U.S. Overdose Crisis Could Be Worse Than We Thought

By Pat Anson, PNN Editor

The number of deaths attributed to opioid overdoses in the U.S. could be 28 percent higher than reported due to incomplete death records, according to a new study appearing in the journal Addiction. Researchers at the University of Rochester say nearly 100,000 overdose deaths may not have been counted because the opioid involved was not identified.

The discrepancy is pronounced in several states, such as Pennsylvania, Alabama, Mississippi, Louisiana and Indiana, where the actual number of overdoses caused by legal and illicit opioids could be twice as high as current estimates.

"A substantial share of fatal drug overdoses is missing information on specific drug involvement, leading to underreporting of opioid-related death rates and a misrepresentation of the extent of the opioid crisis," said senior author Elaine Hill, PhD, an economist and assistant professor in the University of Rochester Medical Center. "The corrected estimates of opioid-related deaths in this study are not trivial and show that the human toll has been substantially higher than reported, by several thousand lives taken each year."

Hill and her colleagues found that almost 72 percent of unclassified drug overdoses that occurred between 1999 and 2016 involved prescription opioids, heroin or illicit fentanyl — translating into 99,160 additional opioid-related deaths.

Researchers discovered the discrepancy while studying the economic, environmental and health impact of coal mining and oil and gas drilling. Appalachia and other regions of the country hit hardest by the opioid crisis overlap with areas where there is coal mining and shale gas development.

As a part of her research, Hill was attempting to determine whether the shale boom improved or exacerbated the opioid crisis. She discovered that close to 22 percent of all drug-related overdoses were unclassified, meaning the drugs involved in the cause of death were not reported.

A 2018 study at the University of Pittsburgh reached a similar conclusion, estimating that as many as 70,000 opioid related-deaths were not reported. Coroners and medical examiners in many states often did not specify the drug that contributed to the cause of death.  

Critics have long complained that overdose data reported by the CDC and other federal agencies is flawed or cherry-picked. CDC researchers admitted in 2018 that deaths attributed to opioid medications were “significantly inflated” because overdoses involving illicit fentanyl were erroneously counted as prescription opioid deaths. Toxicology tests cannot distinguish between pharmaceutical fentanyl and illicit fentanyl.

The overdose data is further muddied because multiple drugs are involved in almost half of all drug overdoses.

Poor Overdose Data Concentrated in Several States

In their study, Hill and her colleagues obtained overdose death records from the CDC’s National Center for Health Statistics. Using statistical analysis, they correlated information on unclassified overdose deaths with potential contributing causes, such as previous opioid use and chronic pain conditions.

While the overall percentage of unclassified deaths declined over time – apparently due to efforts to improve overdose data -- the number remained high in several states. In Pennsylvania, for example, the official number of opioid-related deaths was 12,374. Researchers estimate that the actual number of deaths was 26,586.

"The underreporting of opioid-related deaths is very dependent upon location and this new data alters our perception of the intensity of the problem," said Hill. "Understanding the true extent and geography of the opioid crisis is a critical factor in the national response to the epidemic and the allocation of federal and state resources."

The CDC recently reported that drug overdose deaths dropped 4.1% in 2018 – the first decline in nearly three decades -- led by a significant drop in overdoses involving hydrocodone, oxycodone and other painkillers. But deaths linked to illicit fentanyl, methamphetamines and psychostimulants are surging, threatening to reverse the overall trend.

“One thing that we’re seeing is that the decline doesn’t appear to be continuing in 2019. It appears rather flat, maybe actually increasing a little bit,” said Robert Anderson, PhD, Chief of the Mortality Statistics Branch, National Center for Health Statistics.

Drugs Kill in Other Ways

All of these studies miss the mark, according to research published in PLOS ONE, because they don’t include deaths caused by infectious disease, drunk driving, suicide, and cardiovascular disease — all of which are affected by drug use.

"The basic records being kept are annual reports on the number of deaths from drug overdose. But that's only part of the picture,” said Samuel Preston, a professor of sociology at the University of Pennsylavnia. "Drugs can kill in other ways."

In 2016, 63,000 deaths were attributed to drug overdoses, but Preston and his colleagues estimate that the actual number of drug-associated deaths was around 142,000. Drug use shaved off nearly a year-and-a-half of life for men and three-quarters of a year for women.

"It's not just about the supply of drugs, but that there's something else behind all of it that causes people to either use drugs or alcohol or commit suicide because they've lost interest in their life," said co-author Dana Glei, a Georgetown University demographer.

Drug Tests Show Kratom Use Doubled in U.S.

By Pat Anson, PNN Editor

Kratom use in the U.S. appears to have doubled in the last two years, according to a large analysis of urine drug tests by Millennium Health. The first of its kind study also found that nearly 1 out of 4 people who tested positive for kratom were abusing opioids, benzodiazepines or other substances.

Kratom is an herbal supplement that millions of Americans use to self-treat their chronic pain, anxiety, depression and addiction. It comes from the leaves of a tree that grows in southeast Asia, where kratom has been used for centuries as a natural stimulant and pain reliever.

Millennium Health analyzed over 400,000 urine samples collected from 2017 to 2019, using liquid chromatography mass spectrometry to test for mitragynine and 7-hydroxymitragynine, two alkaloids that are the active ingredients in kratom.

The drug tests were ordered for patients by doctors in primary care, pain management and addiction treatment. As a result, the findings may not represent the typical kratom user.

Positivity rates for kratom doubled over the study period, rising from 0.9% in January 2017 to 1.8% in November 2019. Use of kratom rose in every section of the country, with the highest positivity rates reported in Idaho (4.2%), Montana (2.9%), Colorado (2.3%), Utah (2.3%) and Florida (2.1%).

The American Kratom Association generously estimates that over 15 million Americans use kratom. As interest in the herbal supplement has grown, so have the number of doctors ordering drug tests to see if their patients are using it.

“There are clinicians out there, that are caring for these type patients, that are likely to have kratom users in their population. It’s a small number, about 2 percent or so, but it’s likely increasing,” says Eric Dawson, PharmD, Vice-President of Clinical Affairs for Millennium.

One of the more surprising aspects of the study was how many kratom users were abusing other substances. For urine samples testing positive for kratom, nearly 25% were also found to be positive for non-prescribed opioids and 22% tested positive for non-prescribed benzodiazepines, an anti-anxiety drug.

Methamphetamine, fentanyl, cocaine and heroin were also more likely to be detected in positive samples for kratom versus those that tested negative.

SOURCE: MILLENNIUM HEALTH

Kratom use has been growing in the U.S. as people seek alternatives to opioid pain relievers and other pharmaceutical drugs. Many also use kratom to self-treat alcoholism or opioid addiction.

