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Meg Mangin R.N.
Research Team
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Posted: Sat Oct 8th, 2005 12:24 |
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Pain Control
Pain is a common symptom in Th1 diseases. Any part of the body may be affected by inflammation resulting in pain. Lymph nodes are located all over the body and are prime suspects to swell and produce pain from immunopathology in Th1 disease.
Adjusting the MP meds is the best way to manage immunopathology, including pain. But if that is not enough, don't be afraid to try pain medication if you need it. Your doctor will assess the risk/benefit ratio.
When pain has been chronic and severe, it is not unusual for inflammatory symptoms to be indicative of both longstanding and ongoing inflammation and immunopathology. For purposes of pain control, it is not necessary to differentiate. If your intolerable pain is not managed by adjustment of the MP meds, you should be using palliative methods for relief. This will buy you some time for resolution of the inflammation with the MP.
Most pain medications your doctor has determined are safe for you will be okay to take while on the MP.
It's important not to take pain meds unless you need them but pain control is an important part of medical care. You can help yourself by learning all of your pain management options so that you do not suffer needlessly. You have the right to adequate pain control.
Pain control and pain management are extensive subjects that require specific expertise. There is a lot of valuable information on these subjects on the Internet.
If your clinical picture is complicated and your pain is severe, you might be best helped by consulting an expert in pain management at a local pain clinic.
The following links are good sources of information for you and your doctor:
Overview of pain and pain management
How to relieve pain without medication
Pain
Pain medication
Inadequate pain control impairs the healing process
No one advocates "over-using" pain medications; but in many the level of pain is truly incapacitating and these folks have to have pain control just to be able to get through each second and minute of the day. The good news is that as one proceeds one will eventually get to the point where the pain meds can be weaned down and then off.
Studies have shown that people in hospitals given adequate pain control tend to heal faster and are able to be discharged sooner than those who are not given adequate pain meds; so it is more complex than one might think. The physiologic consequences of uncontrolled pain are myriad, and should not be overlooked.
To me the goal is to try and take the minimum amount of pain medication needed to try and make life livable while progressing on the MP. It is better to stop the unrelenting pain before it emerges to become unbearable, and taking as low a dose as possible that is still effective every 4 to 6 hours can beat it to the punch.
The "tough it out" mentality can backfire in some when it gets too tough. We all have to be tough to embark on a therapy that involves immunopathologic responses to treatment, but realistically pain control is a required part of recovery in many of us.
The label your illness has should not really matter in regards to getting help with your pain; since pain is pain is pain.
It distresses me when physicians do not properly address pain issues for whatever reason. Pain is debilitating and interferes with healing. You may need to go to a skilled pain clinic to get the proper dosing of pain medication. ~P.Bear R.N.
Following are links to the information in this thread:
TENS (transcutaneous electrical nerve stimulation) units
Related information - Immunopathology
Back pain
Physical therapy may reduce Th1 inflammation and pain
Visualization techniques
Pain medications
Cold weather can exacerbate joint pain
The therapeutic effect of pets
Massage
Migraine
Pacing activities and rest
Morphine may be immunosuppressive
Last edited on Mon Mar 17th, 2008 15:52 by Meg Mangin R.N.
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Meg Mangin R.N.
Research Team
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Posted: Sat Oct 8th, 2005 12:38 |
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(filelink)
TENS (transcutaneous electrical nerve stimulation) units
Does TENS work?
How to use a TENS unit
Types of TENS units
What is TENS?
For various TENS unit products, google "TENS unit".
CAUTION: The TENS unit should be used only under the continuing supervision of a physician. Electrical stimulation devices are contraindicated in persons using a CARDIAC PACEMAKER, in pregnancy, and various conditions. Please consult your physician about the use of a TENS unit for your condition.
Personally, I think the simpler the better. When you are sick the last thing you need are dozens of controls. Something like:
http://www.bodyclock.net/acatalog/1stchoice_tensunit.html
Personally, I liked the smaller electrodes, eg
http://www.bodyclock.net/acatalog/round_electrodes.html
Disclaimer: I have never tried the above devices, nor have I bought from that company. I purchased all my own devices when visiting Japan and Singapore. They sell in just about every store in Akihabara - hundreds of models 
ps: some states in the USA require a Doctor's prescription to buy a TENS unit, so always get your Doc's advice.
..Trevor..
ADD Jan 8 05: I just got an email from Sharper Image, advertising that they have begun selling a TENS unit, FDA aproved, without prescription. You can find it here http://tinyurl.com/7c7st
It is not clear to me if the electrodes are loose, and can be moved over the pain, or whether they are locked into the belt. I will take a trip to the store in our mall later today and take a closer look.
For those 'newbies' who weren't around in the early days of the MP, TENS units are great for relieving muscle and joint pain,and they don't affect the bacterial killing. Any visitor to the Far-East (Japan, Korea, China, Malaysia) will find these in every electrical store. But they have been banned from OTC sale in this country for several years.
Congratulations, Sharper Image, first the amazing 'Ionic Breeze' and now this
ps: note the 60-day free trial offer. This unit is expensive, but...
pps: those of you in the UK can already buy this type of unit from 'Boots', etc.
-I too have the arm/rotator cuff problem and have found the TENS unit very helpful for the pain. If you have insurance that will cover it you should give it a try. The insurance company will pay to rent one per month to see if it helps. I use an Epix XL, my husband just got an Epix VT for his back.
My husband's PT recommended this one to purchase saying it was as good as the more expensive one that the insurance company paid for: BioStim, Alimed.http://tinyurl.com/2fmova You need a doctor's Rx which I'm sure wouldn't be hard to get. The PT thought it was around $140 but at this website it says $299. I don't know if you can shop for price somewhere else. But I use mine a lot and it would be worth the price. It's drug free pain relief. ~Janice
There is a discussion here
There are much less expensive units available, but Sharper Image comes with a "60 days risk-free" trial period.
These used to work wonders with my migraines. I purchased much cheaper units in Korea and Japan, however, where they sell them amongst the washing machines, and just about everybody uses them for pain control... There is no real difference between excitation waveforms, etc, all the units seemed to work pretty well.
Be very careful to only use the minimum necessary amount of energy, and you might find that two electrodes on the back of the neck, straddling the spine and about 1 inch apart horizontally, about half way vertically between the shoulder blade and the base of the skull might work well. Maybe 5-15 minutes should be all that is needed to knock down a migraine (before it really starts).
Try it out on body muscles first, so that you get the hang of the unit's controls. Don't use it yourself if you are too ill to control it carefully. Make sure somebody else is present to give you assistance in case you have problems.
Disclaimer: I am not licensed to give advice on specific treatment of your disease. Please clear the use of TENS unit with your licensed medical practitioner.
