Tag Archives: pain

Quick Hits: Americans Open to Non-Drug Pain Treatments, Psychiatric Drugs’ Impact on Cognition & More

More than three-quarters of Americans — 78% — say they are willing to try non-drug alternatives for pain before turning to prescription painkillers. Results from the Gallup-Palmer College of Chiropractic Annual Study of Americans show that 40% of Americans consider prescription painkillers such as opioids a “crisis” or “very serious problem.” And 55% of those who know about the nation’s opioid epidemic place some of blame on the drug industry’s encouraging physicians to prescribe opioids. Another 53% place a lot of blame on doctors overprescribing painkillers to patients. About 23% of those polled said prescription pain meds such as opioids are not very safe, and 8% said opioids are not safe at all. In 2015, more than two-thirds of the opioid deaths reported involved prescription opioids such as oxycodone, hydrocodone, morphine and fentanyl. Posted Sept. 13, 2017. Via Gallup.

Taking high doses of antipsychotic drugs over an extended period may be associated with poorer cognition in schizophrenia. However, taking low doses of antipsychotics such as benzodiazepines and antidepressants over a long time doesn’t affect cognition, according to a new study published in the journal European Psychiatry. The research also found that schizophrenia patients who took a long break from using antipsychotic drugs tended to see their cognitive function improve. Posted Sept. 5, 2017. Via EurekAlert/European Psychiatry.

Women who take antiepileptic drugs (AEDs) during pregnancy have a higher risk of having premature babies or babies that have a low birth weight for their age in the womb. Women with epilepsy who took AEDs while pregnant had a 9.3% increased risk of having a premature baby, while women without epilepsy who took an AED had a 10.5% increased risk, according to results published in the Annals of Neurology. Women who did not take a medication and didn’t have epilepsy had only a 6.2% increased risk of a premature baby. Compared to women who didn’t take an AED and didn’t have epilepsy, women with epilepsy who took one of the drugs gave birth to a child with a mean lower birth weight of 3.9 ounces. For women who took an AED and didn’t have epilepsy, the figure was 4.8 ounces. Common AEDs include Lamictal (lamotrigine), Topamax (topiramate), Tegretol (carbamazepine), Keppra (levetiracetam) and Neurontin (gabapentin). Posted Sept. 11, 2017. Via Medical Express/Annals of Neurology.

Half of Americans Misusing Prescription Drugs, Opioids

Over half of Americans are misusing their prescription drugs — such as taking too much of a drug they are prescribed or taking medications that they are not prescribed — including powerful opioid painkillers, according to a new study examining patient lab tests.

Quest Diagnostics examined more than 3.4 million lab tests taken between 2011 and 2016 involving prescription medications and found that 52% of Americans are misusing them, such as not taking a drug according to their doctor’s orders. Essentially, “every other American tested for inappropriate use of opioids and other prescription drugs,” F. Leland McClure, PhD, a director at Quest, said in a statement.

Last year, more than 33,000 specimens were tested by Quest for opioid, benzodiazepine (a type of tranquilizer medication) and alcohol use last year. Results showed that more than 20% of those tested were positive for both opioids and benzodiazepines, 10% were positive for taking opioids and alcohol, and 3% were positive for taking all 3. Because opioids and benzodiazepines can slow down the body’s central nervous system, when taken together, trouble breathing, heart problems and even a risk of fatal overdose are possible.

Research showed that drug misuse was prominent in all age groups and among both genders. On the bright side, adolescent drug misuse dropped from 79% to 29% from 2011 to 2016. Also, in 2011, drug misuse in samples was 63%. That figure dropped to 52% in 2016.

About 20% of the lab specimens that tested positive for heroin also tested positive for the presence of fentanyl, a power opioid painkiller, that wasn’t prescribed to the patient. Taking heroin and fentanyl together greatly increases the risk for drug overdose and death.

These results are concerning because, according to the study, “treatment of pain, especially chronic pain, is a major challenge for medical professionals, and opioids can provide significant relief for some patients.”

