ACTIQ is a medication in a unique oral transmucosal delivery system (OTS?). It offers personal pain control by providing pain relief in 15 minutes (though you may not experience full relief for up to 45 minutes after finishing an ACTIQ unit). Actiq is designed to be dissolved slowly in the mouth in a manner to facilitate transmucosal absorption.

Actiq is supplied in six dosage strengths. Each unit is individually wrapped in a child-resistant, protective blister package.

The FDA urged drugmakers to put new warning labels on popular antidepressant medications. Alerting to watch for suicidal tendencies, hostility and agitation in patients taking the drugs.

FDA focuses on Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro, Wellbutrin, Effexor, Serzone and Remeron and follows a warning by the British government last year advising physicians not to prescribe most widely used antidepressants to children.

Avinza was approved by the FDA in March 2002 for the treatment of moderate to severe chronic pain in patients that require continuous, around-the-clock therapy for an extended period of time. A once-daily dose of Avinza in the extended release capsule formulation provides relief from pain for a 24-hour period. Avinza is available in 30, 60, 90 and 120 mg capsules.

Side Effects

A Northern California biotechnology company said Wednesday it was developing an abuse-resistant version of the pain killer OxyContin, sometimes called “hillbilly heroin” because of its popularity as an illicit drug.

South San Francisco-based Pain Therapeutics said its experimental gel capsule resists the easy tampering that turns the approved pill from a legally prescribed pain killer for long-suffering patients into a potent and sometimes fatal high for drug abusers.

In another study exploring nonsystemic treatment modalities, Jabbari B. found that patients with chronic low back pain may respond to injections of botulinum toxin A. In a prospective study involving 75 patients, patients received paraspinal intramuscular injections at baseline and then at recurrence of pain, typically at 4, 8, and 12 months after the initial therapy. Although a modest number of patients reported significant improvement, 56% at 3 weeks and 54% at 2 months, the investigators did note that among initial responders, 90% responded to subsequent treatments. Among the patients overall, there were 3 adverse events — 2 transient flulike reactions and 1 episode of acute root pain after the injection.

Two men suing physician Dr. Robert Harned, claiming he over-prescribed painkillers, causing them to become addicted. Each suit seeks $1.5 million for the plaintiffsí pain and suffering. Also named in the suit are Chatham Medical Associates, where Harned practiced, and Stop & Shop Pharmacy, which filled some of the prescriptions.

From a press release: Thirty-three patients with unrelenting CRPS (Complex Regional Pain Syndrome, also known as Reflex Sympathetic Dystrophy – RSD) were treated using this novel approach developed by Dr. Graeme E. Correll, BE, MBBS, in Mackay, Queensland, Australia. Pain relief and the duration of this relief appeared impressive. After only one treatment, there was complete relief in 76% (25) of the group.

In another front in the quest to find effective nonopioid pain management strategies, Childers and associates[10] have found that low doses of cyclobenzaprine, a muscle relaxant related to the tricyclic class of antidepressants, when given as monotherapy, is as effective as cyclobenzaprine and ibuprofen combined. In addition, the low dose — 5 mg 3 times daily — is as effective as a higher dose used in other research with cyclobenzaprine — 10 mg 3 times daily. In this 7-day study, Childers and colleagues randomized 867 patients with acute muscle spasm of the back or neck to 5 mg of cyclobenzaprine 3 times daily or 400 mg or 800 mg of ibuprofen. All 3 treatment groups had a significant improvement over baseline (P < .001). The findings led the investigators to conclude that for musculoskeletal pain with a spasmodic component, cyclobenzaprine monotherapy, even at a low dose, is as effective as combination therapy with ibuprofen, a finding that broadens the options for patients who cannot take ibuprofen.

US and Australian research team which has made a breakthrough in revealing how opioid drugs such as morphine both relieve pain and also cause addiction.

