Pain Medications

Opioid Prescription Dangers Reinforced in Recent Study

cmaynard — Tue, 01 Sep 2009 10:45:18 -0700

September 2, 2009
by: Sylvia Marten

In the past, physicians have expressed reluctance about [url:6620,type=|node|,content=|prescribing opioids for chronic back pain|] and other symptoms, and these concerns certainly seem more than justified following recent findings about the significant, dangerous misuse of such medications.

While opioids like oxycodone (Oxycontin, Percocet, Percodan), hydromorphone (Dilaudid), hydrocodone (Vicodin), etc. may be prescribed to treat chronic [url:145,type=|term|,content=|back pain|], some doctors will not do so out of fear that patients will become addicted and that they themselves will be prosecuted for prescribing these drugs.

If these physician concerns initially seem a bit worrisome and cautious to those outside the medical field, consider the findings in a recent study that analyzed 938,586 urine toxicology tests of 500,000 patients who had been prescribed opioids for chronic conditions:

Only 25 percent of the analyzed patients took their medications as prescribed (that is, without illicit drug use or misuse)
27 percent of the patients had a drug level higher than expected (indicating overuse of the opioids)
11 percent of the patients had major illicit drugs like cocaine or methamphetamines in their urine (indicating illegal drug use in conjunction with the prescribed opioid use).

It should also be known that the prescribed medication was not detected in 38 percent of the patients and that it was lower than expected in 15 percent of the patients, indicating patients taking less than prescribed amounts or even potential drug diversion (use of prescribed drugs for recreational or other unintended purposes).

Study Relevance to Back Pain Doctors and Patients

For doctors who treat back pain, this study highlights:

The potential dangers of opioid prescriptions, particularly in terms of improper use and addiction
The importance of physicians identifying patients who may be more prone to misuse, abuse or diversion of opioids
The need for physicians to monitor prescribed opioid use by patients
The benefits of urine testing as a tool for such monitoring

As for back pain patients, the study reinforces the need for them to clearly understand:

The risks involved with opioid use, including what happens when you take too much or too little of these drugs, and how they react when taken in conjunction with other medications.

While speaking with a physician is often a great way to learn more about the benefits/dangers of opioids as prescribed pain medications, patients may also go the extra mile and do their own homework by checking out sites like the FDA, Medline Plus and a back-pain specific site like Spine-health.

For more information on back pain medications, visit our [url:169,type=|term|,content=|Pain Medication Health Center|].

Source: Therapeutics Daily

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"Off-Label" Drug Confusion Can Impact Back Pain Patients

cmaynard — Wed, 26 Aug 2009 14:09:18 -0700

August 27, 2009
by: Sylvia Marten

A significant minority of physicians incorrectly identified the use of certain drugs as having been approved by the U.S. Food and Drug Administration (FDA), according to a national survey that reiterates the importance of patients understanding "on-label" versus "off-label" drug use.

When the safety and effectiveness of a drug has been demonstrated in studies, pharmaceutical manufacturers seek FDA approval, which includes getting approval of a label that describes indications of use, dosage and method of administration. If the drug and its label are approved by the FDA, doctors may prescribe it to the general population.

When the drug is prescribed for uses that are clearly listed on its label and have been approved by the FDA, such usages are described as “on-label.”
When the drug is prescribed for usage that is not described on its label and has not been approved by the FDA (which doctors may legally do for various reasons), its use is described as “off-label.”

Here’s a prime example in relation to patients dealing with [url:145,type=|term|,content=|back pain|]:

While the brand name drug Neurontin (gabapentin) has been approved by the FDA for “on-label” use among adult patients with post-herpetic neuralgia, it is commonly prescribed “off-label” to patients who have been diagnosed with chronic back pain or chronic low back pain.
In other words, while the Neurontin label does not indicate usage for back pain, it is still prescribed “off-label” for this condition.

With this understood, a University of Chicago-led survey of nearly 1200 physicians (specifically 599 primary care physicians and 600 physiatrists from around the country) revealed some confusion about the “on-label” and “off-label” usage of select drugs among 22 drug-indication pairs.

So What Did the Survey Reveal?

More [url:169,type=|term|,content=|Pain Medication|] Info

[url:1916,type=|node|,content=|Muscle Relaxants|]

[url:1917,type=|node|,content=|NSAIDs|]

[url:1924,type=|node|,content=|Pain Killer Addition|]

Physicians correctly identified the FDA-approved status of just slightly more than half (55%) of the drugs in the survey. Especially of interest, physicians who had previously prescribed drugs for “off-label” uses were more likely to respond incorrectly in the survey that such uses of the drug had been approved by the FDA.

Here are just a few drugs whose “on-label” usage created confusion in the survey:

Lorazepam. This drug has not been approved to treat chronic anxiety, yet 26% of the surveyed physicians thought it had been approved for this purpose, with 33% of those incorrect physicians having previously prescribed the drug for this reason.
Seroquel (quetiapine). This drug has not been approved by the FDA for treatment of dementia with agitation, yet 13% of the surveyed physicians thought that it has been approved for this purpose, with 19% of those misinformed physicians having previously prescribed Seroquel to treat such dementia.

Also of interest is the fact that some doctors were prescribing Seroquel for dementia at a time of the study (2007-2008) when the FDA had advised that quetiapine not be prescribed for dementia.

Patient Considerations with "Off-Label" Drug Usage

With these findings in mind, why should patients -- especially those with back pain, [url:149,type=|term|,content=|neck pain|], and other pain related to the spine -- care?

Here are a few reasons:

Doctors may prescribe drugs for “off-label” usages for many purposes that are quite relevant, specifically when back pain and/or neck pain has not responded to other approved treatments.
As seen in both the Lorazepam and Seroquel examples, physicians are not always right when prescribing drugs as "on-label."
As evident in the Seroquel example, doctors may unknowingly prescribe drugs for “off-label” purposes at times when the FDA has already advised against such actions.
For any patient who is prescribed a drug, it is important to confirm if the specific usage is “on-label” or “off-label.” If the drug is being prescribed “off-label,” it is particularly crucial to get an understanding of the risks and benefits of such usage.
Patients should do their homework and check out recommended drugs and their approved indications and uses on reputable sites like the FDA, Medline Plus and the [url:169,type=|term|,content=|Pain Medications|] section of Spine-health, in addition to speaking with their doctor.

For more information, see the resources below.

Source: Therapeutics Daily

Update (September 2, 2009): In related news, the world's largest drug maker Pfizer has been penalized a staggering $2.3 billion as part of a record settlement for alleged violations of federal drug rules, including marketing painkiller Bextra and three other drugs for "off-label" purposes that were not approved by the FDA. According to the allegations, Pfizer personnel created false doctor requests for pain reliever Bextra, anti-psychotic Geodon, antibiotic Zyvox, and anti-epletic Lyrica in order to provide doctors with unsolicited information about unapproved uses of these drugs. While it is legal for doctors to prescribe medications for "off-label" purposes, drug manufacturers may not market those drugs for reasons not approved by the FDA, something that Pfizer would hopefully be aware of now. Source: Associated Press

New Study Highlights Antidepressant Use for Back Pain and Sleep Problems

cmaynard — Tue, 04 Aug 2009 07:17:12 -0700

August 3, 2009
by: Sylvia Marten

Since insomnia and depression may often occur in conjunction with chronic pain, low doses of sedating antidepressants may be prescribed to help patients sleep and receive some pain relief.

