The New CDC Guidelines and my Thoughts on how it Might Impact Fibromyalgia Survivors

CDC Link to Statistics on Prescription Drugs and Overdose

NIH Medline Plus Article on Prescribed Pain Medications and Doctors/Patients Roles

2012 Link: NIH Medline Plus Article on the 5% who Overdose on Prescribed Opioids

Note: The NIH link supports the CDC link that states that overdoses due to prescribed opioids dropped in 2012. The CDC notes that during this time frame, and up to the present time, prescriptions were also less. One item that would help to us to understand the CDC’s report is giving statistical information on how much this drop in prescriptions was/is starting in 2012.  Was it also 5% as stated by the NIH? Personally, I am wondering if it coincides with the timing of the introduction of Cymbalta and Lyrica. It seems to me that these medications exploded in the prescribed med arena about then, a few years after it was approved by the FDA for use in both depression and chronic pain. The same, or many similar, pathways in the brains of both depressive disorders and chronic pain react to both medications. However, they address different issues. Both of these medications come with a very long list of concerns the user should pay attention to, including “suicidal thoughts or actions”. I will leave you with this thought and continue on with my considerations in what is happening in the medical arena and my thoughts on how these new guidelines may affect us.

Hello Peers,

As promised a few days ago, I am going to do my best to address the new guidelines from the CDC concerning how to, or if opioid prescriptions should be written by doctors for any chronic pain other than cancer. These are my thoughts on the subject (I have not performed any empirical research, only added trusted links to sites that do use empirical research).  Please remember that I have posted previously that there are alternative methods that work for Peers, along with lifestyle changes. This post is strictly addressing the new CDC guidelines.

In reviewing these two links above, I discovered data within them that makes sense to me. I discussed a part of what may have occurred in the note section after the second link; the emergence and ever-widening prescribing of medications intended for depression, but now often used for chronic pain management. The link to NIH’s article discusses the need for practitioner education about opioid prescriptions and the importance of monitoring their patients for the possibility of addiction that leads to overuse, and, overdose. To be fair, there may be further links in the CDC articles that also discuss this.

Interestingly, this post is very similar in content to my post yesterday concerning monitoring co-morbid mood disorders when prescribing opioids. There will always be those who have co-existing conditions that may lead to emotional addiction and not just physical dependence, but abuse. These guidelines help push us towards the creation of  the need to check the patients past history for a known history of mental health conditions and implementing a full intake history to discover any potential genetic, behavioral or environmental factors to follow-up with in discussion at each visit. That takes this subject back to the need for educational classes for Fibromyalgia diagnosis, posted a while back. The emphasis of the outcomes of these two studies show how important it is for the pain patient to be honest with their doctor if they do have a co-morbid condition that could lead to abuse. The importance of scheduling a visit every month with your doctor, bring your medications, and sign a pain contract. While you are there always briefly discuss with your doctor how your month was; social activities or lack of, exercise, and any event that increased or decreased your pain.

I have always done this my doctors. I wrote down notes about my month, my pain levels and what caused the increase or decrease, along with a count of how much was left of each separate medication and then divided it into days left to refill, beginning with the request of my first doctor. He then added my letter into my chart. I have never obtained refills on opioid medications, except for a few months when I traveled. It is part of my monthly chores to visit my doctor every three and half weeks to obtain my next refill. I began this monthly ritual 14 years ago. The CDC guidelines may create requirements like this for all pain patients. It should be a heads up  that we should all begin doing this on our own (if you’re not already), and even suggest a pain contract before the doctor does. This is being proactive, taking control of our own bodies and could help to decrease fears about abuses for all of us.

