tag:blogger.com,1999:blog-26519588473699449282024-03-12T15:03:39.794-07:00My Pain LifeWhen life is a struggle with chronic painAnonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.comBlogger111125tag:blogger.com,1999:blog-2651958847369944928.post-29528239699532414062015-12-31T10:41:00.002-08:002017-01-14T00:53:48.571-08:00Fibromyalgia responds to simple Flexeril treatment<br />
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Fibromyalgia is a condition with no official cure, and patients often try multiple treatments as they seek relief. From insomnia to muscle pain, the problems can affect multiple parts of the body and decrease the quality of life. However, some patients have found that Flexeril helps them fight the pain and find relief. Before you consider this treatment, you may want to consult your doctor and examine all of your options.</div>
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<strong style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;">Understanding Flexeril</strong></div>
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Flexeril is a prescription muscle relaxant and also known as cyclobenzaprine. It is able to reduce pain by stopping nerve impulses and is generally considered a short-term fix. The medication tends to be <a href="http://www.webmd.com/drugs/2/drug-11372/flexeril-oral/details" style="border: 0px; color: #6ca021; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: bold; line-height: inherit; margin: 0px; padding: 0px; text-decoration: none; vertical-align: baseline;">combined with physical therapy</a> and other treatments to provide more relief. Fibromyalgia patients have reported that this drug helps them reduce muscle spasms.</div>
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Read the rest of the story HERE: http://www.emaxhealth.com/12410/fibromyalgia-pain-decreases-simple-flexeril-treatment </div>
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Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-70749749660436772322015-12-31T10:38:00.000-08:002015-12-31T10:38:19.199-08:00Chronic Pain Relief Wand gains US FDA approval<div class="body" style="background-color: white; color: #3b3a39; font-family: Georgia, 'Times New Roman', Times, serif; font-size: 14px; line-height: 18px; outline: 0px;">
In her late 60s, Lakshmi has been in constant pain ever since she suffered a stroke paralysing her left part of the body. “It was impossible to move or sleep, I was in a miserable state,” she recalled, still walking gingerly. But, for the past one year, her condition has improved allowing her to “move around, avoid sleep medications and reduce painkillers”.</div>
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She attributes the change to a hand-held ‘Chronic Pain Relief Wand’ or simply ‘CP Relief Wand’, a neuro-modulator which, when applied to the area of pain for a few minutes, promises to provide immediate relief.</div>
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Read the rest of the story here: http://www.thehindu.com/news/cities/Hyderabad/the-answer-to-chronic-pain/article8047007.ece</div>
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Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-26543324469307604722015-01-29T19:39:00.001-08:002015-01-29T19:39:40.682-08:00Loretta Lynch is not the Attorney General for Pain Patients - Please sign White House Petition!Drop Attorney General Nominee Loretta Lynch as nominee. Lynch has indicated she is against marijuana legalization. http://t.co/60fuYD9Svb Please sign this petition to the White House if you think our next AG should not turn back the clock on marijuana legalization. We don't need another decade of inequitable enforcement of current marijuana laws. Please share widely.Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-17298613596873150782014-12-18T13:08:00.002-08:002014-12-18T13:08:43.256-08:00PROFESSOR-SURGEON TEAM HEADED TO THIRD PHASE CLINICAL TRIALS<div style="background-color: white; border: 0px; color: #404040; font-family: 'Neue Helvetica W02'; font-size: 16px; line-height: 27.1999988555908px; margin-bottom: 1.5em; outline: 0px; padding: 0px; vertical-align: baseline;">
Carol Duffy is proof that changing your mind is not only acceptable, but that doing so can often lead to something momentous. Duffy, an associate professor in the Department of Biological Sciences, is headed somewhere that very few faculty members have the chance to go – to a third phase clinical trial for a drug combination that has shown promising results to treat not only one, but several painful and debilitating illnesses.</div>
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How have researchers not found this far-reaching treatment before? Because it never occurred to them that diseases such as fibromyalgia, chronic pain, and irritable bowel syndrome could be caused by a virus, specifically herpes simplex virus type 1. This virus causes cold sores and forever lives in the body of anyone who has been exposed to it, which amounts to about 90 percent of the population.</div>
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Another fact that physicians didn’t realize is that HSV-1 is best kept at bay using not just antiviral medications, but through a combination of antivirals and other drug types. That’s where Duffy, The University of Alabama’s resident expert on HSV-1, has been able to shed some light.</div>
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<strong style="border: 0px; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Preparing for Takeoff </strong></div>
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As an undergraduate zoology major at Northern Arizona University in Flagstaff, Arizona, Duffy never imagined that she’d become a virologist. Her dream was to become a veterinarian. She stayed in her hometown of Flagstaff because she wanted to remain with her horse.</div>
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In a zigzag path of trial-and-error, Duffy shadowed vets, worked in the medical research and development division of a manufacturing company, and conducted research as an undergraduate in her advisor’s lab. Through these experiences, she stumbled upon two things she realized she loved more – research and microbiology.</div>
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Read the rest of the story here and draw your own conclusions. I am just posting this for informational purposes, and am not endorsing the program.</div>
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<span style="color: #404040; font-family: Neue Helvetica W02;"><span style="line-height: 27.1999988555908px;"><a href="http://www.as.ua.edu/home/professor-surgeon-team-headed-to-third-phase-clinical-trials/">http://www.as.ua.edu/home/professor-surgeon-team-headed-to-third-phase-clinical-trials/</a></span></span></div>
Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-36542196244725321432014-07-19T17:07:00.000-07:002014-07-19T17:07:15.895-07:00 Fibromyalgia Research Update from Integrated Tissue Dynamics<table cellpadding="0" cellspacing="0" style="color: #212222; font-family: arial, helvetica, verdana, sans-serif; font-size: 12px; width: 100%px;"><tbody>
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<em>Editor's comment: In June 2013, we told you about new research conducted by Integrated Tissue Dynamics (INTiDYN), which found that people with fibromyalgia have excessive sensory nerve fibers around specialized blood vessel structures located in the palms of the hands. (See “<a href="http://www.prohealth.com/library/showArticle.cfm?libid=18169" rollapp-href="http://www.prohealth.com/library/showArticle.cfm?libid=18169" style="color: #018fd0; text-decoration: none;">Fibromyalgia: It's Not All in Your Head – It's in Your Hands!</a>”) This week Dr. Frank Rice, President and Chief Scientist at INTiDYN, sent out this letter updating us on what they have been doing since releasing their groundbreaking study last year. Following the letter, you'll find links to the original journal article and related documents as well as some additional notes from Dr. Rice.</em></div>
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<em style="color: #212222; font-size: 11pt;">Follow the link for the rest of the article. </em><span style="color: #212222;"><span style="font-size: 14.666666984558105px;"><i><a href="http://www.prohealth.com/library/showarticle.cfm?libid=19066">http://www.prohealth.com/library/showarticle.cfm?libid=19066</a></i></span></span></div>
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Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-92117000375408093082013-06-07T13:44:00.002-07:002013-06-07T13:44:28.228-07:00Fibromyalgia Pain & Premature Aging<div style="background-color: white; color: #333333; font-family: Verdana; font-size: 12px; line-height: 18px; margin-bottom: 1em; margin-top: 1em; padding: 0px; text-decoration: inherit;">
<span style="color: #4d4a42; font-family: Georgia; font-size: 11px;">By </span><a class="url fn" href="http://chronicfatigue.about.com/bio/Adrienne-Dellwo-30128.htm" rel="author" style="color: #3366cc; cursor: pointer; font-family: Georgia; font-size: 11px; font-weight: bold; margin: 0px; padding: 0px; text-decoration: none;" zt="18/1YO">Adrienne Dellwo</a><span style="color: #4d4a42; font-family: Georgia; font-size: 11px;">, About.com Guide</span><span class="date" style="color: #999999; font-family: verdana; font-size: 10px; line-height: 1.5; margin: 0px 0px 0px 9px; padding: 0px; text-decoration: inherit;">June 3, 2013</span></div>
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<span style="text-decoration: inherit;">"Researchers compared telomere lengths of people with fibromyalgia and healthy controls and found there wasn't a huge difference, overall. However, when they looked at the fibromyalgia participants who had higher pain levels, they found shorter telomeres than in controls or lower-pain patients. Participants who had high pain AND high depression levels had the shortest telomeres, with lengths suggesting they were six years older than their actual age.</span></div>
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Telomere shortness was also linked with low <a href="http://chronicfatigue.about.com/od/glossary/g/painthreshold.htm" style="color: #3366cc; cursor: pointer; font-family: inherit; font-style: inherit; margin: 0px; padding: 0px;">pain threshold</a> and sensitivity, as well as with less gray matter in regions of the brain involved in pain processing. This kind of premature gray-matter loss has been linked to fibromyalgia by earlier research."</div>
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Read the entire story <a href="http://chronicfatigue.about.com/b/2013/06/03/fibromyalgia-pain-premature-aging.htm?nl=1" target="_blank">HERE</a>.</div>
Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-24629272518048627432013-06-01T00:03:00.005-07:002013-06-01T00:03:40.091-07:00New Study Seeks 10,000 Veterans For Marijuana Treatment Monitoring<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Here is the link to the story on the study.</span><br />
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<a href="http://www.theweedblog.com/new-study-seeks-10000-veterans-for-marijuana-treatment-monitoring/"><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">http://www.theweedblog.com/new-study-seeks-10000-veterans-for-marijuana-treatment-monitoring/</span></a><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">To donate to the project or to get more information on how you can participate, use the link below:</span></div>
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<a href="http://www.rockethub.com/projects/26525-veterans-post-traumatic-stress-and-medical-marijuana?goback=%2Egde_1566457_member_244099649" style="border: 0px; color: #347c17; margin: 0px; outline: 0px; padding: 0px;" target="_blank"><span style="font-family: Arial, Helvetica, sans-serif; font-size: large;">www.rockethub.com/projects/26525-veterans-post-traumatic-stress-and-medical-marijuana</span></a></div>
Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-41546124961749866972013-05-31T17:42:00.002-07:002013-05-31T17:42:39.587-07:00Does chronic mean forever?The word "chronic" can be scary, and it's true that both fibromyalgia and chronic fatigue syndrome are considered chronic conditions.<br />
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However, that's a far cry from meaning that you'll always be as sick as you are right now.<br />
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Medically speaking, chronic means "of long duration." An illness is considered chronic when it has a slow progression and lasts for a long time. True, sometimes it lasts for the rest of a person's life – but not always.Most of us will never get to the point of being symptom free, but we can make real improvements and regain much of what we've lost.<br />
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Read the entire story <a href="http://chronicfatigue.about.com/od/faqs/f/Does-chronic-Mean-Ill-Be-Sick-Forever.htm?nl=1" target="_blank">HERE</a>Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-27131750506626236962013-05-10T09:05:00.004-07:002013-05-10T09:05:57.713-07:00Inflammation Continues in Chronic Pain Patients<br />
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<span style="background-color: transparent; color: #333333; font-family: arial; font-size: 12px;">By Ed Susman, Contributing Writer, MedPage Today</span></h1>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; color: #666666; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Published: May 10, 2013</span></div>
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<span style="background-color: transparent; background-position: initial initial; background-repeat: initial initial; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Reviewed by <a href="http://www.medpagetoday.com/reviewer.cfm?reviewerid=55" style="color: #003f85; outline-style: none; text-decoration: none;">Robert Jasmer, MD</a>; Associate Clinical Professor of Medicine, University of California, San Francisco</span></div>
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<li style="background-attachment: scroll; background-color: transparent; background-image: url(http://content.everydayhealth.com/medpagetoday/images/listbullet.png); background-position: 0px 4px; background-repeat: no-repeat no-repeat; border: 0px; font-size: 12px; margin: 0px; outline: 0px; overflow: visible; padding: 0px 0px 10px 10px; vertical-align: baseline;">Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.</li>
<li style="background-attachment: scroll; background-color: transparent; background-image: url(http://content.everydayhealth.com/medpagetoday/images/listbullet.png); background-position: 0px 4px; background-repeat: no-repeat no-repeat; border: 0px; font-size: 12px; margin: 0px; outline: 0px; overflow: visible; padding: 0px 0px 10px 10px; vertical-align: baseline;">Even after long-term treatment with opioids, inflammation persists in many chronic pain patients as evidenced by C-reactive protein levels and erythrocyte sedimentation rate.</li>
<li style="background-attachment: scroll; background-color: transparent; background-image: url(http://content.everydayhealth.com/medpagetoday/images/listbullet.png); background-position: 0px 4px; background-repeat: no-repeat no-repeat; border: 0px; font-size: 12px; margin: 0px; outline: 0px; overflow: visible; padding: 0px 0px 10px 10px; vertical-align: baseline;">Point out that the elevated inflammatory markers suggest that the underlying cause of pain is still active or there may be on-going neuroinflammation related to centralized pain.</li>
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NEW ORLEANS -- Even after long-term treatment with opioids, inflammation persists in many chronic pain patients as evidenced by C-reactive protein levels and erythrocyte sedimentation rate, a California researcher reported here.</div>
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Of the 40 patients taking high dose opioids, over 100 mg equivalents of morphine a day, 8 individuals (20%) were found to have high levels of the inflammatory markers, said Forest Tennant, MD, director of the Veract Intractable Pain Clinic in West Covina.</div>