With this in mind, a recent study details the prevalent use of antidepressants in the United States, especially for patients with [url:145,type=|term|,content=|back pain|] and sleeping problems.

According to a study of nearly 50,000 children and adults in the Archives of General Psychiatry, the number of Americans using antidepressants doubled in the last decade, to approximately 27 million in 2005 (the last year in which data was available).

A USA Today story notes how doctors have become more comfortable prescribing antidepressants for back pain and sleep problems since newer drugs are much safer and have fewer side effects.

As just a few examples, doctors may prescribe antidepressants like Escitalopram (Lexapro), Duloxetine (Cymbalta), Desvenlafaxine (Pristiq), Trazodone (Desyrel), Amitriptyline (Elavil) and Doxepin (Sinequan) for sleeping problems because they are non-addictive, have low side effects, and include pain relieving properties that are absent in their predecessors, the hypnotic class of medications.

However, to some medical professionals in the story, the use of antidepressants is a bit alarming and at least warrants more mental health training for doctors.

As just one example that raises some concern, the new study notes how the percentage of children using antidepressants rose from 1.4 percent in 1996 to 2.6 percent in 2005. The USA Today story added that antidepressant use by children did drop 10 percent in 2005 following an FDA “black box” warning from the year before about the suicidal risks in children using antidepressants.

Important Considerations with Antidepressants and Pain Medications

Whether or not Americans have become too dependent on antidepressants and other pills is subject to debate; what must be noted is that any patient who plans on taking antidepressants for depression, chronic back pain, insomnia or other problems should be fully aware of the side effects involved and only do so under the guidance of a trusted medical professional.

Learn more about depression and insomnia stemming from chronic pain, and examine other methods besides antidepressants to address such problems, in the following resources:

[url:804,type=|node|,content=|Chronic Pain and Depression|]
[url:830,type=|node|,content=|Definitive Depression Guide|]
[url:17137,type=|node|,content=|Antidepressants as Sleep Aids|]
[url:1318,type=|node|,content=|Chronic Pain and Insomnia: Breaking the Cycle|]
[url:1081,type=|node|,content=|Chronic Pain Management|]
[url:1080,type=|node|,content=|11 Chronic Pain Control Techniques|].

What Back Pain Patients Should Know about Stop-Smoking Drugs Chantix and Zyban

cmaynard — Tue, 07 Jul 2009 11:43:47 -0700

July 8, 2009
by: Sylvia Marten

The U.S. Food and Drug Administration (FDA) just announced that a black box warning will be carried on two popular, “stop-smoking” drugs – varenicline (Chantix) and buproprion (Zyban, Wellbutrin) – following a report detailing some very significant side effects with their use.

According to the FDA’s adverse event reporting system, use of these two drugs has been linked with serious changes in behavior, including:

depression
agitation
hostility
thoughts of suicide.

More specifically, the report linked:

98 suicides and 188 attempted suicides to use of varenicline
14 suicides and 17 attempted suicides to buproprion use.

While noting the importance of getting people to quit smoking, the FDA added that it simply wants closer monitoring of these two drugs.

Consequently, the FDA is going to ask the manufacturers of Chantix and Zyban – Pfizer and GlaxoSmithKline, respectively – to conduct clinical trials examining behavioral changes with usage of these drugs.

Smoking has long been linked to causing back pain and is often a reason why surgeons may not want to perform spinal surgery on certain patients.

Since smoking can slow down the recovery time after back surgery, many patients may have to quit smoking prior to surgery.

If you have recently quit smoking in wake of a scheduled back surgery, or have stopped smoking following back surgery, it’s important that you know the risks of stop-smoking drugs, as the above information about Chantix and Zyban demonstrates.

And if you have used any of these stop-smoking drugs and noticed changes in your behavior similar to the symptoms listed above, get in touch with your doctor as soon as possible.

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Pain Killers Scrutinized after Shocking Death of Michael Jackson

cmaynard — Wed, 01 Jul 2009 11:55:00 -0700

July 1, 2009
by: Sylvia Marten

It’s been nearly a week since pop singer Michael Jackson’s sudden death from cardiac arrest, and questions still remain as to what led to his death.

According to various news reports, Jackson was addicted to the narcotic pain killer Demerol for more than 20 years and also received daily doses of another pain killer, Oxycontin. According to an unnamed senior law enforcement official in an ABC News report, Los Angeles police were told that Jackson did in fact receive a Demerol injection an hour before his death.

A lawyer for Jackson’s physician, Dr. Conrad Murray, has said that his client did not prescribe Jackson with any of these pain killers, but many medical experts think that Demerol and possibly other drugs played a role in the death.

Whether this is true or not, Jackson’s death provides a sad but absolutely necessary forum to talk about pain killer addiction.

While pain killers like Vicodin, OxyContin, Norco and Hydrocodone are typically prescribed to treat pain, what is often forgotten or not known with patients is that pain killers cause changes in the brain’s chemistry that are not under their control.

More specifically, the brain increases the number of receptors in response to the specific pain killer, and its nerve cells stop functioning. Since the body is receiving opiate pain killers, it stops producing endorphins (the body’s natural pain killers). Consequential degeneration of the nerve cells often auses a physical dependency for these opiates.

What is also not known by many patients is that taking pain killers over a long period of time may actually increase a person’s sensitivity to pain, possibly causing them to up their doses, become addicted and put their health in serious danger.

An overdose of pain killers can lead to respiratory arrest (when breathing slows and stops). Low blood oxygen may then cause the heart to quiver and not circulate blood, and lead to cardiac arrest (when the heart stops circulating blood).

Pain killer addiction is a very real problem in the United States. It has been estimated that more than 4.7 million Americans (roughly 2% of the U.S. population) are dependent on prescription pain killers.

Learn more about pain killer addiction and treatment in the following resources:

[url:808,type=|node|,content=|Pain Medications|]
[url:6639,type=|node|,content=|How Pain Killers Sometimes Increase Chronic Pain|]
[url:1924,type=|node|,content=|Pain Killer Addiction Treatment|].

In related news, Jackson’s death comes at a time when the European Medicines Agency (EMEA) wants a specific pain killer off the market and the U.S. Food and Drug Administration (FDA) is considering major changes to the use of one pain reliever.

The EMEA has said that the pain killer dextropropoxyphene (known as propoxyphene in the United States) should be withdrawn from the European market because a “significant” number of patients have allegedly been overdosing and dying from it (although the EMEA did not provide a specific number of casualties, according to a Wall Street Journal story).

Propoxyphene (e.g. Darvocet) has been used in the United States to treat mild to moderate pain since the late 1950s. It is marketed today by many drug manufacturers, and the FDA is reportedly considering whether to withdraw this pain killer.

For back pain patients who use or are considering taking a pain medication, especially medications with addiction potential, it is essential to understand and carefully monitor the use of that medicine. Do the upfront research to understand the medication options for your particular type of back or neck pain, and work closely with your medical professional to watch for side effects and risks of dependency. Some medicines are safe for short term use, but become potential dangers when used longer than indicated or in combination with other drugs.

