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All Posts in Category: Lifestyle

Walmart tightens its opioid prescription policies

Walmart is making its opioid policy more strict, limiting the duration of such prescriptions and requiring that they be filled electronically.

The company announced on Monday that within 60 days, it will only fill first-time acute opioid prescriptions for seven days or less nationwide, and it will limit the dosage to 50 morphine milligram equivalents, or MMEs, per day. The CDC publishes MME conversion guides to help pharmacists figure out the right dosage for each type of prescribed opioid.

 There are more than 5,300 Walmart (WMT) and Sam’s Club locations in the United States.
The new restrictions follow recommendations from the Centers for Disease Control and Prevention. A CDC study found that people who were prescribed at least one day of opioid therapy had a 6% chance of being addicted a year later — but for those prescribed eight or more days of treatment saw that chance spiked to 13.5%. The CDC also notes that patients who are prescribed higher dosages are more likely to die from an overdose.
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Chronic Pain and Intimacy

Eight Ways to Improve Your Sex Life with Chronic Pain

If you suffer from chronic pain, you may feel that intimacy with your partner isn’t possible or sometimes even desirable. Chronic pain can affect mobility. And fatigue and depression make it hard to get in the mood. Often it’s easier to simply mourn the loss of this part of your relationship. But don’t do that just yet.

You’re not alone:
Sexual desire and functioning are difficult for many people with pain. More than half of the respondents in one study said that pain placed limitations on their sex lives. They reported pain and fatigue as having the biggest effects. According to experts, both men and women with pain commonly experience a downturn in their sex lives.

Roadblocks to desire:
Emotions related to pain and sex are complex. You may feel fear or anxiety for a number of reasons. Pain or reactions to medication may make you question your ability to become aroused, perform sexually, or have an orgasm. Limited mobility or painful joints can prompt feelings of unattractiveness or discomfort about your body. Perhaps a previous attempt to have sex with your partner didn’t go smoothly, and you’re afraid it will happen again. Or you may be dealing with a combination of these obstacles.

Ways to help:
The good news is that you can have a fulfilling sex life with chronic pain. It requires a bit of planning and maybe some new foreplay and positions, but pleasure is possible. You may even experience a break from your discomfort and pain: orgasms release chemicals called endorphins that are natural pain and stress fighters.

To bring more intimacy into your relationship, consider trying a few of the following:

     Take a warm bath:A soothing soak can relieve pain. If you’d like, ask your partner to join you. Sex needn’t follow. Just relaxing together can be a sensual first step to reintroducing intimacy into your relationship.
     Plan for “least-pain” times:Your pain may feel worse at certain times of day. Sex in the morning or afternoon may be better than at nighttime. Set your alarm clock a little earlier, or plan a quiet weekend afternoon with your partner. Also, get to know when your pain medication kicks in. By becoming more aware of when you have the most pain relief, you can time intimacy to when you’re feeling your best.
     Play with positions:Some sexual positions may be more comfortable for people with arthritis. And don’t forget foreplay. Massage, oral sex, and other alternatives to intercourse can help take attention or pressure off of parts of the body that are painful to move or touch.
     Rule out depression:If you feel as if your sex drive has dropped, talk with your healthcare provider about whether you might have depression. Lack of desire can be a symptom.
     Fight fatigue:Keep your energy level up by getting eight hours of sleep, building good nutrition into your diet, and practicing stress-reduction techniques like yoga or meditation.
     Get moving: Regular workouts will help to keep joints more mobile and boost your energy, mood, and positive feelings about your body. Gentle exercises before sex also can improve range of motion.
     Monitor medications: The medications that you take to control pain or other symptoms may affect sexual function. For example, some antidepressants can decrease your ability to experience orgasm. Consult your healthcare provider or pharmacist about possible side-effects.
     Go slowly: Give yourself permission to nurture intimacy at a comfortable speed. Kissing, cuddling, and other gestures of affection will convey love and let your partner know that you value being close.

Source: https://www.painaction.com/eight-ways-improve-sex-life-arthritis-pain/

In addition, the utilization of opioid medications significantly reduce testosterone levels in both men and women which can have a huge impact on sexual desire and performance. Reduced testosterone levels are also associated with decreased muscle mass, increased fat deposition, reduced bone density, and increased pain levels. Eliminating opioids from your medication regimen will help restore more normal sexual desire and function and can actually reduce current pain levels says Dr. Benjamin Lowry.

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Opioid commission unveils new partnerships, drug supply limits to stop epidemic

New Jersey Governor Chris Christie held the third formal meeting of President Trump’s ongoing Commission on Combatting Drug Addiction and Opioid Crisis, where officials in the pharmaceutical industry and government detailed new partnerships and efforts in the hopes of limiting the use of opioid prescriptions for combatting pain and recommending new treatments for pain management without the use of addictive substances.

