From : Bio-Magnetic Therapy
If you're experiencing breakthrough pain, new fast-acting narcotics may offer control -- and pain relief.
By Jeanie Lerche Davis
Reviewed by Brunilda Nazario, MD
For people in chronic pain, sharp spikes of breakthrough pain can be a big problem. What causes it -- and how can you find pain relief? That's an important question for many patients, especially those with cancer.
"Breakthrough pain occurs when you're doing something that triggers extra pain, like getting up after knee surgery," explains Michael Ferrante, MD, director of the UCLA Pain Management Center. "Sometimes breakthrough pain just occurs, without any obvious trigger. In essence, it means the patient needs more medication to cover the chronic pain and another drug for the breakthrough pain."
For those taking narcotics, breakthrough pain might be a sign that the body is developing tolerance to the narcotic, Ferrante says. "Tolerance means you need to take more of the drug over time to achieve the same pain relief."
When a patient develops a narcotic tolerance, the doctor can increase the dosage to provide the same pain relief -- but the risk of side effects gets higher with the higher dose, explains Salahadin Abdi, MD, PhD, chief of pain medicine at the University of Miami School of Medicine.
"Instead of increasing the dosage of that narcotic, a good solution is to change to a different narcotic," Abdi tells WebMD. "You can then use a relatively small dose of the new narcotic to get the same effect. You can switch to yet another narcotic later on if you need to."
Drugs called NMDA antagonists (N-methyl-D-aspartate) have been another advance in narcotics for pain relief, says Rollin M. Gallagher, MD, MPH, director of pain management at the Philadelphia VA Medical Center. NMDA antagonists block NMDA receptors to stop or minimize opioid drug tolerance.
"NMDAs allow us to provide pain relief with a lower dose of a narcotic drug," Gallagher tells WebMD. " Opioids are very effective, very safe, because they don't damage organs like other drugs do -- but you can develop tolerance. NMDAs can help prevent tolerance." Meaning less drugs and better pain relief.
With cancer pain, an extended-release morphine drug is often prescribed for the underlying pain. A faster-acting narcotic is used to treat the breakthrough pain, Ferrante explains. These are potent, immediate-release narcotics often referred to as rescue medications -- to "rescue the individual from that pain," he says.
Actiq and Fentora contain the narcotic fentanyl, and are FDA-approved for breakthrough cancer pain in adult patients who are already taking other opioid medicines for pain relief:
Dilaudid (hydromorphone), MSIR (morphine), Oxycodone, and other narcotics can also be prescribed for breakthrough pain relief, says Abdi. "They work similarly, but depending on the severity of breakthrough pain, one may work better than another. These drugs act quickly, then disappear from the system relatively quickly."
"You want something that gets into the bloodstream fast," Ferrante tells WebMD. "That's what breakthrough medication does... you put it in your mouth, and you get a good dose real quick. For people with severe cancer pain, these are really good. They are serious, potent medications."
For less severe breakthrough pain, doctors prescribe two narcotics that also contain acetaminophen (the active ingredient in Tylenol): Percocet (with oxycodone), or Vicodin (with hydrocodone), he adds.
In the pipeline: Ferrante expects even better pain relief medications to become available -- administered via the nose or dissolved under the tongue. "These are excellent ways to get the drug in the bloodstream very, very quickly," Ferrante says.
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Researchers Say Pill May Cause Loupes
Researchers Say Pill May Interact With Genetic Predisposition to Slightly Boost Lupus Risk
By Kathleen Doheny
Reviewed by Louise Chang, MD
April 13, 2009 -- Women who take birth control pills, especially higher-dose versions, may have an increased risk of getting lupus, an autoimmune disease, according to a new study.
"Women who take oral contraceptives have a 50% higher risk of having lupus than women who don't take them," says study researcher Samy Suissa, PhD, a professor of epidemiology at McGill University in Montreal.
But to put that in perspective, he says the overall risk is still small. In the study, Suissa and colleagues also found the risk higher in women who take the higher dose pills -- those with 50 micrograms of estrogen or more -- and in women currently taking them who have just taken the pills for a few months.
