Medicare Plan Would Require Insurers to Report Suspicious Opioid Prescribing

By Pat Anson, PNN Editor

Doctors, patients and advocates are reacting with alarm to a proposal by the Centers for Medicare and Medicaid Services (CMS) that would require insurance companies to report “substantiated or suspicious activities” by healthcare providers, including “inappropriate prescribing of opioids.” Insurers would also be authorized to unilaterally suspend payments to pharmacies for “credible allegations of fraud.”

If adopted, critics say the sweeping rule changes would have a chilling effect on providers and put insurance company profits ahead of patient well-being.

At issue is a notice published in the Federal Register last month, which details changes proposed for Medicare and Medicaid programs for 2021 and 2022. The notice has drawn little attention from the public, news media or healthcare organizations, which have been preoccupied with the coronavirus pandemic.

Many of the rule changes proposed by CMS are being made to implement the SUPPORT Act, which was passed by Congress in 2018 to reduce opioid abuse and promote substance abuse treatment.

Current CMS policy allows insurers – known as “plan sponsors” -- to voluntarily report potential fraud by doctors and pharmacists. The proposed rule change would require such reporting, when there is “credible evidence of suspicious activities of providers or suppliers related to fraud, and other actions taken by the plans related to inappropriate opioid prescribing.”

Insurers would report allegations to CMS through an internet portal, while the public would be encouraged to call a fraud tip hotline. Credible cases of “bad actors” would then be referred to law enforcement, according to CMS:

"Implementing these provisions will allow CMS, MA (Medicare Advantage) organizations and Medicare Part D plan sponsors to share data and information regarding bad actors, take swift action based on such data and information, and achieve enhanced outcomes in our efforts to fight the opioid crisis. In addition, this regulation will provide the means for more effective referrals to law enforcement based on plan sponsor reporting, ultimately resulting in reduced beneficiary harm and greater savings for the Medicare program.” 

Insurers would be allowed to consider a wide range of factors to determine if opioid prescriptions are inappropriate, including a patient’s health condition, medical records, opioid dosage, refills, and even the “time and distance between a prescriber and the patient.”

Patient advocates say the plan gives too much power to insurers and wrongly assumes that prescription opioids play a major role in the opioid crisis.

“The regulations planned here will constitute a major regulatory burden on the practice of medicine and implicitly make the assumption that sponsors or pharmacists are better judges of patient benefit and risk than prescribers,” said Andrea Trescot, MD, Stephen Nadeau, MD, and patient advocate Red Lawhern, PhD, in a joint statement. 

“These rule changes assign major responsibilities and powers to Medicare Part D sponsors. Since these sponsors have a pecuniary interest in minimizing the drugs they pay for, profit rather than patient well-being will be the major driver of their procedures and protocols. Both physicians and advocates spend hours each week dealing with denial of care, including medications, by sponsors. The people denying the care are often not physicians and they make no attempt to access patient medical records to develop informed judgments.”

Under the CMS proposal, insurers would also be required to enroll patients deemed at risk for opioid abuse into “Drug Management Programs” that would limit which doctors and pharmacies they can see to obtain prescriptions for opioids and benzodiazepines, a class of anti-anxiety medication.  

‘Big Brother’ Approach

Although the CMS proposals have been publicly available on the Federal Register for over a month, only a few dozen comments have been received to date.

“This sounds like we (chronic pain patients) will be targeted for simply getting the care we need to sustain a basic level of living,” wrote one poster. “Often times, assumptions are made that we are drug seekers, drug abusers, and such. Sometimes it takes trying different medications and different doses to get to where we need to be in order to live life. This may look bad on paper to someone without clinical training, education, or experience. Things aren't always what they seem.” 

“My gosh you people are trying to fix a non-existent problem. The issue now is not prescription drugs that us senior citizens take. It is heroin and fentanyl analogs,” said another. “IT IS TIME WE AS A COUNTRY STOP TRYING TO FIX A MEDICAL ISSUE WITH LAW ENFORCEMENT. There is no need for the government to get between me and my doctor when it comes to my pain medication.”

Many posters are concerned that providers and patients could face sanctions over unproven allegations.

“I am EXTREMELY concerned for this ‘Big Brother’ approach you are taking yet again,” said another poster. “I do not have an addictive personality. What if someone decides to say I do? Then my doctor who is already living in fear of the DEA may go along with whatever determination this government decides to make about me.”   

“So the idea is to shut down doctors with a mere investigation? Based on accusation? Not even charged but only accused? This is truly a new low in individual rights,” said another. “I would think that doctors would almost entirely abandon controlled substances prescribing altogether. Perhaps the motivation for this.”  

While CMS says “a fraud hotline tip, without further evidence, is not considered a credible fraud allegation,” some worry that unsubstantiated claims could still result in sanctions against a provider.   

It was a complaint from a woman in upstate New York that recently led to a North Carolina doctor losing his DEA license. The woman doesn’t know Dr. Thomas Kline or any of his patients, but reported Kline to the state medical board because she didn’t like his tweets defending the use of opioid medication. Kline sees several patients from out-of-state, one of the red flags that CMS would consider suspicious.

“I think the sticky wicket is probably the words ‘credible allegations of fraud.’ Such as the Dr. Kline fiasco. THAT wasn't credible but the Board sure made it out to be,” says Rick Martin, a retired pharmacist and pain patient.   

What do you think of the CMS proposal? The public comment period ends April 6. To leave a comment, click here.

What If the Opioid Crisis Is Worse Than We Think?

By Roger Chriss, PNN Columnist

A recent study in the journal Addiction reports that the opioid crisis in the U.S. may be worse than we’ve been led to believe. The number of overdose deaths linked to legal and illicit opioids over the past two decades could be about 28 percent higher than reported.

Economists Andrew Boslett, Alina Denham and Elaine Hill looked at drug overdose deaths between 1999 and 2016 in the National Center for Health Statistics. Of 632,331 deaths, over one in five had no information on the drugs involved. The researchers estimated that as many as 72% percent of those deaths likely involved opioids. This yields an additional 99,160 deaths involving prescription opioids, heroin, fentanyl and other street drugs that were not counted.

This estimate may or may not be right, but it is definitely not new. Claims like this have been around for years.

In 2017, Business Insider reported on an investigation by CDC field officer Dr. Victoria Hall, who looked at the Minnesota Department of Health's Unexplained Death (UNEX) system. She found that 1,676 deaths in the state had “some complications due to opioid use,” but were not reported as opioid-related deaths.

A 2018 study at the University of Pittsburgh found that as many as 70,000 overdose deaths were missed because of incomplete reporting.

‘Cooking the Data’

It has long been suspected that the CDC’s opioid overdose death toll is faulty – either too high or too low, depending on your point of view. Public health data in the U.S. is shoddy, the result of a fractured and fragmented system that has little central guidance or administrative oversight. The overdose numbers aren’t as reliable as they should be, which raises suspicion they are being manipulated.

