Seldom Mentioned Downside Of Painkiller Epidemic: Patients Don’t Feel Better

When I signed on board Hospice Inc., in New Haven, Connecticut, in 1975 as a bright 25-year-old who wanted to do some good in this world, the challenge put to me by Florence Wald, a former dean of the Yale School of Nursing who had organized the young organization to build the very first inpatient hospice in the United States (which she succeeded in doing five years later in neighboring Branford), was that we had a mission to reshape public attitudes toward the control of pain in America.

Florence Wald’s experience in the U.S. healthcare establishment was that physicians here were much less willing to use powerful painkillers like morphine in treating the terminally ill than their British or European counterparts because of a misplaced fear of addiction. “Terminal cancer patients don’t get addicted to painkillers,” Florence told me flatly, “nor do they experience euphoria from the use of painkillers. This is a perception that is just dead wrong, and we need to change it. We can treat pain more effectively, and we have a duty to do so.”

In the third of a century since then, the burgeoning hospice movement in America has brought comfort and freedom from pain to millions of Americans facing terminal disease, and eased the predicament of their families, who often suffer as much if not more than their dying relatives. Public attitudes toward painkillers have also evolved dramatically, including the views held by America’s physicians, who have become more willing to condone powerful opioids when they are needed to control pain.

But there may have been a downside to this change in perception and prescription.

Barry Meier is a reporter for The New York Times who has written extensively and eloquently on problems associated with prescription painkillers, a little-discussed epidemic that began about twenty-five years after I concluded my two-year stint with hospice. In June, Meier published an ebook with the “Kindle Single” program at Amazon called A World of Hurt: Fixing Pain Medicine’s Biggest Mistake which explores this chapter of the American prescription painkiller story, which is simply this: There is a growing body of evidence that these pain-numbing drugs, along with causing an epidemic of abuse, are often quite ineffective in treating long-term pain. They may actually be harming patients.

Barry Meier’s first book, Pain Killer: A ‘Wonder’ Drug’s Trail of Addiction and Death, focused on a better-known story about painkillers, namely the pandemic of abuse that occurred surrounding the powerful drug OxyContin, especially by teenagers seeking a new high.

Barry Meier was interviewed by his paper on June 23, 2013, and elaborated on what he was trying to do with his eloquent writings on painkillers, why doctors and patients resist giving them up, and some of the side effects of these drugs.

“A decade ago, drug companies and medical experts launched a ‘War on Pain’ that promoted the widespread use of powerful narcotic painkillers for common conditions such as back pain,” Meier told the Times. “Specialists claimed that a ‘bright line’ separated the drugs’ benefits for patients from their dangers when abused on the street by young people and others.”

Today, Meier says, many of those same experts who once endorsed painkilling drugs have had a change of heart. They have reached the revised conclusion that the opioid boom “ranks among medicine’s biggest mistakes.” They cite recent studies that tie long-term use of these drugs, particularly at high doses, to addiction, dependence, reduced sexual drive, lethargy and other problems. Based on stories of researchers, patients and others, A World of Hurt highlights how treating pain differently can benefit both pain patients and the public’s health. “The promise that high-powered drugs could provide a cure-all, the key to winning the ‘War on Pain,’ was an empty one,” Meier asserts.

Meier’s critics will argue that the compelling anecdotes and stories he puts forward, along with references to various studies, don’t make a case strong enough to deprive patients who suffer from pain from the medications that allow them to manage it. No one claims pain control is perfect, and the jury is probably not in yet when it comes to assessing the level of abuse or misuse. More work will need to be done. But I see the pendulum swinging the other way today than I saw it moving in 1975.

What is the answer? Perhaps a better scientific understanding of the brain mechanisms of pain will help us uncover new medications that act differently than opioids? Meier will surely find fertile ground for continued writing on this subject for many more years. In the meantime, he has made a significant contribution to public understanding of pain and pain control, and his new ebook is a marvel of clarity and concise writing. I heartily recommend it.

Your Ultimate Pilates Body Challenge by Brooke Siler

The author runs a prominent Pilates studio in Manhattan and trained with one of Joseph Pilates’s original students. However, despite that background, this book is less of an encyclopedia authentic Pilates exercises and instead a good shot at helping ordinary people (especially women apply Pilates to real life.)

Her point is that she’s seen too many students do well for an hour while being taught or working out, but then forget their Pilates when they leave the studio. They walk with a slump, slouch and so on.