The NIH article is suggesting that this  relationship with our doctor, along with increased doctor education and visits should be mandatory in chronic pain patients.  The CDC article is simply following their history of trying to prevent death from overdoses, be it from prescribed medication or illegally gained medications and street drugs that can cause overdose. It is also not new that prescription medications are being attacked for overdoses. It is easier to address something you can track like prescription medications; try tracking the amount of illegal street drugs and overdoses, it is not nearly as simple as pulling records from doctors, pharmacies and hospitals. It will not stop being discussed and their guidelines will continue to be handed out on this subject. I applaud it. If you have ever experienced the pain of loss due to a friend or a family members overdose, it is horrible.

I found in the literature that numbers have gone down for the last three years; in overdose and prescriptions. What I don’t find, but believe is very important in this discussion, is how people are obtaining medications they don’t need and how many people in chronic pain who are denied assistance turn to street purchases of pain medication which could play a part in the overdose count by the CDC. This is much more alarming to me then the idea that all doctors should be better educated when assisting chronic pain patients. Especially monitoring their paitients who may begin to show signs of addiction. I am fairly sure, but could be wrong, that there are more overdoses from street drugs by addicts than there would be from prescribed medications if these methods were used.

The CDC sounds this type of alarm every decade. Their current alarm is focusing on pain medications. They have focused on this before and will again, with good reasons. There is not enough practitioner education about chronic pain, pain contracts and how to monitor  patients in case they fall into that 3-5%  of persons who might become abusers. Pharmacies have the ability to track every prescription from every pharmacy in at least 48 states, but, do they?  Why don’t pharmacies and doctors interact closely in tracking the filling of prescriptions by patients? If any abnormalities showed up in the pharmacy tracking system, alerting doctors would help enormously to avoid abuse and possible overdose. Both would also be able to flag the patients who are obtaining opioids under false pretenses. I believe strongly that the prescribed chronic pain patient overdoses would fall by a large percent if this was incorporated.

http://www.nh.gov/pharmacy/prescription-monitoring/

I am not overly concerned at this point in time about the CDC creating these guidelines. If I become alarmed or, if you are already concerned, take action. Advocate for yourself and your Peers. Find a petition or create one online and send it not only to the CDC but to your doctors group, insurance company and pharmacies, suggesting these or other reasonable items to include in chronic pain management.

If I responded well to the newly created and prescribed anti-depression drugs, I would take them! But, I don’t. I take opioids and  have created a Well lifestyle, integrating alternative therapies, understanding my triggers, using exercise, and I spent years journaling my every daily activity and corresponding pain levels in order to reach the functional ability I currently experience. It’s not perfect, but it’s much better than the first several years. I hope that all the Peers find their answers, using the treatments that works best for them.

Pro-guidelines and education for needed chronic pain treatment,

Lucinda Tart, Fibromyalgia Peer Advocate/Life Skills Advisor

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Similarities Between Fibromyalgia and Mood Disorders Some Research Points out the Links

Link to Research/Presentation by NCBI on Fibromyalgia and Spectrum Proposal of Other Co-Existing Disorders

Hello Peers,

I have been having a distressing, verbally attacking posting conversation about Fibromyalgia and the link to mood disorders these last few days. Unfortunately, this has occurred in a “safe” post forum, where discussions like these are not productive or helpful for the general needs of Peers. I believe I started this problem by stating that there was no empirical research that connected these disorders. I generally point out items I think lead Peers down a road that may increase either disinformation or fear of new and different symptoms. I don’t do this to be a know-it-all and this time I was called out onto the posting “mat” about my statement by the original poster. I was informed that I was wrong and that as someone who is a therapist, I should check out my DSM-IV book. I apologized for the second time to the other Peer and posted I would not engage in this on this space anymore. All this did spark my interest and I Googled the research available on this topic.