The study is published in the April 15 issue of Arthritis & Rheumatism.
Previous studies focusing on a possible link between birth control pills and lupus have produced conflicting results, Suissa tells WebMD.
His study evaluated more than 1.7 million women, ages 18 to 45, who were in the U.K. General Practice Research Database, which includes more than 6 million people.
The women had prescriptions for combined oral contraceptives, which contain both the hormones estrogen and progestin. The researchers followed the women for eight years, on average, and found that 786 women had gotten a first-time diagnosis of lupus.
In lupus, something goes awry with the immune system, and the body produces autoantibodies that attack and destroy healthy tissue, according to the Lupus Foundation of America. Patients have inflammation, pain, and damage in various parts of the body.
Suissa's team matched up each patient with lupus to 10 people from the study database who did not have lupus when the patient was diagnosed.
They found use of oral contraceptives was linked with an increased risk of getting the disease. "I think we have clear evidence that these pills, especially at higher doses, can increase the risk of lupus," Suissa says.
But the contraceptive alone probably does not boost the risk, he says. "We think it probably interacts with some genetic predisposition."
While the overall risk of birth control pill use and lupus was boosted by 50%, or 1.5 times, Suissa says, the risk went up by 2.5 times among new users, during the first three months.
He also found that the higher doses of pills -- those with 50 micrograms of estrogen or more -- was associated with a higher risk of lupus than the lowest dose -- those with 30 micrograms or less of estrogen.
Those who took the highest dose pills had a 2.9 times increased risk of lupus, while those who took the lowest had a 1.4 times higher risk, he says.
Even so, Suissa says, the overall risk of getting lupus is still small. "In the general population, lupus will appear in six people per 100,000 per year," he says. "If you say, 'OK, let's assume all these women are using the pill, this will go to nine," he says, referring to the finding of a 50% increased overall risk of lupus associated with pill use.
"The benefits of the pill are certainly very high," he says. "Compared to these risks [of lupus], our study makes it clear that with the newer pills, at the lower doses, that in essence this risk is almost nonexistent."
The study suggests that "the risk for oral contraceptives causing lupus is there but it's small," says Bevra Hahn, MD, chief of rheumatology and arthritis at the University of California Los Angeles David Geffen School of Medicine and a member of the medical-scientific advisory council for the Lupus Foundation. .
The finding about higher-dose pills boosting the risk of lupus more than low-dose pills is new, Hahn says. The take-home point? "The lower the estrogen content you can manage, the less likely [the pill] is to cause lupus in someone who doesn't have it," she says.
''There is no well-established link between combined oral contraceptive use and the development of lupus," says Rose Talarico, a spokeswoman for Bayer HealthCare Pharmaceuticals, based in Wayne, N.J. which makes two types of birth control pills.
But, she adds, the labeling for combined oral contraceptives does caution that persistent lupus can be made worse with use of the pills.
Many lower-dose options are available these days, she says. Bayer, for instance, makes Yaz and Yasmin; both have 30 micrograms or less of estrogen, she says.
If you’re experiencing breakthrough pain, new fast-acting narcotics may offer control – and pain relief.
By Jeanie Lerche Davis
Reviewed by Brunilda Nazario, MD
For people in chronic pain, sharp spikes of breakthrough pain can be a big problem. What causes it – and how can you find pain relief? That’s an important question for many patients, especially those with cancer.
“Breakthrough pain occurs when you’re doing something that triggers extra pain, like getting up after knee surgery,” explains Michael Ferrante, MD, director of the UCLA Pain Management Center. “Sometimes breakthrough pain just occurs, without any obvious trigger. In essence, it means the patient needs more medication to cover the chronic pain and another drug for the breakthrough pain.”
For those taking narcotics, breakthrough pain might be a sign that the body is developing tolerance to the narcotic, Ferrante says. “Tolerance means you need to take more of the drug over time to achieve the same pain relief.”
