Karen D. Davis talks about your brain on pain
Source: Toronto Star
The $200 vaccine against shingles is too expensive for many. Ontario should help seniors to pay for it.
To anyone who's suffered from it, the blistering rash known as shingles is one of life's most excruciating experiences.
Caused when the long dormant chickenpox virus reactivates, usually later in life, the red blisters can spread across the body and even creep into the eyes, resulting in blindness.
While not all cases have such tragic outcomes, for many shingles is so debilitating that it leads to months of treatment and expensive hospital care. With the exception of a vaccine that has been available for some five years, nothing can be done to avoid it.
Ontario Health Minister Deb Matthews would be wise to consider the cost of shingles treatment on the health care system and fund the herpes zoster vaccine for older Ontarians. Although expensive, it will save money and trauma in the long run.
Given the fact that the virus mostly affects seniors – Ontario's fast-growing demographic – it makes sense that the Ministry of Health prevent the illness among those most at risk.
As the Star's Nancy J. White reports, awareness of the vaccine is relatively low but the biggest impediment is the $200 fee that patients must pay. To some it may not seem like much money, but for many it's yet another drain on precious dollars.
If only to roll out the program as soon as possible, Matthews could decide on an age group that would best benefit from the shingles shot — perhaps those aged 60 and older. At least it's a start.
Indeed, the vaccine is recommended by the National Advisory Committee on Immunization for people over 60, although it is also approved for those in their 50s. The lifetime risk for developing shingles is between 20 to 30 per cent, with a sharp increase after 60.
There are some complications to this readily available treatment. Right now, the vaccine must be kept frozen, which limits widespread distribution, but a new refrigerator-ready version could be available this year. In any case, this isn’t a good reason to avoid preventive measures.
Caledon's Shirley White made several trips to the emergency department before her case of shingles was diagnosed. On her third visit, 77-year-old White said she was "literally screaming. Very sharp pains going through me like fire."
As the boomer generation ages, more people will share White's experience. But government willing, there’s a powerful solution to head off that suffering.
Original article from: thestar.com
Source: Toronto Star
Immunization isn't just for kids. Here's a list of vaccinations recommended for adults:
Herpes zoster (shingles) vaccine is recommended for people age 60 and over.
By: Nancy J. White
A yearly flu shot. All adults are encouraged to get a seasonal influenza vaccination.
Pneumococcal vaccine. Anyone aged 65 or older should get the one-time shot that protects against 23 strains of pneumonia. It's also recommended for younger adults with high-risk conditions, such as lung disease.
Tetanus and diphtheria (Td) vaccine. While most people got this injection as children, adults should get booster shots every 10 years.
Tetanus, diphtheria and pertussis (Tdap) vaccine. Adults are encouraged to receive a Tdap injection to protect against pertussis (whooping cough). It counts as one of the every 10 years Td shots.
Herpes zoster (shingles) vaccine. It's recommended for people age 60 and over and is approved for those in their 50s. The vaccine costs about $200. Some private plans will reimburse.
Travel vaccines. Different protection is needed depending on the countries visited. They are not publicly funded.
Original article from: thestar.com
Source: Toronto Star
Shingles is a painful illness caused by the chickenpox virus that can show up without warning later in life. One big road block to getting the vaccine is the cost
By: Nancy J. White
The first time Shirley White went to the emergency room with sharp back pain, she thought she’d pulled a muscle moving furniture. The doctor injected her with pain medication.
Two days later, she was back in emergency. Not only was the pain worse, but an itchy, blistery rash was spreading from her back to her front on her left side. A classic case of shingles, the doctor said. Herpes zoster, known as shingles, is caused by the chickenpox virus which lurks in the spinal nerve roots for decades after the childhood disease. Doctors don't know why the virus may suddenly reactivate later in life.
On her third visit to emergency, the pain was excruciating. "I was literally screaming," says White, 77. "Very sharp pains were going through me like fire."
