Articles Posted in Pain

rheumatoid-arthritis-hands-2-300x200More than 50 million Americans struggle with arthritis: Three in 10 of them find that stooping, bending, or kneeling can be “very difficult.” One in five can’t or find it tough to walk three blocks, or to push or pull large objects. Grown-ups with arthritis are more than twice as likely to report fall injuries.  Arthritics have lower employment rates, and a third of them 45 and older experience anxiety or depression. So what to do about this leading cause of disability, a painful condition whose woes will only grow as the nation ages and already is responsible for $81 billion in direct annual medical costs?

Experts from the Centers for Disease Control and Prevention recommend that those with the most common arthritis forms—osteoarthritis, rheumatoid arthritis, gout, lupus, and fibromyalgia—avoid a reflexive reach for pain-killing pills. Instead, they must keep moving. “Physical activity,” CDC experts said in a new study, “is a proven strategy for managing arthritis. …” It also “has known benefits for the management of many other chronic conditions” that also afflict those with arthritis—including heart disease, diabetes, and obesity.

Although arthritis commonly is associated with seniors, the majority of adults with the condition, more than 32.2 million Americans, are younger than 65. Arthritis is much more common among women than men, and much less so among Hispanics and those of Asian descent that among whites. It afflicts those with a high school or less education more than those who completed college or higher.

Back-Pain-300x188Back pain is one of Americans’ leading debilitating complaints, prompting us to spend billions of dollars annually for relief and costing more than $100 billion, especially in lost work and wages. But an influential physicians’ group, joining a growing number of other experts, now recommends that we buck up, exercise, keep moving—and stay away from a reflexive reach for drugs, especially powerful painkillers, to deal with aching backs.

The American College of Physicians, with guidelines published in the Annals of Internal Medicine, concedes it is breaking with longstanding medical views on treating low back pain. But the group’s experts said they conducted a “systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain.”

They found that many patients with low back pain recovered over time “regardless of treatment,” and these individuals might benefit most from heat, rest, exercise, and over the counter, non-steroidal medications. Another group of back pain sufferers might need physical therapy, stress reduction, acupuncture, yoga, or ta-chi. Only after patients have not found relief with “non-pharmacological therapy,” should doctors consider giving non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. If these don’t work, tramadol (Cymbalta) or duloxetine (Ultram) might be considered.

prescription-bottles-1-300x170Some diligent, grown-up sons and daughters may want to check in on mom, dad, and grandma, grandpa, all the aunties and uncles, too. That’s because there’s yet another warning that too many doctors are whipping out their prescription pads all too readily and writing scripts for retirement-age Americans, who now take on average three psychiatric drugs without any mental health history.

Research published in the JAMA Internal Medicine shows that over-prescribing of powerful psychotropic drugs, including sleeping pills, painkillers, and anti-depressants may be more common than believed. The study was based on an analysis of data from a big number of doctors’ office visits, with researchers finding the number of “polypharmacy” incidents (cases in which seniors received scripts for multiple drugs) increased between 2004 and 2013 from 1.5 million to 3.68 million.

This doubling resulted from seniors’ greater openness in talking with their doctors about mental health issues, and, in instances where visits were related to “anxiety, insomnia, or depression,” the researchers write. But, in disturbing fashion, a high number of women and rural patients were involved in cases where multiple psychotropics were prescribed, and many of the prescriptions were for painkillers.

top-selling_edited-300x163Big Pharma has ruthlessly exploited a well-intentioned measure that sought to provide medications to treat patients with rare diseases that might otherwise have been ignored. Drug companies, instead, have manipulated the 1983 Orphan Drug Act to create legally protected monopolies so they can gouge desperate patients with astronomically priced products that already were taken by as many as millions.

These findings, part of an investigation by Kaiser Health News, a nonpartisan service focused on health policy issues, were just some of the outrages that surfaced in recent days involving Big Pharma: Two big drug makers have just agreed to pay hundreds of millions in fines for anti-competitive practices or failing to report suspicious transactions, while two pharmacy operations also will fork over millions to settle suits with federal authorities over anti-kickback violations or lax controls.

Kaiser said its scrutiny of orphan drugs, those targeted at diseases affecting fewer than 200,000 Americans nationwide, found that a third of the approvals by the federal Food and Drug Administration involved medications that already were approved for mass markets and were simply re-purposed.

oxycontin-150x150Big Pharma stayed in an unpleasant spotlight last week, with developments including:

How OxyContin reformulation may have hiked heroin-related deaths

A  new study has helped to explain the nationwide surge in heroin-related deaths, and how these likely are the unintended consequence of reformulations of OxyContin, a powerful, addictive painkiller. The study by the University of Pennsylvania and the RAND Corp., published by the National Bureau of Economic Research, scrutinized state-level data both on OxyContin abuse and heroin fatalities, which tripled from 3,000 in 2010 to 10,500 in 2014. Areas of highest misuse of the prescription painkiller dovetailed with those where heroin-related deaths spiked.

knee-replacement-300x240Uncle Sam is struggling to figure how best to ensure the safety, quality, and accessibility of a major surgery for a sharply rising number of seniors who need it and want the government, through Medicare, to pay for it. Baby boomers, after decades of running, dancing, aerobics, football, basketball, zoomba, and all manner of joint-stressing activity, are lining up for knee replacements. Where should these procedures occur and how should they be paid for and evaluated?

