A simple test could soon help doctors identify patients at risk of developing arthritis before they show any symptoms. Researchers at the University of Missouri say a new biomarker test now being reviewed by the Food and Drug Administration (FDA) could help millions of people get treatment for the disease before their joint pain and stiffness becomes chronic.

Over 27 million Americans suffer from osteoarthritis, the most common form of arthritis. Currently doctors are unable to diagnose patients until they show symptoms – when it is often too late for preventive and minimally invasive treatment options to be effective.

A research team at the University of Missouri’s Comparative Orthopaedic Laboratory has developed a test using specific biomarkers that can accurately determine if a patient is developing arthritis and predict the potential severity of the disease. The test can be run off of a single drop of fluid from a patient’s joint, which is obtained with a small needle similar to drawing blood.

“With this biomarker test, we can study the levels of specific proteins that we now know are associated with osteoarthritis,” said James Cook, a researcher from the MU College of Veterinary Medicine and a professor in Orthopaedic Surgery. “Not only does the test have the potential to help predict future arthritis, but it also tells us about the early mechanisms of arthritis, which will lead to better treatments in the future.”

The MU researchers developed the biomarker test by analyzing the arthritic joints of dogs. Veterinarians say 20 percent of middle-aged dogs and 90 percent of older dogs have osteoarthritis in one or more joints. Because canine joints operate similarly to the joints of humans, the test is being adapted to human patients.

“This test has already shown early usefulness for allowing us to monitor how different treatments affect the arthritic joints in people,” Cook said. “With further validation, this test will allow doctors to adjust and fine tune treatments to individual patients. Also, being able to tell patients when they are at a high risk for developing arthritis will give doctors a strong motivational tool to convince patients to take preventive measures including appropriate exercise and diet change.”

The biomarker test is currently available for licensing and is in the process of gaining FDA approval.  The MU study is being published in the Journal of Knee Surgery.

A new study by one of the nation’s largest drug screening laboratories has found that nearly a third of chronic pain patients aged 50 or older are not taking the painkiller they were prescribed. Over one in four patients were also found to be taking a medication not prescribed by the doctor who ordered a urine drug test.

The peer reviewed study of over 725,000 urine screens was conducted by Ameritox. “Patterns of Drug Use in the Older Chronic Pain Population” was presented this week during the annual meeting of the American Pain Society.

The common perception is that America’s prescription drug epidemic is caused by younger people, but the data suggest that older pain patients have the same issues with non-compliance and misuse of drugs as the general population.

“This population has a risk of medication misuse and illicit drug use that warrants attention,” said Dr. Harry Leider, Chief Medical Officer of Ameritox. “A powerful medication was found in one in four older patients — one that the doctor prescribing a pain medication was not aware of. This data provides a compelling rationale for routinely monitoring medication use in older patients on chronic opioids.”

Older patients are also more likely to have multiple drugs prescribed by different doctors for different medical conditions.  That places them at higher risk for dangerous drug interactions. Common side effects from drug interactions include constipation, changes in mental alertness, depression and falls.

The Ameritox study found:

• 31.8% of older patients did not have a prescribed painkiller detected.
• 28.1% had a non-prescribed drug detected.
• 7.6% had an illicit drug detected (marijuana, cocaine, heroin or PCP).
• 45.9% of samples had no abnormality.

The rates of misuse and non-compliance by patients in the Ameritox study are similar to those found in a recent study of drug screens conducted by Quest Diagnostics. Both companies claim regular urine screens will help physicians monitor whether their patients are misusing drugs.

“Older adults are the fastest growing subset of the U.S.population and one of the largest groups of chronic pain patients,” said Lisa Burke, PhD, RN, Ameritox.  “Pain medication monitoring, through urine drug testing, is an important tool to help clinicians ensure their patients – regardless of their age – receive the best possible care and achieve relief from chronic pain.”

Ameritox also paid for a study presented during February’s annual meeting of the American Academy of Pain Medicine. A panel of experts recommended drug testing of chronic pain patients at least four times a year if a doctor believes they are at risk of misusing painkillers. Regular drug screening was recommended even though the panel admitted “there currently is a limited evidence base to support the expert panel’s recommendations.”

Being distracted isn’t typically a good thing. After all, being distracted at work, school, or behind the wheel, can lead to poor productivity, bad grades, or even a serious car accident. But mental distractions may make your pain easier to handle, according to two new studies inGermany.

Using high-resolution spinal imaging, researchers at the University Medical Center Hamburg-Eppendorf found that mental distractions inhibit responses to the earliest stage of pain signals — in pain-sensitive cortical and subcortical sections of the brain. Distractions also affect endogenous opioids, which are naturally produced by the brain and play a key role in the relief of pain.

“The results demonstrate that this phenomenon is not just a psychological phenomenon, but an active neuronal mechanism reducing the amount of pain signals ascending from the spinal cord to higher-order brain regions,” said lead researcher Christian Sprenger.
In the study, Sprenger and his research team asked participants to work on easy and hard memory tasks, while also being subject to painful heat to their arms. The memory tasks consisted of remembering letters.
The participants were found to perceive less pain when distracted by the harder memory tasks. Spinal imaging also revealed lower spinal cord activity, which corresponded to their less painful experience.
The researchers repeated the study by giving some participants naloxone, an opioid inhibiting drug, while others received a simple saline injection. The participants that received the opiod blocking drug saw a 40 percent decrease in the pain-relieving effects of distraction when compared to the saline infusion only group.
The researchers concluded that the perception of pain is less intense when a person is distracted from pain by a challenging cognitive mental task.
“Our findings strengthen the role of cognitive-behavioral therapeutic approaches in the treatment of pain diseases, as it could be extrapolated that these approaches might also have the potential to alter the underlying neurobiological mechanisms as early as in the spinal cord,” said Sprenger
The study findings are being reported in the Cell Press publication, Current Biology.

Don’t Look and It Won’t Hurt

A second study found that there may be some basis behind the old adage about looking away during a needle injection. Researchers found that past experience with needle pricks, along with information received before an injection, shape your pain experience.

“Throughout our lives, we repeatedly experience that needles cause pain when pricking our skin, but situational expectations, like information given by the clinician prior to an injection, may also influence how viewing needle pricks affects pain,” says lead author Marion Höfle, a doctoral student at the Charité – UniversitätsmedizinBerlin.

Study participants received a painful or non-painful electrical stimuli applied to their hand while watching video clips showing a needle pricking a hand, a Q-tip touching a hand, or a hand left untouched.  The clips were presented on a screen near the participants’ hand, giving the impression that the hand on the screen belonged to them.

Participants reported that their pain was more intense when they viewed a needle pricking a hand than when they saw a hand alone or being touched with the Q-tip.

Researchers conducted a second test, but this time participants were told that either the needle or the Q-tip videos were more likely to be associated with pain. The researchers found that those video clips were more likely to be associated with pain. This suggests that a patient’s expectation prior to a medical treatment influences the intensity of their pain.