..Trevor..
Acupuncture
Acupuncture is fine, and, if it gives you pain relief, you can continue it with confidence it will not interfere with your recovery.
..Trevor..
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Aussie Barb
Research Team
| Joined: | Thu Jul 22nd, 2004 |
| Location: | Australia |
| Posts: | 18791 |
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Posted: Sat Oct 8th, 2005 17:10 |
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(filelink)
Factors that exacerbate pain
Immunopathology
Immunopathology may cause an increase in pain. See Immunopathology (Herx)....What is it?
Do not hesitate to use any of the medication adjustment options in My immune response / symptoms are too strong. What should I do? Check the precautions and the options one at a time and assess the issues listed in Tools to check. Ask in your progress report if you need help.
If you are concerned do not hesitate to contact your Doctor.
Anxiety
Anxiety can be a immune reaction and it can magnifiy the perception of other symptoms. Some folks have reported that taking Valium (do not use generic diazepam) also reduces pain.
Valium is also a useful adjunct for the relief of skeletal muscle spasm due to reflex spasm to local pathology (such as inflammation of the muscles or joints, or secondary to trauma). See:
How can I control my anxiety?
When and why should I use Valium?
Fatigue
Inadequate rest can contribut to an increased perception of pain. See I have insomnia and fatigue. What should I do?
Idiopathic pain
Lymph nodes are located all over the body:
and these should be considered the prime suspects to swell and produce pain from immunopathology in Th1 disease.
Gout
Gout is a disease resulting from the deposition of urate crystals caused by the overproduction or underexcretion of uric acid. The disease is often, but not always, associated with elevated serum uric acid levels. Clinical manifestations include acute and chronic arthritis, tophi, interstitial renal disease and uric acid nephrolithiasis. The diagnosis is based on the identification of uric acid crystals in joints, tissues or body fluids.
Excess serum accumulation of uric acid can lead to a type of arthritis known as gout. Gout can occur where serum uric acid levels are as low as 6 mg/dL (~357µmol/L), but an individual can have serum values as high as 9.5 mg/dL (~565µmol/L) and not have gout. It isn't necessary to keep uric acid levels within normal range during the process of recovery.
Standard treatment for acute attacks is nonsteroidal anti-inflammatory agents, colchicine or intra-articular injections of corticosteroids. Probenecid, sulfinpyrazone and allopurinol may be ordered to prevent recurrent attacks.
NSAIDs are the preferred form of analgesia for patients with gout. Indomethacin is the most commonly prescibed NSAIDs used to relieve the pain of gout.
It is okay to take allopurinol to reduce uric acid to prevent recurrant attacks unrelieved by pain meds and adjustment of MP meds.
Several agents (including allopurinol and benzbromarone) are reported to lower urate levels with varying degrees of success in preventing acute attacks of gout. Several folks on the MP have used allopurinol for a short time without ill effect.
We recommend testing urate periodically and discontinuing the urate-lowering medication when the level is normal. Be sure and drink adequate fluids.
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Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| 24+ years not Dx| Cut D/exp July04| NoIR Aug04 Comm Beni|Q| Sept05 off Thyroxine| CLICK ABCofMP
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Aussie Barb
Research Team
| Joined: | Thu Jul 22nd, 2004 |
| Location: | Australia |
| Posts: | 18791 |
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Posted: Sun Nov 6th, 2005 21:43 |
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Back pain
(filelink)
Dr Greg Blaney MD wrote, regarding herniated disc:
In my opinion, there is a definite correlation between disc disease and Th1. It being at the C7-T1 area (C8 is the nerve, not the vertebra) could also indicate a problem with the upper rib cage. C7 is where most of the neck extension occurs and that disc could be more vulnerable to mechanical stress if there is a upper rib restriction.
Restricted upper rib motion can be diagnosed by a number of means. One, palpation by therapist trained in osteopathy. Two, reduction or absense of radial (wrist) pulse with elevation of arm to horizontal, 1st rib; or above head 3rd rib. Treatment is to re-establish normal movement usually using manual techniques.
Both pathological calcification caused by D dysregulation and inflammation of the dorsal roots of the spinal nerves are seen in Th1 diseases and improve with the MP. However, improvement is usually later in phase 2 or 3 and can be associated with increased symptoms earlier.
Also, the cytokines found in tick borne diseases which are one source of Th1 pathogens, have been shown to weaken connective tissue and can cause a variety of hernias including disc herniation.
Dr Marshall wrote: Dr. Greg Blaney finds that a lot of idiopathic spinal pain patients respond to the MP, and many actually exhibit overt Th1 metabolites
Members' experiences
-I have had decades of chronic back issues with years of various interventions: manipulation, ultrasound, physical therapy, water therapy, massage, exercise, acupuncture, etc. Thankfully, I've now recovered from all forms of stiffness, pain, and spasms, so the MP did resolve the inflammation that was obviously the unrelenting culprit.
However, whether it were then or now, prolonged bed rest and back pain go hand-in-hand. A sustained position of any sort, for me, would always aggravate my back. Even after back surgery twenty-six years ago, the surgeon insisted that his patients get out of bed ASAP and "move." I did take a muscle relaxer to be able to freely move and used a pain pill for only a brief period of time. We were encouraged to walk, walk, walk. Following that advice, I was able to leave the hospital before everyone else and was able to return to work the quickest.
One therapy, years later, that felt wonderful was in a heated pool with a physical therapist at a rehab center. My muscles responded very quickly to that treatment, and being able to exercise and see the progress gave me an emotional boost. ~Carole
see Caroles Story
-Herxing in the back can result in increased inflammation, which can be painful. It may be affecting either nerves or muscles, but Herxing is temporary. It gives you a good idea of where all the problems are. The best advice as per posts above: keep the Herxing tolerable. It's easier to control it than to try to regain control.
Other members have talked about the "pain of lying down," and other back pain. For instance, Th1 inflammation can affect the little-known sacro-iliac joint, causing sacroiliac pain.
Sometimes a person has been so overwhelmed with many symptoms, or a particular symptom was usually so subtle, that it doesn't get "sorted out" from other pain until the person experiences the Herxheimer. I found that was true of many of my neurological symptoms. I can assure you that the MP has addressed and resolved many symptoms I had not planned on recovering from - they just weren't that important to me at the time I started.
Along with the MP, I relied on manual therapies from my osteopathic physicians to help with some Herxing. The therapy I found most helpful was craniosacral therapy. You may want to explore finding a medical practitioner in your area who practices manual therapy. ~Belinda
Coccyx pain
-There is a special cushion called a "tush cush" that became my constant companion for controlling this sort of immunopathology. I am sure there are a variety of similar cushions available. I use one in my chair at home. It has a handle so it can easily be carried with you for use away from home. I've found that the trick is to not sit on any hard surface or chair (for any amount of time) because doing so aggravates this problem. Once the cycle of aggravated inflammation and pain starts, it can be difficult to settle down. ~Belinda
Muscle spasms
Spasming has also been reported as immunopathology.
