some (in my opinion) unnecessary outreaching to other departments such as the Agriculture & Quarantine department and also the department of trade, this has stirred up another hornet’s nest.” 

According to the AKA, the Ministry of Agriculture sent a memo in the past week to various agencies in the Indonesian government recommending the ban on kratom be formalized at all levels of government.  

Macrae fears that kratom will also be classified as an illegal controlled substance in Indonesia, which would effectively ban its growth and export.  

“Was the FDA involved? For sure yes! Unfortunately, this went through the U.S. embassy in Jakarta as well.”

— Duncan Macrae, Kratom Supplier

“This means it has no scientific or medicinal use and will even prevent further research from being done on the plant in Indonesia,” said Macrae. “Was the FDA involved? For sure yes! Unfortunately, this went through the U.S. embassy in Jakarta as well.” 

A leading Indonesian politician called on the government to ignore the “world health mafia” and conduct research on the risks and benefits of kratom before banning it.

"Once again the government does not play a ban without doing deep professional research. It is tantamount to throwing away the nation's own assets. In the end Indonesia will only be an importer of finished products from kratom leaves," Daniel Johan, Deputy Chairperson of the House of Representatives, told a local news agency. "Indonesia must master its downstream products so that it is truly beneficial for the people of Indonesia and the world, so that we do not even enter the format of world health mafia war."

Kratom is already banned for domestic use in Indonesia, although the export of raw kratom product is allowed. In 2016, about 400 tons of kratom were shipped every month from Indonesia’s top growing region -- worth about $130 million annually, according to a report from Agence France-Presse. Most of those exports went to the U.S.

The FDA has linked kratom to dozens of fatal overdoses -- although multiple substances were involved in nearly all of those deaths. The FDA has also found salmonella bacteria and heavy metals in a relatively small number of kratom products. 

Last year, the Department of Health and Human Services (HHS) recommended to the DEA that kratom be classified as a Schedule I substance – which would effectively ban it nationwide. Currently, the DEA doesn't even list kratom in its annual report on drug threats. 

The AKA is planning to send another delegation to Indonesia this month to lobby against a kratom ban.

Opioid Addiction Rates Redux

By Roger Chriss, PNN Columnist

The Oklahoma opioid trial is garnering attention for what could be a pivotal role in determining the liability of Johnson & Johnson and other drug makers in the opioid crisis. A key point hinges on a seemingly simple question: What percentage of people on long-term opioid therapy develop addiction?

Dr. Timothy Fong, a UCLA psychiatrist and defense expert, refuted claims by prosecution witness Dr. Andrew Kolodny that people who take opioid pain medication over extended periods have a 25% chance of becoming addicted. Fong said other studies suggest that patients who take opioids over long periods might have addiction rates closer to 1 to 3 percent.  

There is an extensive literature on these estimates, including NIH studies and published research from leading experts. I covered some of them in a PNN column last year (see “How Common Is Opioid Addiction?”)

“The best and most recent estimate of the percentage of patients who will develop an addiction after being prescribed an opioid analgesic for long-term management of their chronic pain stands at around 8 percent,” NIDA director Nora Volkow, MD, told Opioid Watch.

Why are there so many different estimates? There is an important distinction between the incidence and prevalence of a medical condition. Briefly, incidence represents the probability of occurrence of a given medical condition in a population within a specified period of time. In contrast, prevalence gives the proportion of a particular population found to be affected by a medical condition.

The distinction is not just semantics and is critical in epidemiology. As explained in Physiopedia, “incidence conveys information about the risk of contracting the disease, whereas prevalence indicates how widespread the disease is.”

Besides obvious difficulties in determining incidence (the necessary clinical trials will never receive approval) and measuring prevalence (the required public health monitoring is well beyond our current capability), we instead have to rely on proxy measures derived from prescription drug databases, medical records and surveys.

We also have to make decisions about the “specified period of time” when determining incidence and the assessment of the “medical condition’ for prevalence.

There is no universally agreed upon time frame for the development of addiction or opioid use disorder after opioid initiation, whether medical or non-medical. Similarly, the definition of opioid use disorder has evolved over the years.

Further, in many cases incidence and prevalence are calculated based on assumptions made by researchers. For instance, in an Annual Review of Public Health article co-authored by Dr. Kolodny, a 2010 study is cited that found 26% of chronic pain patients met the criteria for opioid dependence and 35% met the criteria for opioid use disorder. This seems to be the source of the 25% claim used by Kolodny in the Oklahoma opioid trial.

But the 2010 study doesn’t distinguish between incidence and prevalence. It is also not clear how many of the surveyed pain patients had an opioid use disorder diagnosis before the onset of medical opioid therapy.

A similar critique can be levied against the authors of a 1980 letter in The New England Journal of Medicine that claimed opioid addiction was rare in pain patients. Some have claimed publication of the letter helped launch the opioid crisis. 

The problem with all of these studies is that they are retrospective in nature, limited to a particular patient population, and constrained by the diagnostic criteria in use at the time. And the estimates derived from such studies do not necessarily implicate or exonerate Johnson & Johnson.