“It appears from our analysis that many patients may be at risk of overdose or other adverse health effects caused by concurrent use of opioids including fentanyl and other drugs such as benzodiazepines,” Jeffrey Gudin, MD, medical advisor for Quest, said in a statement.

Overprescribing: Do You Really Need to Take That Med?

Do you take 4 pills a day? If so, you’re like most Americans. Yet what are we taking all these pills for, and are they improving our lives?

The overuse of prescription drugs has become a serious problem in the US. We hear about this most in the context of opioids — narcotic painkillers whose widespread use and abuse has become a national crisis.

The overuse of antibiotics has also become the focus of an intensive campaign to steer doctors and patients to more judicious use.

The soaring use of prescription drugs has been driven by several factors: A plethora of new drugs coming to the market; a culture that has come to expect a “pill for every ill”; aggressive marketing to both doctors and consumers by the pharmaceutical industry; and treating some “pre-”diseases with pills rather than with lifestyle changes.

Between 1997 and 2016, the number of prescriptions filled in the US increased 85% — from 2.4 billion to 4.5 billion — even though the population increased by just 21%. Nearly half (49%) of adults take at least 1 prescription drug, 23% take 3 or more and about 12% take 5 or more, according to the latest data from the CDC (Centers for Disease Control and Prevention). One in 10 adults takes 10 or more drugs, and the average adult takes 4 prescription medications, according to a Consumer Reports survey of 1,947 adults conducted in April.

What can you do to make sure you’re not getting a drug you don’t need and to avoid harm?

Ten “secret shoppers” were sent to 45 drugstores across the US in a recent Consumer Reports investigative study. The shoppers were testing how well pharmacists identified potential problems with drugs.

Of course, it’s your doctor who should be your main consultant on the medicines you take. But bring a big measure of skepticism to your doctor visits: The evidence is now clear that they can be a part of the problem.

Based on the secret shoppers’ findings and more than a decade of Consumer Reports’ grant-funded Best Buy Drugs program, we have compiled a list of drugs that you should use special caution with when prescribed by your healthcare provider.

(For more detailed information, check out Consumer Reports’ September 2017 cover story and the physician-led Choosing Wisely program.

Abilify and Seroquel for Dementia or ADHD

These powerful antipsychotics have potent sedative effects and can be downright dangerous. Studies over the last decade show they have been overprescribed in general and particularly for elderly people with dementia.

The FDA and other healthcare and physician organizations now advise against their use entirely in elderly people. Multiple studies over many years have found an increased risk of death in elderly people prescribed these drugs.

Abilify (aripiprazole) and Seroquel (quetiapine) are also overprescribed to treat children and adults with attention-deficit/hyperactivity disorder (ADHD). The two drugs are not even approved for this condition. Their use to treat ADHD is not advisable unless a person is diagnosed with other psychiatric conditions, such as bipolar disorder. And even then, caution is warranted. Behavioral therapy is a better initial treatment for ADHD.

Advil, Aleve, Celebrex and Any Opioid for Back and/or Joint Pain

The non-steroidal anti-inflammatory drugs (NSAIDs) Advil (ibuprofen), Aleve (naproxen) and Celebrex (celecoxib) are commonly prescribed to treat back and joint pain (and headaches, of course). Short-term use — up to 10 days — is fine at the lowest dose that helps.

But long-term use — which is all too common — is ill-advised because all these drugs can cause bleeding in the intestines and stomach, and increase the risk of heart attack and stroke (especially at higher doses).

Opioids should simply never be a first-line treatment for either chronic back pain or garden-variety periodic back pain (“I threw my back out” kind of pain). The risks are too high. The side effects include drowsiness, sedation, nausea, vomiting, constipation, addiction and overdose. Instead, try yoga, swimming, gentle stretches, tai chi, massage, physical therapy, acupuncture or heat.

For intense pain flare-ups (pain in the range of 8 to 10 on a 10-point scale), an opioid can be useful, but it should be prescribed at the lowest dose that’s effective and for the shortest time possible, like a day or 2. And never more than a week to 10 days.