The Caledon resident, who was laid up for nearly four months two years ago, might have avoided the illness, or at least reduced its severity, if she had gotten the shingles vaccination. Available in Canada since 2009, it's recommended by the National Advisory Committee on Immunization for people age 60 and older and approved for those in their 50s. A person's lifetime risk of developing shingles is about 20 to 30 per cent, and that risk steeply increases as a person ages into their 60s and 70s.
But not a lot of seniors have been rolling up their sleeves. Awareness of adult immunization, apart from the yearly flu shot, is generally low, and the relatively new shingles vaccine faces additional challenges. Some patients stall, wondering about the best age to get it. Overall, the vaccine reduces the incidence of herpes zoster by 51 per cent but is less effective for older seniors, those who are most at risk. So far, studies show the vaccine lasts for at least seven years.
The biggest road block, however, is the cost, about $200, which some private plans cover. No province funds it yet. Ontario’s Ministry of Health and Long-Term Care says it continues to review information about the vaccine to consider funding. One specific concern, according to the ministry, is that the vaccine must be kept frozen, inhibiting broad distribution. Currently, patients usually take a prescription to a pharmacy and go promptly to the doctor with the vaccine in an ice pack.
Read full article here
Source: Ontario Ministry of Health
Ontario's Narcotics Registry is now online.
Updating an item that is of interest to many ACTION members, the Ontario government's narcotics registry is now up and running.
Since November of last year, patients have been required to show identification to their doctor in order to fill a prescription for a controlled drug.
Now, Ontario has begun using the information to begin electronic tracking of narcotic prescriptions.
The government says that the database will track strength of prescriptions, who they were written for, and the professional ID numbers of pharmacists and doctors who issued and filled the prescriptions.
Source: Metro News
Source: National Post
ACTION Ontario attended the Canadian Pain Summit in Ottawa, an event that was covered by the National Post
ACTION Ontario recently attended the Canadian Pain Summit. It was a great opportunity to meet with pain groups and influencers from across the country, to discuss how we can work together to get action for our membership.
Postmedia correspondent Sharon Kirkey attended the Canadian Pain Summit, and wrote a piece that was featured in many of Postmedia's newspapers across the country, including the National Post.
Kirkey spoke to the fact that chronic pain is a growing concern, as wait times for pain balloon across the country.
Action is required, on the part of both federal and provincial governments. Please join ACTION Ontario, and help us to bring a comprehensive pain management strategy to the province of Ontario!
The Globe and Mail's Andre Picard takes on the Oxycontin ban
This country's premiere health writer has taken on the issue of pain management, and how it is the real issue at the heart of the current debate around Oxycontin.
"We pay far too little attention to the effectiveness of medications used for legitimate purposes like pain control. At the same time, we fret incessantly about drug abuse while doing virtually nothing to prevent or treat addiction. Worse yet, we behave as if these challenges are somehow unrelated when, in fact, they are intricately linked.
The OxyContin story is a prime example of this public-policy hash and underscores the crying need for a plan, a strategy. We need a War on Pain a lot more than we need a War on Drugs."
The full article can be found here.
ACTION Ontario is in full agreement with Mr. Picard.
The province of Ontario desperately needs a comprehensive pain strategy, and ACTION will continue to advocate on behalf of those most affected by chronic neuropathic pain.
Source: CTV.ca, by Dr. Marla Shapiro
As a province, Ontario has the dubious distinction of having the highest use of prescription drugs containing narcotics in the world. In fact, between 1991 and 2009, the number of prescriptions in Ontario for oxycodone drugs alone rose by a whopping 900 per cent.
As a result, starting this month, there is a new Ontario Narcotics Strategy and I would not be surprised if other provinces followed this initiative.
The strategy wants to promote the proper use of controlled substances and make sure these medications are used properly.
The first question is what are these drugs? In broad strokes, they would include medications that are often used to relieve pain, such as acetaminophen and codeine and other pain narcotics listed below. Another class of medication would include those often used to treat ADD and ADHD, such as Ritalin. Medications in the benzodiazepine family are also considered controlled medications.
The strategy hopes to raise awareness of patients and physicians alike on the safe use of these drugs. However, with this new strategy, there will be monitoring of the prescribing and dispensing of these medications through a newly established provincial narcotics monitoring system.