Update: The FDA announced on July 8 that it would not withdraw Darvocet, Darvon and other pain killers with propoxyphene from the market despite calls from one consumer group to remove them. The FDA added that it would require a boxed warning of propoxyphene overdose risks and force manufacturers to study the fatality rates from overdoses.

9 Quick Back Pain Tips for Airplane Rides

cmaynard — Fri, 26 Jun 2009 08:22:42 -0700

June 26, 2009
by: Sylvia Marten

Looking forward to that much-awaited summer vacation but worried about dealing with chronic lower back pain, especially on a long flight?

If so, follow these lower back pain management tips -- courtesy of Spine-health’s continuing series on dealing with [url:145,type=|term|,content=|back pain|] on summer vacation -- to make your trip as painless, comfortable and stress-free as possible.

Let’s get started with some things you can do prior to your flight.

Utilize Your Doctor

As Haglandc of the Spine-health forum wonderfully points out, your doctor is one of your best advocates when preparing for a vacation. Here’s why.

A doctor may be able to provide a letter about your [url:896,type=|node|,content=|lower back pain|] to the airline and flight crew, which may then make accommodations for your needs. In the case of one forum member, that meant getting upgraded to business class, allowed to lay on the floor and rest during long flights, provided with a bunch of blankets for cushions, and afforded the opportunity to get up and walk around when others remained in their seats.
A doctor may provide you with prescription drugs like narcotics or muscle relaxants to help make the plane ride easier on your lower back pain. If this is the case, be sure to keep all of your prescription drugs in their original bottles (for airport security reasons) and bring a doctor’s note with you that specifies the medications you are on and the medical necessity.

Contact the Airline

Generally speaking, it usually cannot hurt to contact the airline a couple of weeks prior to the flight and let them know of your back pain. In the case of one forum member, speaking with the airline prior to flight made boarding much easier.

With a letter provided by a physical therapist, this passenger was allowed to bring on his [url:1940,type=|node|,content=|Transcutaneous Electrical Nerve Stimulation|] (TENS) unit, a portable, pocket-sized device that blocks pain signals by sending electrical impulses to certain parts of the body, and go through security without have to take it off.

You may be surprised that the airline may be able to make accommodations for your back pain, especially when you give them a decent notice of your condition. As just a couple of examples, the airline may be able to:

Provide you with medical attention (if necessary) via wheelchair assistance and early boarding
Have airline personnel carry your luggage for you and/or lift it into the overhead bin for you
Accommodate you with special shuttles and elevator platforms for boarding
Allow non-medical assistants to accompany you through security and boarding.

Put More Thought into Scheduling Your Flight

Take into account how you can make your flight less stressful on your back rather than rushing to book tickets by:

Exploring the possibility of taking a flight when there will be less people on board and more room for you to lie down across seats.
Contacting the airline prior to scheduling a flight and let them know of your back pain. They may be able to provide you with more insight on when flights tend to be very crowded and much lighter.
Trying to limit the down time between in-flight connections or layovers, if applicable.

Now that you’ve done some work prior to your flight, here’s what you can do to curtail back pain during it.

Bring Over-the-Counter Pain Medication

Utilize over-the-counter pain medication like acetaminophen (e.g. Tylenol) or [url:1917,type=|node|,content=|NSAIDS|] ibuprofen (Advil, Motrin and Nuprin) or naproxen (Aleve), to provide back pain relief on your flight.

Take your pain medication one hour before your flight to give it time to get into your system.
Carry your pain medications together in a clear plastic bag and have them on you at all times, in case you need to resort to them during the flight.
Inform flight attendants that you are on medication. This way they can monitor you if necessary.

Provide Support to Your Back While in the Air

For lower back pain, providing support behind your lower back, often with a back roll or even a couple of pillows (which a flight attendant may be more than willing to give you), is a good way to prevent slouching that may lead to back pain and to keep your spine straight.

One forum member talked about how he brings a neck pillow on board to help with his [url:912,type=|node|,content=|neck pain|].
Back braces, tube-shaped pillows with microfibers inside and other materials providing support are common companions of passengers with back pain and can be purchased inexpensively at many stores.

Watch How You Are Sitting

Airplane rides can be a bit tight and uncomfortable at times, especially if you’re not in a luxury class.

If your legs are not positioned at a right angle when you sit in an airplane seat, ask for something (pillows, blankets) to prop up your feet and keep your knees at a right angle. Doing so keeps stress off the lower back.
If you have long legs, request an exit row or bulkhead seat, which generally has more leg room.

Get Up, Move & Stretch as much as possible

Staying stationary for prolonged periods of time stresses the spine and can make back pain much worse.

See if there is room at the back of plane to do some quick stretching, which can provide more flexibility to the back and ease stiffness. Just be sure not to get up and move when there are jerking movements.

Alternate between Heat and Ice

Stock up on inexpensive heating options like ThermaCare heat wraps or warm gel packs and apply them while in the air.
Bring an empty hot water bottle and ask the flight attendant to fill it up during your flight.
Carry a small gel pack on the plane and have the flight attendant store it in the fridge when you are not using it.
Have a Ziploc bag on hand and ask the attendant to fill it up with ice that you can apply to your back.

Of course, do not apply heat or ice directly to the skin and be sure to check in with the airline to see what items are acceptable to carry on.

Relax and Try to Get Some Rest

A long flight provides plenty of time to [url:1080,type=|node|,content=|relax|], with just some suggestions including:

Getting comfortable via a back or neck support, sitting properly or reclining your seat, and maybe even taking some pain medication prior to your flight
Breathing slowly (inhale deeply, count to five, exhale slowly and repeat 10 times) to relax your muscles and nerves
Listening to some soothing music on an iPod
Bringing a novel or some other reading materials that can stimulate your mind and divert your attention away from your back pain
Staring out at the clouds and scenery (if you have a window seat) and letting your mind drift
Thinking about your vacation destination and how long you’ve waited for this day.

Hopefully these tips will help and even spark some more ideas as you prepare to deal with your back pain on a vacation plane ride.

Thanks again to those forum members who provided ideas with how they’ve dealt with back pain on airplane rides in the past.

Feel free to provide us with any other tips that you feel may be helpful to others, and be sure to check in at the Spine-health blog for future tips on dealing with back pain during summer vacation.

Happy travels to you.

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Top 7 Back Pain Treatments for Summer Vacation Car Rides

cmaynard — Wed, 17 Jun 2009 08:06:30 -0700

June 17, 2009
by: Sylvia Marten

Well, it’s that wonderful time of year when school is letting out, the weather is getting beautiful and the days are much longer and brighter. For most people, the summer is an ideal time to get away from the grind of the 9-to-5 and take a vacation with family.

With money tighter and the economy what it is, more families vacationing this summer may decide to travel by car, which may not present the most ideal situation for people dealing with a history of lower back pain.

Still, [url:896,type=|node|,content=|lower back pain|] doesn’t have to throw a wrench in your summer travels. In fact, if you keep the following tips in mind, you may very well make your trip a comfortable one.

In the first installment of Spine-health’s summer series of tips for limiting back pain on vacation, we examine how you can “have the back” of your back during that long car ride to the destination of your dreams.