The Atlantic makes a similar point about the coronavirus outbreak.

"Everyone is cooking the data, one way or another. And yet, even though these inconsistencies are public and plain, people continue to rely on charts showing different numbers, with no indication that they are not all produced with the same rigor or vigor," wrote Alexis Madrigal. “This is bad. It encourages dangerous behavior such as cutting back testing to bring a country’s numbers down or slow-walking testing to keep a country’s numbers low.”

The implications of under-counting deaths in the overdose crisis require careful consideration. Political campaigns, public policy, state laws and regulations, and clinical practice are built on these numbers. For instance, the Trump administration was recently touting a 4% decline in overdose deaths, but that reduction may not exist.

Similarly, cannabis advocacy groups argue that state legalization has reduced overdose deaths. But again, that reduction may evaporate with better data. State laws and regulations are built on the assumption that trend lines were going in a particular direction. But maybe they aren’t.

Most important, policy groups have argued strenuously that reducing prescription opioid utilization would alleviate the overdose crisis. But if there are vastly more deaths than recognized, where does that leave these groups?

Of course, determining cause of death is a process fraught with difficulties. The New York Times reports that morgues are overburdened and understaffed, many suspected overdose deaths are not fully evaluated, and reporting on the cause of death is not standardized.

Making a probabilistic assessment is even more fraught. For instance, a recent attempt to use stool samples to measure how many rodents, birds and other wildlife are eaten by domestic cats was undone by the discovery that cat food manufacturers regularly change their ingredients.

In other words, there are many known problems and occasional surprises in public health data, so any estimate has to be treated with caution. But if opioid overdoses are vastly undercounted, then we should reassess the policies and politics of the crisis.

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.

Chinese Scientists Using Stem Cells to Treat Coronavirus Patients

By Pat Anson, PNN Editor

As scientists around the world scramble to develop vaccines, therapeutic treatments and diagnostic tests for the coronavirus, Chinese doctors are having some initial success using stem cells to treat — and possibly cure — coronavirus infections.

Dr. Dongcheng Wu, who runs a stem cell lab in Wuhan, China – the epicenter of the COVID-19 outbreak – says he has successfully treated nine critically ill patients hospitalized with coronavirus pneumonia.

The patients had acute lung inflammation and serious breathing problems when they volunteered for experimental injections of Mesenchymal stem cells (MSCs) derived from human umbilical cords. All nine reportedly recovered within days.

“This treatment could potentially save thousands upon thousands of lives, so naturally we are very happy with these results,” Wu told the Daily Mail. 'Yes, it is a cure, but it is still very early in the process and we still have work to do.”

Wu is the chief science officer for Blue Horizon International (BHI), a New York-based foundation that supports research in stem cell therapy and cellular regenerative medicine.

BHI is currently recruiting 48 coronavirus patients in China for a placebo-controlled study of MSC injections.

In studies on mice, researchers found that MSC cells migrated to the lungs, where they significantly reduced inflammation and repaired damaged tissue.

BLUE HORIZON INTERNATIONAL

“So we thought what the heck, let's give it a shot. We gave nine patients, who were in hospital with severe, acute pulmonary dysfunction, we gave them core blood stem cells via IV and 100 percent of them got better, so of course we were astounded,” Dr. Brian Mehling, co-founder of BHI, told the Daily Mail.

The BHI study is not the first to use stem cells to treat coronavirus patients. According to the South China Morning Post, over a dozen clinical trials are underway in China using stem cells as a treatment for COVID-19.

Last month, a 65-year old woman infected with coronavirus was fighting for her life in an intensive care unit when she was injected with stem cells. Within days, her vital signs returned to normal, she began walking again, and tested negative for the COVID-19 virus.

Like Dr. Wu’s patients, the woman received MSC cells derived from the umbilical cords of newborn babies.

“Although only one case was shown here, it could be very important and inspire similar clinical practices in treating critically ill COVID-19 patients,” researchers reported in ChinaXiv, a Chinese website that publishes studies that have not yet been peer-reviewed.

Stem Cells ‘Could Cure’ Coronavirus Patients

Another new study, published in the journal Aging and Disease, found that MSCs given to seven coronavirus patients in Beijing “could cure or significantly improve” their symptoms.

“The pulmonary function and symptoms of these seven patients were significantly improved in 2 days after MSC transplantation. Among them, two common and one severe patient were recovered and discharged in 10 days after treatment,” researchers reported. “Thus, the intravenous transplantation of MSCs was safe and effective for treatment in patients with COVID-19 pneumonia, especially for the patients in critically severe condition.”

A Beijing doctor, who asked not to be identified, said there was growing discussion in the Chinese medical community about stem cells as a treatment for coronavirus.

“The stem cell industry may have some vested interest to promote their technology in this crisis, but if it really works, it should be made available to more patients,” she told the Morning Post.

Chinese stem cell researchers appear to be far ahead of their counterparts in the United States, where stem cell therapy remains controversial and there are more regulatory hurdles. Virtually all of the coronavirus stem cell studies listed in a U.S. database of clinical trials are being conducted in China.

Texas-based Celltex Therapeutics recently asked the Food and Drug Administration for permission to conduct a clinical study in the U.S. on the safety and efficacy of MSCs as a treatment for coronavirus.

Misdirected Anger Over the Opioid Crisis Hurts Innocent People

By Dr. Lynn Webster, PNN Columnist

It's practically a cliché now to refer to the five stages of grief: denial, anger, bargaining, depression, and acceptance. However, it was Elisabeth Kübler-Ross's classic book, “On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy & Their Own Families,” that first helped us understand how people grieve.

Since the book was published over 50 years ago, mental health experts have recognized that grieving is a personal process, and that not everyone will experience all five stages. Sometimes, people skip a stage altogether, or spend more time in one part of the healing process than in another, or circle back to stages they have already traversed. It’s not always a linear process. Kübler-Ross believed grieving itself was a constructive process that moved towards healing.

While her book focuses on grief associated with death and dying, we also experience the various stages of grief with other losses. The coronavirus may cause the loss of our daily routine. Addiction may bring about the loss of our jobs, family support and even self-respect. Chronic pain may mean the loss of a life once lived. We can experience the stages of grief Kübler-Ross describes any time we are consumed by a loss.

Trapped in the Anger Stage of Grief 

For most people, anger is a part of grieving and sometimes a person gets a bit stuck in it. Experiencing prolonged anger can be destructive. We can internalize that anger, hurting ourselves, or we can express it toward others. In some cases, our rage can be directed at people we don't even know. 

