Recovery Michigan

The number of opioid prescriptions has decreased in the past few years, after more than a decade of explosive growth. This reflects new practice guidelines underscoring opioids’ generally poor effectiveness at reducing chronic pain, increased monitoring of prescribers by government and health-care organizations, and widespread horror within and without medicine over the epidemic of opioid-related deaths.

Although reducing the number of prescriptions will decrease the number of people who become addicted to opioids, too many prescribing restrictions could deny opioids to patients who need and benefit from them. How can we know if and when prescribing controls have gone overboard and the population has insufficient access to prescription opioids? In short, how will we know if the effort to restrict opioids has gone too far?

United Nations data provide one important benchmark against which to judge how much more or less opioid consumption might be appropriate for a given country. And what it finds about the United States is jaw-dropping: Even when the list is restricted to the top 25 heaviest consuming countries, the United States outpaces them all in opioid use.

For example, Americans are prescribed about six times as many opioids per capita as are citizens of Portugal and France, even though those countries offer far easier access to health care. The largest disparity noted in the U.N. report concerns hydrocodone: Americans consume more than 99 percent of the world’s supply of this opioid.

Migraines are not like other headaches, just ask someone who has had one. Comparing a migraine to a headache is like comparing a toy train to the super-train in Japan, there really isn’t any comparison. A migraine can be completely debilitating and so intense that sufferers will do almost anything to relieve the pain. Sufferers of migraines have done everything from banging their heads against walls, taking large doses of medications, essential oils, diet changes, activity changes, etc. The lists of things a migraine sufferer will do to stop or decrease the pain can be as lengthy as a child’s Christmas wish list. However, very few treatments really work to reduce the pain, and very little is actually known about the causes and treatment of migraines.

Migraines are one of the more prevalent claimed disabilities among Veterans. It is currently ranked 8^thin most prevalent disabilities in new compensation claims. Studies suggest that approximately 36% of those returning from Iraq experience migraine type headaches. Another study showed that of those suffering from migraine type symptoms, about 22% showed symptoms of anxiety, 50% showed symptoms of depression, and almost 40% had symptoms of PTSD. The exact causes of migraines remain unknown, but there are links. Traumatic brain injuries such as exposure to explosives, extremely loud noises, and actual head injuries are leading factors in migraines. However, there are now links to exposures to chemicals such as burn pits and chemical solvents.  There may also be secondary links such as the neck, eye, or back injuries, fibromyalgia, and mental health issues.  There can also be other secondary issues from the migraines such as sleep disorders, chronic mental health issues such as depression.  Detailed information on how migraines are rated can be found here.

According to a study published in the National Institutes of Health (NIH) entitled, “Experiences of social exclusion and bullying at school among children and youth with cerebral palsy,” kids with cerebral palsy are often the target of bullying during school hours. There are a number of reasons why bullies hone in on children with cerebral palsy and other disabilities, some of which include:

• Children with cerebral palsy may stand out from their other classmates
• Bullies often think children with cerebral palsy cannot defend themselves
• Children with special needs may have a lower “social standing” in school, making them easy targets
• Low frustration tolerances lead to children with disabilities having meltdowns easier, something that bullies tend to target
• Problems with motor skills and physical limitations, such as not running fast enough
• Children with assistive devices may be perceived as “weird or strange”

A new study demonstrated that individuals with major depressive disorder had a significant reduction in depressive symptoms during a 12-week integrative health intervention that included Iyengar yoga classes and coherent breathing. Participants who took three yoga classes a week were more likely to achieve lower depression scores after 12 weeks than subjects who took two classes, according to the study published in The Journal of Alternative and Complementary Medicine, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available open access on The Journal of Alternative and Complementary Medicine website.

The article entitled "Treatment of Major Depressive Disorder with Iyengar Yoga and Coherent Breathing: A Randomized Controlled Dosing Study," is coauthored by Richard Brown, MD, Columbia University College of Physicians and Surgeons (New York, NY), and John Eric Jensen, PhD, Harvard School of Medicine (Boston, MA) and McLean Hospital (Belmont, MA), and colleagues from Boston University School of Medicine, Boston Medical Center, Massachusetts General Hospital, and Biostatistical Solutions (Boston, MA), Edith Nourse Rogers Memorial Veterans Hospital (Bedford, MA), and New York Medical College (Valhalla, NY).

In the study, adults 18-64 years of age with major depressive disorder participated in either three (high-dose intervention) or two (low-dose) yoga classes per week and practiced coherent breathing at 5 breaths per minute. The researchers used a Depression Inventory measure to assess depressive symptoms in the 30 participants, at the beginning of the study and throughout the 12-week intervention.

