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The Joint Commission on the Accreditation of Healthcare Organizations says that nearly a third of Americans will experience chronic pain sometime. It’s estimated that about 50 million Americans live with chronic pain, the No. 1 cause of adult disability in the United States, JCAHO says, adding that chronic pain accounts for about $100 billion in lost productivity and is the major cause of worker absenteeism. Dr. Lynn Webster, president of the Utah Academy of Pain Medicine (a local chapter of the American Academy), who also directs Lifetree Clinical Research and Pain Clinic, said that numbers are probably higher. About half of us will experience chronic pain at some point, he said. And he warns that the pain itself can become a debilitating disease if it’s not controlled or people don’t learn to cope with it. “As it exists over time, it changes the central nervous system in ways that contribute to the problem.”

The goal of treatment, Webster said, is to “allow people to function at the highest possible level and maximize quality of life.”

Some patients get immense relief from prescriptions, while others don’t get much, said Webster.

“Unfortunately, there’s a lot of devastating pain problems for which we have only minimal ability to provide relief,” said Webster. That’s when pain experts look beyond traditional medicine to help patients.

Exercise is immensely helpful with nearly all chronic pain, although many patients resist at first because it may hurt to move. But the more someone does – as long as it’s done correctly to avoid worsening condition – the better the body responds and the more it can do. “We try to achieve as much as possible,” Webster said, noting that for some patients that’s building up to walking three miles a day and for another “huge success” might be the ability to sit at the dinner table with the family.  

Nearly anyone with chronic pain can get at least some relief using multiple approaches, Webster said. “We may need to coordinate the physical, medicinal, and mental element in treating the more severe problems.” Doctors may prescribe physical therapy or an exercise program such as low-impact aquatic therapy, which Gardner loves. “Some patients need help from behavioral psychologist,” not because they have a mental illness but because “there’s a tremendous impact on all aspects of life, and they need to learn how to deal with that and keep it in perspective so psychological pain doesn’t drown us.”

Insurance coverage is another issue for chronic pain, Webster and Brooks said. If an X-ray doesn’t show a clear-cut source of pain, it may be “placed in a category as more of a behavioral issue and dismissed or at least lessened,” said Webster. Insurance may not cover some of the complementary treatments.

“There is an under treatment of pain. There are usually treatment options if people are persistent. At the same time, not all treatments are successful, and there’s risk to all procedures. And over-the-counter remedies can be dangerous or potentially harmful,” Webster said.

The very good news, he adds, is “there’s a lot in the pipeline that’s going to be available in the next few years. – Deseret Morning News; Salt Lake City, UT 

 

As Dr. Lynn Webster sees it, there’s a big pain problem in this country that is only to get worse if something isn’t done soon. Webster, the medical director of Lifetree Clinical research and pain Clinic in Salt Lake City, visited St. Peter’s Hospital on Friday to give a presentation on the conundrum of under-treated pain sufferers and doctors’ reluctance to prescribe opioids.

“There’s an attitude that if you’re on opioids for a long time, you’re an addict,” Webster said. “That’s a myth; it’s not true.”

“Not all chronic use of opioids is abuse,” Webster said. “And those who do abuse opioids are thought to be addicts. And that’s not true.”

It’s important for doctors and patients to understand the difference between abuse and addiction, Webster said, because one out of two humans will experience severe and intractable pain and uncontrolled intractable pain is a leading cause of suicide.

“A huge number of baby-boomers will experience pain and need opioids,” Webster said. “Access should be personal for everyone.”

Webster hopes that by providing education to doctors and pain sufferers, the pain conundrum will be solved.

“Access (to opioids) has to be appropriate without judgment and without criticism but with compassion,” Webster said. – Independent Record; Helena, MT

 

The U.S. Food and Drug Administration has approved a “usual adult dosage” on the package insert for methadone that several studies say could be deadly. “The usual adult dosage is 2.5 mg to 10 mg every three or four hours as necessary,” reads the drug’s package insert under “For Relief of Pain.”