See When and why should I use Valium?
Related topics:
Back pain from CWD
Lower Back Pain
Massage and Physical Therapy
Shoulder pain
frozen shoulder
range of motion exercises
Facial pain
Many people with Th1 disease experience facial numbness and tingling. Some people will also experience facial tingling and numbness when their 1,25-D surges in response to sunlight sensitivity/sunlight exposure. See Why are my symptoms more intense after exposure to light &/or Vit D?
See also:
P.Bear's post to JJM
TMJ
Last edited on Tue Mar 4th, 2008 16:37 by Meg Mangin R.N.
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Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| 24+ years not Dx| Cut D/exp July04| NoIR Aug04 Comm Beni|Q| Sept05 off Thyroxine| CLICK ABCofMP
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Meg Mangin R.N.
Research Team
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Posted: Mon Nov 21st, 2005 02:32 |
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Physical therapy may reduce Th1 inflammation and pain
(filelink)
Trauma induces activation of AngiotensinI (AT1) to initiate wound recovery through the destruction of damaged cells, remodelling, the laying down of fibrous material and angiogenesis.
This reaction also results in a steering away from an effective immune response to pathogens.
Chronic muscle skeletal dysfunction often perpetuates repetitive strain on hypermobile areas, actually pseudo-hyper mobile, as is usually a result of compensation for a restricted area, causing local activation of AT1.
I have observed in many patients that an important precipitator of increased Th1 disease is physical injury. My speculation is that the physical trauma further activated AT1 due to the wound response, suppressing the immune system further and allowing increased bacterial growth.
Therefore, one could expect some temporary reduction in symptoms from inflammation due to muscle skeletal dysfunctions by ARBs (Benicar) but as stated by Trevor, with continued blockade of AT1, a Herx reaction resulting from improved immune response would cause an increase in symptoms including myofascial pain.
From this information and personal observation, it is very beneficial to have appropriate physical therapy to correct underlying structural problems to lessen continued stimulation of AT1, thus supporting the return of a more normal AT1 & AT11 response. ~Greg Blaney, MD
-You might check to see if someone locally provides the hands-on therapy called "cranio-sacral" therapy. This was something that helped me with joint and muscle pain, including TMJ. There are no injections involved and it is non-invasive. ~Belinda
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Meg Mangin R.N.
Research Team
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Posted: Thu Dec 1st, 2005 02:22 |
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Visualization techniques
(filelink)
In my experience it is well to remember that only you know as an individual what makes you relax, and it is what was told to me by the professional that taught me visualization.
She suggested to me to tape an experience that I knew would help me with what relaxes me.
After serious thought, I realized that the crashing of waves of the ocean, fairies, the color blue, my grandmothers kitchen smell..etc was what made me feel relaxed and I also observed that while I had thought about these things that I didn't feel pain.
So on my limited budget, I went to buy a tape recorder, one that you can record with and made my first relaxation tape. I did my breathing (only i was told to take in a good 3-4 deep breaths) in through the mouth then naturally releasing the breath with no force.
You must find a 'sanctuary'.
So after breathing I began making my own relaxation tape. I started off with remembering my grandmother, how she was always there to serve, the smell of her kitchen and the love and spices she used to cook with to enhance the memory cells, then bid her bye seeing a beautiful blue sky, with the puffiest white clouds, I then walked (as I am in a chair this was special for me) to the beach through a beautiful park in which I heard giggling, curious I followed the laughter and found fairies dancing and singing a tune which welcomed me as they knew I enjoyed them, they told me that they where dancing to my health  ,well being..........etc.
I agreed with my visualization person that making your own was better, for I am the only one who really knows what relaxes me.
2bonnie
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Meg Mangin R.N.
Research Team
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Posted: Sat Dec 3rd, 2005 11:31 |
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(filelink)
Pain medications
There is no pain medication (except corticosteroids) contraindicated specifically because someone is on the Marshall Protocol. Please discuss with your PCP or pain management specialist what pain meds are right for you. You may find that other symptoms diminish too once you get your pain under control. Pain is exhausting in itself.
Remember to increase Benicar first when pain increases.
Be sure to investigate non-medication methods of controlling pain also.
NSAIDs
NonSteroidal Anti-inflammatory Drugs are commonly used for mild to moderate pain. The most prominent members of this group of drugs are aspirin, ibuprofen, and naproxen partly because they are available over-the-counter in many areas. Paracetamol (acetaminophen) has negligible anti-inflammatory activity, and is strictly speaking not an NSAID.
Dr Marshall usually suggests trying Tylenol (acetaminophen, paracetamol) first for pain. Please follow precautions regarding not exceeding recommended dosage.
Safety warning regarding Tylenol (acetaminophen, paracetamol): Tylenol dosage should be limited to a total of 4 grams (4,000mg) in a 24 hour period for persons with healthy livers. If you have liver disease (keep in mind that Th1 inflammation in the liver is often subclinical), you should take Tylenol with caution and with your doctor's approval.
Ibuprofen (Motrin, Advil) is not contraindicated on the MP but it does have some serious side effects (it's hard on the stomach and may prolong bleeding time) so please check with your doctor. It can also cause fluid retention.
-I always recommend Motrin over Advil, Advil has two times the additives a Motrin, (18) versus (9) and the additives are some very difficult substances for the body to even break down. l have seen whole advil pills on xray in lower GI of some very ill pts. ~VEZ
Since aspirin has serious side effects, chiefly 'thinning the blood' and causing gastric upset, it should be taken only if your doctor says it's okay to take. We do not recommend the routine use of aspirin for its touted preventative characteristics. As always, check with your doctor regarding your own particular circumstances.
Naproxen and naproxen sodium are marketed under various trade names including: Aleve, Anaprox, Miranax, Naprogesic, Naprosyn, Naprelan, Synflex. Like other NSAIDs, naproxen is capable of producing disturbances in the gastrointestinal tract. Addition of a proton pump inhibitor such as omeprazole will prevent this adverse effect.
Also like other NSAIDS, naproxen can inhibit the excretion of sodium and lithium. Extreme care must be taken by those who use this drug along with lithium supplements. Naproxen is also not recommended for use with NSAIDs of the salicylate family (Aspirin) (drugs may reduce each other's effects), nor with anticoagulants (may increase risk of bleeding). Naproxen preparations containing sodium (e.g., Anaprox, Aleve, etc.) are not recommended for use in patients with sodium-sensitive hypertension, due to potential adverse effects on blood pressure in this small subset of hypertensive patients.
