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When it comes to managing pain, whether it be acute or chronic, there is no one single quick fix. A holistic approach to pain management may be the key to helping you move better, sleep sounder, reduce discomfort and get your life back on track.
For those experiencing pain, the impact that is has on day to day living can be widespread; impacting on all facets of life including employment, caring for children, relationships, sleep, mental and physical health and general activities of daily living (ADL). “Pain” is an umbrella term used to describe a wide range of uncomfortable sensations felt in the body. No two people will experience the same pain, as each person’s perception of pain will be different. This is why a pain management plan that works for one person may not work for the next.
Finding your own successful pain management plan may take time, trial and error; however engaging with the right multidisciplinary team of health professionals can help you on your way.
It is important to understand the two types of pain:
Here’s a rundown of the most commonly used alternative treatments for chronic pain:
- Acupuncture. Once seen as bizarre, acupuncture is rapidly becoming a mainstream treatment for pain. Studies have found that it works for pain caused by many conditions, including fibromyalgia, osteoarthritis, back injuries, and sports injuries.
How does it work? No one’s quite sure. It could release pain-numbing chemicals in the body. Or it might block the pain signals coming from the nerves.
“I think there’s good scientific evidence for acupuncture and I prescribe it,” says F. Michael Ferrante, MD, director of the UCLA Pain Management Center in Los Angeles. “The nice thing is that even if it doesn’t work, it doesn’t do any harm.
- Marijuana. Setting aside the controversy, marijuana has been shown to have medicinal properties and can help with some types of chronic pain.
There’s strong evidence that marijuana has a modest effect on certain types of nerve pain — particularly pain caused by MS and HIV, says Steven P. Cohen, MD, associate professor in the division of pain medicine at Johns Hopkins School of Medicine in Baltimore. Since it also relieves nausea, marijuana can help people who are suffering side effects from chemotherapy.
However, marijuana does have risks. For some people, Cohen says, those risks can be serious, including addiction and psychosis. Because of the dangers and the obvious potential for abuse, experts generally only turn to marijuana when all other treatments have failed.
On a practical level, you also need to be aware of the laws regarding the use of medical marijuana in your state. Could you be arrested for smoking marijuana for medical reasons? Talk to your doctor. There are also two prescription drugs, called pharmaceutical cannabinoids, that are derived from the active ingredient of marijuana. They are sometimes used for pain, although they are only FDA-approved for nausea caused by chemotherapy and HIV-related weight loss.
- Exercise. Going for a walk isn’t a treatment, exactly. But regular physical activity has big benefits for people with many different painful conditions. Study after study has found that physical activity can help relieve chronic pain, as well as boost energy and mood.
If you have chronic pain, you should check in with a doctor before you start an exercise routine, especially if you have any health conditions. Your doctor might have some guidance on what to avoid, at least as you get started.
- Chiropractic manipulation. Although mainstream medicine has traditionally regarded spinal manipulation with suspicion, it’s becoming a more accepted treatment. “I think chiropractic treatment works reasonably well for lower back pain,” Oaklander tells WebMD. “Studies have shown that it’s comparable to other approaches.”
- Supplements and vitamins. There is evidence that certain dietary supplements and vitamins can help with certain types of pain. Fish oil is often used to reduce pain associated with swelling. Topical capsaicin, derived from chili peppers, may help with arthritis, diabetic nerve pain, and other conditions. There’s evidence that glucosamine can help relieve moderate to severe pain from osteoarthritis in the knee.
But when it comes to supplements, you have to be careful. They can have risks. Oaklander says that high doses of vitamin B6 can damage the nerves. Some studies suggest that supplements such as ginkgo biloba and ginseng can thin the blood and increase the risk of bleeding. This could lead to serious consequences for anyone getting surgery for chronic pain.
“Supplements can cause real harm,” says Ferrante. He points out that people with chronic pain can be at higher risk of side effects from supplements. Why? They’re more likely than the average person to be taking other medications or getting medical procedures or surgeries.