“You have these two camps, very pro-kratom and very anti-kratom. We purposely tried not to fall into either one and simply answer the questions we were being asked and see what the data is,” Dawson told PNN. “I’m very interested to see what happens to kratom moving forward in the next few years because the benefits are very compelling, but conversely so are the negatives. It’s quite an interesting compound for sure.”  

Most federal agencies take a dim view of kratom. The FDA says kratom is addictive, has opioid-like qualities, and should not be used for any medical condition. The CDC has linked kratom to dozens of fatal overdoses -- although multiple substances were involved in nearly all of those deaths.

Although kratom remains legal at the federal level, several states have banned kratom and some counties and cities have enacted local ordinances prohibiting sales.

A recent study funded by the National Institute on Drug Abuse concluded that kratom is an effective treatment for pain, helps users reduce their use of opioids, and is “relatively safe” to use.

Fighting Medical Injustice in North Carolina

By Michael Harmon, Guest Columnist

I’m writing on behalf of my wife Lynda, a 30-year victim of fibromyalgia. Lynda was hit by a drunk driver in 1985 and despite years of neurological testing and procedures, we were unable to stop this dreaded disease from spreading throughout her body.

By 1993, she was confined to a chair and faced 24/7 pain. Regrettably, the only plausible outcome in her mind was possible suicide, a place many with chronic pain find themselves.

Then we found a doctor willing to prescribe methadone. The medication worked and Lynda was given back a small semblance of life. It was still a very limited lifestyle, but she could occasionally shop, go to dinners, drive and take care of her house. 

Two other doctors carried on this fight for the next 20 years, with the same prescription and same dosage. They were years that my daughter and I counted as bonus years, given the dark periods of the early 1990’s.

Then the CDC got involved with its 2016 guideline establishing voluntary, not mandatory, amounts allowed for opioid prescriptions. The guideline led to forced tapering of patients, and penal sanctions and revocation of medical licenses for doctors found to be non-compliant with the new “standard of care.”

LYNDA HARMON

In 2018, Lynda’s pain doctor started the tapering protocol, and immediately we saw her tailspin into a dark depression. She knew what was coming! Her methadone dosage was cut to about 15-20% of her normal prescription levels of the past 25 years.

By early 2019 she was once again in a chair, rocking in pain, 24/7. And yes, suicide was once again on the table. But hey, the government was happy, the politicians were happy, and her doctor wasn’t going to lose her livelihood!

Befriending Dr. Thomas Kline

I met Dr Thomas Kline in February of 2019 after reading an article he wrote that chronicles in detail over 30 pain patients who took their lives as a result of being tapered. I befriended this “true healer” and wanted to help him bring awareness of this injustice any way I could.

After 6 months of talking and working on these issues, Dr. Kline asked me one day if he could help Lynda. I knew he was not taking patients and I never asked him to help Lynda, I just wanted to help him bring light to this terrible problem.

Dr. Kline met Lynda in August and after lengthy interviews, examinations and medical testing, Lynda switched her pain care to Dr. Kline. We were delighted!  

DR. THOMAS KLINE

The protocol of methadone was slowly and professionally raised each month, and by January 2020 Lynda’s mood lifted. Thoughts of suicide disappeared, and movement of her extremities became easier and free of pain. You could tell her life was being returned to her.

Then came the news of last Monday, February 17 that Dr. Kline was under investigation by the North Carolina Medical Board.

He was told to surrender his DEA license, which means he can no longer prescribe opioid medication. All 34 of his patients were left in limbo, basically thrown to the wolves.

Who could do such a thing? Is this truly a medical board of doctors who made an oath to alleviate pain and suffering? Tell me, what are these 34 patients supposed to do? No doctor will take their case, for fear of losing their own livelihood.  

Lynda has only a few days left of her last prescription, as she was due to pick up her monthly meds last Tuesday, the day after receiving the news of Dr. Kline’s suspension. This type of oversight is inhumane and should have no place in a modern society. I would argue that we treat our pets better than this!  

Now don’t get me wrong, I am fully supportive of the President’s effort to fight the opioid crisis on the streets of America, on our borders, internationally and in hospitals. I agree wholeheartedly to the jailing of doctors that write scripts to bogus patients who profit from the sale of the drugs on the street. This is abhorrent.  

But the people we are talking about, people like my wife, have been on these medical protocols for chronic pain for 10, 20 and 30 years plus! They are functioning citizens of our society. These people have mortgages, car payments, and children in college. How are they going to work without the medicines needed to overcome their daily pain?   

Some are military veterans who were busted up and blown up, defending our freedom. One veteran commenting on the tapering of his pain meds was recently quoted as saying, “Once again my country has asked me to lay down my life!” 

Lynda and I consulted with three doctors last week, doctors of the highest repute, and each of them had no answer to this horrible matter. How can this be?  

Perhaps Dr. Kline’s DEA license will be reinstated, maybe not. Life will go on for this kind man and perhaps he will begin to enjoy the retirement he had seen for himself and his family when he moved to Raleigh. For that I am happy. This truly is a doctor who cares, and cares enough to push the limits in order to help improve the human condition.  

But what about his 34 patients? What about other patients around the country who, like Lynda, are on the threshold of suicide?  What are they going to do? They no longer have a Dr. Kline in their lives or a government that cares. If they did care, they would not be investigating a great doctor like Dr. Kline. They'd be empowering him and others to get in the middle of this injustice and fix it! 

Michael and Lynda Harmon live in South Carolina.

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

Be Strong and Proud on Rare Disease Day

By Roger Chriss, PNN Columnist

This coming Saturday, February 29 is Rare Disease Day worldwide. The day recognizes thousands of rare diseases and disorders that together impact millions of people worldwide, both patients and their caregivers.

The goal of the day is to raise the profile of the rare disease community and to spread the word: “Rare is many, rare is strong and rare is proud!”  

According to the National Organization of Rare Disorders (NORD), there are over 7,000 rare diseases that are chronic, progressive, degenerative, disabling and frequently life threatening. Many rare diseases are familiar to chronic pain patients, from Trigeminal Neuralgia and Chiari Malformations to Porphyria and Ehlers-Danlos syndrome.

A disease is considered rare in the U.S. when it affects fewer than 200,000 people, while in Europe a disease is rare if it affects fewer than 1 in 2,000 people.

Because there are so many disorders, a total of 300 million people worldwide are thought to be affected by rare diseases. And though each disease is unique, many share common features like chronic pain and limited mobility, and require complex medical care.

Events are planned throughout the week leading up to February 29. NORD is hosting a variety of events, including a gathering at the International Spy Museum in Washington, DC on Saturday.

