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Welcome,Tim Guith's Page 5. Sections on  Opiods WAR ON PAIN: THE FLEECING OF AMERICA'S  PAIN PATIENTS  UNDER OPIOID THERAPY Trigeminal Neuralgia, aka Tic douloreaux  or  TN
&
Temporomandibular  Joint aka TMJ   Click Here to see my other record file at IAmFightingCancer.com  Bookmark this page now!  
 
Scan down to read my very lengthy and detailed web journal. Call me if I can help you. 713-467-3025

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Page 6.  Bilateral Facial Pain and Bitter Taste in the Mouth. http://www.briannelsonconsulting.com/trigeminal-neuralgia-tn/bilateral-facial-pain.html 

Page 7  of 7 Patient Painful Stories  You are at: http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/patient-painful-stories.html

You can find this site again  by typing  the word "neuralgia1" backwards, ie.  OR "1aiglaruen"in Google. Brian "

Bookmark this page now!

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If after you scan to the bottom of this  website and still can't find the information you are looking for try another Google search here.
Tim Guith's Page 5. Sections on  Opiods WAR ON PAIN: THE FLEECING OF AMERICA'S  PAIN PATIENTS  UNDER OPIOID THERAPY Trigeminal Neuralgia, aka Tic douloreaux  or  TN
&
Temporomandibular  Joint aka TMJ   Click Here to see my other record file at IAmFightingCancer.com  Bookmark this page now!  
 
Scan down to read my very lengthy and detailed web journal. Call me if I can help you. 713-467-3025 Brian
Signature Card For:                 Brian Nelson    31 Gessner Rd. , Houston, TX  77024
Tel. 713-467-3025 (Refers to my cell)      Fax 713-467-3192        
Click here to e-mail me.

www.NelsonIdeas.com
       Make a difference in the world!  "Idea Possibility Consulting"
www.BrianNelsonConsulting.com    There are so many new ways to make more profit. 
www.PartyTentCity.com 
                                The best modular party tent you can buy!
www.IamFightingCancer.com   Brian's story on Cancer and TN.  Post your Cancer story!
Misspelled Words on this pagetrigemnal, trigeminal, trigemial, trigeminl, tigeminal, trgeminal, trieminal, trigminal, trigeinal, trigeminar, tligeminal, tligeminar, tr1gen1ma1, tr1gen1mal, trigenimal, trigemimal, trigeminla, trigemianl, trigemnial, trigeimnal, trigmeinal, triegminal, trgieminal, tirgeminal, rtigeminal, trigemina, rigeminal, neuralgia, nuralgia, neralgia, neualgia, neurlgia, neuragia, neuralia, neuralga, neurargia, neurargai, neulalgia, neulalgai, neulargia, neulargai, neuralgai, neura1g1a, neuralg1a, meuralgia, neuraliga, neuraglia, neurlagia, neuarlgia, nerualgia, nueralgia, enuralgia, neuralgi, euralgia, tic, tik, tick, t1c, tci, itc,dou1oreaux, douloreaxu, douloreuax, douloraeux, douloeraux, doulroeaux, douolreaux, doluoreaux, duoloreaux, oduloreaux, douloreau, douloreax, douloreux, douloraux, douloeaux, doulreaux, douoreaux, doloreaux, duloreaux, ouloreaux, douloreaux,tenporomad1bu1ar, tenporomad1bular, tenporomadibular, temporomadibulra, temporomadibualr, temporomadibluar, temporomadiublar, temporomadbiular, temporomaidbular, temporomdaibular, temporoamdibular, tempormoadibular, tempoormadibular, temproomadibular, temopromadibular, tepmoromadibular, tmeporomadibular, etmporomadibular, temporomadibula, temporomadibulr, temporomadibuar, temporomadiblar, temporomadiular, temporomadbular, temporomaibular, temporomdibular, temporoadibular, tempormadibular, tempoomadibular, tempromadibular, temoromadibular, teporomadibular, tmporomadibular, emporomadibular, temporomadibular

Trigeminal Neuralgia, aka Tic douloreaux  or  TN
& Temporomadibular Joint
aka
TMJ  Eventually Cancer.
You are at Page 1 of 4 Section 1-25

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You  are at PageTim Guith Page 5. Sections 101 to 125 Opiods

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Trigeminal Neuralgia , TN, tic douloreaux, is the trigeminal nerve producing  false signals from the brain sending excruciating lightening strikes of facial pain to one side of the face. Compendium.  My new Dr. has prescribe a small does of methadone, an opiod. Therefore I had to add a little more research to this page.  See my TN Story below or go to: http://www.PartyTentCity.com/mytnstory.html .  

MTNSB   Include page Pending Paste.

Tim Guith Page. Sections 101 to 125 Opiods

 You are at. http://www.BrianNelsonConsulting.com/trigeminal-neuralgia-tn/tim-guith.html  UD 09/06/2006 12:55:13 PM -0500

Trigeminal Neuralgia , TN, tic douloreaux, is the trigeminal nerve producing  false signals from the brain sending excruciating lightening strikes of facial pain to one side of the face.  Treatment is by medication, radiosurgery, craniofacial surgery or neurosurgery  or Microvascular Decompression  (MVD) for nerve pain relief. Trigeminal Neuralgia typically is near the nose lips, eyes, or ears.

This  compendium is also "Brian's Pain Journal". Let me hear about your face pain. I can publish on the web  anything you have to say about  trigeminal neuralgia. It will help other with face pain.  We can become "Pain Pals". The cause and permanent cure for
tic douloreaux (TN) are still unknown.  If your group would like a speaker about TN  call me. 

Page 1 of 5.

 
by  Brian Nelson
bnelson@PartyTentCity.com

713-467-3025 Houston,  TX 

  Hi Aiglaruen

This website  about Trigeminal neuralgIa. has pages 1, 2, 3 AND 4. Please Wait for the download time of a 1-2 minutes page. T
th 
This page was updated on 09/06/2006 12:55 PM -0500

101

This letter is for the record and to keep a PAIN JOURNAL of where the above stated title problem stands. 

 You are at Page 5 of 7 Sections  101-125 Opiods
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1Brian Nelson
www.NelsonIdeas.com

www.PartyTentCity.com
www.BrianNelsonConsulting.com
31 Gessner Rd.
Houston,  TX  77024
713-467-3025 
Research on Brian's Pain Management.

What Is Trigeminal Neuralgia?

Brian Nelson’s Report Pain on Left side of Head.
Brian Nelson, 31 Gessner Rd. , Houston, TX  77024
  713-467-3025 .
Here is an interesting MVD website about surgery successes. I am surprised it was on the net.   http://www.hfs-assn.org/surgery.htm 

