More than 1/3 of Americans are Taking Pain Medication with Dangerous Side Effects

These medications carry the risk of depression, including suicidal symptoms, as a possible adverse effect. There are safer pain management approaches — see your doctor of chiropractic for drug-free pain relief.

More than a third of Americans are estimated to be taking at least one prescription medication that carries the risk of depression, including suicidal symptoms, as a possible adverse effect—and they may have no idea—according to a study published this week in JAMA.

The study is an observational one, meaning it can only identify associations and not whether common drugs are causing depression or suicide in people. Still, the researchers found some worrying links between the use of common medications and the potential for depression. Most notably, the researchers found that those taking three or more medications with depression risks had a greater chance of self-reporting depressive symptoms on a nine-question survey. Their rate of self-reported depressive symptoms was 15.3 percent, about double the rate reported by those taking just one drug with a risk of depression and about triple the rate of those taking no medications with risk of depression.

This is particularly concerning, the researchers suggest, because patients may not make a connection between their depressive symptoms and the drugs they’re taking. Drugs with risks of depression are very common, they may not have clear warning labels, and some can even be purchased as over-the-counter medications. The most common of them are drugs such as hormonal birth control, beta-blockers (used for conditions such as high blood pressure, heart attacks, and migraines), and proton-pump inhibitors (used for acid reflux).

In all, there are more than 200 medications in use in the US that list depression or suicidal symptoms as possible adverse effects. The only class of drugs with a “black-box warning”—the Food and Drug Administration’s clearest and gravest warning label—for suicidal risks are antidepressants.

While the study is just a starting point for probing the potential role of prescription drugs in depression and suicide, the authors argue that now is the time for more research. The study comes as public health researchers report high rates of depression and suicide in the country. Between 2013 and 2016, 8.1 percent of American adults had depression in a given two-week period. Last week, the Centers for Disease Control and Prevention released nationwide figuresshowing that suicide rates had increased nearly 30 percent overall between 1999 and 2016, with nearly every state seeing increases. Of those who committed suicide, 54 percent were not known to have a mental health condition such as depression.

Dreary data

The authors of the JAMA study—led by Dima Mazen Qato, a pharmacist and health policy expert at the University of Illinois at Chicago—say that more research into the links between drugs and depressive symptoms are needed. In the meantime, they suggest that doctors should better communicate risks to patients who are taking medications with potential side effects of depression and suicide.

Their conclusions are based on data from a nationally representative observational survey that collected information between 2005 and 2014 on 26,192 participants aged 18 or over. Overall, 37.2 percent of participants reported taking at least one medication that listed depression as a potential adverse effect, with 7.5 percent of those taking three or more.

The prevalence of self-reported depressive symptoms rose from 6.9 percent in the participants taking just one risky drug to 9.5 percent in those taking two, and to 15.3 percent in those taking three or more. Those taking no drugs with a risk of depression had a rate of self-reported depressive symptoms of 4.7 percent. Thus, the more drugs with a risk of depression, the greater the likelihood of depressive symptoms, the researchers found.

This held up when the researchers excluded data on patients who were taking psychotropic drugs—ones that intended to alter a mental state. It also held when researchers compared rates of depressive symptoms just in patients with high blood pressure, comparing those that took three or more drugs with a depression risk and those who took drugs with no such risk.

The researchers also noted that the situation may be getting worse over time. Breaking the data out across the survey period, they found that use of drugs with a risk of depression increased from 35 percent in 2005-2006 data to 38.4 percent in the 2013-2014 data. Between those time frames, use of three or more risky drugs increased from 6.9 percent to 9.5 percent.

The study had plenty of limitations in addition to being an observational study. For one thing, the survey data didn’t include information on mental health history. So, it’s not possible to sort out the patients who had preexisting or independent cases of depression. Also, the self-reported survey on depressive symptoms is a screening tool, not a diagnostic. And self-reported data can yield skewed or incomplete pictures of mental health.

