FDA pulls Darvon off the market: confirms heart danger

The FDA asked for the discontinuation of the sales of all painkillers containing proxyphene, mostly known under the branded names of Darvon and Darvocet, because of the potential for serious heart problems.

If you are taking any painkiller that contains proxyphene, please contact your doctor to seek their advice.

Please be forewarned that the drug can cause withdrawal symptoms if you suddenly stop taking it. Talk to your doctor about how to taper off of it, and what else you could do to help manage your pain.

Brand names of proxyphene include but not limited to-

Darvon
Darvon-N
PP-Cap

Brand names that have a of combination of products

Balacet (containing Acetaminophen and Propoxyphene)
Darvocet A500 (containing Acetaminophen and Propoxyphene)
Darvocet-N (containing Acetaminophen and Propoxyphene)
Darvon Compound 32 (containing Aspirin, Caffeine, and Propoxyphene)
Darvon Compound-65 (containing Aspirin, Caffeine, and Propoxyphene)
PC-CAP (containing Aspirin, Caffeine, and Propoxyphene)
Propacet (containing Acetaminophen and Propoxyphene)
Propoxyphene Compound 65 (containing Aspirin, Caffeine, and Propoxyphene)
Wygesic (containing Acetaminophen and Propoxyphene)
Darvocet

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Fentanyl Recall

Many chronic pain patients take extended-released medications to help regulate their pain. Similar to once a week birth control pills, extended-released pain medications give chronic pain patients a steady stream of medication without letting them worry about when to take their next dose. After all, it is always easier to manage your pain that it is to subdue it.

I have tried many types of extended-released medication, everything from birth control pills to topical lidocaine patches. Unlike short acting (2-4 hours) medications, extended-released meds can be difficult to tell when they are not working correctly. Hence, why I find this recall very important to tell you about.

This week Actavis Inc. announced a voluntary recall to the wholesale and retail levels only of 18 lots of Fentanyl Transdermal System 25 mcg/hour C-II patches manufactured for Actavis by Corium International in the United States. (via) The company said that they were unaware of any patients who had experienced adverse effects from the products. (via)Reports say that the patches are releasing the medication at a faster rate than intended. Patients treated with a patch that releases fentanyl faster than intended could experience symptoms of opioid overdose, including excessive sedation, respiratory depression, and apnea. (via)

Please read the following for more information:
Actavis Press Release: 21/OCT/2010
Med Page Today

Which came first the chicken or the egg?

Which came first?The age-old question of which came first the chicken or the egg baffles scientists and comedians alike, and especially chronic pain patients.

Similar to the auras that precede migraine headaches, the onset of many of my pain attacks begin with simple yet effective signs telling me to, “Batten down the hatches girl, a storm’s a brew’n”. Usually a few days before a major pain attack, my IBS (Irritable Bowel Syndrome) acts up, my appetite decreases, and my sleep becomes restless. And, just to make life interesting, my warning signs have gone from a simple physical symptoms to a complex list of disorganized and unpredictable physical, neurological, and emotional reactions.

Part of the course with Fibromyalgia is memory lapse and a other neurological aliments called Fibro Fog. For example, my favorite is always the game of “Where did I leave my keys? – Just to find them in the fridge!” Fibro fog has always been manageable for me, until lately when it has begun to impair my ability to fully do my job. Imagine always having that one word on the tip of your tongue, that one idea just outside of your reach, that one memory remotely within your view- that is what my life feels like before a pain attack with Fibro Fog. Add in my usual IBS, sleep and appetite issues, and my life is just peachy.

This change in my body’s behavior led me to schedule an appointment with my pain doctor. Here’s the kicker- we do not know exactly what is causing the neurological issues. It could be the stressors in my life, my FM condition itself, or my medication. Hence, what came first the chicken of the egg?

The medication that helps my neuropathic pain has a side effect that could be causing my neurological symptoms. To make matters worse, without this medication I could not function as a normal member of society because of my nerve pain. On a day without a pain attack looming, my medication is at the appropriate level. However, combine the medication levels with the chemical reactions my body goes through before an attack, and WHOA MAMA let the Fibro Fog games begin.

So now, what do I do? My doctor and I decided to play the waiting game while I document my reactions over the next month. If we change my meds, I could end up in more pain, end up with a different type of pain, or better yet, end up with a whole other set of side effects: either physical, emotional, or neurological. Sometimes not knowing if the issue is a symptom or a reaction is the hardest puzzle to solve. Hopefully, by going back to the basics of keeping a pain journal will resolve all of our questions. I guess until then I will have a bunch of frozen keys.