The scientists tested a new drug called AV411 that blocks morphine’s effects on glia cells but not on neurons, resulting in effective pain relief without the side effects of addiction.

Currently, AV411 is in clinical trials at the Royal Adelaide Hospital. And it is being developed by Avigen Inc., a Californian biopharmaceutical company.

ABC News

OxyContin, a powerful painkiller introduced on the market seven years ago, has proven a wonder drug for many sufferers of persistent pain.

But now, in the wake of conservative radio show host Rush Limbaugh’s announcement that he’s “addicted” to prescription pain medications – among them, OxyContin, according to law enforcement officials – much of the nation is aware that the drug can take powerful hold of people who misuse it.

American Medical News

A California court ruling could spur physicians to become more knowledgeable about the best way to treat their patients’ pain.

Physicians might want to get up to speed on the latest pain management techniques available now that a California jury has held a doctor liable for undertreating pain. The jurors in June found the internist guilty of elder abuse and recklessness and awarded the now-deceased man’s family $1.5 million.

A careful review of the patient’s medical history is the first essential in choosing a medication. Patients with chronic pain can often tell what has worked in the past and what has not. In one study of cancer patients using opioid analgesics, 44% required trials of two or more opioids, and 20% required three or more, before achieving satisfactory pain relief without intolerable side effects. As in selecting any drug, both adverse and beneficial effects must be evaluated in the context of the individual patient’s current physical condition.

Duloxetine and Diabetic Neuropathic Pain

Like several antidepressants in the selective serotonin reuptake inhibitor (SSRI) class, the serotonin and norepinephrine reuptake inhibitor (SNRI) duloxetine is showing promise in the setting of diabetic neuropathic pain. In 3 studies with overlapping investigators, it was found that patients who did not have symptoms of depression obtained significant relief from duloxetine. One study by Wernicke and associates found that 2 different doses, 60 mg daily and 60 mg twice daily, are effective, well tolerated, and do not impair control of diabetes. In an open-label study focused on safety and tolerability. Raskin and colleagues found that the treatment was well tolerated, although statistically significant but clinically unremarkable changes in blood pressure and heart rate were more likely to occur in patients receiving duloxetine. The remaining study also focused on safety and tolerability, and showed that several comorbid conditions common to diabetes, such as hypertension and hypercholesterolemia, did not adversely affect the patients’ ability to tolerate duloxetine.

Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, and gastrointestinal tract. When these drugs attach to certain
opioid receptors, they can block the transmission of pain messages to the brain. In
addition, opioids can produce drowsiness, cause constipation, and, depending upon he amount of drug taken, depress respiration. Opioid d

Every now and then folks ask me to list the list of meds that can and do cause drug-induced movement disorders. This is to educate you, if you are concerned about the side effects of a drug you are currently taking, speak up, talk with your doctor. If you are starting a new one, you will be the only one to investigate it. Arm yourself with knowledge. Be an informed consumer. Listen to that little voice in your head, and be in tune with your body.

does any one get rebound headaches (migraines) as a result of taking chronic pain medications,

for my pain i am taking:
avinza 150mg per day
MSIR 15mg as needed (max 120mg a day)
zoloft 100mg a day
synthroid 50mcg a day

gabitril is one new medication i started (with a starting dose, i think it was 50mg) about 4 weeks ago, but stopped 4 day into it because of constant, but not very strong headaches, incidentally this last attack of migraines continued after stopping the gabitril.

i have been having headaches since then, with some days better and some days real bad, went to emergency room twice, done wide range of scans and checkups with out finding anything wrong with me or my head.