Misdirected anger can cause harm. We create physical and emotional harm for ourselves when we rage at people and circumstances beyond our control. Also, we can cause harm to innocent people when they are caught in the crossfire of our misplaced anger. 

Pain News Network recounts how anger affected one of the pain community's clinicians, Dr. Thomas Kline. Kline advocates for people in chronic pain and has used social media to dispel what he feels are myths about opioids.  

A mother who lost her son to a heroin overdose came across Dr. Kline's Twitter account. In her grief, the mother took offense at what she perceived to be Dr. Kline's advocacy of opioids. She filed a complaint with North Carolina's medical board, alleging that he was "giving out information regarding opioids that is not correct and could cause harm."  

She was not Dr. Kline’s patient and neither was her son. In fact, she didn't even know him. But she was convinced he was a bad doctor because he treated people in pain with opioids. Her complaint triggered an investigation that led to Dr. Kline losing his DEA license to prescribe opioids and other controlled substances. Now his 34 patients are suffering.

It is horrible for parents to lose a child, and it is unfortunate that this mother has only a partial understanding of how opioids cause harm. 

However, we can understand her anger. She has suffered a loss, and she believes opioids killed her beloved son. "My son used opioids, and opioids are lethal. Now my son is gone. Therefore, opioids killed my son," may be her logic. 

Separating Prescription Opioids from Illicit Opioids 

It is flawed thinking to lump prescription opioids together with illicit opioids such as heroin. Prescription opioids have a medical purpose, whereas illicit opioids do not. This mother did not lose her son to an overdose of prescription medication.  

It's not only people who have had personal tragedies in their lives who may be inappropriately angry. We also see people who write about the opioid crisis, policymakers, regulators, and the public venting their contempt toward anyone who defends opioids as a legitimate therapy for some patients.   

People can be forgiven for getting angry in the moment. If they have experienced a personal loss from prescription opioids, it’s reasonable for them, in their grief, to blame opioids or the doctor who prescribed them. But it's harder to accept their vengeance when they draw a false equivalency between prescription opioids and illicit drugs.  

Opioids, like all medications, have benefits and risks. Unfortunately, people with chronic pain suffer because of misunderstanding and misplaced anger.  

People whose loved ones have died from addiction often receive sympathy, while people in pain are left unattended in the shadows. Of course, people with addiction as well as people with pain deserve treatment rather than abandonment. Anger at the doctors who use opioids to try to treat their illness is unhelpful and inappropriate. 

I'm reminded of Nan Goldin, a New York-based photographer who survived an addiction to OxyContin and has now devoted her life to fighting the opioid epidemic. Her anger is directed at the Sackler family and Purdue Pharma, whom she holds responsible for the opioid crisis — even though, according to The New York Times, Goldin "overdosed on fentanyl, which she thought was heroin."  

Neither of those substances are produced by Purdue Pharma.  

People in grief may transform their sorrow into rancor without looking squarely at the whole truth or confirming their beliefs with research. Their anger may feel healthy and productive to them, because anger provides an outlet for grief. The rage they feel against opioids and the people who manufacture, prescribe, or take them allows those grieving to not to have to deal with more difficult issues, such as the loss of a loved one or the real reasons why we develop addictions. 

In the final analysis, misdirected anger is destructive and harmful to innocent bystanders, who become collateral damage. It hurts others. It may hurt society. And it also hurts the one who is stuck in the grieving process and, unfortunately, has not yet come to a place of healing. 

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.

The Other Epidemics

By Mia Maysack, PNN Columnist

Those who believe the coronavirus outbreak is the only epidemic underway are sorely mistaken. There are multiple epidemics happening due to opioid hysteria, primarily innocent patients being neglected in their pursuit of pain management.

This is being confused with the very real addiction problems that are on the rise. Too many don't know the differences between the two, nor do they seem to care.

These failures in our healthcare system and our human rights continue to be violated.

The last time there was a virus circulating in my home, I was thankful to have been able to hit up the nearest convenient store for necessities. My ID was checked for a cough suppressant. Had I been denied it, recovery surely wouldn't have been smooth or perhaps even possible for someone who literally cannot afford to become any sicker.

This is exactly what's happening to millions of people on a much grander scale, who are rightfully prescribed something by a professional -- which respectfully isn't anybody else's business. Their legitimate medical need is far more serious than the common cold.    

I'm passionate about this cause, though I’ve been shamed for speaking out because it hasn't been a large part of my personal story as pain meds are intolerable for me.   

However, I am not immune to its repercussions, having lost several people to overdoses and knowing many who live in a state of dependence upon a substance of some kind or another. I've witnessed what should've been a short-term treatment turn into something where a person literally feels as though they cannot live without.

But an addict seeking a fix and a patient desperate for pain relief aren't the same.      

I've seen the hopelessness firsthand when access doesn't come through. And even with it, minimal comfort is experienced for short periods of time, which is always better than the contrary. Having options for pain management as well as a health team that cares are direct contributing factors in quality of life or lack thereof.   

Missing a Lifeline

The present-day coronavirus panic shines light on another example. How is one to cope without water, toilet paper or canned food if or when this spreads further and possibly hinders the ability to simply maintain? What if you couldn't get what you needed and always felt under the weather? 

Adding insult to illness, why does it take the threat of a modern-day plague for reflection on things that should already be happening? 

Because of the opioid prescription crackdown, there are countless individuals who remain unable to grab hold of a lifeline. It has been taken away from them or has yet to present itself. Both are dire and require immediate attention, acknowledgement, awareness and action.       

Corporate profiteers and those who live by “Do No Harm” are working in tandem -- resulting in treatment being withheld, licenses threatened, and the lives of providers and patients alike being shattered. 

In response to these very real issues, we've reverted to extremes — despite the whole “it's a problem, get rid of it” approach not proving to have been a sustainable answer.  Ever. 

Another issue is that the pain community is so passionately up in arms that we often fight against each other.

Recently a colleague of mine literally stated they "felt guilty" because their discomfort had improved! When that happens, the tone becomes “then you're not that bad” and don’t have a right speak out. Or in my case, being physically incapable of tolerating pain meds has earned me the title of an ignorant bigot ableist.

People throw these insults around like grenades that obliterate any potential to connect or relate. I also find the trolling, comparisons, labeling and hate disheartening because it is so misdirected.

The intent should be to be on the same page as human beings who live in pain. It's not about what specific type, what caused it, how long you’ve had it, or whether a certain treatment option has helped you. It’s not a contest. This is far bigger and way more important than any of that. It's an opportunity to reconstruct the cracked foundation of brokenness that has become exposed.

But that won't happen unless we set differences aside, remain focused on what's important, work collectively in problem solving, and devote the same effort used to tear others down to instead cultivate a solution.  

Mia Maysack lives with chronic migraine, cluster headaches and fibromyalgia. Mia is the founder of Keepin’ Our Heads Up, a Facebook advocacy and support group, and Peace & Love, a wellness and life coaching practice for the chronically ill.

