Day: 06/06/2015

Cannabis Might Be the Next Migraine Drug

http://www.hightimes.com/read/cannabis-might-be-next-migraine-drug

A recent review of medical literature, courtesy of the Headache Center at the Cleveland Clinic Neurological Institute in Cleveland, Ohio, has shown that cannabis has potential therapeutic effects for the treatment of headache disorders, including migraines…

“A review of 38 published randomized controlled trials evaluating cannabinoids in pain management revealed that 71 percent concluded that cannabinoids had empirically demonstrable and statistically significant pain-relieving effects, whereas 29 percent did not,” Eric P. Baron of the Cleveland Clinic Department of Neurology and author of the report said.

Human biology can back this up as well.

“CB1 receptors [one of the body’s cannabinoid receptors] are 10 times more concentrated then μ-opioid receptors in the brain,” he continued…

Hospitals Back Providers Applying for New York State Marijuana Licenses

http://www.nytimes.com/2015/06/06/nyregion/hospitals-back-providers-applying-for-new-york-state-marijuana-licenses.html?partner=rssnyt&emc=rss

New York’s new medical marijuana program has drawn the interest of several major hospitals, which have formed alliances with aspiring growers to try to make the drug accessible to their patients…

The drug is supposed to become available to patients in January. It will be available for only 10 conditions specified in the law, and it will take the form of drops, vapor or capsules and cannot be smoked or put into edibles.

Michigan Cops Legally Rob ‘Every Belonging’ from Medical Marijuana Patient

http://www.pharmaciststeve.com/?p=10712

Medical marijuana user Ginnifer Hency told a group of Michigan lawmakers last week that a drug task force raided her home and kept ‘every belonging’ she owned — including her vibrator — even after a judge dismissed the charges against her…

Hency explained that her neurologist had recommended medical marijuana to treat pain associated with multiple sclerosis. She is also registered in the state of Michigan as a caregiver for five other patients, giving her the ability to distribute medical marijuana…

“They have had my stuff for 10 months, my ladder, my iPad, my children’s iPads, my children’s phones, my medicine for my patients,” Hency noted. “Why a ladder? Why my vibrator, I don’t know either. Why TVs?”

“The prosecutor came out to me and said, ‘Well, I can still beat you in civil court. I can still take your stuff,’” Hency recalled, adding, “I was at a loss. I literally just sat there dumbfounded.” …

But under the proposed law, local agencies would continue to keep 100 percent of the proceeds from forfeitures, “which gives them a strong incentive to target people based on the assets they own instead of the threat they pose to public safety,” Sullum wrote.

http://www.forbes.com/sites/jacobsullum/2015/05/28/state-legislators-reconsider-forfeiture-laws-that-turn-cops-into-robbers/

“After they breached the door at gunpoint with masks, they proceeded to take every belonging in my house,” Shattuck said. The cops’ haul included bicycles, her husband’s tools, a lawn mower, a weed whacker, her children’s Christmas presents, cash (totaling $85) taken from her daughter’s birthday cards, the kids’ car seats and soccer equipment, and vital documents such as driver’s licenses, insurance cards, and birth certificates. “How do you explain to your kids when they come home and everything is gone?” Shattuck asked.

She added that her 9-year-old daughter is now afraid of the police and “cried for weeks” because the cops threatened to shoot the family dog during the raid. Although “my husband and I have not been convicted of any crime,” Shattuck said, they cannot get their property back, and their bank accounts remain frozen…

Doctor Cleared of Criminal Charges for Opioid Prescribing

https://edsinfo.wordpress.com/2015/06/06/doctor-cleared-of-criminal-charges-for-opioid-prescribing/#comment-3601

In this exclusive interview, Practical Pain Management spoke with Jennifer Bolen, JD, who was hired by Dr. Roggow and her local legal counsel as an expert attorney to handle medical expert issues and jury instructions…

Initially, the case was brought as a federal criminal complaint based on the word, or affidavit, of a local police officer, who was serving on a federal drug task force. That same police officer later presented testimony to a federal grand jury, resulting in the indictment of Dr. Roggow…

The government looks at [medical pain management] as if there’s something wrong when a physician hits a certain quantity (dosage) or hits a certain timeframe of prescribing. [This type of assessment] should be a concern for all physicians.

