Pain News
IMPORTANT NEWS:
There have been several recalls of the fentanyl patches. We have had patients who have experienced acute withdrawal and/or other complications as a result of defective patches. If you are using a fentanyl patch, please contact your pharmacy to find out if your particular brand and lot number are affected by the recall.
Scroll down the list or click on one of these quick links:
- News in General about the office - soon
- News about Chronic Pain - soon
- New Medications
- New Indications for current medications
- New Warnings for current medications
- Legal Issues in pain medicine
- New Procedures for pain diagnosis or treatment
- New Research into pain
NEW MEDICATIONS COMING and HERE NOW (remember all medications have risks and not all medications are appropriate for any particular condition): back to top
- Remoxy is moving closer to FDA approval: Remoxy is a long-acting form of oxycodone (the pain drug that makes up OxyContin, Percocet and other medications). Remoxy is a long-acting form (like OxyContin) but with a difference: it is an abuse-resistant form that is expected to be less likely to be abusable and abused. This can be a benefit to legitimate pain patients who use oxycodone currently. Those pain patients who use a less abusable form of a given drug help show society that they are using the medication for a legitimate pain purpose. Click here to Google Remoxy.
- Flector is an NSAID patch. Containing a well-known anti-inflammatory agent (known in pill form by the brand name Voltaren), the Flector patch is intended to be placed directly on the site of pain, with a focus on inflammatory musculoskeletal injuries. Although the same warnings are present with all NSAIDs, the FDA data suggest that the GI side effects may be reduced with the patch. Time will tell.
- Amrix is now available. The use of Flexeril (cyclobenzaprine) is very common for muscle spasm. Amrix is a 24-hour (long-acting) form of cyclobenzaprine. An advantage of a 24-hour formulation is a consistent delivery of medication throughout the day and night. Another benefit is the absence of the sudden onset of the short-acting forms of cyclobenzaprine. Clinical experience suggests that patients unsing the 24 hour form do not have the sudden sleepiness associated with taking a regular form of cyclobenzaprine, although of course, the risk of sleepiness is still present. The use of a sustained-release preparation also reduces the overall number of medication units dispensed. Our Amrix information can be found here.
- Endo laboratories in conjunction with another pharmaceutical company is developing a fentanyl nose spray for breakthrough pain. There also is a "mouth patch" form of fentanyl that may be effective for breakthrough pain. These products are in various stages of trials and likely are a few years away from release.
- Amitiza is a new medication for constipation. Although for idiopathic constipation, the medication may be appropriate for opioid-induced constipation, which means the constipation that comes from taking pain medications.
CURRENT MEDICATIONS that may receive additional indications, which means additional FDA-approved uses: back to top
- Fentora is a breakthrough pain medication that has been FDA
approved for breakthrough cancer pain. Because most chronic pain
is non-cancer pain, most of the use of Fentora has been for
other forms of chronic, life-long pain syndromes. The makers of
Fentora have submitted the medication for potential FDA approval
for breakthrough pain in chronic back pain and/or neuropathic
pain based on recent studies that showed it significantly
helpful for chronic back pain and/or neuropathic pain.
Currently, the FDA has accepted the supplemental drug
application and will make a decision as to the information above
sometime toward the end of 2008. Click
here to learn more information about
Fentora for
back pain and neuropathic pain. The search may include
information about risks and improper use of pain medications.
Fentora, being very strong,
also has had some new warnings. As with other opioids, there
is a risk of overdose or other fatal event with misuse.
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NEW WARNINGS about current medications: back to top
As you know, information changes daily and as time moves forward, we find more and more side effects and/or problems with almost all medications. It is always important to remember that medications carry a risk and the full extent of that risk may not be known for many years...