The New York Times has reported that surgeons, some in hospitals and some in free-standing surgical centers, are riven by proposed rule changes that would allow patients 65 and older with Medicare to undergo complex, extensive knee replacement operations on an outpatient basis.

The surgeons who now do these operations in hospitals say this is a risky move for patients, who now typically spend several days hospitalized in recovery. The “hospital” docs say knee replacement is a complex procedure, with high risk of infection and post-operative complications, because, for example, patients receive powerful clot-busting drugs and potent painkillers as part of the surgical regimen.

newborninhospital_mhi_default-300x199Some new cautions have been issued on some key aspects of children’s health care. The federal government is increasing its warnings on anesthetic use for children and expectant moms, while a newspaper investigation is raising issues with common newborn screenings and their inconsistency and inaccuracy. Meantime, a health news site is adding to questions about a much-touted program to reduce head trauma harms in kids’ athletics.

FDA warnings on anesthetics for babies, expectant moms

Let’s start with the federal Food and Drug Administration cautions on “repeated and lengthy use of general anesthetic and sedation drugs” with children younger than 3 and pregnant women. The agency says it has been studying potential harms of these powerful medications for these two groups since 1999, and will label almost a dozen common anesthetics and sedation drugs with new warnings.

cdc death causesImportant indicators about Americans’ health and well-being are trending the wrong way: For the first time in almost a quarter century, the nation’s life expectancy has declined.  Meantime, fatal overdoses by Americans taking opioid drugs continued to surge and exceeded 30,000 in 2015. And abuse of heroin has exceeded that of traditional prescription painkillers, with deaths due to heroin-related causes surpassing gun homicides.

Experts were surprised by the life expectancy decline, which reflected an increase in eight of the top 10 causes of death (see figure right from the federal Centers for Disease Control and Prevention, National Center for Health Statistics) including heart disease, diabetes and kidney disease, and Alzheimer’s—but not cancer.

It may be a statistical blip from one particularly bad year. The last time a comparable dip occurred was in 1993 due to high rates of deaths from HIV-AIDS, flu, homicides, and accidental deaths. Some experts said the decline in life expectancy, which for men fell on average in years from 78.9 to 78.8, may be attributable to increasing issues with Americans and obesity, and health care hitting limits on progress against heart disease.

fda hipThe pain and suffering that a flawed medical device can cause can last a long time. A Dallas jury provided a timely reminder of that, deciding six California plaintiffs should be paid more than $1 billion for the harm they suffered because of metal-on-metal hip replacement hardware made by Johnson & Johnson’s DePuy Orthopedics unit.

The Californians proved to jurors that they suffered tissue death, bone erosion, and other at times excruciating injury due to the faulty Pinnacle hip replacement product, which they said had been promoted as longer lasting and less risky than other alternatives. Jurors also heard that DePuy knew the products were defective and failed to warn patients.

Johnson & Johnson said it had acted appropriately and believed the verdict, which came in one of more than 8,000 Pinnacle-related lawsuits in Texas alone, would be overturned on appeal due to what the company said were errors by the presiding judge.

hep-c-imageAlthough the partisan wrangling over what’s next with American health care seems to ignore the maddening realities confronting patient-consumers,  a new look at the plight of poor Kentuckians provides a harsh look at the collision of many major health policy controversies including soaring drug prices, the Affordable Care Act, and the prescription drug abuse crisis.

Stat, the online health news site, deserves credit for the grim picture it painted of health care dysfunction in the nation’s heartland. Kentucky has been ravaged not only by opioid drug abuse, including record numbers of overdose deaths, it also is struggling with a stark, related rise in diseases.  In particular, cases of Hepatitis C have skyrocketed by 364 percent in Kentucky and surrounding states. Infections are growing most among young, rural whites, and to the growing concern of public health officials, Kentucky is recording increasing numbers of cases in which pregnant moms are infecting their babies.

Hepatitis C, a viral infection that damages the liver and is a factor in 19,000 Americans’ death annually, can lurk in the body for long periods before becoming deadly. As many as 4 million Americans may carry it and not know it until their liver damage becomes severe. The virus (depicted in the illustration above) spreads among addicts of pain-killing medications because they too often progress from prescription pill-popping to shooting up other increasingly powerful opioids like fentanyl and heroin.

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