Two drugs typically used in the treatment of neurologic disease, memantine and tiagabine, show potential in 2 different pain settings — migraine and fibromyalgia, respectively. In the first study, Sorensen and Jenson explored memantine, which is approved for the treatment of Alzheimer’s disease, as a prophylactic agent for reducing the frequency of migraine. The 18 patients in the study had been refractory to a variety of other prophylactic agents and acute migraine therapies. However, 11 of the patients described their results as excellent and 4 as good. Sorensen also investigated the anticonvulsant tiagabine as a treatment for primary fibromyalgia syndrome. The short-form of the McGill Pain Questionnaire was used. Again, the 11 patients had not responded to a variety of standard treatments, including opiates, NSAIDs, tricyclic antidepressants, and another anticonvulsant — gabapentin. In this case, 6 patients reported an excellent result and 1 reported a good result, again with the McGill short form. One patient discontinued due to nausea and sedation, and 1 patient withdrew due to a poor response. Dr. Sorensen stressed that further investigation would be necessary with both therapies, although the initial results are promising.

Dr. Ian Gilron, an anesthesiologist at Queen’s University in Ontario studied using painkillers morphine and gabapentin in patients with diabetes or shingles-related pain. On their own, each drug reduced pain by about one-quarter or one-third. Used together, they worked simultaneously on different areas of the brain, and reduced neuropathic pain by 45 per cent.In addition, patients didn’t require as much medication to get an effect.

The results of Gilron’s study will be published on April 5, 2005 in the New England Journal of Medicine.

Pain Therapeutics said it would start testing Oxytrex in the second half of 2007, enrolling into the “Extreme Study” about 120 patients who depend on large daily doses of oxycodone — or doses greater than or equal to 120 mg — to treat severe chronic pain, whom the company said are particularly prone to physical dependence and withdrawal.

There is reason to believe that Oxytrex will produce greater analgesia, while producing lower levels of tolerance and dependence, than oxycodone.

PRIALT (Ziconotide Intrathecal Infusion) for Severe Chronic Pain in patients for whom intrathecal (IT) therapy is warranted, and who are intolerant of or refractory to other treatment, such as systemic analgesics, adjunctive therapies or IT morphine.

PRIALT is a Novel Non-Narcotic Treatment Based on Marine Snail Peptide Blocks Pain Signals.

In a controlled 6 month trial, 110 subjects with nonspecific low-back pain (average duration, 14 years) were randomized to have repeated prolotherapy with 20% glucose/0.2% lidocaine (lignocaine) or normal saline injections into tender lumbo-pelvic ligaments. Subjects were also randomized to a program of flexion/extension exercises or to normal activity. With follow-up through 12 months in 96% of subjects and through two years in 80% of subjects.

The self-adhesive unit contaning fentanyl hydrochloride is the size of a credit card, can be worn on the upper arm or chest. Fentanyl may also have an advantage over morphine in that it does not have active metabolites that can accumulate over time.

In a study with 636 adult postsurgical patients, patients were randomized to receive fentanyl hydrochloride by PCTS or IV morphine by PCA pump. Rates of withdrawal from the study were similar.

An Oregon woman suing her doctor and his medical clinic for $4 million. She said that his medical treatment included intercourse which was needed to help alleviate her lower back pain.

The doctor, Randall Smith, was stripped of his license and sent to jail for 60 days last year for charging the stateís Oregon Health Plan $5,000 for his 45-minute ìtreatmentsî involving the woman.

News 10 has an article about Prolotherapy, which is use a dextrose (sugar water) solution, which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.

Part of the theory is the injections cause an inflammation that causes healing, and anti-inflammatory drugs stop healing process.

Two studies involving the transdermal lidocaine 5% patch show that it may have a role in both musculoskeletal and neuropathic pain. In one study, Hobart and Nalamachu reviewed the charts of 14 patients, all of whom had pain secondary to entrapment, tendonitis, and bursitis. Of these patients, 82% reported significant improvement over baseline symptoms, with an average improvement of 44%. This led the investigators to consider that the lidocaine patch may allow such patients to take lower doses of systemic analgesics. In the study involving neuropathic pain, Gammaitoni and colleagues pooled data from 3 open-label studies involving 286 geriatric patients with neuropathic pain. The patients reported a significant reduction in the degree to which pain interfered with sleep, and treatment was linked to a significant reduction in pain intensity and an increase in pain relief (P < .001 for all). Of these patients, 144 (50.3%) had a decrease over baseline of at least 30% in average daily pain. Most of the adverse events were local in nature, such as rash. These findings led the investigators to conclude that the patch may have particular value for elderly patients who are at increased risk of toxicity from systemic medications.