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"The elevated inflammatory markers suggest that the underlying cause of pain is still active or there may be on-going neuroinflammation related to centralized pain," Tennant stated in his poster presentation at the annual meeting of the American Pain Society.</div>
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He also reported that 12 patients had abnormal hormone levels, the most common of which was low serum pregnenolone, found in 4 (10%) of the patients.</div>
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"All 40 patients reported sustained pain control on a stable opioid dosage and improvements in one or more physiological functions," Tennant reported. The only category in which patients failed to consistently report better results was for vision, for which 5% of patients said their vision was better and 5% said it got worse. The rest of the patients responding to the questionnaire reported no change in vision.</div>
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He evaluated outcomes among 40 patients treated at his clinic between July and October 2012, all of who received high dose opioid therapy for the past 10 or more years. Prior to opioid therapy, all of these patients received multiple non-opioid treatments. Patients claimed constant, debilitating pain with severe insomnia.</div>
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The evaluation included two questionnaires; one asked about depression, hopelessness, and quality of life before and during opioid treatment and the other about improvement in 17 physiologic functions.</div>
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"Every patient reported improvement in depression, hopelessness, and quality of life," said Tennant.</div>
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Patients experienced great improvement in several functions such as: movement, 77.5%; concentration, 67.5%; walking, 62.5%; sleeping, 62.5%; appetite, 50%; memory, 42.5%; reading, 42.5%; and libido, 40%.</div>
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<a href="http://www.medpagetoday.com/MeetingCoverage/AAPM/31404" style="color: #003f85; outline-style: none; text-decoration: none;" target="_blank">Hormonal suppression</a> was a complication in 8 patients: corticotropin (2; 5.0%), cortisol (3; 7.5%), testosterone (2; 5.0%), and pregnenolone (4; 10.0%).</div>
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"The high dose opioid patients studied here greatly improved many physiologic functions and mental outlook," he reported.</div>
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David Craig, PharmD, clinical pharmacist specialist at Moffitt Cancer Center at the University of South Florida, Tampa, told <em style="border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">MedPage Today</em>:</div>
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"One of the questions I would have about this study is whether the patients with ongoing inflammation have some underlying condition that is causing the inflammation. If these patients have non-cancer low back pain, for example, then the inflammation finding would be more interesting than if these patients had another condition such as rheumatoid arthritis or lupus."</div>
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Craig, a former member of the APS board of directors, also said, "There have been animal studies that suggest that opioids depress immunity, and that may be what this study is getting at, that maybe there is some interplay between the presence of opioids and the depression of the immune system."</div>
Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-18946815391703323982013-04-10T16:38:00.002-07:002013-04-10T16:41:38.828-07:00Chronic pain ranks well below drug addiction as a major health problem in new poll<span style="background-color: white; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 12px;">Contact: Anna Briseno</span><br />
<a href="mailto:abriseno@researchamerica.org" style="color: #666666; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 12px; text-decoration: none;">abriseno@researchamerica.org</a><br />
<span style="background-color: white; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 12px;">571-482-2737</span><br />
<span class="relinst" style="font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 12px;"><a href="http://www.researchamerica.org/" style="color: #666666; text-decoration: none;">Research!America</a></span><span style="background-color: white; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 12px;"> </span><br />
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<span style="font-size: 12px; font-style: italic;">High percentage of Americans concerned about misuse of pain medication</span></h1>
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ALEXANDRIA, Va.—April 9, 2013—A new national public opinion poll commissioned by Research!America shows only 18% of respondents believe chronic pain is a major health problem, even though a majority of Americans (63%) say they know someone who experienced pain so severe that they sought prescription medicines to treat it. Chronic pain conditions affect about 100 million U.S. adults at a cost of approximately $600 billion annually in direct medical treatment costs and lost productivity.</div>
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Most Americans are concerned about the misuse of pain medication to treat chronic pain. A high percentage (82%) believes that taking prescription painkillers for long-term, chronic pain could result in addiction, which nearly 50% of Americans describe as a major health problem. An overwhelming majority (85%) are very concerned or somewhat concerned that prescription pain medication can be abused or misused. Indeed, 40% believe that prescription medication abuse and addiction is a major problem in their community.</div>
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According to the National Institutes of Health, an estimated 1.9 million people are addicted to prescription pain relievers. The number of unintentional overdose deaths from prescription pain relievers has quadrupled since 1999, outnumbering those from heroin and cocaine combined. As drug addiction becomes more prevalent, most Americans are split on whether addiction and chronic pain are getting the attention they deserve by medical researchers, elected officials and media.</div>
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"We need to better understand addiction," said Research!America President and CEO Mary Woolley. "We shouldn't shy away from research on new pain treatments based on fears of abuse. The suffering is simply too great. More robust investment in research and the engagement and support of policy makers and health care providers are essential to developing effective strategies to reduce the prevalence of addiction."</div>
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Two-thirds of those polled (66%) were unaware that tamper- and abuse-resistant formulations for some prescription pain medications are now available. These formulations of medications have physical and chemical properties that make them more difficult to abuse; for example, making pills harder to crush to inject or snort.</div>
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Other poll highlights:</div>
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<li>60% say chronic pain tends to be dismissed by doctors and the public.</li>
<li>More than half (54%) say doctors are not discussing the possibility of developing dependence or addiction to pain medication enough with their patients.</li>
<li>52% believe doctors should have limits on the amount and dosage of pain medication they are allowed to prescribe.</li>
<li>Based on their experience or what they have heard, respondents say they would use the following treatments to try to relieve chronic pain: physical therapy (64%), over-the-counter pain medication (55%), diet or lifestyle change (54%), chiropractor (49%), prescription pain medication (47%), herbal remedies (38%), and acupuncture (36%).</li>
<li>When asked what percentage of drug overdose deaths involve physician-prescribed pain medication or prescription medication obtained illegally, responses varied widely. In fact, 75% of pharmaceutical overdose deaths involve an opioid pain medication.</li>
<li>Only 4% say it's the responsibility of law enforcement to address the prescription drug abuse problem.</li>
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The national public opinion poll was conducted online in March 2013 by Zogby Analytics for Research!America. The poll had a sample size of 1,016 with a theoretical sampling error of +/- 3.1%.</div>
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To view the poll, visit: h<a href="ttp://www.researchamerica.org/uploads/March2013painaddiction.pdf">ttp://www.researchamerica.org/uploads/March2013painaddiction.pdf</a></div>
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<b>About Research!America polls</b></div>
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Research!America began commissioning polls in 1992 in an effort to understand public support for medical, health and scientific research. The results of Research!America's polls have proven invaluable to our alliance of member organizations and, in turn, to the fulfillment of our mission to make research to improve health a higher national priority. In response to growing usage and demand, Research!America has expanded its portfolio, which includes state, national and issue-specific polling. Poll data is available by request or at <a href="http://www.researchamerica.org/">http://www.researchamerica.org</a>.</div>
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<b>About Research!America</b></div>
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Research!America is the nation's largest nonprofit public education and advocacy alliance working to make research to improve health a higher national priority. Founded in 1989, Research!America is supported by member organizations representing 125 million Americans. Visit<a href="http://www.researchamerica.org/" style="color: #666666; text-decoration: none;" target="_blank">http://www.researchamerica.org</a>.</div>
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Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-55530061641871382362013-03-30T22:31:00.001-07:002013-03-30T22:44:52.351-07:00Suicide and chronic painI don't fiend over the stats on my blog like some people do, but I do check them occasionally, and I've noticed a lot of people end up here after "googling" chronic pain and suicide. Yes, my stats can tell me that, and it is quite disturbing to me. I sort of feel like I have a responsibility to have something here that is helpful for people in chronic pain who are thinking of taking that step.<br />
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I want you to know, there are enough good days to make it worth it, if you can find the right doctor or team of doctors to treat your pain condition. I understand what it feels like to be so tired of being in pain I don't think I can make it another day. But I didn't give in to those thoughts, and I have a much better quality of life today than I did then. And I still have those thoughts at times, but I know that my intense pain episodes will end, and I can have a few good days, or weeks, or even months at a time.</div>
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If you are thinking of harming yourself because you are in constant pain, please wait until you can see your doctor before making such a drastic decision. A person in chronic pain truly is not in a condition to make such profound decisions when in an acute pain episode. You literally can't think clearly and shouldn't make any major life decisions during this time. First of all, don't harm yourself. Next call someone and tell them you are thinking of taking your life. Preferably a local or national suicide hotline, your physician, or psychologist, or even just a friend if you can't tell anyone else.</div>
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One of the things I always think about is the fact that when a person commits suicide, their children are more than twice as likely to take their own lives also. I just couldn't do this to my children, whom I love dearly, and I don't want you to do this either. If you don't have children, think about the impact your decision will make on everyone that knows you. Please visit the suicide hotlines page <a href="http://www.suicidepreventionlifeline.org/" target="_blank">HERE</a> if you are still thinking of suicide or harming yourself in any way. You will find national numbers where you can talk to a professional about the issues you are having.</div>
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Please feel free to post your feelings and experiences in the comments here on this page. Sometimes, seeing your thoughts written down can make them real to you and perhaps help you to feel more comfortable calling a hotline number. </div>
Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-41711082281545776532013-03-14T20:32:00.001-07:002013-03-14T20:32:32.096-07:00Nerve damage may underlie widespread, unexplained chronic pain in children<a href="http://www.sciencedaily.com/releases/2013/03/130311101748.htm#.UUKVwzbb0OA.blogger">Nerve damage may underlie widespread, unexplained chronic pain in children</a>
Some researchers think this may be a new disease. Go to the link for the entire article.<br />
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<span style="background-color: white; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: 15px;">Small-fiber polyneuropathy (SFPN) involves widespread damage to the type of nerve fibers that carry pain signals from the skin and also control autonomic functions such as heart rate, blood pressure and sweating. Most commonly associated with diabetes, SFPN can be caused by other disorders in older adults or by exposure to toxic substances. Typical symptoms include chronic pain in several parts of the body, often beginning in the feet or lower legs, along with symptoms of autonomic dysfunction such as gastrointestinal problems, dizziness or fainting when standing, rapid heart rate, and changes in the appearance of skin. Specific diagnostic criteria have been established for SFPN, and accurate diagnosis can guide app</span>Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-71548154598476005512013-02-19T15:36:00.001-08:002013-02-19T15:36:24.263-08:00Today's a bust<span style="font-size: large;">This entire day has been an absolute bust. I've done almost nothing except sit in my recliner and use my netbook (it is easier on my hands and wrists because it is lighter than a laptop).</span><br />
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<span style="font-size: large;">On days like today I feel that my body and I are on opposite sides of some great war. I want to try and make the pain separate from my body. This gives me some hope that things will get better if I keep fighting for the energy just to exist.</span><br />
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<span style="font-size: large;">This is merely a psychological game that gets me through especially rough spots. In reality if there were anything I could do to make it better, I would have already done it. If I don't feel like I have some hope of getting better soon, my mind just can't accept it.</span>Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-42897809154541492013-02-12T13:31:00.000-08:002013-02-12T13:31:06.988-08:00Israel's medical marijuana industry produces scientific results<br />
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<strong>The Quiet Giant: Israel’s Discreet and Successful Medicinal Cannabis Program</strong><br /><br />by Lindsay Stafford Mader <br /><br /><em>HerbalGram</em>. 2012; American Botanical Council</center>