In Ontario, since 2000, there has been a 41% increase in narcotic related deaths and a 5-fold increase in oxycodone -elated deaths. The strategy not only seeks to monitor and partner with physicians and pharmacists, but also to treat addictions.
The monitoring systems will establish a data base that will collect and store both prescribing information and the dispensing of these medications. (The monitoring system is still under development and will come into effect spring 2012). Through this monitoring, it will be easy to identify unusual trends as well as develop harm reduction strategies. It can establish who is double-doctoring, refill too soon and poly-pharmacy to name a few.
If you are a patient on these medications, when you ask for a prescription, it will have to be done in person. You will have to provide a valid form of identification both to the prescriber and the pharmacist. The prescriber will have to completely identify themselves with their College registration number. All of this information will have to be recorded on the prescription accurately.
So what happens with this information? Well, the ministry can now identify patterns of inappropriate or excessive use and implement a province wide system of alerts. It allows the ministry to share that information to regulatory colleges and law enforcement authorities. At present the ministry is working with the Narcotics Advisory panel to examine what kind of health information it could share with providers. Similarly a physician who appears to be practising in a manner that raises alarm could also have their information provided to the regulatory college.
Ontario's Narcotics Strategy includes exploring opportunities to provide additional support for the treatment of addiction. The ministry currently provides funding for a number of substance abuse treatment programs, including withdrawal management, community counselling and residential treatment and support services. Additional information on specific treatment programs can be accessed on the Ontario Ministry of Health website.
Got a pain? Take a pill. Increasingly, we have become a nation of avid consumers of strong narcotic pain relievers - drugs like oxycodone, fentanyl and morphine. A recent survey found Canadian pharmacies filled an astounding 17 million prescriptions for opioids last year! This country is one of the world's top per capita users of prescription narcotics. In Ontario alone, prescriptions for meds containing oxycodone have risen 900 per cent since 1991.
Are we really in that much pain?
Yes - chronic pain is a growing problem, particularly as our population ages. Back pain and headaches are two common reasons why people are prescribed with narcotics.
The problem is they're highly addictive when given to poorly selected patients
The other problem is they're popular on the street. Drug users chew, melt and inject long-acting OxyContin - to get an immediate and intense high. So intense, it can and does kill. Non-medical use of opioids is now the fourth-leading form of substance use in Canada, behind alcohol, tobacco and cannabis.
Later this month, White Coat will take its microphones on the road to discuss the issue. In advance of our town hall, we'd like to hear from you.
We want to hear from patients who was prescribed pills for pain, and now can't seem to stop taking them. We want to hear from family members of patients.
We want to hear from physicians who have prescribed opioid pain relievers and who have seen not just the benefits but the harms of doing so.
We also want to hear from pharmacists who in some cases are reluctant to dispense medications prescribed by doctors.
Call our vox box 1-866-648-6714. You can also email us at firstname.lastname@example.org, or contact us through Facebook or Twitter. We realize this is a sensitive issue, so if you do get in touch, please let us know your name and how to reach you -- but we won't use your name on the air unless you're comfortable. We'll share some of your comments and questions during the taping of our upcoming town hall.
Melissa Schippers, 15, of Gatineau, Que., suffers from complex regional pain syndrome, a chronic pain condition that, in Melissa's case, causes intense burning, aching and stabbing pain in her feet at her home in Gatineau, Que., Aug. 5, 2011.
Melissa Schippers once asked her doctors if they could amputate her feet to stop the pain.
Even now, more than a year after her toes, ankles and knees turned suddenly purple, almost black, during the last few days of Scout camp, her doctors can't tell her when the pain will end.
Her feet and ankles are swollen, the skin pink and splotchy. Some days it seems as if the skin might burst. She walks on the outside edges of her feet, to keep the pressure off. This summer, while painting a mural on the side of her backyard shed, the artistic teenager from Gatineau, Que., was hit by electric-shock-like pain in her feet that was so intense she fell to the ground. Slowly she crawled on her hands and knees to the sliding back door to the kitchen, taking breaks when she had to, and when she finally made it inside, she collapsed on the floor, waiting for the worst of it to be over...