Moreover, it is possible that addiction rates have varied over time and were influenced by factors that were not yet understood or even known. For example, recent research has found an association between opioid overdoses and drug diversion among family and friends, cold weather, altitude above sea level, and medical cannabis legalization.

The NIH work that Dr. Volkow refers to in her Opioid Watch interview works to account for all of these factors. So as Volkow stated last year, the “best and most recent estimate" stands at about eight percent. Improved public health surveillance, epidemiological research, and patient monitoring may shift this number up or down, and will increase confidence in the estimate.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

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.

Disabled Workers and Chronic Pain Patients Need a Voice in Congress

By Amanda Siebe, Guest Columnist

I’ve always wanted to serve my community. Nine years ago, I thought the best way to do that would be as an EMT and firefighter. I wanted to be there for people in their hour of need to provide help and comfort. But in 2011, that goal came to an abrupt end.

While working as a restaurant manager, I fell and badly sprained my ankle. What should have been six weeks of recovery turned into full body Reflex Sympathetic Dystrophy (RSD). Because my employer placed more value on profits than they did on my health and safety, I continued to work in the kitchen, repeatedly slipping and falling before abandoning my crutches.

That simple injury ended up taking my dignity, financial stability, and eventually it will take my life. All because my employer didn’t have another manager to run the restaurant while I recovered.

Because of my disability, I never thought much about running for political office. But as I watched the lack of representation the disabled community has and felt the impact policies and funding cuts have on my life, I began to wonder: How could I not run?

I may not have the body that I once did, but my mind and passion are still sharp, as is the case with many disabled individuals. My wheelchair has not made me any less of a person or any less deserving of a representative who looks like me and understands my plight.

So here I am, taking a stand to say that while we may be disabled, we’re still worthy of quality life and pursuit of happiness.

I’m running in the 2020 election as a Democrat in Oregon’s 1st Congressional District to fight for the care and benefits we deserve and were promised.

Federalize Workers Compensation

AMANDA SIEBE

As a disabled worker, I was assured there was a safety net to catch us if we got hurt, but I quickly realized that’s not the case. We aren’t told that workers compensation is run by private insurers who have more loyalty to their shareholders than to injured workers. These companies increase profits by denying injured workers medical care, leaving them to suffer as they fight to justify every treatment, medication and benefit.

Currently, each state dictates the worker compensation laws these companies follow, resulting in injured workers getting better treatment in some states than in others. A worker in New York is no more valuable than a worker in Alabama. That’s wrong and must change.

We must end this system of profits over people. We need to federalize workers compensation and prevent lobbyists and private interest groups from ripping apart our safety net. Workers who give their time, bodies and lives to employers must receive the care and respect they deserve.

End Forced Tapering of Pain Patients

Patients with chronic and debilitating pain have been hit especially hard during the opioid crisis. Patients on stable doses of prescription opioids for years are being forcibly tapered and left to suffer. Less than 3% of chronic pain patients become addicted to opioid medication, but doctors are still taking many patients off of these drugs.

When patients are forcibly tapered without properly managing their pain, it forces some to turn to the bottle, the street or suicide for pain management. Thousands have already died as a result of losing their opioids. This must stop.

Increase Disability Payments

After my injury, I went from being the family breadwinner, earning about $50,000 a year, to trying to survive on $735 a month. Young disabled people are especially hard hit because we don’t have decades of high-earning work history to draw on, resulting in lower benefits. That’s if they can even get on SSDI. Those who become disabled before 45 often won’t get approved for disability or have to fight for years to get it.

We must stop using age as a determinate of disability. If disability doesn’t discriminate based on age, then neither should our government.

Currently, there are 554,000 homeless people in our country. Of those, 40% are disabled and 30% are elderly. The average Social Security Disability benefit is $880, while the average rent for a 1-bedroom apartment in Portland, Oregon is $1,400.

It’s no wonder when our government pays starvation wages as a benefit that so many disabled and elderly become homeless. We can reduce our nation’s homeless rate by over half just by making SSI and SSDI comparable to a living wage. We must ensure our most vulnerable citizens have a basic quality of life, too.

IMAGE BY NATALIE BEHRING

The disabled community needs many other things that have gone ignored by Congress. While the Americans With Disabilities Act of 1994 was a huge step forward, it hasn’t been updated in 25 years. We need the ADA to match the knowledge and technology of today.

Many people provide care to disabled family members while still holding down a full-time job. It’s time we paid these family caregivers, who save insurers and healthcare providers hundreds of billions of dollars each year. Paying them would give needy families financial stability and independence.

Medicare For All

We’re an important voice in the healthcare debate and we need to be part of the conversation. If we are to have Medicare For All, then it needs to cover all conditions, all medications and all medically necessary treatment for all patients. Medicare as it currently stands is underfunded and not good enough. We need to fight for universal healthcare coverage so patients no longer have to fight for proper care.

Even though 1 in 5 adults are disabled, we are sorely under-represented in Congress. We need representatives who understand the unique situations and problems we face. We’ve been forced to sit on the sidelines as others decide our care, benefits and future. It’s time we had a say.

