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A Win for Pain Docs & Chronic Pain Patients?

Following two years of tight controls that kept doctors from writing multiple prescriptions for morphine-based painkillers in one visit, the DEA has loosened up. They have proposed a formal rule to allow doctors to write three 30-day prescriptions, two of which are future-dated, during a single appointment for patients who need constant supplies of morphine-based painkillers.

A “formal rule” is government speak for a policy that it thinks people should obey, but isn’t legally binding. In this case, it gives doctors more freedom while leaving the door open for DEA prosecution.

It definitely looks like a nod toward progress. The question is whether it is merely symbolic — or, much worse, a diversionary tactic. Any opinions on whether this is step in the right direction or just a smokescreen?

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News, News, News

There is never enough time for me to post about all that I want to write about. And there’s been a ton of headache news lately. Here are some highlights.

Detailed Results of Trexima Studies (the drug isn’t named in the study, but it looks like Trexima to me)

  • Neck pain and discomfort decreased significantly at two hours for the compound versus placebo in study 1 (35 and 44 percent) and study 2 (28 and 54 percent).
  • Sinus pain and pressure decreased significantly at two hours for the compound versus placebo in study 1 (19 and 33 percent) and study 2 (23 and 38 percent).(1)
  • More patients were pain free at two hours in both studies (52 and 51 percent) compared to placebo (17 and 15 percent) and sustained pain-free response was maintained for significantly more patients (45 and 40 percent), without the use of a rescue medication, to 24 hours, compared to placebo (12 and 14 percent).
  • The compound was effective in rapidly eliminating migraine pain, as measured by pain-free rates at 30 minutes, one hour, two hours and four hours.
  • Incidence of migraine associated symptoms (nausea, phonophobia (sensitivity to sound) and photophobia (sensitivity to light)) was lower with the compound than with placebo.
  • The compound was generally well-tolerated. In both studies, only nausea (3 and 4 percent) and dizziness (1 and 2 percent) were reported in at least 2 percent of patients who took the compound versus placebo (1 and 2 percent for nausea, 0 and < 1 percent for dizziness).

Confusion Over Safety Of NSAIDs For Pain Relief Leads Patients To Suffer In Silence
Almost two thirds of people surveyed (64%) said they were confused about what to take for pain relief because of conflicting information on drug safety that has emerged following the withdrawal of Vioxx (rofecoxib), a COX-2 selective non-steroidal anti-inflammatory drug (NSAID) . Around 4 out of 5 (78%) said they didn’t know enough about the risks and benefits of medicines, whether prescribed or bought over-the-counter. Almost half (47%) said they weren’t using any painkiller medication at all for a number of reasons. Some were concerned about side effects, often after reading worrying news stories about painkillers, some had been advised to stop medication by their PCP and some thought they could manage without them.

Triple Therapy Synergy for Frequent Severe Migraine (registration may be required to read this)
The combination of behavioral migraine management, preventive medication, and optimal acute therapy appears to provide a superior reduction in migraine activity measures, functioning, and quality of life compared with any one alone, according to a study presented at the American Headache Society meeting here.

For these patients, “effective migraine management may require three components: a tailored acute therapy, preventive medication and behavioral migraine management to get the optimal results,” said Kenneth Holroyd, Ph.D., a professor of health psychology at Ohio University in Athens, Ohio, in an oral presentation.

Overweight Kids More Likely to Get Headaches
Children with headaches are 36 percent more likely to be overweight, results of the new research suggest.

“The numbers tell us that being overweight may contribute to kids having more headaches, most often migraines,” said Andrew D. Hershey, M.D., Ph.D., director of the Headache Center and a pediatric neurologist at Cincinnati Children’s Hospital Medical Center. “There likely are a number of causes, including poorer general health, body stress, lack of exercise and nutrition. It may not be that being overweight directly causes migraine, but that the reasons for being overweight cause these children to have worsening headaches.”