Metamizol (pyrazolones) is an NSAIDs used in Germany, Spain and Italy, and in many South American countries. It is prohibited in other countries because of its capacity to induce agranulocytosis and aplastic anaemia. In addition to its effects on bone marrow, metamizol may also cause cutaneous reactions, allergic idiosyncratic reactions such a bronchospasm, anaphylactic shock, toxic epidermal necrolysis, hepatitis and severe hypotension. This article warns about taking metamizol in combination with spasmolytics. Metamizol is described in this article as being safe and well-tolerated when not used in combination pain products or with cyclosporine. There is more detailed info on this website that indicates blood pressure is a concern only if the drug is administered by IV or intramuscular injection, not by mouth. Unless your doctor says otherwise, this analgesic may be safely taken while on the MP.
If liver function is poor
Use all OTC pain medicatins, including ibuprofen, aspirin and acetaminophin (Tylenol) with caution if you have liver disease. They may be safe if taken at recommended doses....your doctor is your best source of info regarding a pain med that is safest, including stronger pain meds such as opioids.
Any pain medication can jeopardize an already stuggling liver and many folks with Th1 inflammation have subclinical liver inflammation.
Cox-2 inhibitors
Cox-2 inhibitors are controversial these days. Please see this Discussion re Celebrex
-I’ve have a love-hate relationship with Celebrex. I took 400.mg/day Celebrex for several years prior to starting the MP. I was one for whom the gastro-intestinal benefit was very real. I could not take other NSAIDS because they caused so much stomach discomfort and I really needed all the help I could get with RA joint pain.
After about a year on the MP I decided to stop this med and found that not only did my joint pain increase, but I also experienced more fatigue and greater flu-type feeling (at the same antibiotic doses). This suggested to me that it was, in fact, having some immune-suppressing effect. I decided to do without it and mainly use Vicodin to deal with the pain.
During the last few months I have gone back to using Celebrex occasionally. I find that now with my joint pain so dramatically reduced, I am more aware of the difference between the anti-inflammatory effect of the Celebrex and the pain killing effect of he Vicodin and using the two in combination translates to using less medication overall. I have also had spells of muscle cramping for which 2mg Valium has been very helpful.
Using the least amount of palliative meds is definitely the way to go. However, good pain management for your daughter is critically important as well. The MP is a long process. The tough part is that only she will know what works best for her when it comes to keeping symptoms tolerable. I know I could never have gotten through over three years on the MP without serious pain medication.
Rest assured, as time goes by, and you address the underlying cause of your daughter’s illness, her need for pain medication will recede.~Carol
Local pain relief
For localized pain, Topical pain relievers may provide some temporary relief but avoid those with salicylates. Dencorub is in the first category. OTC topical creams with capsacian (made from hot peppers) in them work well. They produce a sensation of heat which fools the nerve endings into not noticing the pain. This might work well on joints. Be careful to wash your hands well after applying it. It's very painful if you get it in your eyes.
I bought a box of Icey Hot Patch 'socks' at noon today and am still wearing the one I put on about 12:30. The pain is still very much there when I walk or bend my ankle a certain way, but it is SO much better. ~LisaN
Other non-narcotics drugs used for pain relief
Lyrica is a "small" molecule. It is therefore very non-specific in what it targets in the body. There are tens, probably hundreds of potential targets for a molecule that small. It would be a fruitless task to try and identify all the actions of Lyrica (with molecular modeling), including all its potential adverse actions.
When I gave my "Visiting Professor" presentation at the FDA I did include several drugs other than those of most interest to us, but it takes a long time to compute this, and I have decided that "small" molecules are a waste of time. Especially when I looked at the frequency and type of adverse events the FDA was listing for Lyrica. I would never use it, and I would never recommend its use. ..Trevor..
Opioids and narcotics
There are Opioid receptors on lymphocytes. I have looked at the molecular genomics of mu, delta and gamma varieties. There is little doubt that we still have a lot to learn about the way that the immune system actually works. But relax just a little, as I am somewhat ahead of you in worrying about quantifying these things
In general terms, if your Doctor prescribes opioids for your pain, they seem to have less interaction with Th1 disease than some of the other pain medications (aspirin, for example)."
"Opioids are the preferred method of dealing with extreme pain in the MP cohort, for pain where Paracetamol (Tylenol, acetaminophen) just doesn't do the job. The key is to address the cause of the pain. Benicar does that. Always use four-hourly 40mg benicar before resorting to pain medications." Dr. Marshall
Opioid is a medical term commonly used for classes of pain-relieving medications. Opioid is another word for narcotic. Opioids work to relieve pain in two ways. First, they attach to opioid receptors, which are specific proteins on the surface of cells in the brain, spinal cord and gastrointestinal tract. These drugs interfere and stop the transmission of pain messages to the brain. Second, they work in the brain to alter the sensation of pain. These drugs do not take the pain away, but they do reduce and alter the patient’s perception of the pain.
An opioid is any agent that binds to opioid receptors, found principally in the central nervous system and gastrointestinal tract. There are four broad classes of opioids:
-endogenous opioid peptides, produced in the body
-opium alkaloids, such as morphine (the prototypical opioid) and codeine
-semi-synthetic opioids such as heroin and oxycodone
-fully synthetic opioids such as pethidine and methadone that have structures unrelated to the opium alkaloids
The word narcotic is more commonly used to refer to these pain-relievers that are 'substance controlled' by law. But narcotic also includes street drugs.
A narcotic is an addictive drug, derived from opium, that reduces pain, induces sleep and may alter mood or behavior. The derivation of the word is from the Greek word narkotikos, meaning "benumbing or deadening," and originally referred to a variety of substances that induce sleep (such state is narcosis).
In U.S. legal context, narcotic refers to opium, opium derivatives, and their semi-synthetic or fully synthetic substitutes as well as cocaine and coca leaves, which although classified as "narcotics" in the U.S. Controlled Substances Act (CSA), are chemically not narcotics.
Many police in the United States use the word 'narcotic' to refer to any illegal drug or any unlawfully possessed drug. An example is referring to cannabis as a narcotic. Because the term is often used broadly, inaccurately or pejoratively outside medical contexts, most medical professionals prefer the more precise term opioid, which refers to all natural, semi-synthetic and synthetic substances that behave pharmacologically like morphine, the primary constituent of natural opium poppy.
Opioids used to treat existing pain are not addicting and you have a right to have your pain relieved.
Many doctors are hesitant to prescribe what they feel is a lot of pain medication. You may need to demand that they give you enough pain medication to take care of your pain.