1. Cover Your Bases by Getting Comfortable Immediately.

Whether you’re going to be driving or sitting in a car on your vacation trip, chances are you’ll be in the vehicle for extended periods, likely hours at a time. While this may sound extremely basic, make sure you’re comfortable from the get go.

Unfortunately, not all cars include built-in lumbar support or other ergonomic features. With that said, here are some tips for making your car more ergonomically-friendly for your back.

If your car seat provides little back support, roll up a towel, pillow or back support and place it between your lower back and seat for some more support. There are many different types of cushions and pillows (including but not limited to ones for sciatica, the [url:149,type=|term|,content=|neck|], lumbar spine, bottom and full body) that you can also purchase to alleviate your back pain.
Don’t sit on your wallet, cell phone or anything else that may throw your spine out of whack.
Reduce reaching (which places more stress on the lumbar spine, neck, shoulder and wrists) by sitting as close to the steering wheel as possible without compromising your safety.
Sit up straight with your knees slightly higher than your hips, and keep your chin pulled in.
Since staying still is bad for your back, don’t just pick a position and stay in it. Rather, adjust your seat and make slight adjustments to your position every 15-20 minutes.
Perhaps you’ll be renting a car for your vacation. If so, seek a car that provides lumbar support, is high enough for you to see past other vehicles without having to cringe your back and neck, and allows an easy way to get in and out without having to do much bending.

2. Bring a Small Cooler & Stack an Ice Pack.

Chances are you’ll already be bringing a small cooler with little snacks and beverages for yourself or the kids as you begin your vacation trek in the family car, so you might as well store a small ice pack in there as well.

[url:1664,type=|node|,content=|Applying ice|] to where you’re experiencing back pain – most often for no more than 20 minutes – is typically a good way to curtail any pain.

As most back pain is accompanied by inflammation, ice therapy can slow back swelling, numb sore tissues, slow the nerve impulses in the affected area, and decrease tissue damage.

Just remember that you should never apply ice directly to the back, but should rather keep it in a towel or another protective barrier to avoid ice burn.

3. Alternate Ice with Heat Therapy via These Inexpensive Means.

Alternating ice and heat is often an effective way to combat back pain, so be sure to bring something that can provide some warmth to your back.

Since lower back pain typically develops from strains and over-exertions that place tension in the muscles and soft tissues around the lower spine, hence leading to a lack of proper circulation and the transmission of pain signals to the brain, [url:1662,type=|node|,content=|heat therapy|] may reduce such signal calling and decrease stiffness by stretching the soft tissues around the spine.

Here are just a few options for how you can “light a fire” under your back during your summer vacation car ride.

Right before you leave, fill up a hot water bottle that you can place on your back. Be sure to refill your water bottle when you make bathroom breaks at rest stops.
While you’re preparing for your vacation by buying new clothes and snacks, be on the lookout for a heating pad with a car adapter that can simply plug into your vehicle’s cigarette lighter.
If you have leather seats with heating power, turn this function on for a few minutes at a time.
Gear up with other less expensive heating options, like warm gel packs and heat wraps. As an example, something like a ThermaCare heat wrap can be used to deliver low level heat to your back for several hours.

As you can see, there are plenty of affordable ways to provide heat therapy to your lower back pain. Just remember, that like ice packs, you should never apply heat directly to your skin.

4. Make Rest Stops So Much More – Utilize the Open Space for Back Exercises.

While this may seem counterintuitive, exercise is often a good treatment for lower back pain. Specifically, active [url:1183,type=|node|,content=|back exercises|] keep discs, muscles, ligaments and joints healthy by distributing nutrients into the disc space and soft tissues in the back.

Now if you have been to one rest stop, you’ve likely been to them all. In addition to providing lovely facilities to use the rest room and being stocked full of vending machines where you can get some of the oldest coffee in the world, rest areas are typically known for having plenty of flowing, green space.

After taking care of business at the rest stop, be sure to utilize its open space by making it a point to do some back exercises, including stretching and working on your hamstrings (FYI: you should stretch your hamstrings twice a day when dealing with low back pain).

Even walking around a bit is a good way to stretch out the muscles.

Here are just some [url:1246,type=|node|,content=|lower back pain exercises|] that may work for you (with that said, a physical therapist or spine professional can provide you with more back exercises).

If you have done back exercises in the past to curtail lower back pain, you’ll want to keep your routine, even when going on vacation, which is all about breaking routines.

Make it a point to spend a couple of minutes doing back exercises at a rest stop before getting back on the road with the Joads, and be sure to get to a stop every couple of hours.

5. Make Good Use of the Back Seat (if available).

If your back pain is proving unbearable and the back seat is available, use it to lie down and rest.

Simply lie down in the back seat (obviously when the car is parked and not moving) with your knees slightly bent. Put a blanket on the seat and rest a pillow under your head.

In simple terms, try to get as comfortable as possible and adjust your positioning when necessary.

6. Substitute Your Pain Medications with Tylenol, Ibuprofen or Naproxen.

Taking your pain medications is not advisable when driving. With that in mind, you can always alternate with over-the-counter pain relievers like Tylenol, ibuprofen (Advil, Motrin and Nuprin) or naproxen (Aleve).

These [url:1917,type=|node|, content=|NSAIDs or non-steroidal anti-inflammatory drugs|] are often effective in limiting inflammation associated with back pain and typically don't produce the gastrointestinal side effects of aspirin.

7. Sit Back, Relax and Rest.

There’s a reason why passenger seats recline. And there’s usually no better time to catch up on some sleep than during a long car ride.

If your lower back pain is nagging, taking a nap may be an effective way to limit the pain.

While sleeping in a car may be difficult for some people, most people are able to adapt and find a good way to nap and get some much needed refreshment and back pain relief.

Here are some general tips for doing so.

Recline the passenger seat in a position that is most comfortable to you.
Depending on how you feel and what you prefer, you may want to use a comfortable pillow to rest your head on and a back brace to support your back.
Throw on a pair of headphones, simply stare out the window at the wonderful scenery passing by, and drift off into your own place of contentment.

Well, hopefully you find these tips helpful as you treat back pain during your summer vacation car ride.

If you have any tips that you would like to add, feel free to let us know in the “Comments” section.

With that said, be on the lookout for next week’s tip on dealing with back pain on plane rides to your summer vacation hot spot.

Fibromyalgia Treatment, Savella, Now Available on Market

cmaynard — Wed, 17 Jun 2009 06:23:38 -0700

June 17, 2009
by: Sylvia Marten

In January 2009, the U.S. Food and Drug Administration (FDA) approved Savella (milnacipran HCl) for the management of [url:700,type=|node|,content=|fibromyalgia|], a muscular pain syndrome known for producing generalized back pain and muscle pain, general feelings of fatigue and specific tender areas.

Savella is now available to consumers by prescription only. It became commercially available in late April. With an estimated six million Americans affected by fibromyalgia each year, Savella is the third FDA-approved medication for this condition behind:

[url:6763,type=|node|,content=|Lyrica (Pregalabin)|], which was approved in June 2007; and
Cymbalta (Duloxetine HCl), which was approved in June 2008.

While it is unknown how Savella specifically improves the conditions of fibromyalgia, it does inhibit the reuptake of neurotransmitters serotonin and norepinephrine (more so).

