News

7 May 2010

Germany, the USA and Canada – Overusing Opioids?

If you think the USA, Canada and Germany are overusing the medications known as opioids, there may be other countries you could add to the list. But these seem to be the top three, and there is concern – as always – about medication abuse.

This is a big topic of discussion, and it comes up again as specialists in Canada recommend new guidelines for doctors who are prescribing medications such as morphine, codeine and OxyContin.

I think most would agree on this point – we need to get the medications to the people that can benefit, and not prescribe it to patients that won’t benefit. But just how to go about this isn’t easy. People with chronic pain often complain that they’re mistaken for abusers, and even in the medical world there’s a lot of debate over just what "addiction" even is. It’s been suggested more than once that some of these medications are not as addictive as they’re sometimes thought to be.

But there is concern in Canada because of the rapid increase in opioid consumption, and also deaths related to the drug.

But of course a big concern is overdose deaths, so we’re not talking about deaths from prescriptions. And a study in the USA sponsored by SAMHSA (Substance Abuse and Mental Health Services Administration) suggested that over half of those who used painkillers for non-medical purposes got them from friends for free. A challenging problem to deal with.

There’s also the issue of taking more than one medication, which can make statistics difficult (all right, so this many people died taking an opioid, but was it really due to the drug or a combination of factors?).

So in both Canada and the USA (I imagine Germany faces similar issues, though I haven’t researched the situation there as much) there are guidelines and agencies to try to regulate these things and make recommendations to doctors. But in both countries, the situation remains complex and we’re far from having answers.

The fear is, of course, that tighter guidelines will raise costs for those who would benefit, and make it harder for them to get the medications they need, opioid or otherwise.

The new Canadian recommendations are mostly common-sense, however. For example, know your patient’s medical history, monitor to see if the opioids are really helping, start with a trial, and so on.

But will the guidelines help? I suspect that it will still come down to the attitude of the doctor. Somehow, good information needs to get into her hands – how to deal with different types of pain, which drugs help and how, what the risks are, and how to listen to patients and understand what the need really is.

But that information too often gets lost in politics, prejudice and power-plays. Hopefully we can all do our part to work with our doctors to find the right treatment.

What do you think? How can these countries get the best treatment to the right people, while keeping drugs away from people who will be harmed by them?

If you’re in Canada and want to go more in-depth, you can read the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain here.

5 May 2010

Chronic Pain Study (for participants worldwide)

James News 1

Would you be interested in joining an internet-based study on chronic pain and its links with social and psychological events in your life?

Terry Borsook, a PhD student in Psychology at the University of Toronto is opening the study to those who have had chronic pain for at least six months. You need to be at least 21 years old, be fluent in English, and have a typical wake-sleep cycle (you’re generally awake during the day and asleep at night).

It’s only a three week study, and includes a time of orientation and then just a few minutes a day answering a few questions. It’s internet-based, so open to anyone worldwide. Having a world-wide audience here, I wanted to make sure you knew about the study, because I’m sure many of you are eligable.

It’s a unique study, and will not only help with ongoing research into chronic pain, it could help you. You’ll have summaries of your diaries, and, if you choose, you’ll be one of the first to receive a summary of the whole study.

Terry writes:

This is the first study of its kind and will, I hope, finally shed light on the types of experiences and psychological states that tend to be associated with the improvement and worsening of pain, function and the quality of daily life.

You can sign up now by going to the home page at the Mount Sinai Hospital: Wasser Pain Management Centre Pain Study

via How to Cope with Pain

1 May 2010

What do you tell your Doctor?

James News 2

When it comes to your symptoms, have you told your doctor about all of them? Here are the answers our visitors gave in our most recent poll:

Poll - telling your doctor about symptoms

Surprised?

There are actually a host of reasons why you might not tell your doctor about your symptoms. For example:

You haven’t connected them with your specific disease/disorder
You think your doctor will think you’re crazy
You feel your doctor doesn’t have time, so you stick with the basics
You’re simply embarrassed.
You’ve had the symptom so long you think of it as "normal".

There may be other reasons too – what’s your reason?

Chronic headache disorders can be related to a host of symptoms – it really is hard to keep track of them all and remember to tell your doctor. There are many symptoms that have been related to migraine, as another example.

But one of those symptoms may be the missing connection that will bring you the treatment you need.

How do you keep track of symptoms? Have you discovered symptoms you weren’t even thinking of at first? What do you tell your doctor? Let’s discuss it!

30 April 2010

New Telcagepant Trial To Start This Year

James News 0

Drug company Merck is planning to start a new trial for the drug Telcagepant this year, a spokeswoman for the company says.

We last talked about this up-and-coming migraine drug back in October (see New Migraine Drug Telcagepant â€“ Not Dead Yet. It shows promise, but Merck stopped trials of Telcagepant as a preventative when some patients showed elevated levels of liver enzymes (read more here).