Someone reading that label could believe it is safe for an adult to consume up to 80 milligrams of methadone a day. But 50 milligrams of methadone or less can kill a patient not used to strong painkillers, studies say.

“Most people would die if they took 80 milligrams a day,” said Lynn Webster, a pain doctor and researcher from Utah. “That’s an extremely dangerous, liberal guideline.”

Webster said he would prescribe no more that 20 milligrams per day to someone new to opioid drugs. Elderly or sick patients should start much lower.

The language on the package insert isn’t the only problem, Webster said. When doctors want to switch patients from one drug to another, they often rely upon conversion tables published by the drug manufacturers. Those tables are out of date and just plain wrong he said. The conversion tables are designed for a single dose, not for several days or weeks of use, he said. Unlike other opioid drugs, methadone builds up in the body and is slow to leave.

“I think those conversion tables are misleading and very dangerous to use,” he said. – The Charleston Gazette; Charleston, WV; Part of an ongoing Gazette investigation.

 

Some patients could die if they followed the “usual adult dosage” on methadone’s package insert, said several researchers and pain doctors contacted by the Gazette-Mail. Doses of 50 milligrams or less of methadone have killed people not accustomed to the drug, according to several studies. Researchers now recommend a starting dose of 10 milligrams a day or less for patients not used to narcotic painkillers. But the package insert says the usual adult dosage is “2.5 mg to 10 mg every three or four hours necessary,” or up to 80 milligrams a day. The inserts are written by the drug manufacturers and approved by the federal Food and Drug Administration.

“That’s an extremely dangerous, liberal guideline,” says Lynn Webster, a physician and published researcher who runs Lifetree Clinical Research and Pain Clinic in Utah. “I doubt any board-certified specialist would say that is a safe starting dose.” - The Charleston Gazette; Charleston, WV; Part of an ongoing Gazette investigation.

 

Methadone is much cheaper than other narcotics. A one-month supply (90 pills of five milligrams each) costs about $8, compared with $80 for generic morphine or $100 for OxyContin, according to First Databank, a national reference of prescription drug prices.

Insurance companies, workers’ compensation programs and state health programs like Medicaid all are pushing methadone over more expensive alternatives, said Lynn Webster, a pain researcher and physician from Utah.

Webster told the Gazette he feels pressured to prescribe methadone by insurers.

“I’ve had insurance companies deny payments for OxyContin because they feel it is not indicated. Or they say they aren’t going to pay for enough of the drug to be effective, so we can’t control pain at the amount they authorize,” Webster said. “We can either prescribe methadone or nothing at all.” - The Charleston Gazette; Charleston, WV; Part of an ongoing Gazette investigation.

 

Not every clinical trail deals with potentially lifesaving drugs, but when taking on deadly diseases, doctors and drug companies rely on the ill to help show the effectiveness of potential treatments.

Many patients diagnosed with terminal illnesses are more than willing to fulfill their role in the drug development pipeline. They take chances on drugs under development, regardless of potential side effects.

Each patient considering the merits of entering a clinical trial must weigh the possible benefits against the potential risks of taking the treatment. Participation requires informed consent. Independent panels known as institutional review boards (IRBs) examine each clinical trial in part to make sure those running the studies will explain the process in an understandable manner, said John Hurdle, chairman of the University of Utah’s IRB.

The review boards examine the risks and potential benefits of proposed studies as well as the intended methods to be used in the research. The U’s panel is examining more than 1,500 proposals.

In each case, the key is that prospective patients must understand what will happen in the trial.

“The patient must be told all of what is known about the drug on the negative side,” said Lynn Webster, a doctor who oversees trials for Utah’s Lifetree Clinical Research and Pain Clinic.

Patients might decide to participate in trials because their ailments have no treatment. Other participants might be looking for new ways to treat their diseases because existing drugs might cause unwanted side effects or might be inadequate, Webster explained. – The Salt Lake Tribune; Salt Lake City, UT

 

The package insert that comes with methadone contains dangerous and potentially deadly language about the “usual adult dosage” of methadone, according to several physicians and pain researchers contacted by the Gazette-Mail. The drug manufacturer writes the language and the FDA approves it. “The usual adult dosage is 2.5 mg to 10 mg every three or four hours as necessary,” reads the drug’s package insert under “For Relief of Pain.”