Some research has found that norepinephrine, believed to be responsible for feelings of joy, is low in people with fibromyalgia, which is often associated with symptoms of depression. While Savella does not treat depression, it acts like an antidepressant, according to its Medical Guide.

Earlier this year the FDA granted approval of Savella after it statistically showed improvements in pain, global assessment and physical function for more than 2,000 patients with fibromyalgia in two U.S. pivotal phase III clinical trials.

For more on Savella, visit: the official Savella website.

Be sure to check out the Spine-health blog for the latest information and findings on Savella.

Sources: FDA Drug Details for Savella; Forest Laboratories, Inc. Press Release for Savella

More Information on This Topic:

[url:844,type=|node|,content=|Fibromyalgia Symptoms|]
[url:846,type=|node|,content=|Fibromyalgia Diagnosis|]
[url:854,type=|node|,content=|Fibromyalgia Medications|]
[url:851,type=|node|,content=|Fibromyalgia Alternative Treatments|]

Doctors are Using Placebos More: About Half Prescribe Placebos, 60% Believe It's Ethically Acceptable

Ben Parr — Fri, 24 Oct 2008 10:56:04 -0700

By: Ben Parr
October 24th, 2008

A new survey published in the British Medical Journal has uncovered some very interesting data on how physicians view and use placebos.

1200 practicing internists and rheumatologists in the United States were surveyed. Of those 1200, 679 doctors responded, and the results have created some talk amongst the news. Here are some of the most interesting information the survey uncovered:

62% of physicians believe that the practice of prescribing a placebo (giving a patient a treatment that has no theraputic benefit while allowing the patient to believe there is one) is ethically permissible.
When prescribing placebos, doctors usually give a patient over the counter [url:6033,type=|node|,content=|analgesics|] (41%), vitamins (38%), and sometimes antibiotics or sedatives (13% each)
Doctors usually describe the placebo as potentially beneficial medicine or a treatment not usually associated with their condition (68%)
Only 5% of physicians explicitly describe them as placebos

The numbers are surprising for a lot of people. Some doctors believe that this is not a cause for alarm - patients may feel better "taken care of" or may receive other benefits from vitamins or analgesics. Others physicians have voiced concern that prescribing sedatives or antibiotics can have unintended consequences to patients.

Regardless, this survey may be highlighting a new trend in health.

Posted by: Ben Parr

Source: Prescribing "placebo treatments": results of national survey of US internists and rheumatologists, British Medical Journal, 23 October 2008.

Additional Reading:

1) [url:1917,type=|node|]

2) [url:6033,type=|node|]

3)[url:1906,type=|node|]

Fibromyalgia: Cortisol May Help

Stephanie — Thu, 20 Mar 2008 08:53:23 -0700

March 20, 2008
by: Stephanie

New research shows that [url:700,type=|node|,content=|fibromyalgia symptoms|] of pain and fatigue may be alleviated by administration of Cortisol, a naturally occurring hormone in the body.

Kent Holtorf, MD, Medical Director of the Holtorf Medical Group Center for Endocrine, Neurological and Infection Related Illness, has concluded that most patients diagnosed with fibromyalgia and/or chronic fatigue syndrome have abnormal adrenal function (based on a review of 50 published studies that assessed adrenal function in this patient population).

Doctor Holtorf's study, recently published in the Journal of Chronic Fatigue Syndrome, demonstrated that patients that were given cortisol as part of a multi-system treatment experienced significant improvement in their symptoms, including reduced pain and more energy.

Dr. Holtorf's research was confirmed in an observational study he conducted that followed 500 patients from his clinic, where all of the patients were given cortisol as part of their treatment protocol:

94% showed improvement by the fourth visit;
75% noted significant improvement;

As shown in the study published in Journal of Chronic Fatigue Syndrome, cortisol doses of 5-to-15 mg a day were shown to have little or no associated risk while having the potential for significant benefit for patients with fibromyalgia or chronic fatigue syndrome.

Source:

PRNewswire

Read more:

Fibromyalgia Message Boards

Posted by: Stephanie

How to Prevent Osteoporosis with a Once-a-Year Injection

spine-health — Tue, 04 Dec 2007 13:58:39 -0800

December 4, 2007
by: Sylvia Marten

The need to take a once-a-day or even once-a-month osteoporosis medication may soon be eliminated. Recent studies indicate that a once-a-year osteoporosis injection of zoledronic acid like Reclast® can prevent spine fractures and hip fractures from [url:141,type=|term|]. In a 3-year study conducted by the manufacturer of Reclast®, Novartis, it was determined that there was a 70% reduction of spine fractures and 40% reduction of hip fractures in a group of 7,736 postmenopausal women.

Reclast® - now approved by the FDA - is a [url:699,type=|node|,content=|bisphosphonate|], a class of drugs that is used to treat [url:141,type=|term|,content=|osteoporosis|]; a class that also includes medications such as Boniva, Fosamax and Actonel. According to the FDA, more than half of postmenopausal women on daily or weekly biphosphonates will discontinue osteoporosis treatment after one year, leading to a higher risk of fractures. Given as a 15-minute infusion, the Reclast® (zoledronic acid) injection for osteoporosis has the benefit of long-lasting protection.

Reclast® was originally used in the treatment of metastatic bone cancer and was found to have positive impact on bone density, reducing the degenerative effects of [url:141,type=|term|,content=|osteoporosis|].

Osteoporosis is a degenerative bone disease in which one's bone density is reduced over time. It is a silent disease, and most sufferers of osteoporosis do not know that the condition exists until they experience a [url:930,type=|node|,content=|spinal fracture|] or hip fracture. Postmenopausal women are at the [url:699,type=|node|,content=|highest risk for osteoporosis|], but osteoporosis can affect anyone, especially individuals over the age of 40 and those who do not have enough calcium in their diets.

Some physicians noted a minor risk of atrial fibrillation, a potentially dangerous cardiac rhythm disorder, when taking zoledronic acid intravenously. However, in the 3-year study, there was not a significant increase in mortality or morbidity. It is always a good idea to discuss any [url:922,type=|node|,content=|osteoporosis medication|] risks with your physician prior to treatment.

Source: Novartis Pharmaceuticals, Inc.

Additional Reading:

[url:930,type=|node|]

[url:934,type=|node|]

[url:926,type=|node|]

[url:6021,type=|node|]

[url:6027,type=|node|]

Resources:

Novartis Reclast Website

ABC News: Experts Speak Out: Once-a-Year Injection for Osteoporosis

Health24.com: Once a Year Jab vs. Osteoporosis

Associated Content: Once-a-Year Injection to Replace Traditional Osteoporosis Drugs

National Osteoporosis Foundation

FDA Bisphosphonate Safety Review

read more

Is Your Pain Medication Prescribed Off-Label?

Mon, 01 Oct 2007 14:46:35 -0700

October 1, 2007
by: Sylvia Marten

Experts estimate that 21% of prescriptions for common drugs are written for off-label uses. According to a study on Off-Label Prescribing published in the Archives of Internal Medicine, three-fourths of those prescriptions were for off-label uses that lacked scientific support. What's going on?