It’s like a rabbit trail; someone has the government focused on the quantities and chronicity of prescribing and that isn’t really where they should focus. That means everyone’s potentially in trouble if their quantities vary from what some government medical expert might say is right…

The level the government thinks triggers the allegation of drug trafficking is a moving target because it depends on who the government’s medical expert witness is. In reality, there is no ceiling dose on opioid therapy and there is not sufficient literature to identify a common ground for high-dose opioid therapy…

You know you are in trouble, even with a not-guilty verdict, when government representatives tell a jury that all people who use pain medication become addicts, that all our client did was make addicts out of these people. That is exactly what the prosecutor said in the final argument. If this doctor had been convicted, it would have been open season for any caregivers in this area.

TMJ and Trigeminal Neuralgia

TMJ and Trigeminal neuralgia (TN) have a lot in common.  I think what’s missing from the information I found on Wikipedia (and via Google) is that TMJ can cause TN.

Trigeminal neuralgia… is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve… It has been described as among the most painful conditions known to humankind. It is estimated that 1 in 15,000 or 20,000 people suffer from TN, although the actual figure may be significantly higher due to frequent misdiagnosis. In most cases, TN symptoms begin appearing more frequently over the age of 50, although there have been cases with patients being as young as three years of age. It is more common in females than males…

TMJ is also more common in women than men.  What has confused TMJ researchers is that some people have TMJ but don’t have that much pain or any pain at all, while others have intense pain.  Since the TN nerves are part of the jaw joints, it just makes sense that these nerves can be a part of TMJ pain.

This disorder is characterized by episodes of intense facial pain that last from a few seconds to several minutes or hours… To describe the pain sensation, patients may describe a trigger area on the face so sensitive that touching or even air currents can trigger an episode; however, in many patients the pain is generated spontaneously without any apparent stimulation. It affects lifestyle as it can be triggered by common activities such as eating, talking, shaving and brushing teeth. Wind, high pitched sounds, loud noises such as concerts or crowds, chewing, and talking can aggravate the condition in many patients. The attacks are said by those affected to feel like stabbing electric shocks, burning, pressing, crushing, exploding or shooting pain that becomes intractable…

Since I describe my facial and head pain as constant and not episodic, I didn’t think that I suffered from TN.  But since I was forced to stop treatment with prescription medications, I have developed pain storms that are more episodic in nature.  The pain flares don’t last for minutes or hours, they last for days, and the triggers are very similar.

When pain levels are constant and at such high levels, it’s very difficult to differentiate between joint/bone pain and nerve pain, so patients have a hard time relating this kind of information to doctors.  I think TMJ pain starts out as joint/bone pain, but can easily develop into nerve pain.

As with many conditions without clear physical or laboratory diagnosis, TN is sometimes misdiagnosed. A TN sufferer will sometimes seek the help of numerous clinicians before a firm diagnosis is made.

The only way to determine problems with the jaw joints is by MRI, but even that test doesn’t always accurately diagnose TMJ.  Since dentists diagnose TMJ through things like clicking and range of motion in the jaw, and symptoms like headaches and facial pain, MRIs are not usually performed. Plus, MRIs are expensive and not covered by insurance for TMJ, especially if ordered by a dentist.

There is evidence that points towards the need to quickly treat and diagnose TN. It is thought that the longer a patient suffers from TN, the harder it may be to reverse the neural pathways associated with the pain.

This is true with just about all pain, which usually starts out as acute and then develops into chronic and intractable pain.  Once pain is chronic, there is no going back, which is why treating pain early is so very important.  Doctors used to know this, but the drug war has caused doctors to be more cautionary when treating pain, including refusing to treat it.

The differential diagnosis includes temporomandibular disorder. Since triggering may be caused by movements of the tongue or facial muscles, TN must be differentiated from masticatory pain that has the clinical characteristics of deep somatic rather than neuropathic pain. Masticatory pain will not be arrested by a conventional mandibular local anesthetic block.

To diagnose my TMJ, the dentist performed nerve blocks which did not stop the pain.  This test differentiated dental (tooth) pain from jaw pain.  But perhaps my diagnosis should have also included TN.  Not that it matters, as there are very few treatments for both TMJ and TN.  And a lot of those treatments just make the conditions worse, especially surgery.  You cannot cut into facial nerves and expect the trauma to not make the pain worse.  In fact, my TMJ surgery might have actually caused the TN.