Answer Addiction

Tag: Pain relief

  • Can Low-Dose Naltrexone Work For Pain Relief?

    Can Low-Dose Naltrexone Work For Pain Relief?

    Some chronic pain patients say that naltrexone has offered them much-needed relief.

    Naltrexone has changed Lori Pinkley’s life. But unlike most people who have benefited from the drug, she’s not using it to treat alcohol or opioid use disorder. Pinkley uses naltrexone to treat chronic pain. 

    “I can go from having days that I really don’t want to get out of bed because I hurt so bad, to within a half-hour of taking it, I’m up and running, moving around, on the computer, able to do stuff,” Pinkley told NPR. 

    Jumpstarting Endorphins

    Pinkley’s physician, Dr. Andrea Nicol, is a pain specialist at the University of Kansas. She started prescribing naltrexone to Pinkley about a year ago. For people living with substance use disorder, she said, 50 milligrams of naltrexone blocks the brain’s opioid receptors.

    However, Nicol said that in her pain patients, a much lower dose of about 4.5 milligrams helps their malfunctioning nervous systems reset and work optimally, and jumpstart the production of endorphins, which contribute to natural pain relief. 

    “What it’s felt to do is not shut down the system, but restore some balance to the opioid system,” she said. 

    There have not been any wide-scale studies of low-dose naltrexone, which is sold under the brand names Revia and Vivitrol to treat addiction. However, a review recently published in the journal Medical Sciences found that naltrexone has entirely different effects at low doses. 

    Different Dynamics In Low Doses

    “In substantially lower than standard doses, they exert different pharmacodynamics,” the review authors wrote of naltrexone and a related drug, naloxone. This makes them potentially useful in treating pain, and keeping patients off high-dose opioids, said Dr. Bruce Vrooman, the study author. He added that patients on low-dose naltrexone report fewer side effects than patients on opioids. 

    “Those patients may report that this is indeed a game changer. It may truly help them with their activities, help them feel better,” he said. 

    Doctors Are Unaware Of Its Off-Label Use

    However, naltrexone faces barriers to becoming a widely-used pain reliever. First, many doctors don’t know that it can be prescribed for pain relief, or may not be comfortable prescribing it “off label.” In addition, pharmacies don’t sell such small doses, so people using low-dose naltrexone need to use compounding pharmacies, and insurance often won’t cover the medicine. 

    Finally, there is little interest from companies in producing naltrexone products. Since it’s already available as a generic, there’s less profit to be derived from it. 

    “Bringing a new drug to market requires getting FDA approval and that requires doing clinical trials,” said Patricia Danzon, a professor of health care management at the Wharton School at the University of Pennsylvania. “That’s a significant investment, and companies—unsurprisingly—are not willing to do that unless they can get a patent and be the sole supplier of that drug for at least some period of time.”

    View the original article at thefix.com

  • Can Hypnosis Help Chronic Pain Patients Find Relief?

    Can Hypnosis Help Chronic Pain Patients Find Relief?

    A new review examined whether hypnotic intervention could provide “meaningful” pain relief.

    Undergoing hypnosis could significantly reduce pain that people experience, but it’s too early to tell whether this could be used to treat chronic or acute pain, experts say. 

    A review recently published in the journal Neuroscience and Biobehavioral Reviews found that study participants who were exposed to painful stimuli like heat or cold were able to reduce the amount of pain they experienced by 29-42% by using methods of hypnosis. 

    “These findings suggest that hypnotic intervention can deliver meaningful pain relief for most people and therefore may be an effective and safe alternative to pharmaceutical intervention,” study authors wrote. Yet, they warned, “High quality clinical data is, however, needed to establish generalisability in chronic pain populations.”

    Lead study author Trevor Thompson, a psychologist based at the University of Greenwich, England, noted that “experimental pain”—that created by heat, cold or other stimuli in a lab—is not a direct comparison to real-life pain from injury or chronic pain, or “clinical pain.” 

    “It is important, of course, to acknowledge that clinical pain isn’t quite the same thing as experimentally induced pain,” he told Medical Express. That’s because injuries and ongoing pain “involve more negative emotional states, less sense of control over pain, and adverse effects on quality of life,” he said. 

    Still, the fact that hypnosis provided such significant relief to people who were being hurt was significant. 

    “If hypnosis is effective at reducing experimental pain, there’s reason to be optimistic it would have the same effect on clinical pain,” he said.

    Mark Jensen, professor at the University of Washington in Seattle and editor of the Journal of Pain, said that previous research has indicated that hypnosis techniques can reduce the amount of pain that patients experience. How effective it is depends on the root cause of the pain, he said. He added that it’s important that people be informed consumers, and use hypnosis as one of many strategies for managing their pain. 

    “Anyone can hang out a shingle and call themselves a ‘hypnotist,’” he said.

    Jensen said that hypnosis uses a combination of relaxation and imagery to tap into the body’s natural pain-relief systems. Other research has indicated that hypnotherapy techniques change the body’s perception of pain. It’s often much more subtle than many people think, he added, and it’s certainly not a way to immediately remove all pain. 