The FDA held a public meeting on Monday to update stakeholders in the rare disease community on the agency’s efforts to improve treatment for rare diseases. That includes a new request for applications to its Orphan Products Grant Program, which funds clinical trials of so-called “orphan” drugs that could potentially be used to treat rare diseases.

The National Institutes of Health is coordinating panel discussions on Friday, February 28 in Bethesda, MD to improve diagnosis and treatment, expand clinical trial resources, and increase awareness of rare diseases.

In all, NORD lists over 400 events in 106 countries marking Rare Disease Day, including conferences, research presentations, exhibits, walks, rallies and a variety of fundraisers.

Rare Disease Day started in 2008 with the first events held in Canada and Europe. The date February 29 was chosen because it is rare (Rare Disease Day is on February 28 in non-leap years).

Treatment Often Limited

Rare diseases and disorders often go undiagnosed and untreated. Due to their rarity, expertise, treatment and resources are limited for people living with a rare disease, who can also face discrimination at work and school.

Research on rare diseases can actually help improve understanding of more common disorders and lead to new treatments. For instance, Yale neuroscientist Dr. Stephen Waxman discovered the gene SCN9A and its role in two painful hereditary neuropathies. Treatments for these disorders may help people with many other forms of peripheral neuropathy, as Waxman explains in his book, “Chasing Men on Fire.”

Moreover, rare diseases are often misunderstood. They do not look like typical illness and may require unusual forms of medical care. So Rare Disease Day also represents a chance to raise awareness about the importance of research, specialist centers, and healthcare professionals who work on such disorders.

Although most rare diseases do not have a cure, they can all be managed and patient lives improved. Rare Disease Day is an opportunity to focus on promising research, improving patients’ lives, and promoting action.

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.

FDA Approves First Intravenous Preventive Treatment for Migraine

By Pat Anson, PNN Editor

The U.S. Food and Drug Administration has approved the first intravenous treatment for the prevention of migraine in adults, adding to an increasingly crowded field in new migraine drugs.

Lundbeck, a Danish pharmaceutical company, said Vyepti (eptinezumab-jjmr) would be available in April 2020. The recommended dose is 100 mg every 3 months; although some patients may benefit from a dose of 300 mg. Price details were not released.

Vyepti is a humanized monoclonal antibody that prevents migraines by blocking a key protein — calcitonin gene-related peptides (CGRP) -- from binding to nerve receptors in the brain.

Since 2018, the FDA has approved three injectable CGRP inhibitors for migraine prevention and recently approved the first oral tablet for migraine treatment. Vypeti is the first CGRP blocker to be administered intravenously.

“With the approval of Vyepti, I am pleased that we are now able to offer a new IV therapy that achieves the key treatment goal of preventing migraine over time while also delivering on the need for earlier onset of efficacy,” Dr. Deborah Dunsire, President and CEO of Lundbeck, said in a statement.

The efficacy and safety of Vyepti was demonstrated in two phase III clinical trials (PROMISE-1 in episodic migraine and PROMISE-2 in chronic migraine) involving over 1,700 patients. Treatment benefit was observed for both doses of Vyepti as early as one day after infusion, and there was a sustained reduction of migraines through the second dose.

“The PROMISE-2 data showed that many patients can achieve reduction in migraine days of at least 75 percent and experience a sustained migraine improvement through 6 months, which is clinically meaningful to both physicians and patients,” said Dr. Peter Goadsby, a professor of neurology at King’s College, London and the University of California, San Francisco. “Vyepti is a valuable addition for the treatment of migraine, which can help reduce the burden of this serious disease.”

Patients were allowed to continue using other migraine or headache medications during the trials. About 2 percent of patients treated with Vyepti discontinued treatment due to adverse reactions, such as an upper respiratory infection and hypersensitivity that causes facial flushing and rash.

Lundbeck has submitted an application for market authorization of Vyepti in Canada and plans to file in the European Union during 2020, followed by the submission of drug applications in other countries around the world, including China and Japan.

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

Pain Patients Left in Limbo by Dr. Kline Investigation

By Pat Anson, PNN Editor

They call themselves the “NC 34” – thirty-four patients left in limbo after the North Carolina Medical Board told their doctor this week to surrender his DEA license. Without that license, Dr. Thomas Kline can no longer prescribe opioid pain medication and other controlled substances.

Kline’s 34 patients, who all suffer from chronic and rare diseases, now face the imminent prospect of withdrawal and uncontrolled pain when they run out of opioid medication in the next few weeks or days.

“The board has no idea how irresponsible their actions were taking away Dr. Kline's DEA license, because the board has adversely affected the lives of 34 of Dr. Kline's chronic pain patients, all of whom are pain refugees and all of whom require opiate therapy on a daily basis in order to have some semblance of a quality of life,” says Leslie Bythewood, a Kline patient who lives with hypothyroidism and Chiari malformation of the brain, which causes severe migraines and cluster headaches.

“When our pain meds run out, we are going to go through not only withdrawal but our original pain is going to rise exponentially and make our lives miserable, insufferable and totally unlivable once again.”

As PNN has reported, the North Carolina Medical Board won’t say why it is investigating the 76-year old Kline, who until now had no record of any complaint or disciplinary action taken against him.

Kline has no idea why his practice has come under scrutiny. In recent years, he’s become an outspoken advocate for pain patients — maintaining that doctors should decide when and how to treat their patients with opioids, not state medical boards or the DEA.

Kline says he was pressured by state investigators into surrendering his DEA license when they made a surprise visit to his office in Raleigh on Monday – a decision he now regrets.

“I was never notified when these inspectors came out that it was voluntary. They called me on the phone and said they were coming by in two hours to get you to surrender your license,” Kline told PNN. “I’ve been telling doctors, ‘Never surrender your license.’  But I thought this was something different. And it threw me for a loop as to why this is coming from the medical board.”

‘I Have 7 Days of Meds Left’

Kline’s medical license remains active and he can still see patients, he just can’t write prescriptions for opioids or other controlled medications. Kline has urged all 34 patients to find new prescribers.  

“All of the patients have been searching and searching and searching and they can’t find anyone,” says Kline, who treats several out-of-state patients who travel hundreds of miles to see him because they can’t find a local provider willing to treat them.

Opioid hysteria, fear of prosecution and medical discrimination have made doctors and pharmacists reluctant to accept new pain patients, particularly those on high opioid doses.  

“Right now, prospects are slim of finding either a provider or a pharmacy.  I don't know what is going to happen,” said Jeff Geurin, a disabled Air Force veteran in Georgia who was injured in a parachute accident.

“I have severe chronic pain, the only relief from which has come from high-dose opiate medications.  After the VA discontinued all veterans off pain meds in 2015, and shortly thereafter the civilian doctors, I was out of options. I was planning my suicide in 2018, and two weeks before my planned exit, Dr. Kline rescued me.”

