pain

RECENT POSTS

One Man’s Sedation-Free Colonoscopy (And Why You Should Try It Too)

By David C. Holzman
Guest Contributor

I’m one of an elite group of American patients. Only about one percent of us undergo colonoscopy without sedation. The big secret: it doesn’t have to be painful. And it’s probably safer than with sedation.

Like most Americans, I was ignorant of all of this until about a month ago. In my imagination, a sedation-free colonoscopy would have been painful indeed, the device snaking up my GI tract, pushing against my insides as it resisted the twists and turns. Then my best friend, Greg, who has made several suggestions that have resulted in distinct improvements in my life, suggested forgoing the drugs, as he had recently done.

Gateway to the author's colon (Courtesy)

Gateway to the author’s colon (Courtesy)

It made sense. I could drive myself to and from the hospital, and I’d be able to work when I got home.

Greg had also told me that there’s a correlation of anesthesia with loss of memory later in life. Some googling revealed that this may be true in some cases. But despite that uncertainty, that made the unmedicated colonoscopy far more compelling.

It helped to learn that Dr. Douglas Horst, who would be doing the colonoscopy, did a number of them unsedated, and even more, that he called me to discuss it, putting my mind even more at ease. (He gets top grades on several different doctor evaluation websites.)

And overall, the discomfort was minimal, hitting maybe 3-max out of 10 on the pain-meter for seconds at a time here and there, and otherwise never going beyond 2 out of 10, comparable, perhaps, to a very mild cramp. I’d much rather have another colonoscopy than an upset stomach.

The Prep: Dystopian Poison

Far worse than the colonoscopy was the “prep.” Continue reading

Overdose Antidote: What The Government Doesn't Do, And What You Can

naloxone

(PunchingJudy/Flickr Creative Commons)

You hear a lot these days about the national epidemic of painkiller overdoses. What you don’t hear so much about is what you can do to respond to those overdoses when they happen, much as we learn about CPR or defibrillators for heart attacks.

In an opinion piece just out in the Journal of the American Medical Association, Northeastern University assistant professor of law and health sciences Leo Beletsky and his co-authors argue that the government should do far more to enable the public to fight overdoses. Why doesn’t it? And what can each of us do? He explains here.

By Leo Beletsky
Guest contributor

Now a true national crisis, overdose from opioid drugs like Oxycontin and heroin kills about 16,000 Americans every year. Outranking car accidents, it is now the leading cause of accidental death in many states, including Massachusetts.

Rural and poor communities are particularly hard-hit, but contrary to popular belief, this epidemic does not discriminate: Overdose victims come from all classes, races, and age groups. Deaths afflict both legitimate and illicit users of prescription medications as well as those using street drugs like heroin.

Many of these deaths could be averted. Long-term prevention efforts are needed, but in the meantime, there are some straightforward things we can all do immediately to stop overdoses from turning fatal.

First: From the onset of the telltale signs of overdose, such as shallow breathing and slow pulse, it typically takes 30 to 90 minutes for the victim to die. This provides a precious window of opportunity to save a life. The tragic reality is that people often don’t recognize the overdose in time and thus don’t quickly call 911.

Second: Most people do not realize that once an ambulance has been called, they can help save the victim’s life. The key is to determine if the person is breathing; if not, rescue breathing and CPR should be performed. And ideally, the drug naloxone should be given to the victim.

Leo Beletsky

Northeastern University’s Leo Beletsky (Courtesy of Northeastern)

What is naloxone? Known by the brand name Narcan, it is an overdose antidote, a drug whose only effect is to reverse an overdose from opioid drugs like Oxycontin, Vicodin or heroin. Given via injection or nasal spray, it blocks the opioid receptors in the brain, typically working within about four minutes to revive the victim.

It seems like a no-brainer, doesn’t it? Shouldn’t anyone who takes opioids, or who is close to someone who does, know what to do in the event of an overdose, and keep this potentially lifesaving drug available?

In fact, however, it is much harder than it should be to get and fill a prescription for naloxone, even though it’s extremely safe and has no potential for abuse.

Why? Continue reading

Foreman: For Adults In Pain, Just Say Yes To Marijuana

(“Caveman Chuck” Coker/flickr)

By Judy Foreman
Guest Contributor

I have just finished writing a book on chronic pain and, although I didn’t initially plan it this way, I ended up devoting an entire chapter to marijuana because, as I did my research, I found considerable evidence that marijuana is both safe and reasonably effective at relieving pain. In fact, if a person taking opioids (narcotics) for pain relief also smokes marijuana, the dose of opioids needed can often be reduced.