Still, the authors conclude that “polypharmacy” (taking more than one drug at the same time) is a concern for medications with risk of depression—and one that requires more research.

Source. [Author: Beth Mole].

Sleep tips: 6 Tips for Better Sleep

You’re not doomed to toss and turn every night. Consider simple tips for better sleep, from setting a sleep schedule to including physical activity in your daily routine.

By Mayo Clinic Staff

Think about all the factors that can interfere with a good night’s sleep — from work stress and family responsibilities to unexpected challenges, such as illnesses. It’s no wonder that quality sleep is sometimes elusive.

While you might not be able to control the factors that interfere with your sleep, you can adopt habits that encourage better sleep. Start with these simple tips.

1. Stick to a sleep schedule

Set aside no more than eight hours for sleep. The recommended amount of sleep for a healthy adult is at least seven hours. Most people don’t need more than eight hours in bed to achieve this goal.

Go to bed and get up at the same time every day. Try to limit the difference in your sleep schedule on weeknights and weekends to no more than one hour. Being consistent reinforces your body’s sleep-wake cycle.

If you don’t fall asleep within about 20 minutes, leave your bedroom and do something relaxing. Read or listen to soothing music. Go back to bed when you’re tired. Repeat as needed.

2. Pay attention to what you eat and drink

Don’t go to bed hungry or stuffed. In particular, avoid heavy or large meals within a couple of hours of bedtime. Your discomfort might keep you up.

Nicotine, caffeine and alcohol deserve caution, too. The stimulating effects of nicotine and caffeine take hours to wear off and can wreak havoc on quality sleep. And even though alcohol might make you feel sleepy, it can disrupt sleep later in the night.

3. Create a restful environment

Create a room that’s ideal for sleeping. Often, this means cool, dark and quiet. Exposure to light might make it more challenging to fall asleep. Avoid prolonged use of light-emitting screens just before bedtime. Consider using room-darkening shades, earplugs, a fan or other devices to create an environment that suits your needs.

Doing calming activities before bedtime, such as taking a bath or using relaxation techniques, might promote better sleep.

4. Limit daytime naps

Long daytime naps can interfere with nighttime sleep. If you choose to nap, limit yourself to up to 30 minutes and avoid doing so late in the day.

If you work nights, however, you might need to nap late in the day before work to help make up your sleep debt.

5. Include physical activity in your daily routine

Regular physical activity can promote better sleep. Avoid being active too close to bedtime, however.

Spending time outside every day might be helpful, too.

6. Manage worries

Try to resolve your worries or concerns before bedtime. Jot down what’s on your mind and then set it aside for tomorrow.

Stress management might help. Start with the basics, such as getting organized, setting priorities and delegating tasks. Meditation also can ease anxiety.

Know when to contact your doctor

Nearly everyone has an occasional sleepless night — but if you often have trouble sleeping, contact your doctor. Identifying and treating any underlying causes can help you get the better sleep you deserve.


Stay safe in high temps!

Drink plenty of fluids, wear sunscreen and watch the temperature when exercising outdoors.

Pay attention to warning signs

During hot-weather exercise, watch for signs and symptoms of heat-related illness. If you ignore these symptoms, your condition can worsen, resulting in a medical emergency. Signs and symptoms may include:

  • Muscle cramps
  • Nausea or vomiting
  • Weakness
  • Fatigue
  • Headache
  • Excessive sweating
  • Dizziness or lightheadedness
  • Confusion
  • Irritability
  • Low blood pressure
  • Increased heart rate
  • Visual problems

If you develop any of these symptoms, you must lower your body temperature and get hydrated right away. Stop exercising immediately and get out of the heat. If possible, have someone stay with you who can help monitor your condition.