Someone reading that label could believe it is safe for an adult to consume up to 80 milligrams of methadone a day. But 50 milligrams of methadone or less can kill a patient not used to strong painkillers, studies say.

“Most people would die if they took 80 milligrams a day,” said Lynn Webster, a pain doctor and researcher from Utah. “That’s an extremely dangerous, liberal guideline.” - The Charleston Gazette; Charleston, WV; Part of an ongoing Gazette investigation.

 

Dr. Lynn Webster’s campaign to stop unintentional overdoses of prescription drugs has three parts.

So far there are no studies to show why it is occurring so often and who is at risk, said the president of the Utah Academy of Pain Medicine in Salt Lake City, but the problem is critical enough that steps need to be taken now.

Webster plans to speak at functions throughout the state.

First, he wants to educate physicians on how they can be part of the solution.

He said he personally checks the state’s data system to see if a new patient has recently received prescriptions from another doctor.

Most pharmacies report prescriptions to the data system. He also randomly checks his established patients if he becomes suspicious.

“It’s not a foolproof method. There are a few pharmacies that don’t report to the state,” he said.

Second, he wants to educate patients.

A small percentage of patients who are using pain medications or antidepressants take too many pills or combine them with other drugs or alcohol.

“We need to educate them about how dangerous and lethal this can be,” he said.

Third, he wants to educate the larger community.

Family members of a patient sometimes are unaware of the risks their loved one is taking when they use too much of a medication or combine it with other substances, he said. – Standard Examiner; Ogden, UT

 

Dr. Lynn R. Webster visited Vernal to present a seminar on pain-related medical topics. His seminar was the first of such seminars that will be given across the state to educate physicians, health care providers, and people suffering from chronic pain about the dangers of pain medicine. Webster is kicking off his campaign to reach the goal of zero unintentional deaths due to overdosing on pain medicine. Vernal was a good place to start his campaign because the rate of unintentional deaths in rural areas is higher than in urban areas.

Dr. Webster is board certified in anesthesiology and pain medicine. He is also certified in addiction medicine. He has seen numerous deaths from accidental overdose of pain medicine. He is alarmed by the astronomical increases in unintentional overdose of prescription drugs.

“We cannot allow the death rate to continue to grow,” said Webster. “Undertreated pain or pain that cannot be controlled is the most powerful stimulus for overusing prescription drugs. It is not generally about addiction,” he said.

Sometimes, despite all the medical community has, some pain cannot be adequately helped. Webster with hope to patients can look with hope to the future because technology is creating new things that are much better than what is available now in controlling pain.

The biggest challenge to reaching the goal of zero unintentional deaths is the lack of data. Better data about the reasons people use more drugs than prescribed is needed. “We don’t know a lot of what we need to know in order to solve the problem, but we can’t wait for the data,” said Webster. “I think just being aware will help the problem.”

Dr. Webster is concerned that if something is not done about the problem, regulators such as the FDA will try to eliminate or decrease access to strong pain medication. Webster believes that if this happens, there will be an increase in death’s due to suicide. “If pain isn’t controlled to the best of our ability,” said Webster, “there will be an increase in the number of people who try to escape their pain through more drastic measures such as suicide.”

During his seminar, Dr. Webster also discussed the stresses that pain causes that leads to overdose. He mentioned that unrelieved severe pain, the fear of not being believed, the impact of pain on family and friends, the financial impact of chronic pain and insurance denials for treatment all can lead to overdose. 

Dr. Webster’s message was clear, “If you use a strong pain medicine such as an opioid, take it just as prescribe. Patients do not have enough knowledge to alter the doses themselves.”

Webster is hoping to establish a foundation or organize to raise funds that can be used to research the problem. “There is so much we don’t know, but what we do know is that the rate of unintentional death is rising at an alarming rate. – Vernal Express; Vernal, UT

 

Colby Hunsaker woke up with a headache in the fall of his high school sophomore year.