National Institutes of Health Director Dr. Francis Collins advised the commission that the agency is looking to build partnerships with researchers across academia, government, prescribers and patients to “cut in half the time needed to make available prescriptions that are non-addictive.”

He said areas like developing “potent but non-addictive drugs” for pain relief and offering new avenues for treatment would become a top priority for the partnership.

Source: CBS News
Read More: https://www.cbsnews.com/news/opioid-commission-unveils-new-partnerships-drug-supply-limits-to-stop-epidemic/

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Smoking and its Effect on Pain

Smoking and its Effect on Pain

Kristian Delgado, M.D.

The question of how smoking affects pain is complicated and multifactorial. It is true that patients who smoke are more likely to develop low back or other types of chronic pain. Additionally, those that smoke are more likely to report higher pain levels, they are also more likely to use higher levels of analgesic or pain medicines, and their pain is likely to have a greater impact on their daily life. Several studies have shown links between moderate to heavy smoking (one or more packs per day) and disability related to pain. Several Finnish studies found teenage smoking was a significant risk factor for developing pain, this trend was also dose responsive. People that smoked more were more likely to develop pain than those who smoked less.

There are several epidemiological studies that show trends within the population. We now know that those who smoke are at risk of developing painful conditions. Smoking is a risk factor for osteoporosis, lumbar disc disease and poor bone healing. We also know that smoking impairs wound healing, thus those that smoke take longer to heal following injury and may have associated chronic pain. In addition to increasing the risk for painful conditions, people who smoke were found to have a greater intensity of pain as well as more areas of pain within their body, in comparison to non-smokers. Smokers are more likely to report functional and life impairment related to their pain and appear to have worse outcomes in terms of disability related to their pain.

Some people report that smoking a cigarette can decrease their immediate pain. In fact, it has been shown that the nicotine found in cigarettes has been shown to temporarily decrease pain. Several studies have shown that giving patients nicotine before surgery led to decreased pain and decreased use of opioids in their post-operative period. These studies were based on non-smokers only. The effect was not seen in those who were already using cigarettes on a regular basis. Those who smoke regularly may have a reduced sensitivity to the effect of nicotine on pain. Smoking long term is problematic for controlling pain due to the development of tolerance. The nicotine levels in the body are only steady for about one hour, meaning someone would need to keep smoking continuously to help with pain. Over time this would have less and less effect even if they continued to smoke hourly. Lastly those withdrawing may experience depressed mood, anxiety, stomach upset and irritability.

Smoking has also been shown to be an independent risk factor for opioid use. In smoking patients being treated for pain, opioids were more likely to be used. Additionally, those already on opioids were more likely to need higher doses of their medication to control their pain than non-smokers. What this amounts to is that while the nicotine found in cigarettes may provide some initial benefit for pain control in non-smokers, overall it will make pain much more difficult to treat.

There is evidence that smoking is not directly related to the perceived pain level. It is associated with increasing levels of depression. Depression is highly associated with chronic pain and vice versa, chronic pain is associated with higher levels of depression. Among those with depression, the rate of smoking is significantly higher than the rest of the population, as high as 45%. Like smoking, depression has been found to be associated with increased chronic pain conditions including low back and neck pain.

Smoking is associated both with developing pain and seems to have a greater impact on pain in those who develop chronic pain. We know that those who smoke are more likely to have some level of depression, and those with depression are more likely to have pain. Those using chronic pain medications are also more likely to need more medicine to treat their pain and are less likely to improve with treatment. We know from a physical standpoint smoking interferes with the body’s ability to heal itself, and lastly we know that smoking has been associated with higher use of narcotic or opioid prescriptions which have their own risks and complications.

A recent analysis looked at data from 2 universities with over 5000 patients who were being seen for spine related pain. Those patients who stopped smoking before beginning therapy for their pain or quit during the course of treatment had lower overall pain scores and greater functional improvement. Those who continued to smoke were unlikely to have improvement in pain or function and were more likely to have disability related to their pain.
Some people are able to quit just by making up their minds to do so. For most, this is difficult and they may need additional resources. The first conversation you may want to have is with your primary care physician. Having that partnership may provide you the support and resources you need to quit. Many people may feel that if they stop and start again, that they have failed, but it is important to remember that many people need more than one attempt at quitting. Your doctor may be able to provide you with a medication that could help. There are nicotine replacement strategies with gum and/or patches. There are also plans that help with cutting down and stopping in a gradual process. Online and phone resources for support are www.smokefree.gov/ or through the CDC website http://www.cdc.gov/TOBACCO/quit_smoking/how_to_quit/ or the American Lung Association website http://www.lung.org/stop-smoking/how-to-quit/

At Integrated Pain Associates, we successfully treat many types of chronic pain through a targeted, multi-disciplinary approach. We are conveniently located throughout Central Texas with locations in Killeen, Waco, and Temple. Contact us for more information or to schedule an appointment.