Misspelled Words on this page  trigemnal, trigeminal, trigemial, trigeminl, tigeminal, trgeminal, trieminal, trigminal, trigeinal, trigeminar, tligeminal, tligeminar, tr1gen1ma1, tr1gen1mal, trigenimal, trigemimal, trigeminla, trigemianl, trigemnial, trigeimnal, trigmeinal, triegminal, trgieminal, tirgeminal, rtigeminal, trigemina, rigeminal,neuralgia, nuralgia, neralgia, neualgia, neurlgia, neuragia, neuralia, neuralga, neurargia, neurargai, neulalgia, neulalgai, neulargia, neulargai, neuralgai, neura1g1a, neuralg1a, meuralgia, neuraliga, neuraglia, neurlagia, neuarlgia, nerualgia, nueralgia, enuralgia, neuralgi, euralgia,opiod, opyod, opioid, opyoid, op1o1d, opiodi, opiiod, opoiid, oipoid, poioid, opioi, opiid, opoid, oioid, pioid,chronic, chrik, chroik, chrnik, chric, chrnic, cronic, chonic, chronc, chronik, chromic, cromic, chomic, chrmic, chroic, chromc, chromik, chrni, croic, chroi, croik, clonic, cronik, clonik, cric, crik, chroni, crnic, chri, crnik, chron1c, chronci, chroinc, chrnoic, chornic, crhonic, hcronic, hronic,cav1tat1ona1, cav1tat1onal, cavitational, cavitatiomal, cavitationla, cavitatioanl, cavitatinoal, cavitatoinal, cavitaitonal, cavittaional, caviattional, cavtiational, caivtational, cvaitational, acvitational, cavitationa, cavitationl, cavitatioal, cavitatinal, cavitatonal, cavitaional, cavittional, caviational, cavtational, caitational, cvitational, avitational,ostonecrosis, osteoneclocys, osteonecrosis, ostenecrosis, osteonecrosee, osteonecrosys, osteoecrosis, osteoneclosee, osteonecrosus, osteoncrosis, osteonecrocee, osteoneclosis, osteonerosis, osteoneclocee, osteoneclosys, osteonecosis, osteonecrocus, osteoneclosus, osteonecrsis, osteoneclocus, osteonecrocis, osteonecrois, oteonecrosis, osteoneclocis, osteonecross, oseonecrosis, osteonecrocys, osteonecros1s, osteomecrosis, osteonecrossi, osteonecroiss, osteonecrsois, osteonecorsis, osteonercosis, osteoncerosis, osteoencrosis, ostenoecrosis, ostoenecrosis, osetonecrosis, otseonecrosis, soteonecrosis, osteonecrosi, steonecrosis,oxycont1n, oxycontin, oxycomtin, oxycontni, oxyconitn, oxycotnin, oxycnotin, oxyocntin, oxcyontin, oyxcontin, xoycontin, oxyconti, oxycontn, oxyconin, oxycotin, oxycntin, oxyontin, oxcontin, oycontin, xycontin,analgesic, analgesik, anargesik, analgesc, analgeic, analgsic, analesic, anagesic, anlgesic, aalgesic, anargesic, ana1ges1cs, analges1cs, analgesics, amalgesics, analgesisc, analgescis, analgeiscs, analgseics, analegsics, anaglesics, anlagesics, aanlgesics, naalgesics, analgesis, analgescs, analgeics, analgsics, analesics, anagesics, anlgesics, aalgesics, nalgesics

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101 SCIENTIFIC AMERICAN February 1990 Volume 262 Number 2

The Tragedy of Needless Pain

Contrary to popular belief, the author says, morphine taken solely to control pain is not addictive. Yet patients worldwide continue to be undertreated and to suffer unnecessary agony

by Ronald Melzack_________________________________________________________
RONALD M]ELZACK, who has been studying the neurophysiology of pain for 35 years, is E. P. Taylor Professor of Psychology at McGill University and research director of the Pain Clinic at the Montreal General Hospital. After earning a Ph.D. in psychology from McGill in 19S4 and accepting fellowships in the U.S. and abroad, he joined the faculty of the Massachusetts institute of Technology in 19S9. There, he and Patrick D. Wall began discussions that led to the 196S publication of their now famous ,gate control" theory of pain. He returned to McGill in 1963. This is his third article for Scientific American.

102   WAR ON PAIN: THE FLEECING OF AMERICA'S  PAIN PATIENTS  UNDER OPIOID THERAPY

By katt52@webtv.net     http://pnews.org/art/2art/warpain.html

There's a little known secret that's happening all across the nation, robbing people of their dignity and killing others. It is the same little secret that makes the suicide rate 900% higher than in the national average. (Intelihealth August 4,1997)

Chronic pain is the most under treated epidemic that our nation has ever faced. Millions of Americans suffer needlessly, shunned by a medical community that is running scared. On a regular basis, family physicians and pain specialists alike, are losing there ability to prescribe narcotics to their chronic intractable pain patients. The government's unsuccessful "War on Drugs" project has done nothing to stop the pouring of drugs over the borders or the black market, street drugs. What it HAS done is put the medical community under siege by the Drug Enforcement Agency (DEA). In the DEA's quest to look like they are winning the "War on Drugs", they have turned to your doctor's office for suspects.

Cases in point"  Click Here:

Cases in point:

1992 Dr. McNiel- Mosheim, Tennessee

Notified that he was under investigation when two "badged" officers came into his office to look at patient's files. Over a year later, charges were brought against Dr. McNiel for "non-theraputic" prescription writing. Along with more than $20,000 in fines, Dr. McNiel was labelled as having a "co-dependent" relationship with his patients. He was court ordered into a co-dependency group. He fought back and won. He is now back in practice.

1996- Dr. McFadden- Tupelo, Mississippi

Federal and state investigators showed up with a search warrants, seizing the medical records of 36 of his patients. A few months later, Dr. McFadden was charged with eleven counts of violating the Mississippi Medical Practice Act. It took several years of exhausting all means, both financially and emotionally, but he fought back and won. He is now back in practice.

1998- Dr. Metellus- Davie, Florida

Two under-cover police officers went to Dr. Metellus' office posing as pain patients. Equiped with fraudulent X-rays, the officers received pain medication. The officers then filled the presciptions and later arrested Dr. Metellus for drug trafficking. This family physician, with no prior record, is serving a 25 year mandatory sentence and faces over 1/2 million dollars in fines.

Dr. Ronald Wright, the former Broward County Medical Examiner told reporter, John Grogan, "I think he was completely set up." Wright was hired by the state to interpret Metellus' medical records and has gone on record saying, "From my perspective, it's pretty clear. He's innocent." (Sun Sentinel, June 17, 1998)

"The Police State of Medicine"

Dr. William Hurwitz, who himself had lost his license in 1996 for over prescribing opiates, spoke to the Drug Policy Foundation in 1997, of his patients..." over 200 of these patients with crippling pain from failed backs, arthritis, multiple sclerosis, interstitial cystitis, arachnoiditis, RSD, TMJ, Trigeminal neuralgia, and phantom limbs. . . the list goes on and on and on. Many of them had come to me after years of unsuccessful attempts to obtain relief from a multitude of procedures, doctors, and pain clinics. They were treated like addicts and criminals.

They were stigmatized, insulted, neglected and abandoned. Betrayed by the whole medical profession with the refrain, 'I would like to help you, but I can't. I don't want to lose my license.' But who can blame the doctors, who are themselves the victims of the thuggish drug-control police and the heartless and mindless bureaucrats who serve on boards of medicine."

Skip Baker, president of the American Society for Action on Pain (ASAP) contributed the following, "If the public knew for instance that the chance of "addiction" was less than one half of one percent for a Pain Patient, or that tens of thousands MORE people die from LACK of drugs, than die as a RESULT of them, that millions of innocents are in jail for nothing, they would know the scare was all propaganda. By instilling FEAR in the American People about "Drugs" they can better control them. First it was FEAR of the USSR, now it's drugs. The entire undertaking is to get people so afraid of a non-threat that they are willing to give up the Constitution in order to be "protected" from the alleged threat. The only "threat" that's out there is the attack on the truth."

A recent New England Journal of Medicine editorial stated that 56% of cancer outpatients and 82% of AIDS outpatients received inadequate pain treatment.

In an article in the "Toronto Star" (July 17,1998) Don Colburn writes, "To the researchers who recently studied cancer pain in more than 13,000 nursing home patients, one finding stuck out like the proverbial sore thumb....

