A Nation Running from Pain: What Can Be Done About It
March 19, 2015
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By Dr. Mercola
According to the most recent statistics from the Centers for Disease Control and Prevention (CDC), lethal heroin overdoses nearly quadrupled between 2000 and 2013 in the US, escalating from 0.7 to 2.7 deaths per 100,000 during this timeframe.
Heroin-related deaths were nearly four times more prevalent among men than women in 2013, and lethal overdoses were highest among Caucasians between the ages of 25 and 44. The greatest increase in heroin-related deaths was seen after 2010.
As noted by Medical News Today:1
"During the period investigated, the researchers found an average increase in heroin-related drug-poisoning deaths of six percent per year from 2000 through to 2010.
From 2010 through 2013, the average increase was a staggering 37 percent per year..."
Prescription Painkillers Are the New Gateway Drugs
What many fail to realize is that this trend is actually fueled by legal drug addiction. The reason for the resurgence of heroin is in large part due to it being less expensive than its prescription counterparts.
Addictive prescription drugs such as Vicodin, OxyContin, Percocet, codeine, and Fentora, all of which are opioids (derivatives of opium) are widely overprescribed for pain.
Many painkiller addicts also turn to heroin when their tolerance level surpasses their allotted prescription dosage, or when they're no longer allowed to refill their prescription.
According to previous statistics, prescriptions for opioid painkillers have risen by a staggering 300 percent over the past decade.2 As of 2012, 259 million prescriptions for opioids and other narcotic painkillers were written3 in the US, and these drugs actually claim far more lives than heroin does.
In 2010, prescription painkillers were responsible for 16,600 deaths; heroin was involved in about 3,000.4 By 2013, the number of heroin deaths had increased to 8,257,5 but as noted in the featured article:6
"Although heroin-related drug-poisoning deaths have increased sharply in recent years, the overall rate is still considerably lower than that for opioid analgesics.Dr. Andrew Kolodny, chief medical officer at a drug treatment center called Phoenix House has also previously spoken out on this issue, noting that:7
In addition, NIDA [National Institute on Drug Abuse] suggest that the abuse of prescription opioids such as Oxycontin and Vicodin could be the first step toward heroin abuse for many people."
"Heroin use is increasing because we have an epidemic of opioid addiction (caused by overexposure of our population to painkillers) and not enough has been done to expand access to treatment in communities hit hardest."
Financial Conflicts of Interest Fuel Narcotic Prescription Rates
Despite dramatic increases in prescriptions, two recent papers assert that no solid evidence can be found in the medical literature supporting the long-term safety and effectiveness of narcotic painkillers.
Many suffering from chronic pain end up using painkillers for years on end, yet there are no studies longer than one year on record. Most trials do not go past six weeks.
There's also a lack of standardized trials evaluating the side effects of opioid use, which is the "golden standard" of medical science-based evidence. With such blatant lack of safety and effectiveness backing their use, why are so many people getting prescriptions for narcotic painkillers?
Even pregnant women are being prescribed these highly addictive and dangerous drugs! According to one recent study8,9 more than 14 percent of pregnant women were prescribed opioid drugs during their pregnancy, despite the risks for birth defects and other pregnancy-related problems.10
Not surprisingly, financial conflicts of interest appear to be part of the answer. As reported by Reading Eagle:11
"The two papers,12,13 published in the Annals of Internal Medicine, highlight a key issue in one of the major medical controversies of the last decade: how America got thrust into an opioid epidemic...
The stories... revealed that behind that surge in opioid prescribing was a network of pain organizations, doctors, and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the companies that made them."
Antidepressants Are Also Widely Overprescribed
A recent article in The New York Times14 penned by Psychiatrist Julie Holland highlights another disturbing trend, namely that of medicating away our emotional pain. While men tend to be more prone to get hooked on painkillers, women are more apt to fall into the antidepressant drug trap. Dr. Holland writes:
"Sales of antidepressants and antianxiety meds have been booming in the past two decades, and they've recently been outpaced by an antipsychotic, Abilify, that is the No. 1 seller among all drugs in the United States, not just psychiatric ones. As a psychiatrist practicing for 20 years, I must tell you, this is insane..."According to Dr. Holland, one in four American women is on a psychiatric drug, as is one in seven men. And, while some are helped by these drugs, many are not. In fact, most simply do not need them, and are needlessly placing their health at risk, as these drugs come with a laundry list of serious side effects.
It's also well worth noting that researchers have concluded there is very little evidence that selective serotonin reuptake inhibitors (SSRIs, such as Prozac, Paxil, Zoloft, and others) have any benefit to people with mild to moderate depression, and that they actually do not work any better than a placebo.