Celexa, Cymbalta, Lexapro and Prozac for Mild Depression

Antidepressants are overprescribed for people who have mild or so-called “situational” depression — that is, depression triggered by a life event such as a death in the family, job loss, divorce or breakup, accident, trauma or diagnosis with a serious health condition.

You don’t need a pill if these life events befall you. Social support, time and psychotherapy or counseling almost always help. Also, be sure to exercise and perhaps try meditation and/or yoga. For the vast majority of people who have situational depression, the symptoms lift within a few weeks to a couple months.

Nexium, Prevacid and Prilosec for Heartburn

These drugs, called proton-pump inhibitors (PPIs), reduce stomach acid. They were designed to treat a condition called gastroesophageal reflux disease (GERD). But they are greatly overprescribed for common, uncomplicated heartburn, which most of the time can be just as effectively treated with over-the-counter (OTC) products such as Maalox, Pepcid AC, Tums or Zantac 75.

The problem with taking PPIs is that they carry serious risks — a few of which were not fully appreciated until a few years ago. These include a reduction in the body’s ability to absorb certain nutrients and medications, along with an increased risk of gastrointestinal and other infections.

Instead, as a first-line treatment, eat smaller meals, don’t lie down soon after eating, lose excess weight, and avoid acidic or greasy meals that trigger heartburn.

If heartburn occurs twice weekly or more for 4 weeks or longer despite the above diet and lifestyle changes, then you might have damaged your esophagus. Check with your doctor, and if GERD is diagnosed, it would be appropriate to take a PPI for a few months while your esophagus heals.

Ambien, Belsomra and Lunesta for Insomnia

These strong sleeping pills are way overprescribed for people who have insomnia triggered by a life event, as well as for people who have chronic insomnia.

If you find yourself in the first group, try an OTC sleep aid containing an antihistamine, but not for longer than a few days. People with chronic insomnia are not helped in the long term by taking these medicines, recent evidence shows. Instead, try cognitive behavioral therapy (CBT), where a provider teaches you good sleep habits and suggests ways to change your behavior and nighttime habits.

Prescription medicines have significant side effects and risks, including dizziness, next-day drowsiness, impaired driving, dependence, and worsened sleeplessness when you try to stop.

AndroGel, Axiron, Androderm and Aveed for Low Testosterone

Low testosterone (“low T”) is a controversial diagnosis. If you get such a diagnosis and your doctor advises you to take any of these medicines, get a second opinion.

A small percentage of men (usually in their 50s, 60s and 70s) have “low T,” but the manufacturers of these products have sought to create a condition that is not firmly established in medical literature — one marked by low energy and low sex drive due to “low testosterone.”

Don’t buy into it. The drugs can cause blood clots in the legs, sleep apnea, an enlarged prostate and possibly an increased risk of heart attack or stroke.

Instead, talk to your doctor about treating common underlying conditions that can decrease testosterone level, such as diabetes, obesity and aging. Also discuss non-drug ways to boost energy and vitality by exercising, getting enough sleep and couples therapy with your partner.

Actonel, Boniva and Fosamax to Treat Osteopenia (Low Bone Density)

These drugs, called bisphosphonates, are widely prescribed to treat a condition dubbed “pre-osteoporosis.” But there’s scientific controversy about the prevalence and impact of mildly or marginally low bone density, and whether it warrants treatment with these strong medicines.

All have side effects and carry risks, which include diarrhea, nausea, vomiting, heartburn, esophageal irritation and bone, joint or muscle pain. Long-term use has also been linked to an increased risk of fractures of the femur (thigh bone).

Before considering one of these medicines, walk more, quit smoking and try eating more foods high in calcium and vitamin D. If bone density tests show you have full-blown osteoporosis, you should consider one of these medicines. But use caution with long-term use.

Detrol and Oxytrol for “Overactive Bladder”

The sudden or frequent need to pee is frustrating and inconvenient. These medicines, called anticholinergics, are often prescribed even to people who have mild symptoms.