Other sites to read on Fibro Fog:

www.fmaware.org
www.health.com
www.fibrohaven.com

Life changes; going with the flow

Dealing with chronic pain for so many years, I have had my share of health insurance headaches. Actually, I think by now my brain is hard-wired to just have a headache anytime I hear the word health insurance. Ouch, there one goes again.

Recently, I started a new job. Which means switching to COBRA, then over to my new company’s insurance plan. While I was in the process of switching to COBRA, they decided to stop carrying my old health plan, unbeknownst to me, COBRA, or either of my health plans, old or new. Sometimes, I wonder if there is a man behind the big green curtain just messing with my medical insurance to watch me go insane. Really, if he is out there, he is winning!

This entire ordeal took place during the time I ran out of my medication. If you are reading my blog, you know exactly how freaked out I felt to be out of my meds. They help me sleep, get out of bed, and basically function as a productive member of society. At the same time, they add nausea, constipation, mood swings, appetite issues, and brain fog to my already complicated medical history. It’s truly a love-hate relationship.

After many phone calls and trips back and forth to my very patient pharmacy, I was finally able to resolve some of my insurance issues. Wait, I said some. To make a long story short, I was not able to resolve all my insurance issues. This has left me without one of my medications for about three weeks. I thought that this would leave me with many sleepless nights while suffering in pain, and not having the resources or strength to make it through a full day of work.

But au contraire, my pain is under control! If there is one thing chronic pain has taught me, it has been how to meet life’s challenges head on without fear. I knew the only way I was going to make it through my insurance debacle, was to think straight. The only way I can do that is by not being in pain. If I can’t have my medications to help me, what other things could I do to help myself? I watched what I ate, my activities, and my stress levels. Everything I really should be doing to stay healthy anyways, but now I was on survivalist mode. And you know what? It’s working! I have been able to make it through my days with less medication.

So please don’t forget, just because things might look worse for you one minute, give it a few. Think of how to react to your world around you and what is best for your body. Find your inner strength to meet your challenges. You never know how it just might turn out for you when you do!

Weathering the Storm


Have you ever driven through a town after a massive hurricane? The town looks worn down, beaten, but in a way stronger because it has made it through the storm, and will live to see another day. When you live with a chronic pain condition, your body feels just like that town, worn down and yet in a strange way it grows stronger.

Growing up in the south, you learn to listen to the weatherman during the same time every year and just prepare for stormy weather. Once and a while, the “big one” hits, and when it does, there is no doubt what must be done. Time to board up the windows; place sand bags where needed; bring the potted plants and garden furniture inside, and just batten down the hatches. There’s no use trying to hide.

Living with a chronic condition is like living in the storm belt of the south. Each condition has its own health hurricanes, as it may. After a while, you learn how to predict when they are coming, and how to prepare for them. The hardest part is learning to listening to your own body and taking the proper precautions before its too late.

Just like with any natural disaster preparation, when it comes to your health, making an escape route or a game plan can be your greatest ally. When a crisis hits or your pain is at its highest level, it is hard to think straight which can make it difficult for you to eliminate your pain or communicate to others what you need.

An easy way to make a pain relief strategy is to simply make a few lists of what types of pain you have, what makes that pain better, and then what makes that pain worse.

It sounds like a lot to do. But simply start brainstorming your lists together and it’s amazing what you will discover about yourself. Do the lists in whatever order feels best for your situation. Remember there are no right or wrong answers here. Just be honest with yourself.

List 1) Pain:
What types of pain do you have?
Write down whatever comes to mind. You can list physical and emotional issues here.

Examples: trouble sleeping, depression, all over body aches, headache, sharp right hand pain, dull lower back pain, constipation, etc.

List 2) Solution/ Therapy:
What helps you? What makes you feel better.
(I have done this list two different ways. I have simply jotted down things that help me out, and other times I match specific therapies to a type of physical or emotion pain.)

Examples: Heating pad, hot bath, medication, cold compress, stretching exercise, diet

List 3) Stressor/ Cause:
What makes things worse?
I find this list the most difficult to do. Take your time writing down things that you know make your pain worse. You might want to just keep a journal, and note how you feel each night before you go to bed. Write down in your journal any activities or changes in your routine that impacted your condition.

