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The new CDC guidelines on pain and opioid use have been released, and these guidelines have left many patients wondering what these rules and recommendations mean for patients who have cancer, those who are dying, and individuals who deal with chronic pain. Millions of Americans struggle with opioid use disorder and the number of overdose deaths has continued to rise when opioids are abused. Studies have shown that using this class of drugs for chronic pain may be ineffective. Even worse, some studies show that when chronic long term pain is treated with these narcotic drugs this treatment may actually make the pain worse, leading to a vicious cycle where the patient never gets better in spite of being on the pain medications.
It is estimated that around 70% of people who have pain and opioid use is prescribed for have chronic pain, and the CDC guidelines list the various alternative treatments that should be tried before a doctor prescribed this class of medication. There are non narcotic medications which may provide relief, and exercise, physical therapy, and other non drug treatments may also be effective at helping to relieve chronic pain. The CDC is not calling for cancer patients or end of life patients to be refused proper pain management though. According to the report “these medications have a legitimate and important role in the treatment of severe acute pain and some severe chronic pain conditions but they are also overprescribed or prescribed without adequate safeguards and monitoring. According to the CDC opioids for patients who have non cancer pain should never be the first line of treatment or the only treatment used.
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A National Institute on Drug Abuse funded research study shows that when states implement prescription drug monitoring programs the rate of opioid overdose deaths is reduced. The research study has been published in the Health Affairs journal, and it also found that when these programs monitored more drugs which had abuse potential and made more frequent database updates the rate of deaths from opioid overdoses were even lower than the reduction seen when the programs did not have these characteristics. Monroe Carell Jr. Children’s Hospital at Vanderbilt, Division of Neonatology, assistant professor of Pediatrics and Health Policy, and lead author of the study Stephen Patrick, M.D., MPH, M.S., explained that “Today, opioid overdose deaths are more common than deaths from car crashes. Our study provides support that prescription drug monitoring programs are part of what needs to be a comprehensive approach to the prescription opioid epidemic.”
The senior study author of the research study on the effect that prescription drug monitoring programs have on opioid overdose deaths was professor and chair of the Department of Health Policy at Vanderbilt Melinda Buntin, Ph.D. According to Buntin “This work is important not only because it demonstrates that prescription drug monitoring programs can save lives, but also because it shows that there are specific actions that states can take to strengthen their programs.” The opioid abuse epidemic in the USA and Canada is a growing problem. If these programs can reduce the number of people who die from abusing these drugs then they should be implemented everywhere.
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Noninvasive electrical brain stimulation is an effective treatment for symptom reduction for a number of mental health and physical disorders according to emerging research, but neuroscientists are warning that this is not a DIY treatment that anyone should attempt at home. Close to 40 scientists signed an open letter that the Annals of Neurology published which warns against trying to self administer this type of treatment outside of a medical setting. Deep Brain Stimulation Program associate director and Harvard Medical School neurology professor Michael D. Fox, M.D., Ph.D., explains “There is much about noninvasive brain stimulation that remains unknown. Some risks, such as burns to the skin, are well recognized. However, other potential problems may not be immediately apparent. As neuroscientists we perceive an ethical obligation to draw the attention of both professionals and DIY users to some of these issues.”
University of Pennsylvania Laboratory for Cognition and Neural Stimulation postdoctoral research fellow Rachel Wurzman, Ph.D., first author for the study, also weighed in on noninvasive electrical brain stimulation as a DIY treatment. “Published results of these studies might lead DIY users to believe that they can achieve the same results if they mimic the research studies. However, there are many reasons why this simply isn’t true Outcomes of tDCS can be unpredictable, and we know that in some cases tDCS use can actually make brain function worse.” The open letter authors also wrote that “We know that stimulation from a few sessions can be quite lasting, but we do not yet know whether such changes are reversible, and the possible risks of a larger cumulative dose over several years or a lifetime have not been studied.”
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A recent study on sleep disorders, military veterans, and PTSD shows that these disorders have increased considerably in the last decade. The study involved over 9.7 million United States military veterans and the results showed that in 2010 vets had a risk of developing sleep disorders which was more than 6 times what the rate was in 2000. Because patients with PTSD, or those who had combat experience or another mental disorder, had the greatest rate increase the connection between these conditions is hard to ignore. During the study period the PTSD prevalence among vets also tripled. Study participants with chronic diseases such as cancer, cardiovascular disease, and others also had higher rates of sleep disorders as well.
University of South Carolina Arnold School of Public Health Department of Epidemiology and Biostatistics associate professor, senior study author, and principal investigator James Burch, Ph.D., discussed the study on sleep disorders, military veterans, and PTSD. Burch explained that “Veterans with PTSD had a very high sleep disorder prevalence of 16 percent, the highest among the various health conditions or other population characteristics that we examined. Because of the way this study was designed, this does not prove that PTSD caused the increase in sleep disorder diagnoses. However, we recently completed a follow-up study, soon to be submitted for publication, that examined this issue in detail. In that study, a pre-existing history of PTSD was associated with an increased odds of sleep disorder onset.” The study results must be viewed with the fact that 93% of the study participants were men while only 7% were women.
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A research study conducted in partnership by the VA Ann Arbor Healthcare System and the University of Michigan Health System has shown that veterans who suffer from both PTSD and substance use disorder have an increased risk of death. This is the very first study which examines associations and links between substance use disorder and death for vets who have PTSD, and the study included data on the youngest veterans who have come back from the Iraq and Afghanistan conflicts. According to VA Ann Arbor post-doctoral fellow, University of Michigan research fellow, and lead author of the study Kipling Bohnert, Ph.D., the study provides some important clues about the best methods of treating veterans for positive outcomes.
Bohnert the study underlines the importance of treating veterans for both PTSD and substance use disorder, explaining “Attention needs to be paid to veteran patients with PTSD, with an emphasis on identifying those who might also have a problem with drug or alcohol use. This study highlights the potential importance of effective treatment for both conditions in helping veterans after they’ve returned from conflict.” More research is necessary to determine why younger vets seem to exhibit stronger associations between the risk of death and substance use disorders. Director of the National Serious Mental Illness Treatment Research & Evaluation Center at the VA Federic C. Blow, Ph.D., who is also the senior author of the study paper which was published, stated “In theory, a treatment program that addresses both issues — substance use and PTSD — should reduce the risk of death from all causes, and this may be especially true for the nation’s youngest veterans.”