For 7 ½ years now, the pounding, stabbing, throbbing pain has been with him constantly – 24 hours a day, seven days a week. Well, almost constantly – Hunsaker said he was blessed to be migraine-free for four days.

The now-23-year-old Kaysville man has tried many treatments – physical therapy, acupuncture, Botox injections, sinus surgery, allergy therapy, massage, chiropractic adjustments, colonics, nerve burns, spinal injections, muscle relaxants and narcotics.

Nothing helped.

Out of ideas, Hunsaker enrolled in a study called Precision Implantable Stimulator for Migraine, or PRISM, at Lifetree Clinical Research in Salt Lake City.

“This is a fascinating research study,” said Lifetree medical director Lynn Webster, who is the implanting physician and principal investigator for the study.

PRISM may help migraine sufferers because it electrically stimulates the occipital nerves in the back of the head.

These nerves interconnect with other nerves outside of the skull and form a continuous neural network that can affect any given area through which any of the main nerves or their branches pass.

The mechanism by which the stimulation may work is under investigation, but could involve a transmission of electrical signals to the area of the brain where migraine signals can be interrupted, Webster said.

The PRISM device has two components.

One component features two electrode leads that look like medium-sized wire. These leads are placed under skin high in the neck or at the base of the head.

The wires are tunneled to a power source called a generator, Webster said.

The generator is a bit smaller than most pacemakers and can be implanted in several areas, but most commonly is placed in a buttock or the lower back.

The double-blind, placebo-controlled study will include about 150 patients from 15 sites across the nation. Some of those patients will get the real stimulation; others will not.

“None of the patients will know who received the real things until the study is over. However, after three months of the trial, all patients will be programmed to receive the active stimulation,” Webster said.

The first phase of the study should be completed within one year, though patients will be followed for four years to determine the long-term success of the stimulation, Webster said. 

The first phase could be made public in about two years if the study is completed within the year. However, it will be five to six years before the long-term results will be published,” he said.

Webster said participants of the study should be recognized as heroes.

“It is research like this that is important for new advances to be made. Obviously, manufacturers of new medications and devices will profit if it is successful, but the real contributions are made by and for those who suffer from the conditions the research is designed to help,” he said. – Standard Examiner; Kaysville, UT

 

Known primarily as the drug prescribed for heroin withdrawal, methadone is gaining popularity as a painkiller – with sometimes deadly results. From 1999 to 2002 the number of methadone-related deaths tripled to 2,361, according to the Centers for Disease Control’s injury center.  One reason? Given the widespread abuse in recent years of such painkillers as OxyContin, many doctors started prescribing methadone. But methadone stays in the body longer, so there’s a greater danger of taking too much. “It will build up in the body over a few days or a week or two to a lethal level and patients won’t even know,” says Utah physician Lynn Webster, who has studied the issue. “If you add Zoloft [which pathologist Cyril Wecht says was in Daniel’s system] the risk is much higher because they can both cause the same type of arrhythmia.” (In Daniel’s case Wecht believes a lethal combination of drugs caused a deadly irregular heartbeat.) With studies showing that many people who overdose on methadone have a legal prescription, “there needs to be more awareness” about the drug’s dangers, says Webster.

Daniel had been under treatment for depression and back pain, but according to medical information obtained by PEOPLE, his doctors did not consider him suicidal. Nor was there any indication from doctors or acquaintances that he was addicted to drugs or alcohol – which raises the question of where he obtained the methadone and Zoloft. According to someone with knowledge of the investigation, a nurse found a methadone pill in a plastic bag in Anna Nicole’s hospital room not long after Daniel’s death. Yet, while methadone is an increasingly popular painkiller, “it is not a medication that we prescribe,” says Hubert Minnis, the ob-gyn who delivered Smith’s baby by C-section.

Meanwhile, in Los Angeles, photographer Larry Birkhead has questions he wants answered too. On Oct. 2 Birkhead filed a paternity suit claiming that he is Dannielynn’s father; the suit asks that the child be given a drug test. “He wants to find out if [Danielynn] has drugs in her system,” says Birkhead’s attorney Debra Opri. “He’s very concerned about the presence of drugs in the home.” Being in the Bahamas, however, protects Smith from having to respond to a suit filed in California, so long as she stays out of the state.