What stunned the researchers was that one out of four of the patients in day-in, day-out pain received no pain medication at all. "We thought we'd find a more ambiguous issue of undertreatment of pain - but not no treatment," says Vincent Mor of the Centre for Gerontology and Health Care Research at Brown University and co-author of the pain study. "That's the most disturbing finding -the absence of even very mild analgesics for 26 per cent of the patients in pain." "Daily pain is prevalent among nursing home residents with cancer and is often untreated, particularly among older and minority patients," the study concludes.

Previous studies also found that pain is widely undertreated in both hospitals and nursing homes.

Researchers offer several reasons why pain goes untreated, particularly in older patients. They include poor communication, inadequate training of doctors and exaggerated fears about addiction. "Drugs, particularly narcotic painkillers, are not viewed positively" by nurses and doctors, Mor adds. "There's a very strong worry about addiction." Yet the American Geriatrics Society guidelines, issued in March, concluded that addiction "appears to be very low" in such patients."

From a pain forum on the internet, these words tell a tale of frustration and despair,

"...how many more pain patients will become one of the 200 people who call Dr Kevorkian weekly, before this insanity stops? How can we watch the goverment "criminalize" pain patients while putting themselves in a position of practicing medicine without the benifits of a medical degree? When the DEA enters into the medical field and sets protocol for what constitutes "over-prescibing", a situation is created where non-medical people are deciding medical policy."

According to the "National Chronic Pain Outreach Association" an estimated 34 million patients suffer from chronic pain and that an estimated 7 million of these patients can't relieve their pain without opiods.

There's change in the air as people like Skip Baker over at ASAP, continue to fight for the rights of pain patients. An internet forum, created to exchange ideas and offer support, continues to grow in numbers. When contacted, Mr. Baker offered the following, "The War on Drugs has become a "War on People in Pain" and is effecting at least 8 million Intractable Pain Patients whose pain can only be controlled with powerful narcotic pain medicine. 30 million more have some form of Chronic Pain. For the DEA it's much easier to "go after" an unarmed doctor than a "drug dealer" in the streets. They have put so many caring doctors out of business for treating pain, that there are nearly none left to deal with the problem of Chronic Pain. As a result, thousands are taking their own lives each year, and at least 17,000 are dying as a result of the bleeding complications of NSAIDS, because doctors are afraid to prescribe "real" pain medicine."

K A T T

[NOTE: Attitudes must change. Doctors have been prevented from helping patients by not prescribing adequate pain medication to chronic-pain patients, for fear of losing their licenses to practice proper medicine. The problem for those with Chronic Pain has never been addiction, it is a quality of life often unattainable, and the solution is simply a lack of public information. Thanks katt for providing this timely article.-----TheGolem]

Tim Guith's Page 5. Sections on  Opiods WAR ON PAIN: THE FLEECING OF AMERICA'S  PAIN PATIENTS  UNDER OPIOID THERAPY Trigeminal Neuralgia, aka Tic douloreaux  or  TN
&
Temporomandibular  Joint aka TMJ   Click Here to see my other record file at IAmFightingCancer.com  Bookmark this page now!  
 
Scan down to read my very lengthy and detailed web journal. Call me if I can help you. 713-467-3025 Brian
Signature Card For:                 Brian Nelson    31 Gessner Rd. , Houston, TX  77024
Tel. 713-467-3025 (Refers to my cell)      Fax 713-467-3192        
Click here to e-mail me.

www.NelsonIdeas.com
       Make a difference in the world!  "Idea Possibility Consulting"
www.BrianNelsonConsulting.com    There are so many new ways to make more profit. 
www.PartyTentCity.com 
                                The best modular party tent you can buy!
www.IamFightingCancer.com   Brian's story on Cancer and TN.  Post your Cancer story!
103 TRIGEMINAL NEURALGIA
You may be wondering what lightening has to do with Trigeminal Neuralgia (TN). For some, it is what comes to mind when asked to describe the pain. It feels like powerful jolts of electricity are going through your  face, usually in the lower jaw. TN usually occurs on one side of the face.

TN is universally thought to be the worst pain known to mankind. It usually strikes after the age of 50.  It is now known that it can exists even in children. Although this is rare, it can strike at any age. Some are NOT diagnosed with TN because their doctor says they are "too young" to have it. This is simply not the case.  TN can also be a symptom of Multiple Sclerosis (MS).

Often the first trip will be to the dentist. TN or other facial neuralgias PAIN symptonms often present themselves in the teeth or jaw. Many have gone through unnecessary dental procedures trying to cure the pain and which have made it even worse.

Then you may go off to your family doctor. Hopefully he/she will recognize it and send you to a neurologist.

The first line of defense is usually an anti-seizure drug called carbamezapine (Tegretol). Be careful with it and insist blood work be done.  it can wipe out white blood cells and  you can got dangerously ill with meningitis. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

104  http://www.nurseslearning.com/courses/corexcel/CXNRP-1600/Chap2/course/chap1/p4.html
http://www.geocities.com/HotSprings/Sauna/5851/tn.html


Substance Abuse: A History of the Opiods

Effects of the Opiods

Analgesic Effects: The primary reason for the use of opiods is for pain relief. These agents suppress the perception of pain without completely clouding the consciousness.

Each of the opiods relieves pain in dose-related increments, until they reach a plateau. This plateau is different for each of the opiods. Beyond this plateau, ever-greater doses will only produce greater side effects such as respiratory depression, sedation, seizures, and loss of motor control.

Among the most effective analgesics are parenterally administered heroin, morphine, and hydromorphone (Dilaudid) because of their rapid absorption and high threshold for side effects. Codeine and methadone have good oral absorption, but morphine and meperidine (Demerol) do not.

Antitussive Effects:
Opiods suppress the cough reflex by decreasing the sensitivity of the central respiratory center to rising carbon dioxide levels. Death from respiratory arrest can result.

Respiratory Effects: Respiratory arrest is the major cause of death from acute opiod overdose. The opiate antagonists (e.g. naltrexone) can dramatically reverse respiratory depression.

Gastrointestinal Effects: Nausea and emesis may be the initial reaction due to central stimulation, but as central depression occurs, emesis may not occur even with an emetic agent. Both the longitudinal and circular muscular layers of the intestine contract simultaneously, sharply reducing peristalsis action. This can be a helpful effect in patients with dysentery, minimizing loss of fluid and electrolytes. However, the effect can be unpleasant in people being treated for pain because these same effects on the gastric musculature lead to constipation.

Smooth Muscle Effects: The smooth muscle of the urinary bladder is stimulated by opiods. This can produce a troublesome feeling of constant urgency, however, most opiod abusers come to ignore this due to reduced central perception of this effect. The uterine muscle is mildly affected by opiods so that labor is frequently prolonged.

Peripheral Effects: Opiods induce a release of histamine which results in peripheral blood vessel dilation, and may cause reddened skin and itching. Another mechanism causes reflex vasoconstriction inhibition resulting in orthostatic hypotension.

Endocrine Effects: Opiods act on the pituitary gland to decrease thyroid activity and production of gonadotropins and adrenocorticotropic hormone. This leads to lessened sexual desire in both men and women.

CNS Effects: There are receptor sites in the central nervous system for endogenous, opiod-like substances called enkephalins, dynorphins, and endorphins. These substances, collectively called opiopeptins, attach to their receptor sites and act as neurotransmitters in the regulation of pain and other body functions.Apparently opiod drugs mimic the natural endogenous opiopeptins, attach to their receptor sites, and act in their place to regulate pain and certain other body functions.

