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    Lightbulb Chronic Pain

    Chronic pain is one reason people get hooked on opioids...

    Nerve 'Memories' Hold Clues to Treating Chronic Pain
    May 12, 2016 - With the U.S. Congress focusing on an epidemic of opioid abuse in this country, some new research is focusing on chronic pain as one of the reasons people get hooked on pain meds.
    As VOA reported Wednesday, an estimated 30,000 people in the United States will die this year as a direct result of opiate abuse. The United States consumes 80 percent of the world's prescription opiates, and an estimated 100 million Americans live with pain. The U.S. Congress, in a rare show of bipartisan support, is considering all kinds of initiatives to fight the epidemic and restrict the free flow of painkillers. Meanwhile, some scientists are focusing on why our natural response to pain can persist long after an injury is fully healed.

    Your nerves remember

    We've all had our share of scrapes, cuts, bruises, sprained ankles and broken bones. They hurt, then they heal. The pain comes, and then it goes. Except sometimes it doesn't. Researchers from King's College London set out to answer a simple question: why does pain sometimes persist even after an injury is fully healed? "We are ultimately trying to reveal why pain can turn into a chronic condition," said Dr. Franziska Denk, an author of the study. "We already knew that chronic pain patients have nerves that are more active."


    OxyContin, an opioid drug. Americans, even though comprising only five percent of the world's population, consume eighty percent of the its supply of pain medication

    In those cases, the nervous system remains highly sensitive in an area of injury, causing pain that doesn't go away for weeks, months, even years. So the scientists focused on some particular immune cells in mice that previous research has shown play a role in persistent pain. What they found is that when SOME nerves are damaged something called their epigenetics change, and it stays changed. Think of the epigenetics as the nerves' "memory." In the same way a particularly bad memory can cause emotional pain long after a breakup or the loss of a loved one, epigenetics seem to keep the nerves active long after an injury has passed.

    Therapy for your nerves

    What the researchers don't know is why some nerves don't remember pain, and why others just can't forget. After all, nerve cells are replaced just like skin cells and blood cells. "Cells have housekeeping systems" Denk said, "... the majority of their content are replaced and renewed every few weeks and months. So why do crucial proteins keep being replaced by malfunctioning versions of themselves?" Understanding that, and finding a way to coax the nerve cells into letting go of their bad memories, could open the door to solving the problem of chronic pain, and the wave of damage, death and addiction that is its hallmark.

    http://www.voanews.com/content/chron...y/3327325.html
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    US House Passes Comprehensive Bill on Painkiller Addiction
    May 13, 2016 - The U.S. House of Representatives has passed a comprehensive bill on opioid abuse, a group of 18 measures designed to combat the nation's epidemic of addiction to painkillers.
    The legislation takes steps to set up federal grants and a task force designed to examine pain management methods and the prescribing of pain medication. The vote to pass the measures was an overwhelming 400 to 5. Public awareness of the crisis has been heightened in the past few weeks, after the sudden death of pop star Prince, who died April 21 at age 57 after reportedly seeking treatment for painkiller addiction.

    That high-profile news event, combined with the fact that many members of Congress are seeking re-election in November, means the incentive to take legislative action was high. The Senate is considering similar legislation and, in a rare bipartisan effort, both Democrats and Republicans hope to unite their efforts and give the president one comprehensive bill to sign into law.

    On Thursday, the White House released a statement calling on Congress to approve $1.1 billion in new funding for drug treatment listed in President Barack Obama's budget proposal for next year. Michael Botticelli, director of the Office of National Drug Control Policy, said it is not enough to call attention to the public health crisis. He said "actual funding" is needed to prevent the misuse of opioids and increase access to treatment and recovery services.

    Painkiller addiction is a uniquely American problem: While the United States represents only 5 percent of the global population, Americans consume 80 percent of the world's supply of pain medication. Opiate use in the United States has quadrupled since 1999, helped along by low cost and ease of access to opiate painkillers and a common perception among doctors that the risk of addiction was low. The issue has received major attention only in the past decade, with policymakers and health care professionals struggling to care for the 4.5 million people in the U.S. who are estimated to be addicted to prescription opiates.

    http://www.voanews.com/content/us-ho...n/3329634.html

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    My VA doctor tried to prescribe that chit (OxyContin) for my arthritis. I did the research and decided that weed was far preferable.
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  3. #3
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    Lightbulb

    Family, friends support important to managing chronic illness...