For too long, we’ve been victims of circumstance — told that we can’t run for office because our bodies prevent us from giving everything we have. That’s a lie.

Running for Congress isn’t what I thought I’d do be doing with the time I have left, but everyone deserves representation. We’re a part of this country and it’s time we were treated as such. It’s time for the disabled community to unite and be represented. We deserve better. 

Amanda was diagnosed in 2012 with Reflex Sympathetic Dystrophy (RSD), also known as Complex Regional Pain Syndrome (CRPS). Since her diagnosis, she has advocated for chronic pain and disability rights. In 2016, Amanda was the recipient of the WEGO Health Advocate Rookie of the Year Award.

Amanda has dedicated her life to improving her community and has fought to teach her 11-year-old son, Keagan, the same. Further information about Amanda’s congressional campaign can be found on her website.

The information in this column is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Canadian Doctors Prescribe Opioids to Keep Patients Off Street Drugs

By Pat Anson, PNN Editor

So-called “safe injection sites” – supervised clinics where intravenous drug users can inject themselves -- remain controversial in the U.S. Efforts to establish such sites in San Francisco and Philadelphia are mired in political and legal opposition.

But supervised injection sites are already operating in several Canadian cities, where they are seen as an important resource in reducing the risk of overdose and getting drug users into treatment.

Some Canadian doctors, however, believe the injection sites leave out a key population – illicit drug users who don’t normally inject drugs. Rather than run the risk of those patients turning to risky street drugs, they are prescribing opioid medication to them.

“We have to be willing to step outside of our comfort zone and out of the medical establishment comfort zone and say that we need to keep people alive,” Dr. Andrea Sereda, a family physician at the London Intercommunity Health Centre in Ontario told Global News.

Sereda is prescribing hydromorphone tablets to about 100 patients, most of whom were homeless and using street drugs. So far there have been no fatal overdoses, half the patients have found housing, and they have regular contact with healthcare providers.

“It’s not just a prescription for pills, but it’s a relationship between myself and the patient and a commitment to make things better,” Sereda said. “That involves me taking a risk and giving them a prescription, but it also involves the patient committing to doing things that I recommend about their health and us working together.”

Sereda says her “safer supply” program is only intended for patients who have failed at addiction treatment programs where methadone or Suboxone are usually prescribed.

A similar pilot program recently began at a Vancouver clinic, where hydromorphone tablets are given to about 50 patients, who ingest them on site under staff supervision. At another clinic in Toronto, hydromorphone is prescribed to 10 patients who would normally rely on the black market, where drugs are often tainted with illicit fentanyl or its lethal chemical cousin, carfentanil.

“I’ve had people who, literally, their urine is just all carfentanil,” Dr. Nanky Rai, a physician at Parkdale Queen West Community Health Centre told Global News. “That’s really what terrified me into action.”

Other physicians are warming up to the idea. Last week over 400 healthcare providers and researchers sent an open letter to Ontario Premier Doug Ford asking that high dose injectable hydromorphone be made widely available to illicit drug users.

“We could rapidly implement hydromorphone prescribing,” Jessica Hales, a Toronto nurse practitioner, said in a statement. “Clients want this. Prescribers are eager to deliver it. But it is not covered under the Ontario Public Drug Plan, which is how almost all of my clients access prescription drugs.”

What About Pain Patients?

But patient advocates say the safe supply movement should be expanded to include pain patients who have lost access to opioid medication or had their doses drastically reduced.

“The Chronic Pain Association of Canada fully endorses the safe supply initiative, but asks why we’re helping one group while hurting the other, pointlessly. Safe supply is equally critical for the million or so unfortunate Canadians, including children, who suffer high-impact chronic pain and can no longer obtain the drugs they need,” Barry Ulmer, Executive Director of the Chronic Pain Association of Canada, said in a statement. 

“These patients have long been sustained by the pharmaceuticals and don’t abuse them. But now they’re routinely forced down or completely off their medications, blamed for overdoses they have no part in.”

Some pain patients are turning to street drugs. In PNN’s recent survey of nearly 6,000 chronic pain patients in the United States, eight out of ten said they are being prescribed a lower dose or that their opioid prescriptions were stopped. Many are turning to other substances for pain relief. About 15 percent have obtained opioid medication from family, friends or the black market, or used street drugs such as heroin and fentanyl.

“I know seven people personally that have gone to the streets to get pain relief. Four of them died because it was mixed with fentanyl. Two committed suicide,” one patient told us.

“I have been without a prescription for two years and have been getting medication on the street. I cannot afford this and I have no criminal history whatsoever. I have tried heroin for the first time in my life, out of desperation and thank God, did not like it,” wrote another patient.

Barry Ulmer says these patients need a safe supply too.

“Prescribing opiates safely to those with addiction makes sense. But simultaneously denying legitimate pain patients their medications doesn’t. It’s pointless — and cruel. Let’s give people with pain the same respect and care we give people with addiction,” he said.