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<a href="http://cms.herbalgram.org/herbalgram/issue97/hg97-featcannabis.html" target="_blank">Link to original article</a></center>
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<span style="font-family: Arial; font-size: 10pt;">Despite its status as one of the world's leading nations for medical research and innovation, the United States has a remarkably restrictive system in place to regulate medicinal cannabis research. Even when the US Food and Drug Administration (FDA) approves medicinal cannabis studies, the researcher or institution must then obtain approval from the Public Health Service (PHS), as well as procure cannabis material from the National Institute on Drug Abuse (NIDA), which has a monopoly on the supply of cannabis that can be used for research throughout the entire country.<sup>1</sup> Cannabis (<i>Cannabis</i>spp. Cannabaceae) is the only scheduled substance for which PHS approval is required, and those wishing to study the plant often have been rejected by the agency — effectively quelling this important area of science. An increasing number of US states have taken matters into their own hands by legalizing medicinal cannabis for residents with certain health conditions. But the federal government continues to raid and shut down state-based medicinal cannabis operations, even sending some of these business owners to prison. Although the US situation is largely based on the discrepancy between state and federal law, Americans and citizens of other countries that ban medicinal cannabis could learn just how successfully, compassionately — and non-controversially — such a program can be handled by looking at the unique national medicinal cannabis program in Israel.</span></div>
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<b><span style="font-family: Arial; font-size: 10pt;">Path to Medicinal Access</span></b></div>
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<span style="font-family: Arial; font-size: 10pt;">The Israeli government always has classified cannabis as dangerous and illegal, and it remains a crime to use the herb recreationally and without a license from an approved physician. Unlike US state-based medicinal cannabis initiatives, the nationwide program in Israel has won growing support from government officials, inciting relatively little controversy among Israeli citizens, public officials, and religious leaders.<sup>2</sup> </span></div>
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<span style="font-family: Arial; font-size: 10pt;">In 1995, the Israeli Parliament Drug Committee formed a subcommittee to examine the legal status of cannabis, which recommended that the government continue to categorize cannabis as illegal, but also that it allow and regulate access to medicinal cannabis for severely sick patients.<sup>2,3</sup></span></div>
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<span style="font-family: Arial; font-size: 10pt;">“The second recommendation was of course extremely positive and important,” said Boaz Wachtel, a medicinal cannabis activist in Israel who served as one of two public representatives on the committee (email, November 29, 2012).<sup>3</sup> “For the first time a Parliament-nominated committee acknowledged the medical use of cannabis and created an opening to advance the subject.”</span></div>
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<span style="font-family: Arial; font-size: 10pt; letter-spacing: -0.1pt;">Wachtel noted other important factors behind the committee’s recommendations, including the US Food and Drug Administration’s 1985 approval of the synthetic THC-containing drug Marinol<sup>®</sup>, as well as input from Raphael Mechoulam, MD, who also served on the committee. Dr. Mechoulam, a Bulgarian-born Israeli scientist, isolated tetrahydrocannabinol (THC) in 1964.<sup>2</sup> In 1992, Dr. Mechoulam and colleagues Lumír Ondřej Hanuš and William Anthony Devane isolated and described anandamide, a endogenous cannabinoid neurotransmitter in the human brain.<sup>4</sup></span></div>
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<span style="font-family: Arial; font-size: 10pt;">“I assume that the successful cannabis research in Israel has had some impact on the decision by the Ministry of Health to proceed with a carefully regulated medical marijuana program,” said Dr. Mechoulam (email, December 6, 2012). “The committee I chaired in 1995 consisted mostly of government officials. Their overall attitude was quite liberal. We tried to minimize criminalization and to find ways to legalize medical use. Our report was never discussed or approved, but I am under the impression that it affected the attitude of the police and the Attorney General.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">Several societal and political forces also were at play before and during the Israeli government’s cautious but genuine interest in medicinal cannabis, said Rick Doblin, PhD, executive director of the California-based Multidisciplinary Association for Psychedelic Studies (MAPS), who has collaborated with the Israelis on medicinal cannabis and MDMA (also known as ecstasy) research. For one, Israel’s most important ally, the United States, is opposed to medicinal cannabis and Israel did not want to compromise that relationship. On the other hand, there is the deep, fundamental Jewish principle to ease suffering, which many saw cannabis as doing.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">“Also the fact that Mechoulam is from Israel and they had this tradition in being world leaders in cannabinoid research, they put their toe in the water,” said Dr. Doblin (oral communication, December 4, 2012). “They did see that there is an awful lot of suffering that marijuana can help reduce at a very low cost.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">When considering a national program, the Israeli Ministry of Health (MOH) consulted with Dr. Doblin and MAPS and a few additional medicinal cannabis groups on programs in other countries. Israel strived to comply with international drug treaties, particularly the 1961 United Nations Single Convention on Narcotics, which “aims to combat drug abuse by coordinated international action” and limits narcotic drugs to medical and scientific use.<sup>5</sup> Among several provisions on medical usage in the 44-page document, the Single Convention calls for limiting “the cultivation, production, manufacture, and use of drugs to an adequate amount required for medical and scientific purposes, to ensure their availability for such purposes and to prevent illicit cultivation, production and manufacture of, and illicit trafficking in and use of, drugs.” (Interestingly, this is the very same treaty that the United States has used to argue in favor of its stifling monopoly on cannabis research supply.<sup>1</sup>)</span></div>
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<span style="font-family: Arial; font-size: 10pt;">“The Israelis have been quite aware of the obligations of the Single Convention and the different ways it has been interpreted around the world,” said Dr. Doblin. “They could see that even though the US wasn’t willing to go that far on a federal basis, that there were states that were going this far and also other countries, like the Netherlands and Canada. That helped them to feel more comfortable because what we were able to show them is that the International Narcotics Control Board — which evaluates compliance with international treaties, particularly the Single Convention — had never censured any of the countries or spoke out against them.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">Despite Israel’s initial concerns for compromising its strong relationship with the United States, Dr. Doblin noted that he has seen no evidence of such backlash. “None at all,” he said.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">To satisfy an important Single Convention requirement for one specific agency to oversee certain functions related to the medicinal use of prohibited drugs, Israel appointed its MOH<b> </b>to lead the country’s medicinal cannabis program.<sup>3 </sup>Still, implementation was slow and measured. In 1996, Wachtel met with an MOH official to discuss the implementation of the cannabis subcommittee’s recommendations, and he also submitted a request to supply an HIV patient with medicinal cannabis.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">“He said, ‘You have opened an important but controversial door — find a way to implement the program that would not cost the Ministry any money,’” said Wachtel, recounting the official’s response. “Supplies were a problem. The police [were] not willing to provide the cannabis confiscated from the black market. The patients need a few strains of standardized, organic product that will not damage their weakened immune systems. The MOH did not have an answer at this point.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">About two years later, the MOH permitted several patients to grow a few cannabis plants in their own homes, but most became too sick to attend to the plants and an accusation arose that the HIV patient was selling cannabis to minors.<sup>3</sup> As a result of these initial roadblocks, the MOH did not issue any additional medicinal cannabis prescriptions for two years. It considered importing cannabis, but due to concerns regarding cost and Single Convention limitations, officials eventually decided to allow a young Crohn’s Disease patient to grow cannabis for himself and the other six patients who were licensed at the time. He also became too sick to grow. With the MOH still unsure of exactly how to implement large-scale production of medicinal cannabis, the program experienced several years of little action.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">“The breakthrough occurred when the MOH appointed Dr. Baruch as the new Deputy Director specifically to deal [with] the issue of medical cannabis,” said Wachtel. “The final decision to approve requests from patients and move the program forward was in his hands.”</span></div>
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<b><span style="font-family: Arial; font-size: 10pt;">Modern Evolution of Israel’s Medicinal Cannabis Program</span></b></div>
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<span style="font-family: Arial; font-size: 10pt;">Israel’s medicinal cannabis program has evolved ever so slowly with each passing year. During its first decade, the government issued only 62 prescriptions. Now about 9,000 medicinal cannabis prescriptions are currently active, said Yehuda Baruch, MD, the former head of the program (email, December 4-16, 2012).</span></div>
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<span style="font-family: Arial; font-size: 10pt;">“The vision [has been] to help those in need when there is no other viable option [at] an affordable price and with as little bureaucracy as can be,” said Dr. Baruch, who is also a psychiatrist and director of the Abarbanel Mental Health Center in Bat Yam. The widespread relief medicinal cannabis can provide to many patients does not come without the paradoxical negative, from Dr. Baruch’s perspective, that the same patients also achieve a recreational high. “The increasing number [of permits] is both a point of concern because the main source today for recreational use is medical cannabis, but also a blessing because it is one more medicine in the pharmacopeia that can be used when all else has failed, and since it works by a different mechanism of action, it may prove successful.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">Dr. Baruch led Israel’s medicinal cannabis program for a decade, from 2002 until December 2012. (Although his replacement has not been publicly announced, sources for this article have indicated it is Yuval Lanshaft, a former high-ranking Internal Security officer.) For several years Dr. Baruch was the only physician in the entire country allowed to issue patient licenses, and he also was in charge of organizing and leading the program along with the Ministry of Agriculture, Homeland Security, and the customs office.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">“I personally lectured in every academic or medical meeting that was possible, even if it was a very small one,” said Dr. Baruch, “and gave my private phone number and an invitation to call on anything. I also worked closely with relevant politicians and discussed the subject in the Israeli parliament various times. All in all, a lot of leg work.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">In 2010, the MOH decided to allow additional physicians in five hospitals to provide medicinal cannabis licenses to patients, lifting the heavy responsibility from Dr. Baruch and enabling somewhat faster and easier patient access to the herb.<sup>6</sup>Currently, nine physicians are permitted to share this load. Dr. Baruch noted that while all senior physicians in the country can <i>request</i> a license for any number of their patients who might benefit from medicinal cannabis, only these nine MOH-appointed physicians are allowed to <i>approve</i> and <i>issue</i> permits. Because cannabis can be prescribed only as a “last resort” medicine, patients usually are told about it while they are in emergency rooms and oncology and pain wards, and the requesting physician must state that all drug treatment used thus far has been unsuccessful.<sup>7</sup></span></div>
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<span style="font-family: Arial; font-size: 10pt;">While the increase to nine physicians was an improvement, Dr. Doblin noted that having this few prescribing doctors might impose burdensome limits on a nation of patients (news reports have referenced a MOH study that found 40,000 Israelis could benefit from cannabis<sup>8</sup>).</span></div>
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<span style="font-family: Arial; font-size: 10pt;">“I think that right now [Israel’s program] is a tremendous success,” said Dr. Doblin. “It’s too limited, I would say, because there are a lot more people that could benefit. The Ministry is keeping a fairly solid control over the growth of the program. But in the Israeli context, I think that prevented a backlash, so maybe that was the right approach at the time. Still, it’s not the best approach since patients are not currently permitted access for [post-traumatic stress disorder] and other conditions.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">Initially, patients could obtain medicinal cannabis licenses only for asthma, and years later additional conditions were accepted, including AIDS wasting syndrome, vomiting and pain associated with chemotherapy for cancer, and all other applications were considered on a case-by-case basis, said Dr. Baruch. Now patients with the following conditions are considered for prescriptions:</span></div>
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<span style="font-family: Arial; font-size: 10pt; position: relative; top: 1pt;">•<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: Arial; font-size: 10pt;">Chronic pain due to a proven organic etiology</span></div>
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<span style="font-family: Arial; font-size: 10pt; position: relative; top: 1pt;">•<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: Arial; font-size: 10pt;">Orphan diseases (<i>i.e.</i>, diseases and conditions that affect only a small percentage of the population and for which few, if any, pharmaceutical drugs are developed)</span></div>
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<span style="font-family: Arial; font-size: 10pt; position: relative; top: 1pt;">•<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: Arial; font-size: 10pt;">HIV patients with significant loss of body weight or a CD4 cell count below 400</span></div>
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<span style="font-family: Arial; font-size: 10pt; position: relative; top: 1pt;">•<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: Arial; font-size: 10pt;">Inflammatory bowel disease (but <i>not</i> Irritable Bowel Syndrome)</span></div>