As Nassau police continued their probe, there were still no announced plans by press time for Daniel’s funeral, and his body remains in a Nassau funeral home. Nor were there any plans for an official wedding; the couple “will do it where it’s legal at some point,” says Scott. For now, the symbolic ceremony has provided Smith and Stern with some much needed solace. “At one point, I asked Howard, ‘Are you sure you want to do this?’” says James, 50, who executive-produced the upcoming movie Illegal Aliens, which stars Smith (her son Daniel was an associate producer). “And he said, ‘She needs something now.’”

So while James’ wife, Denise, took care of Dannielynn below deck of the catamaran, Smith had her hair set in rollers before slipping on a white veil. Then, at around 3 p.m., Stern, in a black dress suit and open white shirt, and Smith, holding a bouquet of red roses, exchanged vows and Bible verses–as well as temporary rings, because the real ones weren’t yet ready. After the ceremony “we all cheered and Anna wanted to jump into the ocean,” says James. “But there were sharks out there, so we sped back to [Sandy Cay], and then Anna and Howard jumped in. She got a little sore [in her C-section incision] from that.”

Not your typical ceremony, perhaps. But since Daniel’s death, says James, “this was the first time I had seen Anna come out of her grief for a moment.” –People Magazine

 

Lynn Webster, president of the Utah Academy of Pain Medicine and medical director of Lifetree Clinical Research and Pain Clinic in Salt Lake City and Ogden, will present his “Zero Unintentional Deaths” campaign to the medical staff at Brigham City Community Hospital on Wednesday.

“There are too many unintentional overdose deaths from opoids, which are narcotic medications for treating pain,” he said. “Many die because they are simply trying to escape the pain.”

“It is a tragedy that can be prevented for many chronic pain sufferers, and this story needs to be told to the American public.”

Webster’s campaign went national Sept. 22, when he talked about it on ABC’s newsmagazine show “20/20.”

“I believe it is most likely that patients are trying to escape the harsh reality of pain by using more medication than prescribed,” Webster said. “It’s understandable that patients want to escape the pain, but some patients ignore the risks because they are overwhelmed by pain.”

Sometimes, patients take too much medication in an attempt to get some sleep, he said. Others mix them with alcohol or valium-like drugs, which can be lethal.

“Many patients do not have their pain treated adequately,” Webster said. “As a result, they overuse the medications. Doctors then label patients ‘addicted.’

“Overuse of medication is not necessarily addiction, but it is abuse, and abuse can be a result of undertreatment of pain and lack of compassion from the medical profession.”

Prescription drugs abuse is a serious nationwide problem, Webster said, but Utah may be feeling the effects more than other states–Utah has had the greatest increase in methadone-related deaths in the country.

“When some physicians change from one medication to another, the way they do the conversion may result in an amount that is too much for a particular patient,” he said.

“In particular, this happens with methadone. Methadone takes longer to eliminate from the body, so it can build up in some people much too quickly before their bodies can adjust to it.

“When this happens, it may stop respiration before stopping the pain. Physicians must know how to prescribe it, and patients must use it only as prescribed.”

Webster said he is working on behalf of the Utah Academy of Pain Medicine and the Utah Department of Health to find a way to study the problem of unintentional overdose deaths in Utah and to come up with solutions to the problem without compromising access to pain therapy.

He has proposed to develop a study that will utilize a root cause analysis in a sophisticated way to understand risk factors. If approved, the research will be conducted on a national scale.

“The most important reason is that people are dying who shouldn’t be,” Webster said.

“But also because the fear and uncertainty created threatens our future ability to treat the tens of thousands of Utah residents who suffer from severe pain. Not only will clinicians fear to treat pain, but regulators will feel pressure to limit pain treatment.

“I feel a sense of responsibility to help correct a problem that is correctable.” – Standard Examiner; Brigham City, UT

 

The FDA addressed several other findings of the gazette-Mail investigation:

The old package insert gave a “usual adult dose” of 2.5 mg to 10 mg “every three or four hours as necessary.”

