Chronic Non-Malignant Pain Opiate Options

You got pain?  Take a pill to ease the strain.  Chronic nonmalignant pain affects everyone.  It can be a major cause of personal and family distress.  In addition to the pain of pain many live with secondary effects such as depression which leads to family chaos, work absenteeism, and decrease in activities of daily living to the point of depression.  Prescription medication like nonsteroidal anti-inflammatory drugs (NSAIDs include ibuprofen, naproxen, celebrex and more) and opiates (oxycodone, hydrocodone, codeine, morphine and more) are the gold standard for acute and chronic pain management.  Once you have seen the doctor you are most likely to get one or both of these depending on the etiology of the pain.  Once the cause of the pain is found and treated the need for pain medication may cease.  If this fails to work, the pain meds continue.  This can be a hazard to your health.

In 2012 there were about 183,000 deaths worldwide.  In 2014 there were over 47,000 lethal drug overdoses making it the leading cause of accidental death in the United States (2012 statistics: United Kingdom: 3,200, South America/Latin America/ Caribbean: 7300, European Union: 6100, Oceania: 1900).   This exceeds the number of deaths in road accidents in most countries. Research from studies done in 2013 revealed that opioid analgesics were the primary cause of most drug overdoses in the United States.  Over three-quarters of these deaths were accidental or unintentional.  Opioids (75%) were the most common drug followed by benzodiazepines, antidepressants, and antipsychotics.  Prescription pain relievers accounted for over 18,000 overdose deaths.  Misuse of these medications often leads to illicit heroin use.  Why?  It is easier to get and less expensive than prescription opioids even though the rate of prescribing opioids has almost tripled since 1994.  This has increased the mortality rate from overdosing over 400% in women and over 200% in men from 1999 to 2010.

Pain can be managed in ways that use less prescription pain medicine.  The pill may be the easiest way and is usually the first thing a patient is offered.  There are many options to finding relief while decreasing your risk of opiate dependence or overdose. Your doctor can do the following:

• advise on other treatments and refer to appropriate specialists
• discuss risks, side effects, etc of prescription pain drugs
• educate, provide resources for education on the diseases, pain management (articles, books, videos, agencies like Partnership for Drug Free America)
• prescription drug monitoring (doctor-patient contract, drug tests)
• use of non medicinal treatment
• identify risky drug use patterns
• require visits for refills
• referral to pain management specialist
• behavioral therapy consult

Opioid dependence and overdose can be prevented.  Using opioids responsibly is the patient’s responsibility.  It is up to you to recognize what these types of drugs can do to you.  Relief of pain is the objective; however, the addictive potential must be taken into consideration.  It is important to get a correct diagnosis of the pain as there is probably non opiate treatment that can make it tolerable or resolve it totally.  Make opiates the option instead of the treatment of choice.  Best health!

Personalized Precision Medicine

As we look forward to medical breakthroughs of the future, precision medicine becomes more of a reality in your medical care. Precision medicine uses treatment and intervention based on a person’s genetic and non-genetic (e.g. lifestyle, environment).  Unlike the present but ever changing protocols for wellness and disease management that are used on everyone, precision medicine is individualized just for you.  It will be your own prescription for staying well and treating your ailments. 

The basis of precision medicine is genomics.  Sequencing of your genome is done.  This molecular process identifies normal and abnormal genes.  Genomic mutations are studied and tested for different characteristics.  The results of this testing allows for prevention, diagnosis, and treatment based on your molecule makeup within your genes that have been influenced by family history, lifestyle, and environment.  DNA analysis of your genes in addition to a thorough history and physical will help your doctor determine what you have and what health risks may be present.  This information will then be used for further diagnosis and treatment.  Prevention of conditions that you are prone to develop may be less likely to develop if at all.

Precision medicine has become prevalent in drug treatment as well as disease diagnosis.  Clinical pharmacogenetics makes use of patient’s genetic data as a guide for drug therapy.  This information can then help your doctor pick the right medication for you. Pharmacogenetic information for blood thinners like coumadin and clopidogrel can be helpful in choosing which will work best for you with least complications.  Neonatal (newborn) diabetes and mature onset diabetes of the young (MODY) are rare causes of diabetes.  The cause of these types of diabetes is from an inherited mutation of one gene (monogenic).  Genetic testing can make the correct diagnosis that would otherwise be missed or misdiagnosed.  Some cancers have specific gene mutations that can be detected and treated successfully based on this information.  Drugs are made to target these and eradicate the cancer.

Thousands of disease genes and genetic tests have been discovered since the Human Genome Project of 2003.  As costs go down and precision medicine improves, personalized medicine will get more precise.  Prevention instead of treatment will be more likely.  Genetic tests and treatments for the individual will be precisely what the doctor orders for you.  Best health!

High Blood Pressure: How Loud It Can Be

High blood pressure (HBP) is louder than you may think.  Often called the “silent killer”, hypertension has symptoms to let you know it is present.  Symptoms may include headache, dizziness, fatigue, weakness, blurred vision, seizures, unexplained anxiety, and more.  Though nonspecific these signs and symptoms do correlate with high blood pressure. If you have a family history of HBP and heart problems, it is very likely the symptoms will be present. Untreated hypertension may lead to more serious conditions like heart attacks and strokes.

When you experience symptoms suggestive of hypertension, it is important to get it checked.  This should be done by a health care professional, but can be done at home, also.  Consistent readings above 140/90 call for assessment and treatment.  A complete physical exam, complete blood tests, and EKG should be done to check for overall good health and findings that are seen with hypertension. 