Taken together, the study reveals several important findings. “Clinicians may be advised to provide information that reduces a patient’s expectation about the strength of forthcoming pain prior to an injection,” Höfle wrote. She further states that, “because viewing a needle prick leads to enhanced pain perception as well as to enhanced autonomic nervous system activity, we’ve provided empirical evidence in favor of the common advice not to look at the needle prick when receiving an injection.”

Their research is published in the May issue of Pain.

Everyone knows that the cost of healthcare is rising, but most American families who receive health insurance through an employer have no idea just how expensive it is.

The average cost for a typical American family of four receiving healthcare through an employer-sponsored preferred provider organization (PPO) is $20,728, according to a study published by Milliman, Inc., a Seattle-based consulting and actuarial firm.

“Some families may be surprised to hear their total average healthcare costs are exceeding $20,000 this year,” said Scott Weltz, an actuary in Milliman’s Milwaukee office. “Most people who receive health insurance through their employer are insulated from the true costs associated with the care they receive.”

Although healthcare costs are 6.9% higher in 2012 than they were last year, it’s the lowest annual percentage increase in the ten years of data studied by Milliman. This year’s $1,335 increase pushed the average healthcare cost for a family of four above $20,000 for the first time.

“The average rate of increase this year dips below 7% for the first time since we began analyzing these costs, but the total dollar increase is still the highest we have seen,” said Lorraine Mayne, a principal and actuary for Milliman in Salt Lake City. “This helps illustrate the challenge of controlling healthcare costs. When the total cost is already so high, even a slower rate of growth has a serious impact on family budgets.”

Milliman also analyzed how employers and employees split the cost of healthcare. In 2012, a typical employer will contribute $12,144 of the $20,728 total; while employees will pay the remaining $8,584 through out-of-pocket expenses and payroll deductions. Percentage wise, employers will pick up about 59% of the costs, while employees will pay 41%.

Fourteen cities were included in the Milliman study, and nine of the 14 exceeded the national average of $20,728. Only three cities — Phoenix, Atlanta, and Seattle– had healthcare costs less than $20,000.

Here’s the breakdown of five of the most and least expensive cities, according to the report:

Most Expensive Cities for Healthcare

Least Expensive Cities for Healthcare

The Milliman report noted that the Affordable Care Act, widely known as Obamacare, has so far had only a limited impact on healthcare costs because most of the Act’s provisions haven’t been implemented. According to a recent review by the Congressional Budget Office, full implementation of Obamacare will lead to a small reduction in the number of people receiving employment-based health insurance.

One of the nation’s largest drug screening labs says 50 million Americans suffer from chronic pain.

The American Academy of Family Physicians puts the number at 70 million, a figure long used by several other medical societies.

Last summer, the Institute of Medicine (IOM) raised the estimate even higher. It released the landmark study Relieving Pain in America, which declared that 116 million Americans suffer from chronic pain. That number has been repeated in thousands of news reports and dozens of medical organizations (including the National Institutes of Health and the FDA) have adopted the mantra: 116 million Americans are living in pain.

Or are they?

“It’s a ridiculous number,” said Dr. Andrew Kolodny, chairman of the department of psychiatry at Maimonides Medical Center in New York City. “That’s just an outrageous statement. It’s absurd to say almost half of all Americans are disabled by chronic pain.”

Dr. Kolodny is a controversial figure in the field of pain medicine. As president of Physicians for Responsible Opioid Prescribing, he’s been a vocal critic of the overprescribing of narcotic painkillers. Kolodny believes the pharmaceutical industry is behind efforts to exaggerate the number of Americans with chronic pain.

“My biggest concern is the way in which the number is used and the report itself is used by people advocating for aggressive prescribing of opioids for chronic pain. That really concerns me,” Kolodny told American News Report. “This was language that was lobbied for by the pharmaceutical industry and by organizations funded by industry. They wanted a report on chronic pain because they knew it could be used in advocacy for opioids or other treatments and ultimately they got the report that they wanted.”

Kolodny’s concerns are drawing new attention because of a U.S. Senate investigation of the financial ties between drug makers and non-profit pain organizations that often advocate the use of opioid painkillers.

In February, Kolodny raised his objections during the annual meeting of the American Academy of Pain Medicine. One of the authors of the Institute of Medicine report, Dr. Sean Mackey of  Stanford University’s School of Medicine, defended the IOM panel that wrote it, saying it received “zero, nothing, zilch, pubkiss” from the pharmaceutical industry.

Weeks later, the Institute of Medicine quietly revised it number. Instead of 116 million Americans living in pain, the IOM now estimates the number at 100 million.

Is Chronic Pain a Disease?

Kolodny thinks the new figure is still too high and has “dangerous implications.” He believes it will be used in lobbying efforts to get chronic pain classified as a disease.

“There are significant consequences if you call something a disease. Labeling anything a disease is something the industry is always very interested in, whether they want to call shyness a disease and call it “socialphobia” so that they can prescribe Zoloft for it,” Kolodny said. “If you say chronic pain is a disease, that means I can prescribe you OxyContin and I’m treating your disease.”

Kolodny thinks that’s the wrong approach. He believes doctors should treat the underlying conditions that cause pain – be they inflammation or fibromyalgia – before dealing with the pain itself.

“I do think chronic pain is a serious problem and highlighting that is important if it leads to people receiving evidence based treatment. Unfortunately, I don’t think that’s what is happening,” he says.

“It’s a disease and there’s plenty of data to support that,” says Daniel Bennett, MD, DABPM, a Denver pain physician who is the Chief Medical Officer of American News Report. Bennett believes the IOM’s old number of 116 million underestimates the number of Americans with chronic pain, because it doesn’t include millions of people who might never see a doctor for chronic back pain or headache.

“That’s why these studies are underestimating because they’re looking at actual physician encounters and that’s not the way we should be tracking pain,” said Bennett. “All they’re looking at is who is actually presented for treatment.  That’s underestimating the problem, especially since back pain is a male predominant problem. How many guys do you know that of their own volition go to the doctor? They don’t.  It’s their spouse or girlfriend, someone else is taking them, saying ‘I’m tired of putting up with this.’ Those are the ones buying over the counter non-steroids.”

A recent Gallup survey supports Bennett’s views. It found that 47 percent of people had at least one type of chronic pain. Over a third of those in their mid-50s and older have neck or back pain.

All of which raises the same question. How many Americans suffer from chronic pain?

“I wouldn’t even want to guess. I do think that true chronic pain is a serious problem and I think it’s a common problem, but I have no idea. I just think the 100 million figure is absurd,” says Dr. Kolodny. “Part of being alive means experiencing pain. So certainly there are 100 million people who will frequently experience pain. That doesn’t mean there are 100 million people disabled with the disease of chronic pain.”