That could lead a patient to think 80 milligrams a day is safe, even though studies have found that 50 milligrams or less can kill patients who aren’t used to strong painkillers, the Gazette-Mail found. The FDA deleted that “usual adult dose” from the new patient information. 

“This is great news,” says Dr. Lynn Webster, founder of a nonprofit foundation devoted to eliminating drug overdose deaths. Webster has traveled the country during the past year spreading the message about the potential dangers of methadone.

“It is absolutely crucial that this information get out,” he said. “Methadone is a powerful, effective, and lifesaving drug, but it is potentially deadly if misused.” - The Charleston Gazette; Charleston, WV; Part of an ongoing Gazette investigation.

 

The Food and Drug Administration has warned about the life-threatening reactions, such as respiratory depression and cardiac arrhythmia, that can occur in methadone patients.

Dr. Lynn Webster, president of the Utah Academy of Pain Medicine and Medical Director of Lifetree Clinical Research and Pain Clinic, said the warning should be taken seriously by both health-care professionals and the public.

He recently began a national education campaign to inform doctors, chronic pain sufferers and communities about the increasingly serious issue of unintentional overdose deaths with prescription medications, including methadone. He has also addressed these dangers on ABC’s “20/20” and Court TV.

Webster said some patients might overuse the medication in a desperate attempt to entirely escape pain.

“One pill is often not enough, and two may be more effective,” he said. “However, methadone is unique in that the length of time it provides pain relief is only four to eight hours while its effect on suppressing breathing may last for two to three days.”

Webster also said when first given, methadone patients do not have a tolerance to the breathing depressant effect, and repeated dosing can cause patients to stop breathing, usually at night.

Early symptoms of too much methadone include being excessively sedated, not being able to stay awake and snoring heavily, Webster said.

“The worst symptom of methadone is when no breathing occurs,” Webster said. “This, of course, is when it’s too late.”

Methadone was introduced into the U.S. by Eli Lilly and Company in 1947. According to the FDA, worldwide, there has been an explosion of deaths related to the drug.

Webster said his biggest concern with methadone is that the drug won’t be available to patients who need it because of the increased deaths associated with its use.

“All pain relievers, including methadone, are powerful medications,” he said. “Not enough respect is paid to the power behind these medications. They are intended to be used as physicians prescribe them, not as patients feel they need them.

“Too often, patients use pain medications as if it is aspirin or ibuprofen. If one pill helps a little, then two must help a lot. This careless approach can be lethal.”

LEARN MORE:

Source: Dr. Lynn Webster – Standard Examiner; Ogden, UT

 

PET technology is being utilized by pharmaceutical and biotech firms nationwide as they develop new pain medications that are less likely to cause dependency or addiction. Lifetree Clinical Research is now among the first in the Intermountain West to make this technology available to its clients.

“Although medical researchers have been working for years to determine what causes drug addiction, much remains to be learned. By providing glimpses of the neurologic and chemical pathways activated by drug consumption, PET scans can help trace the causes and effects of drug abuse in the brain and may even help scientists devise new strategies for addiction prevention and treatment," Lifetree Clinical Research Medical Director and Lead Research Investigator Dr. Lynn Webster said.

He added, “In the future, I believe neuroimaging-PET scans, functional MRIs and more-will be used extensively to understand where drugs work and their limitations with different emotional disease states.”

Webster said that PET scanning works by injecting an individual with molecules that contain a small amount of radioactivity. Once these tracing molecules are inside the body, scientists can observe and measure increased metabolic activity in various anatomical structures. One way to evaluate the abuse liability of test agents is to observe which areas of the brain become active under normal and abnormal simulations. Assessing the effects of a test product and correlating those findings to a PET scan can help researchers better understand the drug. - PharmaLive; web publication

 

 

Opioid-based pain medications may cause sleep apnea, according to an article in the September issue of Pain Medicine, the journal of the American Academy of Pain Medicine.

