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This effect has been measured with laboratory mice as well. Scientists have done experiments in which they place a mouse’s tail on a hot plate and then slowly turn up the temperature to see how hot it gets before the mouse feels pain and flicks its tail off the hot plate. When mice are given opioids, they tend to flick...
In some patients, the pain medications may help to reduce the pain of their initial injury but wind up making their overall pain situation worse.
Sibell said that despite a worsening of their condition, patients are reluctant to give up on pain medications and medical procedures in part because that’s been the promise of medicine for hundreds of years, that doctors can fix what’s broken, can address what’s wrong and restore the patient to their original state.
But the hope of a fix, the dream of being pain-free, is a seductive one, and one that patients aren’t willing to give up easily. Sibell had one patient who was scheduled to have his 14th back surgery. Each of his prior 13 surgeries had made his situation worse.
“Well, I have hope for this one,” he told the doctor.
“For someone who is basically living in a state of suspended animation, there is no reality check,” Sibell said.
He saw another patient who was taking 13,000 milligrams of Tylenol per day, a massive dose that put him at severe risk for liver failure. When the patient admitted it wasn’t really helping him, Sibell asked him why he continued.
“Because you have to do something,” he replied.
Once More had his diagnosis, his life changed dramatically. He had been on opioids for two to three years but was becoming increasingly concerned about what they were doing to him.
Convinced the drugs were no longer helping him, More decided to quit cold turkey.
The opioids were a backup plan, a crutch that he knew he had to discard or he would wind up using.
Many chronic pain patients simply can’t come to grips with the notion that their opioids might be making them worse or to conceive of giving them up. Patients often say that medication is the only tool they have to manage their pain.
Sullivan and his colleagues at the University of Washington recently published a small study in The Journal of Pain showing that patients who underwent a support program to help them taper off of their drugs wound up with less pain and were less likely to have pain interfere with their lives. They had a lower risk of l...
Patients remember how great it felt when they started taking opiates and are always seeking that feeling again. But when asked if their pain level or functional status is any better after being on opioids for months, most say it is not. With long-term opioid use, the patient’s condition begins to look more and more lik...
Clauw estimates that only 20 percent of chronic pain patients may be getting any benefit from taking opioids. The rest are exposing themselves to major risks and may be making their condition worse.
Many of the drugs that are now used to treat the brain pain in chronic pain patients have come out the fibromyalgia world. Antidepressants like Cymbalta (duloxetine) or Elavil (amitriptyline), and muscle relaxants like Flexeril (cyclobenzaprine) work by affecting those top-down natural opioid pathways that can minimize...
And doctors have found that when patients respond to those drugs, they usually see multiple symptoms improve, whether that be insomnia, depression, anxiety or pain.
Studies showing that Cymbalta worked for peripheral nerve conditions such as low back pain and osteoarthritis were a watershed moment for the chronic pain field, showing just how big a role the volume control aspect played in chronic pain.
In 2003, Michelle Marikos fell off a two-story porch at a party in Chico, California, pushed over the edge by a drunk sorority sister. With three crushed vertebrae in her neck, she came within a fraction of a millimeter from paralysis if not death. She spent the next six months at her home in Ashland in a brace to immo...
She wanted to have a second surgery on her neck, but doctors said they couldn’t do the surgery unless she reduced her daily dose of pain medications. She enrolled in a six-week chronic pain management program at the Mayo Clinic in Rochester, Minnesota, that would help her taper off the opioid drugs.
Outside of pain medicine, health care providers often have little else to offer patients. Primary care physicians struggle to manage chronic pain within a 15-minute appointment, and nothing is more efficient than writing out a prescription for a pain medication or increasing the dose if it doesn’t work.
Specialists may have more time to spend with patients, but their tools are generally limited to physical fixes: the surgeries and procedures that are mostly ineffective for centralized pain.
Patients in chronic pain are like a car with a check engine light that won’t turn off. Mechanics can take apart the engine searching for the problem, but in the end, it may just be the warning light system that’s malfunctioning.
Meanwhile, insurance plans will cover pills and procedures but often balk at ongoing physical therapy, acupuncture, chiropractic work or various types of behavioral therapy that have shown to be effective in reducing chronic pain. And many of those services are simply not available in rural communities, leaving doctors...