A new sleeping pill is on the market for patients with insomnia. Its name is Intermezzo and what makes this sleeping pill unique and potentially dangerous is that it is for “middle of the night” insomnia. The drug is made by Transcept Pharmaceuticals and is being marketed by Purdue Pharma (the maker of OxyContin) as their latest blockbuster drug. Purdue Pharma is spending $100 million on sales and marketing to promote Intermezzo.

Intermezzo is the first sleeping pill approved by the Food and Drug Administration to treat people who wake up in the middle of the night and are unable to get back to sleep.

The spearmint flavored drug is taken sublingually (under the tongue) and is meant to be taken “while in bed.” The active ingredient is zolpidem, which is also the active ingredient in the popular sleeping pill Ambien. By taking Intermezzo sublingually about 25% of the dosage is quickly absorbed through the tissues of the mouth, producing a rapid onset of sleep — thus the rationale for taking the sleeping pill while in bed. The remainder of the dose is swallowed and maintains sleep for the rest of the night.

The FDA says the drug is a “safer choice” than Ambien because it contains a smaller dose of zolpidem. “With this lower dose there is less risk of a person having too much drug in the body upon waking, which can cause dangerous drowsiness and impair driving,” said Robert Temple, MD, deputy center director for clinical science for the FDA.

The risk of next-day driving impairment is increased if Intermezzo is taken with alcohol or other drugs. And the label warns people not to drive for at least one hour after waking and at least five hours after taking Intermezzo.

Side Effects of Intermezzo

The FDA approved Intermezzo after two small clinical trials involving only 370 patients. The studies were relatively short (a few weeks in duration), and it is not clear if the drug is effective or can cause addiction when used for more than 35 days. The most common adverse reactions to Intermezzo in the trials were headache, nausea and fatigue.

When patients wake in the morning, they should wait until they are fully awake before driving or engaging in other activities requiring mental alertness. Patients should not do dangerous activities until they know how Intermezzo affects them.  Abnormal thinking and behavior changes have been reported in patients while under the influence of sleep medicines such as zolpidem; including driving or eating while not fully awake, having sex, talking on the phone, sleep walking, hallucinations and other bizarre behavior that patients often have no recollection of doing.

I have problems with Intermezzo — big problems.  First, it is being marketed by a pharmaceutical company that lied about a very dangerous drug called OxyContin.  We are now immersed in OxyContin deaths and addictions throughout the U.S. and Canada because of Purdue Pharma’s criminal marketing.

Intermezzo came on the market in early April. But under FDA rules, Purdue cannot advertise the drug to the public until it has been on the market for at least six months. So for now, Purdue is relying on its sales force – which is marketing Intermezzo directly to doctors.

While talking to my primary care physician recently I asked him about Intermezzo. He was familiar with the drug and impressed with it. I told him that I had concerns with any sleeping pill being taken at 3:00 am and the patient being able to get behind the wheel of a car to drive to work.  He told me to do more research before I wrote about Intermezzo because a pharmaceutical representative had told him Intermezzo was to be taken at bedtime — just as Ambien is.

Purdue Pharma representatives lied to the medical profession when they aggressively marketed OxyContin as less likely to be addictive or abused.  They couldn’t possibly be repeating this criminal marketing ploy with Intermezzo could they?  You interested FDA? Or will you wait until Intermezzo is a train wreck as OxyContin is in every state in the country?

Marianne Skolek is an activist and investigative reporter for Salem-News.com who lost a daughter to prescribed OxyContin in 2002. Marianne writes from the perspective of families devastated by the prescription drug epidemic.

The views, opinions and positions expressed in this column are the author’s alone. They do not inherently or expressly reflect the views, opinions and/or positions of American News Report, Microcast Media Group or any of its employees, directors, owners, contractors or affiliate organizations. American News Report makes no representations as to the accuracy, completeness, currentness, suitability, or validity of any information in this column, and is not responsible or liable for any errors, omissions, or delays (intentional or not) in this information; or any losses, injuries, and or damages arising from its display, publication, dissemination, interpretation or use.

Opposing views, opinions and positions about this column are welcomed by American News Report and or Microcast Media Group. Publication or lack of publication of opposing views, opinions and/or positions does not imply, suggest or expressly reflect an endorsement or disapproval of the originating commentary on the part of American News Report or Microcast Media Group.

The U.S. Food and Drug Administration is warning doctors and chronic pain sufferers on its website that a powerful painkiller injection cartridge manufactured by Hospira, Inc. may contain more Hydromorphone than the 1 milliliter dose printed on its label.

Hospira initiated a voluntarily recall of a lot of the injectable painkiller after receiving two complaints that vials contained too much of the morphine-derived medicine.

Hydromorphone, which is also distributed under the brand names Dilaudid and Palladone, is a very potent opioid that is prescribed for severe chronic pain and other conditions.  It is thought to be 6-8 times more powerful than morphine.

“Opioid pain medications such as Hydromorphone have life-threatening consequences if overdosed. Those consequences can include respiratory depression (slowed breathing or suspension of breathing), low blood pressure and reduced heart rate including circulatory collapse,” Hospira said in a statement.

The hydromorphone vials were distributed between September and October, 2011, to wholesalers and a limited number of hospitals throughout 28 states and the District of Columbia. The company has asked that pain patients who have been prescribed the drug to stop using it and to contact their physician if they experience any problems.

The recall is Hospira’s second this year, according to the FDA. On April 17, the company initiated a voluntary recall of its morphine sulphate injection vials, and warned that overdoses of morphine sulphate can also be life-threatening. The recall involved drugs distributed in 10 states.

“While voluntary recalls aren’t necessarily emblematic of major (manufacturing) problems, we are concerned by the fact that both of the recent recalls involved overfilling opioid products, which is a serious FDA concern,” Jason Gerberry, a Leerink Swann analyst, told ChicagoBusiness.com.

The most recent recalled drug vials come from lot number 07547LL and have an expiration date of July 1, 2013. No adverse events or overdoses have been reported to date.

A powerful California Congressman has injected himself into the debate over a non-narcotic pain relief treatment that has been used for over three decades to treat chronic pain.

Rep. Darrell Issa, Chairman of the House Committee on Oversight and Government Reform, wants to know why the Centers for Medicare and Medicaid Services (CMS) plans to discontinue long-standing Medicare coverage for transcutaneous electrical nerve stimulation (TENS) for patients with chronic low back pain.

TENS involves the delivery of an electric current to the skin through surface electrodes, primarily for the purpose of pain relief.  Chronic low back pain is generally considered low back pain that has persisted for at least three months.

Congressman Issa, in a letter dated May 3, wrote that “TENS has long been recognized by CMS as an effective treatment for Medicare beneficiaries with low back pain and its costs have long been covered by Medicare when prescribed by physicians.” Issa asked the CMS to provide him with  information explaining the rationale behind its decision.