Examples: diet, sleep pattern, weather changes, money stressors (I notice that after talking to the health insurance companies my pain increases the next day), airplane travel, exercise (over or under doing it)

Now match up with your lists, pain with solution/therapy to stressor/ cause. When you are done you will have a chart that will help you listen to your own body. And when you can’t think because the pain is too high, all you have to do is look at your list.

Remember that this is just guide for you. It can be changed, altered, or simply thrown away and started all over again. Don’t be afraid to learn and grow. You have weathered the storm and you will be better for it.

All backed up; opioid induced constipation

274783-main_FullConstipation is often a side effect of opioid use. It seems like you can never win. You take one medication to get rid of your pain, and then another one to get rid off all the side effects. It is estimated that out of all the patients who taken opiates for chronic pain, 40-90% will develop constipation. ( Via) There are many medications that your doctor can prescribe to you. Just like all medication regimens, finding the perfect cocktail is always a challenge.
Of course, when it comes to your bowel, this challenge is not always a fun one.

Besides what your doctor tells you, there are many things you can do to help yourself.
Diet and overall lifestyle changes will have a big impact on your GI system.
Try to make sure you:

• Increase the amount of fluid you drink per day.

• Eat more fiber. If this is difficult try adding a fiber wafer to your morning meal. Remember fiber doesn’t always mean oatmeal and whole grains. Fresh vegetables and fruits are wonderful sources of fiber, especially pears, apples, bananas, raspberries, and oranges!

• Get moving! Increase your exercise and daily activity.

• Allow time for privacy on the toilet. Also, stock you bathroom with good things to read. After all, if you are going to be in there awhile, might as well read a trashy novel or two!

If your stomach hurts from being bloated, try taking a hot bath, or using a hot water bottle. I move the hot water bottle from my stomach to my lower back from time to time.

Another trick to get things moving is to gently massage your stomach in small circles in a clockwise rotation. Start below your ribcage and work your way around. You will not need to use much pressure. This massage helps to get your intestines moving. It feels best for me after I take a hot bath when my body is a little more relaxed.

Herbs:
Just like western medications, there are many herbs that can help or hurt your medical situation. And should be taken only under the advisement of a medical professional. Some western medications can be affected by relatively what seem to be harmless eastern herbal remedies.

New advances in medicine are happening daily! There are now medications made specifically for people affected with opioid induced constipation (OIC). If you have been taking opioids for a while because of your chronic pain, one of these two medications just might help.

Methylnaltrexone (available as Relistor(R)) helps restore bowel function in patients.” It is delivered via subcutaneous injection and specifically targets opioid-induced constipation. When given alongside opioid therapy, it is designed to displace the opioid from binding to peripheral receptors in the gut, decreasing the opioid’s constipating effects and inducing laxation. Methylnaltrexone blocks peripheral opioid receptors in the gut and unlike other opioid antagonists has restricted ability to cross the blood-brain barrier. As a result, it antagonizes only the peripherally located opioid receptors in the GI tract, so it’s action reverses opioid-induced constipation without precipitating withdrawal symptoms or affecting or reversing the central analgesic effects of opioids .” (Via)

Another medication, brand name Targinact, combines the extended released opioid Oxycodone with extended release Naloxone to help the GI tract. This combination is a wonder duo! Naloxone is most commonly used to counter the effects of opioid overdose. Naloxone is an opioid receptor competitive antagonist. (Not to be confused with Naltrexone, which is an opioid receptor antagonist with qualitatively different effects, used for dependence treatment. Low-dose Naltrexone is in pain study trails at Stanford right now. Read my posting about the study.) By being an opioid receptor competitive antagonist, “Naloxone provides an inability for the opioid receptor to have an effect on the gut, counteracting opioid-induced constipation – without impacting on the centrally acting analgesic efficacy of oxycodone.” (Via) It binds to the receptor so that it does not bind to your gut.
Science just keeps improving!
opioid4

A major drug deal was signed this week between AstraZeneca and Nektar Therapeutics for the continued development of NKTR-118 and NKTR-119 programs. Both of these studies are something to watch out for in the near future. NKTR-118 is drug still in its testing phrase “that combines Nektar’s advanced small-molecule polymer conjugate technology platform with naloxol, a derivative of the opioid-antagonist drug naloxone.” (Via) NKTR-119 combines the drug from NKTR-118 and determines what opioid combination will work best with it to help eliminate constipation associated with opioid usage.

