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News to Noodle

I’m tired of complaining, so here’s some news and information.

Children May Outgrow Migraines

A majority of adolescents with migraines either stop having headaches or develop less-severe ones as they reach adulthood, new research shows.

Of the 55 children studied, 40% had remission by their early 20s, while 20% shifted to less troubling tension-type headaches, according to the report, published in the Oct. 24 issue of Neurology.

Migraine Study Brings Men New Headaches

. . . [M]en who experience migraine attacks have a 24 percent increased risk of suffering from major cardiovascular problems and a 42 percent increased risk of suffering a heart attack.

Web Health Info Seekers Tend Not to Check Sources

Only one-fourth of Americans who search the Internet for health advice regularly check the source and date of the information they find to assess its quality. . . .

Just 15 percent of those surveyed said they always checked the source and date of the health information found online, while another 10 percent said they did so most of the time. Three-quarters of those surveyed said they checked the source and date sometimes, hardly ever or never, Pew said.

I’m appalled by these numbers. There’s too much bad information online to accept it at face value. I never use a source that I’m even slightly skeptical of.

[via Kevin, MD]

Oh, the pain of it all! Oh, the pain!

An ER doc’s take on distinguishing real pain patients from drug seekers:

I occasionally wish my job demanded something more than a valid DEA license, and decision-making skills beyond “yes narcs” and “no narcs.” It just drains the carpe right out of your diem to start the day off in a series of ugly little dogfights over drugs with people whom, to put it charitably, you have concerns about the validity of their reported pain.

Now please don’t jump to conclusions here. Pain sucks, and in the common event that I know to a reasonable certainty that someone is suffering, I am quite free with the narcotics. That’s a big part of my raison d’etre. The problem is that increasingly, it seems that the chronic pain complaints far outnumber the acute pain complaints, and treating chronic (or recurrent) pain in the ED is fraught with difficulty to say the least. You don’t know the patient, they come to the ED over and over for the same thing, they are demanding (both in terms of time expended and emotional energy), some are dishonest, there always seems to be some barrier to treatment which requires ED therapy (“Doctor out of town,” “Lost prescription,” “Only a shot works,” “Threw up my pills,” etc), and there is never objective evidence of physical disease.

[via Kevin, MD]

Sensitivity to Pain Explained

Stabbing back pain or the aches of arthritis send some people to bed in misery while the same distress seems easily tolerated by others. Why does pain hurt some people more than others? Scientists finally have an answer.

It involves a single molecule under control of a gene that acts like a dimmer switch. A “bright” or high setting excites sensory nerves to produce more of a chemical called BH4. For scientists, BH4 has one meaning, but for sufferers, it might as well mean “Big Hurt.” Lower settings block BH4, protecting people from the wrench and bite of chronic pain.

New Report Finds Pain Affects Millions of Americans

One in four U.S. adults say they suffered a day-long bout of pain in the past month, and one in 10 say the pain lasted a year or more, according to the government’s annual, comprehensive report of Americans’ health. . . .

6 Responses to News to Noodle

  1. katy says:

    I am so tired of hearing doctors bitch and moan about how rough they’ve got it with us unruly pain patients seeking “narcotics”. Ever notice that they all call these medications *narcotics* to begin with?

    I don’t use narcotics–heroin addicts use narcotics. I am on opioid therapy and yeah there’s a whole world of difference in the words–first impressions are often what matters most with these poor “drained” doctors, and I’m afraid that the gulf between a drug user shopping around for “narcotics” and a responsible patient taking opioid medications as prescribed is wide and vast!

    Characterizations like the ones he makes above, inocuous as they may seem, contribute to the stigma attached to opioid treatment for people with chronic intractable pain. I know tons of fellow migraineurs who wake up every day in excruciating pain and go to bed with the same pain who have tried everything out there and have had no relief, and their lives have gotten smaller and smaller as the pain has grown bigger and bigger, but they won’t try opioids because of attitudes like these. They think they’ll be seen as taking narcotics, or worse, *using* narcotics to “get through the day”. It’s downright irresponsible of doctors to perpetuate that kind of bullshit myth, even in their blogs.

    I hate that so many people won’t even consider opioid therapy because they’re afraid of stuff like this, and this is just a teeny tiny miniscule speck of the problem.

    *grumbles*

  2. Christina P says:

    Well, actually, opioids are, pharmacologically, also known as narcotic analgesics. The term has a medical meaning, as well as political, criminal, and vernacular meanings. So, maybe you should not feel as defensive about the word as you obviously do.

    Some physicians avoid using opioids because of undue regulatory pressure from state medical boards. This is unfortunate, but is a very real problem in some locations.

    In the treatment of headache, however, many of us use opioids very sparingly because of the issue of medication overuse headache. And in many cases, when the pain has grown “bigger and bigger”, it is because of the use of daily opioids. This is not a “bullshit myth”. While opioid analgesics may not be the cause of daily or chronic headache, it is well-documented that frequent use worsens the severity of established daily headache, and will increase the frequency of intermittent headache.

    It is unfortunate when physicians who do not understand headache or its treatment view headache sufferers as drug-seekers. I tend to view them as “pain-relief seekers”. But, there are many avenues to pursue in pain management, and opioids represent just one of those avenues.

  3. katy says:

    “Well, actually, opioids are, pharmacologically, also known as narcotic analgesics.”