CMS will issue a final ruling on TENS coverage for chronic low back pain on June 11. CMS’s proposal is to provide TENS coverage only to those Medicare patients who are enrolled in a prospective clinical study with a randomized controlled design.  Industry officials have been pointing out that clinical studies enroll only limited patients and are generally restricted to specific geographic regions.

The American News Report first reported on the matter March 15.  The proposed CMS decision memo can be read here.  A website petition has been signed by nearly 8,000 patients and clinicians protesting the decision.

This debate comes at an interesting time. The chronic pain world is already reeling from reports of possible over prescription of pain medication as well as the pharmaceutical industry’s influence on various non-profit pain organizations.

One pain physician noted that if TENS coverage is dropped, the options available to treat the elderly greatly diminish. “In my practice, a TENS unit is a first line therapy. It is a conservative approach that allows the patient to have control over their pain,” said Dr. Matthew Kaplan of All Saints Hospital in Racine,Wisconsin.”

Physical therapists also use TENS in their practice to treat chronic pain patients. Dana Dailey has been a physical therapist for 24 years and is currently pursuing her doctorate in physical therapy at the University of Iowa.

“TENS has been a safe and affordable treatment with minimal side effects.  It allows for self-management of pain in conjunction with medication, exercise and other treatments,” said Dailey.   ”I use TENS in both acute and chronic conditions to decrease pain and increase function.”

If the CMS decision stands, other private insurers may eventually stop covering TENS as well.

A national survey of peripheral neuropathy patients found that over half took at least two years before they received the right diagnosis from their doctors. Many also receive inadequate pain care and go through distressing life changes.

Peripheral neuropathy affects over 20 million Americans, making it one of the most common chronic diseases and a leading cause of adult disability. Neuropathy results from injury to the peripheral nerves, which disrupts the body’s ability to communicate with muscles, organs, and tissues. With early diagnosis, symptoms can often be controlled. A delay in diagnosis and treatment could lead to loss of sensation, weakness, chronic pain, and disability.

The Neuropathy Association surveyed nearly two thousand patients, asking them about the length of time between the first onset of symptoms and a confirmed diagnosis of neuropathy. Fifty seven percent waited two or more years before getting the right diagnosis. Nearly one-third were receiving no treatment for their pain.

“While early intervention and treatment can be critical to slowing disease progression, our biggest challenge is many Americans still do not know about neuropathy, are unaware they have it, and do not recognize warning signs. Too often neuropathy is discovered after irreversible nerve damage has occurred.” said Dr. Thomas H. Brannagan, III, medical advisor for The Neuropathy Association.

Nearly half (49%) of the patients were told their neuropathy is “idiopathic” — of an unknown cause. Fifteen percent of those surveyed have diabetic neuropathy, the second most common cause. Other types of neuropathy can be caused by accident or trauma, cancer, chemotherapy, toxins, infectious disease and HIV/AIDS. There are over 100 known forms of neuropathy.

“Neuropathy is often misrepresented as only being diabetes-related. We know that diabetic neuropathy typically represents a third of the neuropathy patient community; yet, close to half of the patients receive an idiopathic neuropathy diagnosis. This survey supports the fact that confirming a diagnosis, when possible, requires physicians and patients working in partnership for a thorough evaluation to identify the possible source of the nerve damage,” says Brannagan.

The survey found a wide range of treatments being used for neuropathy, with many patients using multiple therapies to control their symptoms.

• 66% Use pain medications such as pregabalin, gabapentin, duloxetine and opioids.
• 29.9% Receive no treatment for pain.
• 22.7% Use complementary therapies such as vitamins, acupuncture and TENS units.
• 16.5% Use topical pain relievers such as lidocaine or capsaicin.
• 10.5% Receive physical therapy or occupational therapy.
• 4.6% Receive intravenous immunoglobulin or plasmapherisis.
• 4.1% Interventional therapies such as local anesthetic blocks and spinal neurostimulators.

“With the potential for millions of Americans to suffer from neuropathy’s progressive chronic pain and disability, the U.S. is currently unprepared to face a major public health crisis if healthcare providers, the media, and public policy officials continue to ignore the inadequacy of medical resources and research funding for neuropathy,” said Tina Tockarshewsky, president and CEO of The Neuropathy Association.

This week is the eighth annual Neuropathy Awareness Week, an event launched by the Association to promote greater attention to and prevention of neuropathy.

Patients with multiple sclerosis can get relief from pain and muscle tightness by smoking marijuana, according to a new study in California. But the benefits from smoking pot came with  side effects – patients in the study had shorter attention spans and reported they were getting “too high” or dizzy.

The study is being published in the Canadian Medical Association Journal.

Multiple sclerosis is an inflammatory disease that affects the ability of nerve cells in the brain and spinal cord to communicate with each other. There is no known cure. Many patients with multiple sclerosis suffer from spasticity, a common and disabling condition of the disease in which the muscles tighten and become difficult to control. There are drugs that relieve spasticity, but they can have adverse effects and do not always improve the condition in some patients.

Researchers at the University of California, San Diego School of Medicine, conducted a randomized, double-blind study with 30 participants to see whether smoked cannabis can relieve pain and muscle spasticity. Most previous trials focused on the effect of cannabis taken orally through pills and sprays.

“We found that smoked cannabis was superior to placebo in reducing symptoms and pain in patients with treatment-resistant spasticity, or excessive muscle contractions,” said lead researcher Jody Corey-Bloom, MD, PhD, professor of neurosciences and director of the Multiple Sclerosis Center at UC San Diego.

Researchers measured the spasticity of each participant’s joints using a modified Ashworth scale, an objective tool used to measure the intensity of muscle tone.  Participants who smoked cannabis once daily for three days experienced an almost one-third decrease on the Ashworth scale compared to a placebo group. Pain scores also decreased by about 50 percent.

“We saw a beneficial effect of smoked cannabis on treatment-resistant spasticity and pain associated with multiple sclerosis among our participants,” wrote Corey-Bloom.

Although generally well tolerated, smoking cannabis did have mild effects on attention and concentration. About one in five complained of dizziness, headache or fatigue after smoking. Six percent said they felt “too high.”

The study is the fifth clinical test of cannabis reported by the University of California Center for Medicinal Cannabis Research (CMCR). Four other human studies on control of neuropathic pain also reported positive results.

“The study by Corey Bloom and her colleagues adds to a growing body of evidence that cannabis has therapeutic value for selected indications, and may be an adjunct or alternative for patients whose spasticity or pain is not optimally managed,” said Igor Grant, MD, director of the CMCR, which provided funding for the study.

I am writing in response to Marianne Skolek’s column of May 9, published in the American News Report.

Contrary to Skolek’s report, Dr. Andrew Kolodny, the president of Physicians for Responsible Opioid Prescribing (PROP), is engaging in partisan rhetoric that hobbles the discussion of the treatment of chronic pain.

I have been a volunteer advocate, never a paid employee, working with the Action Network of the American Pain Foundation (APF) for the past 4 years, until the foundation ceased operations this week.

