The Good News and the Bad News – From this Year’s Headlines
, there is a real need for alternative pain management options as diminished access to opioid medications forcing patients to seek solutions “outside the box”.
this Year’s Headlines
By Ginevra Liptan, MD.
CBD (cannabidiol) is everywhere
You can get CBD at the health food store or in your coffee drink now, and everyone is curious about it. Recent New York Times had this to say about CBD “It’s hot, everywhere and yet almost nobody understands it.”
we only have limited information on effectiveness, dosages, side effects and potential medication interactions.
Ginevra Liptan, MD
What is behind the CBD explosion? Access has greatly increased to changing legal status over the past few years and CBD has found huge visibility thanks to social media. And finally, there is a real need for alternative pain management options as diminished access to opioid medications forcing patients to seek solutions “outside the box”.
The bad news:
- The CBD industry is unregulated and can be hard for consumers to know the quality and purity of CBD products, meaning it really is not very “medical” yet.
- Vastly inadequate current state of research means we only have limited information on effectiveness, dosages, side effects and potential medication interactions.
The good news:
- CBD has great potential as a treatment for many different conditions including anxiety, PTSD and chronic pain
- Patients can easily access this relatively low risk treatment for pain.
Opioids are OUT
Of course, it makes sense to ensure that opioids are a last choice option to be utilized only if other treatments are not effective, and to ensure that opioids are prescribed safely and with focus on preventing misuse and abuse.As our society reckons with opioid abuse, across the country opioids are being pulled away from patients—in many cases without other effective options to replace them— resulting in increased suicide rates and worsened agony for those in chronic pain.
There is now a great deal of fear and panic among chronic pain patients that opioid pain medications are going to be yanked away without any replacement. Chronic pain patients and advocates in Oregon are fighting against a proposal by Oregon Medicaid to mandate a taper of opiates for all chronic pain patients. When I testified against this before the Oregon Health Authority my primary argument was that fibromyalgia and chronic pain patients need MORE tools in their pain management toolbox, not less. Of course, it makes sense to ensure that opioids are a last choice option to be utilized only if other treatments are not effective, and to ensure that opioids are prescribed safely and with focus on preventing misuse and abuse.
The bad news:
- The hysteria around the opioid abuse crisis has lead to a chronic pain crisis as opioids are being pulled away from patients without effective replacements.
The good news:
- As opioids fall out of favor, significantly more research dollars are being directed towards studying new approaches to treating pain.
For example just this year resiniferatoxin, a plant-derived chemical that can destroy nerve endings that signal pain, while leaving other sensory nerves intact, has emerged as a promising painkiller.
A new drug that lowers brain glutamate activity is showing promise for fibromyalgia pain. This medication lowered glutamate levels in certain areas of the brain important in pain, and also lowered pain levels, with no major reported side effects
A novel non-drug therapy using electrical stimulation of the occipital nerves lowered fibromyalgia pain. Small electrodes were implanted under the skin in the back of the neck under local anesthesia. One study showed that this type of electrical stimulation increased the brain’s ability to filter out pain signals resulting in decreased pain.