Chiropractic care helps with pain from the workforce

American workers are no stranger to low back pain (LBP). Over 80 percent of Americans experience at least one episode of LBP over the course of their lives, and nearly 1 in 4 workers report LBP–making it a top reason to seek chiropractic care. The nationwide cost for treatment and management of LBP continues to climb upwards of $100 billion annually, with two-thirds of this cost being the result of lost wages and reduced productivity. Employers bear much of this burden. Accounting for productivity loss as well as medical expenses, the total cost to employers for back pain amounts to $51,400 per 100 employees annually. Despite significant advances in pharmaceuticals, injections, and spinal surgeries, LBP is still on the rise, and health insurance costs for its treatment continue to increase. Because low back pain often appears with other symptoms, such as depression and chronic fatigue, the costs for employees and employers are multifaceted, impacting both personal and professional life.

So how can we better treat low back pain and improve its deleterious effects on workplace health and wellbeing? The short of it:  Primary care doctors need more training in pain management, and greater collaboration with diverse specialists, including physical therapists, chiropractors, acupuncturists, behavioral health providers, and health coaches. Traditional treatments for low back pain include diagnostic imaging, spinal injections, and surgeries. As a team of physical medicine experts with specialized training in pain science, we see that significant lasting improvement in low back pain comes from comprehensive, integrated care plans for patients.

Research shows that traditional methods like MRI imaging do not add significant value to the diagnostic and treatment process, and can, in fact, create circumstances for lower-value, higher risk treatment at higher costs. One study in Health Service Research found that patients were initially prescribed advanced imaging over physical therapy for LBP management both paid more and had a higher likelihood for complex treatments, including spinal surgeries, injections, fusions and opioid medications. This increased rate can be attributed to a number of factors–from financial incentives and relationships with device companies to a larger aging population, and advancements in surgical techniques and fusions being more easily achieved. The sheer volume of MRI imaging, subsequent injection and surgical procedures has increased the risk of unnecessary surgery.

Higher spending in healthcare has grown typical alongside higher rates of surgery, which account for a significant proportion of all LBP-related expenses. Over the course of a decade, hospital spending for spinal injections increased by more than 500%, from $75 million to $482 million. Despite increased surgical procedures, prescription painkillers, and medical spending, research has been mixed when it comes to successful patient outcomes. In fact, it remains possible for disability and pain to continue post-surgery. A 2011 study compared workers’ compensation in patients who received treatment for lower back pain in the form of either spinal fusion surgery or non-surgical treatment like exercise and physical therapy, and found that patients who did not have surgery went back to work sooner–within two years of injury–and were less likely to continue taking opioid medications. While there is no question that some patients require more complex treatment methods, such as fusions for highly painful and unstable lumbar segments, a significant portion of patients undergo surgical procedures that are not warranted and have the potential to do more harm than good for long-term patient outcomes. A 2015 study in Acta Neurochirurgica found that repeated fusions yielded poor results for patient pain management and not only recommended careful consideration as a preventative measure against future “unnecessary” spinal fusions, but promoted alternative nonsurgical methods.

Research study after research study reveals the exorbitant costs of care and that the current standards of treatment are not the most effective options for LBP. As a result, the American College of Physicians and American Pain Society strongly recommends that the initial and costly MRI approach to low back pain should be taken only when significant neurological signs and risk of cancer are present. Behavioral therapy, chiropractic, physical therapy, exercise, and acupuncture are promoted by the CDC as cost-effective, results-driven solutions to pain management that have the potential to ameliorate chronic pain. The Alliance for Health Policy came to a similar conclusion in September 2017 during a briefing on the intersection of physical and behavioral health in chronic pain management. Their expert medical panel concluded that better integration of primary, behavioral and physical care will reduce the number of opioid prescriptions and, at the same time, improve pain symptoms.

A collaborative approach to spine care that involves a variety of non-surgical therapy options, including exercise and movement, is fast-becoming the most cost-effective option with better long-term outcomes. Here’s one example of what this looks like in real life:  One of our recent patients, Susan, had utilized the same primary care physician for twenty years to treat her chronic low back pain. After two decades of opioids and cortisone shots, Susan changed up her healthcare provider and decided to experience our integrated model of care. Rather than only receiving a prescription for pain medication, our primary care providers immediately referred Susan to our physical medicine team. We introduced her to new treatment alternatives like physical therapy and acupuncture, which helped her to “manage pain better and stand on her feet much sooner.” Integrated care models allow patients to explore a variety of options for care in a convenient and time-efficient way, ultimately arriving at the best pain management solutions faster.