The drugs can cause constipation, blurred vision, dizziness and confusion. So before trying one, cut back on caffeine, soft drinks and alcohol, and watch your liquid intake overall. Also, try bladder training (slowly increasing the time between bathroom visits) and Kegel exercises — repeatedly tightening and relaxing the muscles that stop urine flow. These techniques have been proven effective.

If several weeks or months of non-drug strategies don’t provide enough relief, consider an anticholinergic.

Actos and Glucophage for “Pre-diabetes”

Pre-diabetes is a widely accepted condition (unlike “low T”), but there’s no consensus on how aggressively to treat it, or if people with it should take drugs. People with pre-diabetes have blood glucose (sugar) levels at the high end of normal.

Because these diabetes medicines have side effects and carry risks — including dizziness, fatigue, muscle pain and, in rare cases, the dangerous buildup of lactic acid and a vitamin B12 deficiency — talk to your doctor about non-drug options first, such as exercise, a diet rich in unprocessed and non-starchy foods, and weight loss.

If you develop type 2 diabetes, however, you should consider a diabetes drug.

Drugs to treat Pre-hypertension

Like pre-diabetes, pre-hypertension is an accepted condition that warrants monitoring. It’s defined as blood pressure at the high end of normal. But, also like pre-diabetes, there’s no consensus on when to treat it with drugs.

Many classes of medicines are used. They include ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers and diuretics. All are effective at lowering blood pressure but have side effects. Diuretics can cause frequent urination, low potassium levels and erectile dysfunction. ACE inhibitors and ARBs can cause high potassium levels and reduced kidney function. Calcium channel blockers can cause dizziness, an abnormal heartbeat, flushing, headache, swollen gums and, less often, breathing problems.

Unless a patient has other conditions that make the case for starting a drug, non-drug options are a better initial treatment to bring blood pressure into the normal range. Most important among them: Quit smoking, cut back on sodium and alcohol, lose excess weight, and exercise.

Belviq, Contrave, Qsymia and Xenical for Obesity

These weight loss drgs have mixed effectiveness. They work for some people and not at all for others. For patients who are significantly overweight or have diabetes or heart disease, and have been unable to lose weight through exercise and diet, one of these medicines may be worth trying.

But the drugs should not be a first-line treatment for anyone who is just 10 to 20 pounds overweight and hasn’t yet really tried lifestyle and diet changes. All have side effects that are common and can be quite discomforting. Constipation, diarrhea, nausea and vomiting are common.

The drugs also carry rare but dangerous risks, including leaky heart valves with Belviq and liver damage with Xenical.

Americans are all too often pushed — or rushed — into taking drugs too soon. Sure, lifestyle changes can be hard. But they don’t have side effects and the risks are well defined and easily avoidable. And the payoff from adopting a much healthier diet or sticking to an exercise regimen often goes well beyond addressing the medical condition at hand and improves your overall physical and mental health.

Quick Hits: Psychedelic Ecstasy Eyed for PTSD, Ibuprofen May Raise Blood Pressure, and More

The psychedelic MDMA, better known as the party drug ecstasy, could become a treatment for post-traumatic stress disorder (PTSD) after the FDA acknowledged MDMA may have therapeutic value. The agency has granted MDMA breakthrough therapy designation, an acknowledgment that the drug could provide significantly better results in treating PTSD than existing treatments. It also means that the FDA will assist researchers in accelerating the development and review of MDMA for PTSD. The Multidisciplinary Association for Psychedelic Studies (MAPS) and the FDA have also agreed on the design of 2 Phase 3 trials investigating MDMA in conjunction with psychotherapy. The trials will enroll 200-300 people with severe PTSD and compare 2 groups over a 12-week period: 1 will receive 3 administrations of MDMA as an adjunct to psychotherapeutic techniques; the other a placebo with psychotherapy. MAPS’ own prior studies showed that after 3 MDMA-assisted psychotherapy sessions, 61% of participants no longer classified as having PTSD and after 12 months, 68% didn’t have PTSD. Posted August 26, 2017. Via MAPS.
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The popular over-the-counter pain reliever Advil (ibuprofen) may increase blood pressure in patients with arthritis compared to the prescription analgesic Celebrex (celecoxib). Researchers also found that ibuprofen may possibly increase the risk of cardiovascular disease in those with rheumatoid arthritis and osteoarthritis. In a study comparing ibuprofen, Celebrex and Aleve (naproxen), results published in the European Heart Journal showed that the average blood pressure of those given Celebrex decreased by 0.3 mmHg over 24 hours. However, ibuprofen and naproxen increased blood pressure by 3.7 and 1.6 mmHg, respectively. Researchers also found that the percentage of patients with normal blood pressure who developed high blood pressure after taking one of the pain medications was 23% for ibuprofen, 19% for naproxen and 10% for celecoxib. All 3 of the meds are known as non-steroidal anti-inflammatory drugs (NSAIDs). Celebrex is also known as a COX-2 inhibitor, the same drug class as Vioxx (rofecoxib), which was pulled from the market in 2004 amid cardiovascular concerns. And a study published last year found that patients who had taken any of the 3 drugs had the same rate of heart disease, heart attack or stroke from taking it. Posted August 28, 2017. Via European Heart Journal/Science Daily.