Study Finds Antidepressants Make Tramadol Less Effective for Pain Relief

By Pat Anson, PNN Editor

Common antidepressants interact with the opioid medication tramadol to make it less effective for pain relief, according to a small new study from University Hospitals (UH) in Cleveland. The findings suggest that some patients who exceed their prescribed dose of tramadol may be under-medicated and are seeking more effective pain relief.

Prescriptions for tramadol – which is sold under the brand names Ultram and ConZip – have increased in recent years because it is widely perceived as a “safer” opioid with less rick of addiction. Many patients, however, say tramadol is not as effective as hydrocodone, oxycodone and other opioids.  

UH researchers reviewed the prescription records of 152 patients who received tramadol for at least 24 hours.

Those patients who were also taking the antidepressants Prozac (fluoxetine), Paxil (paroxetine) or Wellbutrin (bupropion) required three times more tramadol per day to control their breakthrough pain, compared to patients not taking the antidepressants.

Previous studies on healthy volunteers have shown effects on blood levels when combining tramadol with those particular antidepressants. However, this was the first study to document the effects of this interaction in a real-world setting with pain patients.

"We knew that there was a theoretical problem, but we didn't know what it meant as far as what's happening to pain control for patients," said Derek Frost, PharmD, a UH pharmacist and lead author of the study, which was published in the journal Pharmacotherapy.

Frost says millions of Americans may be suffering the ill effects of this drug-to-drug interaction.

"Tramadol relies on activation of the CYP2D6 enzyme to give you that pain control," Frost said. "This enzyme can be inhibited by medications that are strong CYP2D6 inhibitors, such as fluoxetine, paroxetine and bupropion.

“Many chronic pain patients are taking antidepressants, mainly selective serotonin reuptake inhibitors (SSRIs), which many of these CYP2D6 inhibitors fit into. There are a lot of patients who experience both, unfortunately. The likelihood that somebody on one of these offending agents and tramadol is relatively high."

Frost says the problem has a relatively easy fix.

"We have a lot of other antidepressants available that are in the same class of medication that don't inhibit this particular enzyme, such as Zoloft (sertraline), (Celexa) citalopram and Lexapro (escitalopram)," he said. "You also have other options for pain control - non-opioid medications such as NSAIDs. If we need to use opioids, a scheduled morphine or a scheduled oxycodone would avoid this interaction."

Tramadol is a synthetic opioid that was rescheduled by the Drug Enforcement Administration in 2014 as a Schedule IV controlled substance, a category that means it has a low potential for abuse. That same year, hydrocodone was rescheduled as a Schedule II drug, meaning it has a high potential for abuse. Many patients who were taking hydrocodone were switched to tramadol as a result of the rescheduling.

American Pain Society Files for Bankruptcy

By Pat Anson, PNN Editor

The American Pain Society (APS) filed for bankruptcy Friday after an overwhelming vote by its members to dissolve the financially troubled medical organization. In a membership vote last month, 93% voted in favor of a recommendation by the APS board of directors to file a voluntary petition for Chapter 7 bankruptcy.

The APS is a non-profit, research-based organization that focuses on the causes and treatment of acute and chronic pain. Although many of its members are researchers and academics who are investigating non-opioid treatments for pain, the APS was targeted as a defendant by Simmons Hanly Conroy and several other law firms seeking to recover billions of dollars in damages in opioid litigation cases.

In a press release, APS said efforts to resolve the “meritless” lawsuits without lengthy and expensive litigation were unsuccessful.

“It’s the perfect storm and now pointless to continue operations just to defend against superfluous lawsuits.  Our resources are being diverted to paying staff to comply with subpoenas and other requests for information and for payment of legal fees instead of funding research grants, sponsoring pain education programs, and public policy advocacy,” APS President William Maixner, DDS, said in a statement.

“As a result, the Board of Directors no longer believes APS can continue to fulfill its mission and meet the needs of our members and the pain care community.”

Press coverage of the APS often parroted what the opioid lawsuits alleged. The Guardian, for example, called the APS a “pawn of big pharma” and claimed the organization “pushed doctors to prescribe painkillers.”

The Guardian’s coverage was based largely on a report by Sen. Claire McCaskill (D-MO), who accepted over $400,000 in campaign donations from Simmons Hanly in her failed bid for re-election in 2018. APS is named as a defendant in several opioid lawsuits filed by Simmons Hanly, which stands to make hundreds of millions of dollars in contingency fees if the lawsuits are successful. The Guardian failed to mention any connection between Simmons Hanly and McCaskill.

The APS’ bankruptcy filing likely brings an end to its monthly publication, The Journal of Pain, which has been rated among the top five scientific journals in pain science. The current issue features research articles on diverse topics such as meditation for low back pain, diagnostic codes for fibromyalgia, whether opioids are effective for chronic noncancer pain, and the use of virtual reality to relieve arm pain.

“APS has been advocating for increased investment in research for many years, and it is particularly ironic that APS’s voice will go silent at this critical time in our history, when increased investment in pain research has finally become a reality in an effort to combat the opioid crisis,” said Roger Fillingim, PhD, an APS past president and professor of psychology at the University of Florida School of Dentistry.  