First, let's talk about what we mean by on "label" drugs. In the U. S. , the FDA requires that drug makers submit, test and get approval from the FDA for specific uses of their product before the product can ever be marketed. To obtain approval, pharmaceutical manufacturers must submit extensive study data demonstrating safety and effectiveness, a process which usually takes several years and millions of dollars. When a product is approved by the FDA, a specific "label" for that product is approved too. The label must include the product's approved indications, dosage and method of administration, and use in specific populations.

So, what is "off-label"? After the FDA approves a drug for its specific use, physicians can prescribe the product for uses not covered by the approved label. This is "off-label" use. Off-label uses include:a drug prescribed to patients with conditions not listed on the approved label; departure from the approved drug dosage, method of administration, or patient population; and unapproved product combinations, such as using two different drugs to treat a single condition. This practice is perfectly legal but it lacks any kind of oversight.

"Off-label" drugs for back pain. Among the types of drugs commonly prescribed off-label, most common were heart drugs and anti-convulsants (indicated for seizures). For example, gabapentin, brand name Neurontin, had one of the highest proportions of off-label use among specific medications, namely for neuropathic pain (it is only indicated for use in controlling epileptic seizures and in pain from post-herpetic neuralgia). Neurontin also happens to be a quite commonly prescribed drug for people diagnosed with chronic back pain or chronic low back pain. This of course means the drug is being prescribed off-label in the back pain patient population.

Patients should always consider carefully all medications that are prescribed to them. It is fair for patients to ask their doctors whether a prescription is on or off-label, and this can be easily and more thoroughly researched on reliable health information websites that address medications, such as MedlinePlus, the FDA, or condition-specific sites. If off-label, it is important to know whether there is sufficient data to support its use or if the practitioner's decision is based on anecdotal evidence. The patient should weigh off-label recommendations against the alternatives with his/her practitioner, and ultimately decide if he/she is comfortable with an off-label drug for the specific health issue being addressed. It is important for patients to keep in mind that a drug prescribed off-label to them is a drug that has not been approved by the FDA for some element of their specific health situation.

Is "off-label" drug prescribing good or bad? There isn't a clear cut answer. Anecdotally, many of my colleagues and personal circle of friends have experienced off-label drug use with positive results. For example, our children have been prescribed albuterol for various severe pulmonary episodes (not asthma, for which it's indicated) with much success. The Spine-health.com message boards are full of stories of people taking medications off-label for back pain or [url:887,type=|node|,content=|leg pain|] as prescribed by their doctors, with many experiencing much needed pain relief not possible with approved drugs. So, off-label use can be positive in that it expands access to important health benefits that may not be possible with alternatives. On the flip side, concerns and warning bells should go off with respect to safety and the long-term impact of a drug use that has not been extensively studied.

The study authors cited several reasons as to why the high percentage of off-label prescribing is occurring, with some reasons being legitimate and others not. The practice itself raises issues that require addressing, including a better/faster process for getting legitimate additional uses for a drug indicated, but also for ensuring patient safety for patients dutifully following an off-label treatment protocol as prescribed by physicians they trust.

Posted by: Sylvia

Additional reading:

[url:1921,type=|node|]
[url:1948,type=|node|]
[url:808,type=|node|]

Consumer Reports for Pain Medications?

Fri, 14 Sep 2007 17:03:48 -0700

September 14, 2007
by: Sylvia Marten

Sure. Savvy consumers often look to the expertise of Consumer Reports before buying a car, a washing machine, or a video camera. But what about for pain medications?

Well, Consumer Reports is also in the medication rating business and has issued another report in their free medication series that covers drugs for Nerve Pain and Fibromyalgia.

What I like about the report is that it’s peer-reviewed by medical experts, combines effectiveness, safety/risk, and pricing information, and is written for consumers. [Note: the information has not been affirmed by Spine-health.com’s medical board and you’ll need to check with your doctor anyway regarding any information in there.]

For someone newly diagnosed with a condition or if your doctor is recommending switching to a new medication, it may be helpful to make a pit stop and review a report like this. Particularly for people with chronic pain conditions who may need to take a pain medication for an extended period of time, the reality of cost has to be part of the equation of managing the condition. Physicians are often more focused on the pain problem and may be less attuned to cost differences when there is a choice of drug.

Additional resources:

[url:1915,type=|node|]
[url:137,type=|term|,content=|Chronic Pain Health Hub|] – for a variety of pain relief options (not just pain meds)
[url:830,type=|node|,content=|Depression Guide|]

14 Natural Pain Relievers

Thu, 09 Aug 2007 14:41:12 -0700

August 9, 2007
by: Stephanie

Many who live with chronic back pain would really love to be less dependent on painkillers to manage their pain. But how? Natural pain relievers may be the answer. Here’s a list that might help – each of these won’t be for everyone, but any number of these natural pain relievers might help you be able to rely less on pain medications and feel more in control of your life.