"I would suggest regularly changing around opioids so as to make sure that only the pain was being affected by them. There are opioid receptors on lymphocytes. In general terms, if your Doctor prescribes opioids for your pain, they seem to have less interaction with Th1 disease than some of the other pain medications (aspirin, for example). This has to be a decision between you and your licensed Physician.
I am generally comfortable with opioids, they are definitely the preferred pain killer, after higher-dose Benicar. If the Benicar doesn't control the pain then you should discuss opioids with Doc. Talk with Doc about more than one type. Try three weeks on one, there weeks on another, or some other regime which Doc is comfortable with. That is really the only way to observe cause and effect." ..Trevor..
Oxycontin
You are taking a considerable amount of Oxycontin, but it's about in the low end of the middle of the daily amount that is listed for possible dosages. There's really no reason that I can see that you shouldn't be able to take more than you are. I think that you need to ask your pain specialist why she is resistant to increase your dosage. I know that they're under more scrutiny because of the black market of the drug, and that could be part of her concern.
Oxycontin - RX-List
Dr. Koop - Drug Library
While the OxyContin controlled-release tablets are all generally considered to be good for twelve hours, the 80 and 160mg tablets especially are intended for every twelve hour dosing.
See also:
Safety warning re fentanyl (Duragesic)
The Use of Opioids
for the Treatment of Chronic Pain
Darvon-n is an opioid used to treat moderate to severe pain.
Members' experiences with opioids
-I didn't relish speaking with my doctor about the possibility of prescribing opioids to help manage my pain while on the MP. I've had a bad experience with a physiological addiction to Ativan at low levels (used as a sleep aid) in the past and I wasn't sure who would be more reticent about the use of opiods. Because I am unable to take aspirin or acetomeniphen and NSAIDs are of limited use and with MCS I've had more than my share of terrible reactions to both over-the-counter and prescription drugs, meditation had always been my pain reliever of choice. At the same time, if taking pain killers, opiods in particular, would help keep my immunopathological response tolerable while not suppressing my immune system as many pain killers do, I was aware that I wanted to do whatever I needed to do to manage my recovery.
And so I figured I would wait until the appointment after I experienced intolerable pain to speak with my doctor. I mean, I'm pretty good with pain (she boasts, remembering the time she had a molar, which had broken into 4 separate parts according to the 4 roots, pulled out without anesthesia, amazing the dentists and his assistants with her pain tolerance).
Wrong move. During one 12-day period about a week into beginning the abx, I had about five different body pains occurring at the same time (ranging from a 5 to a 9 in pain on a scale of ten) and a migraine with little relief throughout. It was intolerable. I was bereft. Speaking to my doctor about opiods over the phone was not what I wanted to do, and so I toughed it out.
Armed with oxycodone (following that appt), I took just half the dose at the next mega-pain attack and the overall pain level was dropped to about a four, which was not only tolerable, but allowed me to know that I was still killing the bacteria and also when the response stopped (thankfully, unlike the 12-day bout, it stopped after 8 hours). I went from feeling like one big whimper to feeling like I could manage my pain and therefore survive the MP.
I encourage everyone to talk with your Doctor about pain management in advance no matter how well you think you have managed the various pains you've had in the past. ~Claire
See also Morphine may be immunosuppressive
Tramadol (Zydol, Ultram, Zytrim, Calmador, Ultracet,Tramacet)
Tramadol is an atypical opioid which is a centrally acting analgesic, used for treating moderate to severe pain.
"There is reason to infer that tramadol might be more of a problem than other pain meds but it is not contraindicated. I would suggest regularly changing around opioids so as to make sure that only the pain was being affected by them." ..Trevor..
Note: Tramadol is okay to take if it is effective for your pain and you are experiencing an adequate level of immunopathology.
See the information about opioids and altering pain meds. If you have been taking tramadol for a long time and want to change, be sure to wean the dose down. Don't discontinue it suddenly.
-Tramadol may not have a significant effect upon certain aspects of immune function; but there are other reasons for people to use caution with it. For me (in my former use of it) I found I got a terrible unusual headache as soon as my level of drug diminished; and had to take more just to stop the head pain. This would happen with just one dose, long before any long term physical addiction. At least in some this predisposes for addiction potential even more than percocet or vicodan, that for me never had this effect.
There is also a major problem with tramadol causing the possibility of a seratonin syndrome when used with some antidepressants. Since tramadol acts to inhibit the re-uptake of serotonin and norepinephrine in addition to its opioid type actions it can be dangerous in those who are on SSRI's as well as trazodone. Although many people do tolerate Tramadol I urge caution in anyone using certain antidepressants.
The opiates this site recommends for unbearable pain do not have this possible side effect. The only synthetic opiate I know of that can also cause this is Demerol, which should also be avoided if on an antidepressant that effects serotonin or norepi.
"The phenylpiperidine series opioids, pethidine (meperidine), tramadol, methadone and dextromethorphan and propoxyphene, appear to be weak serotonin re-uptake inhibitors and have all been involved in serotonin toxicity reactions with MAOIs (including some fatalities). Morphine, codeine, oxycodone and buprenorphine are known not to be SRIs, and do not precipitate serotonin toxicity"
Tramadol is frequently prescribed merely because it is not labeled as a controlled substance, even though it probably should be. It is rather difficult to stop taking for many people, and often needs to be weaned slowly. People should be aware that it has multiple effects that are totally separate from its moderate pain-killing potential.
I am convinced that certain opioids when taken in the usual doses are immuno-suppressive. The research on this in many painkillers has been done, and can be reasonably be viewed as fact; even in the light of an incomplete understanding of the role of the VDR. I think you could read studies on the immune modulating effects of opioids till the cows come home and barely even touch the stack of articles.
The preliminary evidence I have seen on tramadol is that it has a better profile than morphine in terms of immune suppression, and some anesthetists and anesthesiologists prefer it for that reason. My direct personal experience with this drug (Ultram/tramadol) is that it was a terrible choice for me....I do feel that some will be able to tolerate it and others can not and should not try to given the fact that there are other options." ~P.B. RN
Members' experiences with Tramadol
-Started spontaneous crying and overwhelming thoughts of suicide and a huge increase in pain not to say itching etc. due to Tramadol. ~Chris P.
-Worked out that the nausea and vomiting are due to the Tramadol. ~IngeD
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Meg Mangin R.N.
Research Team
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Posted: Mon Dec 5th, 2005 02:31 |
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(filelink)
Cold weather can exacerbate joint pain
Warm water works wonders for my hands. Just soaking them with warm water as hot can I can stand helps lots. I learned that trick from a physical theraphis and it works well for feet also.
My godmother made me a woolen scarf that I wear all the time. It's amazing how it keeps stiffness out of the cervical area.