    Analysts Accent Role of Friends, Family in Managing Patients' Chronic Illnesses
    December 29, 2016 - When it comes to helping patients manage chronic illnesses like diabetes or heart disease, friends and family may be more helpful than the family doctor — and they're a lot cheaper, too. That's the conclusion of analysts at the University of Pennsylvania's Center for Health Care Innovation.
    In an article in The New England Journal of Medicine, behavioral economists said leveraging existing social relationships can lead to new healthy habits and behaviors, such as improvements in diets and exercising. That's because friends and family members are around patients more than the doctors and nurses who manage their care and see them only occasionally.


    A diabetes patient walks on a treadmill as part of an exercise program to help control the disease.

    The researchers present a five-step ladder of social interactions that can influence healthy behaviors. At the bottom rung, patients are trying to manage their health condition alone, often with the least success. As one moves up the ladder, the degree of success increases with the levels of social interaction. At the top rung, there's mutual support between the patient and loved ones, with shared goals, leading to the most positive results. Social interactions, said researchers, are more likely to lead to healthful behaviors, such as steering a patient away from a sedentary activity, like watching television, to taking a walk or going to the gym. And they noted friends and family can more effectively suggest better choices at restaurants than a doctor telling a patient to watch his diet.

    'Missed opportunity'

    Center director David Asch, who co-authored the article, called the benefits of these cost-free social interactions a "missed opportunity" that remains "largely untapped" by the medical community. He said concerns about privacy frequently get in the way of medical personnel's desire to rally the assistance of social connections. While Asch noted that privacy is important in some cases, patients with diabetes, for example, would "love" it if friends and family would help them manage their condition and get their health under control.

    The authors pointed to studies that have shown the benefits of social interactions in health care. For example, in one investigation, patients who talked on the phone weekly with a peer saw a more significant drop in a marker of diabetes, called glycated hemoglobin levels, than those who worked only with clinicians. "Sure, health care is serious business," wrote Asch. "But who says it can't be social?"

    http://www.voanews.com/a/analysts-ac...s/3656051.html

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    CDC says Some Doctors Still Prescribe Too Many Opioids...

    Some Doctors Still Prescribe Too Many Opioids, CDC Finds
    July 6, 2017 - A report out today from the Centers for Disease Control and Prevention finds that use of these highly addictive narcotic pain meds dropped in the last few years. But a closer look at the numbers in the CDC study reveals another, more troubling trend: Some doctors are still overprescribing opioids, which puts lives at risk.
    Overall, the use of OxyContin, Percocet, Vicodin, and other opioid pain medications decreased by 13 percent between 2012 and 2015. Yet even with that drop, prescribing remains alarmingly high, according to the CDC. In 2015, U.S. doctors prescribed enough opioids to medicate every American around the clock for three weeks. “The amount of opioids prescribed in the U.S. is still too high, with too many opioid prescriptions for too many days at too high a dosage,” said the CDC's acting director, Anne Schuchat, M.D.

    Safer Pain Relief

    Last year, the CDC released guidelines advising doctors to not prescribe more than three days' worth of opioids for most patients. “Healthcare providers have an important role in offering safer and more effective pain management while reducing risks of opioid addiction and overdose," Schuchat says. But because some doctors are too quick to prescribe opioids, patients need to speak up and ask about other options for relieving pain, advises Consumer Reports’ medical director, Orly Avitzur, M.D. "The thinking on opioid prescribing has changed in recent years as the severity of the risks of the drugs has come to light," Avitzur says. "We also have far more research supporting the effectiveness of safer medications and even nondrug measures."


    For example, research shows that the combination of over-the-counter acetaminophen (Tylenol and generic) and an anti-inflammatory drug such as ibuprofen (Advil, Motrin IB and generic) or naproxen (Aleve and generic) can actually work better than an opioid to relieve pain after a dental procedure. And the American College of Physicians now recommends avoiding opioids for most cases of back pain. Instead, the APC recommends trying nondrug options such as heat, acupuncture, massage, spinal manipulation, and yoga before resorting to any medication.

    However, that updated advice can be slow to trickle down to all doctors' everyday practices, Avitzur says: "Prescribing habits become deeply entrenched. So it's important to remind your healthcare providers that you don't want—or need—a lengthy opioid prescription." Longer courses and higher doses of opioids are appropriate for people suffering severe pain from cancer or a terminal illness, she says. "But even after surgery or an injury, most other patients can transition to safer OTC pain relievers within three days, says Avitzur. "Very few patients need powerful prescription painkillers for more than a week."

    Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

    https://www.yahoo.com/news/doctors-s...223001966.html
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    U.S. FDA asks Endo to withdraw Opana ER opioid; shares fall
    Thu Jun 8, 2017 | The U.S. Food and Drug Administration said on Thursday it has asked Endo International Plc to withdraw from the market its long-lasting opioid painkiller Opana ER, sending the company's shares down more than 12 percent.
    "After careful consideration, the agency is seeking removal based on its concern that the benefits of the drug may no longer outweigh its risks," the agency said in a statement. The move comes after a panel of advisers concluded in March that the benefits of Opana ER, which was approved in 2006 and reformulated in 2012 to resist abuse, did not outweigh the risks. While nasal abuse rates fell, the rate of intravenous abuse increased.

    The withdrawal marks the first time the agency taken steps to remove an opioid pain medication due to the public health implications and comes amid an intense national debate about the abuse of opioids. Opioids were involved in more than 33,000 deaths in 2015 and opioid overdoses have quadrupled since 1999, according to the Centers for Disease Control and Prevention. "We are facing an opioid epidemic - a public health crisis, and we must take all necessary steps to reduce the scope of opioid misuse and abuse," Dr. Scott Gottlieb, the FDA's newly appointed commissioner said in a statement.

    Opana ER has also been associated with a serious outbreak of HIV and hepatitis C, the agency said, as well as a serious blood disorder known as thrombotic microangiopathy. The move coincides with a lawsuit filed on May 31 against the pharmaceutical industry by Ohio, charging that a number of companies, including Endo, Purdue Pharma, Teva Pharmaceutical Industries Ltd, Johnson & Johnson and Allergan Plc conducted misleading marketing campaigns that downplayed the drugs' addictiveness. Some other states and cities have filed similar lawsuits.

    Gottlieb said the agency will "continue to take regulatory steps when we see situations where an opioid product's risks outweigh its benefits, not only for its intended patient population but also in regard to its potential for misuse and abuse." Endo's shares fell 12.2 percent to $12.10 in extended trading.

    http://www.reuters.com/article/endo-...-idUSL1N1J52BK

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    A number of years ago, after a root canal, I was given hydrocodone, and I took a pill every morning thereafter for about a week. It not only took my mind off the pain, it made me feel great - focused, energized yet relaxed, like I could take on the world and do anything. Then one morning, I started to take the pill and I stopped, looked into my own eyes in the mirror and thought, "Uh oh". At some undeterminable point I had gone from patient to recreational drug user. I wasn't having the pain any longer, but I kept taking the pill every morning because of the way it made me feel. I put the bottle in the back of the medicine cabinet and forgot about it. Lesson learned.

    A few months ago, I was having a great deal of pain with my lower back and went to my doctor about it. He prescribed heat, rest, Ibuprofen - everything but pain meds, and I'll confess to being somewhat irritated for a while...but I understood. Three weeks ago I had a tooth extraction, and - again - whereas until recently I'd have certainly been given something, probably oxy or Vicadin, I got nothing. Last week I was sent to a specialist, an oral surgeon, because I was still having pain from the tooth, and he prescribed twenty oxycodone tablets. I didn't turn them down or tear up the scrip or anything like that - I had it filled, and it's sitting in my medicine cabinet in case I, or someone else in the family, should ever have serious need for it. I mean, it's right - very right - to be concerned about the possibility of addiction and all of that...but there are still situations where it's needed, and the way things are going, with most doctors all but boycotting those drugs all together, it's probably a good idea to have it in reserve, just in case.

    I should mention that a few days earlier, my twenty-something son remembered that he had been given an oxy scrip last November when he'd had a foot injury, and still had the bottle in the back of his closet. He gave it to me - it's in the back of the medicine cabinet with my own scrip - and I was somewhat surprised (and pleased) to see that he hadn't taken a single pill...there were still twenty in the bottle. (I'm not suggesting that my youngest was a bad or especially wild kid when he was in high school, but I'm afraid, ten years ago, that bottle of oxy would have had, between him and his friends, a very short lifespan.)
    "The first thing you want to do after being shot is make sure you are not shot again." - Ace Atkins

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