For historical and political reasons, the federal government persists in classifying marijuana as a Schedule I drug, which means it is deemed to have a “high potential for abuse” and no recognized medical usefulness. Both parts of this are false.

Although the government has stymied marijuana research in this country, there has been significant research from other countries on the risks and benefits of inhaled marijuana.

Marijuana used alone is actually remarkably safe, in part because, unlike other drugs, including opioids, it does not cause respiratory depression.

In fact, there are simply no deaths – zero – from marijuana alone, according to the federal Centers for Disease Control and Prevention. This is in stark contrast to deaths from alcohol (80,000 a year), tobacco (443,000 a year), even NSAIDS, non-steroidal anti-inflammatory drugs, which kill an estimated 7,000 to 10,000 American adults every year.

Marijuana used alone is actually remarkably safe, in part because, unlike other drugs, including opioids, it does not cause respiratory depression.

Nor does marijuana seem to be the “gateway” drug that opponents claim it to be. A 1999 report from the Institute of Medicine, part of the National Academy of Sciences, found that marijuana is not the substance that gets teenagers on the road to substance abuse – underage tobacco and alcohol use are. Continue reading

When The Doctor Says This Won’t Hurt A Bit — And Incredibly, It’s True

In May, my six-year-old daughter, Julia, smashed into our front door handle and got a deep, bloody gash in her forehead.

We rushed her, head wrapped like a tiny mummy, to the medical center at MIT, where we generally go for pediatric care. Julia wept while the nurse cleaned and examined her lacerated skin. After a short exam, she sent us to the emergency department at Children’s Hospital Boston for stitches. “How bad is that, generally?” I asked, having never experienced suturing either for myself or my cautious, risk-averse, older daughter.

“It can be traumatic,” the nurse said.

Julia cried, “I don’t want stitches.”

It’s a large needle, but Julia is too busy coloring to notice.

So I braced myself for the worst: an endless wait and nerve-wracking bustle; screaming, germ-laden children and brusque, end-of-shift staff. But more than anything, I dreaded the inevitable pain in store for my small child with the deep cut.

(I know, kids get banged up on the path to adulthood and some pain is unavoidable. Still, when bloody heads are involved, I tend to overreact.)

Indeed, I was in full Mama Bear mode when into our exam room strode Dr. Baruch Krauss, the attending physician that evening.

Dark, lean and intense, Dr. Krauss shook my hand and then went straight to Julia, complimenting her pink, sparkly shoes. She lit up and was eager to chat. They talked about exactly how old she was (nearly six-and-three-quarters) and what she likes to do (climb trees). Then he gently rubbed a bit of Novocaine gel on her cut and said he’d be back.

I hovered nervously around Julia, checking and rechecking the cut and generally exuding anxiety, while my husband sat quietly, telling me to calm down. Sure, that’ll work.

Five times over the next 40 minutes or so, Krauss came in and re-applied the anesthetic, gently squeezing the site with his thumb and forefinger. Why, I wasn’t sure. Was it a dosing thing? Was he just numbing the wound even more before the scary stitching began? With each visit, he engaged Julia to learn something new about her. For instance, she loves to draw.

And, she loves snacks. On my way back from the cafe with treats, Krauss stopped me in the hall and said something like, “I’m going to stitch her up; it really won’t be bad.” I rolled my eyes. But, he added, “I need you to work with me. I’m going to give you a task.” Fine, I said, though the whole thing sounded a little gimmicky.

Krauss returned with an oversized 101 Dalmations coloring book and a handful of Magic Markers. He opened to a page overflowing with dog outlines. “Julia,” he said. “I want you to color each dog’s ear a different color, OK? Which color do you want to start with?”

“Purple,” she said, grabbing the marker. Focused, driven and completely oblivious to the large needle now going into her head, Julia colored in dog ears for the next 30 minutes. (This is a kid who, when awaiting her first flu shot, sprinted down a hallway until cornered by three nurses.) Every once in a while, Julia checked with Krauss to see if he approved of the colors. Great, he said. “Now, their paws. Each a different color.”

My job was to hold the coloring book up straight.

My husband took video. (That was his stress-reducing task, I suspect.)