I am also making different size "pillows" that are stuffed w/corn feed (corn fed to cows). Pop them in the microwave or oven to warm for 1min.to test the heat. Then place it on the stiff or painful area. You make the pillow made in thick cotton material and then can make a case just like regular pillow so that you can wash the "pillow case" when needed. If you keep the mirowave at a low tempwhen heating up this pillow, it will last a loooooooong time. I found that using rice or beans as fillers dont last and will burn before 1st winter is over. This makes a wonderful gift of healing.
2bonnie
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Meg Mangin R.N.
Research Team
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Posted: Fri Dec 9th, 2005 15:24 |
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The therapeutic effect of pets
(filelink)
Pet Therapy
Kev says: My dog is my new best mate and I am instantly feeling much better emotionally for having him. And I mean I "REALY" feel better. I go out more, i walk more and I laugh more, i have something else to think about other than my sarc symptoms and medication. It is quite remarkable the power of pets.
Lee wrote:
Hubby bought me two hair dogs both hypo-allergenic. One shih tzu and a lhasa apsa (poppi). One is kept fairly short haired and the other long for but I have never had a reaction to either .... They are both medically approved companion pups as the docs realize how much time I spend alone and indoors and I need them as much as I need my benicar .....
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Meg Mangin R.N.
Research Team
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Posted: Fri Jan 27th, 2006 02:13 |
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Massage massagelink
Regarding massage, I use a machine called a "pro shiatsu" which I find is superb for relieving any back (or other) muscle herx. You can buy one on eBay for the price of a single real massage and will never have to venture outside into the light for a real massage again. Also it is untiring and relentless and will never get sore thumbs LOL. patrickburke
The Chi machine may help relieve some symptoms and it doesn't appear to be harmful. Do not use the associated infrared Hothouse machine.
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Aussie Barb
Research Team
| Joined: | Thu Jul 22nd, 2004 |
| Location: | Australia |
| Posts: | 18791 |
| Status: |
Offline
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Posted: Tue Jun 20th, 2006 19:10 |
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Migrainefilelink
Migraine headaches
Migraines are not uncommon in Th1 diseases. Often the Benicar blockade is enough to resolve migraines.
See:
Prophylactic Treatment of Migraine With an Angiotensin II Receptor Blocker
Norwegian research gives hope for migraine sufferers
First study to show the potential for effective prevention of migraine with and AT1 receptor blocker
If your migraines persist, the first step is adjustment of the MP medications to reduce immunopathology.
Adequate eye protection will be particularly important for anyone with headaches to reduce the effect of light on the brain (amygdala).
If you have a precription medication for anxiety this may be very helpful or you may need to use your pain med regularly.
Dr Marshall suggests using a TENS unit at the base of your skull. Always ask your Dr.
Massage & Physical therapy
Members' experiences:
-Also wanted to mention that ever since being on the MP I have not had any bouts with migraine headaches! I have suffered with debilitating migraines since I was in my late twenties (although they have been less severe and less frequent the last few years). This is a major relief for me! ~Adrianne
For almost 30 years now I have not been able to tolerate sugar because within minutes of ingesting it (even the smallest amounts) muscles in my neck and elsewhere tighten up and it inevitably leads to a severe migraine headache. Well, since starting on the MP, I have not had ANY kind of headache which is amazing because before I had headaches more often than not. I will confess before you all that I succumbed to temptation and had some wonderful lemony chocolate nut thing, covered with whipped cream. I savored and enjoyed every bit of it but as soon as I finished I popped an extra 20 mg. of Benicar and even though I felt some achiness in my muscles--it dissipated and I was fine!!!!!!!!!!! It truly was a happy Mother's Day! ~ Adrianne
-I had much the same thing happen. I had been declared a refractory case by a major headache clinic in the Boston area years ago, and my neurologist also threw up his hands and just tried to relieve the attacks rather than prevent them. I have been nearly 9 MONTHS without a migraine since starting the MP. Had a couple of days where it felt like one was trying to get started (you know the sensation I'm sure), but that was about it.
The fact that the MP is going to cure my other problems as well just makes it that much better. I didn't expect the migraines would just go *poof* as soon as I got up to speed on the benicar. I can hardly wait to walk into my neurologist when I am done and tell him how I did it. I suspect he'll listen, too! ~Knochen
-One of my major symptoms was horrible migraines, and I had been treated for many, many years unsuccessfully. I was at some major headache clinics like the Faulkner in Boston and they basically gave up on me after trying everything under the sun. And I do mean everything! (more than 25 years of them doing various things) I was a real mess from the migraines alone, let alone my other problems. But the MP fixed my migraines almost from day one. It's been nearly 2 years now without any migraines at all. I don't even get that awful sensation like I might get one. Remarkable? Miraculous, is what I'd call it. ~Knochen
Related FAQs:
What is a neuro Herx?
How does stress affect Th1 inflammation?
Why is my 'herx' more intense after exposure to Light & / or Vitamin D?
Will Herxing cause increased eye inflammation? If you are concerned please check with your Opthalmologist. It is important to visit a health-professional when you need advice about your eyes. << << Adequate eye protection will be particularly important for anyone with eye inflammation.
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Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| 24+ years not Dx| Cut D/exp July04| NoIR Aug04 Comm Beni|Q| Sept05 off Thyroxine| CLICK ABCofMP
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Lottie
Board Staff
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Posted: Tue Aug 1st, 2006 17:54 |
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(filelink)
Non medication strategies to reduce pain
Before opening a bottle of pills, try these seven, safe alternatives first:
1. Apply a heat pack on sore muscles, joints or over the liver for pain relief.
2. Soak in a warm bath with Epsom salts.
3. Following all directions, rub a natural, topical pain reliever onto the area of pain.
4. Make sure you have adequate rest. Fatigue always worsens pain.
5. For muscular pain, gentle stretching or mild physical activity can deliver the oxygen and blood flow needed for relief.
6. Find a credentialed massage therapist with experience in chronic pain. Massage therapy enhances circulation, helping to reduce physical pain.
7. Some patients achieve pain relief with complementary and alternative therapies, such as chiropractic or acupuncture. Only seek advice or treatment by a qualified professional, and be sure to discuss any of these therapies with your physician.
Pace activities and rest
Remember that pain is Mother's Nature's way of letting us know that something is wrong. The idea of pain control is that the pain be tolerable. So that you can perform the Activities of Daily Living.
You say that when you >>> "wear the TENS, I do things I otherwise couldn't do from pain, so it makes everything overall worse."
Are these things that HAVE to be done? And done by you? I suspect that you need to learn to pace yourself.
