Category Archives: Pain Medicine

Pain by the numbers

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 Illustration of the pain pathway in René Descartes' Traite de l'homme (Treatise of Man) 1664

Illustration of the pain pathway in René Descartes’ Traite de l’homme (Treatise of Man) 1664

By Rachel Gotbau
KHN

In one of the largest population studies on pain to date, researchers with the National Institutes of Health estimate that nearly 40 million Americans experience severe pain and more than 25 million have pain every day.

 

Those with severe pain were more likely to have worse health status, use more health care and suffer from more disability than those with less severe pain. Continue reading

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Pain patients say they can’t get medicine after crackdown on illegal Rx drug trade

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Lesley Young testified that she has driven 100 miles to try to find a pharmacy that would fill painkiller prescriptions for her husband Chris. (Photo by Jessica Palombo/For KHN)

By Rachel Gotbaum
KHN

The accident happened 10 years ago when Chris Young was 35.

He owned a salvage yard in Maui, Hawaii, and his employee had hoisted a junker on a machine called an excavator when the hydraulics gave out.

The car fell on him from above his head, smashing his spine.

“He was crushed accordion-style,” says his wife Lesley.

The accident left Young with a condition known as “partial paraplegia.” He can’t walk and he needs a wheelchair, but he does have some sensation in his legs. Unfortunately for Young, that sensation is often excruciating pain.

“It feels like electric shocks, like lightning bolts going down my legs. And when it gets down to the bottom, it feels like someone is driving a big metal spike up my legs,” says Young.

To control the pain, Young, who has since moved to Florida, needs high doses of narcotic painkillers, but he can’t always fill his doctor’s prescription.

He is not alone. In what may be an unintended side effect of a crackdown on prescription drug abuse, Young and other legitimate chronic pain patients are having increasing trouble getting the medicine that allows them to function on a daily basis. Continue reading

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The gray areas of assisted suicide

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When J.D. Falk was dying of stomach cancer in 2011, his wife says doctors would only talk about death in euphemisms. (Photo: courtesy of Hope Arnold)

By April Dembosky, KQED

SAN FRANCISCO — Physician-assisted suicide is illegal in all but five states. But that doesn’t mean it doesn’t happen in the rest. Sick patients sometimes ask for help in hastening their deaths, and some doctors will hint, vaguely, how to do it.

This leads to bizarre, veiled conversations between medical professionals and overwhelmed families.

Doctors and nurses want to help but also want to avoid prosecution, so they speak carefully, parsing their words. Family members, in the midst of one of the most confusing and emotional times of their lives, are left to interpret euphemisms.

Doctors and nurses want to help but also want to avoid prosecution, so they speak carefully, parsing their words.

That’s what still frustrates Hope Arnold. She says throughout the 10 months her husband J.D. Falk was being treated for stomach cancer in 2011, no one would talk straight with them.

“All the nurses, all the doctors,” says Arnold. “everybody we ever interacted with, no one said, ‘You’re dying.’”

Until finally, one doctor did. And that’s when Falk, who was just 35, started to plan. He summoned his extended family. And Hope made arrangements for him to come home on hospice. Continue reading

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Most states list deadly methadone as a ‘preferred drug’

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465px-Methadone.svgBy Christine Vestal
Stateline

The federal government has been issuing warnings about the dangers of methadone for nearly a decade.

Two years ago, states started removing it from their Medicaid “preferred drug lists.” (Joe Amon/Getty Images)

As prescription drug overdose deaths soar nationwide, most states have failed to take a simple step that would make it harder for doctors to prescribe the deadliest of all narcotics.

Methadone is four times as likely to cause an overdose death as oxycodone, and more than twice as likely as morphine, yet as many as 33 states make it easy for doctors to prescribe. 

Methadone overdoses kill about 5,000 people every year, six times as many as in the late 1990s, when it was prescribed almost exclusively for use in hospitals and addiction clinics where it is tightly controlled.

It is four times as likely to cause an overdose death as oxycodone, and more than twice as likely as morphine. In addition, experts say it is the most addictive of all opiates.

Yet as many as 33 states make it easy for doctors to prescribe the pain medicine to Medicaid patients, no questions asked. Continue reading

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Narcotic Painkillers in Pregnancy Common, Harmful to Baby: Study – WebMD

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Blue Pregnant BellyUse of prescription narcotic painkillers is common in pregnancy and increases the likelihood a baby will be born small or early, or go through painful drug withdrawal, a new study finds.

These prescription painkillers, also called opioids, include drugs such as hydrocodone (Vicodin), oxycodone (Oxycontin), codeine and morphine.

Nearly 30 percent of the Tennessee mothers-to-be in the new study used at least one of these drugs while pregnant, and the associated risks went up if they also smoked or took antidepressants.

via Narcotic Painkillers in Pregnancy Common, Harmful to Baby: Study – WebMD.