While under Kline’s care, Geurin says he’s been able to live a relatively normal life. He was thrilled recently to land a job as a 911 dispatcher.

“I have about 7 days of meds left, so I'm going to be hurting and withdrawing while starting a new job. I'm scared, I'm angry, and I'm sad for all the other patients of Dr. Kline who have been ripped from stability and pain control for no good reason,” Geurin wrote in an email. 

“This board is putting all our lives at risk by keeping him from prescribing to us.”

— Kristina Mitchell, Kline patient

“There's another patient that is already talking of suicide. And what are you supposed to say to him? No, don't do it? That would be like telling the people trapped in the North Tower on 9/11 not to jump, they have to stay in the tower and burn to death.”  

“I am almost ready to check myself out of this life, because I can't seem to find a single caring physician since Dr. Kline lost his DEA license, and I know for a fact that I simply cannot live with this constant, intense pain,” said Bythewood.

“I deserve the right to proper medical care. A diabetic isn’t denied insulin, but pain patients are being targeted because of an opioid epidemic,” said Colleen Davis-Harrison, a Kline patient who has multiple sclerosis and arachnoiditis, a chronic inflammation of spinal nerves. “I will support Dr. Kline and my fellow patients. I just hope no one gets hurt or does something stupid while others wait to see what’s in the cards for us.” 

“I do not have another doctor to write my prescriptions. I had already exhausted all of my options in my state when I went to Dr. Kline,” said Kristina Mitchell, a patient with Ehlers-Danlos syndrome (EDS) who lives in Virginia. “Without him I don't know what I will do. Withdrawal is not my concern, that won't last. The full force of my pain coming back is my greatest fear and I know I can't handle it. 

“I hope this gives you a general idea of what an amazing, good, caring and life-saving doctor Kline is. Without him, myself and 33 other people may not be here today. This board is putting all our lives at risk by keeping him from prescribing to us.” 

Duping of Healthcare Providers

Will Kline be able to get his DEA license back? One expert says that is unlikely. 

“I have never heard of any controlled substance registrant who surrendered or otherwise lost a controlled substance registration being able to get it back from the DEA,” said attorney Michael Barnes, who is managing partner at DCBA Law & Policy, a law firm that advises healthcare providers.

Barnes tells clients not to be intimidated by DEA or medical board investigators who claim that surrendering a license is only temporary.

“If you surrender that authority, it doesn’t matter if there used to be a piece of paper. Surrendering of the authority is saying ‘I’m giving up my right to prescribe.’ This is part of the duping of healthcare providers, where they think they are doing one thing. In reality they’re doing something that’s permanent,” Kline told PNN.  

The North Carolina Medical Board’s investigation of Kline apparently began a few months ago, when it asked him for the records of nine patients. A spokeswoman for the board told PNN that investigations of healthcare providers typically take six months to a year to complete. 

In the interim, Barnes says the board should be proactive and make sure the “NC 34” are getting the care that they need. 

“The board should ensure that each of those patients receive a referral to a qualified, certified pain treatment professional who is capable of meeting these patients’ unique medical needs,” Barnes said. “The medical board really has an obligation, not just to give a paper with some addresses on it, but to make certain that each of these individuals is accepted into a practice and actually receives medical care.”

“The medical board has made a big mistake and has taken one of the finest doctors I have ever known, the only doctor I have ever trusted,” says Jess Stewart, another Kline patient who lives with EDS. “He wasn’t a pill mill doctor and instead of being worried about him I would be more focused on the illicit fentanyl out on the streets. You see, it’s actions like this that are forcing people to the streets. 

“Do I need another doctor? Now I do, thanks to the board. But there was nothing wrong with the one I had.”

I Can’t Imagine Life Without Kratom

By Kimberley Flink, Guest Columnist

I'm 59, a native Floridian and spent most of my entire life actively outdoors. About five years ago, I woke up and could barely move, my body was wracked with intense muscle pain. I was in tears simply brushing my teeth, taking a shower, holding a coffee cup or even opening a door.

If I had to attempt to describe the pain, it would be similar to doing a triathlon and never practicing a day for it. Every muscle ached and throbbed in constant, chronic soreness. I felt like a little old lady when walking, standing and sitting, with groans of pain to boot.

Finally, after several trips to the doctor, they diagnosed me with fibromyalgia and a series of drugs were prescribed: anti-depressants, muscle relaxers, gabapentin and all the typical prescribed pharma arsenals.

Nothing helped with the pain. Instead they gave me side-effects that ranged from horrid headaches, weird sensations in my body, and the list goes on. So I set out to approach a holistic natural path.

Marijuana made me overeat and I didn't like staying high. I cleaned up my diet, took organic superfoods and spent tons on supplements, all to no avail.

Then a friend recommended kratom. And from the first day of taking it I was literally in tears, thanking God for a respite.

I do not even take the recommended dosage, so as to not overuse it, and I do not take kratom every single day, so I do not become addicted.  On the days I don’t take it, I'm suffering and hardly able to get out of bed.

KIMBERLEY FLINK

I cannot imagine my life without kratom, as I am now able to spend time with my granddaughter, go on short outings and function somewhat normally. I do not get high, overeat and have no ill side effects. It gives me a little energy and dials down the pain level severely. 

It would be a serious injustice to not have kratom available to people like myself, who suffer with chronic pain and do not want the heavy-duty drugs that people get addicted to or take their life by overdosing.

To compare kratom with alcohol, nicotine, opioids or other drugs that can cause death is absurd. I know what addiction is and those who say otherwise are simply abusing kratom. Or they’re using some other black market, knock-off product.

Kratom is the only thing that has given me a good portion of a quality life back. I thank God for it!

Kimberley Flink lives in Florida.

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

Patients with Arachnoiditis and Ehlers-Danlos Need Adrenaline for Pain Control

By Dr. Forest Tennant, PNN Columnist

In this era of opioid controversy and tragedy due to forced opioid reduction, the scientific information on adrenaline-type agents can help control constant, intractable pain and help reduce opioid use.

Overlooked in the opioid controversy is the key point that an adequate supply of adrenaline-related neurotransmitters – such as dopamine and norepinephrine – are necessary in the brain and spinal cord for pain relief. Unfortunately, constant intractable pain depletes the natural supply of endorphin, dopamine, adrenaline and noradrenalin, and their levels must be replaced to adequately control pain.  

Persons with a severe, intractable pain condition like Adhesive Arachnoiditis (AA) and/or a genetic connective tissue disorder like Ehlers-Danlos syndrome (EDS) will need an adrenaline agent, also called a stimulant, for pain control, maximal function, keeping opioid dosages stable, and preventing sedation and overdose. 