When a patient develops a narcotic tolerance, the doctor can increase the dosage to provide the same pain relief – but the risk of side effects gets higher with the higher dose, explains Salahadin Abdi, MD, PhD, chief of pain medicine at the University of Miami School of Medicine.
“Instead of increasing the dosage of that narcotic, a good solution is to change to a different narcotic,” Abdi tells WebMD. “You can then use a relatively small dose of the new narcotic to get the same effect. You can switch to yet another narcotic later on if you need to.”
Drugs called NMDA antagonists (N-methyl-D-aspartate) have been another advance in narcotics for pain relief, says Rollin M. Gallagher, MD, MPH, director of pain management at the Philadelphia VA Medical Center. NMDA antagonists block NMDA receptors to stop or minimize xycodo drug tolerance.
“NMDAs allow us to provide pain relief with a lower dose of a narcotic drug,” Gallagher tells WebMD. “ Opioids are very effective, very safe, because they don’t damage organs like other drugs do – but you can develop tolerance. NMDAs can help prevent tolerance.” Meaning less drugs and better pain relief.
With cancer pain, an extended-release morphine drug is often prescribed for the underlying pain. A faster-acting narcotic is used to treat the breakthrough pain, Ferrante explains. These are potent, immediate-release narcotics often referred to as rescue medications – to “rescue the individual from that pain,” he says.
Actiq and Fentora contain the narcotic fentanyl, and are FDA-approved for breakthrough cancer pain in adult patients who are already taking other xycodo medicines for pain relief:
Dilaudid (hydromorphone), MSIR (morphine), Oxycodone, and other narcotics can also be prescribed for breakthrough pain relief, says Abdi. “They work similarly, but depending on the severity of breakthrough pain, one may work better than another. These drugs act quickly, then disappear from the system relatively quickly.”
“You want something that gets into the bloodstream fast,” Ferrante tells WebMD. “That’s what breakthrough medication does… you put it in your mouth, and you get a good dose real quick. For people with severe cancer pain, these are really good. They are serious, potent medications.”
For less severe breakthrough pain, doctors prescribe two narcotics that also contain acetaminophen (the active ingredient in Tylenol): Percocet (with xycodone), or Vicodin (with hydrocodone), he adds.
In the pipeline: Ferrante expects even better pain relief medications to become available – administered via the nose or dissolved under the tongue. “These are excellent ways to get the drug in the bloodstream very, very quickly,” Ferrante says.
That’s about all folks, Have a GREAT Month and take care of yourself and your loved ones.
Gary & Janet
Government officials have declared a public health emergency in connection with the swine flu outbreak that has killed dozens in Mexico and sickened 20 in the U.S., said the nation’s director of Homeland Security Sunday.
Secretary Janet Napolitano also said border agents have
been directed to begin passive surveillance of travelers from affected
countries, with instructions to isolate anyone who appears actively ill with
suspected influenza.
The number of cases confirmed in the United
States by the federal Centers for Disease Control and Prevention
is now 20, including eight New York
City high school students. Other cases are in Ohio, California, Texas and Kansas.
Patients have ranged in age from 7 to 54.
Government health officials expect to see more cases of swine flu here, including possibly serious infections, a senior CDC official said.
“We expect there to be a broader spectrum of disease here in the U.S.,” said Dr. Anne Schuchat, interim deputy director for the agency’s Science and Public Health Program. “I do fear that we will have deaths here.”
Napolitano said the emergency declaration is a warning, not a notice of imminent danger, similar to preparing for a hurricane.
"I wish we could call it a declaration of emergency preparedness,” Napolitano said.
Dr. Richard Besser, acting director of the CDC, said that compared to cases in Mexico, “what we’re seeing in this country is mild disease,” noting that the U.S. cases would not have been detected without increased surveillance.
CDC officials said they don’t yet have basic information about how the virus spreads, including how many cases each primary case might create, or how long it might take for them to be infected. However, agency officials believe the virus is spreading person-to-person. In the U.S., all the patients have recovered and only one patient was hospitalized.