Pills for Breakfast: Five Things I Wish I Knew Sooner About Chronic Pain - NPR

Pills for Breakfast: Five Things I Wish I Knew Sooner About Chronic Pain- National Pain Report
http://bit.ly/1uVOIve

I'm sure we all have many things we'd line to add (feel free to list them in the comments below), but this it's a great article.

Steve

GW Pharmaceuticals cannabinoid for cancer pain likely to have encouraging US market penetration, abuse possibility uncertain – experts

GW Pharmaceuticals cannabinoid for cancer pain likely to have encouraging US market penetration, abuse possibility uncertain – experts
http://ctcaho.pe/1lfsPUe

Although approval is limited to cancer related pain, Sativex should be made widely available due to a relatively low abuse potential for patients who don't get enough relief from opioids alone.

As a Marinol/dronabinol user, I'm excited about the possibility of a cannabinoid product without the intense high and unpredictable absorption of oral THC (Marinol). I can also verify the article's assertion that cannabinoids alone are inferior to cannabinoids added to to opioids.

I'm not sure if I'm the only one, but I'm extremely excited for this new, non-opioid (& opioid boosting) pain medication. I also find reports like this one reassuring, and a little exciting (I'm sure it's no big deal for patients in medical cannabis states, but it's important for those of us in Republican hell states, we have no cannabis, no Medicaid expansion, and we're desperate for a decent cannabinoid (oral dronabinol is terrible & the Marinol inhaler is stuck in clinical trials)).

Steve

Summer Break

I haven't been paying much lately because my wife and I have had ridiculously busy weeks topped off with our daughter's kindergarten graduation yesterday (Tuesday). Her last day of school is tomorrow (or, rather, today... Thursday) and it's a half day (they get out at 10:45am).

While I'm extremely excited for her schedule to open up so that we can do more fun stuff (summer reading program, zoo trips, beach, museums, etcetera), I'm also worried about returning to chasing after her all day and all of the other things that go along with being a parent with chronic pain.

I've made rules for myself to prevent the typical cycle of over exertion & paying for that over exertion. I don't have them all written down, but they include (in no particular order):
1) TAKE BREAKS
2) "No" isn't a dirty word
3) Neither is "later"
4) kids don't need you to literally chase after them, just keep them within your eyesight when outside your home
5) Play dates are your friends (when you watch other people's kids, they really entertain your kid and you get free time when their parents return the favor)
6) don't afraid to ask for help
7) Kids will test you anytime things change, enforce discipline in June so July & August are smooth sailing
8) Don't forget your pain medication & don't skip doses, keeping your pain under control makes you a better parent
9) when you need a break, ask/tell your kid(s) to
10) DON'T BE SO JUDGEMENTAL/HARD ON YOURSELF
11) make time for yourself
12) make time for you & your significant other

Steve

Miss Understood: The Ungrateful

Miss Understood: The Ungrateful - National Pain Report
http://bit.ly/1kli7qr

So many people around us take for granite their health, even with us as constant reminders. They make underhanded comments/remarks about being on disability/not having to work and how they have no free time because they actually work. If course what they fail to realize is that being in chronic pain, or having any chronic illness is like having fulltime job with erratic mandatory overtime.

Because there original post basically says everything that needs to be said, I'm going to leave you with that.

Steve

P.S. Please remember to click the red post you'll title (this post title says "Miss Understood: The Ungrateful" in bright red) everytime you read a post from the homepage. They're are three reasons that I ask for this:
1) It allows you to read the comments
2) that page allows you to add your own comments, which I HIGHLY encourage
3) It allows my Google Analytics to tell me how many times reach page is loaded & allows me to judge popularity of individual posts

Thank you

Pain-somnia (mini-post)

It's well past 5am & I have to get up at 7:25am, my pain induced insomnia (aka Pain-somnia) had kept me up all night, despite significant pharmacological treatment.  Unfortunately, with about two hours until I need to get up, there's nothing that I can take right now to help me sleep (even Zanaflex/tizanidine knocks me out  a bit longer than two hours). It is infuriating to feel so tired, but be unable to actually get any sleep.

I hope that you're all doing well, in minimal pain & getting plenty of sleep.

Steve

Sham Medical Devices & "All-Natural" Treatments

I recently responded to a question about NEUROVA, a copy of TENS unit that doesn't require a prescription (a HUGE red flag).

