Doctors, Meds & Supplements, Society, Treatment

Opioids Under-Prescribed Due to Addiction Fears?

Fear of Addiction Means Chronic Pain Goes Untreated, according to an NPR story that aired last weekend. While there’s definitely some truth to the headline, it obscures the nuances of physicians’ reluctance to prescribe opioids (a.k.a narcotics) for chronic pain in general and headache disorders specifically (particularly migraine).

Opioids were originally prescribed for short-term pain, like from surgery or an injury, or for use in end-of-life care. Chronic pain is a serious medical issue that is both under-treated and has limited treatment options, so it’s understandable that opioid painkillers filled that void, especially because opioids are the only source of relief for many people with chronic pain. Unfortunately, they began to be prescribed for long-term use before there were a lot of studies on their long-term effects. Now that research is catching up, this use is being questioned.

Beyond addiction, other potential problems for using opioids for chronic pain include opioid-induced hyperalgesia, tolerance and the systemic effects of long-term use. Opioid-induced hyperalgesia, when opioid use increases a person’s sensitivity to pain, is one concern. Tolerance — which requires taking increasingly higher doses of the medication for it to still be effective — is another. The repercussions of regular (and often increasingly higher) doses of opioids could have on the body’s systems should also be considered.

Headache disorders have additional issues. Rebound headache (medication overuse headache) is the most widely addressed concern. In addition, the American Migraine Prevalence and Prevention study found that using opioids more than eight times a month can cause episodic migraine to transform into chronic. (Diana Lee recently reported that there may be a difference between short-acting opioids and long-acting ones and that long-acting opioids may be OK for long-term pain management for people with chronic migraine.) Headache specialists also believe opioids impair the efficacy of preventive medications.

On top of all that, opioids aren’t even particularly effective for any type of head pain. In the video I shared last week, headache specialist Mark Green explained why:

“Part of the reason for that is there are fundamental differences in the chemistry of head pain compared to visceral pain. In the receptors subserving head pain, we really don’t have a lot of opioid receptors, so the upside for the use of opioids is rather low. That’s why we use, for example triptans and ergots. Those serotonin receptors are very well represented on those receptors that subserve headache.”

What do I get from all this?

  • Boiling down concerns about opioid use to a fear of patients becoming addicted is an oversimplification.
  • There are a lot of unknowns about opioid use for chronic pain. As more research is published, the less they seem like a good long-term solution.
  • Head pain is different than bodily pain and migraine may different still.
  • Chronic migraine isn’t a chronic pain disorder, nor are chronic cluster headaches. I don’t know where tension-type headache falls on the continuum, but I’m inclined to believe it’s more on the side of other types of headache disorders.
  • Using opioids can significantly alter treatment for an underlying headache disorder.
  • Mostly, I’m left with a lot of questions (and so are researchers and physicians).

I’m not anti-opioid, but want anyone who takes them for headache disorders to know the facts and to be very, very careful. Ideally, your headache specialist would be the prescriber, but fewer and fewer are willing to prescribe opioids (not out of fear of addiction or the DEA, but because of the ramifications for treating the condition you’re using opioids for in the first place). If your headache specialist won’t prescribe them, still be honest with them about how often you use them and at what dose — without that information, your specialist can’t treat your headache disorder properly.

Note: I’ve used words like “potentially” and “can” a lot in this post because not everyone’s the same. It’s important to be aware of the risks, but also to remember that not everyone will have all the same issues.

Society

Tell Social Security to Include Headache Disorders in Disability Benefits: Take Action TODAY!

speak up for Social Security Disability benefits for headache disordersApplying for Social Security Disability benefits is a complicated battle for people with headache disorders. The process can last years and rulings often go against the patient. One reason for this is that the Social Security Administration’s official criteria to qualify for benefits does not include headache disorders as potentially disabling.

The Social Security Administration is currently revising the criteria for neurological disorders. Despite urging from several members of Congress and the Alliance for Headache Disorders Advocacy, the administration has said they will not include any headache disorders in the revised criteria. Without this inclusion, people who are disabled by headache disorders will continue having to fight for years and through numerous appeals for benefits they may not ultimately receive.