Merck took some time to discuss options with FDA (USA) officials. After some months, they have decided to go ahead with another safety trial in 2010, though they’re still working to design the study.

Telcagepant is one of a group of drugs called CGRP receptor antagonists. Many patients who haven’t benefited from triptan type drugs are looking forward to trying Telcagepant. However, researchers are also interested to see how Telcagepant and other CGRP receptor antagonists will work along with triptans.

Stay tuned to find out more about this upcoming study, and the results. Also, we hope to see other drugs in this class researched for migraine.

via Migraine Patients to Wait for Triptan Alternative

29 March 2010

The Language of Pain: A Review

James News, Resources 2

I just finished reading the brand new (2010) book, The Language of Pain: Finding Words, Compassion, and Relief by David Biro, MD. So – let’s talk about it!

Today I was standing in line at the bank. On the back of someone’s t-shirt I read,”Pain is weakness leaving the body.” The quote has been made famous by the US Marines.

All right, I know what they’re trying to say. But if pain is weakness leaving the body – why do I feel so much weaker today (post migraine attack) than I did Saturday (pre-migraine attack)?

You might actually be surprised how much debate there is over how to define pain. What is pain? Is it a warning – something that keeps us from harm? Yes, sometimes. But sometimes pain causes the harm, it seems. Or even takes on a life of its own.

The Language of Pain: Finding Words, Compassion, and Relief

Pain, whatever it is, drives us inside ourselves. No one understands, and words seem to go from a stream to a trickle until they finally dry up.

Perhaps a good introduction to the book is in the author’s postscript:

… At its most intense, there is no time to think, let alone try to represent how one feels. … So why bother trying to speak? Why not just close one’s eyes, as I did many years ago in my hospital room, and wait for it to pass? And for those who witness pain, why bother trying to break down the wall of private experience and attempt to share what cannot be shared?
The simple answer is that we must. We must because the consequences of not trying are too great…

We must… but — how?

The goal of the book, if I could summarize it, is to free our tongues so that we can talk about pain (or draw, pain, sing, – most forms of expression fit in this case). Not only talk about it, but talk in ways that help us to understand it better. To deal with it better. And to share in ways that help others understand a little better – doctors, friends, family – the world.

It’s amazing that such a big topic hasn’t been discussed more. Don’t get me wrong – art, visualization, conversations of all kinds have been going on throughout history, and are strongly in the mainstream of medicine today. But the how – how to express pain – it’s a topic we don’t talk about enough.

Dr. Biro has done an excellent job tackling a very difficult topic. He’s done his research – everything from the literature of Charles Dickens and and James Joyce to the paintings of Frida Kahlo to the expressions of cancer and migraine patients.

He’s also navigated the very tricky waters of philosophy. It’s easy to get lost in the never-ending mazes of philosophy, and perhaps he does get a little off-course when he touches on ultimate questions, such as God and pain. But over all, he does a remarkable job sifting through philosophy and coming up with something very practical.

That practical thing is a box of tools that you or I can use to express – and understand – our pain better. He introduces us to different types of metaphor – different ways to approach the topic.

I’m more convinced than ever, after reading The Language of Pain
, that being able to express our pain is key. Key to survival, key to understanding, key to treatment – yes, even key to finding cures. As the author writes:

Physicians like me are often humbled by the uncanny sense that some patients have about what goes on inside their bodies. Deciding that something is wrong with them, or, less commonly, that nothing is wrong, patients will blatently contradict the assessment of their doctors and the “objective” data gleaned from sophisticated medical tests. Often they turn out to be right.

But many of us have only experienced the opposite side of communication. The vacant look when you try to explain. That look that says,”I won’t say you’re lying, but I know it can’t be that bad.”

The doctor that brushes you off. The employer that thinks you just want to take a day off.

But as powerful as misunderstanding can be, real communication can be just as powerful when it comes to solutions.

Dr. Biro isn’t exaggerating. If we want to move forward – and fight things like migraine – we must communicate. And it’s a skill we can learn.

It’s taken me a long time to get to this review. Not because I wasn’t interested in the topic, but because this isn’t the kind of book you can scan. It’s not a long book, but it’s not a book to rush through. You need to take the time to understand what is being said, and hopefully let it become a part of you, so that your creative expression starts to show it.

Though it’s not an easy read, it’s certainly not just a book for “artsy” people or clever writers. It’s for every patient in pain – and that’s the point.

I have a feeling this book won’t be read as much as it should be. Then again, more and more people, both patients and professionals in the health care field, do seem to be more and more aware of the necessity of clear communication. If that’s you, this is a great place to start.

You can also find The Language of Pain: Finding Words, Compassion, and Relief at Amazon UK.