“We found that sleep-disordered breathing was common when chronic pain patients took prescribed opioids,” explains lead author Lynn R. Webster, MD, from Lifetree Clinical Research and Pain Clinic in Salt Lake City, Utah. “We also found a direct dose-response relationship between central sleep apnea and methadone and benzodiazepines, an association which had not been previously reported.

The authors also note that if opioid medications increase sleep apnea risk as their research suggests, then chronic pain patients who are prescribed opioids have a higher risk of morbidity and mortality.

“The challenge is to monitor and adjust medications for maximum safety, not to eliminate them at the expense of pain management,” Dr. Webster concludes. – EurekAlert!; web publication

 

Opioid-based pain medications – used to treat chronic pain – may cause sleep apnea, suggest U.S. researchers.

Opioids are often used for cancer patients, but are gaining widespread acceptance as long-term therapy for chronic pain unrelated to cancer.

Lead author Dr. Lynn R. Webster of the Lifetree Clinical Research and Pain Clinic in Salt Lake City studied sleep lab data on 140 patients taking around-the-clock opioid therapy for chronic pain for at least six months.

The study, published in Pain Medicine, showed a higher than expected prevalence of sleep disordered breathing in opioid treated chronic pain patients. Obstructive and central sleep apnea syndromes occurred in the population, where obstructive sleep apnea is known to be underdiagnosed, but has been estimated at roughly 2 percent to 4 percent.

People who stop breathing during sleep because of faulty brain control have central sleep apnea – as opposed to obstructive apnea, which is triggered by obesity and other health problems, and is accompanied by loud snoring, Webster said. – Earthtimes.org; web publication

 

Opiod-based pain medications – used to treat chronic pain – may cause sleep apnea, suggest U.S. researchers.

Opioids are often used for cancer patients, but are going widespread acceptance as long-term therapy for chronic pain unrelated to cancer.

Lead author of Dr. Lynn R. Webster of the Lifetree Clinical Research and Pain Clinic in Salt Lake City studied sleep lab data on 140 patients taking around-the-clock opioid therapy for chronic pain for at least six months.

The study, published in Pain Medicine, showed a higher than expected prevalence of sleep disordered breathing in opioid treated chronic pain patients. Obstructive and central sleep apnea syndromes occurred in the studied population at 75 percent more than observed in the general population, where obstructive sleep apnea, which is triggered by obesity and other health problems, and is accompanied by loud snoring, Webster said. – YellowBrix Industry Watch; web publication

 

Opioid-based pain medications may cause sleep apnea, according to an article in the September issue of Pain Medicine, the journal of the American Academy of Pain Medicine.

“We found the sleep-disordered breathing was common when chronic pain patients took prescribed opioids,” explains lead author Lynn R. Webster, M.D. from Lifetree Clinical Research and Pain Clinic in Salt Lake City, Utah. “We also found a direct dose-response relationship between central sleep apnea and methadone and benzodiazepines, an association which had not been previously reported.”

The authors also noted that if opioid medications increase sleep apnea risk as their research suggests, then chronic pain patients who are prescribed opioids have a higher risk or morbidity and morality.

“The challenge is to monitor and adjust medications for maximum safety, not to eliminate them at the expense of pain management,” Dr. Webster concludes. – News-Medical.Net; web publication

 

 

A never-before-reported association has been found between opioids like methadone and benzodiazepines used by chronic pain patients and sleep-disordered breathing.

“We found that sleep-disordered breathing was common when chronic pain patients took prescribed opioids,” explains lead author Lynn R. Webster, MD, from Lifetree Clinical Research and Pain Clinic in Salt Lake City, Utah. “We also found a direct dose-response relationship between central sleep apnea and methadone and benzodiazepines, and association which had not been previously reported.”

The authors also note that if opioid medications increase sleep apnea risk as their research suggests, then chronic pain patients who are prescribed opioids have a higher risk of morbidity and mortality. “The challenge is to monitor and adjust medications for maximum safety, not to eliminate them at the expense of pain management,” Dr. Webster concludes.