I am a person who’s lived with constant harrowing pain for over 45 years. I am not writing here as a representative of the APF, but as a person with pain and a knowledgeable advocate who has worked for the improved care of people like me — who suffer needlessly because of under-treatment and non-treatment of chronic pain.

In my years as an APF volunteer, I never once received any money or gifts from the pharmaceutical industry or was I asked to shill for their products. I don’t know anyone at the APF who was ever contacted by a pharmaceutical representative to do anything on their behalf or advocate for their products, as Kolodny would have the public believe. My work was never to advance one treatment option over another.

Drum Beat to Demonize Opioids

Kolodny and PROP have been part of the drum beat in the press to demonize one of the many legitimate treatments for chronic pain. Yes, I support the careful use of opioid medicines for appropriately diagnosed patients. But I also support evidence-based solutions to protect the public. I support the reasonable use of opioids, as one of many treatments for chronic pain, while also seeking balance between the legitimate needs of people with pain and keeping these medicines out of the hands of those seeking to use them illegitimately.

I started taking OxyContin four years ago, before switching to Suboxone, a prescription medication designed to ease detox from opiates. Over the years I’ve undergone countless medical procedures, including a dozen surgeries to deal with the fallout from a set of incredibly painful diseases: a broken spine, Behcet’s Disease, microscopic colitis, chronic epididymitis, fibromyalgia, dozens of kidney stones, arthritis and arachnoiditis. During treatment of the latter, my spine was nicked in surgery, causing irreparable inflammation of the arachnoid layer of my spinal cord. I am not alone in having such an awful list of medical conditions that cause relentless pain.

18 years ago I had to give up my professorship, my practice of psychotherapy, consultation and public speaking in the face of grinding pain; none of which I imagine Kolodny and other PROP members has had to struggle with. It was not until my involvement with the APF and my decision to use opioid medicines that I got some semblance of my life back. As with countless others, my use of an opioid medication is NOT the only treatment I use. I have used psychotherapy, physical therapy, therapeutic massage, acupuncture, acupressure, guided imagery, meditation, hypnosis and a daily spiritual practice.

The constant drum beat of biased articles without the entire context, such as those by ProPublica, needs to be challenged. All we as people living with pain want is balance. Yes, there is a growing incidence of people illegitimately using opioid medicines. Legitimate patients using these medicines under a physician’s care also run the risk of becoming addicted, but not the 40% that Kolodny recently claimed. It would be nice if these wildly inflated figures were backed up by well-crafted research producing reliable and valid evidence.

Critics claim that the number of deaths due to the “over prescribing” of opioid medicines is climbing yearly. What is rarely reported is that the cause of death among recreational or addicted users is often complicated by the person combining the opioids with other medicines, such as benzodiazepines, and washing them down with alcohol. Yes, that combination often leads to respiratory failure and death. But which of the three is the culprit? One or all of them?

Under-Treatment of Chronic Pain

There are 100 million Americans who live in chronic, miserable pain. Many go untreated and easily fall into depression and, scandalously, thousands die from suicide. My heart goes out to people who have lost a loved due to opioids. But untold thousands die yearly from pain. Whose heart goes out to them?

Because of this hysteria in the press and the constant drum beat from people like PROP many people are being dropped or denied service by their providers and left in the hell of their pain.

The state of Washington is a horrible example. After they passed draconian measures against pain treatment in that state, the number of abandoned pain patients has steadily climbed, subjecting people with chronic pain to unmitigated torture. Pharmacies are becoming increasingly more reluctant to fill legitimate opioid prescriptions. How is this effective in treating the millions of us in need of help? It must be noted that we have not seen any evidence yet that these types of draconian measures will protect the public, while providing good treatment to people in pain.

We need reasoned, evidence based solutions that will reduce illegal use of opioids while protecting the millions like me — who are no longer sitting on the sidelines of our lives thanks to the use of these legal medicines. Opioids are not the only arrow in the medical quiver. But to restrict or eliminate these medicines will subject millions of us to medieval torture.

Mark Maginn lives in the east bay of San Francisco where he is a poet, writer and social justice activist. Mark’s blog can be found here.

The views, opinions and positions expressed in this column are the author’s alone. They do not inherently or expressly reflect the views, opinions and/or positions of American News Report, Microcast Media Group or any of its employees, directors, owners, contractors or affiliate organizations. American News Report makes no representations as to the accuracy, completeness, currentness, suitability, or validity of any information in this column, and is not responsible or liable for any errors, omissions, or delays (intentional or not) in this information; or any losses, injuries, and or damages arising from its display, publication, dissemination, interpretation or use.

Opposing views, opinions and positions about this column are welcomed by American News Report and or Microcast Media Group. Publication or lack of publication of opposing views, opinions and/or positions does not imply, suggest or expressly reflect an endorsement or disapproval of the originating commentary on the part of American News Report or Microcast Media Group.

An FDA review of bone building drugs widely used to treat osteoporosis has found that they provide little if any benefit after long term use – and may even lead to more bone fractures. About 10 million Americans suffer from chronic pain caused by osteoporosis and bisphosphonates have long been recommended as a way to treat the disease.

The FDA review, published online in The New England Journal of Medicine, was prompted by growing evidence that long term use of bisphosphonates may actually lead to weaker bones in some women. Osteoporosis is caused by a decline in mineral bone density, which makes bones weaker over time and more likely to fracture. To rebuild bone density, millions of elderly Americans have been prescribed bisphosphonates, which are sold under the brand names Fosamax, Boniva, Actonel, and Reclast, as well as some generic drugs.

The FDA stopped short of recommending that people stop taking the drugs, but said cautionary labeling should be updated. The agency reviewed studies which found that after three to five years of use, bisphosphonates may contribute to thigh fractures, jawbone deterioration or even esophageal cancer.

The review only analyzed long-term use and did not address whether a woman should be prescribed a bone building drug in the first place. Women are more likely than men to get osteoporosis, because after menopause their bones start to lose density faster. A review of two industry funded studies showed significant reductions in fracture risks during the first three to four years, but little or no benefit afterward.

Osteoporosis is responsible for 1.5 million fractures in the U.S. annually at a cost of $14 billion. About half of all women and a quarter of all men over the age of 50 will break a bone due to osteoporosis, according to the National Institutes of Health.

The National Osteoporosis Foundation and the National Bone Health Alliance, both of which are funded by drug makers, issued statements urging patients not to stop taking bisphosphonates without first discussing it with a physician.

“Members of the public and healthcare professionals alike have been looking for clear guidance about appropriate length of time to continue bisphosphonate treatment. I’m happy to see the importance of regularly monitoring patients on an individual basis to determine their need for continued therapy,” said Robert Recker, MD, president of the National Osteoporosis Foundation and vice-chair of the National Bone Health Alliance.

Recker also claimed that “drug holidays” would be a way to avoid long term use of bisphosphonates.