This led me to the decision to write a post about scams. Scammers are taking advantage of chronic pain patients, especially desperate pain patients, and the current climate regarding opioids.

The most common scam medical devices are "electric stimulators", which are a cross between those electric weight loss belts from the 90s that were supposed to give you abs without working out and TENS units, they bypass FDA clearance & approval by calling them "electronic massagers". These "TENS" units are not the same thing as the more expensive FDA approved TENS units that treat pain, especially neuropathy. Any legal TENS unit (the devices that can treat pain) require a prescription. Really, anything that is supposed to treat pain but isn't approved by the FDA or a similar international agency is suspect. Prescriptions are required for all legitimate longterm pain treatments with only a few exceptions (even FDA approved OTC treatments, like acetaminophen/paracetamol/Tylenol and Ibuprofen/Advil/Motrin aren't safe and effective longterm chronic pain treatments without doctor supervision (which is why the label tells you to seek medical care if you haven't improved after a few weeks). Acetaminophen/APAP is hepatotoxic and NSAIDs cause stomach irritation and bleeding.

Anyway, back on track...

When it comes to sham medical devices and "all-natural" treatments, the websites are great places to found clues, the wording frequently gives them away. Examples of Ted flags include:
* bad mouthing other treatments, especially opioids
* vague explanations of how it works
* not listing ingredients
* anything that's "proprietary" or "patented"- Remember patenting doesn't mean it works, it means they filled some paperwork. If they're advertising or bragging about the patent, they're scraping bottom for ways to con you out of your limited resources

If you want all natural, drug free treatments, research & purchase specific supplements, not "proprietary blends". You can save a fortune by purchasing these ingredients in bulk and putting them in capsules by yourself. Amazon sells everything you need, if you're interested.

Disclaimer: The links above are affiliate links, which means that if you click either link and subsequently make any Amazon purchased I, or rather my daughter's college fund, will receive up to 2% of the purchase price of eligible items.

Xartemis XR

I recently saw an advertisement for Xartemis XR. The new opioid is overpriced, completely unnecessary, and dangerous. Xartemis XR is essentially OxyContin with acetaminophen (INN: paracetamol), aka Tylenol, added. Tylenol alone kills or hospitalizes more people than all legal opioids combined. The US government has a campaign against the unnecessary use of acetaminophen because of the hepatotoxicity of acetaminophen, even when used within guidelines.

Daily intake of acetaminophen (APAP) should not exceed 2600-3000mg (THREE GRAMS) per day and it should NEVER be taken on a regular basis because even normal doses of acetaminophen can be toxic after two weeks.

Tylenol is added to Percocet & Vicodin for ONE REASON, as an abuse deterrent. Unfortunately, that doesn't work, people just get acetaminophen poisoning.


Extended release opioids are primarily intended for long term use by chronic pain patients, so who is this stupid product intended for?


Xartemis XR (oxycodone/APAP extended release) is a SCAM to extort more money from insurance companies and cash in on the current climate of opiophobic hysteria. If your doctor tries to prescribe this for you, ask them why they are giving you an expensive name brand drug that is inferior to the generic alternatives and push for something better.

Distinguishing Intractable Pain Patients from Drug Addicts

Distinguishing Intractable Pain Patients from Drug Addicts

By Joel S. Hochman, MD

http://bit.ly/IPvsAddict


Maybe one of you will better understand what appears to me to be nothing but an excuse to keep pain patients from getting their meds. It seems to me that fear of Diversion is a poor excuse for denying legitimate pain patients access to opioids, especially when nothing else works. The DEA has NO AUTHORITY to regulate medicine, they can only go after a doctor if (s)he prescribes "outside of medical practice", meaning that they were intentionally writing prescriptions that were not intended to treat a legitimate medical condition. Unfortunately, doctors don't decide which doctors are prescribing in the "due course of medical practice", and neither do any other medical professionals. DEA agents (glorified cops) and prosecutors make these decisions. They've scared doctors to the point where the doctors have started to lie to their patients in order to reduce the number of controlled substances (especially opioids) that they prescribe.

My biggest question is this....

If physicians can distinguish so easily between addicts and legitimate pain patients (which I do believe that they can), why is it that the DEA can't tell the difference between prescriptions to legitimate patients and prescriptions written to addicts?

