Amersham Osteopathic Clinic

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Overdoses of Prescription Opioid Pain Relievers in the USA

KEY POINTS from a recent paper by the US Centers for Disease Control and Prevention:

Death from opioid pain relievers  (like Tramadol and Vincodin) is an epidemic in the USA.

http://www.cdc.gov November 4, 2011 / 60(43);1487-1492)

Sales of opioid pain relievers quadrupled between 1999 and 2010.

Enough opioid pain relievers were prescribed last year to medicate every American adult with a dose of 5 mg of hydrocodone (Vicodin and others) taken every 4 hours for a month. Abuse of opioid pain relievers costs health insurers approximately $72.5 billion annually

In 2007, nearly 100 persons / day died of drug overdoses in the US. The death rate of 11.8 per 100,000 population in 2007 was roughly three times the rate in 1991. Prescription drugs have accounted for most of the increase in those death rates since 1999.

In 2009, 1.2 million emergency department (ED) visits (an increase of 98.4% since 2004) were related to misuse / abuse of pharmaceuticals. opioid pain relievers now account for more overdose deaths than heroin and cocaine combined.

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Plagiocephaly – get it checked

Research is emerging on the effect of positional / deformational plagiocephaly / flat head syndrome:

 

Article from JAMA Pediatrics. 2011 July; 165(7): 653–658. doi: 10.1001/archpediatrics.2011.92. Development in Toddlers With and Without Deformational Plagiocephaly. Collett, BR, Starr, J et al.

Deformational / positional plagiocephaly is flattening of a baby’s skull, typically considered  to be a cosmetic condition.

Parents are recommended to see their GP, a paediatrician or a qualified health professional early if there are any signs of flat head / plagiocephaly or torticollis / wry neck for this to be checked.

A qualified paediatric osteopath will also check your baby’s neck and spine and may give exercises and home care advice.

Remember, most babies with plagiocephaly are absolutely fine, they just have a slightly wonky head from lying on their back for long stretches.

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Salt and blood pressure

Salt intake may not affect blood pressure

The Journal of the American Medical Association recently published a study investigating the relationship between salt and high blood pressure (hypertension). This study (3,681 people) correlated salt intake, high blood pressure, cardiovascular disease and death. People with greater salt excretion were found to have significantly less heart disease and less death from cardiovascular disease.

Published in the May 4 2011 issue of JAMA, the study examined health outcomes related to salt intake by measuring the amount of sodium excreted in urine. Lower sodium excretion was associated with increased risk of cardiovascular death, higher sodium excretion did not increase risk of hypertension or cardiovascular disease complications.

“The assumption that lower salt intake would, in the long run, lower blood pressure, to our knowledge, has not yet been confirmed in longitudinal population-based studies.” said the study, which concluded that associations between systolic pressure and sodium excretion did not mean less morbidity or improved survival.

Low sodium excretion was a predictor of higher rates of death from cardiovascular disease.

Authors say that these current findings do not support current recommendations of generalised and indiscriminate reduction of salt intake for everyone. Only in hypertensive patients did reducing salt in the diet lower blood pressure.

Interestingly, the JAMA study shows that a slight decrease in blood pressure occurs with lowered salt intake but did not affect blood pressure other than in patients with existing hypertension.

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The risks of NSAIDS

Even short-term NSAID use is considered risky in cardiac patients

In patients who have previously had a heart attack (myocardial infarction / MI), most nonsteroidal anti-inflammatory drugs (NSAIDs), even when only taken for a week, have been associated with increased risk of death and recurrent heart attacks.

The study, published on May 9  2011 in Circulation, found that use of NSAIDs was associated with a 45% increased risk of death or recurrent MI in the first 7 days of use and 55% increased risk if patients continued taking NSAIDS.

“We found that short-term treatment with most NSAIDs was associated with increased and instantaneous cardiovascular risk” said one of the authors. “Results indicate that there is no apparent safe therapeutic window for NSAIDs in patients with prior MI and challenge the current recommendations of low-dose and short-term use of NSAIDs as being safe”.

Some NSAIDs were associated with more risk than others, but none were shown to be completely safe. Researchers could not identify a period that appeared to be safe, no matter how little time they were taken. Patients were taking commonly available / prescribed medication like ibuprofen and diclofenac as well as COX-2 inhibitors like Vioxx and celecoxib. Diclofenac was associated with early and higher cardiovascular risk than Vioxx (withdrawn in 2004 because of its high cardiovascular risk).

All NSAIDs, except naproxen, were associated with an increased risk for death or recurrent MI, diclofenac had the worst risk.

So, if you know anyone who has had a heart attack, make sure they are aware of the real risks of even small doses of NSAIDs like ibuprofen – which is commonly taken for headaches, back and neck pain and tendinitis.

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Hypnotic relaxation vs amitriptyline for tension-type headache – relaxation wins!

A new study of 98 patients chose to either try Hypnotic Relaxation or medication (in the form of amitryptiline, an antidepressant known for alleviating headaches when taken in smaller doses). Patients who were already using more analgesics were more likely to opt for the medication option. Eleven of the patients initially choosing medication and 2 of the patients initially choosing hypnotic relaxation decided to try the other group during the trial.

Long-term adherence to treatment with Hypnotic Relaxation exceeded that of amitryptiline. At the end of the study period, 26 of 47 patients who tried Hypnotic Relaxation compared with 10 of 27 who tried amitryptiline decided to continue receiving their initial treatment. It wasn’t a ramdomised study as patients chose which group they wanted to be in.

The study concludes that the relaxation therapy was more popular choice, patients who tried this reported greater symptom relief than those choosing the medication and they were found to have greater treatment compliance.

Despite decades of research showing the effectiveness of non-pharmacological treatment of headaches, self-management or complementary methods like this are not commonly recommended by all GP’s yet.

Interestingly a number of patients at the clinic find osteopathy very relaxing and also find it beneficial if they are headache sufferers. Maybe research will show if there is a similar mechanism of action.

Hypnotic Relaxation vs Amitriptyline for Tension-type Headache: Let the Patient Choose. Ezra, Y; Gotkine, Marc et al. Headache. 2012;52(5):785-791. © 2012 Blackwell Publishing

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As well as being principal at Amersham Osteopathic Clinic, I am also Consultant in Charge at the Osteopathic Centre for Children's London clinic (part of the Foundation for Paediatric Osteopathy) and teach theory and practical techniques on the current Diploma course. I am on the Sutherland Cranial College of Osteopathy Teaching Faculty. I teach … Read more...