Four receptor sites for opiopeptins have been identified. The mu receptors are believed to regulate euphoria, physical dependence, withdrawal, respiratory depression, and supraspinal analgesia. The kappa receptors have prominent actions on diuresis, sedation, sleep, and spinal analgesia. Stimulation of the sigma receptors can produce emotional unease, dysphoria, hallucinations, and vasomotor stimulation. Delta receptors appear to affect cardiovascular function, contribute to analgesia, and cause changes in affective behavior.

When an opiod drug is in the right shape to fit one of these receptors, it can attach and produce a response (agonist), produce a partial response (partial agonist) or prevent any response from occurring (antagonist). For example, mu receptors are usually occupied by the morphine-like opiods (agonists), but can be displaced by drugs such as naloxone (antagonist) so that their effects at the mu receptor cannot be felt.

All the opiods are addictive substances, but some are more rapidly addicting than others and more likely to be abused.

Tolerance: Tolerance results from the chronic use of opiods. This means that over time the user must increase the dose to feel the euphoric effects, and certain other less desired effects such as respiratory depression, nausea, emesis, and impairment of consciousness. Certain other effects such as orthostasis, myosis, constipation, and urinary urgency continue to be felt with no dose increase. Tolerance to most opiods, especially the more potent analgesics, develops rapidly. But, a period of abstinence reverses tolerance and their user can again experience the effects with a smaller dose. The intermittent use of small quantities of opiods does not appear to produce tolerance. It is estimated that about half of recreational opiod users, in certain settings, do not progress to chronic use.

Cross-Tolerance: Cross-tolerance occurs among the opiods, thus an addict, experiencing withdrawal from one of the opiods, can suppress the withdrawal symptoms by substituting another opiod. When the substituted opiod is stopped, he/she will experience the withdrawal syndrome characteristic for that opiod. This procedure may be followed in the detoxification process.

Fetus: Opiods cross the placenta to affect the fetus. Newborns may have symptoms of intoxication or overdose and experience a withdrawal syndrome similar to that in the adult.

103b  http://www.nurseslearning.com/courses/corexcel/CXNRP-1600/Chap2/course/chap1/P6.html

Current Impact

Opiods today are severely regulated in the United States. However, street demand continues to support a black market characterized by crime and poverty.

Overall, there are three groups of opiod users in the U.S.:

  1. Street Abuser. The average street abuser tends to be a young male, black or Latino with a history of antisocial problems. Typically, he was introduced to heroin by another heroin user and he in turn introduces it to others. Drug abuse usually starts in mid-teens, first with marijuana, then harder drugs, like heroin by age 18. By age 20, the heroin addict is usually arrested for the first time.
  2. Medical Abuser. The "medical" abusers of prescription opiods are predominantly middle-class individuals, women, the elderly, health-care professionals, and people with pain syndrome. The histories of these individuals may be more similar to that of alcoholics than to street abusers, although street opiod abusers also tend to rely on legal prescriptions from physicians as they get older.

    In the 1960's and 1970's propoxyphene HCL (Darvon) was the most abused prescribed opiod in the U.S. with 500 deaths reported in 1979. Many propoxyphene HCL dependents abused prescriptions given them by physicians for pain relief, taking the drug indiscriminately. Commonly abused opiods include such drugs as meperidine (Demerol), morphine, and pentazocine HCL (Talwin). Healthcare professionals are especially at risk to abuse opiods because of their accessibility.

  3. Methadone Abuser. The methadone abuser, while being administered methadone at a clinic, may supplement his maintenance dose with black market methadone, alcohol, or other drugs. Or he may ask to go on methadone maintenance only because he is temporarily unable to obtain opiods, or because he wants to decrease his tolerance to an amount he can afford.
104 Substance Abuse: A History of the Opiods
104 Withdrawal from the Opiods

The cessation of chronic, moderate, or heavy use of an opiod, or a reduction in the amount used, or the administration of an opiod antagonist will produce acute withdrawal symptoms. The severity of the withdrawal symptoms depends up many factors such as the amount used, the length of addiction and how abruptly the drug is withdrawn; among other factors. The following table of withdrawal is a guide to the withdrawal symptoms you might expect.

Table of Opiod Withdrawal Symptoms
(adapted from Frances & Miller)

Stage I--begins within hours of last dose and peaks at 36-72 hours

  • craving for the drug
  • tearing (lacrimation)
  • rhinorrhea (running nose)
  • yawning
  • diaphoresis (excessive sweating)

Stage II--begins at 12 hours and peaks at 72 hours

  • mild to moderate sleep disturbance
  • mydriasis (dilated pupils)
  • anorexia (loss of appetite)
  • piloerection (goose flesh, goose bumps)
  • irritability
  • tremors

Stage III--begins at 24-36 hours and peaks at 72 hours

  • severe insomnia
  • violent yawning
  • weakness
  • nausea, vomiting, diarrhea
  • chills, fever
  • muscle spasms (may be severe)
  • flushing
  • spontaneous ejaculation
  • abdominal pain

Always remember that persons using opiods for short periods of time and for medical purposes, will probably have few and mild withdrawal symptoms. These may include slight restlessness or temporary insomnia. Those who have been "recreationally" addicted to high doses of opiods for long periods of time, may have severe withdrawal symptoms. These may include fever, chills, severe abdominal pain, seizures, coma, and even death. Deaths are rare today from withdrawal due to modern medical management of withdrawal.

Neonatal withdrawal:

Neonatal acute withdrawal symptoms include high-pitched crying, fever, sleep disturbances, frantic fist sucking, yawning, sneezing, nasal stuffiness, increased respirations, tremors, convulsions, vomiting, diarrhea, and dehydration. These symptoms may not be seen until several days to several weeks after birth, since drugs are retained longer in neonates. A protracted withdrawal of up to eighteen months is characterized by increased susceptibility to colds, flu, ear infections, viruses, and other conditions related to a deficient immune system.

From http://www.nurseslearning.com/courses/corexcel/CXNRP-1600/Chap2/course/chap1/P5.html

105 Treatment Options

Mentioned below is Ibogaine, a new treatment option for heroin and cocaine addiction. Treatment methods are discussed in detail in another course NRP-1612, Substance Abuse: Treating Diverse Populations. However, we mention this option here and now because ibogaine is a very new treatment option and is specific for heroin and cocaine addictions.

Ibogaine (NIDA, 1998)

On August 25, 1993, the Drug Abuse Advisory Committee of the U.S. Food and Drug Administration (FDA) voted to permit an individual academic investigator to conduct a limited human investigation of ibogaine. Ibogaine is believed by some to interrupt addiction of some heroin-dependent and cocaine-dependent persons. Ibogaine comes from the root of the iboga plant found primarily in certain West African nations and used in certain African rituals. Ibogaine also is reported to be a hallucinogenic drug. This drug is currently under study and holds promise as an adjunct for treatment. Preliminary reports are due within the next year or two. We will keep this text updated as to the results of the FDA studies.

References

 
Tim Guith's Page 5. Sections on  Opiods WAR ON PAIN: THE FLEECING OF AMERICA'S  PAIN PATIENTS  UNDER OPIOID THERAPY Trigeminal Neuralgia, aka Tic douloreaux  or  TN
&
Temporomandibular  Joint aka TMJ   Click Here to see my other record file at IAmFightingCancer.com  Bookmark this page now!  
 
Scan down to read my very lengthy and detailed web journal. Call me if I can help you. 713-467-3025 Brian
Signature Card For:                 Brian Nelson    31 Gessner Rd. , Houston, TX  77024
Tel. 713-467-3025 (Refers to my cell)      Fax 713-467-3192        
Click here to e-mail me.