DEA Allowing Telehealth for Opioid Prescriptions

By Pat Anson, PNN Editor

Pain patients who are self-isolating during the coronavirus outbreak may be able to get an opioid prescription without visiting their doctor.

In an update on its COVID-19 Information Page, the U.S. Drug Enforcement Administration said prescribers and patients can connect remotely via telehealth – also known as telemedicine --  to get a prescription for opioids and other controlled substances.  

The exemption from the Controlled Substances Act was made possible by the public health emergency declared on January 31 by Health and Human Services Secretary Alex Azar.  On March 16, Azar and Acting DEA Administrator Uttam Dhillon agreed to allow telemedicine to be used for the prescribing of Schedule II through Schedule V opioids and other controlled substances.

“While a prescription for a controlled substance issued by means of the Internet (including telemedicine) must generally be predicated on an in-person medical evaluation, the Controlled Substances Act contains certain exceptions to this requirement,” the DEA said.

“For as long as the Secretary’s designation of a public health emergency remains in effect, DEA-registered practitioners may issue prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation.”

The exemption applies to both new prescriptions and renewals, provided the following conditions are met:

• The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of their professional practice.

• The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system

• The practitioner is acting in accordance with federal and state laws.

Doctors were already allowed under federal law to use telehealth to prescribe controlled substances, but only if they had previously conducted an in-person medical evaluation of the patient. The exemption essentially waves that first face-to-face meeting.

“During this uncertain time, DEA remains flexible and committed to ensuring that the nation’s drug supply chain is uninterrupted,” Dhillon said in a statement. “DEA continues to work with our public health partners to explore options that ensure those in need of vital prescriptions are able to get them, while still adhering to safe practices such as social distancing.”

‘Unaware of Any Shortages’

The DEA also said it was working with the FDA to monitor the supply of medications and was “unaware of any shortages of controlled substances at this time.”

That is a misleading statement, because there are 145 drugs currently listed in an FDA database of drug shortages, including several opioids that are primarily used for anesthesia during medical procedures. The drugs were in short supply even before the coronavirus outbreak.

Last month, the FDA said it was notified by a drug manufacturer that it was experiencing a shortage of one medication due to the coronavirus outbreak. The drug was not identified.

Many ingredients and raw materials used in drug manufacturing are imported from China and India. According to a recent study, nearly two-thirds of the world’s supply of acetaminophen comes from China.

Emergency Refills

Some states are also taking steps to ensure that patients are not deprived of medications during the coronavirus outbreak.

Florida Surgeon General Scott Rivkees issued an emergency order authorizing the use of telemedicine for prescribing opioids and other controlled substances “only for an existing patient for the purpose of treating chronic nonmalignant pain without the need to conduct a physical examination.”

This Washington State Medical Commission authorized pharmacists to grant emergency 72-hour refills for prescriptions that are not maintenance medications. A 30-day emergency supply of maintenance medications was authorized if a pharmacist is unable to obtain refill authorization from the prescriber.

Maintenance medications are drugs used to treat conditions that are chronic or long-term, such as high blood pressure, heart disease, diabetes and, presumably, chronic pain.

The Washington State Department of Health also asked insurance companies to allow patients to get a one-time refill of their prescriptions before the end of the waiting period between refills.

Overdose Deaths Fell by 4.1% in 2018

By Pat Anson, PNN Editor

A new analysis by the CDC has confirmed earlier estimates that drug overdose deaths in the U.S. decreased by 4.1% in 2018, the first decline in the nation’s overdose rate in nearly three decades.

The decline was led by a drop in overdoses involving prescription opioids (-13.5%) and heroin (-4.1%). Much of that progress was offset by a 10% increase in deaths involving synthetic opioids, a category that includes illicit fentanyl and fentanyl analogs.

Fentanyl and other synthetic opioids were involved in 31,335 overdose deaths -- nearly half of the 70,237 drug deaths in 2018 and over two-thirds of the 46,802 opioid deaths.

The 14,975 deaths linked to prescription opioids represent about 22% of the total number of fatal overdoses.

“Decreases in overdose deaths involving prescription opioids and heroin reflect the effectiveness of public health efforts to protect Americans and their families,” CDC Director Robert Redfield, MD, said in a statement. “While we continue work to improve those outcomes, we are also addressing the increase in overdose deaths involving synthetic opioids. We must bring this epidemic to an end.”

U.S. DRUG OVERDOSE DEATHS IN 2018

SOURCE: CDC

Synthetic opioid deaths in 2018 increased in the Northeast, South and West and remained stable in the Midwest. The highest synthetic opioid death rate (34 deaths for every 100,000 people) occurred in West Virginia, which also has the highest death rate involving prescription opioids (13.1 deaths per 100,000 people).

Seventeen states experienced declines in prescription opioid deaths in 2018, with no states experiencing significant increases.

While opioid prescribing has been declining since 2012, much of the CDC’s public messaging remains focused on reducing the use of opioid pain medication.

“Because of the reductions observed in deaths involving prescription opioids, continued efforts to encourage safe prescribing practices, such as following the CDC Guideline for Prescribing Opioids for Chronic Pain might be enhanced by increased use of nonopioid and nonpharmacologic treatments for pain,” wrote Nana Wilson, PhD, a CDC epidemiologist and lead author of the study.

“Additional public health efforts to reduce opioid-involved overdose deaths include expanding the distribution of naloxone, addressing polysubstance use, and increasing the provision of medication-assisted treatment.”

Wilson and her colleagues noted that an increase in overdose deaths among African-American and Hispanics showed a need for “culturally tailored interventions” to address health and other societal factors.   

While the decline in overdose deaths in 2018 is encouraging, preliminary CDC data indicates the trend is not continuing into 2019. Deaths are increasing from synthetic opioids, cocaine, methamphetamine and psychostimulants such as attention deficit disorder drugs.

Overdose deaths often involve multiple drugs, so a single death might be included in more than one category and be counted multiple times. The quality of the data also varies widely from state to state. Only 39 states have good to excellent overdose data, according to the CDC.

A Pained Life: Rationing Pills

By Carol Levy, PNN Columnist

Well, it finally happened. I have been on codeine for many, many years. I have tried other opioid medications, such as morphine, Demerol and methadone, but none helped.

Truth be told, neither does the codeine, usually. Some days my pain from trigeminal neuralgia calms down when I take it. Other times, it has no effect.

For the most part, I take codeine because it gives me a false sense of control. It’s something I can do when the pain gets really bad. I let every prescribing doctor know that. And none has ever refused to give me a prescription. 

I take about one pill a week. Not because the pain is rare, I’ve just learned to stop doing many of the things that triggered the pain, such as eye movement and eye usage. I am now about 80% housebound as a result.