Integrated care models are better able to address all the aspects of a person’s pain experience and help them avoid unnecessary treatment approaches. Low back pain treatments should be informed by evidence-based practices which utilize exercise and movement approaches to healing and be centered on each patient’s distinct symptoms and needs. Such personalized and patient-centered care must include commitment and collaboration among providers who are educated in pain management. The future of workplace wellbeing will depend upon better collaboration among healthcare providers and more effective, integrated, and preventive treatments to low back pain.


Chiropractic by the Numbers

Doctors of chiropractic – who receive a minimum of 7 years higher education – are trained to provide drug-free care to effectively manage acute, subacute and chronic low back pain, neck pain and other neuro-musculoskeletal disorders.

Postpartum pain is best treated with non-pharmacologic options, such as chiropractic care!

Recommendations Developed for Managing Postpartum Pain

Impact of medications on mother-infant relationship should be considered, as many women breastfeed

To understand how pain is typically managed in America, think of it as a baseball team. The physician is the manager, making up the lineup. The starters are pharmaceuticals, particularly opioids. Other forms of pain management, such as spinal manipulation, acupuncture, behavioral therapy, etc. have essentially been relegated to pinch hitters, called in off the bench if the starters aren’t performing. But they’re not ordinarily considered everyday players.

Fortunately, that viewpoint is starting to change, partially driven by the rampant opioid crisis facing the U.S., which was responsible for more than 42,000 deaths in 2016 according to the Centers for Disease Control and Prevention (CDC).

Results of a clinical trial published in the March 8, 2018 issue of the Journal of the American Medical Association (JAMA) already found that the use of opioid vs. non-opioid medication therapy for patients with moderate to severe chronic back, hip or knee osteoarthritis pain “did not result in significantly better pain-related function over 12 months.”

New Team Rotation

Now a new article in the March 28, 2018 issue of JAMA describes the formation of a new Pain Management Collaboratory. This joint project between the National Institutes of Health (NIH), Department of Defense, and Veteran’s Administration (VA) is using $81 million in grants to create a six-year, evidence-based study of non-drug approaches to pain management at VA hospitals around the country.

What sets this initiative apart is that spinal manipulation/chiropractic, behavioral therapy and the other pain management strategies being studied by the Pain Management Collaboratory are not being treated as bench players, or “Complementary Alternative Medicine (CAM),” to use the industry vernacular. Instead, they are taking a front-line, starting role – i.e., being considered as a first choice for patients suffering from many forms of pain.

This could very well be a watershed moment in our approach to pain management. One that we have been building to for a while. Chiropractic in particular has an established body of evidence demonstrating its effectiveness in pain management. In fact, there is more evidence for the efficacy of chiropractic care than there is for the drug-based treatments that most physicians are taught to favor.

New Team Guidelines

The American College of Physicians, after a review of more than 150 studies, concluded that physicians should consider spinal manipulation and other non-drug therapies as their first option for treating acute, subacute and chronic lower back pain. Note: 94 percent of all spinal manipulations in the U.S. are performed by a doctor of chiropractic.

The Joint Commission and America’s Health Insurance Plans (AHIP) have issued similar guidance on the role of non-pharmacologic options in pain management, while the CDC, the U.S. Food and Drug Administration, and the Institute of Medicine, among other organizations, have also called for early use of non-pharmacologic approaches to pain and pain management.

In baseball or any other sport, good managers know how to gauge their athletes’ performance on a daily basis in order to put the best team on the field. The time is right to take chiropractic and other non-drug pain management strategies off the bench and insert them into the starting lineup.