Adrenaline agents have long been known to boost or potentiate opioids, enhance pain relief, and allow less opioid to be used. A study by this author found that the simultaneous use of a stimulant and clonidine lowered opioid dosage by 30 to 50 percent. 

The use of a stimulant in this manner is not new. In the 1920’s, physicians at the Royal Brompton Hospital in London found that a stimulant was a necessary ingredient in the famous “Brompton Cocktail” for relief of severe pain. Today, modern pain relief agents often add caffeine as a stimulant to make the codeine and oxycodone more potent.

Most observers believe that an adrenaline agent given to an intractable pain patient will automatically raise blood pressure and pulse rate. This is generally a myth, because the person with intractable pain often depletes their reserve of dopamine, noradrenalin and adrenaline.  

The use of an adrenaline agent will serve to replace these depleted neurotransmitters and will not generally cause blood pressure and pulse rate to rise. Periodic monitoring is, however, recommended to be continued.  

Multiple Benefits  

A person with intractable pain due to AA, EDS, Reflex Sympathetic Dystrophy (RSD), or another severe and tragic condition will usually have the following conditions – all of which will benefit by an adrenaline agent:

• Weight Gain

• Attention Deficit Disorder (ADHD)

• Depression

• Sedation

• Fatigue

• Memory Loss

Descending Pain

Recent research has learned that constant, intractable pain establishes a “biologic battery” in the brain and spinal cord. This “battery” sends electric currents down the autonomic (non-spinal cord nerves) nervous system. Symptoms of this descending pain include excess heat, muscle spasms, jerking, tremors, sweating and “all-over” pain.  

In contrast to other forms of pain, descending pain isn’t well controlled by opioids and anti-inflammatory agents. The drugs clonidine and tizanidine are less effective. Only adrenaline agents stop it. Some adrenaline agents for persons with AA and EDS include:

• Phentermine

• Adderall

• Phendimetrazine

• Methylphenidate

• Dexedrine

• Modafinil  

Every person with intractable pain due to AA, EDS, RSD, cancer or other painful disease, should educate themselves on adrenaline agents and discuss them with their medical practitioners in order to either lower their opioid dosage or keep it from escalating.   

Simply stated, a person with intractable pain needs at least a small dose of an adrenaline agent for pain relief and optimal function. 

Forest Tennant, MD, MPH, DrPH, has retired from clinical practice but continues his groundbreaking research on the treatment of intractable pain and arachnoiditis. This column is adapted from a bulletin recently issued by the Arachnoiditis Research and Education Project of the Tennant Foundation, and is republished with permission. Correspondence should be sent to veractinc@msn.com.  

Dr. Tennant and the Tennant Foundation have given financial support to Pain News Network and are currently sponsoring PNN’s Patient Resources section.  

FDA Scoffs at ‘Third Way’ Forward in Stem Cell Therapy

By A. Rahman Ford, PNN Columnist

In a commentary recently published in the journal Stem Cells and Development, Jeffrey Gimble, MD, and his co-authors make a measured critique of the FDA’s cautious regulation of autologous stem cells, including cells derived from adipose tissue, a person’s own body fat.  

Gimble, who is the co-founder of Obatala Sciences, a Louisiana stem cell company, shares the FDA’s concerns about the rapidly evolving field of regenerative medicine and proposes a “third way” forward that protects patients, while loosening federal regulation of the industry.

Gimble and his co-authors take aim at “rogue” predatory clinics offering stem cells in a “wild west” medical landscape. In their view, a “combustible mix of unmet needs, an ambiguous regulatory pathway, untested therapies, and clinics rapidly rushing in to fill a void” is at the root of several cases of patients being injured by stem cell procedures.

Sadly, the authors are parroting fictionalized, unsubstantiated stem cell propaganda to support their position.

Gimble and his colleagues contend that autologous cell therapies should be exempt from the FDA’s conventional clinical trial process, which was intended for pharmaceuticals, not a person’s own stem cells.

In their view, primary authority for policing stem cell practitioners should be at the state level, with accreditation agencies, state medical boards and specialty societies. In essence, they want the FDA to relinquish oversight of stem cell therapy.

Gimble and his co-authors recommend the FDA re-evaluate how it categorizes tissues as “structural” or “cellular” to recognize the different safety profiles of stem cells products.  They also think the FDA should work with accreditation agencies like AABB and FACT to develop meaningful accreditation standards, along with a national registry for stem cell therapies.

An Imperfect Way Forward?

This measured “third way” seeks to carve a compromise between the FDA’s regulationist faction and “wild west” stem cell providers -- a new ideological center that synthesizes the aspirations of two opposing parties in an effort to achieve a compromise.

It must be stated that there are serious questions as to whether the authors’ proposed polarity is in fact an artifice created for the specific purpose of legitimizing their “third way.” Upon serious inspection, the authors’ stated “dangers” of stem cell clinics may actually be a disingenuous straw man created for their own business interests.

To promote their own agenda and to gain favor with the FDA, Gimble and his co-authors seem to have thrown stem cell clinicians like Dr. Mark Berman under the proverbial bus. Berman, who is a defendant in a FDA lawsuit over his use of autologous cells, recently won a victory in federal court. The judge found that the FDA may not have regulatory authority over Berman’s procedures and that a trial needs to be held to resolve the issue.

FDA Scoffs at Compromise

Nevertheless, the impetus behind the authors’ recommendations is to move forward with bringing stem cells to patients faster and in a safer manner. Regrettably, the FDA does anything but take the authors seriously. In a lengthy response to the Gimble article, Dr. Peter Marks, Director of the FDA’s Center for Biologics Evaluation and Research, merely reiterates the agency’s firmly-established regulationist position.

After commending the authors for their “desire to accelerate the scientific investigation and development of stem cell therapies,” Marks demonstrates the FDA’s backward-looking posture by stating the agency’s regulation of stem cells “is distinct from the practice of medicine” and should be left alone.

“This is an existing paradigm that has been in place for decades,” Marks wrote. “Autologous cellular therapies do hold tremendous promise, but they will only find their way into routine clinical practice to bring benefit to all patients if they are held to the same standards to demonstrate safety and efficacy as other unproven medical products.”

Marks attempts to bolster his argument by citing patient safety, the dearth of research on adipose-derived stem cells and the unethical “bad actor” clinics that exploit desperate patients. However, the spirit of his position reveals a resistance to any sort of change whatsoever.

Marks and the FDA are living in the past. They consider your cells to be unproven medical products. Apparently, they have yet to realize that the stem cell poles have already shifted.

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

North Carolina Investigating Pain Patient Advocate

By Pat Anson, PNN Editor

Dr. Thomas Kline, a North Carolina physician who is an outspoken advocate for chronic pain patients, is under investigation by his state’s medical board, PNN has learned.