“There is a sad irony that the professional organization best poised to provide the spectrum of science to improve the prevention and treatment of pain and related substance abuse is defunct,” said APS President-elect Gary Walco, PhD, director of pain medicine at Seattle Children’s Hospital.

“Now, more than ever, our nation needs the collective efforts of leading scientists and clinicians who hold patients’ well-being at the highest premium.  The principal focus on punishing those in industry that may have contributed to the problem is shortsighted and far from sufficient.”

The APS is the second professional pain management organization to cease operations this year. In February, the Academy of Integrative Pain Management (AIPM) also shutdown. Opioid litigation has not only been costly for APS and AIPM, it has contributed to steep declines in financial support from pharmaceutical companies for other pain organizations, medical conferences and patient advocacy groups.   

We Are More Than Our Pain

By Carol Levy, PNN Columnist

I was referred to a neurologist who specializes in headaches. Trigeminal neuralgia is very different from a headache, but any port in a storm. I called to make an appointment and was told all new patients must agree to meet with a psychologist. If you refuse, you do not get the appointment.

This seemed like an inherent bias: Patients with head pain must have psychological issues. Does this mean the doctors are prejudging the truthfulness of their pain complaints?

Despite misgivings about seeing a psychologist, I made the appointment.

A few weeks later, the neurologist admitted me into the headache unit of the local hospital. Everyone in the unit had to have a one-on-one meeting with the psychologist.

“Tell me about your life,” she said.

I told her the most salient fact: “I am essentially alone in the world. My family abandoned me decades ago. And when you don’t work it is hard to make friends.”

Her suggestion: “You should go to counseling. They can teach you how to make friends.”

Well, there's a good idea. Except...

Before the pain started, I had no trouble making friends. Since the pain is a different story. Trying to make friends is hard when you don’t have the glue necessary to start a new relationship. I never married and I never had children because the pain took that part of my life away from me.

At my age, a senior citizen, that is often the opening question when you meet new people: “Are you married?” or “How many grandkids do you have?” No and none.

“Do you work? Are you still working?” Again, no. I haven't worked in over 40 years because of the pain.

If I am honest and say, “No to all of those. I have been disabled by a pain disorder since 1976,” the response tends to be a mouth falling open, followed by “Oh, I'm sorry.” Or a somewhat glazed look and a turn away to speak with someone else.

How do you overcome this? I haven't a clue.

But it started me thinking. When, if ever, did any of my doctors ask, “How are you dealing with this?”

I see this often mentioned in support groups: “My doctor never seems to have the time or the interest to find out about me, about how this is affecting my life.”

I am not sure if they don't ask because they don’t care or because it is something they can’t treat with a pill. Maybe they are afraid of hearing the truth for too many of us: “I'm not dealing well with it.”

Isn't part of being a healer taking the whole person into account? Doctors have precious little time to spend with us. Maybe they should take a few extra minutes to learn about the essence of who we are and what the pain has done to our basic core.

There is no medicine or surgery for the effect the pain has on our lives. But being able to say, especially to our doctors, what it has taken from us could help others see us as something more than our pain.  

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

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

Always Check Your Medical Bills and Insurance Statements

By Barby Ingle, PNN Columnist

Recently I received a medical bill and noticed my insurance did not cover any of the costs of my treatment for an emergency care visit. This particular visit happened when I woke up in pain and feeling like I couldn’t take a full breath. I thought it might be a partial lung collapse, something that I have experienced before.

About a month after the emergency care visit, I receive a bill from the provider. The first thing that I checked on the bill was my vital information: name, address, phone and insurance card ID. They had the wrong first and last name and my social security number instead of my plan number.

No wonder the insurance company denied it! It looked like someone else was trying to be me and got the details wrong.

I have done many interviews and articles over the years about medical billing. If I didn’t know how to catch these mistakes, I would have gotten stuck paying the entire bill.

Studies show that 8 in 10 medical bills have at least one minor mistake. These mistakes add up and cost society more than $68 billion in unnecessary healthcare spending, according to Medliminal Healthcare Solutions, a company that helps patients find and fix medical billing errors.

When I checked into the emergency care center that day, I was not able to speak very well and my husband handled the check-in process. He presented my drivers license and insurance card.

When the nurse called me back, she said my name incorrectly, close but incorrect. I corrected her and told her to make sure it is correct in the system because if data such as my name is not correct, the insurance won’t pay. She confirmed my name and the spelling and updated her system. The billing still got it wrong.

When I went back to the emergency care center with the medical bill, the front desk lady said the information was in their system correctly, but billing is done by another group and sometimes data gets mixed up. She gave me the info to contact the billing company.

After returning home, I called the billing company. Their representative said they had my name correct but corrected my insurance information. They are going to re-bill my insurance. My co-pay portion should only be 20% of the bill.

It literally came down to multiple people making little mistakes that led to me receiving a bill that was incorrect. If I didn’t check and see the errors, I would have gotten stuck paying the full amount.