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106 PERSONALIZING a Pain Scale:

Randall Chronic Pain Scale
  Copyright İ 1995-2004 Lois Randall

http://www2.rpa.net/~lrandall/painscale.html   

Introduction

        No two people experience pain alike. What makes this scale unique is that it allows you to create a personal scale using your own words to describe how your pain feels to you and how well (or not) you are able to function at each of the self-described levels.
        After dealing with chronic pain for several years, I realized that I needed a better tool for talking with my doctors: a scale that would describe my perception of pain. I created a way to describe the intensity of my pain in terms we all understand, and I can easily revise it any time my situation changes
        Using the traditional range of 0-10, I added a description and examples that describe what I feel and experience.   I gave a copy of this scale to my doctors and they were able to understand what I hadn't been able to get across to them before.  Because of this simple change in communication, they are now able to help me manage my pain better than ever before.
        Here are examples of my own pain scales.  When I say my pain is a "4" or an "8", my healthcare providers have a clearer understanding of what it is I am experiencing at any given time.
        I updated my pain scale after having my treatment reviewed and changed [see Example 2.]

 

  •   Tips on personalizing the pain scale to describe your own unique pain situation.
  •   Patient Form for personalizing the Randall Chronic Pain Scale (RCPS).
     
  •   Printable Form.
  •   Printable Instructions.
  •   Example One.  Example Two.

     

    RCPS Patient Form

    Pain Level Description Comments
    10
    * Word that describes what "10" means to you.
    (What is your functional ability at this level of pain? Describe briefly.)
    Give examples of what causes a "10".
    How often or what % of your day are you at this level?
    What do you do to relieve this level of pain?
    8
    * Word that describes what "8" means to you.
    (What is your functional ability at this level of pain? Describe briefly.)
    Give examples of what causes an "8".
    How often or what % of your day are you at this level?
    What do you do to relieve this level of pain?
    6
    * Word that describes what "6" means to you.
    (What is your functional ability at this level of pain? Describe briefly.)
    Give examples of what causes a "6".
    How often or what % of your day are you at this level?
    What do you do to relieve this level of pain?
    4
    * Word that describes what "4" means to you.
    (What is your functional ability at this level of pain? Describe briefly.)
    Give examples of what causes a "4".
    How often or what % of your day are you at this level?
    What do you do to relieve this level of pain?
    2
    * Word that describes what "2" means to you.
    (What is your functional ability at this level of pain? Describe briefly.)
    Give examples of what causes a "2".
    How often or what % of your day are you at this level?
    What do you do to relieve this level of pain?
    0
    * Pain Free
    (What is your functional level when your pain is a "0"? Describe briefly.)
    Give examples of when your pain level is a "0".
    How often or what % of your day are you pain free?
    What do you do to maintain "0" pain?
  • Example 1   The author.

    Pain Level Description Comments
    10
    * TOTALLY DISABLING,
    Must take care of pain.
    Happens during flare-ups which are frequent and are related to activity, weather, etc.
    8
    * SEVERE,
    Can't concentrate and can't do all but simple things.
    Happens daily, by mid or late afternoon. Relieved by meds and slowing activity.
    6
    * DISTRESSFUL,
    But able to continue some physical activity.
    My normal condition.
    4
    * TOLERABLE,
    Can be ignored somewhat.
    Late evening, if I've taken meds and rested.
    2
    * MILD,
    Only aware of pain when focused on.
    Rare, very rare.
    0
    * PAIN FREE
     
    I haven't been pain free in 12 years.

    Example 2

    The author after changed treatment plan.

    Pain Level Description Comments
    10
    * DISABLING,
    Must take care of pain.
    Happens during flare-ups which are related to activity, weather, etc.  Normal state w/o medication.
    8
    * SEVERE,
    Can't concentrate and can't do all but simple things.
    Relieved by "rescue" meds and stopping activity.
    6
    * MODERATE,
    But able to continue some physical activity.
    Increases with activity.  Happens daily.
    4
    * TOLERABLE,
    Can be ignored somewhat.
    Some pain.  My usual condition with current treatment options.
    2
    * MILD,
    Aware of undercurrent of mild pain.
    Often relieved by changing activity or position.
    0
    * PAIN FREE
     
    I haven't been pain free in 14 years.
  • 108 http://www.docgetty.com/Chronic.html

    Chronic Pain 

    Dental/Oral Conditions seen frequently which can cause chronic pain:

    • Cavities (Dental Caries)
    • Inflamed Dental Nerve (Pulpitis)
    • Abscess of tooth (Periapical)
    • Abscess of gums or bone supporting tooth (Periodontal)
    • Fungal or viral infections of mouth lining
    • Poor bite (Malocclusion)
    • Joint Problems (TMJ)
    • Trauma

    Non-Dental conditions which can cause pain in the teeth or oral structures.

    • Sinus infections, inflammation, drainage
    • Weather and altitude changes
    • Central nervous system disorder or disease

    Infrequently seen painful conditions

    Trigeminal Neuralgia
    This very painful condition typically manifests itself as sharp, electric, lightning-bolt pain in the face, which can be triggered by touching the face, by a puff of wind, or it may come on spontaneously. It may be regular or very sporadic. True trigeminal neuralgia seems to be associated at times with pressure against the trigeminal nerve near its exit from the skull.

    Atypical Facial Pain

    This type of pain is more difficult to characterize, and depending upon the method of classification used may have several sub-categories, such as myofascial pain, idiopathic pain, and other types of rare pain. Idiopathic means that the cause is unknown.

    Neuralgia Inducing Cavitational Osteonecrosis (NICO)

    Also known as ischemic necrosis, and formerly referred to by some as non-supportive osteomyelitis, this condition is becoming more well known and better understood, as ongoing research is conducted. NICO is described in Oral and Maxillofacial Pathology, by Neville, Damm, Allen, and Bouquot. This is the textbook most frequently used in dental schools in the United States.

    Symptoms may include severe pain in the face, behind the eyes, or even around the top, sides, or back of the head. In the case of NICO, this pain is referred from some area in the jawbones, either upper (maxilla) or lower (mandible).

    Brian

    The actual source of disease may be traced to abnormal bone, often where a tooth has been extracted earlier. Due to poor healing, pathogenic bacteria, suppressed immune system, clotting disorders, or a combination of these, the nerves in these areas can react in highly unusual ways, causing excruciating pain in areas seemingly unrelated to the source. For example, a NICO defect in the lower back jaw may cause a burning pain on the side or the top of the head. The clinical appearance of the diseased area may seem normal, and radiographs do not always show these pockets in the bone, due to the nature of density variations between inner and outer bone and the way in which radiographs are typically exposed. Certain tests may be performed to determine if an area of NICO exists and where it is located. Surgical exposure of the site of ischemic necrosis will reveal dead bone and poor healing, with seldom any trace of pus. Examination of the excised tissue from such sites shows a unique appearance under the microscope. Dr. Jerry E. Bouquot, oral pathologist, head and neck diagnostics, Morgantown, WV, has done much research into this disease, as has Dr. R.E. McMahon of the Oral Surgery Group, Merrillville, IN. For additional information, please visit The Maxillofacial Center for Diagnostics and Research.

    Many patients who are determined to have ischemic necrosis of the jawbones may receive some relief from the surgical debridement of the bony lesion, with subsequent re-evaluation and retreatment as necessary. Actual treatment modalities vary, as do results.

    Frequently this disease is not identified until the patient has exhausted all other avenues of relief, with no discovery of the source of the problem, until eventually the patient is told the pain does not exist, or until they come upon someone familiar with this rare anomaly.