Kline voluntarily surrendered his DEA license to North Carolina Medical Board investigators on Monday, which temporarily prohibits him from prescribing opioid pain medication and other controlled substances to his patients.

The reason for the investigation has not been made public. Kline’s practice in Raleigh, NC specializes in treating patients with chronic and rare diseases, including some on relatively high doses of opioid medication. Kline has been a vocal critic of efforts to rein in opioid prescribing.

"Dr. Kline surrendered his DEA license voluntarily, at the request of the NC Medical Board. In connection with the surrender of his DEA license, Dr. Kline also provided medical records of his patients to NC Medical Board,” Kline’s office said in a statement. 

“Dr. Kline will cooperate with the Board in order to ensure the well-being of his patients. Dr. Kline cares deeply about his patients and their needs at this time. However, he can no longer provide them with opiate pain medication.” 

The state medical board would not comment on the investigation.

DR. THOMAS KLINE

“At this point there has been no public action taken, so I’m not able to confirm or deny what may have occurred with this licensee,” said Jean Brinkley, a spokeswoman for the North Carolina Medical Board. “Investigations are confidential under North Carolina law, so until there’s been an action that’s made public, we can’t discuss it.”

The medical board has no public record of any complaint or disciplinary action against Kline. “As of now, Dr. Kline has an active medical license with no specific restrictions from the board,” Brinkley told PNN.

Without his DEA license, Kline will be unable to prescribe opioids and other controlled substances until the state’s investigation is completed. A typical “quality of care” investigation by the board takes six months to a year to complete, according to Brinkley.

“The average number of days to close a case, from the date it was opened to the date it was closed, was 104 days in 2019. But I will say quality of care cases, because of the need to obtain an independent medical review, typically take longer than that,” she said.

In public hearings, news stories, social media and his own YouTube channel, Kline seeks to expose some of the myths surrounding opioid medication and the damage done to millions of patients who’ve been abruptly tapered off opioids because of fears about addiction.

“This has never been done before in the history of medicine, at least in this country, where people are forced to stop taking medicine that is effective, is working, without side effects, against their will,” Kline says in his YouTube series, Medical Myths Revealed.

“I’ve talked to people that have post traumatic stress about going to the doctor. They lie awake for 3 or 4 days before they go see the physician for fear of another reduction in their pain medicine. This is just awful.”

Many of Kline’s patients will face the same fate, If they are unable to find a new doctor willing to prescribe opioid medication.

Last year the Food and Drug Administration warned doctors not to abruptly discontinue or rapidly taper patients on opioid medication. The agency said it received reports of “serious harm in patients who are physically dependent on opioid pain medicines suddenly having these medicines discontinued or the dose rapidly decreased.” The harm includes withdrawal symptoms, uncontrolled pain, psychological distress and suicide.

In another video, Kline said he researched federal law and could not find a single reference to “overprescribing” opioids.

“Is prescribing high doses a criminal act? No. We’re doctors. We prescribe what is needed. There is no dosage limit for opiates. You can use 1,000 milligrams a day or 10 milligrams a day. It doesn’t matter as long as you’re not getting side effects,” he said.

The CDC’s controversial 2016 opioid guideline recommends no more than 90 MME (morphine milligram equivalent) a day. Although the guideline is voluntary and only intended for primary care physicians treating chronic pain, it has been implemented as law or policy in dozens of states, and by the North Carolina Medical Board.

Over 2,000 people died of opioid overdoses in North Carolina in 2018. As in other states, the vast majority of the deaths involved heroin or illicit fentanyl, not prescription opioids.

Did OxyContin's Reformulation Really Lead to More Heroin Use?

By Roger Chriss, PNN Columnist

A common belief in the opioid overdose crisis is that the reformulation of OxyContin in 2010 led to a large-scale shift to heroin. Seven years after making the pills hard-to-crush to discourage snorting or injecting, The Washington Post reported the abuse-deterrent reformulation had made OxyContin “the chief driver of the explosion in heroin overdose deaths.”

The primary source of this claim is a National Bureau of Economic Research (NBER) paper that states “a substantial share of the dramatic increase in heroin deaths since 2010 can be attributed to the reformulation of OxyContin.”

The NBER paper used data from the National Survey on Drug Use and Health (NSDUH) and the Drug Enforcement Administration to assess usage levels of OxyContin and other prescription opioids, and data from the National Vital Statistics System to measure overdose deaths.

The researchers found that “states with the highest initial rates of OxyContin misuse experienced the largest increases in heroin deaths.”

But this conclusion is now being challenged. A recent study in the journal Addiction Behavior looked at NSDUH data from 2005 through 2014 to evaluate the impact of the reformulation on individuals with a history of OxyContin misuse.

The results showed “no statistically significant effects of the reformulation” on prescription opioid misuse or heroin use. In fact, researchers found a “net reduction in the odds” of heroin initiation after the reformulation.

“Thus, the reformulation of OxyContin appears to have reduced prescription pain reliever misuse without contributing to relatively greater new heroin use among those who misused OxyContin prior to the reformulation,” the authors concluded.

Psych Congress also reported there was little evidence of a shift to heroin from prescription opioids, saying drug trafficking data “don't fully support the often-heard conclusion that efforts to limit access to prescription opioids led to a mass migration to heroin."

Murky Data

The reason for the different conclusions is not clear. But much of what is assumed about abuse-deterrent reformulation is not holding up. Last summer, STAT News reported that rates of OxyContin abuse were similar or higher three years after the drug was reformulated. According to one survey, less than 5 percent of long-term abusers gave up OxyContin, suggesting the reformulation didn’t accomplish much.

Data on heroin use also includes considerable uncertainty, and applying state-level data-sets to understand individual usage patterns is tricky. Plus, data on overdose fatalities can be hard to parse since many victims die with multiple drugs in their systems, and toxicology reporting varies by state.

Since OxyContin’s reformulation, six other opioid medications have been approved by the FDA with abuse deterrent properties, costing drug makers hundreds of millions of dollars in research and development expenses.

Figuring out what happens after a prescription opioid is reformulated is important. Current public health policy and prescribing practices are assuming risks and benefits based on limited evidence. If something different or perhaps more complex is happening, then we need to look harder and make changes.

The implications here are also important, including determining liability and damages in the opioid lawsuits, developing effective public health measures for addiction treatment and the overdose crisis, and creating better risk assessment for pain management.

The impacts of the OxyContin reformation may be smaller and more subtle than previously thought. If the new findings hold, then we may have to rethink the benefits of abuse-deterrent formulations and the trajectory of heroin use. In other words, we need to keep looking closely at the overdose crisis and not assume we have it fully figured out.