As Julia drew, Krauss stitched, about five or six tiny loops in her head. He continued to chat with Julia about the picture and her color scheme; then he’d return to stitching. Soon, it was over. Julia finished her picture and signed it: “To Baruch, Love Julia.”

As we left the hospital, hand in hand into the night, my daughter looked up at me and grinned. “Well, Mama, at least I didn’t have to get stitches.” I looked back at Julia, with her bandaged head and big eyes: “But honey, you did get stitches.” “Really?” she twirled. “Well it was fun.” And she jumped into the car.

The entire experience was so profoundly different from any other medical encounter I’ve ever had as a mother. I understand that in an emergency, the priority is to fix the damage as fast and efficiently as possible. But Krauss offered such a higher level of care that I wanted to know more.

So I Googled him, and my mouth dropped as I read his profile: “Baruch Krauss’ research focuses on pharmacological and non-pharmacological techniques for relieving acute anxiety and pain in children undergoing diagnostic and therapeutic procedures in the emergency department… (my bold).

We’d won the ER lottery with this guy. It was like going in for your regular, ho-hum therapy session and finding Freud. This doctor chose my priority as his priority: to spare my child from pain.

But the story isn’t over. Continue reading

Pain Foundation’s Drug Money Was A Shame, But So Is Group’s Demise

Health columnist Judy Foreman

Note: This post was updated at 11:20 a.m. 5/10/2012. The original version was based on dated material. CommonHealth regrets the error.

ProPublica reports that The American Pain Foundation has shut down just as two U.S. senators are launching a probe into the heavy financial support it received from painkiller-makers. Syndicated columnist Judy Foreman, author of the upcoming book “A Nation in Pain: Healing Our Biggest Health Problem,” considers the news and its background.

By Judy Foreman
Guest Blogger

Okay, everybody, deep breath.

The US Senate on Tuesday launched what ProPublica, a generally terrific online investigative news organization, says is a probe into the makers of “narcotic painkillers” and the manufacturers’ ties to groups that advocate sane, responsible use of them. (By the way, “narcotic” is a loaded word; scientists prefer the less stigmatizing “opioid.”)

Let’s hope the Senate runs a genuinely open, fair investigation and that, in the laudable effort to examine the relationship between Big Pharma and advocacy and research groups, it doesn’t abandon pain patients who need the drugs and use them responsibly.

Out of the massive budget for the NIH, only 1.3 percent goes for pain research, even though pain is the main reason people go to doctors.

In the meantime, three thoughts. First off, what counts as an “epidemic?”

In a letter reportedly sent to drug makers by Chuck Grassley, an Iowa Republican, and Max Baucus, a Democrat from Montana, the Senate probe is necessary because of an “epidemic” of accidental deaths and addiction due to opioid pain relievers. Continue reading

Judy Foreman: Blue Cross Painkiller Policy Risks Hurting Patients

Health columnist Judy Foreman

The state’s largest insurer has just unveiled a plan aimed at stemming abuse of painkillers, a major national problem. The Boston Globe writes about the new policy here, and today’s Radio Boston show focused on it as well, featuring Dr. Lynda Young, Mass. Medical Society president, and Dr. John Fallon, chief physician executive at Blue Cross Blue Shield.

Syndicated columnist Judy Foreman, author of an upcoming book about chronic pain — “A Nation in Pain: Healing Our Biggest Health Problem” – comments:

By Judy Foreman
Guest Blogger

It is wonderful that Blue Cross Blue Shield of Massachusetts is concerned about pain reliever abuse and that the company has consulted with some physicians about ways to curb it.

But it is extremely likely that the policy the company is set to put in place July 1, which allows patients to fill a 15– day prescription and one additional 15-day supply, will end up doing more harm than good, becoming yet another barrier for legitimate pain patients who need opioid medications.

There’s no question that a few physicians prescribe too many opioids and a few patients scam their doctors for more. But the far larger problem is under-treatment of the pain of 100 million Americans, some of whom appropriately need opioid medications.

Blue Cross’ new policy, while it may stem from legitimate, benign motivation, could end up making the lives of pain patients more difficult than they already are. Blue Cross is concerned about “doctor-shopping,” that is, patients going from doctor to doctor to get drugs in order to abuse them. But the truth is that many legitimate pain patients go from doctor to doctor not to abuse drugs but to find someone who understands and can treat their pain. Continue reading

Filling In The Gaps On Pain Prescriptions

Health columnist Judy Foreman

By Judy Foreman
Guest Blogger

Today’s New York times carries a front page article fanning the hysteria – once again – about prescription painkillers.