On physical exam the eye exam may reveal retinopathy and artery narrowing.  This is associated with decreased vision and can proceed to blindness.  Bruits over the carotid arteries in the neck and over the abdomen area suggest vascular disease that can block the arteries off.  This can lead to strokes, chronic kidney disease, peripheral vascular disease (poor circulation in legs), sexual dysfunction and more.  Heart findings and EKG changes can show signs of heart disease that accompany hypertension.  Blood tests provide further information and can even help assess if there are secondary causes.  Your doctor correlates all the information to assess a treatment plan. 

Initial therapy includes lifestyle changes like a healthy, nutritious diet, good sleep, low stress, and exercise.  If your blood pressure reading consistently remains elevated medication may be needed.  This may be temporary or lifetime depending on your lifestyle health habits.  For example, weight loss and eating the right foods especially those known to decrease blood pressure, can totally eliminate the need for medication and its side effects that can create new chronic problems. The best part is that you will feel better, and hopefully prevent any problems from untreated high blood pressure.  Best health!

Chronic Disease: Controlling the Incurable

Chronic disease affects more people as they age. It will affect everyone at some time in their life. Over 80% of the health costs worldwide are incurred by 20% of persons with one chronic disease or more. Chronic disease is defined as any illness that lasts more than three months, and/ or is recurrent. This includes such diseases as morbid obesity, arthritis, heart disease, diabetes, depression and many more. Most primary care doctors and family physicians see more patients with chronic diseases than any other health conditions.  The initial visit of the majority of patients seen on first visit have at least two or more chronic conditions.


Chronic disease management begins first and foremost with knowing as much as you can about the diseases that affect you.  Research yields information that strengthens your knowledge base of cause, effects, and what can be done to make it better or even preventable.  There are many evidence-based treatments that work, but some may help you more than others if at all.  For example, low back pain may be helped with hot or cold therapy, massage. acupuncture, spinal alignment. epidurals. medication and more.  Your spouse benefits from cold therapy and massage which hardly helps you. Hot therapy and acupuncture improves your pain and function, but not that of your spouse.  You must find what works best for you.  Ask your doctors for different treatments other than those they order as well.


Chronic disease responds favorably to a nutritious diet.  With medication noncompliance over 50% for whatever reason, you eat daily which allows for good, healthy food. Many foods have medicinal qualities that help control disease processes while keeping the healthy parts healthier.  Cooked dry beans are the perfect example.  They can provide as much as 9 to16 grams of fiber and 15 to 25 grams of protein in one-fourth cup  (60 to 150 calories).  A 14 ounce bag can yield about eight to ten cups at a cost of less than $2. Eaten alone or in other dishes, beans have powerful potent antioxidants that overpower cellular oxidative stress of chronic disease states.  High fiber is good for so many chronic problems such as heart disease, high lipids, diabetes, hypertension and more.  As you decrease processed foods in your diet, and add more fresh food your body responds with lower blood pressure, less pain, less overall stress, and good feelings of good health!


As chronic diseases progress especially with aging, many people move less.  Less movement opens the door for more chronic disease, and worsening of any you may already have.  Daily motion is the magic potion lotion.  Movement in activities of daily living count, and exercise helps.  At least ten minutes per day helps.  At home exercise programs work and are less stressful than going out.  Fancy home gyms with exercise equipment are nice but unaffordable for many.  Sitting, standing or laying you can do arm circles, leg raises, torso twists, and more.  Walking in place also works.  This type of activity improves physical and mental status to better.


You can control chronic diseases by choosing that which helps what you have.  Controlling the incurable involves routines designed for you.  This in itself improves overall quality of life and gives positive personal satisfaction that helps mental issues that may become chronic in themselves.  Best health!

10 Money Saving Medical Tips

You are your most important asset. Saving your health saves you money. These money saving medical tips can help you do both.

• Keep your health insurance coverage. This is as important as your home and food. Cut expenses elsewhere to keep it in your budget. Let your doctor know if you do not have insurance coverage. Many offer discounts to the uninsured as do other health providers like hospitals and diagnostic centers.
• If you lose your job, get COBRA through your employer. You will have at least 18 months of coverage. You will have to pay for it. It is worth it.
• Be sure you are up to date on your health maintenance. Get in now for your physical and preventive tests (mammogram, blood tests, eye exam, shots, etc.).
• Check your medication, prescription and non-prescription. Review these with your doctor to discontinue any you really do not need, and/or can't afford. Let your doctor know if you are unable to afford any of your medication, so other options can be discussed such as drug assistance programs. Research them yourself on the Internet, and by calling or writing the drug company that makes your medication. Remember to include your non prescription medicines in your budget (like cough medicine, stool enhancers, pain relievers, etc.). Talk with your pharmacist.
• Discontinue unhealthy habits like smoking and excessive drinking. These items cost money and your health.
• If you become disabled, you can withdraw money from your IRA without paying the penalty and taxes. You may need this money to pay for present or future health costs. It may benefit you more while you are well enough to enjoy it. By the time retirement rolls around, you may not be around.
• Eat healthy small servings. Smaller portions of healthy food save your money and your health. Remember this when you eat out.
• Exercise at home. Save your money and time on that gym membership. You can reap the same and better benefits with a home exercise program with or without expensive exercise equipment. Turn on the TV and participate in the fitness shows that are best for you. Exercise DVDs and tapes are a one time expense that can be used again and again. Ride your bicycle, take a walk or jog in your neighborhood. It all counts.
• Continue your home exams like self breast exams, and self scrotal exams. You may detect something early. There is much controversy about the self breast exam, and it is no longer recommended by some. Common sense tells you that self detection is a smart thing to do.
• Save money for your health bank. As insurance companies and plans cover less, you will be paying for more for services and premiums. Keep a nest egg for health expenses.

Remember that YOU are your most important asset. Great health is true wealth!