"The practical findings for this integrative health intervention is that it worked for participants who were both on and off antidepressant medications, and for those time-pressed, the two times per week dose also performed well," says The Journal of Alternative and Complementary Medicine Editor-in-Chief John Weeks, johnweeks-integrator.com, Seattle, WA.

For those suffering the trauma of intensive care, the soothing swoosh of otherworldly ambient music can be a welcome gift.

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ntensive care is no place for the faint-hearted. Improvements in medical technology, particularly the development of the modern positive pressure ventilator, have transformed our efforts at the boundary between life and death. A few decades ago, many of the people in that ward next door would already be dead.

But progress comes at a cost. The noise of life-support machines and vital-sign monitors is a constant background. Phones ring, bin lids bang, staff call for help and doctors are constantly being paged to the next emergency. The racket frequently exceeds World Health Organisation (WHO) guidelines for safe noise levels. In The Guardian in 2016, Helen Taylor, an intensive care survivor, described a ‘constant, frightening’ noise from which there was little respite at night. It’s one reason why a recent article likened the modern ICU to ‘a branch of hell’.

The chaotic atmosphere was less of a problem 10 years ago. If I had stepped next door then, there would have been few patients awake to disturb. The standard approach, while life-saving procedures were being administered, was heavy sedation. While the machine was being fixed, the patient was put into a coma.

That changed with the recognition that, inside those ravaged, intubated bodies, minds were still working. And those minds were not at ease. The British journalist David Aaronovitch had a stint in intensive care after routine keyhole surgery went disastrously wrong. He heard people behind a curtain railing violently against him. As his disorientation deepened, he started to believe that the sinister officers of the night shift were preparing his body for human consumption. They were feeding him oxygen in order to make his flesh sweeter. He was going to be eaten.

This kind of break with reality used to be known as ICU psychosis. Nowadays, the term ‘delirium’ has superseded it, particularly when there is an apparent biological cause such as medication, inflammation or sepsis. In delirium, the patient’s attention is disrupted and vivid hallucinations and delusions sweep in. The British artist Victoria Hume, who made a piece based on conversations with ICU survivors, told me she heard stories of ‘persecution, conspiracy and terror – of bombs under the bed, or being left at the bottom of a lift shaft for eternity, or trapped on a spaceship, unable to return home’. In patients who are heavily sedated and on ventilators, rates of ICU delirium are as high as 80 per cent. 

Researchers at the University of Vermont have identified an association between childhood emotional abuse and opioid abuse in adults.

Previous studies have linked child abuse and opioid addiction in adulthood, but did not identify the specific cause of the opioid addiction.

For the new study, a team of researchers analyzed the results of a series of psychological tests given to 84 participants with a history of opioid abuse and childhood trauma.

The study showed childhood emotional abuse was more strongly connected to opioid misuse than sexual or physical abuse in childhood.

Children who had been emotionally abused were more likely to engage in risky behavior in adolescence and have post traumatic stress disorder, or PTSD, as adults, researchers said.

"If a person is being physically or sexually abused, it's easier to put the blame on the person doing the abuse," Matthew Price, assistant professor in the Department of Psychological Science at the University of Vermont, said in a press release. "With emotional abuse, the abuser is saying 'You are the problem.' Being called names, being told you're not good enough, being told no one cares about you undermines your ability to cope with difficult emotions. To protect themselves from strong emotions and from trauma cues that can bring on PTSD symptoms, people with this kind of childhood experience frequently adopt a strategy of avoidance, which can include opioid use."

I was recently diagnosed with a comorbidity (meaning I have more than one health conditions) of major depressive disorder (MDD, more popularly known as just depression), generalised anxiety disorder (GAD), and borderline personality disorder (BPD). Since the first two are better known, I am going to talk about BPD here.

BPD is a personality disorder characterised by an unstable self-image, inability to regulate emotions and perceive others as more than just good or evil (“black-and-white thinking”), and impulsivity. It’s almost like bipolar II disorder (BD-II) on steroids, with hypomanic and depressive phases condensed into a span of hours or even minutes*. It is, unfortunately, also one of the most badly stigmatised mental illnesses. Not many people are informed of the nature and gravity of mental illness, let alone that of BPD. But those who know a bit about BPD either heard about it from movie stereotypes as in Girl, Interrupted or Fatal Attraction (neither of which is a feel-good movie, to say the least) or from the stigma against this particular disorder, which is rife even amongst the mental health community.

I know most people aren’t aware of mental illnesses and have unfavourable prejudice against them. But little by little we’re making progress in various aspects. Awareness of more well-known illnesses such as depression and post-traumatic stress disorder (PTSD) is spreading. Famous people who came out about their struggles, like Carrie Fisher and her self-deprecating frankness about her bipolar disorder and alcoholism, have also helped paint a more humane image of such illnesses. Nevertheless, the awareness and stigma against personality disorders (PDs) have yet to improve.