“As suggested by the FDA’s ongoing analysis, giving some patients intermittent drug holidays may be appropriate clinical practice,” said Recker.

Bisphosphonates generate billions of dollars in revenue for drug makers around the world. According to Bloomberg, Actonel generated $771 million in 2011 sales for Warner Chilcott, Boniva generated $788 million for Roche and Fosamax had sales of $855 million for Merck.

A U.S. Senate investigation of the pharmaceutical industry targets some of the nation’s most prominent drug makers, medical organizations and pain physicians who advocate the use of narcotic painkillers.

Citing an “epidemic of accidental deaths and addiction” caused by opioid painkillers, Senate Finance Committee Chairman Max Baucus (D-Montana) and Sen. Chuck Grassley (R-Iowa) sent letters to Purdue Pharma, Endo Pharmaceuticals, Johnson & Johnson and nine pain organizations, saying “there is growing evidence pharmaceutical companies that manufacture and market opioids may be responsible, at least in part, for this epidemic by promoting misleading information about the drugs’ safety and effectiveness.”

The letters accuse industry supported pain organizations of playing a major role in spreading that misinformation.

“Improper relationships between pharmaceutical companies and the organizations that promote their drugs can put lives at risk.  These painkillers have an important role in health care when prescribed and used properly, but pushing misinformation on consumers to boost profits is not only wrong, it’s dangerous,” Sen. Baucus said in a statement

“The problem of opioid abuse is bad and getting worse,” Sen. Grassley said. “Something has to change. A greater understanding of the extent to which drug makers underwrite literature on opioids is a good start. Doctors and patients should know if the medical literature and groups that guide the drugs’ use are paid for by the drugs’ manufacturers and if so, how much.”

Dubious Information about Painkillers

A recent series of investigative reports by ProPublica and the Milwaukee Journal/Med Page Today revealed that pharmaceutical companies promote and market their opioids through industry funding of pain organizations. “Dubious information” favoring opioids was used by the organizations in their patient guidelines, position statements, books, educational courses and lobbying efforts.

Baucus and Grassley asked the three drug makers for a list of all payments they’ve made since 1997 to nine pain organizations, including the American Pain Foundation, the American Academy of Pain Medicine, the American Pain Society and the Federation of State Medical Boards.

In addition, the letter asks for information on payments made to several prominent physicians in the field of pain management, including Scott Fishman, chief of the Department of Pain Medicine, University of California, Davis; Perry Fine, Professor of Anesthesiology, Pain Research Center, University of Utah School of Medicine; Myra Christopher, Kathleen M. Foley Chair for Pain and Palliative Care at the Center for Practical Bioethics; and Lynn Webster, medical director and founder of the Lifetree Clinical Research & Pain Clinic in Salt Lake City, Utah.

“I think that the senators don’t have all of the facts. They don’t have enough information. They’ve seen one side of it,” said Dr. Webster, who is president elect of the American Academy of Pain Medicine (AAPM). “This gives me and our organization an opportunity to provide I think a clear picture that what we’ve been doing has been in the best interest of patients and physician education.”

“There are probably no medical professional organizations out there, I would be surprised if there are any, that doesn’t accept funding from industry. But that doesn’t mean they have any input in the content of the information that gets delivered,” Webster told American News Report. “We’ve been very good at delivering an honest and I think unbiased, academic approach to different products in the field of medicine.”

American Pain Foundation Shuts Down

Webster said the AAPM does accept funding from industry, but companies have no say in how the money is spent by the organization. He also said he was “saddened” to hear that another industry supported pain society, the American Pain Foundation, had ceased operations. The organization made the announcement on the same day the senators released their letter, citing “irreparable economic circumstances.”

“I believe the accusation that the American Pain Foundation was promoting unsafe use of medications, particularly opioids, is fallacious. That’s just not true,” said Webster. “I think the loss of the American Pain Foundation is huge. I think few people understand the magnitude of this loss that we’re going to experience because they’re not there. I am very saddened by their disappearance. They’ve done extraordinary work.”

Purdue Pharma, the maker of OxyContin, issued a statement saying the company was reviewing the senators’ letter. “We look forward to cooperating with the committee on this matter,” said James Heins, senior director of public affairs for the company.

In the lunacy of the over-prescribing of opioids for all levels of pain in the U.S. and Canada, there is now a large dose of sanity.  That sanity is an organization called Physicians for Responsible Opioid Prescribing (PROP).  Their mission is to reduce morbidity and mortality from opioids and to promote cautious, safe, and responsible opioid prescribing practices.

The president of PROP is Andrew Kolodny, MD, chairman of the department of psychiatry at Maimonides Medical Centerin New York City. PROP gives some hope to families who are dealing with the death and addiction of loved ones.

I would like to introduce you to Dr. Kolodny and his thinking and ethics regarding the treatment of pain with opioids:

“For years now, many of us have waited for the day that a major media outlet would expose the American Pain Foundation’s relationship with Purdue and other opioid manufactures. Thanks to two Pulitzer Prize winning journalists, that day has come,” Kolodny wrote back in December.

Kolodny is referring to a series of reports in ProPublica that revealed that pharmaceutical companies promote and market their opioids through industry funded pain society organizations, such as the American Pain Foundation (APF).  Some of the APF’s board members have extensive financial ties to drug makers, ProPublica found, and the group has lobbied against federal and state proposals to limit opioid use.

“Thanks to these reporters, APF’s ability to continue lobbying on behalf of opioid manufacturers has just been considerably weakened… and as a consequence, I suspect many lives will be saved,” Kolodny wrote.

It turns out the ProPublica stories were far more damaging to the American Pain Foundation than any of us imagined. The foundation announced May 8 that it has ceased operations because of “economic circumstances” — coincidentally the same day it was sent a letter by the U.S. Senate Finance Committee asking about its industry ties.

Recently the Centers for Disease Control and Prevention made a powerful statement that the increase in the prescribing of opioids has resulted in a rise in overdose deaths.

Another federal agency, the Food and Drug Administration (FDA), could also take a firm stand against the marketing and overprescribing of opioids. But the FDA allows it to continue — at the cost of tens of thousands of addictions and deaths each year. The regulation of dangerous and highly addictive opioids for severe pain only would save countless lives. Why does the FDA not take the lead and have a conscience by ending this prescription drug epidemic?

The FDA will be holding what it calls a “workshop” on May 30 and 31 entitled Assessment of Analgesic Treatment of Chronic Pain. The focus of the workshop will be on the use of opioids and other analgesics in the treatment of chronic non-cancer pain.

Hopefully, members of PROP attending this workshop will bring studies proving to the FDA that we are in a tidal wave of deaths and addictions due to the over-prescribing of opioids. Everyone in the U.S. and Canada seems to recognize this fact — everyone but the FDA and the American Pain Foundation.

Marianne Skolek is an activist and investigative reporter who lost a daughter to prescribed OxyContin in 2002. Marianne writes from the perspective of families devastated by the prescription drug epidemic.