I did indeed find some research. One was a research article that was empirical, from 2008, another was always the always reliable information from the NCBI and a general jargon piece on PyschCentral’s site. The other two research articles I found on Google, not in my professional peer-reviewed journals, are simply about depression in general. Here is what I gathered from the 2008 article and the generally similar information from the NCBI (NCBI offers up-to-date information about Fibromyalgia, this focused on the topic I researched tonight). People with Fibromyalgia and Mood Disorders both have similar problems with their neuroendocrine and autonomic systems responding as normal, along with possible genetic factors, environmental factors and social factors that can trigger any one of these conditions. The problem with the 2008 article is this; the p= numbers are very low. A normal empirical connection is considered .05 in research. There has also been much debate about how the DSM is used in general since the newer DSM-5 came out, with opponents contending that, among other disorders, even normal sadness can be pathologized. That does not mean the DSM-IV does not have important role in understanding mental health; it is the best empirical data in one place for mental health therapists to begin with in determining mental health issues that are currently beyond what their peers are experiencing.

I definitely can see a connection in his hypothesis. And, I do use the DSM-IV but the starting diagnosis should be cautionary as the person’s situation may change as their sadness clears up; without medications. *(This is only my opinion). As a Peer with chronic pain I have discussed depressed days and stated that depression can cause physical pain. We can all think of many co-existing syndromes and/or illnesses, beyond Fibromyalgia and Mood Disorders.  An example would be depression combined with overeating and pain in the persons knees. A person could have arthritis and a mood disorder, heart problems and Fibromyalgia.

As time goes on we may find that there is a strong connection to these two syndromes/disorders. This is why there is always a reason to have your doctor take your full history when you experience any syndrome or illness. Just because you suffer from A doesn’t mean you don’t also have B and C. A person who begins to experience any new symptoms should always seek medical attention, not advice from this blog, a forum or from Google only! We should work closely with the doctor, creating a relationship that lends itself to weeding in/out all possible issues.

I also was called out on the DSM-IV and whether I knew my diagnosis; I do. I have seen many depressed, hospitalized persons with Fibromyalgia. But, not a high number of both in one person. Just like a General practitioner or Pain Management Specialist, I take a full history of the patient, current and past social background and their family history. I have discussed that each of us is unique in our symptom presentation. I found that during my year in the hospital and I find a large difference in one Peer and others in their posts, blogs and in person. Our experiences as we journey towards living Well are unique.

It has been previously posted in my blog that new, empirical research shows dysfunction in our brains, central nervous system and muscles. I was surprised by this post attack to hear that mood disorders were strongly linked to Fibromyalgia. There were two components mentioned in the 2008 research, the neuron receptors in our brains and our autonomic system, that are the same in both syndromes. Fibromyalgia survivors have an additional dysfunction,  our central nervous system. Also discussed in both resources were genetics, social and environmental factors.

Genetics have been a marker for a multitude of syndromes and diseases for a while now. Social and environmental circumstances as well. I am taking the time tonight to delve into this in order to inform my Peers about this thought process. The more we know the more we can learn about chronic pain, differing presentations and what may fit for our unique symptoms. Perhaps these two similar dysfunctions helped to jump-start the new research that includes all three areas and inform doctors to always closely monitor their patients health history. I am truly sorry that the other person became so distraught about it all, this is never my intention. I am grateful that it allowed me to find out about this concept and do research about depression and Fibromyalgia similarities.

One last item is the debate about anxiety and Fibromyalgia survivors. I have had some anxiety my whole life, who hasn’t? One of my parents had overwhelming anxiety most of their lives. I do not think I have ever met a person going through difficult situations who doesn’t have some degree of anxiety. I will leave this for you to think about, and, research if you desire.

Please see your doctor and do your own research. Being informed by doing your own research is the best method to decide what fits for you, makes sense to you and what tools you will want in toolkit.

Links, Information and small rant n rave for the night, (tomorrow, CDC)

Lucinda Tart, Fibromyalgia Peer Advocate/Life Skills Advisor

*This blog is never meant to replace a visit to a professional. I am in no way giving out professional advice, even if I use my professional as my opinion in a post.