I’ve been having a bad time lately with my deep brain stimulator (DBS) implant. It makes the pain worse when I have the device turned on. The result? I have to take more codeine. 

The last time I saw him, the pain management doctor I’ve been seeing for Pennsylvania’s medical marijuana program wrote me a prescription for 120 codeine pills. The prescription called for no refills, but lasted for 10 months because I use the pills so rarely. I had no reason to expect he would not write it for me again.

The last appointment for the refill took literally 2 minutes. This is how the conversation went.

“How are you?” he asked.

“Fine. Thank you.”

“Anything new?” 

“I had a DBS implant a few months ago.” 

“Is it helping?” 

“No. Actually, it is making a major part of the pain worse.” 

“Well at least it is helping some part of the pain. What are you here for today? 

“My codeine prescription.” 

“Okay. Bye.” 

I assumed everything was fine and he would renew the same prescription.  

Since you no longer get a written script that you can read and carry, I was astounded when I got to the pharmacy to pick up the prescription and saw the bottle held only 10 codeine pills. And the prescription was for only 2 months. The doctor didn’t say a word about changing the prescription. 

I called his office. “I don't understand. He didn't say anything to me about reducing the amount. He didn't ask me how and when I take it. Yes, I told the nurse I take maybe one a week, but he never gave me a chance to explain why.”   

The nurse replied: “Well this is what he wrote for. And you will have to come back every two months for another prescription.” 

I have no problem with a doctor deciding it is time to try and reduce a medication, unless it is without explanation or discussion. This seems to be one aspect of the opioid crisis that seems to be ignored.  

I was seeing him once a year to meet the requirements for the medical marijuana program. Now, suddenly I need to come in once every two months for my codeine prescription. No explanation. No discussion. 

We blame the CDC, we blame the FDA and we blame the DEA. But we rarely blame the doctors for these arbitrary decisions.

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.

David vs. Goliath: California’s Stem Cell Program Demonizes Small Clinics

By A. Rahman Ford, PNN Columnist

In a recent article published in Stem Cells Translational Medicine, officials with the California Institute for Regenerative Medicine (CIRM) call for nationally uniform standards for stem cell products to facilitate the ”responsible delivery of regenerative medicine.”

Some of their recommendations are reasonable. However, CIRM’s insistence upon uniformity and their demonization of small stem cell clinics in a contrived narrative is sophomoric, disingenuous and counterproductive.

CIRM was created in 2004 when California voters passed Proposition 71, the California Stem Cell Research and Cures Initiative. Supporters of Prop 71 lamented how the federal government had failed to provide adequate funding for stem cell research, so the state needed to step in and provide $295 million in bonds to advance stem cell treatments to patients with unmet medical needs.

CIRM is currently at a financial crossroads. To date, CIRM has funded over 1,000 research, training and community engagement projects. However, with its initial funding almost gone, it is now seeking an additional $5.5 billion through a ballot initiative. While CIRM has been strong in research, no CIRM-funded trial has won FDA approval. According to Nature, CIRM has funded 55 clinical trials but only one therapy is likely to hit the market any time soon.

Indeed, a 2018 San Francisco Chronicle investigation found that CIRM’s achievements “fall far short of what Prop. 71’s promoters promised.” Furthermore, “the bulk of CIRM grants have gone to basic research, training programs and building new laboratories, not to clinical trials testing the kind of potential cures and therapies the billions of dollars were supposed to deliver.”

Thus, while it’s noteworthy that CIRM-funded scientists have published over 330 scholarly articles in some of the top academic journals, practical results remain negligible to non-existent.

Promises Laid Upon False Premises

California’s scientific and physical infrastructure has benefited greatly from CIRM, but sick and disabled Californians have not. The fact that CIRM’s accomplishments have been so minimal makes their claims about acting in “the best interest of the patient” all the more curious.

Lead author Geoffrey Lomax, PhD, a Program Manager at CIRM, and colleagues argue that clinics offering stem cell treatments are in need of increased regulatory oversight. Toward that end, they recommend a new policy framework with technical, organizational and ethical benchmarks aimed at developing a standard of care for the stem cell industry. It pledges adherence to the FDA clinical trial process and chastises clinics for flaunting long-established rules for drug approval.

“There are documented examples of unproven stem cell interventions causing harm to patients. In the majority of examples, the intervention deviates from the norms of responsible medical practice. Numerous authoritative bodies have raised concerns over the potential for medical and financial harm to result from these practices,” Lomax wrote.

Generally speaking, some of their recommendations make sense. For example, they recommend that doctors, nurses and technicians providing stem cell treatments possess specialized training and expertise. They also recommend that providers educate and evaluate patents throughout the treatment process. Finally, the authors support the creation of a stem cell registry to facilitate the reporting of adverse events resulting from stem cell treatments.

However, these common-sense recommendations are overlaid by a rigid, forced adherence to an anachronistic model of medical treatment. This model is the FDA clinical trial process, which treats a patient’s own stem cells as “drugs.” That is unfortunate, because stem cell therapies are revolutionary, paradigm-shifting and defy old conceptions about drugs and medicine.

Perhaps the most glaring sin is CIRM’s demonization of small clinics offering stem cell treatments. These clinics are producing the real-world results that CIRM has not. This “us vs. them” approach occludes truth and impedes progress to the detriment of those most in need. It is unnecessary to diminish the value of others’ efforts to bolster or justify one’s own. Cooperation, not contrived competition, is in the best interest of patients.

Furthermore, forced uniformity in stem cell policy standards may not be the answer. Let us not forget that it was the state of California in 1996 that led the way on medical marijuana, amidst a cacophony of marijuana opponents who decried the potential for a “wild west” of rogue marijuana dispensaries that would prey upon desperate patients.

Now, years later, we see that none of those calamities materialized. For CIRM to now use the same argument and same invective toward stem cell clinics seems disingenuous and hypocritical.

Lomax fails to see that from the patient perspective the narrative is not “heroic” CIRM vs. the “villain” clinics, but more of a story of the “Goliath” CIRM vs. the “David” clinics. We all know how that story turned out.

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.

Confusion Over Ibuprofen as Coronavirus Treatment

By Pat Anson, PNN Editor

With the number of coronavirus cases growing to nearly 200,000 worldwide, so is confusion about which over-the-counter pain reliever should be used to treat its symptoms. Some health experts say acetaminophen – known as paracetamol outside the U.S. – is better than ibuprofen, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs).

"We recommend paracetamol, not ibuprofen for self-medicating," Christian Lindmeier, a spokesman for the World Health Organization said today.

At issue is whether ibuprofen and other NSAIDs interfere with the body’s immune system and make coronavirus symptoms worse. The debate was kicked off Saturday by a tweet from France’s Health Minister.