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<span style="font-family: Arial; font-size: 10pt; position: relative; top: 1pt;">•<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: Arial; font-size: 10pt;">Multiple sclerosis</span></div>
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<span style="font-family: Arial; font-size: 10pt; position: relative; top: 1pt;">•<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: Arial; font-size: 10pt;">Parkinson’s disease</span></div>
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<span style="font-family: Arial; font-size: 10pt; position: relative; top: 1pt;">•<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: Arial; font-size: 10pt;">Malignant cancerous tumor in various stages.<sup>9</sup></span></div>
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<span style="font-family: Arial; font-size: 10pt;">As of 2011, most patients using cannabis had chronic pain, closely followed by cancer-related conditions.<sup>9</sup></span></div>
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<span style="font-family: Arial; font-size: 10pt;">For many years, the MOH struggled to achieve a cultivation and distribution system that satisfied government officials as well as patients. In 2007, Dr. Baruch licensed one individual in Israel to grow about 50 cannabis plants to provide material to patients free-of-charge.<sup>3</sup> The man, Tsachi Cohen, did so in his parents’ house in northern Israel. The garden was attended and cared for by his mother, a former biology teacher. Eventually, Dr. Baruch licensed several other growers, none of whom were allowed to sell the cannabis for a profit. Many sources interviewed for this article indicated that the initial nonprofit model contributed to the program’s success and acceptance.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">“The first feel that the public got was that these are people acting in the public interest and not for personal gain,” said Dr. Doblin.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">This small-scale operation by the Cohen family eventually grew into the country’s first, and currently the largest, production center, called Tikun Olam (the Hebrew term based on the Jewish principle that all people should try to repair the broken fabric of the universe through acts of kindness, compassion, healing, and justice). Ultimately, all of the growers’ nonprofit model — which relied mainly on donations — could not be sustained due to the increasing number of licensed patients and the intensive and expensive process required for cultivating high-quality cannabis on a large scale. So the government began requiring licensed growers to charge patients a monthly fee of 360 Israeli New Sheqels (approximately $100 USD) for up to 100 grams per month. The initially prescribed monthly dosage is 20 grams, with 42 grams being the average amount, and every patient is charged the same fee every month, regardless of how much cannabis they receive.<sup>8</sup> The price is relatively inexpensive when compared to cannabis in other countries, and several large Israeli medical insurance companies, the Holocaust Survivors fund, and the Ministry of Defense (for some patients with post-traumatic stress disorder) partially cover the cost of medicinal cannabis. </span></div>
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<span style="font-family: Arial; font-size: 10pt;">“The most important [milestone] was the transition from nonprofit to for-profit,” said Dr. Doblin, whose MAPS organization had donated about $85,000 to support the nonprofit facilities. “You could say it was a transition from a non-sustainable model to a sustainable model. Another point that makes Israel so astonishingly successful as a model is that some of their health insurance companies cover marijuana. That’s the kind of information that really needs to get out in America. That for whatever reason, we have insurance companies deciding it is a smart investment to cover medical marijuana. Israel is the only place I know of where that happens.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">There are currently seven licensed growing centers that distribute medicinal cannabis on-site, through home deliveries, in small dispensaries in a limited number of urban locations and hospitals, or at one of the larger distribution centers.<sup>9</sup> The central distribution center, named MECHKAR, a Hebrew acronym meaning research, represents an important aspect of the Israeli program. At MECHKAR, patients not only obtain cannabis, but also are welcomed to be trained and counseled on topics such as which strains and dosage forms might be best for their particular condition and lifestyle; levels and location of pain and any other health conditions; and emotional or religious concerns and experiences.<sup>10</sup> Staff also closely supervise patients throughout the first few months with feedback forms and meetings in order to optimize dosages, reduce any unwanted side effects, and discuss potential drug interactions.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">“We may be the only government on earth right now where patients are sent to use marijuana who have absolutely no desire to use it,” said Mimi Peleg, the director of large-scale training at MECHKAR (email, November 29, 2012). “They do have a strong desire to stop suffering, of course. My first job as a trainer is to relax them enough to even consider the idea that it is okay to use this medication. Working with patients who receive cannabis has taught me that the quality of education that is shared at the beginning of the treatment is an important factor in leading to an optimal control of symptoms.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">From time to time, the MOH discusses the possibility of importing medicinal cannabis from the Netherlands, and it is currently in the process of setting up a large, multi-institutional ministerial Medicinal Cannabis Agency to handle all aspects of medicinal cannabis production, dispensing, testing, and licensing.<sup>3 </sup>The government also has been discussing pharmacy distribution to begin sometime in 2013, but it is unclear if this initiative will actually be implemented on time.<sup>6</sup> If this step is taken, it is anticipated that the large government agency will purchase all cannabis material from growers, store it in government-controlled warehouses, and then distribute it though pharmacies.<sup>9</sup></span></div>
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<span style="font-family: Arial; font-size: 10pt;">“As a cannabis trainer, this shift will impact my current role,” said Peleg. “By and large, I think it is a positive move in the right direction. I [still] see the need for some distribution centers where patients can go for further training and strain adjustments. Treating people with cannabis requires much more than just purchasing medicine at a pharmacy.”<sup>10</sup></span></div>
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<span style="font-family: Arial; font-size: 10pt;">Cannabis is available to patients in a variety of forms such as baked goods, ready-made cigarettes, oils, and tinctures.<sup>10</sup>Patients with a medicinal cannabis license also are allowed to ingest cannabis through Volcano<sup>® </sup>Vaporizers, a device typically costing $500-600 USD retail that heats the cannabis without burning it so that no smoke and reduced amounts of combustion byproducts are produced. Several Israeli health insurance companies and patient care groups also cover some of the price of purchasing or renting a Volcano, which has been licensed by the MOH and approved by the Israel Standards Institute, and several devices donated by Volcano Medic in Israel are available in four public hospitals for patients who cannot afford their own.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">“All this has been a huge cooperative effort,” said Peleg. “They put four Volcanos in major hospitals and patients with licenses can request private mouth pieces and balloons or take their own Volcanos in. I did when I was healing from cancer and thereby avoided needing morphine in recovery! It was wonderful to have the choice.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">For all the bold measures taken with medicinal cannabis in Israel, it remains a largely non-controversial situation. The diverse range of patients helped by the herb includes former soldiers, police officers, settlers, Arab Israelis, and elderly Holocaust survivors. Dr. Doblin mentioned that religious leaders have declared cannabis kosher, and Peleg noted a religious, political, gender, and age diversity among the hundreds of patients she has trained over the years.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">“A month after her initial training, Hanna<sup>*</sup> came back in with [her husband] Hiem<sup>*</sup>, and as is often the case, I barely recognized them,” said Peleg of a Holocaust survivor whom she trained to use medicinal cannabis for pain.<sup>10</sup> “There was an undeniable intimacy between them that had been absent in their prior visit — clearly they had been doing some communicating. Instead of being happy, Hanna was livid and for all the right reasons. She wanted to know who to blame for the fact that she hadn’t been given this medication years ago if it had been known and available. Again, who could blame her? Her pain was gone, she had an appetite, she was communicating with loved ones — cannabis was doing its job. Israel is a very small country. We are only 8 million citizens. Word spreads fast and the pressure on the system is extremely high due to stories like Hanna’s that highlight efficacy.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">Cannabis activist Wachtel also noted the late-1980s discovery of ancient cannabis material in a burial tomb in Israel, which researchers postulated was likely given to a 14-year-old girl, also found in the tomb, to “facilitate the birth process” of her unborn child.<sup>11</sup> “Cannabis,” said Wachtel, “is therefore viewed here as an indigenous medicinal plant, one that was out of use for a while but is now back in its natural place in the modern pharmacopoeia to alleviate a great number of medical symptoms.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">Even with relatively little controversy, Israeli police allege that cannabis fields attract criminals who steal plants to sell on the black market.<sup>12</sup> But Wachtel noted that very little diversion is taking place because the growing operations are typically secured by cameras and armed guards.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">Supporters of medicinal cannabis in Israel also see areas where the program can be improved upon. Peleg noted the need for a national strain bank, retrospective assessments of medicines used concurrently with cannabis, a broadened list of diseases, and a more comprehensive training program for medical professionals and patients. Additionally, the process of requesting cannabis and obtaining a physician recommendation and official patient license, while sometimes quick, also can be very lengthy.<sup>13</sup></span></div>
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<span style="font-family: Arial; font-size: 10pt;">“The system is bursting at the seams,” said Peleg. “If 10 more people worked in the MOH just on cannabis, we couldn’t do all the work that needs to be done.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">Dr. Doblin stressed the need for Israel to produce official medical-grade cannabis supported by Good Manufacturing Practices, thorough documentation, and product standardizations. Even though several Israeli health insurance companies already cover cannabis without it having been through the formal drug-approval process, he noted the possibility of importing medical-grade cannabis from Israel into the United States to support scientific research. (Dr. Doblin’s FDA-approved research that seeks to develop the plant into an approved prescription medicine has been rejected by the PHS/NIDA process.<sup>1</sup>)</span></div>
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<span style="font-family: Arial; font-size: 10pt;">That Israel’s government is generally far more accepting of the herb’s potential as a medicine has enabled a much freer cannabis research community. Dr. Mechoulam, for example, has been obtaining hashish (a preparation made from compressed THC-rich resinous material) from the Israeli police for more than 40 years, with MOH approval. </span></div>
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<span style="font-family: Arial; font-size: 10pt;">“Research in Israel is highly respected and neither the police nor the Ministry of Health have ever raised any major problems,” said Dr. Mechoulam. “They have been, and still are, very helpful. This is true for both basic and clinical research.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">“The benefit of a program like Israel’s is that the government takes a role in ensuring quality and safety of the product, and supports research to further the understanding of the plant’s medical benefits, said Amanda Reiman, PhD, California policy manager for the Drug Policy Alliance (email, December 1, 2012). “In the US, the government has actively prevented research from taking place, and has threatened municipalities that attempt to regulate the quality and safety of the product with criminal prosecution.”</span></div>
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<span style="font-family: Arial; font-size: 10pt;">* Names have been changed to protect patients’ privacy.</span></div>
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<b><span style="font-family: Arial; font-size: 10pt;">References</span></b></div>
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<span style="font-family: Arial; font-size: 10pt;">1. Stafford L. The state of clinical cannabis research in the United States.<b> </b><i>HerbalGram</i>. 2010;85:64-68.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">2. Brinn D. A growth sector. <i>Jerusalem Post</i>. March 19, 2009. Available at: <a href="http://www.maps.org/media/view/a_growth_sector/" style="color: blue;"><span style="color: #000099;">www.maps.org/media/view/a_growth_sector/</span></a>. Accessed December 17, 2012.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">3. Wachtel B. Medicinal cannabis in Israel. September 2011 [unpublished].</span></div>
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<span style="font-family: Arial; font-size: 10pt;">4. Wisneski L, Anderson L. <i>The Scientific Basis of Integrative Medicine</i>, 2<sup>nd</sup> ed. CRC Press; Boca Raton, Florida. 2009. </span></div>
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<span style="font-family: Arial; font-size: 10pt;">5. Single Convention on Narcotic Drugs, 1961. The United Nations. Final act of the United Nations conference for the adoption of a Single Convention, as amended by the 1972 Protocol amending the Single Convention on Narcotic Drugs, 1961. Available at: <a href="http://www.unodc.org/pdf/convention_1961_en.pdf" style="color: blue;"><span style="color: #000099;">www.unodc.org/pdf/convention_1961_en.pdf</span></a>. Accessed December 17, 2012.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">6. Siegel-Itzkovich J. More MDs to get licenses to prescribe medical marijuana. <i>Jerusalem Post</i>. September 6, 2010. Available at: <a href="http://www.jpost.com/HealthAndSci-Tech/Health/Article.aspx?id=187221" style="color: blue;"><span style="color: #000099;">www.jpost.com/HealthAndSci-Tech/Health/Article.aspx?id=187221</span></a>. Accessed November 27, 2012.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">7. Mechoulam R. Israel: legal aspects of marijuana use, medical use. October 20, 2008. International Association for Cannabinoid Medicines. Available at: <a href="http://cannabis-med.org/index.php?tpl=page&id=45&lng=en&sid=1b35fdd1438521c70b7a145c6cf33ffb" style="color: blue;"><span style="color: #000099;">http://cannabis-med.org/index.php?tpl=page&id=45&lng=en&sid=1b35fdd1438521c70b7a145c6cf33ffb</span></a>. Accessed December 17, 2012.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">8. Ryan JD. Patients to pay for medical marijuana. <i>Jerusalem Post</i>. January 19, 2010. Available at:<a href="http://www.jpost.com/HealthAndSci-Tech/Health/Article.aspx?id=166124" style="color: blue;"><span style="color: #000099;">www.jpost.com/HealthAndSci-Tech/Health/Article.aspx?id=166124</span></a>. Accessed November 27, 2012.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">9. Wachtel B. Medical cannabis in Israel: review, lessons and recommendations for other countries. Presentation at Cannafest in Prague, Czech Republic. November 10, 2012 [unpublished].</span></div>