“The recent flurry of news reports of deaths associated with methadone use, and the synergy of opioids ad benzodiazepines in causing respiratory depression, highlight the importance of Dr. Webster’s research. – Medina.com; web publication

 

 

Patients with severe pain who use opioid-based medications may suffer sleep apnea and its complications, including greater likelihood of death, according to a study of Pain Medicine, the journal of the American Academy of Pain Medicine.

The research shows that three-fourths of patients on chronic opioid therapy have some degree of sleep apnea, said Dr. Lynn R. Webster of Lifetree Clinical Research and Pain Clinic in Salt Lake City, who is lead author on the study. They also found a “direct dose-response relationship” between central sleep apnea and methadone used with benzodiazepines.

Webster said sleep apnea may be an underlying factor in the increase in unintentional overdose deaths linked to opioid pain medications, especially methadone.

The research also showed that as many as one-third of patients being treated with opioids had a component of sleep apnea called central sleep apnea, rather than the more common obstructive sleep apnea. Central apnea is when the body makes no effort to breathe, the part of the brain responsible for respiration malfunctioning. It’s also harder to spot, because some of the telltale hints with obstructive sleep apnea, such as being overweight and loud snoring, are absent.

“With central sleep apnea, we don’t know what the indications are,” Webster said.

Anyone with sleep apnea is at greater risk of heart disease and stroke. And Webster said it also has been shown that people with sleep apnea have more intense pain, “which makes pain medicine less effective, which leads to more pain medicine, which leads to more sleep apnea, which increases the risk of heart disease and stroke… It’s a cycle. There are a lot of different factors that are interrelated that can contribute to other problems.”

While someone on moderate to high-dose opioid medications may have significant problems with sleep apnea, Webster said, not all of them will. It is important that patients are assessed to spot cases of sleep apnea and treat it.

“If you can’t modify the sleep apnea and make sure it’s safe, you may have to provide less medication,” he said. However, he noted the research is not a call to reduce use of opioids, but rather to understand the risks they may bring and deal with them.

There are a number of treatments for patients with sleep apnea, including a continuous positive airway pressure (CPAP) mask, use of oxygen and others. “The best treatment for this we do not know yet. You can’t necessarily use the treatments used for other populations for this problem, because the mechanisms are different for them.”

Central sleep apnea in the past has been most strongly linked to heart failure or neurologic disorders like stroke. In these cases it’s presumably a combination of chronic pain and opioid treatment prescribed to it.

The first step is making sure that those who treat patients in chronic severe pain are aware of how common the problem with sleep apnea is, Webster said. He’s working to develop protocols looking at the most appropriate treatment for the degrees of both obstructive and central sleep apnea. Treating sleep apnea may reduce the amount of pain someone experiences and thus the amount of medication needed to cope with it.

“The recent flurry of news reports of death associated with methadone use and the synergy of opioids and benzodiazepines in causing respiratory depression highlight the importance of Dr. Webster’s research,” said Dr. Rollin M. Gallagher, editor of Pain Medicine. “Clearly we need more studies of these mechanisms as well as ways of identifying those at risk. Doctors and patients who are considering opioid medication for pain control must balance this risk against the potential for improved quality of life.”

The researchers examined sleep lab data on 140 patients who were taking around-the-clock opioid therapy for chronic pain. All patients had been on the opiod therapy for at least six months, with stable dosing for at least four weeks. – Deseret Morning News; Salt Lake City, UT

 

 

To develop its abuse resistant version of Kadian, also known as ALO-010, Alpharma enlisted some unlikely trial subjects: recreational drug users with finely tuned perceptions of morphine highs. The company needed to hire what are in effect connoisseurs of drug euphoria because some abuse trials have been skewed when subjects couldn’t distinguish well between effects of an opioid drug and that of a dummy pill, said Lynn Webster, who runs Lifetree Clinical Research in Salt Lake City and was one of the lead investigators for the temper-resistant drug. “We have to have subjects who can help us develop these products,” Webster said.

He said none of the subjects were addicts. Most were experienced drug users who had agreed to participate after reading advertisements for the trials. – The Star Ledger; Newark, NJ