She wants everybody to use Pilates when it’s meant to be used — all the time. You can’t do the exercises contuously, but you can and should keep your posture straight, you weight evenly distributed, your spine in alignment with your muscles.

It does little good for your health to practice correct movements three to five hours a week, but fall back into your unhealthy habits the rest of the time.

She starts off with basic background on Pilates and its principles, and on the concepts of Pilates movement: stability/mobility, resistance/operation, leverage, articulation and balance.

She goes over the benefits of good posture and breathing the Pilates way, as well as advice on how to sit and stand with good posture, so you don’t stress your joints.

Then she includes an unusual section: how to apply Pilates principles to working out on various pieces of exercise equipment: treadmills, elliptical machines, stationary bikes, stair machines, and rowing machines. She gives four variations on the usual way of using these machines, and advises spending two minutes apiece on them (the usual way plus four variations equals five), for a total ten.

Her advice here is to use each machine for the ten minutes total, then move on to the next one, for a workout that last nearly an hour. This is a cardio circuit.

She then gives a series of exercises and variations you can do at home and on the mat. Lifting free weights, jumping jacks, using flexible bands, jumping rope, the roll up, rolling like a ball, single leg stretch, double leg stretch, single straight leg stretch, double straight leg stretch, crisscross, spine stretch forward, open leg rocker, double leg kicks, and low back stretch.

She also includes information on the correct stance for common every day activities: sitting, standing, carrying bags of groceries, holding babies, sitting in front of your computer, using a photocopy machine and driving.

Another chapter covers applying Pilates to various sports such as golf (according to the author, Tiger Woods did), skiing, snowboarding and tennis.

This is a great beginners book to remind them to take their Pilates success from the studio into their daily lives. I doubt many people can do it by themselves unless they’re too young to have already developed a lot of bad habits.

But if you’re already in Pilates classes and therefore already strengthening your core, learning to align your spine, working out your muscles in a balanced way, and increasing your flexibility, this is a great guide on taking Pilates into your daily life, for increased progress and better health.

Depression and Stress Overload

It has been estimated that 21 million Americans live with depression each year. The negative effects of clinical depression can be far-reaching, even life-altering as sadness replaces energy, interest in one’s surroundings is lost, and the impact may eventually provoke autoimmune or neurological conditions if left unchecked over time.

Stress and clinical depression can do much to damage one’s self-esteem, relationships, and overall medical and mental health. Due to the pervasive nature of depression, a holistic approach to healing of depression is necessary to realize maximal health and wellness when it strikes.

Since the mind affects the body and the body affects the mind, it follows that there is a shared chemistry between the two. In essence, that is what the mind-body connection is all about. The mind and body need to work together for healing to occur.

When one endures significant stress, clinical depression may be the result. However, for some people, it doesn’t end there as that same high-level stress can enter the body via the autoimmune system causing a number of medical illnesses including arthritis, multiple sclerosis (MS), Myasthenia Gravis (MG), lupus, and even some forms of cancer. In such cases, it is easy to detach from the stress one experiences and think that the depression and medical issues are separate; and for some that is the case. However, high-impact stress can alter the mind-body chemistry, making the body more prone to infirmity and disability.

Oftentimes, there is a disruption in health that is connected to, possibly even caused by, what I call stress overload. Clearly, there is more to the mind-body connection than meets the eye. Certainly we all have a mind, body and spirit. When we experience infirmity, disability and depression, anxiety, PTSD or a combination, which often go hand in hand, it can be great comfort to acknowledge that we are not in this alone. We have God, or what some call a higher power, to help us simply for the asking. Trusting and believing in a higher being can greatly impact one’s mind-body health as they reach out for guidance, comfort, inner peace, protection and wisdom in dealing with their circumstances. It is a sign of strength to ask for help when we are in need.

The power of prayer is undeniable, as medical research has shown that people who pray, or have someone praying for them in intercessory prayer, heal more quickly. They have shorter hospital stays, and return to work sooner. Overall, they fare better than those who do not have prayer support. This reaching out for help on all levels–mind-body-spirit-is a sign of using all available means to improve one’s health and maximize wellness. Taking one’s medication, engaging in psychotherapy, and utilizing prayer as an adjunct treatment may very well be the comprehensive plan needed to avert medical illness and heal as quickly as possible from depression with the proclamation: ‘Depression Be Gone!’