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<span style="font-family: Arial; font-size: 10pt;">10. Peleg M. Large-scale cannabis training: 3 years of lessons learned in Israel. Presentation at Cannafest in Prague, Czech Republic.<b> </b>October 28, 2012 [unpublished].</span></div>
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<span style="font-family: Arial; font-size: 10pt;">11. Russo E. Cannabis treatments in obstetrics and gynecology: a historical review. <i>J Cannabis Ther</i>. 2002;(3/4):5-34.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">12. Harkov L. Israel is world leader in medical marijuana use. <i>Jerusalem Post</i>. March 6, 2012. Available at:<a href="http://www.jpost.com/Health/Article.aspx?id=260692" style="color: blue;"><span style="color: #000099;">www.jpost.com/Health/Article.aspx?id=260692</span></a>. Accessed November 27, 2012.</span></div>
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<span style="font-family: Arial; font-size: 10pt;">13. Kershner I. Studying marijuana and its loftier purpose. <i>New York Times</i>. January 1, 2013. Available at:<a href="http://www.nytimes.com/2013/01/02/world/middleeast/new-insights-on-marijuana-in-israel-where-its-illegal.html?_r=0" style="color: blue;"><span style="color: #000099;">www.nytimes.com/2013/01/02/world/middleeast/new-insights-on-marijuana-in-israel-where-its-illegal.html?_r=0</span></a>. Accessed January 4, 2012.</span></div>
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<br />Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-78467205244696229992013-02-10T20:28:00.003-08:002013-02-10T20:32:30.499-08:00Doctor pioneering the use of new painkiller<br />
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<span style="font-size: small;"><span style="font-weight: normal;">Link to original story <a href="http://www.marinij.com/millvalley/ci_22527073/mill-valley-doctor-pioneering-use-new-painkiller-chronic?source=most_emailed" target="_blank">Here</a></span></span></h1>
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Mill Valley doctor pioneering the use of new painkiller for chronic pain, says it's safer</h1>
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<a class="articleByline" href="mailto:rhalstead@marinij.com?subject=Marin%20Independent%20Journal:" style="color: #383838; text-decoration: initial;">By Richard Halstead<br />Marin Independent Journal<span class="source-org vcard"></span></a></div>
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Posted: 02/05/2013 06:03:43 PM PST</div>
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Howard Kornfeld M.D. talks to patient Tony Perniconi on Thursday, Jan. 31, 2013, in Mill Valley, Calif. The doctor has pioneered new methods of pain management using a substance called Buprenorphine as a substitute for Vicodin and Oxycontin. (IJ photo/Frankie Frost) Frankie Frost</div>
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At a time when the nation is dealing with an epidemic of prescription painkiller abuse, a Mill Valley physician, Dr. Howard Kornfeld, is championing the use of a painkiller little known in the U.S. that features a greater margin of safety for both overdose and addiction.</div>
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According to the Centers for Disease Control and Prevention, there is currently a "growing, deadly epidemic of prescription painkiller abuse." The CDC says there has been a 300 percent increase since 1999 in the sale of strong prescription painkillers, such as Vicodin and OxyContin. The CDC estimates these prescription painkillers were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined,</div>
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and more than 475,000 emergency department visits in 2009, a number that nearly doubled in just five years.</div>
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Late last month, a Food and Drug Administration advisory panel voted to impose tighter controls on prescriptions for drugs like Vicodin, which contain the opioid pain reliever hydrocodone.<br />
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For the past 20 years, Kornfeld has operated a medical clinic in Mill Valley where he treats patients for chronic pain, chemical dependency and prescription medication management issues. In 2011, Kornfeld also helped establish the first pain management clinic at Highland Hospital in Oakland. At both clinics, Kornfeld has pioneered the use of buprenorphine, a semi-synthetic opioid created in England in the early 1970s, for the treatment <span style="font-size: 11pt;">of chronic pain.</span></div>
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"Myself and a handful of other doctors around the country are trying to get the word out that is a good way to go," Kornfeld said.<br />
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Kornfeld said he first became aware of buprenorphine in the 1990s when he was treating heroin addicts and prescription drug addicts. <span style="font-size: 11pt;">"We heard that the French had turned their addiction problem around with buprenorphine," he said.</span><br />
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At that time, buprenorphine was licensed for use in the United States only for the treatment of pain and could only be administered by injection; but it was little used. <span style="font-size: 11pt;">Kornfeld said, "So since we had patients who had chronic pain, some of whom also had addictions, we decided to pioneer the use of buprenorphine in the U.S. for chronic pain."</span><br />
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Kornfeld also discovered he could legally have several pharmacies convert the buprenorphine into a compounded form that could be dissolved in the mouth.<br />
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Unlike heroin and other opiate derivatives, buprenorphine does not make its users euphoric and is unlikely to cause a lethal overdose by depressing respiration.<br />
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"If a person is already dependent on an opiate, they don't feel any high from buprenorphine," Kornfeld said. "Whereas with OxyContin, methadone, morphine, and Vicodin<br />
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Howard Kornfeld M.D. examines patient Tony Perniconi on Thursday, Jan. 31, 2013, in Mill Valley, Calif. The doctor has pioneered new methods of pain management using a substance called Buprenorphine as a substitute for Vicodin and Oxycontin. (IJ photo/Frankie Frost) Frankie Frost</div>
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there is a tendency for people to double or triple their dose and feel some kind of euphoria and then fall into addiction."</div>
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Kornfeld said if someone takes too much buprenorphine, they will become very sleepy; but the drug won't kill them.<br />
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Patients can become addicted to buprenorphine; however, withdrawal from the drug is much milder than with other opiates.<br />
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"You're not going to be roaming the streets in six or eight hours looking for another fix," Kornfeld said.<br />
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Tony Pernicone, a fine art dealer, auctioneer and appraiser who lives in San Rafael, credits Kornfeld and buprenorphine for enabling him to regain his health after years of struggle.<br />
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Pernicone, 61, said since he was a teen-ager he has struggled with kidney stones and the intense pain that accompanies their production. In addition to producing 20 to 30 kidney stones during his lifetime, Pernicone has also overcome colon cancer, diabetes and other medical maladies.<br />
"My medical record is thicker than the Bible," Pernicone said.<br />
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By the time Pernicone was diagnosed with colon cancer in 2007, his weight had ballooned to 350 pounds, and after a baseball-sized tumor was removed, doctors advised him against chemotherapy, fearing he lacked the strength to survive it.<br />
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Pernicone said that when he first sought Kornfeld's help he was taking the maximum possible dose of OxyContin. <span style="font-size: 11pt;">"It was really unbelievable how I was even talking," he said. "Because of the traditional pain meds I wasn't really in a state of mind where I could recover."</span><br />
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Kornfeld used buprenorphine to help Pernicone stop taking other prescription painkillers.<br />
Pernicone said, "There is no euphoria. It just manages to stop the pain receptors. With that I was able to start exercising and get back into shape. I've lost over 150 pounds."<br />
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Kornfeld said one of the reasons that buprenorphine isn't better known is that no drug company is marketing it aggressively.<br />
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"Pharmaceutical companies view the painkiller market as a huge potential market," Kornfeld said. "They want to invent new drugs that can be patented and buprenorphine at this point, except in certain specific forms, is a generic drug. Huge amounts of money could be saved by moving people from OxyContin to buprenorphine."<br />
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Highland Hospital, where Kornfeld treats patients twice a week, is the medical center of last resort for thousands of low-income and medically indigent patients. Kornfeld said he started his clinic there because the goal of the Alameda County Medical Center was to reduce patients' dysfunctional dependence on opiates.<br />
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"Dr. Kornfeld has enormous passion for this issue," said Dr. Evan Seevak, Medical Director for Ambulatory Care at Alameda County Medical Center. "By using buprenorphine, we've been able to get people off a lot of the other pain medicines they've been using and get them on just a single medicine at a stable dose."<br />
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Contact Richard Halstead via e-mail at <a href="mailto:rhalstead@marinij.com">rhalstead@marinij.com</a></div>
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Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-80585450026352141782013-02-10T19:29:00.002-08:002013-02-10T20:18:22.624-08:00Cymbalta withdrawal<span style="color: #666666; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;"><span style="line-height: 18px;">I have been taking Cymbalta for chronic pain for a few years now. Due to a problem with the pharmacy's communication with me, my refill will not be ready for another few days. I am in the middle of horrible withdrawal symptoms. I ran out of my Cymbalta about a week before the pharmacy will end up mailing me the refill. I had no idea that the withdrawal symptoms from the drug are so intense and wretched. </span></span><br />
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<span style="color: #666666; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;"><span style="line-height: 18px;">I have constant uncomfortable tactile sensations, a profound rebound issue with my pain level, and projectile vomiting to mention just a fraction of the symptoms. Most disturbing is I can feel what seem to be electrical pulses shooting up and down my cervical spine and in my head.</span></span><br />
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<span style="color: #666666; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;"><span style="line-height: 18px;">I can guarantee you I will try very hard not to run out of this med again. It's been a week already and the symptoms show no sign at all of decreasing in intensity. I can only imagine what sort of haywire my brain chemistry is going through.</span></span><br />
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<span style="color: #666666; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;"><span style="line-height: 18px;">Just thought it would be important for people to know this in case they are taking or thinking of taking Cymbalta.</span></span>Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-3629682825242811162013-02-07T18:19:00.003-08:002013-02-07T18:19:56.024-08:00My cat is missingIt's been a tough week, and now my cat suddenly disappeared during the night last night. He is an indoor cat, so the only way he could get out of the house was too sneak out when I put the dog out for his potty break about 3 am. I know this is what happened, and feel so guilty about letting him slip out. <br />
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The dog has been bummed out about it too. He misses his buddy. I walked all over the neighborhood calling the cat's name, Ike, today. No sign of him anywhere.Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-4835785375284356072013-02-07T13:37:00.001-08:002013-02-07T13:37:14.148-08:00Chronic pain affects brain function - new study<span style="background-color: white; font-family: Arial, Helvetica, Sans; font-size: 12px;">Chronic pain suffers often complain of short term memory's problems. The neural mechanisms why this occurs are however not understood. Recent studies in animals showed that pain can disturb several cognitive processes as well as change the brain pathways for how we think and feel. Of the many cognitive disturbances observed the most important include problems in spatial memory, recognition memory, attention and even emotional and non-emotional decisions.</span><br />
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<span style="background-color: white; font-family: Arial, Helvetica, Sans; font-size: 12px;">In the new article the team of researchers from the University of Porto led by Vasco Gallardo describes in a rat model of neuropathic pain how a neuronal circuit crucial for the processing of short-term memory is affected by pain. The circuit, established between the prefrontal cortex and the hippocampus, is essential for encoding and retaining temporary memories on spatial information. The researchers used multi-electrodes implanted in the brain to record neuronal activity during a behaviour dependent of spatial memory - the animals were trained in a maze where they had to choose between two alternative paths and then asked to recall their chosen path.</span><br />
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<span style="background-color: white; font-family: Arial, Helvetica, Sans; font-size: 12px;">The results show that after a painful injury there is a significant reduction in the amount of information that passes through the circuit. This could mean a loss of ability to process information on spatial localization memory, or that those regions critical to memory are now "overwhelmed" by the painful stimuli disrupting the flow of information for memory. According to Vasco Gallardo, the team " has already demonstrated that peripheral nerve injury induces an instability in the spatial coding capacity of hippocampus neurons ", where is seen "a clear reduction in their capacity to encode information on the location of the animal." </span><br />
