Happy Holidays

Christmas tree made of lobster traps and buoys for decorations.The holiday season is upon here in Maine and throughout the world. People are busy planning for celebratory work and family gatherings. Our focus shifts from business as usual to thoughts of what it is that we are thankful for. As we gather with loved ones, we celebrate the meaning and purpose of the season in keeping with our values and beliefs. And as the year passes, we find ourselves taking inventory of what gave us joy, what brought us sadness and what was accomplished as a prelude to making resolutions for the new year.

As we celebrate the holidays, each in our own way, we are reminded that diversity breeds resilience in both nature and in society. When the environment changes, natures’ fauna either relocates, adapts, or ceases to exist. Luckily, the latter is the most unlikely scenario. This is cause for readjustment of and within the new environment followed by a restoration of balance. Society is no different. If we are to become a resilient world community, we must learn to value diversity.

A resilient world community is our hope for the future. Celebrate diversity; it is our path to restoring balance in an everchanging environment. Albert Einstein said, ” We can’t solve problems by using the same kind of thinking we used when we created them.” An influx of new cultures, new philosophies, and new ideas will offer new solutions to old problems that serve to maintain imbalance.

We wish you the happiest of holidays and much optimism for the year to come.

Photo of Charlene Fernald Moynihan
Charlene Fernald Moynihan

 

Cannabis for Chronic Pain?

What we know about CBD is still limited.

Cannabis Americana advertisement.

Many states in this country have legalized medical marijuana. A number have recently legalized recreational marijuana. Maine is one of those. As I pointed out in a previous blog, the medicinal use of marijuana has been around for some time. Cannabis Americano was sold in most pharmacies in the late 1800s and early 1900s. Cannabis was listed as one of the 50 fundamental herbs of traditional Chinese medicine. Cannabis Indica was part of many cold and cough treatments sold over the counter in the latter part of the 19th century and early 20th century. It, and more recently CBD which does not contain THC, are marketed to treat pain, nausea in pregnancy, feelings of anxietydepression, and Parkinson’s disease, to name a few.

There are, however, a number of issues that the users of these preparations should be aware of. Unlike many medications, these drugs have not been studied extensively. And they apparently are not risk-free. One issue being drug interactions. This may be especially true in the elderly who may be taking a number of other medications. Very little research has been done on this and there is considerable controversy even as to the effectiveness of these medications in treating chronic pain.

So what is the consumer to do? Educate yourself about the medication that you are taking, whatever it is. And be aware that some CBD products may be tainted. A California company tested 20 different popular CBD products and found “insanely high levels of dangerous chemicals and misleading labels.” If you are an elderly person making use of a product containing THC be aware that THC may impair your gait and stability increasing the risk of falling and injuring yourself. And there may be some impairment in short-term memory and emotional processing. This is especially a problem for patients with pre-existing cognitive impairment. There is also, apparently, an increased risk for cardiovascular events and an increased risk of psychotic episodes and suicidality.

Again buyer beware. These drugs may have a role in the treatment of pain, nausea and other symptoms, but we need to be aware of the current state of the marketplace, drug interactions and adverse side effects that have occurred. Be aware, too, as to guarantees, or lack of them, regarding the purity of the product that we are consuming. We also need to be aware that there may be other ways of treating these problems, especially pain, without consuming a pharmaceutical.

This article was originally posted to Psychology Today, “In the Face of Adversity“, by Dr. Ron Breazeale, Ph.D. With his permission, we will share a series of posts on Chronic Pain and related issues as a prologue to introducing what Maine has to offer for treatment options.

Continue reading “Cannabis for Chronic Pain?”

Taking a Pill to Solve a Problem

The Rise of the Abuse of Drugs

Old cocaine tooth drops advertisement.

We have all been trained to take medications to solve our problems. And in many cases, this is exactly what we need to do. Pharmaceuticals have played a major role in the advancement of our society and the improvement of our health. Unfortunately, this has taught us that just about any problem can be solved by taking a pill. Just find the right pill and your problem is solved. Continue reading “Taking a Pill to Solve a Problem”

The Opioid Epidemic: Fentanyl

Part Two of Two: Fentanyl has been a game-changer

Line of cocaine forms a human skull at the end.

In the last post, we talked about the opioid epidemic in this country and the dramatic increase in overdose deaths, over 70,000 in 2017]. A report released by the National Institute on Drug Abuse in 2017 reported that between 21 and 29% of patients prescribed opioids for chronic pain misuse them, between eight and 12% of these patients develop an opioid use disorder, an estimated 4 to 6% who misuse  prescription drugs transition to heroin and approximately 80% of the people who use heroin first misused prescription opioids. Continue reading “The Opioid Epidemic: Fentanyl”

The Opioid Epidemic: The Many Causes

Part One of Two: A look at the many causes of this epidemic

Advertisement for Morphine from the 1900's.

As you are undoubtedly aware our communities continue to struggle with an epidemic of opioid misuse and abuse. In 2016 42,000 people died of an opioid overdose. Apparently, 11.5 million people misuse prescription opioid painkillers. Almost 950,000 people used heroin and 2.1 million people suffered from opioid use disorder in the United States.

This epidemic has many causes. One contributing factor is our healthcare system’s over-reliance on narcotic pain medications to treat a large number of patients with chronic pain. Most physicians receive little training in the treatment of chronic pain. Opioids are most effective in the treatment of acute pain but in the treatment of chronic pain, pain that goes on for 3 to 6 months, opioids, in the end, may actually make the pain worse. Most individuals who develop an opioid addiction received opioids initially through a prescription from their physician.

In many communities, primary care physicians provide most of the care for chronic pain patients. They are often unaware of nonpharmaceutical interventions for chronic pain. To be fair those who provide these interventions such as psychologists, physical therapists and acupuncturists have not done enough to educate other providers or the public about the effectiveness of these interventions.

There is little evidence to support the use of long-term opioid therapy in the treatment of chronic noncancer pain. Considering the risk of harm posed by the misuse of opioid prescriptions and the lack of evidence to support opioids for chronic noncancer pain the Centers for Disease Control and Prevention recommend nonpharmaceutical treatments or non-opioid pharmaceutical treatments to be considered as the initial treatment approach for chronic pain. Non-opioid alternatives include, but are not limited to, acetaminophen, anti-inflammatory drugs, membrane stabilizers such as gabapentin, and muscle relaxants. And there are others. Recent research has indicated that these non-opioid alternatives are at least as effective as opioids for low back pain and are less associated with adverse events.

The most widely studied and effective interventions for chronic pain that are nonpharmaceutical include cognitive behavioral therapy and other interventions such as acceptance and commitment therapy, exercise, physical therapy, and interdisciplinary rehabilitation. Depending on the pain condition other therapies with evidence of efficacy include yoga,  biofeedback, acupuncture, spinal manipulation, and massage.

The American Psychological Association is encouraging its members to become better educated and trained in these nonpharmaceutical interventions and to educate other providers in the community and the public about these interventions. We will be talking more about these interventions in future posts.

This article was originally posted to Psychology Today, “In the Face of Adversity”, by Dr. Ron Breazeale, Ph.D. With his permission, we will share a series of posts on the Chronic Pain and related issues as a prologue to introducing what Maine has to offer for treatment options.

Photo pf Ron Breazeale, Ph,D.
Ron Breazeale, Ph.D.