    Dr. Getty first encountered NICO when his father was successfully treated for it in 1981. After graduating from dental school, Dr. Getty continued his interest in this malady, and has studied with Dr. Bouquot. He has experience with treating numerous NICO/ischemic necrosis patients both locally and from as far away as New England, Florida, and even Brazil. He is a clinical investigator with the North American NICO Research Group, and has given testimony as an expert witness before the Superior Court of Washington, DC.

    If you have unexplained head or face pain, and have already been determined to be free from known dental disease, such as cavities or abscesses, sinusitis or TMJ, you need to be sure to rule out a central problem, such as a brain tumor or arterial pressure on a nerve inside the skull. This requres a referral to a neurologist and should be done prior to exploring for any NICO lesion(s). The neurologist will undoubtedly order an MRI and/or CAT scan. If this is negative, and no other source of pain can be identified, please feel free to contact our office for an evaluation. A full examination, necessary radiographs, and in-office tests can be performed. This usually takes about 1-2 hours. Treatment will vary on a case by case basis. If you have been seen by multiple practitioners in the past, it is good to bring a concise summary of all such previous evaluations and treatments, as is relates to the pain problems you have had.

    NICO has been identified most often in areas of previous extraction(s), but has also been seen in areas of failed root canals or in sinus infections which perforate into the maxilla. Often the pain will not occur until years, even decades after the initial extraction or root canal. Antibiotic therapy alone may temporarily decrease pain but seldom alleviates the underlying cause.

    110  http://www.cpmission.com/main/model.html

    THE FEDERATION OF STATE MEDICAL BOARDS OF THE UNITED STATES, INC.

    MODEL GUIDELINES FOR THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF PAIN(Adopted May 2, 1998)

    Section I: Preamble

    The (name of board) recognizes that principles of quality medical practice dictate that the people of the State of (name of state) have access to appropriate and effective pain relief.

    The appropriate application of up-to-date knowledge and treatment modalities can serve to improve the quality of life for those patients who suffer from pain as well as to reduce the morbidity and costs associated with untreated or inappropriately treated pain. The Board encourages physicians to view effective pain management as a part of quality medical practice for all patients with pain, acute or chronic, and it is especially important for patients who experience pain as a result of terminal illness. All physicians should become knowledgeable about effective methods of pain treatment as well as statutory requirements for prescribing controlled substances.

    Inadequate pain control may result from physicians' lack of knowledge about pain management or an inadequate understanding of addiction. Fears of investigation or sanction by federal, state, and local regulatory agencies may also result in inappropriate or inadequate treatment of chronic pain patients. Accordingly, these guidelines have been developed to clarify the Board's position on pain control, specifically as related to the use of controlled substances, to alleviate physician uncertainty and to encourage better pain management.

    The Board recognizes that controlled substances, including opioid analgesics, may be essential in the treatment of acute pain due to trauma or surgery and chronic pain, whether due to cancer or non-cancer origins. Physicians are referred to the U.S. Agency for Health Care and Research Clinical Practice Guidelines for a sound approach to the management of acute1 and cancer-related pain.

    The medical management of pain should be based upon current knowledge and research and includes the use of both pharmacologic and non-pharmacologic modalities. Pain should be assessed and treated promptly and the quantity and frequency of doses should be adjusted according to the intensity and duration of the pain. Physicians should recognize that tolerance and physical dependence are normal consequences of sustained use of opioid analgesics and are not synonymous with addiction.

    The (state medical board) is obligated under the laws of the State of (name of state) to protect the public health and safety. The Board recognizes that inappropriate prescribing of controlled substances, including opioid analgesics, may lead to drug diversion and abuse by individuals who seek them for other than legitimate medical use. Physicians should be diligent in preventing the diversion of drugs for illegitimate purposes.

    Physicians should not fear disciplinary action from the Board or other state regulatory or enforcement agency for prescribing, dispensing, or administering controlled substances, including opioid analgesics, for a legitimate medical purpose and in the usual course of professional practice. The Board will consider prescribing, ordering, administering, or dispensing controlled substances for pain to be for a legitimate medical purpose if based on accepted scientific knowledge of the treatment of pain or if based on sound clinical grounds. All such prescribing must be based on clear documentation of unrelieved pain and in compliance with applicable state or federal law.

    Each case of prescribing for pain will be evaluated on an individual basis. The board will not take disciplinary action against a physician for failing to adhere strictly to the provisions of these guidelines, if good cause is shown for such deviation. The physician's conduct will be evaluated to a great extent by the treatment outcome, taking into account whether the drug used is medically and/or pharmacologically recognized to be appropriate for the diagnosis, the patient's individual needs including any improvement in functioning, and recognizing that some types of pain cannot be completely relieved.

    The Board will judge the validity of prescribing based on the physician's treatment of the patient and on available documentation, rather than on the quantity and chronicity of prescribing. The goal is to control the patient's pain for its duration while effectively addressing other aspects of the patient's functioning, including physical, psychological, social and work-related factors. The following guidelines are not intended to define complete or best practice, but rather to communicate what the Board considers to be within the boundaries of professional practice.

    Section II: Guidelines

    The Board has adopted the following guidelines when evaluating the use of controlled substances for pain control:

    1. Evaluation of the Patient

      A complete medical history and physical examination must be conducted and documented in the medical record. The medical record should document the nature and intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and history of substance abuse. The medical record should also document the presence of one or more recognized medical indications for the use of a controlled substance.

    2. Treatment Plan

      The written treatment plan should state objectives that will be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and should indicate if any further diagnostic evaluations or other treatments are planned. After treatment begins, the physician should adjust drug therapy to the individual medical needs of each patient. Other treatment modalities or a rehabilitation program may be necessary depending on the etiology of the pain and the extent to which the pain is associated with physical and psychosocial impairment.

    3. Informed Consent and Agreement for Treatment

      The physician should discuss the risks and benefits of the use of controlled substances with the patient, persons designated by the patient, or with the patient's surrogate or guardian if the patient is incompetent. The patient should receive prescriptions from one physician and one pharmacy where possible. If the patient is determined to be at high risk for medication abuse or have a history of substance abuse, the physician may employ the use of a written agreement between physician and patient outlining patient responsibilities including (1) urine/serum medication levels screening when requested (2) number and frequency of all prescription refills and (3) reasons for which drug therapy may be discontinued (i.e. violation of agreement).

    4. Periodic Review

      At reasonable intervals based upon the individual circumstance of the patient, the physician should review the course of treatment and any new information about the etiology of the pain. Continuation or modification of therapy should depend on the physician's evaluation of progress toward stated treatment objectives such as improvement in patient's pain intensity and improved physical and/or psychosocial function, such as ability to work, need of health care resources, activities of daily living, and quality of social life. If treatment goals are not being achieved, despite medication adjustments, the physician should re-evaluate the appropriateness of continued treatment. The physician should monitor patient compliance in medication usage and related treatment plans.

    5. Consultation

      The physician should be willing to refer the patient as necessary for additional evaluation and treatment in order to achieve treatment objectives. Special attention should be given to those pain patients who are at risk for misusing their medications and those whose living arrangement pose a risk for medication misuse or diversion. The management of pain in patients with a history of substance abuse or with a comorbid psychiatric disorder may require extra care, monitoring, documentation, and consultation with or referral to an expert in the management of such patients.

    6. Medical Records

      The physician should keep accurate and complete records to include (1) the medical history and physical examination (2) diagnostic, therapeutic and laboratory results (3) evaluations and consultations (4) treatment objectives (5) discussion of risks and benefits (6) treatments (7) medications [including date, type, dosage, and quantity prescribed] (8) instructions and agreements and (9) periodic reviews. Records should remain current and be maintained in an accessible manner and readily available for review.