-Steve

Insomnia

As I am sure most of you know, pain can interfere with sleep on a monumental scale. I had to get up pretty early this morning (actually, I've had to get up early for the past two weeks) and I have to get up early again tomorrow (or rather today), so I took my lorazepam 2mg (x2), tizanidine 4mg, and Rozerem (because I took the Rozerem, I had to skip the melatonin tonight per my PCP's orders). Unfortunately, the earlier of a morning, the worse my insomnia seems to be. I recently added two more tizanidine 4mg, which seems to be the most effective sleep aid in my extremely well stocked arsenal of insomnia remedies. In addition to the pain related insomnia, I have had insomnia since I was a toddler, AND the location of my tumor causes it to mess with my circadian rhythm.

I know that I'm not the only one who does it, but I frequently want to kick my own @$$ for repeatedly calculating how much time I would get to sleep if I fell asleep right now... or right now... or right, well you get the picture =P. This is one of the most self defeating habits of insomniacs, but, if you're anything like me, you simply can't help it!

Personally, I find this unpredictable sleep one of the most frustrating aspects of life with CP/IP because it makes it extremely difficult to schedule absolutely anything.

I feel like this post needs a conclusion, but I can't for the life of me figure out what that should be, so I'll simply wish you all happy slumber.

-Steve

The Innocent Victims of America's Painkiller Panic

The Innocent Victims of America's Painkiller Panic | The Fix
http://bit.ly/1qh5Xbr

High-dose opioids could crack chronic pain

High-dose opiates could crack chronic pain: Nature News & Comment
http://bit.ly/1iWsaaL

Note: The author of this article titled it incorrectly, opiates only refers to natural opioids, like morphine and codeine. Opioid refers to:*natural opiates: morphine & codeine
*semi-synthetic opioids: hydrocodone, oxycodone, oxymorphone, hydromorphone, and diacetylmorphine/diamorphine/Heroin (although it is not legal in the USA, it is a commonly used opiate in the UK & other countries)
*synthetic opioids: fentanyl, sufentanil, meperidine/pethidine/Demerol

Intractable Pain Kills: Definition of Intractable Pain

I was going through my drafts and found a page that I hadn't finished, so I took five minutes and finished it. If anyone is interested, I've finished Definition of Intractable Pain. I tried to keep it short, sweet, and to the point. As always, I'd love feedback (either via email IntractablePainKills@gmail.com or by commenting here)

Marijuana Works Better Than Opiates To Control Pain: Here’s How

Marijuana Works Better Than Opiates To Control Pain: Here’s How- Cannabis Now Magazine
http://bit.ly/1iZJQkP

Instead of rewriting my opinion, again, I've included my comments... They may not be pretty or perfectly formatted, but they get my points across.

~~~~~ Comment #1 ~~~~~

Why is it always cannabis OR opioids?

They work wonders together and cannabis doesn't help everyone.

We don't need more bashing of opioids in the name of advancing cannabis. All opioid side effects wear off over time (except constipation, which is readily managed with Miralax OTC),it's a function of tolerance.

Also, (a side note) while THC is helpful, it is important to remember that THC alone is almost worthless for pain relief (otherwise, my Marinol/dronabinol (CIII) would help). High THC is fine, as long as CBD isn't sacrificed. Also, oral consumption causes rapid, extensive first pass metabolism, which modifies the THC (one of the issues with Marinol/dronabinol when taken as directed).

I think that the most important thing to remember is that CP/IP (chronic/intractable pain) patients are NOT one size fits all.
~~~~~

~~~~~ Comment #2 ~~~~~

Sativex (natural cannabis with plenty of THC & CBD as a transmucosal oral spray-similar to a cannabis tincture) will be a great leap forward for pain patients and other medical cannabis users alike. Aside from being legal and covered by insurance, it will be easily measured.
~~~~~

~~~~~ Comment #3 ~~~~~

That 6% statistic is a gross overestimate, which also includes those who purposefully acquired opioids to abuse them (pill mill patients) and pain patients who were cut off from their legitimate prescriptions by pharmacies like Walgreens & states like Florida.

If you look only at the CP/IP patients who take their medications as prescribed, addiction only occurs in 0.05-0.3% of patients.
~~~~~

~~~~~ Facebook Comment ~~~~~

Why is it always cannabis OR opioids?

They work wonders together and cannabis doesn't help everyone.

We don't need more bashing of opioids in the name of advancing cannabis. All opioid side effects wear off over time (except constipation, which is readily managed with Miralax OTC),it's a function of tolerance.

Also, (a side note) while THC is helpful, it is important to remember that THC alone is almost worthless for pain relief (otherwise, my Marinol/dronabinol (CIII) would help). High THC is fine, as long as CBD isn't sacrificed. Also, oral consumption causes rapid, extensive first pass metabolism, which modifies the THC (one of the issues with Marinol/dronabinol when taken as directed).

I think that the most important thing to remember is that CP/IP (chronic/intractable pain) patients are NOT one size fits all.
~~~~~