“Taking anti-inflammatory drugs (ibuprofen, cortisone, ...) could be an aggravating factor of the infection. If you have a fever, take paracetamol,” said Dr. Olivier Véran, a neurologist.

That same day, the French government reported "grave adverse effects" linked to the use of NSAIDs in coronavirus patients and released new guidelines saying “the treatment of a fever or of pain linked to COVID-19 or to any other respiratory viral disease should be paracetamol.”

But the UK’s Royal Pharmaceutical Society (RPS) disputed whether there was enough evidence to make such a recommendation.

“There is not currently enough information on ibuprofen use and COVID-19 to advise people to stop using NSAIDs. There is currently no published scientific evidence that ibuprofen increases the risk of catching COVID-19 or makes the illness worse. In addition, there is also no conclusive evidence that taking ibuprofen is harmful for other respiratory infections,” the RPS said in a statement.

The Medical University of Vienna also chimed in, calling reports that it had found a connection between ibuprofen use and worse coronavirus symptoms "fake news."

But other experts agreed that NSAIDs can weaken the immune system.

“Despite all of their beneficial effects, it has long been known that anti-inflammatories can have a depressive effect on parts of our immune systems,” Dr. Amir Khan of Britain’s National Health Service said in Al Jazeera. “If we take medicines that dampen this immune response, such as ibuprofen, this can lead to us not fighting off the infection as effectively, potentially leading to a longer illness with a higher risk of complications.

“Paracetamol is not an anti-inflammatory medication and can be used to effectively treat fever as well as mild to moderate pain and can, therefore, be used safely to help treat the fever associated with the coronavirus.”

The NHS also updated its recommendations, cautioning that while there is no strong evidence that ibuprofen makes coronavirus worse, “until we have more information, take paracetamol to treat the symptoms of coronavirus.”

‘Don’t Give Her Ibuprofen!’

The New York Post reported that a 4-year old British girl suffering coronavirus symptoms had difficulty breathing and took a turn for the worse after taking ibuprofen. Amelia Collins had a cough, fever and other flu-like symptoms.

“To those of you that have children please read. If your child has symptoms of corona virus, DO NOT give them ibuprofen,” Amelia’s father posted on Facebook. “Within an hour of giving her [ibuprofen] she dropped dramatically. She was panting while trying to breathe, her heart rate was very rapid, she couldn’t keep her eyes open, couldn’t lift her head up, her body was shaking, she started being sick on herself and her temperature had risen.”

Amelia’s parents called for an ambulance. Fortunately, paramedics were able reduce her fever without taking her to a hospital.

“Now she’s back on [acetaminophen] she’s back to just being her poorly self. The paramedics only told us while here that were not to give her ibuprofen!” the father said.

In 2015, the U.S. Food and Drug Administration warned that “everyone may be at risk” and ordered new warning labels for ibuprofen and other NSAIDs to indicate they increase the risk of a fatal heart attack or stroke.

But acetaminophen also has issues. The pain reliever has long been associated with liver injury and allergic reactions such as skin rash. Acetaminophen is the active ingredient in hundreds of over-the-counter pain relievers and cough, cold and flu medicines – and many consumers have no idea how much acetaminophen they’re taking.

Over 50,000 emergency room visits each year in the U.S. are blamed on acetaminophen overdoses, including 25,000 hospitalizations and hundreds of deaths.

How to Survive Self-Isolation From Coronavirus

By Madora Pennington, PNN Columnist

Like much of the world, I am self-isolating to slow down the spread of the coronavirus. As a medically fragile person, I am afraid. My immunity is poor. I get frequent lung infections and I get them fast, without warning. Would I get a bad case of Covid-19?

I can imagine my death in the ICU, without family, on a ventilator, under protective gear. It’s easy for me to reconcile myself to this possibility, even accept it. I was born with Ehlers-Danlos syndrome, which prevents the body from making proper collagen and causes a host of other health problems.

I am an expert at homebound isolation. I did it for many years, too sick and in too much pain to function. My only job was to survive another day of agony and not lose my mind. Seven years ago, experimental treatment overturned my life sentence of pain and I was freed from my prison of disability.

I sheepishly admit isolating myself from the coronavirus is a lot more fun. This time, I am not sick. Even better, I am not alone. We’re all in this together.

My old life was awful, but it was simple. I had a schedule with targets to accomplish, which may seem laughable to someone who has not experienced prolonged severe illness. Shower, water a plant, unload the dishwasher.

I awoke in the morning, feeling lucky if I got a good chunk of sleep, and resentful if I did not. My spine was so fragile, the pain of laying down on my bed led to torturous spasms. I took morphine, Vicodin and carisoprodol in hopes of falling asleep before the pain hit and hoping to stay asleep after it did. The drugs worked about half the time.

My husband was careful not to wake me as he got ready for work. Up alone, swimming slowly through the thick liquid of my morphine hangover, I faced my favorite part of the day: the bitter warmth of coffee and a view of the city.

In my old life, I lived for simple pleasures because that was all I had. Food was one of them. Cooking dinner every night. Brunches on the weekend. I felt deep appreciation for the times when my pain or my brain fog wasn’t so bad, the times when I had a little energy. I dreamed that one day I might get better.

This was before Facebook, before podcasts, before medical information was freely available on the internet. Life was lonely then, but we didn’t know anything else. We kept my struggles private. No one except my doctor knew how sick I was. That gave me a sense of dignity, as a genetic disorder is so difficult to explain. Better not to, I thought. Besides, the hopelessness brings other people down, and that’s just impolite.

We lived in a one-bedroom apartment because I didn’t have the strength to get around anything bigger. I made the bed. I took walks every day. I fought to take care of as many of the household chores as I could. There was something monastic, perhaps even spiritual about my old life, a life where I spent most of my time alone.

When I got better and exited my sickbed, my life became unbearably complicated. Drug withdrawal, integration into the world, working and building a life. I was, I shamefully admit, deeply depressed. Adjustment Disorder is an emotional disturbance one goes through while adapting to the stress of significant life changes.

Stay On a Schedule

It’s been an easy transition to coronavirus self-isolation. I remember what worked from my old homebound life. Be on a schedule. Every day do this, and then that. Shifting from one task to another makes the day seem fuller. I like to lift some weights when I get stuck writing. Or maybe scrub the kitchen sink. Jump up and fold the laundry. Reorganize something, even if it’s just one drawer, for a quick sense of satisfaction.

Commit to regular meals, as opposed to all day snacking, so you won’t go back to work with clothes that don’t fit. Get sunlight on your face, as early in the day as possible. I hope you have trees or grass or sky to enjoy. They positively affect mood.

Make your bed and stay out of your bedroom. Sleep is a conditioned response. If you lay in bed while reading or watching TV, you send your brain confusing signals about when sleep time is supposed to be. Bedtime rituals help get sleep hormones flowing. Follow the same pattern every night.