The views, opinions and positions expressed in this column are the author’s alone. They do not inherently or expressly reflect the views, opinions and/or positions of American News Report, Microcast Media Group or any of its employees, directors, owners, contractors or affiliate organizations. American News Report makes no representations as to the accuracy, completeness, currentness, suitability, or validity of any information in this column, and is not responsible or liable for any errors, omissions, or delays (intentional or not) in this information; or any losses, injuries, and or damages arising from its display, publication, dissemination, interpretation or use.

Opposing views, opinions and positions about this column are welcomed by American News Report and or Microcast Media Group. Publication or lack of publication of opposing views, opinions and/or positions does not imply, suggest or expressly reflect an endorsement or disapproval of the originating commentary on the part of American News Report or Microcast Media Group.

Dr. Dan Bennett

As the founder and past chairman of the National Pain Foundation (NPF), I can say that the demise of the American Pain Foundation (APF) is sad news for people living with pain. Although the NPF focused on education and empowerment of those affected by pain, APF had a complementary focus on legislative action  — both are sorely needed in the United States.

The number one reason a person seeks medical care is for a pain related problem. It is amazing to me that to this date absolutely no one with financial means has stepped forward to create a formal training program for pain.

If you go to a board-certified internal medicine physician, you pretty much know what the training your health care provider has had to go through; the same could be said if you walked into any board certified neurosurgeon. Not with pain – there are no unified training programs that culminate in a board certification in pain medicine. Yes, there are one-year fellowships. Yes, there are weekend courses to “enhance” a provider’s qualifications, but NOTHING that, over the period of several years, guides men and women to become true practitioners in pain medicine. This is unconscionable in one of the wealthiest of nations.

Both the NPF and APF advocated for these changes – all became enmeshed in the politics that so often dilutes and undermines progressive and essential change.  Both were dependent on outside funding to reach their audiences … neither completed the task.

It is definitely a sad day ….

The American Pain Foundation, a non-profit organization that came under fire for its ties to the pharmaceutical industry, has abruptly ceased operations.

“With deep regret and heavy hearts, we sadly inform you that due to irreparable economic circumstances, APF must cease to exist, effective immediately,” the foundation said in a brief statement on its website. “The Board and staff have worked tirelessly over many months to address a significant gap between available financial resources and funds needed to remain operational. Unfortunately, the economic situation has not changed in any meaningful way, despite our best efforts.”

The statement said the foundation’s board of directors voted to dissolve the organization on May 3. The decision wasn’t disclosed publicly until May 8, the same day the foundation was sent a letter from the U.S. Senate Finance Committee inquiring about its ties to drug makers.

The committee is investigating financial ties between producers of prescription painkillers and pain experts, patient advocacy groups and organizations that set prescription guidelines for doctors.

“Overdoses on narcotic painkillers have become epidemic and it’s becoming clear that patients aren’t getting a full and clear picture of the risks posed by their medications,” Sen. Max Baucus and Sen. Charles Grassley said in a statement.

The American Pain Foundation was founded in 1997 as an independent national advocacy organization for people living in pain. But critics say the Baltimore based foundation was too often a front for the pharmaceutical industry, from which it obtained most of its funding. In 2010, the foundation collected nearly 90 percent of its $5 million funding from the drug and medical device industry.

In a highly critical series of stories last year, ProPublica called the APF “The Champion of Painkillers” and detailed how the organization’s lobbying and education campaigns closely mirrored those of the industry. Some of the foundation’s board members also had extensive ties to drug makers.

“Although the foundation maintains it is sticking up for the needs of millions of suffering patients, records and interviews show that it favors those who want to preserve access to the drugs over those who worry about their risks,” ProPublica reported. “The foundation’s guides for patients, journalists and policymakers play down the risks associated with opioids and exaggerate their benefits.”

The APF’s patient guide, which is no longer posted on its website, was paid for by four companies, according to ProPublica. The guide discussed several treatment options for pain, warning of the risks of over-the-counter painkillers such as ibuprofen, while stating that the side effects of opioids are minor and go away “after a few days.” The underuse of opioids, the guide said, “has been responsible for much unnecessary suffering.”

In the statement announcing the end of organization, the APF said it would transfer its educational material and support programs to other organizations “so that you may continue to benefit from the value these programs have provided to thousands of individuals and families across the country.”

The largest health insurer in Massachusetts is adopting a new program that could significantly limit the amount of pain medication patients receive. The policy, unveiled this week by Blue Cross Blue Shield of Massachusetts, is one of the strictest taken by a private insurer and is the latest in a series of efforts around the country to combat the prescription drug abuse epidemic by limiting access to powerful opioids.

Starting July 1, Blue Cross will allow patients to fill a 15-day prescription and one 15-day refill for short-acting painkillers, such as Percocet and Vicodin. Any further refills after 30 days will trigger a Blue Cross review, requiring physicians to certify that their patients have been counseled about the risk of addiction, as well as an agreement that all subsequent prescriptions will be written by the same doctor and filled at the same pharmacy. The latter rule is aimed at ending “doctor shopping” – in which patients go from doctor to doctor to get a prescription.

“A vast majority of our members who are prescribed pain medications use them safely and appropriately,” said Dr. John Fallon, senior vice president and chief physician executive for Blue Cross. “Still, we must also acknowledge the serious public health problem that the misuse and abuse of prescription narcotics pose to our communities, and we have a responsibility to put in place reasonable safeguards that help to prevent those problems from occurring.”

Blue Cross adopted the new policy after a review showed that 30,000 of its 2.8 million members had received prescriptions for short-acting painkillers for more than 30 days. The insurer believes that practice increases the chances of misuse, addiction and diversion – with unused pills being used by family members or being sold on the street.

The health plan will also have new guidelines for long-acting pain killers, such as fentanyl and OxyContin. Less than 3,000 of its members receive long-acting opioids. Under the new rules, those drugs could not be prescribed at all without prior authorization from Blue Cross.

Cancer patients and those with terminal illnesses will be exempt from the rules. It’s not clear how the rules will impact patients with long-term chronic pain, who do not have cancer or a terminal disease. About 100 million Americans suffer from chronic pain, according to the Institute of Medicine.

Mark Collen, an advocate for chronic pain patients, believes the Blue Cross policy will create more rules and paperwork for doctors, which could raise the cost of health care and limit access to opioids for people with chronic pain.

“This may be guesswork that may increase insurance costs when their members end up in the emergency room trying to get their pain treated,” Collen told American News Report. “It may also increase costs when their members need to see their pain doctor on a monthly basis as opposed to every two or three months.  In addition, increased rules may decrease the number of doctors willing to prescribe opioids — again sending more people to the ER for pain treatment.”

Collen says there is no evidence that “pain contracts” between doctors, patients and insurers have any impact on drug abuse. He said the other rules limiting prescriptions to one pharmacy and one doctor were reasonable.