Psychologist Dr. Steve Munsie displays some of the pain-killer medications that he has to take daily to manage the pain from chronic kidney stones at his home in Laval in Montreal, Quebec on Friday, September 23, 2011.
Steve Munsie thought the pain was going to kill him.
Later, he became afraid it wasn't going to kill him.
Munsie was born with three kidneys - two on his left side and one on his right. He suffers from chronic kidney stones. When he was younger, he produced one or two stones a year.
Today, he produces as many as 30.
There are days he has virtually no pain and there are days the pain is so intense it makes him freeze up in agony.
Margaret Bristow spends most of her time in her Ottawa apartment dealing with fibromyalgia and neuropathic pain. Most days, such as on this Sept. 14, 2011 morning, her pain is a seven on a scale of 10, and there are days she can't walk more than a few steps. She has to survive on less than $10,000 a year in disability pension. She is tired all of the time.
As long as the pain holds steady, Maggie Bristow can function.
She can dress herself; she can tie her shoes and brush her hair. She can make a meal. She can walk more than 30 steps without the pain in her hips crippling her.
But even then, the 51-year-old Ottawa woman can't bear to have her arms or legs touched, and when the pain spikes, it feels as if someone has peeled away her skin, and every nerve ending is exposed. She can't even stand to have clothes on.
Because there is no objective way to measure chronic pain, people who suffer from it often struggle to convince others that their pain is real.
Three months after breaking the fourth cervical vertebra in his neck in a freak hockey accident at the age of 17, Kurt Gengenbach began experiencing a new and spectacular kind of torment.
He started feeling pain in his left pectoral muscle - a constant burning, pins-andneedles sensation that slowly spread to his right shoulder, across his chest, down into his abdomen and finally through his legs and into his feet.
Gengenbach is a quadriplegic. He cannot move his arms or his legs. But he can feel pain. His ankles feel as if they're bound in thick, bonecrushing casts. A Kleenex against his bare shoulder can feel like a blowtorch. The skin on his chest is so hypersensitive he can't breathe deeply to relax when the pain hits, the way his therapist told him to, because expanding his chest makes his skin stretch, and it's torture. "Basically I'm paralysed by pain," he says...
Cathryn Morgan wrote an award winning children's book and is a former teacher in Ottawa who lives with pain daily. Cat was injured in a car crash in 2004. She suffers from severe neck pain, muscle spasms, headaches and fatigue and sees seven specialists (including a neurologist, pain specialist, psychologist and physiotherapist) to help control her pain. She was photographed at her home in Ottawa Wednesday July 13, 2011.
After the accident, Cathryn (Cat) Morgan's neck felt as if it had been smashed down between her shoulders.
Even now, seven years later, it feels as if her neck is on an angle, as if she's always looking left - the way her head was turned at the moment of impact. Her left shoulder usually feels as if it's up around her ear, and she still has that "shoved down" feeling of her neck into her body - that "turtle in the shell" feeling.
Morgan was on her way to her brother's anniversary dinner when she was hit by another car in a parking lot thoroughfare. Her head went back hard against the headrest, then there was a jarring jolt when she hit the speed bump...
Source: The Medical Post
We have a dual tragedy: a large segment of the population who could benefit from opioids - and an epidemic of over-prescribing and abuse.
On a hot July morning, Dr. Alan Russell's patients amble in and out of his small, green office in Brampton, Ont., pouring out their histories of pain. Just before lunch, a petite blond woman turns up to see the physician because—after failed attempts to fix her T12—she finally has an appointment for another back surgery (facet denervation). "I am hopeful," she said, with a furrowed brow twisted by 18 years of chronic pain following a car accident. "I have to be."
Prior to becoming a patient of Dr. Russell's, a physician whose practice focuses on pain, she said other doctors told her to take Tylenol to alleviate the constant burning sensation in her back, which was exacerbated by movement. "It was a joke," she explained, describing how limited her life had become since the accident, how playing with her children and gardening were impossible feats. "It's almost like there's a taboo against people like us, like (doctors) think we're lying, making it up.