Talk on the phone or even better FaceTime or Skype with friends so your brain can have the satisfaction of mirroring and the stimulation of responding to another human’s emotions. Accept your humanness, that you don’t have much control over your life and never did.

There is so much stimulating content now, from streaming services to podcasts, Kindle and audiobooks, ways to feel part of humanity and not so alone. Type your thoughts and feelings into a journal to help process and keep them moving.

My coffee ritual is still my favorite part of the day. It’s reliable and always there for me. I stocked up on great coffee, anticipating society shutting down, along with spam and popcorn, cold medicines and laundry detergent.

You can go outside for a walk, if not many people are around. Walking is relaxing. Gently swinging your arms as you go relieves back pain. My husband and I strap on weights and walk the neighborhood. We wave to our neighbors, most of whom are also living homebound isolation. We stand far apart as we chat.

“Let me know if you need anything,” I say. “I’ll disinfect it and hurl it over to your yard.” They agree to do the same.

Madora Pennington writes about Ehlers-Danlos and life after disability at LessFlexible.com. Her work has also been featured in the Los Angeles Times.

The Other Opioid Crisis: Patient Abandonment and Denial of Treatment

By Georgia Carroll, Guest Columnist 

I am a patient advocate and pain sufferer. I have the usual pains associated with rheumatoid arthritis, a bad knee and a few bulging lumbar discs. But my personal story is nothing compared to what most of the patients I work with are going through. 

I represent only a small fraction of the tens of millions of patients across the U.S. who have been abandoned by their doctors and denied treatment for the pain caused by diseases, injuries and mental health conditions. They are the unintended victims of efforts to curb opioid overdose deaths, even though studies show less than 2% of overdoses involve prescription opiates written for the deceased.  

Leaving these patients without medical care is inhumane and only exacerbates the opioid crisis, forcing some to turn to the street for relief. The victims of this abuse have been crying out for help since before 2013 and nothing has been done. They have been left to suffer, deteriorate and die. Lack of action to protect these patients has elevated the opioid crisis to a self-fulfilling phenomenon.  

Frankly, I was ignorant of how bad the situation was until a few months ago, when our doctor was arrested. For the last five years, he and I have been focused on teaching patients to integrate alternative therapies into their treatment regimens to help them reduce opioid dosages and frequencies.   

Now it is in my backyard and we are the victims, because no one gave a damn about 50 million suffering souls.

We are not drug addicts looking for the next high. We are medical patients who need doctors to responsibly prescribe the opiates we need for relief.

GEORGIA CARROLL

None of the legislation passed in recent years does anything to protect doctors from ill-conceived prosecution or their patients from being abandoned. The Department of Justice, DEA and local law enforcement have not been able to effectively diminish the availability of street drugs, much less stop their distribution. So they misinterpret and pervert the CDC opioid guideline to make their own rules for investigation and prosecution of the “low hanging fruit" of prescribers diligently treating their patients.

Physician intimidation is unacceptable. Patient abandonment is unacceptable.  

A case in point: The doctor of most of the patients for whom I advocate was arrested and the clinic closed without warning last November. The staff were threatened and intimidated, and medical records and computers confiscated, including the external hard drive backup.  In a flash, the doors were locked and 7,000 patients were abandoned with no recourse and no source for prescription refills, even blood pressure and insulin, much less chronic pain, panic attacks or depression. 

It took 10 days for the local district attorney to return the backup drive for patient records. It was blank, completely scrubbed.  We asked the DA to make medical records available to the patients so they could engage new physicians. They refused. Not their responsibility. "Clinic should have had backup," we were told. 

On day 73, after many letters from patients and doctors requesting the files and two street demonstrations, they finally agreed to download individual patient's records to a disc, on request, to be picked up at the DA's office in person or by a representative. 

Doctors and medical facilities across the country are refusing to write prescriptions for opiates to anyone, for fear of suffering a similar fate.  Instead, they are pushing patients to expensive and repetitive injections or surgery.  

Our doctor has been "flagged" by other local doctors, who refuse to even see a patient with his name on the medical files or prescription, even though he is highly respected by most of them. Call it "Not Me Next Syndrome."

The hundreds of patients I work with have now been without effective pain and mental health disorder medications for over 120 days, with no relief in sight.  They have been through the agony of withdrawals unassisted. What recourse do they have?  Continued debilitating suffering, accelerated physical and mental health decline, street drugs and the ultimate relief of suicide.  

These are the calls I receive almost daily. How would you advise them?  How would you manage your symptoms or those of a loved one?  How would you cope?  

Several states have begun to introduce bills to protect doctors from prosecution for doing their job and patients from being cut off cold turkey from their prescribed opiates. But these individual state efforts are inadequate given the number of patients across the country already affected. Patient abandonment and denial of care is now a national public health epidemic and demands immediate, emergency action. 

Georgia Carroll lives in Texas.

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

How to Scrub Up, Stock Up and Hole Up During Coronavirus Pandemic

By Roger Chriss, PNN Columnist

The coronavirus pandemic is now a national emergency. The CDC has a web page specifically for high risk populations, which is older people and those with chronic health conditions. The key advice is to scrub up, stock up, and hole up.

But stocking up on medication (particularly opioids), scrubbing up hands in splints, and holing up safely are going to be hard for people with chronic illness. Here are some useful suggestions.

Stocking Up on Meds

There are ways to stock up on prescription medications and some states are helping. The Washington State Department of Health has asked all insurance companies to allow people to get a one-time refill of their prescription medications before the end of the waiting period between refills.

However, the agency’s website notes that: “Your insurance company may have limitations on refills for certain drugs like opioids.”  

NPR reports that pharmacies may also be able to help, so a talk with your pharmacist may be worthwhile.

Scrubbing Up With Physical Limitations

Scrubbing up is essential, of course, but the need to wear braces and splints makes this difficult for people with Ehlers-Danlos syndrome, arthritis and other health conditions. Cleaning wrist braces is a challenge. One way to reduce the need for cleaning is to minimize use when out, or to use braces that are more easily cleaned.

Another trick is to eschew braces when out and rely on snug winter gloves, which can be easily washed once home. Late winter is often a good time to stock up on gloves because of end-of-season sales. And such gloves may be adequate for stabilization in people with less serious disease.

Of course, it is also important to keep your hands away from your face. People with mobility issues may be in frequent contact with what the CDC calls “high-touch surfaces in public places” (think railings and banisters) in order to maintain stability and walk safely. Hard-hit areas like Washington State are already encourage or require regular sanitizing of such surfaces, but extra caution is required.

Holing Up Safely

Holing up may be something people with chronic illness are well practiced at. But there are important differences because of the coronavirus.