    7. Compliance with Controlled Substances Laws and Regulations

      To prescribe, dispense, or administer controlled substances, the physician must be licensed in the state, and comply with applicable federal and state regulations. Physicians are referred to the Physicians Manual of the U.S. Drug Enforcement Administration and (any relevant documents issued by the state medical board) for specific rules governing controlled substances as well as applicable state regulations.

    Section III: Definitions For the purposes of these guidelines, the following terms are defined as follows:

    Acute pain:

    Acute pain is the normal, predicted physiological response to an adverse chemical, thermal, or mechanical stimulus and is associated with surgery, trauma and acute illness. It is generally time limited and is responsive to opioid therapy, among other therapies.

    Addiction:

    Addiction is a neurobehavioral syndrome with genetic and environmental influences that results in psychological dependence on the use of substances for their psychic effects and is characterized by compulsive use despite harm. Addiction may also be referred to by terms such as "drug dependence" and "psychological dependence." Physical dependence and tolerance are normal physiological consequences of extended opioid therapy for pain and should not be considered addiction.

    Analgesic Tolerance:

    Analgesic tolerance is the need to increase the dose of opioid to achieve the same level of analgesia. Analgesic tolerance may or may not be evident during opioid treatment and does not equate with addiction.

    Chronic Pain:

    A pain state which is persistent and in which the cause of the pain cannot be removed or otherwise treated. Chronic pain may be associated with a long-term incurable or intractable medical condition or disease. Pain: an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

    Physical Dependence:

    Physical dependence on a controlled substance is a physiologic state of neuroadaptation which is characterized by the emergence of a withdrawal syndrome if drug use is stopped or decreased abruptly, or if an antagonist is administered. Physical dependence is an expected result of opioid use. Physical dependence, by itself, does not equate with addiction.

    Pseudoaddiction:

    Pattern of drug-seeking behavior of pain patients who are receiving inadequate pain management that can be mistaken for addiction.

    Substance Abuse:

    Substance abuse is the use of any substance(s) for non-therapeutic purposes; or use of medication for purposes other than those for which it is prescribed.

    Tolerance:

    Tolerance is a physiologic state resulting from regular use of a drug in which an increased dosage is needed to produce the same effect or a reduced effect is observed with a constant dose.



    National Association of State Controlled Substance Authorities Resolution Endorsing the Federation's Model Guidelines
    http://www.medsch.wisc.edu/painpolicy/domestic/NASCSA.htm

    American Academy of Pain Medicine Position and Consensus on The Use of Opioids for the Treatment of Chronic Pain:
    http://www.painmed.org/productpub/statements/opioidstmt.html

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    Tim Guith's Page 5. Sections on  Opiods WAR ON PAIN: THE FLEECING OF AMERICA'S  PAIN PATIENTS  UNDER OPIOID THERAPY Trigeminal Neuralgia, aka Tic douloreaux  or  TN
    &
    Temporomandibular  Joint aka TMJ   Click Here to see my other record file at IAmFightingCancer.com  Bookmark this page now!  
     
    Scan down to read my very lengthy and detailed web journal. Call me if I can help you. 713-467-3025 Brian
    Signature Card For:                 Brian Nelson    31 Gessner Rd. , Houston, TX  77024
    Tel. 713-467-3025 (Refers to my cell)      Fax 713-467-3192        
    Click here to e-mail me.

    www.NelsonIdeas.com
           Make a difference in the world!  "Idea Possibility Consulting"
    www.BrianNelsonConsulting.com    There are so many new ways to make more profit. 
    www.PartyTentCity.com 
                                    The best modular party tent you can buy!
    www.IamFightingCancer.com   Brian's story on Cancer and TN.  Post your Cancer story!
    112
    Current Age Life Expectancy
    50 30 years
    55 28 years
    60 24 years
    65 20 years
    70 16 years
    75 12 years
    80 9 years
    85 6 years
    90 5 years

    (data from IRS Publication 590, Appendix E, Table 1, December 12, 1999)
     

    I just thought you would like to see this little chart.  Only Las Vegas can give better odds.

     

     

     

     

     

     

     

     

     

     

    113  http://www.pslgroup.com/dg/CAD6.htm

    OxyContin Tablets Hailed by World Pain-Care Community

    VANCOUVER, B.C., Sept. 27, 1996 -- OxyContin(TM) generated a groundswell of international support at this year's meeting of the International Association of the Study of Pain (IASP). The enthusiasm of IASP members parallels the powerful U.S. response to the launch of OxyContin -- enabling the drug to achieve its entire expected first-year sales in only eight months.
    OxyContin, a unique, controlled-release form of oxycodone, fits the profile of opioids hailed by experts at IASP. As Stephen Long, MD, Pain Specialist at the Virginia Commonwealth University/Medical College of Virginia, declared: "Now, thanks to controlled-release opioids, we can give our patients around-the-clock, opioid pain control for both cancer and non- cancer pain."
    Dr. Long's opinion echoed through the 3-day meeting. Many IASP members shared the opinion that OxyContin is an excellent opioid for moderate to severe pain requiring opioid therapy for more than a few days. For instance, OxyContin may be appropriate for pain of back injury, arthritis, and other types of noncancer pain, as well as for cancer pain. In the past, other opioid drugs, such as morphine, were generally reserved for only cancer pain.
    OxyContin reached total U.S. sales of $26 million, four months earlier than projected by Purdue Pharma L.P. -- the company that developed and patented OxyContin. Abbott Laboratories now copromotes OxyContin with Purdue Pharma. By year's end, sales will range from $130,000 to $150,000 for each Purdue or Abbott sales representative, bringing total sales to more than $40 million.
    OxyContin is the only oral oxycodone that acts for a full 12 hours to relieve pain -- making it the longest-lasting oxycodone ever. Unlike Percodan(R)*, Percocet(R)* and other combination products, it contains no aspirin or acetaminophen that may be potentially toxic in maximal daily doses.
    With OxyContin, analgesic onset occurs within 1 hour in most patients. There is no ceiling effect to analgesia, allowing physicians to titrate the dosage upward when needed for pain control. Common opioid side effects, except for constipation, often diminish over time for many patients taking OxyContin.
    Please read the accompanying prescribing information for OxyContin Tablets.
    OxyContin Tablets are to be taken whole. Taking broken, chewed, or crushed tablets could lead to the rapid release and absorption of a potentially toxic dose of oxycodone.
    The most serious risk associated with opioids, including OxyContin, is respiratory depression. Common opioid side effects are constipation, nausea, sedation, dizziness, vomiting, pruritus, headache, dry mouth, sweating, and weakness.
    * Registered trademark, DuPont Merck Pharmaceutical Co.
    q12h
    OxyContin(TM) CII
    (Oxycodone HCl Controlled-Release) Tablets
    Warning -- May be habit forming
    10 mg * 20 mg * 40 mg
    Brief Summary on OxyContin(TM) (oxycodone hydrochloride controlled-release) Tablets.
    Before prescribing, see complete prescribing information, including DOSAGE AND ADMINISTRATION.
    INDICATIONS AND USAGE:
    For the management of moderate to severe pain where use of an opioid analgesic is appropriate for more than a few days.
     