I know that one day since I've been on the MP, I had very little pain, but did have energy, and incentive… and I regretted the fact for about a week that I had made "excellent" use of them both, in straightening, and tossing stuff. I learned from that I have to set an alarm for those times that I have days similar to that (which is still kinda rare), so that I know when to stop and not do any more.
When you have energy, do you do more than you should? That could contribute to your pain, and the drowsiness when you wake up.
Are you resting enough? Are you napping during the day? Are you trying to stick to a regular sleep schedule? Don't forget that your body is working hard to get well, and you need to rest. Maybe more than you realize, even for the pain. ~Lottie
Memory foam pad for bed or chair
I have a two inch thick pad that I have on my bed, and it has helped my joint and back pain a lot, I can lay on my side for a while now with it, and my shoulders and hips seem to do MUCH better. I would think that three or four inch thick pad might help your situation. You might even get one of the real thick ones for sitting on. I've forgotten the thickness that they use for wheel chairs, but six inches thick comes to mind. ~Lottie
A comfortable place to rest
Another suggestion I would make is that the couch is really not the best surface for those with the areas of pain he is experiencing. I too, tried, this approach, recliners, most everything.
Finally my husband stepped in, and made our bed the most comfortable haven, with the newer products you can find to distribute weight much more evenly and rid those pressure point areas. Fifteen minutes of sleep at a time, prior to that wasn't uncommon for me either, prior to our "bed makeover".
It was well worth the bit of expense to place memory foam over the surface of our bed, with egg crate cushioning underneath. Memory Foam Pillows keep the cervical spine in a much more aligned state as well. The memory foam has improved that paralyzing stiffness that overtakes you when you have been in a position too long. (As turning sometimes is painful enough to lessen and avoid that that action, and one remains in positions far too long--thus the stiffness).
We placed a two inch memory foam topper on our bed. We had purchased a new bed, just prior to this, trying to get some relief for me. (That didn't happen  ).
Memory toppers will not be effective on overly soft beds, or beds that have been in use for, I believe, they say 3 to 5 years or more, as these beds have already begun to become mishapen from use. You know the sinking to the middle syndrome, or the edges breaking down? This causes fighting in your sleep basically to roll uphill.
You may if you are able-- get a new bed with memory foam already installed. In hindsight I might give 3 inches a try instead of the 2 inches. Although just the 2 inches have made a significant difference, I wonder if the 3 inches may be even better for me. I think the size of the person should be considered, perhaps, too, when choosing. There are plenty of websites to check, and some offer free shipping. ~hrts
-I use a Inversion table periodically which seems to help me. It both moves lymph and helps aline the spine. I do not go all the way back with the movements, just a rocking and then lay at an angle comfy to me. ~Pat
Castor oil pack
A Castor Oil pack (poutice) may relieve pain better than medication.
The info below says to use the pack for 30-60 minutes but you can use it up to 2 hours with a heat source. You can use the pack everyday until you get relief. Then use it as needed.
Precautions
Do not use a heated castor oil pack for uterine growths, cancer tumors, or ulcers. Don't use if you are pregnant, breast feeding, or menstruating. Don't apply over broken skin.
Castor Oil Pack Components
Castor oil.
Two sheets of plastic (garbage bags OK).
1 yard cotton or wool flannel.
Heating pad (if indicated).
Large old bath towel.
3 safety pins.
Preparing a Castor Oil Pack
1. Fold flannel into three thicknesses to fit over the area to be treated.
2. Cut a piece of plastic 1-2 inches larger than flannel.
3. Saturate the flannel with gently heated oil, but not so much that it is drippy. Fold it over and squeeze until it is oozing. Unfold.
4. Place plastic and old towel over flannel to prevent staining of surface you will be sitting or lying on.
5. Lie down, placing flannel over affected area, putting fitted plastic over the flannel.
6. Now wrap the towel around area and pin with safety pins.
7. Place a heating pad (low heat) or hot water bottle on top of the towel.
8. Rest for 30-60 minutes. Use visualization, meditation, or just sleep. A good time to use castor oil packs is just before bedtime.
9. When finished, it's best if you don't get up and walk around and be busy (except to go to the bathroom). Try to stay still and relaxed.
If you are doing your pack at bedtime, have a zip-lock baggie next to your bed, and a towel to remove any excess oil and protect your bed sheets. Fold the oily pack up and put it into the baggie, then drop it to the floor till morning. In the morning, put it in the refrigerator.
If you are not using the pack at bedtime, you can get up and wash the treated area with solution of 3 tablespoons of baking soda to 1 quart of water to remove the oil. Put the pack into the refrigerator.
11. Store the pack in the covered container or baggie in the refrigerator. Remove it from the refrigerator 1-3 hours before you plan to use it, so that it is at room temperature when you are ready to use it.
12. Each pack may be used repeatedly. When it starts to smell stale, make a new pack.
You can purchase the wool or cotton flannel pad and the Castor Oil at http://www.Iherb.com and type in "Castor Oil" in the search box at the top of the page. The cost for the pad, 12x18, and 16 oz. Castor Oil is $8.59. Shipping by U.S. Post Office, first class international, to Canada is $8.00 for a total of $16.59. It takes 3-10 days to receive orders from them in Canada. They have excellent customer service.
I had intolerable pain and swelling of my knee joints to the point where I couldn't walk. I used Castor Oil packs on my knees and it brought pain relief that meds didn't and it reduced the swelling.~Terry
Last edited on Fri Jan 18th, 2008 02:41 by Meg Mangin R.N.
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Dx- Sarc 1999 Cardiac, Neuro, Joints, Myalgia, Skin, SOB, Fatigue (Apr 04-1,25 D 48, 25D 17) (May 05-1,25D 35, 25D < 5) Pred x5yrs-now off! 5/19/04 beg Benicar 10/11 beg Mino, 1/24/05 mod P2, 2/2/06 P2, 1/6/07 P3 - Worked as RN until back injury
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Meg Mangin R.N.
Research Team
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Posted: Mon Sep 11th, 2006 18:18 |
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(filelink)
Trigger point therapy
The Trigger Point Therapy Manual by Davies relies on a do-it-yourself approach that could be looked into --http://www.triggerpointbook.com .
When I was studying this, I also read the two volumes by Travell & Simons.
Amazon.com: Travell & Simons' Myofascial Pain and Dysfunction: The Trigger Poi
I recall that they said besides the ordinary trigger points that develop from muscle strain, if one has a diseased organ (eg. heart or gallbladder), sometimes it can prompt development of a trigger point in a muscle nearby. I really think it would be worth at least reading about. If you identify a trigger point, there are even do-it-yourself instructions that can sometimes really help. Instead of the anaesthetic that is used by a practitioner, there is a special technique they use with ice. You could browse through Davies' Trigger Point Manual at a bookstore even.