So treat supplements and vitamins warily, like you would treat any drug. Always check with a doctor before you start taking supplements, especially if you have any medical conditions or take other medication.
- Therapy. Some people with chronic pain balk at the idea of seeing a therapist — they think it implies that their pain isn’t real. But studies show that depression and chronic pain often go together. Chronic pain can cause or worsen depression; depression can lower a person’s tolerance for pain.
So consider giving therapy a try. Cohen says he’s seen particularly good results with cognitive behavioral therapy, a practical approach that helps people identify and change the thought and behavior patterns that contribute to their unhappiness.
- Stress-reduction techniques. “Reducing stress is really crucial in pain management,” says Savage. There are number of approaches, including:
- Yoga. There’s good evidence that yoga can help with chronic pain, says Cohen — specifically fibromyalgia, neck pain, back pain, and arthritis. “I’ve been including yoga as part of the treatment that I prescribe since the mid-1980s,” Savage says.
- Relaxation therapy. This is actually a category of techniques that help people calm the body and release tension — a process that might also reduce pain. Some approaches teach people how to focus on their breathing. Research shows that relaxation therapy can help with fibromyalgia, headache, osteoarthritis, and other conditions.
- Hypnosis. Studies have found this approach helpful with different sorts of pain, like back pain, repetitive strain injuries, and cancer pain.
- Guided imagery. Research shows that guided imagery can help with conditions like headache pain, cancer pain, osteoarthritis, and fibromyalgia. How does it work? An expert would teach you ways to direct your thoughts by focusing on specific images.
- Music therapy. This approach gets people to either perform or listen to music. Studies have found that it can help with many different pain conditions, like osteoarthritis and cancer pain.
- Biofeedback. This approach teaches you how to control normally unconscious bodily functions, like blood pressure or your heart rate. Studies have found that it can help with headaches, fibromyalgia, and other conditions.
- Massage. It’s undeniably relaxing. And there’s some evidence that massage can help ease pain from rheumatoid arthritis, neck and back injuries, and fibromyalgia.
The FDA is encouraging the development of prescription opioids with abuse-deterrent formulations (ADFs) to help combat the opioid crisis. The agency recognizes that abuse-deterrent opioids are not abuse- or addiction-proof but are a step toward products that may help reduce abuse. The FDA fully supports efforts to better understand the impact of these products in the real-world setting and convened a public workshop on July 10-11, 2017, to discuss the current data and methods for evaluating ADF products postmarketing and what can be done to improve national data and methods moving forward.
The FDA also supports the development of innovative formulations that have the potential to make abuse of these products more difficult or less rewarding. This does not mean a product is impossible to abuse or that abuse-deterrent properties necessarily prevent addiction, overdose, and death. Notably, currently marketed technologies do not effectively deter one of the most common forms of opioid abuse — swallowing the tablet or capsule. Because opioid medications must in the end be able to deliver the opioid to the patient, there may always be some potential for addiction and abuse of these products.
What does abuse-deterrent really mean?
Abuse-deterrent formulations target the known or expected routes of abuse, such as crushing in order to snort or dissolving in order to inject, for the specific opioid drug substance. The science of abuse deterrence is relatively new, and both the formulation technologies and the analytical, clinical, and statistical methods for evaluating those technologies are rapidly evolving. The FDA is working with many drug makers to support advancements in this area and helping drug makers navigate the regulatory path to market as quickly as possible. In working with industry, the FDA is taking a flexible, adaptive approach to the evaluation and labeling of potentially abuse-deterrent products.
Opioids with FDA-Approved Labeling Describing Abuse-Deterrent Properties
FDA has approved these opioids with labeling describing abuse-deterrent properties consistent with the FDA’s Guidance for Industry: Abuse-Deterrent Opioids – Evaluation and Labeling:
- Targiniq ER
- Hysingla ER
- MorphaBond ER
- Xtampza ER
- Arymo ER
- RoxyBondHow does the FDA decide what drugs are considered abuse-deterrent?