Doctors divided over opioids
"I always felt like I was ignored and disregarded." Now, under Dr. Russell's guidance, she's taking oxycodone (OxyContin), paracetamol/ acetaminophen (Percocet) and pregabalin (Lyrica). "These pills have allowed me a bit of interaction," she explained, noting that she can now garden for short periods of time. "Without my medication, I could do nothing at all." Her comments are echoed by the others who come to this Bramptom clinic to see Dr. Russell, a former Londoner who moved to Canada to practise medicine in 1970. Before meeting him, they say their chronic pain was undertreated, and tell of the difficulty accessing doctors who would listen to their complex cases, or give them drugs that were strong enough to manage their particular brand of agony. "I'm getting older but more and more people want to see me because no one (else) wants to see them," said Dr. Russell, now 74 years old. "A lot of people don't believe in chronic pain but it certainly exists, and the best treatment is pain relief with medication." Indeed, there are chronic non-cancer pain sufferers who, like his patient today, benefit from the well-managed use of prescription opioids. But in the face of Canada's "opioid epidemic," some of these people say getting adequate treatment is next to impossible. Theirs are the stories of chronic pain and opioids that we don't hear enough about, Dr. Russell said in an interview. Or as Dr. Angela Mailis- Gagnon, a pain specialist and professor of medicine at the University of Toronto, put it, "North America today faces a dual tragedy. On one hand, there is over-prescribing and inappropriate prescribing. On the other hand, there is serious under-treatment of many patients who can benefit from small or modest doses of opioids, with many physicians reluctant to prescribe even for the most worthy and legitimate cases." Per capita, Canada is the world's third largest consumer of opioids (after the U.S. and Belgium), and provinces across the country, such as Ontario and Alberta, have recorded particularly acute problems. Between 1999 and 2006, oxycodone-related deaths increased nine-fold in Ontario. A recent coroner's report in the province also revealed that in 2008, almost three deaths each week were caused by oxycodone toxicity—levels that remain about the same today. At the national level, a 2011 report for the federal department of justice on prescription opioid misuse, harms and control, said non-medical prescription opioid use is estimated to be the fourth most prevalent form of substance use after alcohol, tobacco and cannabis. But this wasn't always the case. Dr. Mailis-Gagnon explained that in late 1980s, the drugs gained wider use when well-known cancer doctors suggested that opioids were not only effective in cancer patients, but could treat some chronic non-cancer pain patients as well. Around that time, pharmaceutical companies began to heavily advertise the benefits of prescription opioids. "Education regarding opioids was almost exclusively left in the hands of industry and physicians versed in pain who felt very comfortable prescribing and advocating the liberal use of opioids," Dr. Mailis-Gagnon said in an interview. "Gradually many practitioners felt very comfortable prescribing opioids for all kinds of indications and with little knowledge of the potential risks and long-term effects. "It is only over the last five to seven years that opioid abuse, misuse and risks including deaths, started becoming apparent in North America, with numerous studies in Canada and south of the border recognizing the risks and harms of prescription opioids and that over-prescribing is one of the factors contributing to this." In fact, according to IMS Brogan, the number of prescription opioids dispensed from Canadian retail pharmacies climbed from some 14 million in 2006 to over 17 million in 2010. Yet, Dr. Benedikt Fischer (PhD), professor in the department of health sciences at Simon Fraser University, said the increasing awareness about the potential dangers of these drugs has also had a "chilling effect" on prescribing by some physicians. "Healthcare providers realized there's some over-prescribing going on, and with increasing scrutiny and regulation, I think there's some hesitation among medical practitioners (to prescribe opioids), which is of course not the effect we want," he told the Medical Post. A recent report on chronic non-cancer pain in the March 2011 Canadian Family Physician stated that while there may be a number of primarycare physicians (around 40%) who are unwilling to prescribe opioids, there is also a substantial number of physicians who prescribe them frequently, in high doses, and "for questionable indications." Still, the report stated, "many patients who could benefit from an appropriate prescription of opioids continue to be deprived of this option."