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

Voltaren Arthritis Gel Approved for OTC Despite Safety Risks

By Pat Anson, PNN Editor

The U.S. Food and Drug Administration has approved three drugs for over-the-counter (OTC) sale that were previously only available by prescription. One of them is Voltaren Arthritis Pain, a topical gel made by GlaxoSmithKline.

The active ingredient in Voltaren gel is diclofenac, a non-steroidal anti-inflammatory drug (NSAID) that’s been linked to cardiovascular disease and other serious health problems. The gel contains a 1% solution of diclofenac sodium.

Voltaren Arthritis Pain was first approved by the FDA in 2007 as a prescription drug for the temporary relief of osteoarthritis joint pain in the hands, knees and feet. When taken as directed, the agency considers the gel safe to use.

“As a result of the Rx-to-OTC switch process, many products sold over-the-counter today use ingredients or dosage strengths that were available only by prescription 30 years ago,” said Karen Mahoney, MD, acting deputy director of the Office of Nonprescription Drugs in the FDA’s Center for Drug Evaluation and Research.

“Approval of a wider range of nonprescription drugs has the potential to improve public health by increasing the types of drugs consumers can access and use that would otherwise only be available by prescription. This includes providing the millions of people that suffer with joint pain from arthritis daily over-the-counter access to another non-opioid treatment option.”

The FDA said Voltaren Arthritis Pain may take up to 7 days to work. Consumers should stop using it and seek medical attention if their arthritis pain is not improved in 7 days or if they need to use the product for more than 21 days.

The warning label cautions that diclofenac may cause a severe allergic reaction, especially in people allergic to aspirin. Liver damage may also occur if the gel is used more often or longer than directed, or when used with other products containing diclofenac. The label cautions that diclofenac and other NSAIDs increase the risk of heart attack, heart failure and stroke.

Diclofenac One of Riskiest NSAIDs

Diclofenac is not well-known in the United States, but it is the most widely used NSAID in the world. Some experts consider diclofenac so risky it should be banned as an OTC drug.

A large 2018 study in Denmark found that people using diclofenac were 50 percent more likely to have cardiovascular problems, such as atrial fibrillation, heart failure and stroke.

For every 1,000 people who used diclofenac, the study estimated that four would develop a major health problem within a year.

“It is time to acknowledge the potential health risk of diclofenac and to reduce its use. Diclofenac should not be available over the counter.”

— Dr. Morten Schmidt, Aarhus University Hospital

"It is time to acknowledge the potential health risk of diclofenac and to reduce its use," wrote lead author Morten Schmidt, MD, Aarhus University Hospital. “Diclofenac should not be available over the counter, and when prescribed, should be accompanied by an appropriate front package warning about its potential risks.”

Diclofenac was rated as one of the seven riskiest NSAIDs in a 2016 study published by the British Medical Journal. Researchers estimated the risk of heart failure doubled for people taking diclofenac at very high doses.

“The selective COX 2 inhibitors and diclofenac have repeatedly been associated with higher cardiovascular risk, and therefore it seems prudent to avoid them and consider lower risk naproxen at the lowest effective dose,” researchers warned.

According to the FDA’s Adverse Events Reporting System, there have been over 19,000 serious medical cases involving diclofenac sodium since 2010, including 2,294 deaths.  

As PNN has reported, the FDA has effectively slammed the door shut on new opioid pain medications because of the controversy over opioid addiction and overdose. The agency is promoting the use of “safer” non-opioid drugs and recently approved a cocaine-based analgesic nasal spray.

A Pained Life: Prisoners of Pain

By Carol Levy, PNN Columnist

This being President’s Day in the United States, I was reminded of a popular quote attributed to President Franklin D. Roosevelt.

“Men are not prisoners of fate, but only prisoners of their own minds," FDR said.

This is a wonderful quote. For someone in a wheelchair and so physically limited, and who was able to make a very successful and hopefully fulfilling life, FDR’s philosophy makes sense.

Not so much for those of us with intractable pain. Our minds may not be imprisoned, but our bodies are. Our fate is to have pain.

This is not to diminish what President Roosevelt accomplished, or the successes of others with physical or mental limitations. President Roosevelt could not walk without assistance. That was not something he could change.

But pain changes. One moment we may have so little pain we can do the dishes, play with the kids or, in my case, read a book or sing in a chorus. Then boom! The pain, the pain. I can't continue with what I want to do.

We become prisoners of pain.

As many of us know, the invisibility of our pain makes others skeptical. Out of sight, out of mind. I don't see your pain, ergo it doesn’t exist. We are different in so many ways from people like FDR who have disabilities that are plainly visible.

This seems to include even the ability to study and report on findings related to chronic pain. I was researching deep brain stimulator implants for chronic pain, because of the one I recently had implanted. I read a number of studies. Some authors reported good outcomes, others not so good.  

The more I read, the more I realized that research on procedures and treatments for chronic pain cannot be interpreted the same way as studies about cancer and other diseases.  Did the cancer treatment have an effect that benefited the patient?  Yes, they lived longer and the cancer did not spread. Or perhaps the outcome was no, the cancer metastasized and the patient died.   

For us, the conclusions are not as simple. The answers are subjective. Is your pain better? Is it worse? Is it the same? No matter how one answers, can it truly be comparable with those of others in the same study? 

On a pain scale of 1 to 10, what I call a one may not be what you consider a one. By the same token, my 10 may not be your 10, so how can there be a comparison? 

I was once asked if I would be willing to take a survey on suicides or attempted suicides by pain patients. I declined. Absent a suicide note specifying that “I cannot take the pain anymore,” there is nothing but speculation and supposition as to someone’s motive and to what degree it was related to chronic pain. 

We are all prisoners of a disorder that is difficult to treat, much less cure. It will require imagination to put us all in one category and find ways to help us. 

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.”

Study Finds Acetaminophen Eases Social Pain

By Pat Anson, PNN Editor

Most everyone has faced rejection at some point in their lives, such as a divorce, losing a job or being “ghosted” by a friend. Being excluded from a relationship often triggers stress, anxiety, depression and sometimes even a desire for revenge.

Taking the pain reliever acetaminophen ­may not be a prescription for curing the blues, but it can ease social pain and help you forgive others, according to an unusual study published recently in the Annals of Behavioral Medicine. The study adds to a growing body of research that suggests over-the-counter pain relievers have psychological effects on humans.

Researchers in California enrolled 42 healthy young adults in a placebo-controlled trial to see if taking acetaminophen has an effect on social pain.

“Research has shown that physical pain and social pain are influenced by some of the same biological processes in the brain and body. Based on this research, we thought that acetaminophen, which is commonly used to treat physical pain, might also be able to reduce social pain,” explained senior author George Slavich, PhD, director of the UCLA Laboratory for Stress Assessment and Research.