Surgery and Other Treatment Modalities; Preparing in Advance to Avoid Extended Pain

Important Facts for Fibromyalgia Syndrome and Surgery

Hi Peers,

My day began with an acupuncture appointment for my knee. It consisted of four “cupping” and then four “dry needles. This has helped my knee in the past, (I have lump scarring that has created a new pain syndrome where my knee cap, or patella doesn’t move up and down), and I expect the same today. It really wore me out! Fifteen minutes after the appointment all I wanted to do was go to sleep. I did not, so I expect to sleep well tonight. I also think a flare of increased pain is coming. Acupuncture often begins to relieve trauma that has existed for a while. This new healing can create more pain for a few days. In someone with Fibromyalgia procedures like this can cause us to have more issues than in persons without chronic pain.

This reminds me of my arthroscopic knee surgery. I spent time listening to a Mindful Surgery CD for three weeks prior to surgery. There are also free Youtube videos available that assist with this, but I preferred this one to those. This helped me to feel calm before and after surgery; generally I would panic the entire time. What I did not know until afterward the surgery is that research has shown that persons who have a chronic pain syndrome can experience lingering pain and slower healing. It is best to be informed about issues like these and prepare accordingly. I am now 🙂

Now that I have dealt with paperwork, telephone calls, posting on my forums, posting a (hopefully) useful thread for you all, I am going to eat and relax; tonight and over the weekend.

Wishing you all a low pain, happy weekend,

Lucinda Tart, Fibromyalgia Peer Advocate/Life Skills Advisor

Hello Peers and Fellow Bloggers,

I created this site to advocate and hopefully give us all useful tips in living with Well with chronic pain. I see that I have several visitors daily, but I never receive any “likes” or “comments” about my posts. It would help me tremendously to have this feedback. After all, I don’t want to waste your time. If the posts are not useful, please let me know. If they are useful, let me know about that too.
All the best,
Lucinda Tart

Getting Enough Rest, and, Getting out of the House in a Hour or Less

Hi Peers,

This subject is one I have perfected over the last several years. Until three years ago I was in University full-time for ten years, and, performing 26 hours a week in internships (during my undergraduate days it was about 15 hours a week). Being under this much pressure to perform well in classes, constant research papers and wit my additional interning hours, getting enough sleep became a problem even bigger than usual. Anyone who works full-time while living Well with Fibromyalgia also understands this need.

I was generally up until at least 1am working on papers. I did my best to schedule all classes in the afternoon, back to back. This allowed me to try to get at least three hours in a row of sleep. In order to try to get those , hours I usually spent nine to ten hours in bed. I have posted before that for me to keep up with a clean house I break up household chores into pieces, thereby creating time to focus on showering, dressing and breakfast when I got up in those late mornings. Many days I needed to get to school within an hour of awakening. This was when my perfect method of leaving the house in an hour or less became a routine.

I worked on my papers and reading at night, interspersed with dishes or vacuuming, whatever was on my daily list of “need to do most urgently” list. I finished up and then quickly checked on the weather forecast for the next day. Next up, what to wear? I pulled out an outfit with a few extra items by on the side in case the weather changed or I was just dissatisfied with the outcome of my look. Makeup, right by the side of the sink enclosed in an inexpensive, but nice, box. Open, grab the usual items and proceed to put on the usual look, after dressing and starting coffee. My books and note pads, laptop and the rest would be by the door waiting for me to grab.

That’s it. Done, coffee in holder cup with lid, breakfast bar and banana in hand, bag over shoulder with books, light jacket in arm, keys and out the door in 60 minutes. This is a basic synopsis of what I did today, in 45 minutes.  However,just as I was finishing, I received a telephone call explaining that my appointment was rescheduled for next week. Oh well. I took the positive and slowed down. I changed my outfit to another, posted this blog and now I am going to walk my dog. One more, still, scheduled appointment in an hour and a quick stop at the grocery store. My purse, snack, jacket and rest are sitting by the door waiting for me to jump in the car 🙂

Wishing you all the simplest of preparations and a gentle day,

Lucinda Tart, Fibromyalgia Peer advocate/Life Skills Advisor