Friday, August 25, 2006

migraine news roundup 13

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The Sept./Oct. 2006 isssue of AARP The Magazine includes a powerful article that captures the difficulties patients in pain experience in obtaining adequate relief:

Prisoners of Pain
Every three months for three years, Hamalainen saw this neurologist. Each time, she mentioned the pain. Each time, the doctor deftly changed the subject. Each time, she left in pain.

But this time would be different.

Hamalainen waited quietly as nurses wandered in and out of the examination room, taking her vital signs. Finally, she lost it. "My pain is real," she said frantically to one of the nurses. "I need relief. Why does he keep refusing to talk to me about it? What do I have to do?"

The nurse turned to her conspiratorially and lowered her voice. "I should not tell you this," she said. "But he doesn't want to treat your pain because the treatment that works is opioids, and he's afraid to prescribe them."

Worse, some physicians fear that if they deliver humane pain care, they'll face prosecution by the federal Drug Enforcement Administration (DEA) or state medical boards. In recent years, a number of respected doctors have been investigated and even prosecuted after prescribing large amounts of opioids. The result, according to experts, is an environment that scares doctors away from practicing good medicine.

"I've had prominent physicians call me up and say, 'I have patients doing well, taking opioids for otherwise treatable pain, but I'm going to stop writing prescriptions because I don't want the DEA coming into my office and putting handcuffs on me,' " says James Campbell, a neurosurgeon at Johns Hopkins University. "Five years ago, we were actually doing a better job at handling pain patients. Now we've seen a backslide, and patients are definitely the victims. They're suffering."

A great explanation of biofeedback:

Why And How Biofeedback Is Used To Treat Headache

From the journal Neurology, the results of a study on medication overuse headache:

Chronic migraine and medication-overuse headache
Even if no other therapies are begun, eliminating pain and other acute medications is often an effective treatment in cases of probable medication-overuse headache. In particular, migraineurs and patients overusing ergots and triptans may benefit the most. Most experts agree that eliminating potential culprit medications is the cornerstone of successful treatment. Often, clinicians will use other "tricks of the trade" to improve a patient’s odds for success such as starting a drug designed to prevent headaches (known as a prophylactic agent). Usually patients will also be supplied with alternative acute agents thought to be less likely to perpetuate the headache cycle.

The most important thing to remember is that while pain and other acute medications can be extremely effective for treating the occasional migraine headache, using them more than twice a week can actually lead to a problem that can be worse than the migraine headache itself.

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