Release your inner endorphins. These natural chemicals block pain signals from reaching your brain. Endorphins are the body's natural pain relievers, and they can be as strong as many of the strongest pain relievers. Endorphins also help alleviate anxiety, stress and depression -- conditions that often accompany and exacerbate chronic pain. The body produces endorphins during aerobic exercise. A “runner’s high” is not just for those running long distances -- any activity that gets your blood pumping for a sustained period will release pain relieving endorphins into your system.
Find good company. Those who have regular contact with others dealing with similar forms of chronic pain find that their pain becomes more manageable. An online group that is both active and supportive is best. Members of the Spine-health.com Back Pain and Chronic Pain discussion forums say that it is quite simply “free therapy”.
Eat cookies. Research shows that eating sweet foods like cookies, chocolate or ice cream, helps reduce the sensation of pain.
Or just bake the cookies. Enjoying a smell that is both sweet and pleasant has been shown to reduce the [url:6637,type=|node|,content=|perception of pain|].
Feel the heat. Applying some form of heat -- a hot water bottle, gel-filled pad heated in the microwave, electric heating pad, or hot bath -- can go a long way in easing your pain. [url:1662,type=|node|,content=|Benefits of heat|] are twofold: it increases the flow of healing oxygen and nutrients to the damaged area, and it suppresses pain signals being sent to your brain. Some find that wearing a heat wrap, such as Thermacare heat wrap, is best because it releases a low level heat for several hours and can be worn under clothes so you remain mobile.
Cool it with ice. Ahh, how this cools down inflamed and sore tissues. Back pain almost always comes with some level of inflammation, and ice is the best natural way to reduce it. [url:1664,type=|node|,content=|Ice|] also helps by acting as a local anesthetic, and by slowing the nerve impulses, which in turn interrupts the pain-spasm reactions between the nerves in the affected area.
Loosen up. Almost everyone can benefit from [url:1186,type=|node|,content=|stretching the soft tissues|] - the muscles, ligaments and tendons - in and around the spine. Your back is designed for movement, and if your motion is limited it can make your back pain worse. If you suffer from chronic back pain, you may find it takes weeks or months of stretching to loosen up your spine and soft tissues, but you will find that meaningful and sustained pain relief will follow the increase in motion.
Enjoy the outdoors. People who got the recommended daily 400 to 800 IU of vitamin D experienced less pain than those who didn’t, according to a Boston University study of 221 men and women with [url:969,type=|term|,content=|knee osteoarthritis|]. Researchers surmised that Vitamin D helps relieve pain by aiding in the absorption of calcium, which is needed for bone growth and repair. Other research shows vitamin D may directly help soothe pain. 93% of 150 people with unexplained sources of pain were recently found to be deficient in Vitamin D levels, according to recent research at the University of Minnesota. About 15 minutes of sun exposure on your face and hands a day is enough to get your daily dose of D, or a 200-IU supplement of Vitamin D and as much calcium as is found in two glasses of milk.
Imagine yourself to a better place. Guided imagery allows you to hear and internalize therapeutic suggestions that help you feel better. In one study of 28 women with osteoarthritis pain, half of the women listened to a 10- to 15-minute recorded script twice daily that guided them through muscle relaxation techniques. On average, women in the guided imagery group reported that their pain eased by 18% and that their mobility improved by 13%; vs. those in the control group who experienced a 16% worsening of pain and a 2% decrease in mobility. Guided imagery can be learned with a practitioner or on your own using audiotapes or CDs.
Change your inner thinking. Hypnosis involves influencing the subconscious mind in order to change your inner thinking, thereby enabling you to change the way you view pain and assisting in the your body’s healing process. The human body has an infinite capacity for healing, and this is just one technique that many find helpful.
Meditate twice daily. Easy to learn and immediate results make this one of my favorite paths to natural pain relief. Meditation comes in a huge variety of forms --some complex, some simple. My personal favorite is just to find a sound that is pleasing to you but has no particular meaning (my sound is “som”), close your eyes, sit (or lie) still and comfortably, and repeat the sound in your mind. When your thoughts wander, notice that they have wandered and return to your sound. If you feel your pain, notice the pain and return to your sound. Start with a few minutes, and gradually lengthen to thirty minutes. You will find yourself refreshed and reinvigorated, with less pain overall. Meditation can also help reduce the depression, anxiety, stress and sleeping problems that often accompany chronic pain.
Realign your energy flow.The mechanism of action for the ancient Chinese healing technique of acupucture is still not completely understood, but it has been proven in medical trials to reduce certain types of chronic pain, including [url:1358,type=|node|,content=|back pain|]. The American Association of Oriental Medicine has a list of trained acupuncturists. P.S. the needles are super-thin and not painful.
Get enough restorative sleep. Getting enough sleep is critical to managing the pain and healing, so it’s important to employ a variety of [url:1927,type=|node|,content=|sleep aids|] to help you get a healthy amount of sleep. Regular exercise that physically exhausts the body is the best way to promote deep sleep. Visualization, meditation, and other psychological techniques can also help you get to sleep and stay asleep. And don’t forget the power of naps.
Enjoy a massage. In my book, nothing beats a good [url:1287,type=|node|,content=|therapeutic massage|]. It gets the blood flowing, which helps nourish and heal the body, and releases endorphins, which release powerful pain relieving substances in the body (see first point on the list).

Any more thoughts on natural pain relievers? Please share what has worked for you!

Posted by: Stephanie

Sources:

Also see: [url:830,type=|node|]

New Research on Interlaminar Epidural Steroid Injections for Back Pain and Sciatica

Fri, 03 Aug 2007 14:50:58 -0700

August 3, 2007
by: Sylvia Marten

It should be noted that interlaminar epidural injections are different than transforaminal epidural steroid injections (also called spinal nerve blocks) and that transforaminal epidural steroid injections have been shown to be effective for sciatica in clinical trials.

The effectiveness of lumbar interlaminar [url:6010,type=|node|,content=|epidural steroid injections|] for treatment of lower back pain and sciatica continues to be a hotly debated topic.

Some physicians view epidural steroid injections as an important pain relief treatment option for many patients with severe lower back pain that radiates down the leg. They would argue that, while it doesn’t work for everyone, an epidural steroid injection is one of the only non-surgical options that can provide almost immediate pain relief for severe sciatica. Others view the recent reviews as evidence that interlaminar injections should not be performed.

As always, the devil is in the details, and significant details are left out of the clinical trial reviews. Most notably:

The injection protocol in the studies cited do not include the use of fluoroscopy or x-ray to verify proper placement of the medication, despite the fact that fluoroscopic guidance is an important factor in the success of the procedure and is routinely used today.
Most of the studies do not classify patients according to diagnosis and tend to 'lump' different types sources of pain together.

"These methodological flaws are considerable and make it difficult to impossible to draw conclusions from the studies. More clinical studies are needed to properly define the role of epidural steroid injections in low back pain and in sciatica" states Ray Baker, MD, a pain management physician in Bellevue Washington and Medical Advisor for Spine-health.com.

Until more definitive and reliable research is available, patients are advised to make sure that they:

Enlist the services of professionals with extensive experience in doing epidural steroid injections
Always use fluoroscopy to ensure accurate placement
Follow the generally accepted guidelines of limiting the number of [url:168,type=|term|,content=|injections|] to a maximum of three within any one-year period

Sources:

American Academy of Neurology
[url:168,type=|term|]

How Pain Killers Sometimes Increase Chronic Pain

spine-health — Tue, 10 Jul 2007 13:55:33 -0700

July 10, 2007
by: Stephanie

Becoming addicted to pain medication is a disease. This is because the painkillers (e.g. Vicodin, OxyContin, Norco, Hydrocodone) -- commonly prescribed by physicians to treat pain -- cause a [url:1924,type=|node|,content=|change in your brain chemistry|] that is not under your control.

Physical impact of pain killers

Doctor Clifford Bernstein, a pain management physician and author on Spine-health.com clearly outlines how these pain medications physically affect the body:

The brain responds to the pain medicine by increasing the number of receptors for the drug, and the nerve cells in the brain stop functioning
The body stops producing endorphins (the body's natural painkillers) because it is receiving opiates instead
The degeneration of the nerve cells in the brain causes a physical dependency on an external supply of opiates, and reducing or not taking the pain killers causes a painful series of physical changes, known as withdrawal.

At this point many people (an estimated 7% who are prescribed narcotic analgesics) continue taking the pain medication to avoid the withdrawal symptoms rather than to treat the original pain. When this occurs the person is dependent on or addicted to the prescription pain medicine.

Pain killers may actually increase pain

Most people do not know that taking painkillers over a long period of time may in fact increase a patient’s sensitivity to pain (hyperalgesia). This happens because long term use of opiate painkillers causes a decrease in your ability to tolerate pain, and an increased sensitivity to pain. When the pain increases, people are often led to believe they need to take higher doses of pain medication than they were on initially.

For those who are addicted to narcotic pain medications, a detoxification program is often needed. Pain killer addiction is a chemical, physical disease, one that requires expert medical treatment in a safe, humane environment.

Posted by: Stephanie

More resources:

[url:137,type=|term|]
[url:830,type=|node|]

Lyrica Helps with Restorative Sleep

spine-health — Mon, 02 Jul 2007 14:26:41 -0700

July 2, 2007
by: Stephanie

Just read about an interesting study that showed that Lyrica (pregabalin) helped the participants get more restorative sleep, not just fall asleep faster. Thanks to Dr. Steven Poceta, a neurologist, who explains on his Revolution Health blog:

"Slow wave sleep is deep—hard to wake up from—it is highly conserved and the first to recover after sleep deprivation, and it is the stage in which growth hormone is secreted in children. Slow wave sleep seems to diminish as we age. In some ways, slow wave sleep is the “holy grail” of sleep disorders. Getting more of it is always better (more restorative), just like getting younger."