Over the years this has happened quite a number of times to me and I am sure it happens to others. If you don’t compare your explanation of benefits (EOB’s) and provider bills against each other, you could pay more than you should for medical services. This can also happen if you don’t check your medical records. If a medical record is incorrect, you may not care at the time, especially if you received the appropriate care.

But what if you’re in an emergency situation where you can’t check and verify what is in the system? You may end up being given medications that you no longer take due to out-of-date prescription and medical records. You may even be denied coverage because of misinformation in your records.

What billing data should you check? Start with your name, date of birth, date of service, services provided and insurance information. For your medical records, check your name and date of service. Make sure to view your lab results, radiology reports, surgical reports, follow-up care suggestions, and daily notes from nurses and providers.

Also check your insurance EOB’s to see if the co-pays and deductibles you’ve paid matches up with their data, and you get the maximum coverage under your plan. Always check and correct medical information and bills. If you are doing it by phone, record the call if you are in a state where that is allowed. If not, then take good notes. Be sure to keep a copy of every provider bill, EOB, email and letter for your records.

Over a lifetime of chronic illness, you’ll save yourself thousands of dollars and get access to better care.

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics. More information about Barby can be found at her website.  

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

The Push for Stem Cell Censorship Has Begun

By A. Rahman Ford, PNN Columnist

A new study published in journal Stem Cell Reports, entitled “How to Peddle Hope: An Analysis of YouTube Patient Testimonials of Unproven Stem Cell Treatments,” looks at over a hundred videos by stem cell patients posted on YouTube. 

The study appears to have an underlying anti-democratic agenda – to shame YouTube and other internet platforms into removing positive patient testimonials about stem cell therapy (SCT).  Indeed, the use of the pejorative term “peddle” in the article’s title immediately undermines the study’s credibility.

This research epitomizes how propaganda can masquerade as scientific research, and how data can be twisted to meet its masters’ agenda.

The study comes on the heels of a recent federal judge’s decision that the FDA could regulate stem cells made from adipose tissue – a patient’s own fat cells. Although SCT critics generally praised the ruling as a victory for government oversight, outlets like the Washington Post lamented that it would likely not deter clinics from offering the therapy. 

A New York Times article accused the FDA of not acting until patients were harmed, and using enforcement actions that consist only of warning letters without any real teeth.  

STAT News even criticized the National Institutes of Health for allowing stem cell clinics to “co-opt” the nation’s clinical trial database.

Stem cell critics have apparently realized that the three previous stages of their vilification campaign have failed. These stages were:

1. Vilify the patients:  Promote the condescending narrative that patients are desperate, ignorant and too stupid to research stem cell therapy for themselves and decide whether it is best for them.

2. Vilify the clinics: Stem cell clinics are run by shady charlatans who engage in duplicitous business practices that take advantage of desperate, ignorant and pitiful Americans by selling them “unproven” products that couldn’t possibly help them.

3. Vilify the federal government: Federal agencies have not acted quickly or robustly enough to enforce the regulations that govern regenerative medicine, thus tacitly approving the growing “wild west” of clinics offering SCT.

The Push for YouTube Censorship

Critics now appear to be setting their sights on a fourth vilification stage.  In their desperation, they have decided to take a more authoritarian turn towards internet censorship.

The new study’s authors examined 159 YouTube testimonials from patients who had SCT for ALS, multiple sclerosis, Parkinson’s, cerebral palsy and spinal cord injury.  Not surprisingly, they found that most of the videos were published by providers and nearly all discussed the benefits of SCT in improving pain, overall health and quality of life. 

The authors concluded the YouTube testimonials “may be a potent marketing tool” and “are likely to have a wider reach and significant impact on influencing health behavior.” 

The article’s final sentence reveals the authors’ true motive: “Adopting multiple approaches, including patient education, enhancing patient treatment options, and regulatory oversight, are required to make a significant dent in reducing the number of clinics providing unproven SCTs.”

Setting aside the numerous, glaring and egregious methodological shortcomings of the study, the more important issue is one of broader public policy.  These authors appear to be implicitly advocating that YouTube and other internet sites censor videos that are “misleading” or “deceptive” or not published by “reputable organizations.” 

And who or what is to determine whether any particular video meets this criteria?  Wired published an article with the ominous headline “YouTube Testimonials Lure Patients to Shady Stem Cell Clinics,” implicitly calling on YouTube to take action. The notion isn’t farfetched. YouTube has been in the news a lot recently for censoring videos, using nebulous criteria and subjective standards.   

Apparently, SCT critics have jumped on the YouTube censorship bandwagon.  It’s a wagon that seems to claim a new victim every day, and its victims are usually those who threaten the status quo.  Unfortunately, it’s a wagon that travels the pothole-riddled road of authoritarianism.  It’s a road patrolled by people in strange uniforms, with sophisticated and articulate weapons, who dispense a vicious propaganda, and who always claim to have your best interest at heart.

Please make sure to call, email and/or tweet your state and federal legislators to voice your support for the availability and affordability of stem cell therapy.  The people who suffer with pain and disability will not be silenced and will not be censored.  Our democratic voice will be the response to their authoritarianism.