References:
Shi, Yu, Toby N. Weingarten, Carlos B. Mantilla, W. Michael Hooten, and David O. Warner. “Smoking and pain: pathophysiology and clinical implications.” Anesthesiology 113, no. 4 (2010): 977-992.
Hooten, W. Michael, Yu Shi, Halena M. Gazelka, and David O. Warner. “The effects of depression and smoking on pain severity and opioid use in patients with chronic pain.” Pain 152, no. 1 (2011): 223-229.
Behrend, Caleb, Mark Prasarn, Ellen Coyne, MaryBeth Horodyski, John Wright, and Glenn R. Rechtine. “Smoking cessation related to improved patient-reported pain scores following spinal care.” The Journal of Bone & Joint Surgery 94, no. 23 (2012): 2161-2166.

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National Pain Awareness Month

NATIONAL PAIN AWARENESS MONTH
Pain Awareness Month was created to increase awareness about the effect of pain and to educate citizens about the advanced treatment options available to help alleviate pain.

WHAT IS NATIONAL PAIN AWARENESS MONTH?
September is Pain Awareness Month.
This busy month is marked by a variety of different initiatives and activities all with the goal of promoting education, advocacy and awareness about chronic pain in order to break down the barriers to effective pain management.

PAIN IS MORE THAN A SYMPTOM
Undertreated chronic pain significantly impairs quality of life, and can be severely physically, psychologically, and socially debilitating.
• Pain affects more Americans than diabetes, heart disease and cancer combined.
• Workers lose an average of 4.6 hours per week of productive time due to a pain condition.
• An estimated 20 percent of American adults report that pain or discomfort disrupts their sleep a few nights a week or more.
• 80 percent of people in the United States will experience back pain at some point in their lives.
• Besides the common cold, back pain is the number one reason people visit their family doctors.

EDUCATION & AWARENESS
The adoption of pain as the “fifth vital sign” in 2001 has helped increase the legitimacy of pain as not just a symptom but a serious detriment to quality of life, requiring proper medical attention. It also helped further the notion that every person has a right to timely and effective pain management.
Pain does NOT mean pills — There are many interventional pain management options available.
A major aim of Pain Awareness Month is to foster partnerships among individuals and organizations, with a common goal of effecting positive change in the state of pain management. By promoting education, awareness and advocacy, the goal is to recognize and address these barriers to pain management.
In recognition of Pain Awareness Month, there are a variety of different ways that Integrated Pain Associates can promote pain education and awareness – among patients, other providers, and the general public.
Education and awareness are two prominent themes of Pain Awareness Month, and they both undeniably represent a key component of improving the state of pain management. Pain Awareness Month serves as a powerful means to convey the compelling message that millions of people continue to suffer from something that deserves proper management. It is an opportunity for those who suffer from an “invisible” illness to finally have their voices heard, and incite much-needed change.

Interventional Pain Management Techniques
The basis of interventional pain management is to block the production and/or transmission of pain signals to the brain through methods including nerve blocks, spinal steroid injections, radio-frequency ablations, spinal cord stimulation or injection of an anesthetic.
Goals of these interventional techniques include pain reduction, improving and maintaining mobility, and minimizing medication use. The administration strategies enable pain management specialists to selectively target injured and painful body regions while minimizing complications such as infection, bleeding, further injury, and sympathetic crisis.

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DEA’s National Drug Take-Back Day Set for Saturday, April 29

The Drug Enforcement Administration’s (DEA’s) National Prescription Drug Take-Back Day—set for this Saturday, April 29, 2017, from 10 a.m. to 2 p.m. local time—will once again see communities across the country joining with law enforcement to help remove unwanted and potentially dangerous medications from medicine cabinets across the United States.

People can call the DEA’s Registration Call Center at (800) 882-9539 or click here for collection sites in their area. The website will be continuously updated with new take-back locations.

Source: Pain Medicine News
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FDA nominee says nation’s opioid crisis is as serious as Ebola, Zika threats

Scott Gottlieb, the physician and entrepreneur who is President Trump’s nominee to head the Food and Drug Administration, told senators Wednesday that the nation’s opioid crisis is a “public health emergency on the order of Ebola and Zika” and requires dramatic action by the agency and the rest of government.

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