AstraZeneca and Nektar are both major players in the pharmaceutical market. It will be exciting to see what this new partnership will bring to the table!

Until then, make sure you eat right, drink plenty of water, and consult your doctor if you have any questions about what you can do for your GI system.

For further reading check out:

What’s the Best Source of Fiber: The Diet Channel

Scientific America

Medscape

University of Maryland Medical Center

Cooley Team

Also take the time and read this great blog about how you can take care of your intestines on Lumigrate.

Stanford Tests T3 for the Treatment of Fibromyalgia

nav_imageStanford Systems Neuroscience and Pain Lab does it again. Dr. Ian Carroll, MD, MS, and Dr. Jarred Younger, PhD are currently enrolling patients now in a new clinical trial to help fibromyalgia patients. Dr. Younger also worked on Stanford’s research of low dose Naltrexone for the treatment of fibromyalgia.

Stanford says on their site:(via)
“We are investigating whether the thyroid hormone T3 is one such treatment that may alleviate the symptoms of Fibromyalgia. There is significant overlap between the symptoms ofhypothyroidism (low thyroid hormone production), depression, chronic fatigue, and Fibromyalgia. Patients with low thyroid hormone production who have been treated with T3 for depression have had some improvement in symptoms.

This is the first study to examine whether T3 may help with the symptoms of Fibromyalgia. Studies such as this are a necessary step to having an investigational drug become a mainstream treatment. Your participation is a vital part of the search for an effective Fibromyalgia treatment.”

To understand how your thyroid works, here’s a great site:www.endocrineweb.com/thyfunction.html

I also found out about Dr. John C. Lowe. Here is a great interview with him about the subject on about.com.

To see any other clinical trials going on, looking at the clinical trials.gov page is always a good place stop.
Look here to see what they have to say about the study.

Click here to see Stanford enrollment form -> http://snapl.stanford.edu/t3/

Also, check out Lumigrate’s educational video: Hypothyroidism: Misunderstood, Misdiagnosed, Missed! by Dr. Scott Rollins lum-hypothyroid_0

Keep a Pain journal….on your iPhone?

For years now, I have kept a fibro/pain journal. I use the journal to help manage my overall health and pain. With an illness such as Fibromyalgia, it is very difficult to tell which event or series of events affected the way you feel. Am I having a pain attack because I only had 4 hours of sleep two nights ago or was it the ice cream I ate today or the stress of my job or….the list could go on. By keeping a journal, I am able to tell what factors make my pain worse, and what makes it better.

When I first started, I was very diligent about my entries. I marked everything down I ate, every pill I took, and every hour I managed to sleep. I wrote down what helped each type of pain my body went though daily. Over time, patterns began to show. For example, I learned that if I get less than 6 hours of sleep, my nerve pain located in my hands is worse the next day. The journal is also very helpful to bring to all my doctor appointments. I can tell them what is working, and what is not. Whenever I switch medications, I keep track of how my body is adjusting to the new regimen. It makes it easier to describe through the fibro-fog how I feel when it is written down in my journal.

But, just like any management routine, keeping a journal can be a painful chore itself. My frequency of journal entries is not like it used to be. I find that I write in it more on a monthly than a daily basis. Which, makes it very hard to tell why I hurt when I do and how to make it better. For example, do I hurt more today because I walked 2 miles on Sunday or is it that I only took one Alieve this morning. So when I purchased my new iPhone the other day, the very first thing I did was to look for apps that would help simplify my pain journal entries.

I first found an app called Zuri, from Zume Life. It looks great. And it tracks everything! zume.img_assist_customYou can try the first month for free. BUT,…..after that it is $35/month or $300/ year for the service. Your subscription covers you for the iPhone app and a log-in on their website. Even though Zuri, looks great, and has all the features I am looking for in a web 2.O based tool- $300/ year is just too much! So my search continued…..

I found another iPhone app called Pain Tracker. The best part is it’s free! paintracker-iphone-58445.185x185.1249536989.6297
And very simple. The program consists of three parts-
1) your level of pain on a four part scale,
2) where your pain is located, and
3) a place to put notes.
Then, it can chart your pain levels over a period of time for you. So, at your next doctor’s visit when they ask, how’s your pain been in the past 30days- you not only have an answer, but you have a chart to show them! paintracker-iphone-58445.320x480.1249536992.18585
To use Pain Tracker, you don’t have to log into any web site, and each entry is automatically dated and chronologically stored for you.