For 20 consecutive days, a third of the study participants took 1,000mg of acetaminophen daily, while the rest took a placebo pill or no pill at all.

Participants also completed a daily questionnaire that assessed their level of social pain by asking them to think about a person who had wronged them recently. Did they I hope that person “gets what’s coming to them” for what they did?

From their answers, researchers developed a numerical “Hurt Feelings Scale” for every participant.

Over time, researchers found that acetaminophen significantly reduced hurt feelings, but only for participants who had a more forgiving attitude towards others.

“When combined with a tendency to forgive, taking acetaminophen substantially reduced how much social pain people felt over time. More specifically, participants taking acetaminophen who were high in forgiveness exhibited an 18.5% reduction in social pain,” said Slavich. “Based on the findings from our study, it appears as though acetaminophen acts synergistically with peoples' ability to forgive to alleviate the feelings of social pain that are commonly associated with rejection and exclusion.”

Slavich and his colleagues say anger and sadness are normal responses to social rejection, but can lead to long-term health consequences if they persist. However, the researchers stopped short of recommending acetaminophen as a treatment for social pain.  

“Experiencing a socially painful life event, like a relationship break-up, is one of the strongest predictors of developing depression in adolescence and adulthood. Social pain is also associated with decreased cognitive functioning and increased aggression and engagement in self-defeating behaviors, like excessive risk taking and procrastination,” Slavich said.

“Although the idea of prescribing acetaminophen to individuals undergoing difficult interpersonal situations may be attractive, we are not aware of any studies that have shown acetaminophen to be an effective prophylactic against psychiatric disorders for persons currently experiencing socially stressful circumstances.”

Similar Findings in Other Studies

A 2015 Ohio State study also found that acetaminophen seems to dampen human emotions. Student volunteers who took acetaminophen had fewer emotional highs and lows, and were less likely to react to images that normally produce an emotional response, such as pictures of a child crying or happily playing with a cat.

A second study at Ohio State found that acetaminophen can make people feel less empathy for the physical and emotional pain of others.

It’s not just acetaminophen. A review of studies at UC Santa Barbara concluded that ibuprofen and other over-the-counter pain relievers have an overlapping effect on us, both physically and emotionally.

"In many ways, the reviewed findings are alarming," wrote lead author Kyle Ratner, PhD, an assistant professor of psychology at UC Santa Barbara. "Consumers assume that when they take an over-the-counter pain medication, it will relieve their physical symptoms, but they do not anticipate broader psychological effects.”

Acetaminophen -- also known as paracetamol – is the world’s most widely used over-the-counter pain reliever. It is the active ingredient in Tylenol, Excedrin, and hundreds of other pain medications. Over 50 million people in the U.S. use acetaminophen each week to treat pain and fever. The pain reliever has long been associated with liver injury, as well as heart, kidney and blood pressure problems.

Are You at Higher Risk for Coronavirus?

By Dr. Lynn Webster, PNN Columnist

Over 67,000 people have contracted the new coronavirus, now officially referred to as COVID-19. Many of those who died — over 1,500 people to date — were already in poor health.

Fears about the virus spreading led to more than 30 million people being quarantined in the coastal province of Zhejiang, China — which is more than 500 miles away from the epicenter of the virus in Wuhan, China. As I write this, the U.S. and 25 other countries have a confirmed diagnosis of coronavirus

It is clear that COVID-19 qualifies as an epidemic and some experts predict it could become a pandemic (a pandemic is the global spread of a virus, while an epidemic is contained in a particular region, such as China.)

The people with increased risk for experiencing severe symptoms, and possibly dying of COVID-19, are seniors and those with chronic illness. Of course, many people in chronic pain are part of both risk groups. The mortality rate of COVID-19 has been reported to be about two percent.

People with chronic pain may be more susceptible to viruses in general, because chronic pain can change the way our immune systems work. McGill University researchers found that chronic pain changes the DNA in T-cells, a type of white blood cell essential for immunity. Researchers were surprised by the number of genes affected by chronic pain, and hope their findings will lead to new treatments.

Preventing Infections

According to the Centers for Disease Control and Prevention, symptoms of COVID-19 are similar to those of other viruses: fever, coughing, and shortness of breath. Symptoms may be mild or severe, and sometimes deadly.  

Most troubling is that the virus causes respiratory difficulties that can lead to pneumonia — and antibiotics are worthless against viral pneumonia.

In severe cases, COVID-19 can also cause organ failure. A full recovery, according to The Guardian, “will depend on the strength of their immune system."

One of the most effective methods to reduce illness and mortality from viruses is to develop and use a vaccine. Vaccines prevent an estimated two to three million deaths worldwide every year, according to WHO. 

Developing new vaccines used to take at least a decade. However, thanks to recent medical advancements, it may be possible to develop a vaccine that can prevent COVID-19 in a matter of months.  

World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus has called COVID-19 "a very grave threat." However, Ghebreyesus stresses that while we wait for a vaccine to be developed, we are not defenseless. The CDC recommends following the usual advice about protecting yourself from viruses: stay away from people who are sick; wash your hands and avoid touching your eyes, nose, or mouth with unwashed hands; and clean and disinfect objects that you touch. 

Since chronic pain can compromise the immune system, pain patients should follow the best available advice to protect themselves from exposure to COVID-19. The potential of infection is a serious issue that should not be dismissed, particularly for people with chronic pain and illness. 

Feeding on Ignorance 

One of the most significant threats to the spread of disease is social rather than medical: the dissemination of rumors and false information, such as conspiracy theories by anti-vaxxers. Even intelligent people with otherwise good reputations, such as Robert Kennedy, Jr., are promulgating nonsense about vaccines through social media to millions of people. These efforts must be discredited and stopped.  

According to a recent Gallup poll, the pharmaceutical industry is regarded more negatively by Americans than any other industry. There are well-known reasons why the public has a dim view of Big Pharma, but it’s the only industry that can prevent the deaths of an untold number of people during pandemics. In this situation, we need to cheer them on. 

Immunization is important to stop the spread of viruses. But first, the vaccines must be developed. Once they are available, people with chronic pain should discuss the potential benefits and risks of immunization with their physicians.  

President Trump recently said the coronavirus may disappear by April. This is a dangerous statement. In the United States, most viruses wane in the summer, but not always and they usually reappear by fall. Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases, points out that some respiratory viruses may exist year-round in other parts of the world.  

There is never a good time to disregard science. But if there were, the start of a new pandemic surely would not be it.   

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find Lynn on Twitter: @LynnRWebsterMD.

Opinions expressed are those of the author alone and do not reflect the views or policy of PRA Health Sciences.