He also hypothesizes that Lyrica's ability to increase slow wave sleep may explain its effect on helping people with fibromyalgia pain.

As those with [url:137,type=|term|,content=|chronic back pain|] know all too well, the problem isn't just getting to sleep but staying asleep long enough to wake up restored and refreshed.

Let's hope that the scientific community continues to produce and refine agents that will help people with chronic pain get sleep in long enough stretches - true restorative sleep - in order to help them heal.

Posted by: Stephanie

Additional reading:

[url:1318,type=|node|]
[url:6629,type=|node|]

Lyrica Approved to Treat Fibromyalgia

spine-health — Mon, 25 Jun 2007 14:14:57 -0700

June 25, 2007
by: Stephanie

On June 21 the FDA approved Lyrica (pregabalin) as the first drug specifically indicated to treat pain from fibromyalgia. Lyrica is an analgesic (pain relieving) and anit-convulsant medication that is also approved to treat [url:137,type=|term|,content=|chronic pain|]. The study results submitted to the FDA for approval showed that 30 to 60% of study participants experienced significant pain relief with Lyrica.

It is not known exactly how Lyrica works to reduce pain in patients with fibromyalgia. It is thought that the drug may effect how neurotransmitters (chemicals in the brain) transmit signals from one neuron to another.

The data submitted to the FDA were from two randomized, placebo-controlled trials of about 1800 adults. These trials showed that treatment with Lyrica in doses of 300-450 mg per day reduced pain and improved function in patients with Fibromyalgia, and symptoms became worse when the people stopped taking Lyrica.

There are a number of potential risks and side effects with Lyrica, including but not limited to dizziness and sleepiness, blurry vision, impaired motor function, weight gain, trouble concentrating, swelling of the hands and feet, dry mouth, and potential allergic reactions. Side effects, which are somewhat correlated with dosage, may be significant and impair one's ability to drive.

Source:

FDA website - lyrica approval

FDA consumer health information

Posted by: Stephanie

Pain management physicians accused of drug pushing

spine-health — Mon, 18 Jun 2007 13:31:07 -0700

June 18, 2007
by: Stephanie

KevinMD brought to my attention an interesting article in the New York Times about treating [url:137,type=|term|,content=|chronic pain|] - especially through the use of opioids.

Examples of opioids commonly prescribed to treat back pain and other forms of chronic pain include OxyContin, Dilaudid, Vicodin, Percocet, oxycodone, methadone or morphine.

The article quotes research findings that as many as 50% of patients with chronic pain do not get adequately treated for the pain from their physicians. Why? The article postulates a number of widespread factors, such as fear (among both the public and medical community) of [url:1924,type=|node|,content=|addiction|].

The point that surprised me most was an increase in physicians' fear of being prosecuted for prescribing opioids. In 2006, the DEA opened 735 investigations of doctors regarding their drug prescriptions, and just being investigated can ruin a doctor.

The article states "an investigation alone can be enough to put a doctor out of business, as doctors can lose their licenses and practices and have their homes, offices and cars seized even if no federal criminal charges are ever filed. 71 doctors were arrested last year for crimes related to “diversion” — the leakage of prescription medicine into illegal drug markets."

A compelling discussion.

Posted by: Stephanie

Source: When is a Pain Doctor a Drug Pusher? - New York Times

How Chronic Back Pain Gets Stuck in Your Brain

spine-health — Fri, 15 Jun 2007 18:16:59 -0700

June 15, 2007
by: Stephanie

Dr. Vania Apkarian, a professor at the Northwestern University Feinberg School of Medicine, published a study last year that revealed how chronic back pain actually registers in a different part of the brain (the prefrontal cortex) than acute pain (the thalamus). Dr. Apkarian also found that the longer a person has been suffering from chronic pain, the more activity there was in the prefrontal cortex. He was able to accurately determine the number of years the person had experienced back pain just by reading the MRI scan - the scans showed a cumulative tape of how much pain the brain had registered.

Basically, Dr. Apkarian has identified that with chronic pain there appears to be an old memory that essentially gets stuck in a rut in the prefrontal cortex - the part of the brain that governs emotions and learning. Even after the injury/original problem that caused the pain is healed, the brain seems to keep remembering the problem and can't forget it.

More recently, in a follow-up study using laboratory rats, Dr. Apkarian has found that the drug D-Cycloserine seems to help erase or at least dampen that memory. The rats in the study who had [url:137,type=|term|,content=|chronic pain|] from an injured limb seemed to be pain-free after 30 days of treatment with the drug.

The findings have been published in the online version of the journal Pain. Plans are in the works to start a clinical trial.

If this drug works in humans, it would be a very exciting development for many of those coping with chronic back pain.

Posted by: Stephanie

More resources:

Debate About Use of Opioids for Chronic Pain

spine-health — Mon, 11 Jun 2007 14:56:52 -0700

June 11, 2007
by: Stephanie

Excellent point-counterpoint discussion of the effectiveness vs. risks of using opioids for chronic pain (non-malignant), with Dr. Donnell voicing his strong concerns about too much reliance on opioids.

The main criticisms seem to be the lack of scientific studies about the effectiveness of using narcotic pain killers to treat chronic pain, and not enough discussion about the known risks - including a 10 - 16% chance of addiction.

Posted by: Stephanie

Additional reading:

[url:1924,type=|node|,content=|Pain Killer Addiction Treatment|]
[url:1931,type=|node|,content=|Chronic Pain Management - Patients' Advice|]

Pain Medications

Opioid Prescription Dangers Reinforced in Recent Study

Study Relevance to Back Pain Doctors and Patients

"Off-Label" Drug Confusion Can Impact Back Pain Patients

So What Did the Survey Reveal?

Patient Considerations with "Off-Label" Drug Usage

More on this Topic

New Study Highlights Antidepressant Use for Back Pain and Sleep Problems

Important Considerations with Antidepressants and Pain Medications

What Back Pain Patients Should Know about Stop-Smoking Drugs Chantix and Zyban

Pain Killers Scrutinized after Shocking Death of Michael Jackson

9 Quick Back Pain Tips for Airplane Rides

Top 7 Back Pain Treatments for Summer Vacation Car Rides

Fibromyalgia Treatment, Savella, Now Available on Market

Doctors are Using Placebos More: About Half Prescribe Placebos, 60% Believe It's Ethically Acceptable

Fibromyalgia: Cortisol May Help

How to Prevent Osteoporosis with a Once-a-Year Injection

Is Your Pain Medication Prescribed Off-Label?

Consumer Reports for Pain Medications?

14 Natural Pain Relievers

New Research on Interlaminar Epidural Steroid Injections for Back Pain and Sciatica

How Pain Killers Sometimes Increase Chronic Pain

Lyrica Helps with Restorative Sleep

Lyrica Approved to Treat Fibromyalgia

Pain management physicians accused of drug pushing

How Chronic Back Pain Gets Stuck in Your Brain

Debate About Use of Opioids for Chronic Pain