For some time, OxyContin was in the forefront of the news. Because of the issues of abuse, many physicians turned away from OxyContin and instead to the fentanyl patch for long-term pain control. As the use of the fentanyl patch has increased, so have the abuses and overdoses. Most people who abuse the patches are able to remove the drug from the inside of the patch and smoke it, ingest it or inject it; since the patch contains more than 72 hours' worth of the drug, abusing the patch in this manner has resulted in death. However, it is also concerning that some patients who did not try to abuse the patch have also suffered overdose. Accidental overdose can occur by heating the patch (super hot day in the summer, really hot shower, hot tub, sauna, heating pad, etc.). A warmed up patch releases the medication much faster than intended. Although there are warnings about this on the label, many people do not read the labels or instructions; therefore, patient education remains very important. There are three versions of the patch available, one brand name product called Duragesic and two generic products. The two generics are different and are abused in different manners. The FDA released information about these issues in 2006 but has reissued new warnings because of increasing cases of overdose.
That is not to say that OxyContin is not still in the forefront of the news. For information, you can click this Google News link for OxyContin. Unfortunately, as of December 28, 2007, there are active pharmacy robberies and bomb threats and 13-year-olds giving it out at school and 77-year-olds dealing it on the street. As you know, the active substance abuse problem--which is a medical disorder separate from chronic pain--always takes the spotlight over chronic pain (partly because drug abuse often involves crime). It is so very important for legitimate pain patients to keep guard over their medications.... Our OxyContin information can be found here.
Fentora was in the news recently. This is the dissolving fentanyl mouth tablet for breakthrough pain (and is mentioned a few paragraphs above this one). There were three or four deaths potentially related to misuse of the Fentora medication (apparently one case was a suicide, which could happen with any drug and therefore really isn't the drug's fault). Fentora is an effective breakthrough pain medication but must be treated with respect. An overdose of this or other opioid medications could be fatal. Our Fentora information can be found here.
Methadone will undergo some changes in 2008. The most notable change is the elimination of the 40mg tablet for chronic pain. It will be available in 5mg and 10mg for chronic pain (meaning the quantity of medication may increase even if the dose does not increase). Because it is an effective chronic pain medication and because it is very cheap, it is commonly prescribed for chronic pain patients who are seeking the least-costly opioid treatment. The increase in methadone prescriptions is supposedly somewhere around 35% over a year or two. However, it is associated with a significant risk of overdose death, partly because it can affect the heart rhythm, especially if used with certain other drugs, and partly because the side effects can be delayed for a week or so because the medication can slowly build up in the system. Although a very effective pain medication, methadone may have the highest risk and it must be used cautiously and exactly as prescribed. Our methadone information can be found here. Methadone demands respect; misuse can be--and has been--fatal.
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LEGAL ISSUES: back to top
- The DEA has completed a new rule that will allow physicians to prescribe three separate 30-day prescriptions at one time, to achieve the equivalent of a 90-day total amount of medication. The DEA points out that this is an allowance, not a recommendation or requirement. This means that those patients who are selected as potential candidates may receive three separate prescriptions with the notations fill now, fill in 30 days and fill in 60 days, like they may have received in years past.
- The use of methadone for pain management has been increasing greatly, partly because of efficacy and partly because of cost. However, the number of deaths on methadone has also risen greatly. That has resulted in a governmental policy change, the elimination of 40mg tablets for chronic pain use. A patient who takes, say, 120mg of methadone per day for pain previously could have used just three 40mg tablets per day for a total of 90 pills per month. But now, the same patient will need to use twelve 10mg tablets per day for a total of 360 pills per month.
NEW PROCEDURES FOR PAIN MANAGEMENT: soon back to top
- Currently, we have no new procedures to report, but we are watching the news closely.
NEW SCIENTIFIC RESEARCH INTO PAIN SYSTEMS: soon back to top
- There are many pain studies in progress, related to the causes of pain and also to the treatment of pain. Although the studies have not concluded and therefore the outcome is not known, one new bit of information is that patients with chronic pain may have a longer "nerve memory" than patients without chronic pain. Remember the game where you stare at a picture for awhile and then look away and you still see the picture? That is a sort of visual memory. In chronic pain patients, perhaps the nerves have the same type of memory, but for pain signals. Anyway, it is still being sorted out.