A. Rahman Ford, PhD, is a lawyer and research professional. He is a graduate of Rutgers University and the Howard University School of Law, where he served as Editor-in-Chief of the Howard Law Journal. He earned his PhD at the University of Pennsylvania.

Rahman lives with chronic inflammation in his digestive tract and is unable to eat solid food. He has received stem cell treatment in China. 

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.

Kratom Helps Me with Pain and Addiction

(Editor’s note: The author of this column is using the pseudonym “Marc Smith’ because he fears his employment and healthcare could be jeopardized if his true identity were known.)

By Marc Smith, Guest Columnist

I have had a long and treacherous battle with health problems and substance abuse. Starting at age 14, I was diagnosed with multiple reoccurring bone tumors on my right leg below the knee. This led to six major surgeries; three for tumor removal and three for MRSA bacterial infection treatment and debridement.

My knee is completely damaged from the tumor destroying the top of my tibia and the bacteria completely eating away at my meniscus and cartilage. I have severe chronic and acute pain in that leg. I am not a candidate for a knee replacement due to the bone being too damaged and it is not a stable site for an artificial joint.

I have also been in a severe car accident that lacerated my left arm, broke the fibula in my left leg and tore the meniscus in my left knee.

The treatment of these ailments came with a lot of prescribed narcotic pain medications on a regular basis from age 14 on. My tolerance to these medications grew astronomically over 15 years until they stopped working effectively.

I eventually was buying OxyContin on the street and abusing it heavily. This led to IV heroin and cocaine use, and the loss of anything of real value I had.

I struggled with this crippling addiction for 18 years. I tried methadone, Suboxone, Vivitrol and complete abstinence -- with no significant success with any of them. Finally, I tried a strong 12-step recovery program. It worked temporarily, but the physical pain would become too much and I would relapse on opiates.

A year ago, I found kratom and decided to try it for pain relief. It helps me with pain, helps me sleep, curbs craving, and allows me to function and participate in daily life without being in extreme pain. I do not have extreme tolerance building problems with kratom like I did with opioids. The side effects are extremely minor and do not impair my judgment or ability to function.

I am up at 4:30 AM every day and at the gym by 4:45 cycling for an hour. I have found the recumbent bike does not hurt my leg that badly. I lost weight due to exercise and diet changes that kratom helped me make. I am much more positive about taking care of myself and am able to be present for life.

My pain hasn’t completely vanished, but it is manageable due to kratom. My spiritual growth has been a big factor as well in my 12 months of sobriety. These two things working in harmony have literally saved my life. I am a completely different person and my family has their son back.

I do not want to die and the fact that this harmless plant is being targeted makes me scared for my life. Let’s focus on rehabilitation and recovery methods. Let’s focus on illicit fentanyl and other synthetic chemicals, not a natural botanical. Please, take a step back and look at kratom success stories like mine.

Do you have a story you want to share on PNN? Send it 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.

FDA Warns Kratom Vendors

By Pat Anson, PNN Editor

The U.S. Food and Drug Administration has issued two more warning letters to kratom vendors – Cali Botanicals of Folsom, California and Kratom NC of Wilmington, North Carolina – for making unproven claims that kratom can treat pain, addiction, depression, anxiety and other medical conditions.

Kratom comes from the leaves of a tree that grows in southeast Asia, where it has been used for centuries as a natural stimulant and pain reliever. In recent years millions of Americans have discovered kratom -- including many who have lost access to opioid medication -- and found it to be an effective treatment.   

The FDA, however, considers kratom an unapproved drug that shouldn't be used to treat any medical condition.

“Despite our warnings, companies continue to sell this dangerous product and make deceptive medical claims that are not backed by science or any reliable scientific evidence,” said acting FDA Commissioner Ned Sharpless, MD.

“As we work to combat the opioid crisis, we cannot allow unscrupulous vendors to take advantage of consumers by selling products with unsubstantiated claims that they can treat opioid addiction or alleviate other medical conditions.”

What makes kratom dangerous? Sharpless cited FDA studies that found salmonella bacteria and heavy metals in a relatively small number of kratom products.  Kratom has also been linked to dozens of fatal overdoses -- although multiple substances were involved in nearly all of those deaths.

The FDA said Cali Botanicals and Kratom NC were using websites and social media to make unproven claims about kratom's ability to treat medical conditions. Cali Botanicals, for example, makes these claims about kratom's benefits:

• “Kratom is able to reduce the pain levels that reach the brain in a way that’s very similar to opioid drugs.”

• "Kratom is seen as life-saving by former addicts, who found kratom to be the only way they could overcome their addictions."

• “Consumption of kratom can reduce pain and swelling to an injury.”

• “Addicts can wean themselves off of their addictions by replacing their drugs with kratom. It has similar effects as opioids, but without the same dependency. Kratom also helps with the withdrawal symptoms.”

• “Kratom is used for energy, to increase attention/focus, to relax, and also to treat pain and addiction."