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<span style="background-color: white; font-family: Arial, Helvetica, Sans; font-size: 12px;">So to the author "this new work contributes to the demonstration that chronic pain induces alterations in the function of brain circuits that are not directly connected to tactile or painful processes". So as a result of chronic pain it is seen that "are also affected neuronal circuits linked to the processing of memories and emotions, what might mean a need for larger and more integrative strategies in the treatment of painful pathologies", says the researcher. More information: Cardoso-Cruz, H., Lima, D. and Galhardo, V. (2012). Impaired spatial memory performance in a rat model of neuropathic pain is associated with reduced hippocampal-prefrontal cortex connectivity. Journal of Neurosciences. Journal reference: Journal of Neuroscience Provided by University of Porto </span><br style="background-color: white; clear: both; font-family: Arial, Helvetica, Sans; font-size: 12px;" /><br style="background-color: white; clear: both; font-family: Arial, Helvetica, Sans; font-size: 12px;" /><span style="background-color: white; font-family: Arial, Helvetica, Sans; font-size: 12px;">Read more at: </span><a href="http://medicalxpress.com/news/2013-02-chronic-pain-disrupts-short-term.html#jCp" style="background-color: white; color: #0e3266; font-family: Arial, Helvetica, Sans; font-size: 12px; font-weight: bold;">http://medicalxpress.com/news/2013-02-chronic-pain-disrupts-short-term.html#jCp</a>Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-9415549694414209842013-02-04T19:36:00.000-08:002013-02-04T19:36:01.960-08:00Diabetic Nerve Pain, different than a muscle ache<br />
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<span style="font-family: Verdana, Geneva, Arial, Helvetica, sans-serif; font-size: 12px;">The prevalence of diabetes continues to increase significantly, and is expected to affect 53.1 million Americans by 2025, an increase of 64 percent from 2010. One of the most common complications of diabetes is diabetic peripheral neuropathy (DPN), a form of nerve damage. More than one in five people with diabetes experiences painful DPN, also known as diabetic nerve pain, as a direct result of this nerve damage. But despite its prevalence, there are many people who go untreated and do not realize the pain they are feeling is related to their diabetes.</span></div>
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<br />Dorothy is one of the millions of Americans who has diabetic nerve pain. Dorothy was a nurse in the obstetrics and gynecology department of her local hospital for more than 30 years, but her diabetic nerve pain made it difficult for her to continue working with patients. “I had so much pain that I had to get off my feet and moved into a desk role instead of regularly seeing patients, which was a tough sacrifice to make,” she says. “Driving also became difficult for me since the diabetic nerve pain made my feet numb and I couldn’t feel the accelerator. Now, I have hand controls in my car, which enables me to drive and have some independence.”<br /><br />Diabetic nerve pain can include the following common symptoms: burning or shooting pain, pins and needles, stabbing or jabbing pain, painful tingling, numbness or insensitivity to pain or temperature, and extreme sensitivity to touch, even light touch. These symptoms may go unmentioned during a doctor visit since many people are unaware of the connection of this pain to their diabetes.<br /><br />For most people like Dorothy, diabetic nerve pain affects the feet, and is sometimes referred to as a sock pattern, as symptoms may be felt at the tips of the toes and then move along through the feet. It can also progress to other extremities, including people’s fingers and hands. “At first, my feet just felt numb. I had a burning and tingling sensation that progressed to a horrible, stabbing pain. It got so bad I felt like I was walking on glass and I couldn't even stand to have sheets over my feet at night,” Dorothy says.<br /><br /><div align="center">
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Even as someone who worked in the medical profession for so many years, Dorothy did not realize that the pain she was feeling was different from other types of pain, such as a muscle ache or sprained ankle. She assumed her pain was a result of her working on her feet on a daily basis for so many years. It wasn’t until eight years later, after cycling through a number of doctors, that Dorothy received the correct diagnosis of diabetic nerve pain. “After talking to my doctor, I found a treatment that’s helped me manage my diabetic nerve pain,” says Dorothy.<br /><br />The pain Dorothy felt may be similar to the experiences of many other Americans who also have diabetic nerve pain. According to results from an online survey of people living with Type I and II diabetes who experienced symptoms of diabetic nerve pain and characterized their pain as seven or higher on a scale of zero to 10, their pain is frequent and intense. Of those, 67 percent reported experiencing symptoms most or all of the time and nearly half said their symptoms were always painful.<br /><br />Nerve damage due to diabetes is not reversible, but it is important for people to know there are management plans available for diabetic nerve pain. If you think you might have diabetic nerve pain, now’s the time to schedule an appointment with your doctor. Make sure your doctor knows that your pain is the reason for your visit. For more information about diabetic nerve pain, visit <a href="http://www.diabetespainhelp.com/" style="color: #660066; text-decoration: initial;">www.DiabetesPainHelp.com</a>.<br /><br /><img border="0" height="1" src="http://www.brandpointcontent.com/printsite/ImageWriter.ashx?articleid=17515&memberid=72417" width="1" /><br /></div>
Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-20863007865146579062013-02-01T12:50:00.002-08:002013-02-01T12:50:41.211-08:00Should FDA change hydrocodone classification?<span style="background-color: white; color: #333333; font-family: Verdana; font-size: 12px; line-height: 18px;">"While I understand the need to keep narcotics out of the hands of criminals, I don't think this kind of action will make a big difference to the addiction and abuse problems. Most criminals steal their drugs or use fraudulent prescriptions, so how does putting new burdens on doctors and legitimate pain patients solve a problem?"</span><br />
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<span style="background-color: white; color: #333333; font-family: Verdana; font-size: 12px; line-height: 18px;">Read the rest of the story <a href="http://chronicfatigue.about.com/b/2013/01/29/fda-panel-recommends-new-pain-killer-restrictions.htm?nl=1" target="_blank">here</a>. I feel much the same way as she does.</span>Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com1tag:blogger.com,1999:blog-2651958847369944928.post-69668214703086676562013-01-25T15:24:00.002-08:002013-01-25T15:24:29.889-08:00Need more research with diverse populations<span style="font-family: Arial, Helvetica, sans-serif;">I was just reading an article on fibromyalgia research being done, when I saw this sentence, "<span style="background-color: white; color: #444444; line-height: 20px;">Researchers studied patients (mean age, 49.6 years; 95.8% female; 92.7% white) with fibromyalgia . . ."</span></span><br />
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<span style="background-color: white; color: #444444; line-height: 20px;"><span style="font-family: Arial, Helvetica, sans-serif;">Why the heck was this trial virtually all women and all white? I know that men get fibromyalgia at a reduced rate from women, but they are out there. I know some of them myself. We need more diverse demographic groups to study how different groups are affected by this horrid syndrome.</span></span>Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-18261651200772428972013-01-25T15:12:00.003-08:002013-01-25T15:12:56.015-08:00Cannabis improves chronic pain, reduces need for other meds<br />
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Though controversial, medical <i>cannabis</i> has been gaining ground as a valid therapy, offering relief to suffers of diseases such as <a href="http://www.news-medical.net/health/What-is-Cancer.aspx" style="color: #3097c1; text-decoration: initial;">cancer</a>, Post-Traumatic Stress Disorder, ALS and more. The substance is known to soothe severe pain, increase the appetite, and ease <a href="http://www.news-medical.net/health/Insomnia-What-is-Insomnia.aspx" style="color: #3097c1; text-decoration: initial;">insomnia</a> where other common medications fail.</div>
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In 2009, Zach Klein, a graduate of Tel Aviv University's Department of Film and Television Studies, directed the documentary Prescribed Grass. Through the process, he developed an interest in the scientific research behind medical marijuana, and now, as a specialist in policy-making surrounding medical <i>cannabis</i> and an MA student at TAU's Porter School of Environmental Studies, he is conducting his own research into the benefits of medical <i>cannabis</i>.</div>
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Using marijuana from a farm called Tikkun Olam - a reference to the Jewish concept of healing the world - Klein and his fellow researchers tested the impact of the treatment on 19 residents of the Hadarim nursing home in Israel. The results, Klein says, have been outstanding. Not only did participants experience dramatic physical results, including healthy weight gain and the reduction of pain and tremors, but Hadarim staff saw an immediate improvement in the participants' moods and communication skills. The use of chronic medications was also significantly reduced, he reports.</div>
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Klein's research team includes Dr. Dror Avisar of TAU's Hydrochemistry Laboratory at the Department of Geography and Human Environment; Prof. Naama Friedmann and Rakefet Keider of TAU's Jaime and Joan Constantiner School of Education; Dr. Yehuda Baruch of TAU's Sackler Faculty of Medicine and director of the Abarbanel Mental Health Center; and Dr. Moshe Geitzen and Inbal Sikorin of Hadarim.</div>
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<b>Cutting down on chronic medications</b></div>
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Israel is a world leader in medical <i>cannabis</i> research, Klein says. The active ingredient in marijuana, THC, was first discovered there by Profs. Raphael Mechoulam and Yechiel Gaoni. Prof. Mechoulam is also credited for having defined the endocannabinoid system, which mimics the effects of <i>cannabis</i> and plays a role in appetite, pain sensation, mood and memory.</div>
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In the Hadarim nursing home, 19 patients between the ages of 69 and 101 were treated with medical <i>cannabis</i> in the form of powder, oil, vapour or smoke three times daily over the course of a year for conditions such as pain, lack of appetite, and muscle spasms and tremors. Researchers and nursing home staff monitored participants for signs of improvement, as well as improvement in overall life quality, such as mood and ease in completing daily living activities.</div>
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During the study, 17 patients achieved a healthy weight, gaining or losing pounds as needed. Muscle spasms, stiffness, tremors and pain reduced significantly. Almost all patients reported an increase in sleeping hours and a decrease in nightmares and PTSD-related flashbacks.</div>
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There was a notable decline in the amount of prescribed medications taken by patients, such as antipsychotics, Parkinson's treatment, mood stabilizers, and pain relievers, Klein found, noting that these drugs have severe side effects. By the end of the study, 72 percent of participants were able to reduce their drug intake by an average of 1.7 medications a day.<br />
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<b>Connecting <i>cannabis</i> and swallowing</b><br />
This year, Klein is beginning a new study at Israel's Reuth Medical Center with Drs. Jean-Jacques Vatine and Aviah Gvion, in which he hopes to establish a connection between medical <i>cannabis</i> and improved swallowing. One of the biggest concerns with chronically ill patients is food intake, says Klein. <a href="http://www.news-medical.net/health/Dysphagia-What-is-Dysphagia.aspx" style="color: #3097c1; text-decoration: initial;">Dysphagia</a>, or difficulty in swallowing, can lead to a decline in nutrition and even death. He believes that <i>cannabis</i>, which has been found to stimulate regions of the <a href="http://www.news-medical.net/health/The-Human-Brain.aspx" style="color: #3097c1; text-decoration: initial;">brain</a> associated with swallowing reflexes, will have a positive impact.<br />
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Overall, Klein believes that the healing powers of <i>cannabis</i> are close to miraculous, and has long supported an overhaul in governmental policy surrounding the drug. Since his film was released in 2009, the number of permits for medical <i>cannabis</i> in Israel has increased from 400 to 11,000. His research is about improving the quality of life, he concludes, especially for those who have no other hope.<br />
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Source: <a href="http://www.aftau.org/" style="background-image: url(http://www.news-medical.net/pics/remote.gif); background-position: 100% 0%; background-repeat: no-repeat no-repeat; color: #3097c1; padding-right: 10px; text-decoration: initial;">American Friends of Tel Aviv University</a><br />
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Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-76687037462397573602013-01-25T15:05:00.000-08:002013-01-25T15:05:02.690-08:00Chronic pain patients at high risk of suicide<br />
<a href="http://www.orlandosentinel.com/news/os-chronic-pain-suicide-20130124,0,7646024,full.story" target="_blank">Original article</a><br />
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Two months ago, Gary Rager's girlfriend asked him to do the unthinkable.</div>
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The 44-year-old woman, who has suffered disabling <a class="taxInlineTagLink" href="http://www.orlandosentinel.com/topic/health/symptoms/pain-HEISY000035.topic" id="HEISY000035" style="color: black; font-weight: 700; text-decoration: initial;" title="Pain">pain</a> for the past three years, asked Rager if he would help her end her life.</div>
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"I don't want to kill her, and I don't want to go to prison. But I don't want to see her suffer anymore either," said Rager, a 59-year-old Sanford sculptor whose work appears at area theme parks and public spaces throughout Orlando.</div>
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<li class="" style="clear: both; list-style: none outside none; margin: 0px 0px 0px 10px; padding: 0px 0px 5px;"><a href="http://www.orlandosentinel.com/news/osvideo-depression-and-chronic-illness-20130124,0,7744899.embeddedvideo" style="clear: both; color: rgb(0, 0, 0) !important; display: block; text-decoration: initial; width: 214px;" target=""><img alt="Depression and chronic illness go hand in hand" height="105" src="http://www.trbimg.com/img-5101cf01/turbine/osvideo-depression-and-chronic-illness-20130124/187/16x9" style="border: 0px; display: block; float: left; margin-right: 5px;" title="Depression and chronic illness go hand in hand" width="187" /></a><a href="http://www.orlandosentinel.com/news/osvideo-depression-and-chronic-illness-20130124,0,7744899.embeddedvideo" style="clear: both; color: rgb(0, 0, 0) !important; display: block; text-decoration: initial; width: 214px;" target=""><b>Video: </b>Depression and chronic illness go hand in hand</a></li>