Prescription drug abuse is the fastest growing drug problem in the United States. In 2010, the Centers for Disease Control and Prevention reported that 2 million people admitted using a prescription painkiller to get high. Seventy percent of the painkillers were obtained from friends or relatives; either for free, through purchase or by theft.

According to the Massachusetts Department of Public Health, the number of prescriptions for “Schedule II” narcotic pain killers has doubled in the past decade alone, leading the agency to warn  that “although it is important to properly treat pain, the availability of these prescription drugs in the community can be a risk.” Schedule II drugs include fentanyl, methadone, oxycodone, OxyContin, and Percocet.

We all knew it was going to happen sooner or later. Researchers have developed a test to determine whether we’re addicted to Facebook.

Dr. Schou Andreassen, a psychologist from Norway, has developed what she calls the “Bergen Facebook Addiction Scale” in order to test for the time-consuming addiction. Her research, the first of its kind, included over 400 students and is being published in the journal, Psychological Reports.

Andreassen said the number of Facebook users is increasing at a rapid pace, indicating an addiction to social media, which the study referred to as a “subdivision of Internet addiction.” An estimated one billion people use Facebook worldwide.

Her research found that Facebook addiction is more common among younger users, as well as anxious or insecure people who are better able to communicate through the social media rather than face-to-face communication. Women are more at risk for the addiction than men.

Those who show fewer addiction traits include people who are organized and ambitious, and who use Facebook as part of networking, marketing or other work-related activities.

There are several warning signs for Facebook addiction and the study indicates that addicts of social media find the symptoms more difficult to recognize on their own.

Take the Test

The Bergen Facebook Addiction Scale is based on six criteria. Rate yourself on each one. Do they apply to you very rarely, rarely, sometimes, often, or very often?

• You spend a lot of time thinking about Facebook.
• You feel an urge to use Facebook more and more.
• You use Facebook in order to forget about personal problems.
• You have tried to cut down on the use of Facebook without success.
• You become restless or troubled if you can’t use Facebook.
• You use Facebook so much that it has had a negative impact on your job/studies.

According to Andreassen, if you answered “often” or “very often” on at least four of the seven items, there’s a good chance you’re addicted to Facebook.

Quitting Facebook cold turkey could prove to be an impossible effort for the severely addicted or those who have zillions of friends posting on the social network site each day. If you think you are addicted to Facebook and quitting suddenly is impossible, try temporarily disabling your account. Try to define the goals you have for Facebook and keep a schedule of the hours spent on the website. It could be that cutting back on the time spent on Facebook could open up avenues to other sources of activity.

The risk of misusing prescription painkillers peaks earlier than many experts thought – at age 16 — according to a nationwide survey by Michigan State University researchers. At that age, about one in 30 youths start using painkillers to get high.

“While much of the previous thinking was that misuse of these drugs emerged in the final year of high school and during the college-age years, we found that for adolescents the peak risk of starting to misuse these painkillers generally occurs earlier, not during the post secondary school years,” said leader researcher James C. Anthony of MSU’s Department of Epidemiology and Biostatistics. “We suspect many physicians, other prescribing clinicians and public health professionals, will share our surprise in this finding.”

The MSU study used data collected from 138,000 U.S. adolescents by the National Surveys on Drug Use and Health from 2004 to 2008.

Roughly one in 60 young people between the ages of 12 and 21 begin using prescription pain medications each year, outside of the scope of their intended us. The risk of abuse peaks at age 16, when an estimated 2.8% become new users. Risk appears to be lowest from ages 12 to 14, and from ages 19 to 21.

Researchers say the findings imply that anti-drug abuse programs in high school should begin before the senior year.

“With a peak risk at age 16 years and a notable acceleration in risk between ages 13 and 14 years, any strict focus on college students or 12th graders might be an example of too little too late,” they wrote.

A number of prevention programs are sorely needed, according to the researchers. Not only do prescribing guidelines for clinicians need strengthening, but early school prevention programs need to be implemented. Examples of school-based programs include alcohol and tobacco prevention initiatives and peer-resistance drug programs, like the “Just Say No” campaign.

Researchers also say that non-opioid pain relievers, such as ibuprofen, can often be effective at reducing pain, making the  use of narcotic painkillers unnecessary. Additionally, if opioids are prescribed for adolescents or teens, the pills should be kept under lock and key and the number of pills should be limited.

“Patients in transient pain are often given a larger opioid prescription than is needed. It can end up stacked in the medicine cabinet, available to anyone in or visiting the household,” said  Anthony.
The study is published in the JAMA Network publication, Archives of Pediatrics & Adolescent Medicine.

Young men rarely think about growing old, fracturing a hip when they’re elderly, or having chronic pain from osteoporosis. But based on a new Swedish study, maybe they should. That’s because young men who participate in load bearing sports — like volleyball, basketball, tennis and soccer — are better protected against osteoporosis as they age, according to researchers at the University of Gothenburg.

“Men who increased their load-bearing activity from age 19 to 24 not only developed more bone, but also had larger bones compared to men who were sedentary during the same period,” said senior study author Mattias Lorentzon, MD, PhD, of the University of Gothenburg in Sweden.

While often thought of as a woman’s disease, men do develop osteoporosis, usually after age 65. Loss of minerals makes bones more porous and weak over time, putting the elderly at greater risk of fractures, often in the hip, spine, ribs and wrist. Without treatment, 1 in 5 men develop fractures caused by osteoporosis. The disease affects more than 200 million people worldwide.

In the Swedish study, researchers enrolled over 800 young men between the ages of 18 to 20. Bone mass measurements were taken and their exercise habits were noted. Five years later, the men reported their physical activity levels and underwent bone scans.

Researchers found that the men who participated in load-bearing sports for an average of four hours per week had an increase in hip bone density of 1.3 percent. Men who were sedentary or reduced their physical activity showed a 2.1 percent decrease in their hip bone mass.

The two best sports to build bone mass were basketball and volleyball, followed by soccer and tennis. Sports like cycling and swimming — which don’t increase the load on the body’s bones — didn’t seem to build stronger bones or increase bone mass. Bigger bones are thought to offer a shield against fractures.

“Osteoporosis actually seems to get its start by age 25 when bones start to lose tissue. So this study sends an important message to young men,” Lorentzon said. “The more you move, the more bone you build.”

“Such research is crucial to understanding how osteoporosis develops and more importantly how to prevent it,” said Keith Hruska, MD, president of the American Society for Bone and Mineral Research. “Bone fractures from osteoporosis devastate men and women all over the globe and ongoing research is the only way to find ways to protect men from this disease.”

The Swedish study consisted mostly of white men, but the findings are likely applicable to Caucasian men in the United States and other countries around the world. Further research is needed on other ethnic groups and in women to study the impact of load-bearing exercises on osteoporosis protection.

This osteoporosis study is published in the Journal of Bone and Mineral Research.