To meet the FDA’s standards, it is essential that every opioid with labeling describing its abuse-deterrent properties be grounded in science and supported by evidence. Any claims regarding abuse-deterrent properties must be truthful and not misleading based on a product’s labeling, and supported by sound science taking into consideration the totality of the data for the particular drug. Absent sufficient science, there can be no claim of abuse deterrence. Permitting insufficiently proven claims does not serve the public health.
- The FDA has issued two guidances to help industry understand how the agency currently is evaluating these innovative products.
- There are currently NO generic opioids with FDA-approved abuse-deterrent labeling.
- “Guidance for Industry: Abuse-Deterrent Opioids – Evaluation and Labeling” (final guidance) explains the FDA’s current thinking about the studies that should be conducted to demonstrate that a given formulation has abuse-deterrent properties. It also makes recommendations about how those studies should be performed and evaluated, and discusses what labeling claims may be approved based on the results of those studies.
- “General Principles for Evaluating the Abuse Deterrence of Generic Solid Oral Opioid Drug Products” (final guidance) includes recommendations about the studies that should be conducted to demonstrate that a generic opioid is no less abuse-deterrent than the brand name product, with respect to all potential routes of abuse.We continue to encourage the development of innovative abuse-deterrent technologies, and we are also prioritizing the need for data that will help determine the impact of products incorporating abuse-deterrent technology on misuse and abuse. To collect this important information, all the companies that have brand name opioids with abuse-deterrent labeling claims are being required to conduct post-market studies to determine the impact those products are having in the real world. Having that information is critical and will allow us to take the next important steps in this area.
- In addition, FDA supports the development of assessment tools to evaluate packaging, storage, delivery, and disposal solutions, as well as product formulations, designed to prevent and deter misuse and abuse of opioids. To further this effort, the agency held a public workshop on December 11-12, 2017, regarding the role of packaging, storage, and disposal options within the larger landscape of activities aimed at addressing abuse, misuse, or inappropriate access of prescription opioid drug products. A Broad Agency Agreement was amendedto add this additional area of research to those previously noted to be of interest to FDA to address our current knowledge gap in this area.
- How will abuse-deterrent opioids help with the epidemic?
Because abuse-deterrent products are expected to reduce abuse compared to non-abuse-deterrent products, the agency is very interested in exploring new methods for analyzing and evaluating abuse-deterrent features; evaluating the nomenclature use to describe abuse-deterrent features; facilitating development of science for generic versions of these drugs; and taking new steps to encourage the conversion of the market to effective ADFs as part of the FDA’s Opioid Policy Work Plan. The FDA looks forward to a future in which most or all opioid medications are available in formulations that are less susceptible to abuse than the formulations that are on the market today. To achieve this goal, FDA is taking steps to incentivize and support the development of opioid medications with progressively better abuse-deterrent properties. These steps include working with individual sponsors on promising abuse-deterrent technologies; developing appropriate testing methodologies for both innovator and generic products; and publishing guidance on the development and labeling of abuse-deterrent opioids.
Maryland passes new law giving NPs practice autonomy from physicians
Maryland nursing leaders believe patients will benefit from new state legislation that allows nurse practitioners to work independently of physicians. The law also gives independent NPs the ability to open their own practices.
Gov. Larry Hogan signed the Nurse Practitioner Full Practice Authority Act into law in May, making Maryland the 21st state to have passed such legislation.
American Association of Nurse Practitioners President Ken Miller, PhD, RN, CFNP, FAAN, FAANP, called the passage of the Maryland law “very rewarding.”
Fifty years of data prove “that NPs provide high-quality, cost-effective and safe care that can improve access and make healthcare delivery more efficient when NPs are authorized to practice at the top of their education and national certification,” said Miller, a Maryland resident.