    “It’s not all-powerful magic that will eliminate pain,” he said. “It’s not the hocus-pocus you see on TV.”

    View the original article at thefix.com

  • Medical Marijuana Patients Forced To Choose Between Housing Or Pain Relief

    Medical Marijuana Patients Forced To Choose Between Housing Or Pain Relief

    The government’s stance on medical marijuana is leaving some low-income patients in a major bind. 

    Some medical marijuana patients across the country are having to choose between having a place to live or effective pain relief.

    People who apply for, or already receive, federal housing assistance may face discrimination if they use cannabis—even if it is for medical use, even if it is legal in their state.

    That’s because the federal government’s stance has not changed along with the policies of individual states, the majority of whom have legalized cannabis in some form. The U.S. Department of Housing and Urban Development says federal housing policy will continue to prohibit cannabis use until the federal government officially changes its stance on it.

    Currently cannabis is classified as a Schedule I drug, in the same category as heroin and LSD. Drugs in this category are defined as having no medical value and a high potential for abuse.

    Lily Fisher, 55, is a medical cannabis patient under Montana’s medical cannabis program. Fisher, who has a prosthetic foot as a result of developing blood clots while being treated for breast cancer, relies on cannabis for pain relief.

    Fisher previously tried both hydromorphone and oxycodone for her pain, but ultimately preferred cannabis over taking opioids because it gave her fewer side effects.

    While applying for federal housing assistance, Fisher learned that her status as a medical marijuana patient would disqualify her from the process.

    In August, she was notified that she had been removed from the Section 8 waiting list because the state “recently received information from our field office that [she had] engaged in illegal use of a drug.” She would have to reapply.

    “It never even crossed my mind in a million years that that would be an issue,” she said, according to the Billings Gazette. “I started getting shook up and nervous because I’m about to be homeless.”

    Another woman, 66-year-old Mary Cease of Pennsylvania, was also denied access to a Section 8 housing voucher. Cease is a disabled veteran who also prefers cannabis over opioids. “It’s a crazy thing to do to an old woman who has no criminal background, and who owes nobody anything, and is living in a place where you cannot expand your mind,” she said, according to the Pittsburgh Post-Gazette.

    In June, Congresswoman Eleanor Holmes Norton, a representative from Washington, D.C., introduced a bill that would allow the use of cannabis in federally subsidized housing in states where it is legal. “Individuals who live in states where medical and/or recreational marijuana is legal, but live in federally-assisted housing, should have the same access to treatment as their neighbors,” Norton said.

    If such legislation should pass, it would represent a huge victory for medical marijuana patients who fear discrimination in not just public housing, but in the workplace too.

    “No one should have to choose between staying off opioids and a roof over their head,” said Mary Cease’s lawyer, Judith Cassel.

    View the original article at thefix.com

  • Marijuana's Pain-Relieving Properties To Be Studied By UCLA Researchers

    Marijuana's Pain-Relieving Properties To Be Studied By UCLA Researchers

    “The public consumption of cannabis has already far outpaced our scientific understanding. We really desperately need to catch up.”

    Thirty states and Washington D.C. have medical marijuana programs, but there has been little scientific research into the pain relieving properties of pot.

    Now, however, researchers at the University of California Los Angeles are trying to change that, by conducting research into marijuana as a pain reliever. 

    “We’re not trying to do pro-cannabis research or anti-cannabis research,” Dr. Jeffrey Chen, director of the UCLA Cannabis Research Initiative told NBC News. “We’re just trying to do good science.”

    The initiative’s first goal will be to conduct a high-quality clinical research trial into pain relief. It will look at which types of cannabis products provide the most pain relief and whether cannabis may be able to replace opioid pain relievers for some patients.

    Edythe London, a professor of psychiatry and pharmacology at the UCLA school of medicine, designed the study to test different combinations of THC, the principal psychoactive component of marijuana, and cannabidiol, an anti-inflammatory component that does not give a high. She wants to measure which “produces the most good,” she said, in terms of reducing pain and opioid use.

    Studies have shown that states with medical marijuana programs have fewer opioid overdose deaths. However, there haven’t been studies that show whether pain patients are switching from opioids to medical marijuana, or studies to see how effective medical marijuana is at treating pain in individuals.

    Because of this, the proposed UCLA study is “much-needed research,” according to Yuyan Shi, a health policy analyst at the University of California, San Diego, who studies the health consequences of marijuana and opioid use. 

    The study still needs to be approved by the Food and Drug Administration and the Drug Enforcement Administration, and more funding is needed.

    However, Chen said that more organizations and individuals are realizing the importance of studying cannabis. Because of this, the research already has funds from the Semel Institute for Neuroscience and Human Behavior at UCLA, federal and state sources, and private donors, he said. 

    “The public consumption of cannabis has already far outpaced our scientific understanding,” Chen said. “We really desperately need to catch up.”

    Chen hopes that the pain relief study will just be the first step for the research initiative. 

    “While our priority is to study the therapeutic potential and health risks of cannabis on the body, brain, and mind, our mission is the interdisciplinary study of the wide-ranging health, legal, economic, and social impacts of cannabis,” he wrote in a message on the organization’s website. 