But after two weeks of tapering, she realized things hadn’t gotten any worse. Before the class was over, she had already decided she didn’t need the surgery after all.
“If I was going to taper off these medications, I was not going to have the surgery, and go back on,” she said. “That was not something I wanted to go through again.
Marikos learned techniques to help manage her pain, avoiding the boom-and-bust cycle that chronic pain patients often fall into. They overexert themselves when they are feeling good, causing a flare-up of their symptoms and putting themselves out of commission for days. When they recover, they feel the need to catch up...
Now she counsels other patients with chronic pain, helping them break their own cycle of dependence on medications. She tries to sell them on the notion that their road to a better life might start with abandoning opioids.
But once patients understand the pain medication is actually making their pain worse, the decision gets much easier.
Many providers ask patients to sign pain contracts to continue receiving opioids, and those pacts often require patients to try physical therapy or pain management classes. If patients see that alternative pain management strategies can work, they might be more amenable to tapering off their drugs.
But she’s also had many patients ask if they can attend the class again. Safford, who runs the pain classes in Bend, said most patients who attend want to learn better techniques for managing their pain and would rather be off of their pain medications.
Many chronic pain patients have a long list of experiences where doctors, family and friends have doubted their pain. Doctors will tell patients they have good news, the results of the X-ray or MRI shows everything is normal.
For many, the suggestion they should cut back on or stop taking opiates sounds like people don’t believe their suffering is real.
Heesacker has been working with providers throughout the state on how to approach their chronic pain patients.
Chronic pain patients are so used to having their pain discounted, they often feel the need to exaggerate their pain to ensure doctors won’t ignore it. When asked to rate their pain on a scale of 1 to 10, where 10 is the worst pain imaginable, patients sitting calmly in a chair rate it as an 11.
“They’re saying, ‘Please validate me,’” Heesacker said.
She’s sat in on many appointments where providers have told their chronic pain patients they want them to taper off their drugs. In that moment, patients often freak out, she said, reacting as if a Band-Aid is being ripped off of their pain.
It’s incumbent on the doctors, she said, to believe in their patients and help them understand that they’re not being pawned off on some subpar treatment because they have illegitimate pain.
Consider the diagnosis of osteoarthritis, a painful condition that results when the cartilage in the knees, hips or back wears away, leaving bone to rub against bone. Because cartilage doesn’t show up on X-rays, doctors suspecting osteoarthritis of the knee look for a gap between the femur and the tibia.
Until recently, osteoarthritis was thought to be a classic peripheral pain condition, where the degree of damage or inflammation that can be seen on an X-ray and MRI would predict who was experiencing pain and who was not.
“That’s turned out to be almost entirely wrong,” said Dr. Daniel Clauw, a pain expert with the University of Michigan.
What doctors have learned, he said, is that 30 to 40 percent of people with no visible gap on their X-ray who should be in pain are not, while 10 to 15 percent of those with clearly defined gaps have severe pain.
So when patients present with a normal knee X-ray but are feeling pain, there’s nothing for their orthopedist to fix. Doctors then tell patients there’s nothing more that can be done, or worse, that it’s all in their head.
That’s another way that chronic pain differs from acute pain. Understanding the process is a crucial component of the solution. You can understand why a torn ligament in your knee causes pain, but it still requires a physical procedure to fix it. With chronic pain, understanding the process helps to interrupt the cycle...
Moseley’s group in Australia has conducted randomized clinical trials that show chronic pain patients who understand the notion of brain pain sleep better, worry less, have less pain and are more likely to be employed full time.
Brock Monger, a physical therapist with Apex Physical Therapy in Madras, has seen many patients come through his door skeptical that physical therapy will help. They’re there only because it’s a required component of their pain contract. Others are scared that any little movement will leave them hurting.
Monger seeks to discover what those patients really miss doing in their lives and to find a way to get them moving toward that goal, both literally and figuratively.
The mainstays of the new approach to treating chronic pain are improving sleep and exercise. Opioids have a sedative effect that leaves patients groggy, but they often lead to disordered sleep.
A 2014 study of patients at a Veterans Affairs medical center found that individuals with chronic pain taking opioids were more likely to have sleep apnea, impaired sleep and worse sleep quality than chronic pain patients not on the drugs. They were also more likely to report severe pain or depression.