The measure allows nurse practitioners, who usually have two years of post-graduate education and advanced training, to prescribe certain drugs and diagnose and treat routine and complex medical conditions without physician oversight. Prior to the law, nurse practitioners were required to maintain attestation or collaborative agreements with physicians as a pre-condition of licensure and practice.
Nurse practitioners play important role as care providers
These days, it’s not uncommon to feel rushed at a doctor’s appointment. Medical clinics tend to be extremely busy places, so providers are continually looking for ways to serve an increasing number of patients who need care.
Fortunately, the world of medicine continues to adapt to changing demands, and the addition of nurse practitioners into area medical clinics is improving access to patient care.
What is a nurse practitioner? A registered nurse with graduate-level education that allows them to provide care you might think you could only get from a doctor.
For example, nurse practitioners may provide services such as:
-Diagnostic and treatment of most common and chronic illnesses
-Health and wellness counseling
-Screenings and referrals
-Prescriptions for medications
Nurse practitioners first obtain degrees as registered nurses (RNs). Many have extensive nursing experience as RNs before going on to complete a nurse practitioner (NP) program. These programs include many hours of clinical training under the guidance of a credentialed nurse practitioner or physician.
It takes about two years to complete an NP program, followed by state or national certification exams. Oregon was one of the first states to require a master’s degree to become a nurse practitioner. The state requires an advanced degree because nurse practitioners provide similar care to that of a physician.
Like physicians, nurse practitioners may choose to specialize in nearly all areas of health care, including:
-Family and adult health
Medical marijuana legalization led to a 6% drop in opioid prescriptions to Medicaid patients. Adult-use legalization led to an additional 6% decrease.
Cannabis can relieve chronic pain in adults, so advocates for liberalizing marijuana laws have proposed it as a lower-risk alternative to opioids. But some research suggests cannabis may encourage opioid use, and so might make the epidemic worse.
The new studies don’t directly assess the effect of legalizing marijuana on opioid addiction and overdose deaths. Instead, they find evidence that legalization may reduce the prescribing of opioids. Over-prescribing is considered a key factor in the opioid epidemic.
Both studies were released Monday by the journal JAMA Internal Medicine.
A growing body of evidence suggests that cannabinoids — chemical components in Cannabis plants or certain synthetic compounds — can be effective in alleviating pain, either alongside or in place of opioids.
As medical marijuana becomes more accessible in the U.S., it could serve as a safer option for some kinds of pain relief and could even help to reduce the number of people addicted to opioids, experts told Live Science.
When a person uses marijuana, cannabinoids in the drug bind to cannabinoid receptors in the human body. These receptors are part of an existing pain-mitigation network that produces endocannabinoids — “our own opiates” — and primes the body to be receptive to compounds with a similar chemical makeup, Dr. Donald Abrams, a professor of medicine at the University of California, San Francisco, told Live Science.
“We have this whole system of receptors and endogenous [internal] cannabinoids that are probably present to help us modulate the sensation of pain,” Abrams said. “That makes it sort of obvious that other cannabinoids — those that come from plants — could also have some benefit for pain.”
THC, or tetrahydrocannabinol, is the cannabinoid in marijuana that is chiefly responsible for the drug’s psychoactive effects, and cannabidiol, or CBD, is another active cannabinoid that does not cause feelings of intoxication.
Evidence from clinical studies suggests that cannabis or cannabinoids are effective in mitigating chronic pain, neuropathic pain (pain caused by a disease or injury affecting the nervous system), and involuntary and continuous muscle contractions associated with multiple sclerosis, Dr. Kevin Hill, an associate professor of psychiatry at Harvard Medical School, told Live Science in an email.
In a study published in September 2015 in the journal JAMA, Hill reviewed 74 medical studies on marijuana use for pain relief dating from 1948 to 2015. He found that there were positive results across 24 trials for patients with chronic pain, neuropathic pain and multiple sclerosis.