    View the original article at thefix.com

  • Could Ketamine Replace Opioids In The ER?

    Could Ketamine Replace Opioids In The ER?

    A new study examined whether ketamine could work as an alternative to opioids for pain relief in an emergency room setting. 

    Ketamine could be a viable option for acute pain relief, working at least as well as morphine, according to a new medical review. 

    “Ketamine appears to be a legitimate and safe alternative to opioids for treating acute pain in the emergency department. Emergency physicians can feel comfortable using it instead of opioids,” Dr. Evan Schwarz, senior study author, said according to Medical News Today. 

    Schwarz led a team of researchers from the Washington University School of Medicine in St. Louis who reviewed the experience of 261 patients who were given only ketamine to treat their pain in the emergency room.

    The researchers found that ketamine was as effective as morphine for pain relief. There were no severe adverse affects reported, although ketamine did have a higher instance of minor adverse affects. Overall, however, the study authors concluded that ketamine is an effective pain relief tool. 

    “Ketamine is noninferior to morphine for the control of acute pain, indicating that ketamine can be considered as an alternative to opioids for ED short‐term pain control,” study authors wrote.

    Ketamine, which is a well-known party drug, was approved for medical use by the Food and Drug Administration (FDA) in 1970. Since then it has been used as an anesthetic. It is also sometimes used in conjunction with opioids for pain relief. However, the new study indicates that low-dose ketamine can provide pain relief even when it is used alone. 

    With more healthcare providers looking for alternative pain treatments that do not involve opioids, this is a promising finding. Ketamine is not addictive and does not cause respiratory depression, two conditions that are the main risk factors when using opioids to treat pain, particularly in older patients. 

    The study looked at a relatively small number of patients. However, authors said that its findings indicate that more research is needed into using ketamine as a potentially safer pain-relief option for acute pain. 

    “Opioids are commonly prescribed in the emergency department (ED) for the treatment of acute pain,” study authors wrote. “Analgesic alternatives are being explored in response to an epidemic of opioid misuse. Low‐dose ketamine (LDK) is one opioid alternative for the treatment of acute pain in the ED.”

    Ketamine has been showing promise for treating a variety of conditions. Earlier this year, ketamine nasal spray was shown to quickly reduce suicidal ideation in patients being treated in the emergency room.   

    View the original article at thefix.com

  • Could A Scientific Study Have Slowed The Opioid Crisis?

    Could A Scientific Study Have Slowed The Opioid Crisis?

    Researchers suggest that a recent pragmatic trial could have played a key role in curbing the crisis. 

    While opioids are effective for acute pain relief, the widespread addiction and dependence that have swept up the country have showed that the powerful pills have unintended consequences, even as studies suggest that opioids are less effective for long-term pain than over-the-counter options. 

    Most medications are approved after undergoing a randomized controlled trial, but a different type of scientific study could have showed the real-world problems with using opioids for chronic pain relief, according to Aaron E. Carroll, a professor of pediatrics at Indiana University School of Medicine who blogs on health research and policy at The Incidental Economist.

    “These different kinds of studies actually exist. They are called pragmatic trials, and a recent one might have helped serve as a brake as the opioid epidemic accelerated,” Carroll writes in an essay for The New York Times. 

    Whereas randomized controlled studies evaluate whether a drug is effective in ideal circumstances, pragmatic studies measure a drug’s effectiveness in the real world. 

    “A pragmatic trial seeks to determine if, and how, an intervention might work in practice, where decisions are more complicated than in a strictly controlled clinical trial,” Carroll writes. 

    A randomized controlled study of opioids, for example, would compare whether people taking opioids get more pain relief than those taking a placebo. This is challenging, however, because people who are being treated for pain are desperate for relief, and often change treatments hoping to find one that will work. 

    “Under these conditions, it’s hard to get patients to participate, and the same with doctors,” Carroll writes. 

    The Strategies for Prescribing Analgesics Comparative Effectiveness study took a more pragmatic approach to analyzing the effectiveness of pain relief medications, comparing opioids to non-opioid treatment.

    Whether a patient was receiving opioid or non-opioid treatment there were options to progress to stronger pain relief options, which helped people stick with the study long-term, rather than dropping out to try other pain relief. Doctors could also change doses and medications within the same class, tailoring treatment to the individual patients. 

    “That’s how actual care occurs,” Carroll writes. “This way, you can measure how treating someone with opioids might compare with treating someone without opioids for a sustained period.”

    The study eventually showed that adverse symptoms were lower for patients treated without opioids, and those patients were also less likely to become dependent. 

    Although studies like this are important, Carroll writes that they’re unlikely to become mainstream because of their intricacies and expense. 

    “Although drug companies are willing and ready to pay for randomized controlled trials to prove efficacy, it’s not clear who is going to finance studies like these,” Carroll writes. “They use lots of different drugs—which is what happens in the real world—and no company wants to foot the bill for other companies’ products to be evaluated. Certainly no opioid-related companies would want to pay for this trial.”

    View the original article at thefix.com