Chronic pain management programs focus on techniques to improve sleep quality and strategies to quiet anxieties that may be keeping patients awake. Combined with a reduction in the opioid dose, the approach has been shown to improve sleep quality in 80 to 90 percent of chronic pain patients.
Pain management classes also strive to get patients moving. Patients often lose function over time because they are afraid of triggering a flare-up of their pain. But that lack of exercise only leads a deterioration of their condition, and puts that at risk for worse pain.
Patients are also taught self-management or mindfulness techniques that can calm their brains and quell anxieties, keeping that hypersensitivity and brain pain at bay.
“There’s been a shift from this idea of trying to fix chronic pain and make it go away, so really how do you manage it, how do you improve your quality of life?” said Scott Safford, a pain psychologist with St. Charles Health System in Bend.
To help clients get moving, he works with them at the pool, where every gallon of water that someone displaces takes 8 pounds of weight off their achy joints. The pressure of the water provides a steady, calming compression on their muscles, helping to modulate the pain signals coming to their brains. There’s an ease o...
Angela Cruse has been dealing with pain for more than 30 years. A fall in the shower in 1984 led to a diagnosis of a slipped disc and put her in traction, with two 100-pound weights pulling on her body in an attempt to realign her spine. In 1996, she slipped on a wet landing at work and woke one morning several months ...
In Madras, her new doctors were concerned about how many medications she was taking. They lowered the dose on her morphine pump and sent to her to physical therapy at Apex. Cruse had benefited from pool therapy in California, so she eagerly resumed pool work with help from Monger.
She’s now down to only 20 Percocet a month, using the medication only for breakthrough pain. It’s allowed her to get back to gardening. She’s adopted her 16-year-old granddaughter and enjoys throwing the football with her 8-year-old grandson.
Not all patients will be able to completely eliminate use of opioids. The goal of physical therapy and pain management programs is to reduce dependence and improve quality of life.
For patients who go through the process and come out the other side taking fewer or no medications, the transformation can be extraordinary. They emerge from the cognitive fog that has been clouding their lives.
More first visited Suran shortly after stopping his medications, and learned from her some of the techniques for quieting pain used in an approach called Feldenkrais. It involves gentle movements and directed awareness to build mindfulness.
Early in her career, Allison Suran, a physical therapist with Healing Bridge in Bend, asked physicians to send her patients who hadn’t done well with traditional physical therapy. She suggested that they could try the Feldenkrais method she uses instead.
“What I realized right away was I might as well have been saying, send me your chronic pain patients,” she said.
Feldenkrais relies on gentle movements and directed awareness to build mindfulness that can help patients calm their minds and avoid flare-ups. It’s a far cry from medical approach many of her patients are used to and some just aren’t ready to accept the alternative approach.
Suran starts her Calm Your Pain course by explaining to patients that their brain has changed, that they’ve learned patterns of stress over their lifetime that have now been ingrained in their body and their brain. For some patients, the light never comes on.
But for those who can flip the switch, who can abandon the physical explanation of their pain and embrace the brain pain construct, they can see results remarkably quickly.
“There are amazing things that happen in the body when people have hope,” she said.
A friend bought him a gym membership and More started walking on a treadmill, relearning how to walk in a way that keeps his pain at bay. He starts each morning soaking in a hot tub, which allows him to then transition into walking. Sometimes he still dreams of a fix, but he’s coming to grips with the reality that ther...
He’s talked about moving back to New Jersey to be near his family. He worries about not contributing financially at home.
Markian Hawryluk produced this special report as part of a yearlong Reporting Fellowship on Health Care Performance sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.
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Wouldn't it be great if you could simply refinance your own high-interest mortgage, without going through a bank or paying closing costs?
In a way, you can, says Keith Gumbinger of HSH.com, a Riverdale, New Jersey, mortgage research firm. His theory is that you can lower your effective interest rate by pre-paying the loan. That's a strategy that might be especially useful for homeowners who can't refinance or who have a low balance left on thei...
Gumbinger has devised a couple of new calculators that can help homeowners figure out how to do this and whether they want to. One, the PreFi Calculator () will calculate the effective interest rate that results from paying a fixed extra amount every month. The second, called the LowerRate prepayment calculator, can de...
To be clear, pre-paying your mortgage doesn't really lower your interest rate. But what it does do is reduce the actual dollar amount you pay in interest over the life of the loan, so you end up paying the same amount in interest that you would if you had a lower interest rate.
