The End of an Era in Fibromyalgia

The End of an Era in Fibromyalgia - National Pain Report
http://bit.ly/1ib3ES6

Opioids Aren't Increasing Your Pain, but those "non-narcotic" Alternatives Might

Serotonin May Perpetuate Chronic Pain - National Pain Report
http://bit.ly/1aRnuOh
http://americannewsreport.com/nationalpainreport/serotonin-may-perpetuate-chronic-pain-8822871.html

Anyone who has read Dr. Forest Tennant's Intractable Pain Patients' Handbook for Survival or Overcoming Opiophobia knows that, contrary to popular belief, opioid pain medications do not cause pain and doctors are lying or ignorant if they tell you that they do. Unfortunately, opioids are all too frequently blamed for chronic pain. Yes, there are a handful of people who experience an increase in pre-existing pain from truly high doses of opioids. These incredibly rare cases have very specific diagnostic criteria and simply still being in pain on opioids doesn't indicate OIH, especially without a worsening of pain with each dose increase. This is seen as a tool to convince CP/IP patients and their caregivers to "free" the CP/IP patients from the treatments that actually relieve pain (mu-opioids & methadone).

"No magic bullet. The worst propaganda being pushed upon all chronic pain patients, including those with and without intractable pain are the illusive "magic bullet" formulas being advanced by either pharmaceutical and medical device industries, unethical practitioners and some health plans and government agencies...The worst deception these days is the fraudulent pitch that pain can be cured by stopping all medications, as if control is the cause!!"
-Forest Tennant MD PhD

...Here comes the irony... (sorry for the long preamble)
As it turns out, the medications that the OIH proponents prescribe and recommend most often (serotonin increasing antidepressants, like serious SSNRIs, MAOIs, TCAs, & atypical antidepressants, like Remeron/mirtazapine) could be what is actually worsening pain in chronic pain patients! Seriously! How's that for irony? Not only are these doctors manipulating their patients out of effective treatments, but they may actually be making their pain worse with these psychotropic medications (plenty of which are neurotoxic).

Remember, procedures and surgeries are high & ultra high (respectively) profit while doctors get paid NOTHING for writing prescriptions and controlled substances (especially CIIs, like opioids) require even more non-reimbursed time thanks to the overstepping DEA, overzealous prosecutors, strict regulations, and public backlash thanks to an extremely small percentage of hefty doctors who ran already illegal pull mills.

~~While I can understand hesitating to risk your medical license, freedom, career, home, and the hundreds of thousands of dollars that must be spent to defend the criminal charges (still lose medical license & career), it is completely unethical to manipulate a patient into believing a lie so that you can commit malpractice by unilaterally rejecting an entire treatment modality without reasonable cause. I've had several PMs tell me that opioids are my best and/or only option, but they don't personally prescribe. That's horrible, but at least they didn't lie to or attempt to manipulate me like the PMs at Hopkins & UPenn did (unfortunately, this behavior is on the rise and more than half of all PMs engage in this kind of inappropriate behavior)~~

Notes:
* The only non-serotonin antidepressant is buproprion/Wellbutrin/Budeprion
* There is one antidepressant that actually enhanced serotonin reuptake (gets rid of the old, useless serotonin), however the FDA has not approved it (likely to avoid pissing off the multibillion dollar pro-serotonin antidepressant industry). For those of you outside the USA, the only commercially SSRE (Selective Serotonin Reuptake Enhancer) is called tianeptine/Stablon/Coaxil/Tatinol
* The National Pain Report article is based on a medical journal article in Neuron named "Central Terminal Sensitization of TRPV1 by Descending Serotonergic Facilitation Modulates Chronic Pain"
http://www.cell.com/neuron/retrieve/pii/S0896627313011410
http://bit.ly/1aRrRbU
* If anyone reading this believes that they may have OIH (or knows anyone who believes that they have OIH), PLEASE email me! I'd greatly appreciate the chance to discuss it with you. If you're interested, I'll also provide you with information to help you determine if you actually have OIH.

Tramadol/Ultram, tapentadol/Nucynta,and death

I constantly run into chronic pain patients who are being lied to about tramadol and tapentadol. These are not "strong opioids", they do not carry the safety record of morphine, codeine, oxycodone, oxymorphone, hydrocodone, hydromorphone, methadone, or fentanyl. Unlike those real opioids, tramadol and tapentadol have ceiling doses (upper limits on dosage) and they can kill you when combined with antidepressants.

Ultram/tramadol and Nucynta/tapentadol aren't actually opioids at all. They're SSNRIs with mild opioid activity. On their own, either one can cause Serotonin Syndrome (aka Serotonin Storm), which can be deadly. Wherever I found out someone Is talking tramadol (or tapentadol), I like to advise them to make themselves acquainted with the signs and symptoms of Serotonin Overdose.

SSRIs, SSNRIs, triptans, MAOIs, and several other drugs increase serotonin in the brain. Now, serotonin is a good thing, but too much of this good thing starts to kill brain cells and thats when Serotonin Syndrome begins. All antidepressants (except buproprion/Wellbutrin/Budeprion, which is the only NDRI, norepinephrine dopamine reuptake inhibitor)

Just one serotonin increasing drug can cause serotonin storm, but it's rare, most cases of serotonin syndrome/storm are the result of being on more than one serotonin increasing drug concurrently. The most common combination is tramadol plus an antidepressant. Too many doctors prescribe antidepressants (like Cymbalta/duloxetine, Effexor/venlafaxine, fluoxetine/Prozac/Sarafem, paroxetine/Paxil, and Savella/milnacipran) for pain patients. These pain patients get no relief or inadequate relief, but they continue to take them while their doctors start them on tramadol.

The most dangerous thing, in my opinion, about serotonin syndrome is that it can start at any time, even if you have been on a stable dose for years.

Remember that Serotonin syndrome signs and symptoms typically occur within several hours of taking a new drug or increasing the dose of a drug you're already taking, but that can occur at any time.

Common signs and symptoms include:
*Agitation or restlessness
*Confusion
*Rapid heart rate and high blood pressure
*Dilated pupils
*Loss of muscle coordination or twitching muscles
*Heavy sweating
*Diarrhea
*Headache
*Shivering
*Goose bumps

Signs and symptoms of severe serotonin syndrome, which can be life-threatening, include:
*High fever
*Seizures
*Irregular heartbeat
*Unconsciousness

More complete symptom lists are available at Serotonin Syndrome- Wikipedia. If you ever suspect serotonin syndrome, contact your doctor and/or proceed to an Emergency Room immediately. Serotonin syndrome is treatable, and even reversible, if caught early enough.

Steve
IntractablePainKills@gmail.com