Women taking oral contraceptives may have a decreased risk of developing rheumatoid arthritis (RA). Researchers in Sweden compared 2,641 women with rheumatoid arthritis to 4,251 healthy women who served as the control group. Results, published in Annals of the Rheumatic Diseases, showed that the women who had taken oral contraceptives – birth control pills – over an average of 7 years were 15% less likely to develop rheumatoid arthritis compared to those who had never used oral contraceptives. Although the study results reflect a positive relationship between birth control pills and lower RA risk, researchers caution that taking the pills just for RA prevention would be a mistake. Lead author Cecilia Orellana, PhD, a postdoctoral fellow at the Karolinska Institute in Stockholm, told The New York Times, “We are not recommending you start them as a preventive. We can’t overlook the other potential side effects of the drugs on other conditions.” Posted August 23, 2017. Via Annals of the Rheumatic Diseases.

Panel Urges FDA to Change How It Evaluates Opioids

When approving opioids, the FDA should go beyond examining the risks and benefits of the drug on the individual and also look at how such an approval would impact society at large and other members of a patient’s family, according to a new report.

The report, “Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use,” was issued by the National Academies of Science, Engineering and Medicine. It calls for a new “action plan” to fight the opioid abuse epidemic that will require the FDA, other federal agencies, state and local governments, healthcare providers and other health organizations to work together in a long-term effort.

Recommendations include promoting more judicious prescribing of opioids, boosting access to treatment for opioid abuse, preventing more overdose deaths, and spending more money on research to understand pain better and develop alternatives that are not addictive.

In addition, education about the risks and benefits of opioids should be improved for both the general public and healthcare providers. Pain-related education should be mandatory for doctors that treat people with pain, while basic training in the treatment of opioid use disorders should be provided for other healthcare professionals. Prescribers and pharmacists should also be trained to recognize patients who are at risk for abuse or overdose and how to help them.

The committee that wrote the report, which was requested by the FDA last year, is also calling on the agency to complete a review of the safety and effectiveness of all approved opioids. At 1, 4, and 7 years post-approval, the FDA should also reexamine an opioid to make sure post-marketing data is being submitted, according to Medscape. Also, the agency should take a more active role in monitoring opioids, rather than wait for reports to come in.

Reducing opioid addiction has become a top priority for the FDA under Commissioner Scott Gottlieb, who in May established an Opioid Policy Steering Committee to find ways of tackling the problem better.

“One of the areas in which we can have the greatest impact is in reducing the rate of new addictions by helping to make sure that only appropriately indicated patients are prescribed opioids, and that the prescriptions are for durations and doses that properly match the clinical reason for which the drug is being prescribed in the first place,” Gottlieb said in a statement after the report was released.

Medication Errors Making People Ill Skyrocket

A growing number of Americans have become seriously ill due to unintentional medication errors at home – such as taking the wrong medication, the same drug twice or the wrong dosage.