• “Some researchers have even claimed that kratom can protect you against cancer!”

With the exception of that claim about preventing cancer, those are the same benefits that many kratom users report anecdotally.

"For over two years now I have enjoyed drinking my kratom tea a couple of times a day. It helps promote my mood and energy like a cup of coffee would. The tea also relieves my aching joints and muscles, making my chronic fatigue and pain much more bearable," Kim DeMott wrote in a recent PNN column.  

"Kratom does not make me high, nor do I experience side effects. I am now clear minded without the sedation caused by narcotics. And I am devastated that the FDA is working to ban the only thing that has helped me in the past 28 years," fibromyalgia sufferer Mary Ann Dunkel wrote in another guest column.

Kratom has been banned in 6 states and dozens of counties and cities have enacted or are considering their own bans. Last year, the Department of Health and Human Services (HHS) recommended to the DEA that kratom be classified as a Schedule I substance – which would effectively ban it nationwide. Currently, the DEA doesn't even list kratom in its annual report on drug threats. 

Anxiety Is a Symptom, Not a Diagnosis

By Dr. David Hanscom, PNN Columnist

Every living creature on this planet survives by avoiding threats and gravitating towards rewards. The driving force is staying alive and survival of the species. This is accomplished by the nervous system taking in data from the environment through each body sensor and analyzing it.

The first step in this process is for your brain to define reality. A cat is a cat because your brain has unscrambled visual signals and determined the nature of the animal. A cat’s meow is analyzed from the auditory receptors. Your nervous system then links the two inputs together to associate the sound as one that emanates from a cat.

The reason why I am presenting the obvious is to make the point that nothing exists without your brain gathering data, unscrambling it and determining what is.

One of the responsibilities of the central nervous system is to maintain the delicate balance of the body’s chemistry. There are numerous chemicals to keep track of. When there is a threat, hormones will be secreted that increase your chances of survival.

Some of the core response hormones are adrenaline, noradrenaline, endorphins, histamines and cortisol. I won’t list the effects of each of these survival hormones, but the net result is an increased capacity to flee from danger.

All of these allow you to leap into action, but what compels you to do so? It is a feeling of dread that we call anxiety. It is so deep and uncomfortable that you have no choice but to take action.

Anxiety is a symptom, not a diagnosis, disease or disorder. Therefore, it isn’t treatable by addressing it as the problem. Once you understand anxiety is only a warning mechanism, you can address the causes of it.

The Curse of Consciousness 

The universal problem of being human is what I call the “Curse of Consciousness.” Recent neuroscience research has shown that threats in the form of unpleasant thoughts are processed in a similar area of the brain as physical threats and with the same chemical response.  

This curse is that none of us can escape our thoughts, so we are subjected to an endless hormonal assault on our body. This translates into more than 30 physical symptoms and many disease states, including autoimmune disorders and intractable pain. The worst symptom is relentless anxiety.  

In my personal experience and working with thousands of pain patients, it is the mental pain -- manifested by anxiety – that becomes intolerable. Anxiety is the essence of human suffering and physical pain is the final insult.  

Since this unconscious survival mechanism has been estimated to be a million times more powerful than your conscious brain, it isn’t responsive to rational interventions to manage or control it. Without anxiety that is unpleasant enough to compel you take action, you wouldn’t survive. Neither would you survive without the drive to seek physiological rewards. 

Direct Your Own Care

Try to view anxiety as the fuel gauge in your car. It lets you know that you are being threatened. Whether the threat is real or perceived doesn’t matter. But you have to allow yourself to feel it before you can understand and deal with it.  

If anxiety is the measure of your body’s survival hormones, then the only way to decrease it is to lower them. This can be accomplished directly through relaxation techniques or by indirectly lowering the reactivity of your brain to dampen the survival response.  

This is accomplished by stimulating your brain to rewire so the response to a threat results in a lower chemical surge and is of shorter duration. The term for this is “neuroplasticity.” Your brain changes every second with new cells, connections and myelin. 

By not wasting energy trying to treat or solve your anxiety, you now have the energy to pursue a new path with a remarkable surge in energy, life forces and creativity.   

How is this accomplished? Learning tools to calm and rewire your nervous system is the core of the Direct your Own Care (DOC) project. These approaches have been known for centuries, but have been buried under the weight of modern information overload and the rapid pace of life.  

DOC is a four-stage process for you to understand the nature of your pain and relevant issues that allows you to figure out your own version of a solution. The clarity you get will help you connect to your own capacity to heal by developing skills to auto-regulate your body’s chemistry from anxiety to relaxed.  

Success in learning to adjust your body’s chemical makeup is based on awareness and openness to learning so change can occur. It is remarkably simple and consistent. Join me in living your life in a manner that you could not conceive was possible – even better than before you were crushed by pain. 

Dr. David Hanscom is retired spinal surgeon who has helped hundreds of back pain sufferers by teaching them how to calm their central nervous systems without the use of drugs or surgery.

In his book Back in Control, Hanscom shares the latest developments in neuroscience research and his own personal history with pain.

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.