"People who don't really need these drugs are trying to medicate a normal reaction to an unnatural set of stressors: lives without nearly enough sleep, sunshine, nutrients, movement and eye contact, which is crucial to us as social primates..." Dr. Holland writes.
The new, medicated normal is at odds with women's dynamic biology; brain and body chemicals are meant to be in flux. To simplify things, think of serotonin as the 'it's all good' brain chemical. Too high and you don't care much about anything; too low and everything seems like a problem to be fixed.
In the days leading up to menstruation, when emotional sensitivity is heightened, women may feel less insulated, more irritable, or dissatisfied. I tell my patients that the thoughts and feelings that come up during this phase are genuine, and perhaps it's best to re-evaluate what they put up with the rest of the month, when their hormone and neurotransmitter levels are more likely programmed to prompt them to be accommodating to others' demands and needs."
Being Emotionally Numb Is Hardly Healthy...
Selective serotonin reuptake inhibitors (SSRIs) enhance serotonin transmission in your brain, but as Dr. Holland notes, higher serotonin levels does not necessarily equate to improved emotional health... While SSRIs can remove feelings of anxiety, they can also numb you both emotionally and physically—in fact, reduced libido is a common side effect. Also, antidepressants do not actually boost positive emotions; they merely blunt the negative ones. At first glance, this may sound appealing, but there's a price to pay for numbing your emotional repertoire across the board. As noted by Dr. Holland:
"Some people on SSRIs have also reported less of many other human traits: empathy, irritation, sadness, erotic dreaming, creativity, anger, expression of their feelings, mourning, and worry... At higher doses, SSRI's make it difficult to cry. They can also promote apathy and indifference... If the serotonin levels of women are constantly, artificially high, they are at risk of losing their emotional sensitivity with its natural fluctuations...
Change comes from the discomfort and awareness that something is wrong; we know what's right only when we feel it. If medicated means complacent, it helps no one. When we are overmedicated, our emotions become synthetic. For personal growth, for a satisfying marriage, and for a more peaceful world, what we need is more empathy, compassion, receptivity, emotionality, and vulnerability, not less. We need to stop labeling our sadness and anxiety as uncomfortable symptoms, and to appreciate them as a healthy, adaptive part of our biology." [Emphasis mine]
Spike in Suicide Rate Blamed on Recession
Suicide rates among middle-aged Americans have also risen sharply over the past few years. According to a recent paper15,16 published in of the American Journal of Preventive Medicine, stress from job, financial, and/or legal problems played a role in nearly 38 percent of suicides committed by middle-aged Americans in 2010. According to lead author Katherine Hempstead,17 director of the Robert Wood Johnson Foundation and the Center for State Health Policy at Rutgers University in Princeton:
"The middle-aged bear the brunt of economic stress associated with a downturn. They're the bread-winner groups who are raising kids, paying for college, planning for their retirement, and supporting their elderly parents."The study urges employers to become more aware of the impact layoffs can have on their employees, particularly middle-aged employees who do not have very many years left in the job market. As noted by MedicineNet.com:
"Human resources departments and managers should be aware that layoffs can trigger suicides, and be prepared to get people the help they need. 'When somebody is facing termination from their job, that would be a key time to understand those individuals may be at risk for suicide,' [Dr. Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention] said. Friends and family of a person undergoing financial problems should also be on the lookout for warning signs of suicide -- talking about suicide, giving away prized possessions, withdrawal and isolation -- and reach out if they believe the person needs help..."
Red Flags: Is Someone You Know Suicidal?
If someone close to you has recently endured a hardship, or you have noticed a change in their behavior, how can you tell when ordinary stress or sadness has progressed to a potentially suicidal level? Besides straightforward or "sideways" comments about not wanting to live any longer, some of the red flags that a person has a high risk for self-harm include:
If you think someone is suicidal, do not leave him or her alone. A person who appears suicidal needs immediate professional help. Help the person to seek immediate assistance from their doctor or the nearest hospital emergency room, or call 911. Eliminate access to firearms or other potential suicide aids, including unsupervised access to medications.
Acquiring a weapon Hoarding medication No plan for the future Putting affairs in order Making or changing a will Giving away personal belongings Mending grievances Checking on insurance policies Withdrawing from people
If you are feeling desperate or have any thoughts of suicide, call the National Suicide Prevention Lifeline, a toll-free number 1-800-273-TALK (8255), or call 911, or simply go to your nearest Hospital Emergency Department.
A Nation Running from Pain...