Fear Of Addiction Means Chronic Pain Goes Untreated | Health News Florida [Transcript]

Fear Of Addiction Means Chronic Pain Goes Untreated | Health News Florida [Transcript]
http://bit.ly/1iJH9Vs

Chronic Pain affects more people than Diabetes, Heart Disease, & Cancer combined

Untreated & undertreated intractable pain also leads to heart disease (& severe tooth decay). 

Sativex Granted "Fast Track" Review

Marijuana Spray Gets ‘Fast Track’ Review from FDA - National Pain Report
http://bit.ly/1nAnkBC

As a cancer patient, I'm ecstatic about the possible approval of Sativex for cancer pain. I'm currently using Marinol/dronabinol, which is synthetic THC suspended in sesame oil, encapsulated in gelatin. It's terrible medication. The best thing is herbal cannabis, but Sativex is a close second. It's an all natural herbal tincture spray. It isn't just THC, it also includes plenty of CBD and every other cannabinoid.

My Story: Life with Interstitial Cystitis - National Pain Report

My Story: Life with Interstitial Cystitis - National Pain Report
http://bit.ly/1gXa5Yn

This is the story of a woman afflicted with a Interstitial Cystitis due to physician malpractice. She was promised that the pain would subside, but it didn't. She has to go to the bathroom 60-70 times a day, but was denied disability.

She is a fellow pain warrior and my thoughts are with her. Hopefully, she will receive her disability soon and not lose even more than the intractable pain and IC have taken from her already.

Steve

The “Integrative Pain Management” Controversy

Pain-Topics News/Research UPDATES: The “Integrative Pain Management” Controversy
http://bit.ly/1mGX5t2

Ask the Pharmacist: Why Am I Being Denied a Pain Medication? - National Pain Report

Ask the Pharmacist: Why Am I Being Denied a Pain Medication? - National Pain Report

http://bit.ly/1hVfr2n

I know what you're thinking, another link, really? Unfortunately, I haven't felt up to posting any personal posts. Fortunately, I've been running across quote a few great articles.

Steve

American Pain Rights Act Petition

American Pain Rights Act Petition
http://bit.ly/1dGT7h6

My comment:
I'm a cancer patient with severe intractable pain. Because of the rampant Opiophobia caused by the epidemic of anti-opioid propaganda, I can no longer get adequate treatment. Pain patients aren't addicts and we aren't criminals, we didn't choose to live in pain 24/7. We are treated as guilty the moment we walk into the doctor's office, hospital, or pharmacy. Addiction among chronic pain patients is extremely rare (3-7 patients per thousand). Those of its who take our medications as prescribed should NEVER been punished because an minority of people abuse these essential medications.

Drug abusers will get opioids no matter what. These opiophobic policies harm pain patients, but have no effect on addicts other than to raise street prices on pharmaceutical opioids and force them to switch to heroin (diacetylmorphine/diamorphine), which is much more dangerous because they cannot accurately determine dose. There are even a subset of extremely desperate pain patients (mostly in Florida) who have resorted to heroin for pain relief. No one should have to turn to the streets for medical care.

For intractable pain patients, like myself, there is no alternative to opioids. Before doctors prescribe opioids, they make us try dozens of other treatments (with serious side effects).

Opioids aren't nearly as dangerous as NSAIDs or acetaminophen, each of which kill more people each year than all opioids combined.

Overcoming Opiophobia
http://bit.ly/Opiophobia

The Intractable Pain Patients' Handbook for Survival
http://bit.ly/PainGuidePDF