Magnetic Device Short-Circuits Migraine Headaches, Suggests Early Research
A hairdryer-sized magnetic device held briefly to the back of the head may short-circuit migraines before the pain starts, suggests preliminary research being presented at the 48th Annual Scientific Meeting of the American Headache Society (AHS).

People With Near-Daily Migraine Headaches Get Relief From Anti-Seizure Drug
An anti-seizure medication “quiets the brain,” providing relief to people with near-daily migraine headaches, suggest results of a randomized, multi-center study being presented at the 48th Annual Scientific Meeting of the American Headache Society (AHS).

FDA OKs the Pain Drug Opana
The drug, called Opana, is an opioid pain reliever taken by mouth. It will come in an extended-release form, called Opana ER, and an immediate-release version, simply called Opana.

The drugs contain oxymorphone hydrochloride, which was previously only available by injection. Endo Pharmaceuticals plans to relaunch the drug’s injected version for hospital use under the new trade name.

If you know of an article that I missed, please add it to the comments. Thanks!

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Why We Have to Fight Docs for Painkillers

Graham, a med student and blogger at Over My Med Body, writes about an encounter with a patient in the ER:

“‘I usually get Dilaudid and Phenergan’ [said the patient]. These are the words that start to change my diagnosis from ‘kidney stone’ to ‘drug-seeking.'”

Check out the whole story in Graham’s post, entitled “I Usually Get Dilaudid and Phenergan.”

[via Kevin, MD]

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Helping Docs Understand DEA’s Assault on Pain Meds

Is the DEA targeting docs who prescribe pain meds to make up for the agency’s past failures? Critics of the agency’s recent crackdown think so, according to a May 19 article in Medical Economics.

“‘If the battles you’re fighting are being lost, then, to win the war, find battles that you can win,’ says David Brushwood, a professor of pharmacy health care administration at the University of Florida, Gainesville, and a critic of government narcotics policy. ‘Doctors are more conspicuous and easier to find than drug dealers, and, besides, they don’t have guns and they don’t shoot back.'”

The six-page article is written for health care professionals, but it is a concise explanation of the problems that doctors face in prescribing pain meds. The recommendations it gives docs to follow when prescribing pain meds can be helpful for patients to understand how to help the doctor function within the system, thus potentially lessening the struggle to get adequate pain relief.

Pain and the Law, a website dedicated to helping health care professionals understand how to work within the law, is linked to from the Medical Economics article and is worth perusing. The site recommends these pain links for patients.

This previous blog post describes a detailed educational document on the DEA’s stance on pain meds.

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“Potheads and Sudafed,” a New York Times Editorial

“Potheads and Sudafed,” a NY Times editorial that ran yesterday, caught the attention (and raised the ire) of About.com’s headache page guide, Teri Robert. The article addresses issues raised by the FDA’s denial of medicinal marjiuana’s efficacy. Columnist John Tierney writes of the conundrum:

Officially, the D.E.A. says it wants patients to get the best medicine. But look at what it’s done to scientists trying to study medical marijuana. They’ve gotten approval for their experiments from the F.D.A., but they can’t get the high-quality marijuana they need because the D.E.A. won’t allow it to be grown. The F.D.A. actually wants to know if the drug works, but the D.E.A. is following the just-say-know-nothing strategy: as long as researchers can’t study marijuana, they can’t come up with evidence that it’s effective.

And as long as there’s no conclusive evidence that medical marijuana works, the D.E.A. and its allies on Capitol Hill can go on blindly fighting it. Representative Mark Souder, the Indiana Republican who’s the most rabid drug warrior in Congress, has been pressuring the F.D.A. to crack down on medical marijuana. Last week the agency finally relented: in return for not having to start busting anyone, it issued a statement stressing the potential dangers and lack of extensive clinical trials establishing medical marijuana’s effectiveness.

For more information about the DEA’s stance, see this post.

FYI: The article is only available on the Times site if you have a paid subscription, but you can probably use your public library card to read it in a full-text newspaper database online. (The database I used is called ProQuest and I accessed it trhough the magazine and newspaper section of the library’s databases. These specific details are only applicable through my library, of course, but I hope they help you navigate your library’s website.)