When you start looking at the big picture, it becomes rather evident that Americans are running from pain—both emotional and physical—and have bought the lie that happiness and comfort can be induced by chemical substances... All of the statistics covered in this article point to the fact that the US is a nation in crisis, and we're looking for solutions in the wrong places. Instead of facing our pains and dissatisfactions head on, we're suppressing them in order to keep going "as usual." The only ones getting ahead right now is the drug companies. Most everyone else is getting a raw deal...
Depression and physical pain often go hand in hand; the good news is that by addressing depression, you can oftentimes achieve pain reduction as well, and vice versa (if you happen to suffer from both). Another piece of good news is that there are many non-drug alternatives out there that are far safer, and often as or more effective than drugs, and this applies both to pain reduction and depression. For a list of non-drug alternatives specifically for pain relief, please see my previous article, "For Back Pain or Headache, Painkillers Do More Harm Than Good." I'll also close with a brief section on medical cannabis, below, which is a viable option for increasing numbers of people these days, in states that have legalized its use. Following is a list of mind-body techniques that can help ease both pain and depression.
Diet Foods have an immense impact on your body and your brain, and eating whole foods as described in my optimized nutrition plan will best support your mental and physical health. Avoiding sugar (particularly processed fructose) will help normalize your insulin and leptin levels, which is another important aspect of depression. Sugar causes chronic inflammation, which disrupts your body's normal immune function and can wreak havoc on your brain.
Sugar also suppresses a key growth hormone called BDNF (brain derived neurotrophic factor), which promotes healthy brain neurons. BDNF levels are critically low in people with depression, which animal models suggest may actually be causative.
I also recommend taking a high-quality, animal-based omega-3 fat, like krill oil. This may be the single most important nutrient for optimal brain function, thereby preventing depression.Exercise Getting regular exercise is one of the "secret weapons" to overcoming depression. It works by helping to normalize your insulin levels while boosting the "feel good" hormones such as serotonin and endorphins in your brain. Optimize your vitamin D Getting safe sun exposure, which allows your body to produce vitamin D, is great for your mood. One study even found that people with the lowest levels of vitamin D were 11 times more prone to depression than those who received adequate vitamin D. The Emotional Freedom Techniques (EFT) EFT is a form of psychological acupressure. Gentle tapping with the fingertips is used to transfer kinetic energy onto specific meridians on your head and chest while you think about your specific problem and voice positive affirmations. This works to clear the "short-circuit"—the emotional block—from your body's bioenergy system, thus restoring your mind and body's balance, which is essential for optimal health and healing. Massage Massage affects your nervous system through nerve endings in your skin, stimulating the release of endorphins, which are natural "feel-good" chemicals. Getting a massage has been shown to relieve pain from migraines, labor, fibromyalgia and even cancer; reduce stress, anxiety, and depression; decrease symptoms of PMS; and can provide arthritis relief by increasing joint flexibility. Mindfulness and other forms of meditation Practicing "mindfulness" means that you're actively paying attention to the moment you're in right now. Mindfulness training has been found to reduce levels of stress-induced inflammation, which could benefit people suffering from chronic inflammatory conditions like rheumatoid arthritis, inflammatory bowel disease, and asthma. Practicing mindfulness meditation for just four days can decrease pain responses in your brain. Biofeedback Biofeedback allows you to monitor your biological changes, thereby helping you achieve a deeper state of relaxation and teaching you to control your heart rate, blood pressure, and muscle tension through your mind. Biofeedback is often used for stress-related conditions, such as migraines and tension-type headaches, fibromyalgia, back pain, depression, and anxiety. Progressive muscle relaxation Progressive muscle relaxation (PMR) is achieved by tensing and relaxing all the major muscle groups, one at a time, from head to toe. By learning to feel the difference between tension and relaxation, you can more actively disengage your body's fight-or-flight response, which underlies most pain, depression, and stress. Tai Chi While practicing tai chi, your mind is meant to stay focused on your movements, relaxation and deep breathing, while distracting thoughts are ignored. Part of the allure is that it's so gentle, it's an ideal form of activity for people with pain or other conditions that prevent more vigorous exercise. You can even do tai chi if you're confined to a wheelchair. The medical literature shows tai chi helps reduce depression, anxiety, and stress. Breathing techniques Deep breathing activates your parasympathetic nervous system, which induces the relaxation response. Dr. Weil's 4, 7, 8 breathing technique works as a natural tranquilizer for your nervous system. The Buteyko Breathing Method helps improve oxygenation of your tissues and organs, including your brain, and can be particularly helpful to quell a