<li class="" style="clear: both; list-style: none outside none; margin: 0px 0px 0px 10px; padding: 0px 0px 5px;"><a href="http://www.orlandosentinel.com/news/os-boyfriend-assisted-suicideb.jpg-20130124,0,800337.photo" style="clear: both; color: rgb(0, 0, 0) !important; display: block; text-decoration: initial; width: 214px;" target=""><img alt="Chronic-pain patients at high risk of suicide" height="105" src="http://www.trbimg.com/img-5101f112/turbine/os-boyfriend-assisted-suicideb.jpg-20130124/187/16x9" style="border: 0px; display: block; float: left; margin-right: 5px;" title="Chronic-pain patients at high risk of suicide" width="187" /></a><a href="http://www.orlandosentinel.com/news/os-boyfriend-assisted-suicideb.jpg-20130124,0,800337.photo" style="clear: both; color: rgb(0, 0, 0) !important; display: block; text-decoration: initial; width: 214px;" target="">Chronic-pain patients at high risk of suicide</a></li>
<li class="" style="clear: both; list-style: none outside none; margin: 0px 0px 0px 10px; padding: 0px 0px 5px;"><a href="http://www.orlandosentinel.com/news/karen--gary-2008a.jpg-20130124,0,893085.photo" style="clear: both; color: rgb(0, 0, 0) !important; display: block; text-decoration: initial; width: 214px;" target=""><img alt="Karen Brooks with her boyfriend Gary Rager" height="105" src="http://www.trbimg.com/img-5101e131/turbine/karen--gary-2008a.jpg-20130124/187/16x9" style="border: 0px; display: block; float: left; margin-right: 5px;" title="Karen Brooks with her boyfriend Gary Rager" width="187" /></a><a href="http://www.orlandosentinel.com/news/karen--gary-2008a.jpg-20130124,0,893085.photo" style="clear: both; color: rgb(0, 0, 0) !important; display: block; text-decoration: initial; width: 214px;" target="">Karen Brooks with her boyfriend Gary Rager</a></li>
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Such are the desperate measures that many afflicted with chronic disabling conditions — and those who love them — contemplate.</div>
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Some do more than think about it.</div>
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Like many patients in chronic pain, Karen Brooks has seen dozens of doctors over the past few years.</div>
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All take tests and discuss her physical health, but few have inquired about her <a class="taxInlineTagLink" href="http://www.orlandosentinel.com/topic/health/behavioral-conditions/mental-health-HEBEC000013.topic" id="HEBEC000013" style="color: black; font-weight: 700; text-decoration: initial;" title="Mental Health">mental health</a>, said her sister, Michelle Brooks, of <a class="taxInlineTagLink" href="http://www.orlandosentinel.com/topic/us/florida/orange-county-%28florida%29/maitland-PLGEO100100410110000.topic" id="PLGEO100100410110000" style="color: black; font-weight: 700; text-decoration: initial;" title="Maitland">Maitland</a>, who takes her sister to her doctors' appointments.</div>
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Given the high correlation between chronic illness or pain and <a class="taxInlineTagLink" href="http://www.orlandosentinel.com/topic/health/behavioral-conditions/depression-HEBEC00005.topic" id="HEBEC00005" style="color: black; font-weight: 700; text-decoration: initial;" title="Depression">depression</a> — even suicide — more providers need to bring up the dark subject, health experts say.</div>
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Large-scale studies show that at least 10 percent of suicides — and possibly as many as 70 percent — are linked to chronic illness or unrelenting pain.</div>
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Authors of a 2011 British study that looked at the link concluded that patients with such conditions "should be considered a high-risk group for suicide … and much greater attention should be given to providing better … psychological support."</div>
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But doctors are often too busy focusing on physical problems to deal with the mental ones that go with them, say those specializing in chronic illness.</div>
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<strong>Fading away</strong></div>
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Brooks has been diagnosed with several medical conditions in an attempt to explain and treat the severe pain that consumes the left half of her face. Her most recent diagnosis, which she got last week, is <a class="taxInlineTagLink" href="http://www.orlandosentinel.com/topic/health/diseases-illnesses/rheumatoid-arthritis-HEDAI0000036.topic" id="HEDAI0000036" style="color: black; font-weight: 700; text-decoration: initial;" title="Rheumatoid Arthritis">rheumatoid arthritis</a>.</div>
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A progressive, chronic disease that causes painful inflammation in joints throughout the body, rheumatoid arthritis is often misdiagnosed, said Dr. Shazia Bég, assistant professor of rheumatology at University of Central Florida College of Medicine.</div>
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Though she is not Brooks' doctor, Bég said the recent diagnosis could very well explain Brooks' chronic facial pain as well as her overall stiffness, wasting and suicidal thoughts.</div>
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Today, at 5-foot-five, Brooks weighs just 90 pounds — 40 pounds less than in better days. She can't chew, or eat solid food, or get up or walk by herself. She needs someone with her 24 hours a day.</div>
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"I can't imagine living 20 more years like this," said Brooks, sitting in her mother's compact <a class="taxInlineTagLink" href="http://www.orlandosentinel.com/topic/us/florida/orange-county-%28florida%29/winter-park-PLGEO100100410220000.topic" id="PLGEO100100410220000" style="color: black; font-weight: 700; text-decoration: initial;" title="Winter Park">Winter Park</a>home.</div>
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"It's hard to watch someone you love be in pain and fade away," said Rager, who met Brooks in 2007. "But the way the medical system is set up, there's nothing we can do. She has to suffer every day from now until she dies."</div>
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Brooks traces the pain in her jaw back to 1999. She went to several dentists and cranio-facial experts. She tried <a class="taxInlineTagLink" href="http://www.orlandosentinel.com/topic/health/acupuncture-HEPAS0000078.topic" id="HEPAS0000078" style="color: black; font-weight: 700; text-decoration: initial;" title="Acupuncture">acupuncture</a>, pain medications, laser pain treatment and even brain surgery, during which a neurosurgeon moved some blood vessels pressing on a facial nerve.</div>
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Nothing has brought relief.</div>
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"They euthanize a poor animal that's suffering, and call that humane," said Rager. "But they will let a person rot away over years. That's just wrong."</div>
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"It's so sick that these prisoners on death row who have killed 20 people get to lay there with a needle and just fall asleep," said Brooks. "That's the best way to die, and they're the ones who get to die that way."</div>
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<strong>More need to listen</strong></div>
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"It's well-known that people with rheumatoid arthritis have a high risk of depression and anxiety," said Bég. About one-third suffer from these mental-health problems.</div>
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Many believe the number is probably higher, but many patients and doctors don't talk about it.</div>
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Depressed patients do worse with pain relief, which puts them at an increased risk of death from suicide, studies show. That's the case not only for patients who suffer from autoimmune diseases such as rheumatoid arthritis and <a class="taxInlineTagLink" href="http://www.orlandosentinel.com/topic/health/diseases-illnesses/lupus-HEDAI00000319.topic" id="HEDAI00000319" style="color: black; font-weight: 700; text-decoration: initial;" title="Lupus">lupus</a>, but also for those with <a class="taxInlineTagLink" href="http://www.orlandosentinel.com/topic/health/diseases-illnesses/heart-disease-HEDAI0000026.topic" id="HEDAI0000026" style="color: black; font-weight: 700; text-decoration: initial;" title="Heart Disease">heart disease</a> and cancer, experts say.</div>
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"We know that chronically ill patients who are also depressed have lower rates of compliance with their health plans, and poorer outcomes," said Dr. Julie Demetree, a psychiatrist at South Seminole Hospital, in Longwood.</div>
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Although doctors are paying more attention to the relationship between chronic pain and illness and suicide, "there's still room for improvement," she said.</div>
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Part of the solution is for doctors to listen more. "You can get a lot from a patient in a 20-minute visit without having to order tests," said Bég.</div>
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"Not every specialist is trained to treat depression, but all are trained to ask about it, and that's not done," she said.</div>
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Because Brooks is on Medicaid, the list of doctors she can see is short, and the wait for an appointment often long.</div>
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Last April a primary-care doctor referred Brooks to a rheumatologist, a doctor who specializes in<a class="taxInlineTagLink" href="http://www.orlandosentinel.com/topic/health/diseases-illnesses/arthritis-HEDAI000008.topic" id="HEDAI000008" style="color: black; font-weight: 700; text-decoration: initial;" title="Arthritis">arthritis</a>. She finally got in to see him last week. He diagnosed her as having rheumatoid arthritis, but never asked about her mental health, said Michelle Brooks, who sat in on the visit.</div>
<div style="margin-bottom: 10px; margin-top: 10px; padding: 0px;">
Though Brooks still feels her situation is hopeless, Rager and her sister are hopeful that the new diagnosis and new treatment regimen, which includes <a class="taxInlineTagLink" href="http://www.orlandosentinel.com/topic/health/drugs-medicines/steroids-HETHT00007.topic" id="HETHT00007" style="color: black; font-weight: 700; text-decoration: initial;" title="Steroids">steroids</a>, will turn her around.</div>
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"If the diagnosis is correct — and today's blood tests are very accurate — and she gets proper treatment, I would expect her to get better," said Bég.</div>
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"I can't believe it's taken us so long to get here," said Rager. "If this really is the solution, think of all the suffering that could have been prevented."</div>
<div style="margin-bottom: 10px; margin-top: 10px; padding: 0px;">
<em><a href="mailto:mjameson@tribune.com" style="color: black; font-weight: 700; text-decoration: initial;">mjameson@tribune.com</a> or 407-420-5158</em></div>
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Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com1tag:blogger.com,1999:blog-2651958847369944928.post-75199794010231779222013-01-08T20:50:00.004-08:002013-01-08T20:50:47.394-08:00Why Head to Toe Pain <a href="http://www.fmnetnews.com/" title="Go to Home."> Home</a> You can find the original article at the link to the left.
<br />
<h2>
From the Skin Tissue to the Brain</h2>
<em><strong>It all signals pain!</strong></em><br />
<img alt="" class="alignright size-medium wp-image-3206" height="200" src="http://www.fmnetnews.com/wp-content/uploads/doctor-with-couple-300x200.jpg" title="From the Skin Tissue to the Brain" width="300" />How
can you hurt from head to toe? Research shows the pain control system
in the skin, spinal cord, and brain of fibromyalgia patients is
overloaded, offering a reason for why you ache all over. In particular,
immune cells that generally do not cause pain contribute to the flu-like
fibro symptoms that make your whole body hurt.<br />
<h2>
Nerve Fibers in Skin</h2>
Alterations in the way the central nervous system (brain and spinal
cord) works are believed to be a major cause of your fibromyalgia pain,
but researchers are finding that’s not the only source. The immune
cells surrounding the nerve endings in your skin appear to be
contributing to your pain as well. <strong>Seong-Ho Kim, M.D.</strong>
and colleagues in South Korea took tiny biopsies of the skin tissue from
a group of fibromyalgia patients and compared them to healthy controls.<sup>1</sup><br />
<br />
They found that most of the fibromyalgia patients, but none of the
controls, showed enlarged or ballooned Schwann cells. These cells, which
look like a string of sausage links, encase the nerve fibers that
connect your spinal cord to peripheral tissues like your skin and
muscles. These fibers relay information from your tissues to your spinal
cord, and vice versa.<br />
<br />
Under normal situations, Schwann cells provide nutritional support
and protection for nerves. But since they are part of your immune
system, they are always surveying the nearby environment to make sure
nothing happens to threaten or harm your nerves.<br />
<br />
Enlarged Schwann cells are in an activated state, usually triggered
by infections and tissue injury. When activated, these cells pump out
pain-causing chemicals to prompt your immune system to clean up debris
and help repair damaged tissues. But in people with fibromyalgia,
something unusual happens.<br />
<br />
Although the Schwann cells are enlarged, there are no obvious signs
of tissue injury in fibromyalgia patients’ skin. But everything is not
normal. When their skin is examined under an electron microscope, the
pain-producing chemicals secreted by the immune cells are present in
high concentrations.<sup>2</sup> These chemicals, called cytokines,
activate nearby nerve endings and make the skin hurt. Cytokines are also
elevated in the blood and can cause flu-like achiness everywhere.<br />
<h2>
Faulty Pain Filter</h2>
In order for you to actually feel pain, transmissions from your skin,
muscles and other tissues has to reach a level of consciousness in your
brain. Otherwise, all sensations, including light touch, would hurt.
That’s where your spinal cord comes in handy. The cord’s role is to
filter out the less serious nerve signals traveling from your tissues to
your brain and from your brain out to your tissues. In essence, your
spinal cord works like a pain filter, but studies show it’s doing a poor
job in fibromyalgia patients.<br />
<br />
Kim’s team suspects that fibro patients have too many signals are
traveling down through the cord to the tiny nerves in the skin, causing
the fibers to become overstimulated. The Schwann cells attempt to keep
pace by clearing out the waste products and debris, while providing
nutrients to the overworked nerve fibers. In the process, they become
enlarged.<br />
<br />
How do ballooned Schwann cells impact your pain? They secrete
pain-promoting cytokines that irritate nearby nerve fibers. The
irritated nerve fibers in the skin then start relaying signals back to
your spinal cord, saying, “Ouch … help me out!” But the cord fails to
filter the signals and the brain shoots more transmissions back to the
tissues. This process leaves you with painful skin, even though it looks
normal. The same situation likely occurs in your muscles to make them
ache.<br />
<h2>
Spinal Cord Opioids</h2>
<br />
When
experiencing fibro pain, you would think the neurons in your spinal
cord and brain would release lots of pain-killers to get your symptoms
under control. Operating under this assumption, <strong>James Baraniuk, M.D.,</strong> of Georgetown University, and <strong>Daniel Clauw, M.D.,</strong>
of the University of Michigan in Ann Arbor, measured the spinal fluid
level of naturally produced opioid-like endorphins called enkephalins.