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Too little, too late for many New Yorkers seeking hospice

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By Fred Mogul, WNYC

Sandra Lopez and her Chihuahua, Coco, were inseparable. He followed her everywhere, and kept Lopez’s mood up when she was in pain – which was often.

On Oct. 15, Lopez, died at age 49 of pancreatic and vaginal cancer that had slowly spread throughout her body over two years. She left behind a 15-year-old daughter and little Coco. But with hospice care, she spent her last weeks where she wanted to be — at home, with her pain under control.

Sandra was in and out of the hospital in 2014, but for the months she was home, a hospice nurse from Metropolitan Jewish Health System visited once a week to help manage the pain, backed up by a 24-hour, nurse-staffed phone line that Lopez called often.

“Some days the pain is so excruciating,” she told me in August from the couch in her Brooklyn apartment, “that the pain overrides the medication.”

But despite evidence that hospices can greatly relieve discomfort, extend life and save money, and despite a generous hospice benefit available through both Medicare and Medicaid, relatively few people in New York take advantage of it, compared to elsewhere in the country.

Continue reading

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Cambia gives its largest grant ever to UW Medicine: $10 million for palliative care – Puget Sound Business Journal

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Dr. Randy Curtis, right, director of the UW Palliative Care Center of Excellence.

Dr. Randy Curtis, right, director of the UW Palliative Care Center of Excellence.

The grant is Cambia’s largest ever given to any organization and will come in four separate parts, creating three endowments totaling $8 million and $2 million dedicated to immediately improving care at the center.

via Cambia gives its largest grant ever to UW Medicine: $10 million for palliative care – Puget Sound Business Journal.

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Vicodin, some other pain meds will be harder to get – DEA

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Patients who use drugs containing hydrocodone as a pain reliever or cough suppressant are going to have to jump through more hoops to get them starting next month.

The Drug Enforcement Administration is reclassifying so-called “hydrocodone combination products” (HCP) from Schedule III to Schedule II under the Controlled Substances Act, which will more tightly restrict access. Vicodin, for example, is an HCP because it has hydrocodone and acetaminophen.

The final regulation, which takes effect Oct. 6, will mean that patients generally must present a written prescription to receive the drug, and doctors will no longer be able to call in a prescription to the pharmacy in most instances.

Many patients with painful chronic diseases, including cancer, take hydrocodone combination products

.The regulation is a response to the widespread misuse of prescription pain killers.

In an emergency, doctors will still be able to call in a prescription, according to the new rule. And although prescription refills are prohibited, a doctor can, at his discretion, issue multiple prescriptions that would provide up to a 90-day supply.

These measures don’t satisfy consumer advocates or pharmacists who are opposed to the new rule. Continue reading

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Women’s health – Week 49: TMJ

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tacuin womenFrom the Office of Researcher on Women’s Health

Temporomandibular joint (TMJ) and muscle disorders are a group of conditions that cause pain and dysfunction in the jaw joint and muscles that control jaw movement.

Some estimates suggest that TMJ disorders affect over 10 million Americans and appear to be more common in women than men.

The exact cause of TMJ is not clear. Trauma to the jaw or temporomandibular joint plays a role in some TMJ disorders but, in most cases, symptoms seem to start without obvious reason.

A variety of symptoms may be linked to TMJ disorders. Pain in the chewing muscles and/or jaw joint is the most common symptom. Continue reading

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Medicare experiment could signal sea change for hospice

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Diane Meier 176By Michelle Andrews
KHN / JUL 29, 2014

Diane Meier is the director of the Center to Advance Palliative Care, a national organization that aims to increase the number of palliative care programs in hospitals and elsewhere for patients with serious illnesses.

Meier is also a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City.

We spoke about a recently launched pilot program under the health law that allows hospice patients participating in the pilot to continue to receive life-prolonging treatment. This is an edited version of that conversation.

Q. There’s a lot of confusion about how hospice care differs from palliative care. Maybe we should start by clearing up what those terms mean. Continue reading

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Medicare to consider paying doctors for end-of-life planning

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End of life factBy Michael Ollove
Stateline staff Writer

The federal government may reimburse doctors for talking to Medicare patients and their families about “advance care planning,” including living wills and end-of-life treatment options — potentially rekindling one of the fiercest storms in the Affordable Care Act debate.

A similar provision was in an early draft of the federal health care law, but in 2009, former Republican vice-presidential candidate Sarah Palin took to Facebook to accuse President Barack Obama of proposing “death panels” to determine who deserved life-sustaining medical care. Amid an outcry on the right, the provision was stripped from the legislation.

Now, quietly, the proposal is headed toward reconsideration — this time through a regulatory procedure rather than legislation. Continue reading

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Women’s health – Week 35: Pain

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From the Office of Research on Women’s Health

tacuin womenPain is often an indication or warning that something in your body is not quite right, that you should take medicine and/or see a health care provider.

At its worst, however, pain robs us of our productivity, our well-being, and, for those suffering from extended illness, our very lives.

There are two types of pain: acute and chronic. Continue reading

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