panic attack or control anxiety. Hypnosis Hypnosis, which is a trance-like state in which you experience heightened focus and concentration, can help decrease pain by altering your emotional responses to your body's pain signals and your thoughts about the pain. Contrary to popular belief, you do not relinquish control over your behavior while under hypnosis, but it does render you more open to suggestions from the hypnotherapist. In addition to managing pain, cognitive hypnotherapy has been shown to lessen depression and anxiety better than cognitive behavioral therapy. Music therapy Music triggers activity in the nucleus accumbens, a part of your brain that releases the feel-good chemical dopamine and is involved in forming expectations. At the same time, the amygdala, which is involved in processing emotion, and the prefrontal cortex, which makes possible abstract decision-making, are also activated. Studies18,19 reveal listening to music results in less anxiety and lower cortisol levels among patients about to undergo surgery than taking anti-anxiety drugs. Yoga Yoga has been proven to be particularly beneficial if you suffer with back pain, and can also be of tremendous benefit for your mental health.20 According to recent findings, yoga appears to have a positive effect on mild depression, sleep problems, schizophrenia (among patients using medication), and ADHD (among patients using medication). Some studies21,22 suggest yoga can have a similar effect to antidepressants and psychotherapy, by influencing neurotransmitters and boosting serotonin. Visualization and guided imagery Visualization techniques or guided imagery can serve as an important tool to combat both physical pain and depression by imagining being in "a better place" and promoting a state of relaxation. Ideally, you'll want to immerse yourself as fully as you possibly into your visualization, using all your senses: seeing, smelling, tasting, hearing, and feeling, as using all your senses changes levels of brain chemicals, such as serotonin, epinephrine, and endorphins. Mantra The repeated incantation of a mantra—a soothing or uplifting word or phrase of your choice—in a rhythmic fashion can help you relax in a similar way as mindfulness training. The focused repetition, also called autogenic training, helps keep your mind from wandering and worrying, and engages your body's relaxation response. In one study, migraine sufferers were able to decrease the frequency and intensity of their headaches using autogenic training. Other research suggests it may provide helpful longer-term effects on symptoms of depression. Neurostructural Integration Technique (NST) Using a series of gentle moves on specific muscles or at precise points on your body creates an energy flow and vibrations between these points. This allows your body to rebalance itself. The main objective is to remove pain and dysfunctional physiological conditions by restoring the structural integrity of the body. In essence, NST provides the body with an opportunity to reintegrate on many levels, and thus return to and maintain normal homeostatic limits on a daily basis.
Medical Cannabis—Another Option for Pain Relief
Certain forms of cannabis are potent medicine with few or no psychoactive effects. Even the US Surgeon General Vivek Murthy has spoken out about its potential benefits, saying: "We have some preliminary data showing that for certain medical conditions and symptoms, marijuana can be helpful." His statement echoes a growing sentiment in the medical and scientific communities that the health benefits of marijuana should no longer be ignored. The American Academy of Pediatrics (AAP) has also given strong support for research and development as well as a "review of policies promoting research on the medical use of these compounds."
At present, 23 states have legalized medical marijuana.23 Another 11 states have pending legislation for 2015.24 On a federal level, however, the herb is still considered a Schedule 1 controlled substance (other Schedule 1 drugs include heroin, LSD, ecstasy, methaqualone, and peyote). Ironically, oxycodone, fentanyl, and meperidine (Demerol), which are among the most commonly abused opioids and leading causes of opioid overdose deaths, are Schedule II drugs, meaning they should technically be less dangerous than marijuana. Meanwhile, until recently certain opioid prescription drugs such as Vicodin were classified as Schedule III substances, which are defined as "drugs with a moderate to low potential for physical and psychological dependence."
A wealth of research shows marijuana does have outstanding promise as a medicinal plant, largely due to its cannabidiol (CBD) content. Cannabinoids interact with your body by way of naturally occurring cannabinoid receptors embedded in cell membranes throughout your body. There are cannabinoid receptors in your brain, lungs, liver, kidneys, immune system, and more. Both the therapeutic and psychoactive properties of marijuana occur when a cannabinoid activates a cannabinoid receptor.
Research is still ongoing on just how extensive their impact is on our health, but to date it's known that cannabinoid receptors play an important role in many body processes, including metabolic regulation, cravings, pain, anxiety, bone growth, and immune function. To learn more about the legal parameters of using medical cannabis in your state, check out ProCon.org's website.25 I also recommend listening to my interview with Dr. Allan Frankel, a board-certified internist in California, who has treated patients with medical cannabis for the past eight years.
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