    CONTRAINDICATIONS:
    OxyContin is contraindicated in patients with known hypersensitivity to oxycodone, or in any situation where opioids are contraindicated. This includes patients with significant respiratory depression (in unmonitored settings or the absence of resuscitative equipment), and patients with acute or severe bronchial asthma or hypercarbia. OxyContin is contraindicated in any patient who has or is suspected of having paralytic ileus.
    WARNINGS:
    OxyContin TABLETS ARE TO BE SWALLOWED WHOLE, AND ARE NOT TO BE BROKEN, CHEWED OR CRUSHED. TAKING BROKEN, CHEWED OR CRUSHED OxyContin TABLETS COULD LEAD TO THE RAPID RELEASE AND ABSORPTION OF A POTENTIALLY TOXIC DOSE OF OXYCODONE.
    Respiratory Depression
    Respiratory depression, the chief hazard from all opioid agonist preparations, occurs most frequently in elderly or debilitated patients, usually following large initial doses in non-tolerant patients, or when opioids are given in conjunction with other agents that depress respiration.
    Oxycodone should be used with extreme caution in patients with significant chronic obstructive pulmonary disease or cor pulmonale, and in patients having a substantially decreased respiratory reserve, hypoxia, hypercapnia, or preexisting respiratory depression. In such patients, even usual therapeutic doses of oxycodone may decrease respiratory drive to the point of apnea. In these patients alternative non-opioid analgesics should be considered, and opioids should be employed only under careful medical supervision at the lowest effective dose.
    Head Injury
    The respiratory depressant effects of opioids include carbon dioxide retention and secondary elevation of cerebrospinal fluid pressure, and may be markedly exaggerated in the presence of head injury, intracranial lesions, or other sources of preexisting increased intracranial pressure. Oxycodone produces effects which may obscure neurologic signs of further increases in intracranial pressure in patients with head injuries.
    Hypotensive Effect
    OxyContin, like all opioid analgesics, may cause severe hypotension in an individual whose ability to maintain blood pressure has been compromised by a depleted blood volume, or after concurrent administration with drugs such as phenothiazines or other agents which compromise vasomotor tone. OxyContin may produce orthostatic hypotension in ambulatory patients. OxyContin, like all opioid analgesics, should be administered with caution to patients in circulatory shock, since vasodilation produced by the drug may further reduce cardiac output and blood pressure.
    PRECAUTIONS:
    General -- OxyContin tablets are intended for use in patients who require oral pain therapy with an opioid agonist of more than a few days duration. As with any opioid analgesic, it is critical to adjust the dosing regimen individually for each patient.
    Selection of patients for treatment with OxyContin should be governed by the same principles that apply to the use of similar controlled-release opioid analgesics. Opioid analgesics given on a fixed-dosage schedule have a narrow therapeutic index in certain patient populations, especially when combined with other drugs, and should be reserved for cases where the benefits of opioid analgesia outweigh the known risks of respiratory depression, altered mental state, and postural hypotension. Physicians should individualize treatment in every case, using non-opioid analgesics, prn opioids and/or combination products, and chronic opioid therapy with drugs such as OxyContin in a progressive plan of pain management such as outlined by the World Health Organization, the Agency for Health Care Policy and Research, and the American Pain Society.
    Use of OxyContin is associated with increased potential risks and should be used only with caution in the following conditions: acute alcoholism; adrenocortical insufficiency (e.g., Addison's disease); CNS depression or coma; delirium tremens; debilitated patients; kyphoscoliosis associated with respiratory depression; myxedema or hypothyroidism; prostatic hypertrophy or urethral stricture; severe impairment of hepatic, pulmonary or renal function; and toxic psychosis.
    The administration of oxycodone, like all opioid analgesics, may obscure the diagnosis or clinical course in patients with acute abdominal conditions. Oxycodone may aggravate convulsions in patients with convulsive disorders, and all opioids may induce or aggravate seizures in some clinical settings.
    Interactions with other CNS Depressants
    OxyContin, like all opioid analgesics, should be used with caution and started in a reduced dosage (1/3 to 1/2 of the usual dosage) in patients who are concurrently receiving other central nervous system depressants including sedatives or hypnotics, general anesthetics, phenothiazines, other tranquilizers and alcohol. Interactive effects resulting in respiratory depression, hypotension, profound sedation or coma may result if these drugs are taken in combination with the usual doses of OxyContin.
    Interactions with Mixed Agonist/Antagonist Opioid Analgesics
    Agonist/antagonist analgesics (i.e., pentazocine, nalbuphine, butorphanol and buprenorphine) should be administered with caution to a patient who has received or is receiving a course of therapy with a pure opioid agonist analgesic such as oxycodone. In this situation, mixed agonist/antagonist analgesics may reduce the analgesic effect of oxycodone and/or may precipitate withdrawal symptoms in these patients.
    Ambulatory Surgery
    OxyContin is not recommended pre-operatively (preemptive analgesia) or for the management of pain in the immediate post-operative period (the first 12 to 24 hours following surgery) for patients not previously taking the drug, because its safety in this setting has not been established.
    Patients who are already receiving OxyContin tablets as part of ongoing analgesic therapy may be safely continued on the drug if appropriate dosage adjustments are made considering the procedure, other drugs given and the temporary changes in physiology caused by the surgical intervention (see PRECAUTIONS: Drug-Drug Interactions).
    Use in Pancreatic / Biliary Tract Disease
    Oxycodone may cause spasm of the sphincter of Oddi and should be used with caution in patients with biliary tract disease, including acute pancreatitis. Opioids like oxycodone may cause increases in the serum amylase level.
    Tolerance and Physical Dependence
    Tolerance is the need for increasing doses of opioids to maintain a defined effect such as analgesia (in the absence of disease progression or other external factors). Physical dependence is the occurrence of withdrawal symptoms after abrupt discontinuation of a drug or upon administration of an antagonist. Physical dependence and tolerance are not unusual during chronic opioid therapy.
    Significant tolerance should not occur in most of the patients treated with the lowest doses of oxycodone. It should be expected, however, that a fraction of cancer patients will develop some degree of tolerance and require progressively higher dosages of OxyContin to maintain pain control during chronic treatment. Regardless of whether this occurs as a result of increased pain secondary to disease progression or pharmacological tolerance, dosages can usually be increased safely by adjusting the patient's dose to maintain an acceptable balance between pain relief and side effects. The dosage should be selected according to the patient's individual analgesic response and ability to tolerate side effects. Tolerance to the analgesic effect of opioids is usually paralleled by tolerance to side effects, except for constipation. Physical dependence results in withdrawal symptoms in patients who abruptly discontinue the drug or may be precipitated through the administration of drugs with opioid antagonist activity (see OVERDOSAGE). If OxyContin is abruptly discontinued in a physically dependent patient, an abstinence syndrome may occur. This is characterized by some or all of the following: restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia and mydriasis. Other symptoms also may develop, including: irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate or heart rate. 

     

    114 http://www2.rpa.net/~lrandall/opioids.html
    115   http://www.meds.com/conrad/pmcd/port3.html
    116 http://www.rxlist.com/cgi/generic/ms.htm
    117http://www.pslgroup.com/dg/968A.htm

    118  http://www.actiq.com/

     119  http://www.trigeminalneuralgia.us/

    120 http://neurosurgery.mgh.harvard.edu/tn-hfshp.htm

    121 http://www.bgsm.edu/bgsm/surg-sci/ns/tn-hfs.html
    122

    http://neurosurgery.mgh.harvard.edu:80/mvd.htm

    124
    http://facial-neuralgia.org/

    125

    http://www.creps.org/tn/

    http://www.midmichigan.org/consumer/page.asp?OrgID=BF4ECA07F3B4416DB435BED5F9B0685A&id=98164C11EAB6476A9A1B995D5D0BEEEF&s=4&sName=0
     

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    Tim Guith's Page 5. Sections on  Opiods WAR ON PAIN: THE FLEECING OF AMERICA'S  PAIN PATIENTS  UNDER OPIOID THERAPY Trigeminal Neuralgia, aka Tic douloreaux  or  TN
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