This app is very simple and quick to use. I have just started using it, but my hope is that in a few weeks I will be able to track a pattern in my pain levels. This will not only show how much pain I am in, but it might help explain why I am having pain attacks.

I will continue my search for tools to help manage chronic pain, iPhone apps or otherwise. Be sure to check back with this blog, I’ll update it to let everyone know how the Pain Tracker app is working for me.

Please fill free to comment if you have any tools that work to help you manage your pain. Thanks!

Pain Week 2009

LasVegasOn September 9th -12th, 2009, Las Vegas is being taken over by people who bet on something other than just a game of cards or a roll of the dice; this group makes intelligent bets on the understanding of pain as a public health issue. During this upcoming week in September, groups of health care professionals gather to discuss and learn how they can understand, treat, and improve the lives of those of us who live in pain at the PAIN Week ‘09, “the national conference on pain for frontline practitioners.”

This conference, believe it or not, is the ONLY national forum that is around to handle all the educational needs of the professional health care community. Everyone from physicians, pharmacists, to psychologists, and nurses are in attendance to discuss the complexities surrounding a pain patient’s life.

I’m sure with everything in news today, they will have tons to talk about at the conference! From issues about health care reform to the FDA black box labeling of Acetaminophen (Tylenol), political issues will be bouncing off the walls. The soaring costs of prescription pain medications limits people from getting their pain fully treated, especially in this economy. Hey, just by the simple fact that over the past decade alone, outpatient spending on prescription painkillers more than tripled, rising from $13.2B in 2006 from $4.2 B in 1996, (via) makes me want to stash all my pain killers for a rainy day pain attack. Add that to the economy collapsing, and the FDA coming down harsher on painkillers, the pain management doctors and patients certainly have their work cut out for them with medications alone.

Besides political barriers, the educational forum’s aim is to determine effective treatment protocols among current and emerging therapies. Pain is just one of those things, like a hair cut, that is different for everyone; what might work great for one person, is horrible for another. I simply loathe the fact that when someone finds out that I have chronic pain, and then proceed to give me an hour lecture on how to “heal thyself”. Most of us who live with a chronic ailment, know what works for us and what does not. The learning comes into play when new therapies are developed. Hence, the reason behind PAIN Week, for health professionals, the ones treating those living in pain, to understand, discuss, and evaluate new ways to care for us.

For more information, please see PAIN Week’s site

Coming soon to a pharmacy near you: generic pain meds!

In the world of pain management, we have to take the good with the bad. And sometimes with all the treatments we have to make ourselves feel better, the bad part of pain medications out way the good. Their level of toxic-feeling side effects, then the medications we take to lessen those side effects, and of course the price of these medications all add up to their negative points. One insurance company will pay for a medication, where another won’t. When they don’t cover it, you cry at the price. But, it’s always an issue to cry then when you write the check for the pain medication, or cry later when you are rolling on the floor dying in pain at home. With all the endless variables of what is going to work for your condition, you might just as well play the lotto- you might have better luck.

There is hope because this strange field of pain medications and their side effects is going to change sooner than we think. The pain management world is big money business. Which, for us means that they will keep trying new medications and therapies for us. Years ago, Endo labs made a break through with their Lidoderm patch, thus changing the way pain relief was given to a patient. The topical patch gave relief over the course of a day with little to no side effects. Now, Endo is facing the big challenge of the Lidoderm patch coming in generic form. Great for us, less money! Bad for Endo.

The research field will keep advancing in the field of pain management. Business analysis say that this trend will keep growing for the next 3-5 years! We will see an increase in generic pain medications. Even though many of the branded medications have been the fore-runners in the treatments, its time they stepped aside. New treatments will be pushing their way into the market, and making their mark to help many patients find relief. Many of these will not cost as much as their older competitors, which is a great advantage in this recession.

According to one report (via), many of the new drugs hitting the market are reducing their R and D They are building off of brands they already have in production, either by line extensions or expanded formulations. They have learned what they need to know by the medications they have on the market and are just expanding on them. This will help build companies into being more specialized in the pain management arena, and make use of their products with expired patents.

Hopefully, with many more players in the pain management research field, we will have medications that cost us less, with better results and with less side effects! After all life is short, and I want to live every moment to the fullest!
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