There is also one by Devin Starlanyl, but it isn't as focused on or have as much detail on the trigger points and covers a broader array of subjects -- but it also can be useful (Fibromyalgia and Myofascial Pain Syndrome). It might be that if you could release one or more trigger points it could make a big difference. Once they arise, they can be self-perpetuating. ~Joyce Waterhouse
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Meg Mangin R.N.
Research Team
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Posted: Sat Jan 13th, 2007 22:12 |
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(filelink)
Morphine may be immunosuppressive
Br J Pharmacol. 1997 Jun;121(4):834-40.Click here to read Links Sacerdote P, Manfredi B, Mantegazza P, Panerai AE. Department of Pharmacology, University of Milano, Italy.
Antinociceptive and immunosuppressive effects of opiate drugs: a structure-related activity study.
1. Although it is well known that morphine induces significant immunosuppression, the potential immunosuppressive activity of morphine derived drugs commonly used in the treatment of pain (codeine, hydromorphone, oxycodone) has never been evaluated. 2. We evaluated in the mouse the effect of the natural opiates (morphine and codeine) and synthetic derivatives (hydromorphone, oxycodone, nalorphine, naloxone and naltrexone) on antinociceptive thresholds and immune parameters (splenocyte proliferation, Natural Killer (NK) cell activity and interleukin-2 (IL-2) production). 3. Morphine displayed a potent immunosuppressive effect that was not dose-related to the antinociceptive effect, codeine possessed a weak antinociceptive effect and limited immunosuppressive activity; nalorphine, a mu-antagonist and kappa-agonist, exerted a potent immunosuppressive effect, but had very weak antinociceptive activity. The pure kappa-antagonist nor-BNI antagonized the antinociceptive, but not the immunosuppressive effect of nalorphine. 4. Hydromorphone and oxycodone, potent antinociceptive drugs, were devoid of immunosuppressive effects. 5. The pure antagonists naloxone and naltrexone potentiated immune responses. 6. Our data indicate that the C6 carbonyl substitution, together with the presence of a C7-8 single bond potentiates the antinociceptive effect, but abolishes immunosuppression (hydromorphone and oxycodone). 7. The single substitution of an allyl on the piperidinic ring resulted in a molecule that antagonized the antinociceptive effect but maintained the immunosuppressive effect. 8. Molecules that carry modifications of C6, the C7-8 bond and C14, together with an allyl or caboxymethyl group on the piperidinic ring antagonized both the antinociceptive and the immunosuppressive effect of opiates and were themselves immunostimulants.
PMID: 9208156 [PubMed - indexed for MEDLINE]
Moderator's note: nociceptive means sensitive to pain or causing pain.
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Meg Mangin R.N.
Research Team
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Posted: Fri Aug 17th, 2007 23:39 |
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[filelink]
Painful drug war victory
The Washington Times
Zachary David Skaggs
August 16, 2007
Since 2000, the Drug Enforcement Administration has embarked on a muscular campaign against prescription painkiller abuse. It has utilized undercover investigations, SWAT raids, asset forfeiture, and high profile trials against "kingpin" doctors. These tactics should be familiar to anyone who has studied the drug war, but the results are a shocker. Prescription opioids have actually grown scarce.
To put it bluntly, the DEA has finally found a drug war it can win.
"Opiophobia" is a term that describes doctors' increasing unwillingness to prescribe opioid painkillers — a class of drugs that includes Vicodin and OxyContin — and especially high-dose opioids, to those in pain. This fear is rooted in the DEA's practice of jailing those doctors it deems are prescribing outside "legitimate medical standards."
Because pain doesn't show up on an MRI, doctors work together with their patients to achieve proper dosage. And, thanks to individual chemistry, pain level, drug tolerance, or typically, all three, patients vary tremendously in the number of milligrams they require. But when the only thing doctors know for certain is that prescribing large amounts of opioids endanger them, it is those suffering the worst who go undermedicated.
Call it "opiophobia," call it a "chilling effect," or simply, doctors behaving rationally, the result is the same: massive underprescription of opioids and radical undertreatment of pain. A Stanford study puts the number of undermedicated chronic pain patients at about 50 percent. According to the American Pain Society, fewer than 50 percent of cancer patients receive sufficient pain relief.
Retired Marine James Fernandez is a Gulf War vet, a helicopter copilot, and a longtime chronic pain sufferer. While injuries sustained during the Gulf War left him reliant on nearly a gram of OxyContin and MS Contin per day, it was the war on drugs that would ground him.
Following his return from Iraq, Mr. Fernandez was ping-ponged from one doctor to the next, none willing to prescribe at the dose necessary to treat his crippling pain. He reports one military physician even explicitly making mention of his fear of being "red-flagged" by the DEA. Under-medicated but still fighting for his right to pain relief, Mr. Fernandez describes his long-suffering, bed-ridden existence as "mostly miserable, most of the time."
Today, Mr. Fernandez's cause has been picked up by energetic advocates like Dr. Alex Deluca of the Pain Relief Network, but many are not so fortunate.
Take those treated with Vioxx, a popular alternative to opioids that rang up $2.5 billion in sales the year before its discontinuation in 2004. To its credit, Vioxx treated pain, though not nearly as powerfully as opioids. But it was Vioxx's unfortunate side effect of causing heart attacks that led to its discontinuation, not its middling analgesic effect.
Today risk-averse doctors trot out a motley mixture of placebos, from anti-epileptics to tricyclic antidepressants. Risky spinal fusion surgery is performed 20,000 times each year, despite the New England Journal of Medicine finding "no acceptable evidence" of the procedure's efficacy.
But ineffective therapies and dangerous surgical interventions do not draw the DEA's eye — painkillers do.
Some patients attempt to skirt these problematic treatments, not because they've necessarily read the literature, but, more commonly, because they know what has worked for them. The medical community has come to regard them as "doctor shoppers," no different than junkies seeking a fix. The hardening of doctor attitudes against their patients represents another casualty of the DEA's campaign.
The DEA is so used to losing the drug war it has trouble understanding the effect its campaign is having. "To the million doctors who legitimately prescribe narcotics to relieve patients' suffering," counsels DEA Administrator Karen Tandy, "you have nothing to fear."
But doctors have very different incentives than drug dealers, including a wealth of options available to them that do not endanger their lives and livelihood. With doctors cutting back, pain patients — unlike the abusers the DEA is trying to target — are running out of options.
This is the legacy of the drug war's lone success.
Zachary David Skaggs is a fellow specializing in pharmaceutical policy at the Competitive Enterprise Institute.
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Meg Mangin R.N.
Research Team
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Posted: Fri Sep 7th, 2007 03:17 |
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[filelink]
The Poor Management of Pain
by Richard Lee
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