    While I realize this (of course), there is a distinction for many people between the connotations. Technically, a migraine is a headache but a headache isn’t a migraine. Many migraineurs refuse to call their migraines “headaches”, in part because there is a certain connotation to the word headache–it’s perceived as minor–just take an aspirin and you’ll be fine. I have pain and it’s in my head, so yes it’s technically a headache, but it’s so much more than that. Some people even consider the t
    erm migraine inadequate to describe their condition–they insist on using the term “migraine disease”.

    The term narcotic is used routinely by law enforcement and it has a very negative connotation attached to it. I’ve never had a Dr tell me “we’re going to put you on narcotics”. Crystal meth is considered a “narcotic”, but it’s not an opioid, know what I mean?

    Perception matters. And I’m afraid that perception is tied very closely to semantics.

    “In the treatment of headache, however, many of us use opioids very sparingly because of the issue of medication overuse headache. And in many cases, when the pain has grown “bigger and bigger”, it is because of the use of daily opioids. This is not a “bullshit myth”. While opioid analgesics may not be the cause of daily or chronic headache, it is well-documented that frequent use worsens the severity of established daily headache, and will increase the frequency of intermittent headache.”

    Very true, but I’m not referring to the use of short-acting opioids that would, in most cases, produce a rebound situation. Calling it Opioid treatment implies long-acting formulations of the medications, at least I thought it did–if that wasn’t clear, I apologize. (please see: http://www.pulsus.com/Pain/08_SA/Sup8Ae.pdf)

    I don’t feel defensive about this personally–I feel frustrated that many friends and acquaintances whose lives are passing them by won’t even consider this treatment because of societal prejudice about “narcotics”, because of their own prejudices about “narcotics”, and because of misinformation they read and hear about it.

  4. Christina P says:

    I really don’t wish to get into an argument with you here, but I also don’t wish to leave misinformation on the site.

    It is not just short-acting opioids that predispose to medication-overuse headache. That is why we have abandoned the term “rebound headache” as it tends to be misleading. More recent work has found that in most cases, it is the frequency of medication use that leads to medication overuse headache; whether it be caffeine, triptans or opioids really doesn’t much matter.

    I am curious–what would you call a short-acting opiate narcotic analgesic if not an opioid?

    If you have made the personal choice to take daily opioids, that is your choice. I hope it helps you.

    However, please be advised that there are those of us in the medical profession that feel that opioids cause more harm than good on a neurological basis in the brains of most migraineurs, and that has nothing to do with addiction–it has to do with central sensitization of the brain, and worsening of headache over time. And we are entitled to our opinions and choices as well. Patient selection must be made very judiciously, and opioid therapy is generally considered a last resort by those of us in this school of thought, as it may cause irreversible changes in the nervous system. While you may choose to take that risk, please respect our wish not to be responsible for causing such.

    As for the term “migraine disease”, it is my personal opinion that it only serves to cast us in the light of victims, and, in the long run, does not serve us. While I do wish migraine to be taken seriously, it has been stigmatized long enough without being further characterized as a disorder of victims.

  5. katy says:

    “That is why we have abandoned the term “rebound headache” as it tends to be misleading. More recent work has found that in most cases, it is the frequency of medication use that leads to medication overuse headache; whether it be caffeine, triptans or opioids really doesn’t much matter.”

    I did a long trial of being off all analegesics to see if my headaches and migraines improved. Unfortunately they didn’t.

    “While you may choose to take that risk, please respect our wish not to be responsible for causing such.”

    I don’t believe I said anything about not respecting a Dr’s decision not to treat a migraineur with opioids because they believe it’s neurologically detrimental to the patient. I think patients should be COMPLETELY informed about their treatment options and treatment decisions before acting. I believe very much in personal responsibility. But nowhere in that blog entry about us pesky ER pain patients was there a concern about this, just to clarify.

    “Patient selection must be made very judiciously, and opioid therapy is generally considered a last resort by those of us in this school of thought,”

    I consider it a last resort as well.
    This was a last ditch effort to get some kind of quality of life back for me. I’d tried pretty much everything available and either had no success or was unable to tolerate the meds. When I had to make the choice between living my life laying in bed or on the couch, having no social life, being clinically depressed and unable to care for myself properly, unable to work in the forseeable future and in excruciating pain every single day, yeah I chose to try pain relief with the opioid therapy. Yes, fortunately it’s helped a great deal. Soon my Dr is going to add methadone which has been shown to work very very well in headache and migraine for many people and hopefully the pain relief will be even better. Maybe I’ll even be able to go back to work at least part time in the future.

    “I am curious–what would you call a short-acting opiate narcotic analgesic if not an opioid?”

    I would call it an opioid, I just wouldn’t refer to being on them as “opioid therapy” or “opioid treatment” but that’s because that’s been my own experience so far. If I’m wrong and it’s routinely called opioid therapy when someone takes tylenol 3 on a regular basis then I stand corrected.

    “As for the term “migraine disease”, it is my personal opinion that it only serves to cast us in the light of victims, and, in the long run, does not serve us.”

    I personally don’t care for it either.

    I guess we can safely say that semantics matter 😉

  6. Kerrie says:

    Wow, thanks for the great comments. You’ve both made me see sides of this issue that I’ve never considered.

    Thanks for being regular readers. I really appreciate hearing your opinions about blog posts — and I’m sure other readers do too.

    K

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