They compared a fibro group to chronic low back pain patients (regional
pain) and healthy pain-free controls.<sup>3</sup><br />
<br />
The concentration of enkephalins in the fibromyalgia group was almost
fourfold greater than the controls, but pain alone was not the reason
for this difference. The enkephalin levels were nowhere near as high as
in the chronic back pain patients. This means a fibro patient’s spinal
cord is pouring out natural pain-killers (e.g., enkephalins) in a valid
attempt to contain the pain, but given its widespread nature, that’s
just not enough.<br />
<h2>
Opioid Receptors in Brain</h2>
You may wonder if the high concentration of enkephalins in the spinal
fluid (which bathes the brain) are not properly activating the
pain-relieving centers in your brain. After all, given the high
concentrations of spinal opioids, you should not be feeling any pain
whatsoever.<br />
<br />
Clauw’s team measured the number of receptor sites in the brain that
opioid-like substances target to put out the pain. He compared a group
of fibromyalgia patients to a group of healthy controls using brain
imaging.<sup>4</sup><br />
<br />
The opioid receptors in the brain were almost completely occupied in
the fibromyalgia patients, particularly in the areas known to regulate
pain. So the higher amount of enkephalins (opioid-like substances) in
the spinal fluid appear to be properly working on the brain’s receptors
to control your pain.<br />
<h2>
So Why Do You Hurt?</h2>
If you are producing plenty of opioid-like enkephalins and they are
activating the pain-relieving receptors in your brain, why do you still
hurt all over? Researchers don’t know all the details, but the foregoing
findings offer some important clues.<br />
<br />
Studies show the skin is a source of continuous pain transmissions
traveling to your spinal cord. The cytokines produced by enlarged
Schwann cells cause local irritation, which would be expected for
injuries or infections, but there is no evidence of destroyed tissue in
fibro. Yet cytokines continue to be produced for unclear reasons,
causing your flu-like achiness.<br />
<br />
Substantial elevations of the opioid-like enkephalins in your spinal
fluid could be doing more than trying to provide analgesia. They might
also be activating the immune cells in your spinal cord to produce
pain-promoting cytokines, and one study indicates this is the case.<sup>5</sup><br />
<br />
Your body is trying to put out your pain by producing large amounts
of opioid-like endorphins (e.g., enkephalins). But opioids don’t just
relieve pain, they also activate immune cells to release cytokines to
help heal injuries (usually a temporary process). Despite there being no
tissue destruction in fibro, your immune system seems to think there
is. This means your body’s attempts to ease discomfort backfires (e.g.,
the pain-promoting cytokines win out over the opioids), leading to more
rather than less pain.<br />
<br />
<em>Curious about other symptoms caused by pain-promoting cytokines
and your treatment options? The topic was covered in the Summer 2012
issue of the </em>Fibromyalgia Network Journal.<em> Get more with Membership. <a href="http://www.fmnetnews.com/about-us/about-benefits" title="Member Benefits"><strong>Learn about Member benefits.</strong></a></em><br />
<br />
<div align="left" style="font-size: 10px;">
1. Kim SH, <em>et al.</em> <span style="text-decoration: underline;">Clin Rheumatol</span> 27:407-11, 2008.<br />
2. Salemi S, <em>et al.</em> <span style="text-decoration: underline;">J Rheumatol</span> 30:146-50, 2003.<br />
3. Baraniuk JN, <em>et al.</em> <span style="text-decoration: underline;">BMC Musculoskel Dis</span> 5:48-54, 2004.<br />
4. Harris RE, <em>et al.</em> <span style="text-decoration: underline;">J Neurosci</span> 27:1000-6, 2007.<br />
5. Kadetoff D, <em>et al.</em> <span style="text-decoration: underline;">J Neuroimmunol</span> 242(1-2):33-8, 2012.</div>
Anonymoushttp://www.blogger.com/profile/17883002218931946035noreply@blogger.com0tag:blogger.com,1999:blog-2651958847369944928.post-5490879111925066962012-10-25T08:26:00.006-07:002012-10-25T08:26:59.231-07:00<header>
<hgroup>
<h1>
Medtronic Helped Write, Edit Positive 'Infuse' Spine Studies</h1>
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<span>By John Fauber, Reporter, Milwaukee Journal Sentinel/MedPage Today<div>
<span style="color: #666666;">Published: October 25, 2012</span></div>
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Highly positive studies published in peer-reviewed medical
journals depicted Medtronic's spine fusion product as a major
breakthrough in back surgery, but those studies drafted and edited with
direct input from company employees, while the doctors listed as authors
were paid millions, according to a U.S. Senate investigation.<br />
<br />
The company's heavy, undisclosed manipulation of information about
its bone morphogenetic protein-2 product called Infuse included removing
and downplaying concerns about serious complications linked to the
product and overstating its benefits.<br />
<br />
<strong>The Money Trail</strong><br />
Over the course of 15 years, Medtronic paid $210 million to a group
of 13 doctors who co-authored the series of now-repudiated papers about
the product. The payments also included two corporate entities
associated with some of the doctors.<br />
<br />
The investigation by Senate Committee on Finance was prompted in part by <em>Journal Sentinel/MedPage Today</em>
investigations that showed how the practice of medicine has been
corrupted by conflicts of interest involving doctors, drug and device
companies and medical journals.<br />
<br />
The Senate report, to be released Thursday, details how Medtronic
employees, including some working in the company's marketing department,
covertly collaborated with the academic physician authors in producing
11 different papers between 2002 and 2009.<br />
<br />
Such "ghostwriting," though not illegal, has been condemned as a
breach of integrity and transparency because doctors and patients rely
on information in those articles to make medical decisions, not knowing
that the papers may contain biased, inaccurate or potentially harmful
information.<br />
<br />
The Senate's findings highlight problems that should have been
reported as at least a decade ago, said Ray Baker, MD, a Kirkland,
Wash., pain specialist who served on an advisory panel to Medicare and
Medicaid on Infuse.<br />
<br />
"I am just sad this happened," he said. "At every level when we
thought, 'that wouldn't happen,' it happened. The integrity of our
scientific literature is our foundation. It's what predicates our
treatments."<br />
<br />
<strong>Medtronic Denies</strong><br />
Medtronic disputed many of the findings in the Senate's report.<br />
<br />
"Medtronic vigorously disagrees with any suggestion that the company
improperly influenced or authored any of the peer-reviewed published
manuscripts discussed in the report, or that Medtronic intended to
under-report adverse events," a statement emailed by the company said.<br />
<br />
The company said it reported the adverse events to the Food and Drug
Administration and those risks also are listed the product label for
Infuse. Medtronic also called the report's characterization of the
payments to the doctors misleading and unfair.<br />
<br />
"The vast majority of such payments were royalty payments made to
compensate physicians for their intellectual property rights and
contributions, not consulting payments," the company said.<br />
<br />
In 2011, after the <em>Spine Journal</em> devoted an entire issue to
repudiating Infuse research, the company, under its new CEO, Omar
Ishrak, hired Yale University to oversee an independent review of the
safety and effectiveness of Infuse.<br />
<br />
"This sounds eerily familiar to many of the transgressions we've read
about from the pharmaceutical industry," said Harlan Krumholz, MD, a
professor of medicine at Yale University, when told of the Senate
report. "It paints a picture of a company very heavily involved in the
science; marketing contaminating the science; and the medical profession
and researchers being complicit.<br />
<br />
<strong>The Public Trust</strong><br />
"It's no wonder the public has lost confidence in the drug and device industries." Krumholz is overseeing Yale's review of Infuse. Those results are expected in January.<br />
<br />
Medtronic's behavior also drew sharp criticism from two key senators on the committee.<br />
"Medtronic's actions violate the trust patients have in their medical
care," Sen. Max Baucus, (D-Mont.), chairman of the committee, said in a
statement. "Patients everywhere will be better served by a more open,
honest system without this kind of collusion."<br />
<br />
Senior member Chuck Grassley (R-Iowa) said the findings support the
Physician Payments Sunshine Act that he and Sen. Herb Kohl (D-Wis.)
authored. That legislation will require drug and device companies to
disclose such payments beginning next year.<br />
<br />
"The findings also should prompt medical journals to take a very
proactive approach...," Grassley said in a statement. "...The public
will benefit from more transparency and accountability on their part."<br />
In response to the Senate investigation, Medtronic turned over more
than 5,000 documents, including emails involving the doctors and
Medtronic employees as well as 14 years of payments from Medtronic to
the doctors.<br />
<br />
<strong>The Infuse Story</strong><br />
In January 2002, Hal Mathews, MD, spoke glowingly about Infuse to a
FDA advisory panel that was considering whether to recommend approval of
the product.<br />
<br />
Mathews, then a Richmond, Va. spine surgeon who had taken part in the
pivotal Infuse clinical trial, told the panel he had no direct
financial interest in the product and that he was not being paid to
appear at the meeting.<br />
<br />
However, a 2001 email shows that Medtronic worked with the New
York-based public relations firm, Ketchum, to prepare Mathews' speech to
the panel, which went on to recommend approval of the product.<br />
<br />
In addition, though Medtronic told the committee that Mathews was not
paid for any activity undertaken in January 2002, Mathews was paid
under consulting arrangements with the company in 2001.<br />
<br />
In 2007, Mathews was hired by Medtronic as its vice president of medical and clinical affairs.<br />
<br />
<strong>From the Pen of Medtronic</strong><br />
An email indicated that a Medtronic marketing employee, Julie
Bearcroft, was involved in editing a 2005 Journal of Bone and Joint
Surgery article and recommended against publishing a complete list
complications related to the structural integrity of the fused area.<br />
<br />
Those complications -- known as implant migration, subsidence and
end-plate fracture -- had been observed in a clinical trial and had
been formatted in a detailed table, according to an internal Medtronic
email. But, following the advice of Bearcroft, that table was not
included in the published paper.<br />
"I personally think it is appropriate to simply report the adverse
events were equivalent in the two groups without the detail," Bearcroft
wrote in a note on a draft of the article.<br />
<br />
After the editing change was made, the lead author of the paper, Ken
Burkus, MD, a Columbus, Ga. surgeon, sent a draft of the paper to his
co-authors with the note, "this manuscript documents the superiority in
clinical and radiographic outcomes with (Infuse)..." Burkus, who got $6.4 million from Medtronic between 1998 through 2010, did not respond to an email seeking his comment.<br />
<br />
Medtronic officials inserted into papers language that attempted to
portray Infuse as a better, less painful alternative to the standard
technique of using a small amount of a patient's own hip bone for fusing
vertebrae, a claim that has been questioned by independent spine
surgeons.<br />
<br />
<strong>Giving Infuse the Edge</strong><br />
In 2001 and 2002, after viewing early drafts of a 2002 Infuse paper,
Neil Beals, a Medtronic marketing official recommended that the
physician authors make "a bigger deal" out of the supposed pain
reduction with Infuse.<br />
<br />
Subsequently, a sentence was inserted in the paper stating that
Infuse spared patients from being exposed to problems associated using
their own bone for the fusion.<br />
<br />
In its review of Infuse last year, doctors writing in the Spine
Journal said the often-cited donor site pain was less frequent and
serious than Infuse proponents suggested.<br />
<br />
In addition, in a draft of a 2003 paper the authors said that any
pain at the site of the hipbone graft site had been resolved in the
study subjects within a year of the surgery. But Beals questioned that
and inserted language saying residual effects of the donor site should
be noted.<br />
<br />
The final article appears to have adopted his suggestions, noting
that even 24 months after the surgeries "some patients continued to
experience residual pain at the donor site and rated the appearance of
the site as only fair."<br />
<br />
<strong>Downplaying Safety Concerns</strong><br />
The company also tried, unsuccessfully, to adopt weaker patient
safety rules for a clinical trial testing the effectiveness of Infuse in
the cervical spine, a use that remains unapproved and which has been
linked to life threatening swelling in neck.<br />
<br />
In 2008, the FDA warned doctors against using Infuse in cervical
spine fusions, citing 38 cases of swelling in the neck and throat
leading to compression of the airway. Some of those cases required
emergency tracheotomies.<br />
<br />
The weaker safety rules sought by Medtronic would have allowed the
company to continue the clinical trial even if patients experienced
severe swelling in neck.<br />
<br />
Infuse is a powerful biological agent that stimulates the growth of
new bone, but excess bone growth can be a serious problem when the
product is used in certain off-label surgeries. It was approved in 2002
for lumbar spine fusions in which the surgical approach is from the
front.<br />
<br />
The unapproved use has caused serious problems for Patricia Caplinger
and hundreds of other spine surgery patients like her, according to a
lawsuit filed earlier this year against Medtronic in federal court in
Oklahoma.<br />
<br />
The complication experienced by Caplinger was the subject of a 2004
paper written by doctors who have received millions of dollars from
Medtronic. That paper involved a clinical trial of Infuse that had to be
halted five years earlier because of excess bone growth in the spinal
canals of 70% of the patients.<br />
<br />
That clinical trial used Infuse in a surgery similar to what Caplinger underwent in 2010. The surgeons who wrote the article said that patients weren't harmed
by the excess bone growth. But that claim that was refuted by an
Oklahoma surgeon who took part in the trial and told the <em>Journal Sentinel/MedPage Today</em>
last year that he had two patients who developed painful, excess bone
growth that required additional surgeries. Caplinger who lives in
Missouri was not one of those patients.<br />
<br />
<strong>A helping hand in the OR</strong><br />
Caplinger says that her doctor and others surgeons were persuaded by
Medtronic and its "paid physician promoters" to use Infuse in dangerous,
off-label surgeries, according to her lawsuit.<br />
In Caplinger's case, a Medtronic representative actually was present
during her surgery and "was actively involved," providing information
about use of Infuse in Caplinger's procedure, according to the lawsuit.<br />
<br />
Because of the excess bone growth, Caplinger suffers continuous pain
in her back and legs and developed a condition known as foot drop,
which, in turn, led to a ligament tear in her right knee. She also has
required revision surgery on her back and will need another revision
surgery because the bone growth is continuing.<br />
<br />
In an email, Caplinger, a nurse, said she is worried that the pain
eventually will prevent her from doing what she loves the most, working
in the emergency department. "I live with pain every minute of every day," she said. "I have forgotten what not being in pain feels like." A Medtronic spokesperson said the complaint lacks and the company has the court to dismiss the case.<br />
<br />
<strong>Medtronic had answers</strong><br />
The Senate report and accompanying documents also show Medtronic
employees -- in addition to editing drafts of a paper -- at times
covertly drafted responses to questions raised by other doctors who were
examining the work as part of medical journal peer review.<br />
<br />
Case in point: A 2004 paper was published in the <em>Spine Journal</em>
where co-author Charles Branch Jr., MD, also served as deputy editor.
Branch, chairman of neurosurgery at Wake Forest University, received
$3.1 million from Medtronic from 1998 to 2010. His royalty payments have
been split with the university.<br />
<br />
That article also was subject of a 2011 <em>Journal Sentinel/MedPage Today</em> investigation.<br />
The Senate documents include a 2003 email, as the article was being
drafted, in which Bill Martin, the company's vice president of spinal
marketing, wrote: "We may want to steer clear of calling it a flawed
technique. There are still quite a few surgeons utilizing this
technique..."<br />
<br />
About a week later, Rick Treharne, another Medtronic executive, wrote
to one of the paper's authors: "In looking over the data, I was
impressed with how well the BMP (Infuse) patients actually did. So much
so that I added a few paragraphs at the end that you may not agree
with."<br />
<br />
As peer reviewers for the journal looked over the paper, they raised concerns that it was a slanted, advertising piece. "This manuscript is full of biased statements that are a reflection
of the data evaluators -- the company that markets the product," wrote
one reviewer. "Unless the authors can discuss the results in this study in an
unbiased manner, which they have been unable to do in its present form,
this data should not be published," wrote another.<br />
<br />
Treharne then sent one of the co-authors a draft of a letter to be
sent to the editor of the journal addressing the concern. Another
Medtronic executive also helped formulate a response to the editor.<br />
The letter that ultimately was sent to the journal's editor sought to
reassure him, claiming that three of the co-authors were independent,
the Senate investigation found.<br />
<br />
But between 1997 and 2003, two of the "independent" authors had received $8.5 million from Medtronic. "We were falsely reassured that there were independent people looking
at the data," said Eugene Carragee, MD, who took over as editor of the <em>Spine Journal</em> in 2009. "It's a violation of the fundamental trust of peer review."<br />
<br />
When published, the paper described the results of halted clinical trial as "encouraging."<br />
<br />
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This story was reported as a joint project of the <em>Journal Sentinel</em> and <em>MedPage Today.</em></div>
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