I thought this was weird. The girl was prescribed Duragesic for chronic headache and was “discovered unresponsive and with respiratory depression” 21 hours after the patch was first applied. The boy, who was prescribed the drug for throat pain due to mononucleosis, was found in respiratory arrest 14 hours after the patch was first applied. This is from Health Canada.

Ultram ER (tramadol HCl) is the first extended release tramadol product approved in the United States for relief of moderate to moderately severe chronic pain in adults who require around-the-clock treatment of their pain for an extended period of time. Ultram ER is available in once-daily dosage strengths of 100 mg, 200 mg and 300 mg tablets.

The U. S. Food and Drug Administration (FDA) approved Ultram ER in September 2005 based on clinical and safety data obtained from four well- controlled clinical trials. More than 3,000 patients have been treated with Ultram ER in clinical trials.

Vioxx was pulled from the market by its maker after a study found it doubled the risk of heart attacks and strokes.

Experts advised patients to immediately stop taking Vioxx and talk to their doctors about alternatives, which may include generic pain relievers -ibuprofen and aspirin, as well as Celebrex.

A Merck study led to warnings about heart risks being placed on the drug’s label in 2002, and the FDA has been monitoring problems that have been reported since then.

Opioids are commonly prescribed because of their effective analgesic, or pain-relieving, properties. Medications that fall within this class sometimes referred to as narcotics include morphine, codeine, and related drugs. Morphine, for example, is often used before or after surgery to alleviate severe pain. Codeine, because it is less efficacious than morphine, is used for milder pain. Other examples of opioids that can be prescribed to alleviate pain include oxycodone ( OxyContin ), propoxyphene (Darvon), hydrocodone (Vicodin), and hydromorphone (Dilaudid), as well as meperidine

Women who frequently use over-the-counter pain pills may be doing long-term damage to their kidneys.

Researchers found that over a decade, women who took between three and 17 acetaminophen pills weekly increased their risk of kidney problems by 64 percent compared to women who rarely or never used such medications.

Women who regularly took more than that doubled their risks, the study says.

Ziconotide is a novel non-opioid, non local anesthetic, developed for the treatment of severe chronic pain.

The analysis, which included 105 patients, revealed that the difference in pain reduction between the two groups was substantial with a reduction in pain scores of approximately 40% in one group compared to no change in the placebo griup.

Ziconotide also seems to improve the sleep pattern in some patients with chronic severe pain. Patients experienced positive effects on nocturnal sleep duration and believed that remaining pain symptoms interfered less with their daily life.

Several studies showed the potential for the novel analgesic ziconotide in the chronic pain setting. Two studies examined the titration schedule, rapid or slow, as a component that may affect the efficacy and safety of the treatment. In one study by Fisher and colleagues, the investigators followed 27 patients who received ziconotide for 1 year after an initial rapid titration. The median time to stable dosing was 196.5 days, with a median maintenance dose of 0.34 mcg/hour. In the slow titration study, the same investigators followed 119 patients and found that the median time to dosing stability was 279 days, with a median dose of 0.24 mcg/hour. The investigators found that slow titration was feasible and may prevent some of the adverse effects associated with ziconotide, such as dizziness and confusion. Another investigator used the slow titration schedule and found it effective, but explained in an interview that patients need appropriate counseling so that they expect a slow change, with maximum benefits seen after 6 months of treatment. A meta-analysis showed that the treatment is effective in a variety of chronic pain settings and is effective in both cancer and non-cancer-related pain.