In an article about elder care, STAT News suggests that seniors limit visits with people who may be sick and rely on digital communication instead.

Max Brooks explains why that’s important.

A message from me and my dad, @Melbrooks. #coronavirus #DontBeASpreader pic.twitter.com/Hqhc4fFXbe

— Max Brooks (@maxbrooksauthor) March 16, 2020

But to “hunker in a bunker” safely and sanely for weeks requires more. Hospitals and clinics in coronavirus hotspots are already limiting elective procedures and delaying routine care. Staying safe at home while holing up is key.

This means avoiding triggers that can cause exacerbation, as well as activities that impose undue risks. So no home improvement projects, experiments with new recipes or supplements, tests of new fitness activities, or major changes in daily routines.

Of course, things will go wrong. CNBC reports that 54% of Americans are not financially prepared to handle a contagious disease like coronavirus that may limit their ability to work for a few weeks. CNBC suggests phone consultations, telehealth, and avoiding ERs.

Some states are moving to improve access to health insurance in this critical period. Massachusetts and Washington State have both added a special enrollment period for their Affordable Care Act exchanges for people who need health insurance.

As public health authorities issue more general recommendations, people with chronic pain disorders will need to be mindful and take extra precautions on how to stay healthy and functional in the face of the coronavirus. Resources like the ones listed above may help fill in the gaps during this difficult time.

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.

Do Smartphones Cause More Headaches?

By Pat Anson, PNN Editor

People with headaches who use smartphones are more likely to use more pain medication, but get less relief from the drugs, according to a new study conducted in India.

Researchers surveyed 400 people who suffer from a primary headache condition, which includes migraine, tension headache and other types of headaches, asking them about their smartphone and medication use.

The smartphone users were more likely to take pain-relieving drugs for their headaches than non-users, with 96% of smartphone users taking the drugs compared to 81% of non-users. Smartphone users took an average of eight pills per month compared to five pills per month for non-users.

Smartphone users also reported less relief from pain medication, with 84% gaining moderate or complete relief of headache pain compared to 94% of non-users. The study findings were published in the journal Neurology Clinical Practice.

"While these results need to be confirmed with larger and more rigorous studies, the findings are concerning, as smartphone use is growing rapidly and has been linked to a number of symptoms, with headache being the most common," said lead author Deepti Vibha, DM, of All India Institute of Medical Sciences.

The study has limitations. It only examined people at one point in time and did not follow them over an extended period. It also relied on people to self-report their symptoms and use of pain medication.

While the study does not prove that smartphone use causes headaches or greater use of pain medication, it does show an association.

“There is a great deal of speculation among the lay population regarding the effect of computers and mobile phones on ailments such as headaches and neck pain. However, although there are anecdotal stories suggesting a link between technology use and pain, there is little evidence of either a definitive relationship or data absolving mobile phones or computers from a link to recurrent pain,” wrote Heidi Moawad, MD, of Case Western Reserve University, in an editorial accompanying the study.

“Smartphone users may rely on the devices for many hours per day -- while on the go, resting, or working -- which puts a strain on the eyes, neck, and back. As people are becoming more dependent on these devices, it would be worthwhile to know whether using smartphones could lead to health problems.”

A 2017 study speculated that high energy visible (HEV) light – also known as blue light – emitted by smartphones, laptops, desktop computers and other digital devices could contribute to headaches by causing eye strain. Blue light has a very short wavelength that penetrates deep into the eye.

A nationwide survey of nearly 10,000 adults by The Vision Council found that about a third had symptoms of digital eye strain, including neck and shoulder pain, headache, blurred vision and dry eyes.

More information about blue light can be found at BlueLightExposed.com.

Bunny Boy and Me: A True Story About Chronic Pain and Unconditional Love

By Pat Anson, PNN Editor

When most people think of therapy and support animals, a dog or cat immediately come to mind. But after years of struggle with chronic pain from lupus and fibromyalgia, Nancy Laracy needed a different kind of animal.

“Our family had been through so much that I felt we all needed a family pet other than our lizard. And because my husband was allergic to dogs and cats, we settled on a rabbit,” Nancy explained.

She adopted a baby red satin rabbit, a breed known for its calmness and sociability. “Bunny Boy” quickly became part of the Laracy family and would have a profound effect on Nancy’s life. She wound up writing a book about her furry friend, “Bunny Boy and Me: My Triumph over Chronic Pain with the Help of the World’s Unluckiest, Luckiest Rabbit.”    

“Little did I know that Bunny Boy would become my third child in so many ways and that he would be the perfect therapy for my pain,” Nancy told PNN. 

“I had tried acupuncture, massage therapy, chiropractic, mainstream medicine, slept on a magnetic mattress — just about anything. But it was Bunny Boy who took me away from my pain as he slept with me, snuggled with me, and grew to know when I needed him the most. When I had his warm body on mine, I could feel the muscle pain lessen and of course the stress as well.”

Nancy started taking Bunny Boy to her doctors’ appointments, where he had a similar effect on other patients.

“I would see the positive reaction of the patients in pain, sitting in the lobby while we were there. If only for a short time, Bunny Boy would run around, jump on their laps when they allowed him to, knock the magazines all over, and make the patients laugh and smile,” she said. 

In a cruel irony, Bunny Boy got sick and was diagnosed with a similar autoimmune disease, and needed multiple surgeries for a severe jaw abscess. Most rabbits don’t respond well to painful invasive medical procedures, but Bunny Boy was a plucky hare with a strong will to live.

“I provided that same comfort to Bunny Boy as he underwent numerous surgeries and treatments that normal rabbits don’t survive, but he survived due to the strength and love he received from me and my family,” Nancy said.

“The vets who cared for him eventually called him ‘Iron Bunny’ and said to me over and over again that he was only surviving so many things due to our bond which formed in sickness and in health.”

Bunny Boy not only survived, he helped pioneer a new medical treatment that Nancy credits with saving her life, which she discusses in her book.

Bunny Boy lived a long life for a rabbit – nine years – and Nancy went on to adopt a new rabbit that she named Muffin, who also became a therapy animal.

“I started first by visiting nursing homes to see if she had the right temperament. Not only did I visit the patients in their rooms, but they wanted me to visit the patients in physical therapy and it was amazing how Muffin could help the patients increase their physical therapy programs, simply by sitting on their laps during some of their exercises,” Nancy said.

“For arthritis and fibro patients it is important to keep moving at some level and having pets helps us do that. For me a bunny was perfect because I believe it would have been too difficult for me to walk a dog that dragged me or walk a dog regularly period. A bunny is litter trained, doesn’t have to be walked, and they are equally as endearing and social as a dog or cat.”

Bunny Boy and Me is featured in PNN’s Suggested Reading section, along with other informative books on chronic pain and pain management. Nancy is donating all proceeds from her book to charity.