Danger on the frontlines
Those on the front lines report feeling at a loss about how to deal with patients on opioids. Dr. Sarah Giles, a locum family physician in Ontario and Western Australia, said she now finds it difficult to discern whether a patient is legitimately suffering from chronic pain and in need of drugs after having a few run-ins with opioid-addicted patients. "The only times I have ever been threatened in the office and the ER—with the exception of drunks—is from people demanding narcotics," she said. Working in small communities, she has faced backlash after attempts to wean people off the drugs, which has left her to draw this conclusion: "I'm not concerned that there is a whole bunch of untreated pain out there. From my experience, there's a whole lot of narcotics out there, and a lot of people who tell good stories who aren't necessarily in pain." Dr. Giles thinks Canada should follow Australia by implementing a program where patients who have been on narcotics for more than a year have to be seen by a pain specialist in order to continue their use of the drugs. "You're getting a second set of eyes," she said, flicking at the lack of support she feels family doctors get in dealing with pain patients. "This way, pain specialists can say, 'I have seen your patient, I have given them a nerve block, I will follow-up on them.' " Dr. Giles' comments reflect the tensions within the profession that have emerged around the subject of opioids. Dr. Mel Kahan, an addictions specialist with the University of Toronto's department of family and community medicine, said he sees any chilling effect that might be happening now as a reaction by family doctors to that early advertising campaign. "Many of them are reluctant to prescribe opioids, even in small doses. They say it's easier not to prescribe at all." But even Dr. Kahan, who is critical about the use of opioids, said he doesn't agree with a "blanket rejection" of these drugs. "I think family doctors have a right to say, 'I'm going to prescribe safely.' "The profession is divided on this: not just family physicians but pain specialists as well." These divisions also illustrate the fact that the question of how and when to prescribe these drugs is a difficult one. Dr. Mailis-Gagnon noted that long-term randomized trials over three months do not exist; "however, longterm epidemiological studies indicate poor outcomes for chronic opioid users in 10-year followups." She added: "There's no question that some people benefit from opioids, but the question is who?" Dr. Norm Buckley, director of the Michael G. DeGroote National Pain Centre at McMaster University in Hamilton, is trying to answer just that. He has been overseeing the 2015 update of Canadian opioid guidelines. "There are clearly indications for using the drugs, where it's appropriate," he said. Indeed, like other physicians who deal with chronic pain, Dr. Buckley said he believes opioids are the most effective drugs we have to treat it. Yet he feels the problem of misuse is the result of health professionals not getting enough information about how to use the drugs safely and appropriately. "It's unacceptable to say, 'I'm not going to prescribe x, y, z because I don't like it.' Opioids have dangers. But it's not clear that the dangers of using opioids are any different from the dangers of any other drugs." Dr. Buckley's hope is that primary-care doctors will employ the forthcoming guidelines as a tool to assess patients' needs, and not "fall back on the old argument that the college will come and investigate me." Another key to helping doctors feel more equipped to deal with pain patients who may need opioids will be the implementation of a comprehensive pain strategy, said Dr. Mailis- Gagnon, who served as the cochair of the Chronic Pain Task Force of the College of Physicians and Surgeons of Ontario and helped to create the 2010 Canadian guidelines for the use of opioids for chronic noncancer pain. She would also like to see the Royal College of Physicians and Surgeons of Canada go ahead with the creation of a pain subspecialty, so that agreed-upon standards for the profession can be enacted. Meanwhile, others believe a more hands-on approach to the problem is necessary—for example, creating a special fee code that allows doctors to be reimbursed for in-office urine drug screens, and implementing electronic systems in every province that allow pharmacies to see whether a patient's opioid Rx has been filled at another shop. For Dr. Russell, it's as simple as supporting the doctors. He would like to see some kind of mechanism by which doctors could break confidentiality to report patients who are trying to scam the system. "It's the only crime where if you get caught, you can't get charged. No one is helping the doctors," he said. For now, he added, "There is no doubt chronic pain is the worst treated illness out there. We need to do something to make this better."