You have until April 28, 2014 to help change this. Write the Social Security Administration TODAY on the neurological revisions comment page. Submitting your comment directly to the administration is the most effective action you can take, but you can also voice your support by signing this petition. And please ask anyone you know who cares about someone who is disabled by a headache disorder to submit a comment to the administration.

Want to learn more? Read Speak Out for Migraine & Social Security Disability Today by patient advocate and lawyer Diana Lee.

Note: Be sure to leave your comment on the Social Security Administration’s website, not as a comment on this The Daily Headache post. While I always appreciate your comments, only those submitted through official government channels will count.

Society

Migraine in Prison

I have an irrational fear of prison. It’s irrational because I’m not doing anything that could get me incarcerated; it persists because the idea of having chronic migraine while living in prison is my idea of hell.

That’s not an exaggeration. The lights, the sounds, the smells, the crowds… not having easy access to medication (and perhaps not having any access to an effective treatment)… none of the comforts that keep me sane… Having even a single migraine attack in that environment would be horrible, having chronic migraine there is exactly how I envision hell.

Every episode I watched of “Orange is the New Black,” I imagined what it would be like to have a migraine there. Eventually, I stepped outside myself and realized that there have to be many people in prison who have migraine. The thought of anyone enduring even one migraine in such harsh conditions brings tears to my eyes. The idea that someone could have chronic migraine there breaks my heart.

Read more in Prisoners With Migraine on Migraine.com.

News & Research, Society, Treatment

Is a Placebo as Effective as Maxalt?

When the general media got hold of the study results about the efficacy of a placebo versus that of the triptan Maxalt, the reporting — and comments — inevitably became about thinking one’s way out of a migraine. Readers, and even some reporters, pointed out that of course a placebo works for migraine, but it wouldn’t work for a legitimate illness, like cancer or heart disease. Wrong, wrong, wrong!

Starting from when we learn about it in grade school, the placebo effect gets oversimiplifed to: if you think a sugar pill is effective medicine, it will provide relief. The phenomenon is far more complicated than that. The placebo effect may have a positive-thinking element to it, but it also involves complex brain activity — in the physical brain, not the thinking mind — that’s only now starting to be understood. And it has shown to have an effect for all sorts of ailments, not just those that involve subjective reporting.

The placebo effect also involves information and patient empowerment, as Diana Lee explains in Placebo Effect & Migraine: What Does the Research Mean? It’s worth reading the entire insightful piece yourself, but here’s an excerpt:

Rather than demonstrating you can think your way out of experiencing the symptoms of a migraine attack, the results support the idea that how we talk about a treatment can increase the effectiveness of that treatment by 50 percent or more…. If we know a particular medication is likely to be effective for a migraine patient and couple that knowledge with a physician/patient discussion that empowers the patient with the same knowledge, this can only benefit patients.

Coping, News & Research, Society, Triggers

Olfactory Overload

Does anyone else hear about companies’ attempts to “enhance” our olfactory experience and think, “NOOOOOOO!”?

The latest of these endeavors to assault our senses is the oPhone (“o” for olfactory). A person can attach an smell to a message and the recipient “gets” to smell it. Both the sender and receiver have to have oPhones for this to work, so you won’t be forced to smell every text message.

Of course, if this technology takes off, it won’t matter if you don’t have an oPhone yourself. We will all be surrounded by people who are not only shouting into their cellphones, but polluting the air with even more artificial scents than already abound.

As someone who has scent-triggered migraines, news reports of odor-spreading technology fill me with an almost visceral dread. Living in the modern world with heightened senses is already hard enough. At least sounds can be muffled with ear plugs and lights can be managed with TheraSpecs. There’s no effective way to block odors.

Let’s hope that even people who aren’t sickened or panicked by sensory overload will have no interest in smelling a fake version of the croissant their friend just ate.