A prominent number quoted in the article – that, according to the federal Centers for Disease Control and Prevention, 14,800 people died in 2008 in episodes involving these painkillers – is correct. And that’s 14,800 too many. No doubt about it.

But look at what the article failed to say: That, again according to the CDC, half of all those deaths involving prescription painkillers also involved at least one other drug, including benzodiazepines, cocaine and heroin. And that “alcohol is also involved in many overdose deaths.” To blame it all on prescription painkillers – and pain patients and their doctors – is simply not the full truth.

 

The New York Times story also failed to note that, in contrast to the 14,800 people whose deaths involved prescription painkillers, 443,000 American adults die every year from cigarette smoking. And more than 80,000 die every year from excessive alcohol use. Non-prescription painkillers such as NSAIDS (non-steroidal anti-inflammatory drugs like ibuprofen) aren’t exactly benign, either – they kill an estimated 7,000 to 10,000 American adults a year. Continue reading

Senate Hearing On Sweeping Problem Of ‘Pain In America’

As I type this, the United States Senate is holding a major hearing on the huge problem of chronic pain in America. You can watch the simulcast here.

Syndicated columnist Judy Foreman, currently working on a book on pain, writes:

At long, long last, the US Senate is paying attention to chronic pain. At a hearing today, they are listening to a handful of pain experts – and patients – who are filling their ears, and hopefully, their hearts, with details about the enormous, unsolved problem of chronic pain in America. What they may not hear – but should – is how woefully uneducated physicians are about chronic pain. There’s a good, and obviously sad, reason why physicians know so little about pain: Medical schools don’t teach it. A major study of 117 medical schools from Johns Hopkins last year showed that out of all those years in medical school, med students get a median of only 9 hours of pain education. Even veterinary students get more. It’s high time Senators, Congressmen, medical school deans and other powers-that-be took this to heart.

Columnist Judy Foreman On Rampant Under-Treatment Of Pain

Health columnist Judy Foreman

Judy Foreman, perhaps the best-known health reporter in Boston and a nationally syndicated columnist, is now in pain. That is, she is writing a book about chronic pain — titled “A Nation in Pain: Healing Our Biggest Health Problem” –and is deeply immersed in the subject. She has kindly agreed to drop us an occasional post about the world of pain, and here is her first:

There’s a dynamite piece in the Jan. 19 New England Journal of Medicine that I would urge anybody in chronic, severe pain to read.

It’s written by Dr. Philip Pizzo and Noreen Clark, who chaired the committee of pain specialists who wrote an important report last June for the Institute of Medicine, an arm of the National Academy of Sciences. Pizzo is dean of the Stanford University School of Medicine and Clark is director of the Center for Managing Chronic Disease at the University of Michigan.

 

Medical schools barely teach about pain, even though pain is the main reason people go to doctors.

 


In their New England Journal piece, and in the lengthy Institute of Medicine report itself, Pizzo and Clark argue eloquently that under-treatment of chronic pain is rampant in this country, that we have a “moral imperative” to do better and that many patients in severe pain understandably see their doctors as “poor listeners.” (I can vouch for this personally: The first doctor I saw during an 8-month bout of severe neck pain a few years ago suggested my pain was an emotional problem.)

As Pizzo and Clark say, “the magnitude of pain in the United States is astounding.” Continue reading

Study: Persistent Yeast Infections Can Trigger Chronic Vaginal Pain

The mouse vagina: in red are nerve fibers in a state of hypersensitivity after exposure to several yeast infections.

Melissa Farmer, a pain researcher at McGill University, reports in a new paper that persistent yeast infections in mice can lead to chronic vaginal pain, in fact, the same type of pain that human females experience when suffering from a condition known as vulvodynia, chronic pain of the vulva.

Up to 14 million women in the U.S. have vulvodynia at some point in their lives, according to The National Institutes of Health. Characterized by a burning, cutting or raw sensation in response to light touch or intercourse, the condition often goes undiagnosed.

Farmer simulated a vulvodynia-like state in mice by exposing them to a series of three yeast infections.  (Specifically, she put the mice to sleep and then pipetted 20 microliters of yeast in saline solution into their vaginal cavities to induce a severe infection. Continue reading