Here's an example: Say you have 12 years left to pay off a 30-year fixed-rate mortgage that started out at $250,000 and carries a 6% interest rate. You've already paid off $227,355 and only have $62,241 left to pay.
With such a small amount left, you'd have a hard time finding a lender willing to write you a refi loan. Furthermore, with closing costs running into the thousands, you'd have trouble saving enough interest on the refinance to justify the closing costs.
But if you paid an extra $200 a month, you'd burn the mortgage two years early and save $10,925 in total interest costs. The total amount of interest you would pay - $51,318 - would be equivalent to the interest you would pay if your interest rate for the remaining 12 years were 5.36% instead of 6%.
So, you're not technically lowering the interest rate, but you are reaping similar savings. The question is, do you want to do that? Here are some considerations.
-- The strategy fits a narrow category of homeowner. Picture someone who can't refinance an older mortgage, has a high interest rate and wants to get out from under the loan to free up cash for college or retirement.
-- The same old calculus applies: If you can make more money investing than you can save by paying down the mortgage, you're probably better off not paying off the mortgage early. Even a 6% mortgage costs only 4.5% a year if you're in the 25% tax bracket and deduct interest, says Greg McBride, senior financia...
-- You will lose some financial flexibility. "When you take liquid cash or sell other investments to pay off a mortgage, that money's gone," says McBride. "You can't get to it if you need it for an emergency."
-- There may be better things to do with your money. If you've already maxed out contributions to your 401(k), your individual retirement plan, your kids' 529 college savings plan and your emergency fund, and you have no credit card balances, then by all means think about pre-paying your mortgage. But all of ...
-- Having the data helps either way. It's worth using the HSH calculator or a similar prepayment calculator to determine how much you would save by prepaying extra principal every month. Once you get that information, you can compare it to the savings you would see if you refinanced instead. Ultimately, that'...
ALTO, TX (KLTV) - Work is underway in Cherokee County to prepare for another round of potential severe weather on Wednesday night and Thursday morning.
'We're all keeping an eye on it," Pastor Ron Rose said. "It's one of our biggest concerns."
Rose is the pastor at The River Church in Alto and says those who need a place to stay on Wednesday can stay at the church.
“We have a Christian school behind us,” Rose said. "Which is more substantive than a metal building. Matter of fact, we sheltered over there during the last tornado.
"Folks need to prepare," Sergio Serbian, emergency manager, said. "People need to know we do have some potential severe weather coming and they need to have a plan and seek shelter."
Serbian says right now the call is out for more tarps to help cover homes around town and across the county.
"Some of the homes are completely gone, but we want to make sure we try to save those that have a chance," Serbian said.
Tarps can be dropped off at The River Church along HW 69 in Alto. The tarps will then be handed out to volunteer work crews to cover homes.
Three FARC leaders were killed in a bombing raid on their camp in the western department of Choco, according to a report by W Radio.
The attack was carried out by Colombian police and military on the camp of the 57th Front near the border with Panama. Of the reported killed is alias “El Becerro,” who supposedly coordinated security for alias “Mono Jojoy” and is suspected to be key in the financial operations of the guerrilla organization.
Details of the attack and the identities of the supposed dead have yet to be confirmed by the government.
An article on Thursday about President Trump’s rally in Cedar Rapids, Iowa on Wednesday, referred incorrectly to his return to the state. The trip was his first since the inauguration, not since the election.
An article on Thursday about the producer and D.J. Laurel Halo misidentified the nationality of the producer Klein, one of her collaborators on the album “Dust.” She is British, not Nigerian.
An obituary on Sunday about the anthropologist Ben Finney referred incorrectly to the crowd that greeted the arrival of the Hokulea, the sailing canoe whose construction he oversaw, in Papeete Harbor in Tahiti in 1976. The crowd, of some 17,000 people, was more than half the population of the city of Papeete — not of a...
An aerial picture taken on board a helicopter shows a view of the Iraqi capital Baghdad on June 23, 2014.
Gunmen stormed into a Baghdad mall on Monday after setting off a car bomb and launching a suicide attack at its entrance, killing at least 18 people and wounding 50 in the city's mainly Shiite east, Iraqi officials said.
ISIS claimed responsibility for the attack in an online statement.

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