Researchers from the Center for Injury Research and Policy and the Central Ohio Poison Center looked at data from poison control centers across the country between 2000 and 2012. The rate of serious medication errors more than doubled from 1.09 per 100,000 in 2000 to 2.28 per 100,000 in 2012, they reported in the journal Clinical Toxicology. There were 3,065 events reported in 2000, a figure that jumped to 6,855 in 2012.

Overall, there were 67,603 incidents of “serious medical outcomes” that resulted from unintentional drug errors during the 2000-2012 period. One-third of the errors resulted in hospitalization.

Most of those errors – 93.5% – resulted in a moderate impact on the patient’s health. However, 5.8% resulted in a major effect and 0.6% (414) resulted in death. The most common symptoms reported were an increase in drowsiness or lethargy, an unusually fast or slow heartbeat, dizziness or vertigo.

The drug class most likely to result in a medication error were cardiovascular drugs, such as beta blockers, calcium antagonists and clonidine. These represented 21% of the errors, followed by painkillers (12%), especially opioids and Tylenol (acetaminophen), and hormone/hormone antagonists (11%), a category that includes insulin. Cardiovascular and pain drugs accounted for a majority of the fatalities.

The researchers noted that one of the reasons for the dramatic rise in medication errors requiring medical attention was an increase in prescribing of cardiovascular drugs, opioids and insulin over the period studied.

“Drug manufacturers and pharmacists have a role to play when it comes to reducing medication errors,” co-author Henry Spiller, MS, D.ABAT, director of the Central Ohio Poison Center at Nationwide Children’s, said in a statement. “There is room for improvement in product packaging and labeling. Dosing instructions could be made clearer, especially for patients and caregivers with limited literacy or numeracy.”

The researchers also provided a few tips to prevent medication errors at home:

  • Write it down. Parents and caregivers can write down what time medications are given to prevent another caregiver from unintentionally giving the drug a second time.
  • Ask questions. Physicians and pharmacists can teach patients, parents and caregivers how to take or give medications to minimize the likelihood of medication errors. Parents and patients can ask questions until they fully understand how and when to take medications. If you have any questions while at home, contact your pharmacist or physician.
  • Child-resistant packaging. While most medications come in child-resistant packaging, people who take many medications often put them into weekly pill planners. If you are going to use a pill planner, make sure it is child-resistant and keep it out of sight.

Let’s Answer the Questions About Marijuana

I’ve written in the past about the unknowns of marijuana. We don’t have concrete proof confirming the medical benefits that cannabis proponents make. The “high” experienced is different every time for every person. We don’t have a way of measuring impairment that drug creates. There are many strains which all have differing effects and so much more.

It seems crazy, but marijuana is still classified as a “Schedule 1” drug according to the Controlled Substances Act. That means officially the US government’s stance on cannabis is that it has “no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.” This puts it in the same group as drugs such as heroin, LSD and ecstasy.

We Need Research

Marijuana is believed to have many medical benefits but it also has side effects. There is evidence that it can help with pain, stimulate the appetite for people undergoing chemotherapy and treat glaucoma, Parkinson’s disease and seizures, but it is mostly anecdotal or observational in nature. To unleash all the benefits of marijuana and to make sure it is used safely, we need research.

But research is limited because legal access by scientists for study is restricted because it’s a Schedule 1 drug. It’s such a long and cumbersome process requiring paperwork from many different federal agencies that it discourages many researchers from even trying. The Drug Enforcement Agency (DEA) tightly controls access to marijuana for research and has just one main location, the University of Mississippi, where it is grown for this purpose.

Reassign Pot to Schedule II

A solution would be to reassign marijuana as a Schedule 2 drug. This would allow much more research to take place that we can find out if marijuana truly has all the benefits people are talking about and what the risks are. For more information on this topic, please read Pot Research: Why It Matters.)

At MedShadow Foundation, we’ve drafted a petition that will be sent to the DEA and other federal agencies asking them to change marijuana from a Schedule 1 to Schedule 2 drug, which will facilitate medical research on it. If you agree we need more research now, please, sign our petition. And share it with you friends and family too.